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Endocrine 3

  1. Diagnostics 
    1. history and physical exam: palpable thyroid enlargement: (goiter)
    2. elevated serum T3 and T4 levels
    3. elevated radioactive iodine uptake
    4. presence of thyroid autoantibodies
    5. decreased TSH (thyroid-stimulating hormone; comes from pituitary) levels
  2. Complication: thyrotoxic crisis (thyroid storm)
    1. rare but potentially fatal
    2. breakdown of body's tolerance to chronic hormone excess
    3. state of extreme hypermetabolism
    4. precipitating factors: stress, infection, pregnancy
    5. findings include:
      1. systolic hypertension
      2. hyperthermia
      3. angina
      4. infarction or heart failure
      5. extreme anxiety
      6. even psychosis
  3. Management
    1. expected outcomes: to reduce the excess hormone secretion and to prevent complications
    2. pharmacologic 
      1. sodium131I
      2. antithyroid agents: propylthiouracil (PTU)
      3. beta-adrenergic blocking agents: propranolol (inderol)
      4. iodides: useful adjunct
    3. surgical: thyroidectomy: partial or total removal of thyroid gland
    4. diet high in calories, protein, carbohydrates
  4. Nursing interventions
    1. monitor vital signs, especially blood pressure and heart rate
    2. provide quiet, restful, cool environment
    3. monitor diet therapy
    4. provide extra fluids
    5. provide emotional support
    6. administer medications as ordered
    7. teach client
      1. about medications and side effects
      2. stress avoidance measures
      3. energy conservation measures
    8. care of the client undergoing surgery
  5. Disorders of the Parathyroid Gland
  6. Hypoparathyroidism
    1. Definition - parathyroid produces too little parathormone; results in hypocalcemia
    2. Etiology unknown
      1. possibly an autoimmune disorder
      2. most often results from surgical removal of parathyroid glands
    3. Findings (mild to severe order)
      1. neuromuscular
        1. irritability
        2. personality changes
        3. muscular weakness or cramping
        4. numbness of fingers
        5. tetany
        6. carpopedal spasms
        7. laryngospasms
        8. seizures
      2. dry, scaly skin
      3. hair loss
      4. abdominal cramping
    1. Diagnostics  
      1. history and physical exam
      2. positive Chvostek's sign
      3. positive Trousseau's sign (carpopedal spasm as inflated BP cuff is released)
      4. decreased serum calcium
      5. increased serum phosphate
    2. Management
      1. expected outcomes: to restore hormonal balance and prevent complications
      2. calcium replacement therapy: ideal serum calcium level 8.6mg/dl
      3. vitamin D preparations facilitate uptake of calcium
      4. calcium-rich diet
    3. Nursing interventions
      1. monitor carefully for signs of tetany
      2. place airway, suction and tracheotomytray at bedside
      3. institute seizure precautions
      4. administer medications as ordered
      5. teach client
        1. about medications and side effects
        2. signs of vitamin D toxicity
        3. to consume more calcium and get vitamin D from sun exposure to skin
        4. to reduce phosphorus intake: minimize intake of fish, eggs, cheese and cereals
  7. Hyperparathyroidism
    1. Definition - parathyroid secretes too much parathormone; results in increased serum calcium (hypercalcemia)
    2. Etiology
      1. benign growth in parathyroid
      2. secondarily as result of kidney disease or osteomalacia
      3. incidence increases dramatically in both sexes after age 50
    3. Findings
      1. many clients are asymptomatic
      2. gastrointestinal: constipation, nausea, vomiting, anorexia
      3. skeletal: bone pain and demineralization
      4. irritability
      5. muscle weakness and fatigue
    4. Diagnostics 
      1. history and physical exam
      2. elevated serum calcium
      3. decreased serum phosphate level
      4. x-rays reveal bone demineralization
    5. Management 
      1. expected outcomes: to restore hormonal balance and prevent complications
      2. surgery: removal of parathyroid glands - parathyroidectomy
    6. Nursing interventions
      1. care of the client undergoing surgery
      2. after surgery observe for signs of hypocalcemia
      3. after surgery, teach client to consume diet rich in calcium