Prepared By Margaret May RN MSN Fall 2016 Nursing 200

Transcription

1 Prepared By Margaret May RN MSN Fall 2016 Nursing 200

2 The endocrine system are glands organs and hormones that work with the nervous system to regulate body function and maintain homeostasis. Endocrine glands are: pituitary gland adrenal gland thyroid gland parathyroid gland islet cells of pancreas gonads

3 1. What is the function of the gland and what hormone does the gland excrete? 2. What happens when gland is not secreting enough hormones? What happens when the gland is secreting too much hormones?

4 Add the hormone

5 Add medications to decrease hormone secretion Surgery to remove gland Radiation to destroy all or part of the gland

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7 What is the gland? - anterior puituitary gland and what hormone is secreted? TSH (metabolism), ACTH (steroid production), LH(reproductive system), FSH (reproductive system), GH (growth hormone), Prolactin (ovaries) What does low secretion of the hormone look like? TSH-decreased metabolism, ACTH-decreased steroid production, LH,FSH decreased reproductive system, Prolactin-decreased ovary function. What does high secretion of the hormone look like TSH-high metabolism, ACTH-high steroids production, LH and FSH-increased reproductive system, Prolactin increased functioning of the ovaries.

8 Question 1. What is the function of the anterior pituitary gland and what hormones are secreted? This gland regulates the physiological process of the body, including stress, growth, reproduction and lactation. See picture below: GH-Growth Hormone LH,FSH-Affects reproductive Prolactin-affects the ovaries TSH-thyroid hormone Prolactin affects the ovaries. ACTH-affects steroid production(cortisol levels)

9 Deficient Hormone Symptoms Treatment GH Adults: Decreased muscle mass, Recombinant Human Growth Hormone increased body fat, elevated cholesterol, given once daily as an injection under the low bone density (osteoporosis), skin impaired psychological well-being, poor quality of life LH/FSH Decreased libido, erectile dysfunction, irregular or absent menses, decreased body hair, decreased muscle strength, hot flashes, mood changes Men: Testosterone given as either topical gel, patch or injections Women: Estrogen and Progesterone given as either topical patch or pills ACTH Poor appetite, nausea, weakness, vomiting, low blood sugar, low blood pressure, dizziness, body aches Hydrocortisone or Prednisone given as daily pills TSH Fatigue, weakness, cold intolerance, dry Levothyroxine given as daily pills (some skin, constipation, heavy/painful menses, examples include Synthroid, Levoxyl, weight gain, memory loss, mood Levothroid or Armour Thyroid) disturbance Prolactin Inability to lactate No treatment available Vasopressin (ADH) Increased thirst and frequent urination DDAVP given either as daily pills or nasal spray

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11 Diagnosis compared to the growth chart check lab serum growth hormone MRI of the head to assess the pituitary gland Treatment can use growth hormone injections (does not work with all children) Nursing intervention teaching : adaptive mechanisms for the activities of daily living emotional support

12 Type of adenoma Secretion Pathology lactotrophic adenomas (prolactinomas) secrete prolactin galactorrhea, hypogonadism, amenorrhea, infertility, and impotence somatotrophic adenomas secrete growth hormone (GH) acromegaly in adults; gigantism in children corticotrophic adenomas secrete adenocorticotropic hormone (ACTH) Cushing's disease gonadotrophic adenomas secrete luteinizing hormone (LH), follicle-stimulating hormone (FSH) and their subunits usually doesn't cause symptoms thyrotrophic adenomas (rare) secrete thyroid-stimulating hormone (TSH) occasionally hyperthyroidism, [34] usually doesn't cause symptoms

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14 Acromegaly is hyper secretion of the growth hormone that occurs AFTER puberty. Nursing interventions emotional support and prepare patient for surgery Treatment surgical removal of pituitary gland radiation therapy Education patient will need lifelong replacement hormones of corticosteroids and thyroid hormones

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16 Procedures and collaboration and care are the same as for acromegaly

17 What is the gland posterior pituitary gland and what hormone is secreted vasopressin (ADH-anti diuretic hormone-saves fluids) and oxytocin? What does low secretion of the hormone look like deficiency of ADH (kidneys unable to conserve water-resulting in dehydration ). What does high secretion of the hormone look like? Increased amounts of the antidiuretic hormone results in fluid retention and hyponatremia.

18 The disorder is diabetes insipidus deficiency of ADH the results kidneys are unable to conserve water appropriately leading to diuresis. This can be caused by head trauma, tumor, surgery, radiation, CNS infections, malignant tumors or failures of the renal tubules Need to identify underlying causes and treat them

19 Signs and symptoms decreased urine specific gravity chemistry is concentrated results in hypernatremia and hypokalemia polyuria/polydipsia increased urine output client may crave ice water in excessive amounts Diagnosis is a water depression test monitor the weight/hourly urine output assess serum and urine osmolarity MRI of the hypothalamus and the pituitary gland 24 hour urine Nursing interventions weigh daily intake and output monitor blood pressure and heart rate

20 Medications- DESMOPRESSIN VASOPRESSIN ( a synthetic form of ADH) may be given along with hypotonic IV fluids (eg..45 NS) or if long term therapy is needed may add vasopressin and thiazide diuretics Education lifetime vasopressin replacement therapy educate patient to report weight gain or loss polyuria polyphagia Monitor intake and output and avoid foods with a diuretic action

21 SIADH- excessive release of antidiuretic hormone resulting in the inability to excrete an appropriate amount of urine. Patient develops fluid retention and delusional hyponatremia. Causes are tumors, head injury, meningitis, respiratory disorders, and some meds (e.g. VINERISTINE, tricyclic antidepressants, thiazide diuretics) Signs and symptoms concentrated urine hyponatremia hyperkalemia confusion irritability lethargy seizures increased ADH (vasopressin) levels weight gain

22 Nursing interventions- restrict oral fluids 800 to 1000 ml\day intake and output daily weight monitor level of consciousness (mental status) seizure precautions Meds hypertonic solution of 3-5% sodium chloride (remember hypertonic solutions, fluids to run away from the cells) loop diuretics treat the hypovolemic hyponatremia Declomycin vasopressin receptor antagonist- Conivaspatar Therapy surgery chemo radiation

23 What is the gland? Thyroid gland and what hormone is secreted? Thyroid hormone which affects metabolism. What does low secretion of the hormone look like? Low secretion results in slow metabolism-everything in slow motion- e.g.. bradycardia, constipation, depression, etc. What does high secretion of the hormone look like? High secretion results in high metabolism-everything is running fast- Lots of energy, high heart rate, etc.

24 Decreased levels of thyroid hormone will result in decreased metabolism

25 Diagnostics labs for T3, T4, TSH Myexedema coma- rare life-threatening condition. Seen in untreated, uncontrolled, hypothyroidism. Signs and symptoms are change in level of consciousness severe decreased metabolites cause respiratory depression and cardio vascular collapse. Management provide intensive supportive measures. High mortality rate Nursing intervention for hypothyroidism warm environment low-fat low-calorie low-cholesterol diet, increase refuge and fluids avoid sedatives rest periods daily weight Meds- levothyroxine education- lifelong medicine replacement followup with provider to check the levothyroxine

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28 Diagnosis- increase T3 and T4, decreased TSH Thyroid storm life-threatening condition seen in untreated and uncontrolled hyperthyroidism sign and symptom- fever tachycardia hypertension Nursing intervention- Monitor the vital signs encourage rest in a cool environment hi the calorie diet daily weight protection for a client with exophthalmos-giving ophthalmic meds, taping eyes at night decreasing sodium and water and raising the head of the bed

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30 Meds- beta blockers for tachycardia, anxiety and tremors PTU- blocks the thyroid hormones Methimoral (Tapasol) short-term use blocks the production of the thyroxine. Cannot use greater than eight weeks. Monitor the CBC. Risk of agranulocytosis Iodides Lugo solution saturates the gland decreases the hormone production. Radioactive iodine is used to shrink the gland Surgery thyroidectomy preop decrease the thyroid function postop- high Fowlers position, check the dressing,check respirations,keep trach tray and oxygen at the bedside, check vital signs,check for hemorrhage, check for hoarseness which would be a symptom of laryngeal injury, Check for Trousseaus or Chevoks sign - can indicate removal of parathyroid gland and subsequent hypocalcemia- have calcium gluconate at the bedside observe for a thyroid storm gradually in key increase the range of motion of the neck check for late level of consciousness changes.

31 What is the gland Adrenal and what hormone is secreted? ACTH (steroid production- which are used to build muscles, enhance performance, and improve appearance). What does low secretion of the hormone look like? Low secretion of steroids causes muscle deterioration, decreased energy, and effects personal appearance. What does high secretion of the hormone look like? High secretion of steroids results in big muscles, enhanced performance and improved appearance.

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35 What is the gland parathyroid gland and what hormone is secreted? Parathyroid hormone (PTH) which maintains the calcium and phosphate balance. What does low secretion of the hormone look like? Hypocalcemia and hypophosphatemia usually caused by removal of the parathyroid gland during surgery which can cause paresthesia, muscle cramping and tetany, numbness and tingling in fingers. Severe tetany can cause bronchospasms, cardiac dysrhythmias and seizures. What does high secretion of the hormone look like? Usually caused by the removal of a tumor. Manifestations: kidney stones, osteoporosis, abd pain, n & V, muscle weakness, polyuria, polydipsia, htn,cardiac dysrhythmia, hypercalcemia and hypophosphatemia.

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37 ****Nursing Interventions: 1. Monitor ECG 2. Monitor the client for signs neuromuscular irritability. 3. Provide a high calcium, low phosphorous diet. 4. Institute seizure precautions. ****Medications Acute: IV calcium gluconate Chronic-oral calcium salts and phosphorous binders and Vitamin D

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39 Nursing Interventions 1. Minimum of 2,000 ml fluids/day 2. Diet low in calcium and Vitamin D 3. Prevent constipation and fecal impaction 4. Strain all urine 5. Reinforce teaching about safety measures to prevent fractures. 6. Encourage cranberry juice to lower urinary ph

40 Monitor for hypercalcemia crisis, which is life threatening. It occurs when the serum calcium level is greater than 15. A) IV rehydration B) Phosphate therapy C) Calcitonin D) Dialysis

41 Medications 1. Medications that mimic calcium (calcimimetics) such as Sensipar, mimic calcium in the blood and can cause the parathyroid to decrease the release of parathormone. 2. Calcitonin decreases the release of skeletal calcium and increases kidney excretion of calcium: enhanced if given along with glucocorticoids. 3. Hydration and diuretics: furosemide promotes excretion of excess calcium. 4. Biphospates. Therapeutic Measures-Surgical removal of parathyroid gland

42 What is the gland pancreas and what hormone is secreted? Exocrine secretion of pancreatic enzymes ( amylase, trypsin, and lipase) which aid in digestion, and endocrine (secretion of insulin, glucagon, and somatostatin) functions. Insulin lowers blood glucose by facilitating entry into the cells. Somostatin also lowers blood glucose. Glucagon raises blood glucose by converting glycogen to glucose in the liver. What does low secretion of the hormone look like? Hypoglycemia What does high secretion of the hormone look like? Hyperglycemia

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