Wednesday, November 22, 2006

More and more endocrine....and I am out of my thyroid....

Endocrine Review
some covered elsewhere...ie: islets of langerhans covered in DM...not going beat a dead horse with a stick....I am sick. More and more of endocrine to come.
The Endocrine Glands= pituitary-thyroid-parathyroid-adrenals-islets of langerhans-ovaries-testes
The system works with the nervous system…to maintain homeostasis.
The glands secrete directly into the bloodstream. (as opposed to the exocrine glands.)
This system is a negative feedback system.

Hypothalmus- The link between the nervous and endocrine system. Controls the pituitary.
Pituitary- HYPOPHYSIS= The master gland. Secretes hormones that control secretion of other hormones. (pretty cool.)
Posterior Pituitary--secretes Vasopressin (ADH). This is stimulated in response to…increase in blood osmolality…decrease in blood pressure. To control the excretion of water by the kidney. Secretes Oxytocin. Stimulated by pregnancy, childbirth. Function is to --milk ejection during lactation, increase force of uterine contractions.
Anterior Pituitary--secretes FSH, LH, Prolactin, ACTH, TSH, GH, MSH. (Only covering Growth hormone here, have the others covered elsewhere)--What GH does for you= increases protein synthesis, breakdown of fatty acids, increases the glucose levels in the blood. Secretion of this hormone increases when you: exercise, have stress (like now for exams!…I must be secreting a lot of this hormone) have a low blood sugar, starvation. Decreased secretion with hyperglycemia. If you do not have enough secretion= limited growth and dwarfism. Over secretion during childhood= Gigantism. Over secretion during adult hood leads to Acromegaly (think Abe Lincoln) deformities develop of bone, soft tissue, enlargement of viscera, large broad spade like hands…will not grow taller.

Thyroid Gland--lower neck anterior to trachea. 2 lobes. Highly vascular. Hormones= thyroxin (T4) Triiodothyronine (T3)--these are controlled by TSH. Calcitonin not controlled by TSH. It is controlled by Ca+ levels in the blood. Secreted as a response to high serum Ca+ levels. Reduces Ca+ levels by increasing Ca+ deposition into bone. Need Iodine for hormone synthesis. Functions of the thyroid hormones= control cellular metabolic activity. Influence cell replication, brain development, normal growth.
TRH is secreted by the hypothalamus it influences the release of TSH from the pituitary. The environment….when the environmental temp falls--leads to an increased secretion of TRH which results in an elevated secretion of thyroid hormones.
Labs for the Thyroid function= Serum T4= 5-12ug/dl for normal range. Drugs that decrease T4 levels= Heparin, Lithium, Salicylates. Drugs that increase T4 levels= contraceptives. Serum T3= 110-230mg/dl. Accurate indicator of hyperthyroidism. Greater T3 rise than T4 rise. TSH assay= most useful single test to Dx hypothyroidism.
Radioactive iodine uptake= (not going there today!) elevated levels with hyperthyroidism.
Thyroid ScintiScan= evaluates the size and structure of the thyroid. Areas of hyperactivity are hot spots. Gray or black regions. Areas of hypoactivity are cold spots and will show as white or gray regions. Biopsy= Under general anesthesia, needle biopsy. Detects tumors. Complications= Bleeding (of course) respiratory difficulties coming from Hematoma and edema.
Hypothyroidism
Common women 30-60 years. Causes: autoimmune, surgical removal, over treatment of hyperthyroidism. Assessments=bradycardia, general non pitting edema, anorexia, lethargy, slow mental process, clumsy, Intolerance to cold!!, dry skin, sleep a lot. Everything slows down. Nursing Care= VS. I&O. daily weights, decrease calorie in the diet, increase fluids/fiber, stool softener, keep environment warm, access edema (3rd spacing), thyroid replacement as ordered. Medical Treatment= Synthroid, Proloid, Cytomel. Effects of these: increase blood glucose levels. TH supplements increase the effect of Digitalis Glycosides, (watch for dig toxicity), Anticoagulants (watch for hemorrhage) Indocin. AVOID hypnotics sedatives. May produce profound somnolence. Give ½ to 1/3 dose. Call MD to clarify orders if not ordered this way.
MYXEDEMA= most severe stage of hypothyroidism. Pt. Hypothermic, increased lethargy leading to coma, cardiovascular collapse and shock, thyroid hormone given IV, Mortality rate is high.
HYPERTHYROIDISM or GRAVES DISEASE OR THYROTOXICOSIS
Over secretion of thyroid hormones. Metabolic rate GREATLY increased. Goiter seen with iodine deficiency . Mostly women 30-40s. May appear after emotional shock, stress, infection (unknown reasons) Assessments= nervous, insomnia, can not sit still, exophthalmus (bulging eyes), emotionally hyper excitable, apprehensive…tachycardia, palpitations, elevated systolic reading, flushed warm moist skin, Intolerance to heat!!! No menstrual periods, very thin and active. No weight gain even after eating, eating, eating. Thyroid gland is enlarged, soft and may pulsate. Thrill and Bruit over thyroid arteries. Nursing Care= VS- anti-thyroid meds as ordered, cool environment, decrease stress, increase in diet: CHO, protein, calories, vitamins/minerals. No coffee, tea, cola. Medical Treatment= Antithyroid meds= block synthesis of TH, Propacil, Tapazole. Radiation to destroy the gland, Thyroidectomy, Adrenergic blocking agents such as Inderal to decrease the sympathetic activity and alleviates tachycardia.
THYROIDECTOMY
Pre-Operative Nursing= Antithyroid drugs to suppress function. Iodine prep= Lugols or K iodine to decrease size and vascularity of the gland to reduce the hemorrhage risk.
Post-Operative Nursing= Humidified O2. First fluids to soft diet. Limit talking. Assess voice changes injury to the laryngeal nerve, some hoarseness common. Check for hemorrhage= behind/side neck. If patient complains of fullness or pressure at insertion site call MD stat. Check for Respiratory distress= results of edema of glottis, Hematoma, or injury to the laryngeal nerve, have trach set/airway at bedside, Call MD for extreme hoarseness.
Tetany--from accidental removal of the parathyroid gland during surgery. Disturbs Ca+ metabolism. Assess= hyper irritability of nerves, spasms of hands, feet, muscle twitching. At risk for--Airway obstruction, laryngospasm. Treatment= IV calcium gluconate.
Thyroid Storm= results from release of excessive amounts of TH during surgery. Assess for fever, tachycardia, agitation leading to delirium, heart failure, shock.


Parathyroid glands in the neck posterior to the thyroid (4)
Parathyroid hormone regulates calcium and phosphorous metabolism. Vit D increases the actions of the Parathyroid hormone, (I will abbrev. PTH). PH lowers the phosphorus levels in the blood. An increase exaggerates normal bone function. (Remember osteoblasts and osteoclasts? Building up and Cleaning up. From way back when) PTH has 3 basic effects on the body. 1. To increase bone resorption causes Ca+ loss leading to bone demineralization, bone pain from pathological fractures. 2. Increases renal retention of Ca+. 3. To increase GI absorption of Ca+.
HYPERPARATHYROIDISM is a disorder of calcium, phosphate, and bone metabolism. Hyper secretion of PTH. Clinical signs= elevated Ca+ levels above 10.8mg/dl on 3 tests. Skeletal--easy bone fracture, diffuse bone pain. Kidney-- low urine specific gravity. Decreased filtration leading to stones, and renal failure. GI--constipation, anorexia, nausea, vomit. Cardio--dysrhythmia, hypertension. GOALS= increase the renal excretion of Ca+. Decrease GI absorption and bone resorption of Ca+. high volume isotonic saline IV to increase the glomerular filtration of Ca+. Limit oral Calcium. Nursing Care= walking to put the calcium (Ca+) back into the bones. Low calcium diet. Increase bulk/fiber. Stool softener. Avoid bed rest!!
HYPOPARTHYROIDISM caused by inadequate secretion of PTH, from accidental removal of the parathyroid gland during thyriodectomy leading to hypocalcemia. Diagnostics= low Ca+ levels, increased phosphate levels, x-rays may show increased bone density. Tetany-- A serum calcium below 6.5 and the patient will have symptoms. S/s= tingling of fingers, around lips, painful muscle spasm. Dysphasia, laryngospasm, seizures, cardiac arrhythmias. Chvostek’s sign. Trousseau’s sign. Medical Goal= raise the calcium level. 9-10mg/dl. Calcium gluconate IV for acute. Large doses of Vit. D to increase the absorption of Ca+. Aluminum hydroxide (Amphogel) with or before meals to decrease phosphate levels. Nursing Care= Seizure precautions, quiet, emergency trach and IM Calcium gluconate at the bedside. Check serum Ca+ and phosphate levels.
Not enough color to this.....

1 comment:

BUBBLE said...

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