Alterations in Endocrine Function (Part 1) Student Copy.pptx

Endocrine

1. By Debbie Coleman, PhD, RN ALTERATIONS IN ENDOCRINE FUNCTION (Chapters 18, 19)

2. The Basics Pathophysiology and endocrine function Overview of endocrine system Epidemiological/ etiological risk factors Impact of alterations Clinical presentation Role of the nurse Nursing process

3. No Further Need Production Decreases Need in Body Production Increases Dual Regulatory System

4. Hypothalamus Control center of all autonomic regulatory activities of the body Blood Pressure Body Temperature Fluid & Electrolyte Balance Body Weight Goal = Homeostasis

5. Pituitary Gland Controlled by hypothalamus Divided into two sections: Anterior Posterior

6. Anterior and Posterior Pituitary Anterior Pituitary Follicle-stimulating hormone (FSH) Luteinizing hormone (LH) Prolactin Growth hormone (GH) aka somatotropin Thyroid-stimulating hormone (TSH) Adrenocorticotropic hormone (ACTH) Posterior Pituitary Vasopressin (aka antidiuretic hormone “ADH”) Oxytocin

7. Oversecretion of GH Acromegaly Bone and soft tissue deformities Enlargement of viscera Increase in height Gigantism Undersecretion (panhypopituitarism) Dwarfism Anterior Pituitary Dysfunction

8. Understanding Thyroid Function Iodine essential TRH ( Thyrotropin-releasing hormone ) from hypothalamus controls release of TSH TSH (thyrotropin) from anterior pituitary controls release of thyroid hormone Pituitary gland senses and adjusts accordingly (feedback system) Thyrotropin-Releasing Hormone (TRH) Thyroid Stimulation Hormone (TSH)

9. The Main Players (T 3 , T 4 , Calcitonin) T3 and T4 Controls cellular metabolic activity Increases oxygen consumption Alters responsiveness of tissues Influences : Cell replication Normal growth Every major organ system Thyrocalcitonin ( aka Calcitonin ) If calcium levels are high in plasma….calcitonin is secreted and plasma calcium is deposited in bone

10. Thyroid Disorders Congenital iodine deficiency (cretinism) Hypothyroidism Myxedema coma Hyperthyroidism Thyroid storm Goiter Thyroid cancer

11. Risk Factors for Hypothyroidism Medications Hyperthyroid meds Amiodarone Lithium Thaldomides Oncology meds Autoimmune Disorders Hashimoto’s Celiac disease Lupus Rheumatoid arthritis Sjogren’s syndrome Diabetes (Type 1) Hypothalamus Disorders Pituitary Disorders Radioactive Iodine Iodine Thyroid Surgery

12. Hypothyroidism Hashimoto’s disease (most common cause) Women affected 5x’s more then men Early symptoms may be nonspecific Myxedema (rare life-threatening condition) Stupor, coma and death Hypothalmic Cretinism

13. Hypothyroidism Manifestations Extreme Fatigue Menstrual Disturbance/ Weight Gain Slow Speech/ Voice change Tongue, Hands/ F eet May Enlarge Prolonged Effect of Meds / Myxedema Hair Loss Skin/Nail Changes Subnormal temperature Loss of Libido Personality & Cognitive Changes Cardiac & Respiratory Complications

14. Thyroid Diagnostic Tests TSH Serum free T4 T3 and T4 T4 resin uptake Thyroid antibodies Radioactive iodine uptake Fine-needle biopsy Thyroid scan

15. Medications affecting results Estrogen Sulfonylureas Corticosteroids Dilantin Salicylates Danazol Heparin Lithium Dopamine Chloral Hydrate Amiodarone PTU Propranolol X-ray Contrast Clofibrate Tagamet Opioids Furosemide Iodine 5-Fluorouacil Androgens Valium

16. Medical Management Synthetic levothyroxine-replacement therapy - Potential medication interactions - PO or IV - Contraindications Hyperthyroidism Untreated adrenal insufficiency Untreated cardiac arrhythmia MI / Inflammatory cardiac process - Client Education Monitor for side effects / When to take May increase : Blood glucose Oral antidiabetics Digitalis Anticoagulants Indocin Dilantin Antidepressants

17. Hyperthyroidism Excessive output of thyroid hormone Graves’ disease (autoimmune) - Risk factors for Grave’s disease Type 1 DM Pernicious anemia Primary adrenal insufficiency Family history

18. Hyperthyroidism Risk Factors Nicotine Produc ts Pregnancy in last 6 months Toxic multinodular Goiter Female Age 60+ Excess iodine consumption Thyroiditis

19. Hyperthyroidism Clinical Presentation Nervousness Palpitations / Rapid pulse Poor heat tolerance Tremors Diaphoresis Loose bowel movements Enlarged thyroid Oligomenorrhea May be pruritic Increased appetite Weight loss / muscle wasting Elevated BP Cardiac dysrhythmias Visual changes

20. Impact on Overall Health . 2 Thyrotoxicosis Cardiovascular Pregnancy Mental Health Weight loss Sweating Fatigue Agitation Muscle weakness Tremors Irritability Agitation Anxiety Panic attack Mood shifts Insomnia Depression Miscarriage Eclampsia Premature labor Low infant birthweight Tachycardia Atrial fibrillation Cardiac failure Stroke

21. Medical Management

22. Thyroid Storm Stress Injury Infection Surgery Insulin reaction DKA Pregnancy Dig Toxicity

23. Postoperative Care Dressing (potential bleeding) Hematoma formation (check posterior dsg ) Respirations Pain Semi-Fowler’s position Assess voice but discourage talking Consume foods that are easy to swallow Check labs (potential hypocalcemia)

24. Adrenal Gland Adrenal medulla Part of the autonomic nervous system Catecholamines Epinephrine Norepinephrine Adrenal cortex Adaptation to stress Steroid hormones Glucocorticoids Mineralocorticoids Androgens

25. Physiological Response Mineralocorticoid s Retention of Na and H20 by kidneys ↑ blood volume and BP Glucocorticoids Proteins/fats converted or broken down Increased blood glucose (from above) Suppression of immune system Adrenal Medulla Short Term Stress Response Secretes Epinephrine / Norepinephrine Physiological Response Blood glucose rises Vessel constriction ( ↑ HR / ↑ BP) Blood diverted from nonessential organs to heart/skeletal muscles ( ↓ digestion and urine output) Increased metabolic rate Bronchial dilation Secretes Steroid Hormones Adrenal Cortex Long Term Stress Response * See Handout in Class Adrenal Gland Response

26. Steps in ACTH Process Hypothalamus releases corticotropin-releasing hormone (CRH) to anterior pituitary Anterior pituitary releases ACTH Message goes to the adrenal gland (cortex or medulla) * See Handout in Class

27. Adrenal Dysfunction (Cushing’s Disease) Red cheeks, Moon face HTN; red striation (“stretch marks”) Thin arms/legs; Thin skin Pendulous abdomen Ecchymosis (“bruising”) Buffalo hump (‘aka fat pads”) Excessive adrenocortical activity or corticosteroid medications

28. Muscle Weakness Darkened Skin Hypotension (fainting) Salt craving Hypoglycemia Abdominal pain Irritability/ Depression Adrenal Dysfunction ( Addison’s Disease ) Adrenal Insufficiency Extreme Fatigue Addisonian Crisis (aka acute adrenal failure) Life-threatening shock Too Little

29. Purpose Antidiuretic hormone SIADH Diabetes Insipidus Vasopressin Posterior Pituitary Gland (kidneys lose too much water) (kidneys retain too much water) aka ADH (Regulated by need / at night) (Maintains water balance)