Chapter 50 endocrine disorders general .pptx

Endocrine disorders , general

1. Timby’s Introductory Medical-Surgical Nursing, 13e Chapter 50: Caring for Clients With Disorders of the Endocrine System

2. DISORDERS OF THE PITUITARY GLAND #1 Acromegaly (Hyperpituitarism) Pathophysiology and Etiology: oversecretion of GH due to hyperplasia and related hypertrophy Gigantism: oversecretion of GH before puberty Dwarfism: insufficient GH during childhood Acromegaly: oversecretion of GH during adulthood Assessment Findings: Signs and Symptoms Coarse features; huge lower jaw, thick lips, thickened tongue, bulging forehead Bulbous nose, large hands and feet Enlarged organs, muscle weakness

3. Question #1 Is the following statement true or false? Acromegaly is caused by oversecretion of GH before puberty.

4. Answer to Question #1 False Acromegaly is caused by oversecretion of GH during adulthood. Gigantism is caused by oversecretion of GH before puberty.

5. DISORDERS OF THE PITUITARY GLAND #2 Acromegaly—(cont.) Diagnostic Findings GH level; glucose tolerance test Medical and Surgical Management Surgery (hypophysectomy); hormone therapy; drug therapy Nursing Management Psychological support; pacing activities Pain relief; self-care; postoperative care

6. DISORDERS OF THE PITUITARY GLAND #3 Simmonds Disease (Panhypopituitarism) Pathophysiology and Etiology Anterior pituitary hormone activity stops Assessment Findings: Signs and Symptoms Hypothyroidism, hypoglycemia, adrenal insufficiency; gonads and genitalia atrophy; premature aging; cachexia Medical Management Substitute hormones Nursing Management: Client Teaching Adherence: medication schedule; monitor: blood hormone level

7. Question #2 Is the following statement true or false? A sign of panhypopituitarism is premature aging.

8. Answer to Question #2 True Rationale: A sign of panhypopituitarism is premature aging. Also included in the signs and symptoms are hypothyroidism, hypoglycemia, adrenal insufficiency, gonads and genitalia atrophy, and cachexia.

9. DISORDERS OF THE PITUITARY GLAND #4 Diabetes Insipidus (DI) Pathophysiology and Etiology Role of ADH; neurogenic, nephrogenic DI Assessment Findings: Signs and Symptoms Polyuria, weight loss, thirst, weakness, dehydration

10. DISORDERS OF THE PITUITARY GLAND #4 Diabetes Insipidus (DI) Diagnostic Findings Fluid deprivation test, urine specific gravity Medical Management (see Client and Family Teaching 50-1) Drug therapy; IV fluids; thiazide diuretic Nursing Management

11. DISORDERS OF THE PITUITARY GLAND #5 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Pathophysiology and Etiology: causes of SIADH, hyponatremia Assessment Findings Water retention; headaches; muscle cramps; anorexia Changes in LOC Diagnostic Findings: serum, urine levels; sodium, osmolarity levels

12. DISORDERS OF THE PITUITARY GLAND #5 Medical Management: osmotic diuretics; IV administration Nursing Management

13. DISORDERS OF THE THYROID GLAND #1 Hyperthyroidism (Graves Disease) Pathophysiology and Etiology: hypersecretion of thyroid hormones Assessment Findings: Signs and Symptoms (see Table 50-1) Restless, agitated, hand tremors, diarrhea Increased appetite, weight loss, visual changes, exophthalmos, neck swelling Diagnostic Findings: serum T 3 , T 4 , TSH; thyroid scan and ultrasonography

14. DISORDERS OF THE THYROID GLAND #1 Medical and Surgical Management: antithyroid drugs, radiation, thyroidectomy (see Drug Therapy Table 50-1 and Nursing Care Plan 50-1) Nursing Management (see Nutrition Notes 50-1)

15. Question #3 Is the following statement true or false? The etiology of Graves disease is the hyposecretion of thyroid hormones.

16. Answer to Question #3 False The etiology of Graves disease is the hypersecretion of thyroid hormones.

17. DISORDERS OF THE THYROID GLAND #2 Thyrotoxic Crisis (Thyroid Storm) Pathophysiology and Etiology: triggering factors; T 3 and T 4 oversecretion; epinephrine release Assessment Findings High temperature, rapid pulse, dyspnea Cardiac dysrhythmias, vomiting, delirium Hyperthyroidism history, laboratory tests Medical Management Immediate treatment; antithyroid drugs, IV treatment Nursing Management

18. DISORDERS OF THE THYROID GLAND #3 Hypothyroidism Pathophysiology and Etiology Inadequate thyroid hormone secretion: myxedema Assessment Findings: signs and symptoms (see Table 50-1) Slow metabolic rate, lethargy, weight gain, dry skin, menstrual disorders Enlarged heart, atherosclerosis, anemia Diagnostic Findings: serum TSH, T 3 , T 4 ; FT 4 ; RAI uptake

19. DISORDERS OF THE THYROID GLAND #3 Hypothyroidism Medical Management: thyroid replacement therapy (see Drug Therapy Table 50-1) Nursing Management (see Nutrition Notes 50-2)

20. DISORDERS OF THE THYROID GLAND #4 Thyroid Tumors Pathophysiology and Etiology Follicular adenoma; papillary carcinoma Assessment Findings Nodular thyroid, hoarseness, difficulty swallowing, biopsy, physical examination

21. DISORDERS OF THE THYROID GLAND #4 Thyroid Tumors Medical and Surgical Management Thyroidectomy, HRT, radiation Nursing Management Emotional support; handling body fluids RAI: postoperative; radiation precautions

22. DISORDERS OF THE THYROID GLAND #5 Endemic and Multinodular Goiters Pathophysiology and Etiology Iodine deficiency; goitrogenic foods Assessment Findings Enlarged thyroid gland, difficulty swallowing, thyroid scan Medical Management Foods high in iodine; potassium iodide; thyroidectomy Nursing Management Monitor for and relieve respiratory symptoms; provide appropriate diet

23. DISORDERS OF THE THYROID GLAND #6 Thyroiditis Pathophysiology and Etiology Types: acute, subacute, Hashimoto disease Assessment Findings: Signs and Symptoms High fever, malaise, swollen Tender thyroid gland Diagnostic Findings: thyroid scan; lab tests Medical and Surgical Management Antibiotics, analgesics, corticosteroids, thyroid HRT, surgery Nursing Management (see Nursing Care Plan 50-1)

24. DISORDERS OF THE PARATHYROID GLANDS #1 Hyperparathyroidism Pathophysiology and Etiology Primary or secondary condition Primary: adenoma; increased secretions of PTH Secondary: increased secretions in response to hypocalcemia Assessment Findings: Signs and Symptoms Fatigue; hypotonic muscles Skeletal tenderness and pain Cardiac dysrhythmias

25. DISORDERS OF THE PARATHYROID GLANDS #2 Hyperparathyroidism—(cont.) Diagnostic Findings Laboratory tests, MRI, CT scan Medical and Surgical Management Sodium, phosphorus replacements; surgery Nursing Management (see Nutrition Notes 50-3) Monitor I/O; urinary calculi; self-care; safe environment Encourage fluid intake Provide postoperative care Client education: effects of disease; adherence to treatment

26. DISORDERS OF THE PARATHYROID GLANDS #3 Hypoparathyroidism Pathophysiology and Etiology Deficiency of parathormone; trauma to the glands; hypocalcemia Assessment Findings: Signs and Symptoms Tetany; Chvostek and Trousseau signs; laryngeal spasm Diagnostic Findings Serum: calcium and phosphorus; radiographs Medical Management: IV calcium salt; endotracheal intubation; mechanical ventilation; oral calcium Nursing Management (see Client and family Teaching 50-2)

27. DISORDERS OF THE ADRENAL GLANDS #1 Adrenal Insufficiency (Addison Disease) Pathophysiology and Etiology Primary: destruction of adrenal cortex Secondary: surgical removal, hemorrhagic infarction, hypopituitarism, medications Assessment Findings: signs and symptoms (see Box 50-1) Diagnostic Findings Laboratory tests, radiographs, CT scan Medical Management Daily corticosteroid replacement therapy Nursing Management (see Client and Family Teaching 50-3 and Nutrition Notes 50-4)

28. DISORDERS OF THE ADRENAL GLANDS #2 Acute Adrenal Crisis (Addisonian Crisis) Pathophysiology and Etiology Abnormal stress, trauma, salt deprivation Assessment Findings Anorexia, vomiting, diarrhea, abdominal pain, hypotension, fever; Life threatening Diagnosis: symptoms, history Medical Management Corticosteroids, antibiotics Nursing Management

29. DISORDERS OF THE ADRENAL GLANDS #4 Cushing Syndrome Pathophysiology and Etiology: excess ACTH; tumors; corticosteroids Assessment Findings: signs and symptoms Cushingoid syndrome, muscle wasting Moon face, buffalo hump, wounds, masculinization, kyphosis Diagnostic Findings: dexamethasone suppression test; 24-hour urine; blood test; radiographs; IV pyelogram; CT; MRI Medical and Surgical Management : radiation; drug therapy; surgery (see Evidence-Based Practice 50-1) Nursing Management

30. DISORDERS OF THE ADRENAL GLANDS #5 Hyperaldosteronism Pathophysiology and Etiology Aldosterone: secreting adenoma Assessment Findings Muscle weakness, fatigue, cardiac dysrhythmias; headache; increased urine; hypertension Diagnostic Findings: laboratory tests; CT; MRI; adrenal venography Medical and Surgical Management Unilateral adrenalectomy Drug therapy; diet therapy Nursing Management (see Client and family Teaching 50-4)