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Chapter 39

Chapter 39. Nursing Care of Patients with Endocrine Disorders. Endocrine Disorders. Too Much or Too Little Hormone Activity Production/Secretion Tissue Sensitivity Primary Disorder Secondary Disorder. ADH. Too Little = Diabetes Insipidus Too Much = SIADH. Diabetes Insipidus.

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Chapter 39

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  1. Chapter 39 Nursing Care of Patients with Endocrine Disorders

  2. Endocrine Disorders • Too Much or Too Little Hormone Activity • Production/Secretion • Tissue Sensitivity • Primary Disorder • Secondary Disorder

  3. ADH • Too Little= Diabetes Insipidus • Too Much= SIADH

  4. Diabetes Insipidus • Pathophysiology • Insufficient ADH • Kidneys Do Not Reabsorb Water • Diurese 3–15 L per Day

  5. Causes • Pituitary Tumor or Trauma • Drugs • Psychogenic • Nephrogenic

  6. Signs and Symptoms • Polyuria • Polydipsia • Nocturia • Dilute Urine • Dehydration • Hypovolemic Shock • Decreased LOC • Death

  7. Diagnosis • UrineSpecific Gravity <1.001 • Plasma Osmolality Increased • CT or MRI for Cause • Water Deprivation Test • ADH

  8. Therapeutic Interventions • Hypotonic IV Fluids • Hypophysectomy if Tumor • IV or SQ Vasopressin • Intranasal DDAVP • Thiazide Diuretics if Nephrogenic

  9. Nursing Diagnoses • Risk for Deficient Fluid Volume • Risk for Ineffective Self Health Management

  10. SIADH • Pathophysiology • TooMuchADH • WaterRetention • Hyponatremia • DecreasedSerum Osmolality

  11. Causes • Cancers • BronchogenicLung Cancer • Drugs • HeadTrauma • BrainTumor

  12. Signs and Symptoms • Weight Gain Without Edema • DilutionalHyponatremia • Serum Osmolality <275 mOsm/kg • Concentrated Urine • Muscle Cramps and Weakness • Brain Swelling, Seizures, Death

  13. Diagnostic Tests • Serum/Urine Sodium • Serum/Urine Osmolality • Water Load Test

  14. Therapeutic Interventions • Eliminate Cause • Surgical Removal of Tumor • Fluid Restriction • Hypertonic Saline IV • Lasix or Declomycin

  15. Nursing Diagnoses • Excess Fluid Volume • Risk for Ineffective Self Health Management

  16. Growth Hormone Imbalance • Too Little= Short Stature • Too Much= Gigantism, Acromegaly

  17. Growth Hormone Deficiency • Pathophysiology • Deficient GH in Childhood • Growth Not Affected in Adults • Causes • Pituitary Tumor • Failure of Pituitary to Develop • Psychosocial • Malnutrition

  18. Signs and Symptoms • Grow Only to 3 to 4 Feet (5th Percentile) • Slowed Sexual Maturation • May Have Mental Retardation • Other Symptoms, Depending on Other Pituitary Hormones Involved

  19. Signs and Symptoms in Adults • Fatigue, Weakness • Excess Body Fat • Hypercholesterolemia • Decreased Muscle and Bone Mass • Sexual Dysfunction • Risk for Cardiovascular Disease • Risk for Cerebrovascular Disease • Decreased Quality of Life

  20. Diagnosis • GH Level • GH Response to Induced Hypoglycemia • MRI for Tumor • X-Rays

  21. Therapeutic Interventions • Synthetic GH (Somatrem) SQ or IM • Surgery if Tumor

  22. Nursing Diagnosis • Risk for Ineffective Self Health Management

  23. Acromegaly • Pathophysiology • ExcessGrowth Hormonein Adults • Bones Grow in Width, Not Length • Organs and Connective Tissues Also Enlarge • Causes • Pituitary Hyperplasia • Pituitary Tumor • Hypothalamic Dysfunction

  24. Signs and Symptoms • Change in Shoe or Ring Size • Nose, Jaw, Brow Enlarge • Teeth May Be Displaced • Difficulty Speaking and Swallowing • Sleep Apnea • Headaches, Visual Changes • Diabetes Mellitus • Arthritis • Sexual Dysfunction

  25. Example of Acromegaly

  26. Diagnosis • GH Level • GH Response to Oral Glucose • Bone X-Rays • CT Scan or MRI

  27. Therapeutic Interventions • Treat Cause • Hypophysectomy • Lifelong TH, Steroid, Sex Hormone Replacement • Octreotide (Sandostatin) • Bromocriptine (Parlodel) • Pegvisomant (Somavert)

  28. Hypophysectomy

  29. Nursing Diagnoses • Disturbed Body Image • Risk for Injury

  30. Care of the Patient Undergoing Hypophysectomy • Baseline Neurological Assessment • Preoperative Teaching • Deep Breathing, Incentive Spirometry • Avoid Coughing, Sneezing, Straining Postop

  31. Postoperative Care • Neurologic Assessment • Urine for Specific Gravity (Risk for DI) • Nasal Packing and Mustache Dressing • No Coughing, Sneezing, Blowing, Straining, Bending • Report CSF Drainage • HRT with Target Hormones

  32. Patient Education • Blow Nose Gently • Take Stool Softeners and Antitussives prn • Care with Brushing Teeth • Take Hormones as Prescribed • Call if Fever, Drainage, Frequent Urination, Thirst

  33. Thyroid Hormone Imbalance • Hypothyroidism • Hyperthyroidism

  34. Hypothyroidism • Pathophysiology • TH Deficiency • Metabolic Rate Reduced • Primary = Not Enough TH • Secondary = Not Enough TSH

  35. Causes • Congenital • Inflammatory • Iodine Deficiency • Thyroidectomy • Autoimmune (Hashimoto’s Thyroiditis)

  36. Signs and Symptoms • Fatigue • Bradycardia • Constipation • Mental Dullness • Cold Intolerance • Hypoventilation • Dry Skin and Hair • Weight Gain • Heart Failure • Hyperlipidemia • Myxedema

  37. Complications • Myxedema Coma • Hypothermia • Decreased VS and LOC • Respiratory Failure • Death

  38. Diagnosis • T3 and T4 Low • TSH High in Primary • TSH Low in Secondary • Serum Cholesterol and Triglycerides

  39. Therapeutic Interventions • Hormone • Levothyroxine/Synthroid • Maintain 0.1–0.2 mg/day

  40. Therapeutic Interventions for Myxedema Coma • Monitor VS • Warming Blanket • Mechanical Ventilation • IV Levothyroxine (Synthroid)

  41. Nursing Diagnoses • Activity Intolerance • Constipation • Risk for Impaired Skin Integrity • Imbalanced Nutrition

  42. Hyperthyroidism • Pathophysiology • Increased Metabolic Rate • Increased Beta Receptors • Primary = Too Much TH • Secondary = Too Much TSH

  43. Causes • Autoimmune (Grave’s Disease) • Multinodular Goiter • Toxic Adenoma • Thyroiditis • Pituitary Tumor (Secondary) • Synthroid Overdose

  44. Signs and Symptoms • Hypermetabolic State • Heat Intolerance • Increased Appetite • Weight Loss • Frequent Stools • Nervousness • Tachycardia, Palpitations • Tremor • Heart Failure • Warm Smooth Skin • Exophthalmos (Grave’s Disease)

  45. Exophthalmos

  46. Signs and Symptoms in Elderly • HeartFailure • AtrialFibrillation • Fatigue • Apathy • Depression

  47. Diagnosis • Elevated T3 and T4 • TSH Low in Primary • TSH High in Secondary • TRH Stimulation Test • TSI • CT/MRI if Tumor Suspected

  48. Complications • Thyrotoxic Crisis (Thyroid Storm) • Tachycardia, Hypertension • Fever, Dehydration • Coma • Death

  49. Therapeutic Interventions • PTU • Tapazole • Propranolol (Inderal) • Oral Iodine • Radioactive Iodine (I 131) • Thyroidectomy

  50. Therapeutic Interventions for Thyrotoxic Crisis • IV Fluids • Cooling Blanket • Iodine • Propranolol (Inderal) • Acetaminophen (Avoid ASA) for Fever • Oxygen

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