Endocrine ppt

Hypothalamus

Pituitary

Parathyroid

Thyroid

Adrenals

Pancreas

Ovaries

Testes

*Simple Factors

*Negative Factors

*Positive Factors

*Complex Factors

based upon blood levels of a particular substance

gland responds by increasing or decreasing the secretion of a hormone (PTH, insulin)

increases target organ beyond normal (Oxytocin)

Oxytocin: hormone comes from the petuitary

usually involves several glands (T3-T4 release)

Hypothalamus which will influence the anterior pituitary (TSH) which will go to the thyroid (T3-T4)

If hyperthyroid (elevated T3 and T4): pts will have a low TSH

If Hypothyroid: pt will increase TSH, low (T3, T4)

- originating in brain structures

- “circadian rhythms”

- Steroids rise in early morning and decline toward evenings

- Growth hormones peak during sleep

Important part of endocrine system

Produces hormones

Works closely with pituitary

Secretes many hormones

- releasing and inhibiting hormones

- neurons: influence the brainstem and spinal cord and coordinates the ANS, endocrine system and behavior responses such as fear and anger

“master gland”

Located under the hypothalamus at the base of the brain

Anterior and Posterior

Larger portion

Regulated by hypothalamus through releasing and inhibiting hormones

Growth Hormone (GH)

- effects on all body tissue

- growth and development of skeletal muscles and long bones

- role in protein, fat and CHO metabolism

Prolactin

Tropic Hormones

breast development and lactation

Control the secretion of hormones by other glands

TSH, ACTH, FSH, LH, MSH

Under the influence of the hypothalamus (TSH< ACTH< FSH, LH, MSH)

Composed of nerve tissue and is an extension of the hypothalamus

ADH and Oxytocin

- hormones produced in hypothalamus but travel down nerve tracts to Post. Pituitary

- stored in pituitary until released

Hormones not regulated by the hypothalamus

is regulated by fluid volume and plasma concentration

When stimulated the renal tubules reabsorb water

Creating a concentrated urine

• released to response of fluid outcome, it retains water only and keeps in body
• where you need it

Stimulates the production of milk into mammary ducts

Contract uterine smooth muscle

Released by stimulation of touch receptors in the nipples of lactating women

Pituitary Disorder (Anterior)

excessive secretion before the closure of the epiphyses

Pituitary Disorder (Anterior)

excessive secretion after the closure of the epiphyses

when you are an adult and you stop growing but your hands and feet get larger

Pituitary Disorder (Posterior)

• SIADH
• “Syndrome of Inappropriate antidiurectic hormone”

Fluid retention

Dilutional hyponatremia

Concentrated urine

putting out too much ADH, drowning in their fluid

DI – “Diabetes Insipidus”

Increased urine output

Dilute urine

urine is almost plain water and they get very dehydrated

T4 (thyroxine) & T3 (triiodothyronine)

Function is the production, storage and release of these hormones

We need these hormones for metabolism, T4 and T3 speeds up

Iodine is necessary for T4 & T3 hormone production

Affects metabolic rate, growth and development, CHO and lipid metabolism etc

Stimulated by TSH

Produced by thyroid – in response to high levels of calcium

Inhibits resorption of bone, increase calcium in the bone, increase renal excretion of calcium

Usually 4 glands

Small oval structures embedded behind each thyroid lobe

Secrete PTH (parathormone)

Increases calcium

PTH increases bone resorption, resulting in calcium release into blood, and promotes the reabsorption of calcium and excretion of phosphorus

Activates Vitamin D which enhances the intestinal absorption of calcium

Small paired highly vascular

Located on top of kidneys

Consists of two parts: Medulla and Cortex

Releases catecholamines

Effect on all body systems

Releases more than 50 steroid hormones

*glucocorticoids (cortisol)

*mineralcorticoids (aldosterone)

* androgens

- effect on glucose metabolism

- antiinflammatory action

-stress response

-released by negative feedback (CRH and ACTH)

- released in response to fluid volume and altered potassium levels

retains sodium and water and relese/excrete potassium

renin angiotension stimulates the adrenal cortex to secrete aldosterone

Excess: Cushing Syndrome

*effects related to excess of glucocorticoids

Deficiency:

• Generally all three corticosteroids are
• reduce

Not just steroids too little (need to add more)

Excess

*Tumor of adrenal medulla

*Severe hypertension

Too much epinephrine

HR goes up

First check bp high risk for stroke and heart attack

(Islets of Langerhans)

Glucagon – Alpha Cells

Insulin– Beta cells

Increases Sugar

lowers your blood sugar

Goiter

Nodules

Thyroiditis

Hypothyroidism

Hyperthyroidism

Serum T4

Serum T3

Thyroid scan with RAI (Radioactive iodine uptake)

Hypertrophy and enlargement of the thyroid

• Caused by excessive TSH stimulation from
• inadequate thyroid hormones

• Can be caused by Goitrogens
• - foods or drugs that suppress gland function

- enlargement of gland

- interfere with iodine uptake

Surgery may be necessary

Nursing diagnosis: airway, body image, GI

Palpable deformity

May be benign or malignant

Major sign of thyroid cancer is a hard, painless, nodule on an enlarged gland

Ultrasound, CT scan, thyroid scan, MRI Fine Needle Aspiration (FNA)

Inflammation of thyroid

Can be viral, bacterial, fungal, or autoimmune

Can lead to hypothyroidism (Hashimoto’s)

Usually Thyroid hormones are elevated but then may become depressed

TSH low then elevated

Treatment depends on cause and manifestations

Thyrotoxicosis – s/s resulting from excessive circulating T4, T3 or both

More common in women

Highest frequency is 20-40 years of age

Most common form is Graves disease (autoimmune disorder)

Pts loose blink reflex, they can damage eyes

It occurs because of fluid buid up behind the eye an pushes the eye forward

A pt is diagnosed with hyperthyroidism, ( the condition oriiginating in the thyroid)

Increased T4 And decreased TSH

Manifestation are heightened (severe tachycardia, heart failure, shock, fever, restlessness, seizures, delirium, coma, N-V-D)

Life threatening emergency

Etiology? (stress, surgery, trauma, infection)

Treatment aimed at reducing circulating hormones, manifestations and decreasing effects of metabolic rate

Drug therapy:

• Antithyroid Drugs
• *Iodine
• *B-Adrenergic Blockers
• *Sedatives
• *Tylenol
• *Insulin

Radioactive Iodine Therapy

Surgical Therapy

Foods – high in calorie, protein, carbohydrates,

Vitamins

Possible anti-diarrheal meds

Weigh daily, I/O

Why high in everything: because they are loosing weight and they are burning off everything

Limit exercise, like walking

Care related to manifestations… What can a nurse do to ease….??? Ease: no big meals before bed, limit noises, no caffiene, music, get in a good sleep pattern

Post-op care related to thyroidectomy

Eye Care: Tape the eyelids close at night if needed

Airway– tracheostomy tray at bedside WHY?

Assess for bleeding. How? Where?

• Position– Semi Fowlers – avoid flexion of neck,
• neutral position of neck,

Monitor vital signs and which electrolyte imbalance?

Diet– permitted to take fluid as soon as tolerated and soft diet the next day

Education s/s hypothyroidism and when to call doctor

Diet– lower caloric intake

Medication instructions

Regular exercise

Regular follow-up

Insufficient circulating hormones

One of the most common disorders in U.S.

All infants in U.S. are screened at birth

Primary or secondary etiology

Weight gain, constipation, fatigue, bradycardia, slugish, will feel cold, high colesteral levels

Cardiac: HR is slow and cant maintain cardiac output, high risk for congestive heart failure

Myxedema is the medical term for hypothyroidism. Myx is the Greek word for mucin, which accumulates in hypothyroidism. Edema means swelling.

Hypothyroidism not treated or stressed hypothyroidism

Exaggerated hypothyroidism s/s

Alert to hypoglycemia and hyponatremia

Low sodium, low blood sugar,

Mechanical ventilation

IV thyroid supplements

Isotonic fluids (if hyponatremic – hypertonic solution)

IV glucose

Monitor for heart failure

Nutritional Therapy

High in protein, low in calories

High in fiber

Fluids

• Patient and Family Teaching (health teaching p.
• 1459)

Thyroid Hormone replacement

TSH: will be high

caused by overproduction of parathyroid hormone by the parathyroid glands

characterized by bone decalcification and the development of renal stones containing calcium

Fractures and kidney stones , PTH is pulling calcium out of the bone

Asymptomatic

Manifestations of hypercalcemia

PTH levels

Serum calcium and phosphorus levels

Dexa Scan (dual energy x-ray absorptiometry)

Ultrasound, ECG

Phosphorus is low bc calcium is high

Surgery

Conservative treatment for hypercalcemia

Fluids

Increase salt – increase Ca+ excretion

Limit Ca+

Medications: (depends if primary or secondary hyperthyroidism)

Try to lower calcium, prevent injury and prevent kidney stones

Fluids will hel flush kidney stones out

Limit calcium: limit dairy, spinach, green veggies

Safety due to weakness

Ambulate as tolerated

Physical therapy

Fluids

Observe for medication side effects

Report any s/s of back pain

Strategies to relieve constipation

Ambulation will take calcium and put it back in the bone

Might want to give phosphorous ;you want to observe for too much phosphorus

Inadequate PTH (Uncommon)

Most common cause is the result of removal with thyroid surgery

Related to low serum calcium levels

Treat acute tetany

Maintain normal serum Ca+ levels

Vit D supplement (chronic conditions)

Adequate rest periods – monitor activity level

Monitor EKG and cardiac complications(CHF)

Long-term drug therapy and nutrition

High in calcium

Low in phosphorus (limit meats, poultry, cereals)