Endocrine Handout #4

Endocrine handout #4

I. Reading assignment: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 11th ed. A. Chapter 42, Pages 1439-1448 II. Student Learning Outcomes A. The student will be able to describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following 1. Hypopituitarism 2. Diabetes insipidus 3. Acromegaly B. The student will be able to discuss medical terms commonly used in the endocrine system C. The student will be able to review and identify anatomy and physiology of the endocrine system D. The student will be able to identify components of a complete endocrine physical assessment III. Hypothalamus A. Description 1. Attached to ______by the ______B. Location 1. ______2. ______C. Function 1. Stimulate the ______to secrete its ______IV. Pituitary A. Description 1. “______” gland a. ______# hormones b. Size ______c. ______lobe 1) Adenohypophysis 2) ______# hormones d. ______lobe 1) Neurohypophysis 2) ______# hormones

0b6a9559f953e76292f4d8e2d8df1f12.doc 1 04/06/18 V. Anterior Pituitary Hormones Hormone Function/Action Stimulated by Thyroid-stimulating hormone Stimulate thyroid ______(TSH) Stimulate secretion of ______T3/T4 ______metabolism ______temperatures ______Adrenocorticotropic hormone Stimulate adrenal cortex ______(ACTH) Stimulate secretion of ______glycemia ______glucocorticoids Follicle-stimulation hormone Female: (FSH) Stimulate ______to mature ______production Male: Stimulate ______production Luteinizing Hormone (LH) Female: Stimulates ______Male: Stimulate testes to produce ______Melanocyte-stimulation Increase ______hormone (MSH)

Growth hormone (GH) / Stimulate ______Somatotropin Stimulate ______synthesis ____ growth hormone ______serum glucose levels ______Insulin - ______glycemia Prolactin/ Lactogenic Stimulates ______development hormone during pregnancy Stimulates ______secretion after delivery

0b6a9559f953e76292f4d8e2d8df1f12.doc 2 04/06/18 VI. Posterior Pituitary Hormones

Hormone Function/Action Stimulated by: Vasopressin/ Stimulates water ______ ____ serum osmolality Antidiuretic hormone (ADH) ______urine output ____ BP ______H20 in ______Stress ______Exercise Oxytocin Stimulate uterine ______Breast to ______milk

0b6a9559f953e76292f4d8e2d8df1f12.doc 3 04/06/18 VII. Small Group Questions A. Which hormone (s)….. 1. Are gonadotropins? 2. Causes increase synthesis of melanin? 3. Causes ovulation? 4. Causes water retention? 5. In high levels causes increased blood pressure? 6. Increases protein synthesis? 7. Increases the metabolism of fatty acids for energy? 8. Is also called Vasopressin? 9. Is also known as somatotropin? 10. Is an insulin antagonist? 11. Is secreted in response to cold temperatures and stress? 12. Is secreted in response to decreased blood pressure, stress, pain, and exercise? 13. Is secreted in response to decreased Somatotropin? 14. Is secreted in response to hypoglycemia, stress, exercise and increased amino acids? 15. Is secreted in response to increase plasma osmolality? 16. Is secreted in response to stress, hypoglycemia and decreased glucocorticoids? 17. Stimulate ovaries to mature and produce estrogen? 18. Stimulated sperm production? 19. Stimulates adrenal cortex growth? 20. Stimulates breast development? 21. Stimulates testes to produce testosterone? 22. Stimulates the secretion of glucocorticoids? 23. Stimulates the secretion of the thyroid hormone? 24. Stimulates thyroid growth? 25. Stimulates uterine contraction? VIII. Hyperpituitarism A. Definition: ______secretion of pituitary hormones 1. Etiology: ______a. Usually ______& ______hormones

0b6a9559f953e76292f4d8e2d8df1f12.doc 4 04/06/18 IX. Growth Hormone Excess A. Affects 1. Depends on ______2. Epiphyses open (young)  ______B. Gigantism 1. Definition a. ______GH before ______closes 2. Etiology a. ______of anterior pituitary 1) ______in the # of cells  ______3. Clinical Manifestations a. Onset 1) ______b. > ______feet c. ______overall growth d. Do not have the ______that size implies 4. Medical Treatment a. ______of anterior pituitary b. ______of anterior pituitary via surgery 5. Pharmacology a. If pituitary is destroyed or removed  ______6. High risk for a. ______failure b. ______tension c. Thickened ______d. ______e. Delayed ______development 7. Nursing interventions a. ______b. ______charts c. ______beds

0b6a9559f953e76292f4d8e2d8df1f12.doc 5 04/06/18 C. Acromegaly 1. Definition a. ______GH after the epiphyses have ______2. Etiology a. ______-______yrs b. Hyperplasia c. ______3. Clinical manifestations a. Onset ______b. ______= increased in volume d/t ______of existing cells c. “______” appearance 1) Enlarged ______2) Thick ______d. “______” fingers 1) Thick fingers with tips like ______e. ______, ______, ______handshake f. Heart, liver, spleen ______g. ______h. ______, ______skin i. ______hypertrophy  ______j. ______intolerance k. Weight ______l. ______pain m. Hirsutism 1) ______n. ______Libido 1) ______2) Oligomenorrhea 3) Infertility 4. Diagnosis a. History, S&S, x-ray, CT-scan b. Lab: ______

0b6a9559f953e76292f4d8e2d8df1f12.doc 6 04/06/18 5. Prognosis a. ______life span b. DM 1) ____ GH  2)  ______levels  3) ______insulin  4) Stress pancreas  5) DM type ______6. Medical treatment a. Radiation, b. Surgery 1) Transphenoid hypophysectomy i. ______packing 1. Check for ______ii. S&S of ______iii. ______rigidity iv. ______control v. NO 1. ______2. ______3. ______4. ______vi. ______spirometer vii. No ______x 2 wks viii. No ______x 3 months c. Medications 1) Bromocriptine mesylate (Parlodel) i. Action 1. ______GH ii. Nursing Considerations 1. Give with ______iii. Side effects 1. ______

0b6a9559f953e76292f4d8e2d8df1f12.doc 7 04/06/18 2. Stimulates ______ 7. Nursing intervention a. Hx, S&S b. Monitor ______levels c. ______changes d. Vital signs e. Jaw changes  ______

X. Small group questions A. Mrs. Grandios has been diagnoses with acromegaly. 1. What hormonal disturbance causes acromegaly? 2. What signs and symptoms might you expect to see Mrs. Grandios exhibit? 3. What two diagnostic tests might have been performed to diagnosis Mrs. Grandios? 4. What medical treatment do you expect to be implemented with Mrs. Grandios? 5. What complications might you assess or monitor for with Mrs. Grandios? And how would you assess for this? 6. Mrs. Grand was prescribed Parlodel. What would you tell her about this medication? B. What 2 hormones are affected by hyperpituitarism? C. Increased GH in adults is diagnosed as what? D. Increased GH in children is diagnosed as what? E. What would be your priority nursing diagnosis in a patient diagnosed with acromegaly?

0b6a9559f953e76292f4d8e2d8df1f12.doc 8 04/06/18 F. Syndrome of Inappropriate Antidiuretic Hormone (AKA ______) G. Definition 1. ______ADH 2. What does ADS do? a. Kidneys to ______water  b. ______urine output  c. ______fluid (serum)volume H. Etiology 1. #1 ______2. Other ______3. ______I. Clinical manifestations 1. Water ______a. ______b. Weight ______2. Urine a. ______b. specific gravity of urine ______c. Caused by excess 3. ______natremia a. ______b. Normal ______- ______c. ______cramps d. ______4. Serum osmolality ______a. Blood leaks into the ______ b. ______swelling  c. ______, ______, coma  d. ______

0b6a9559f953e76292f4d8e2d8df1f12.doc 9 04/06/18 5. Medical treatment a. Treat ______disorder b. Resolve fluid volume ______1) ______H20 2) Promote ______c. ______replacement 6. Pharmacology a. Furosemide (Lasix) 1) Action 2) Nursing considerations i. Check ______ii. _____&______iii. VS iv. ______3) S/E b. Demeclcycline hydrochloride (Declomycin) 1) Action: Enhances ______c. Fludrocortisone (Florinef) 1) Action: Enhances ______retention 2) Nursing considerations i. Fluid ______7. Nursing diagnosis a. ______

0b6a9559f953e76292f4d8e2d8df1f12.doc 10 04/06/18 XI. Hypopituitarism A. Definition 1. ______secretion of pituitary hormones B. Etiology 1. #1 ______2. Congenital defects 3. Pituitary ______4. Pituitary ______5. Pituitary ______C. Signs and symptoms 1. Clinical manifestations are slow to appear and are not really apparent until ______of the pituitary is destroyed. D. Pathophyiology 1. Primary hypopituitarism a. Trouble with the ______ ____pituitary hormone secretion 2. Secondary hypopituitarism a. Trouble ______ _____ pituitary hormone secrestion b. Usually ______

0b6a9559f953e76292f4d8e2d8df1f12.doc 11 04/06/18 XII. Hypopituitarism: Growth Hormone A. Diagnosis 1. ______B. S&S (______GH) 1. Apparent by ______months 2. Delayed ______3. Growth rate ______unto ______feet 4. Body proportion = ______5. Accelerated ______XIII. Hypopituitarism: FSH & LH A. Female (_____ FSH & LH) 1. ______2. ______3. Decreased ______4. ______atrophy B. Male (______FSH & LH) 1. ______2. ______3. Decreased ______4. Testicles ______& ______XIV. Hypopituitarism: TSH A. Severe ______retardation B. S&S (______TSH) 1. Think ______2. ______3. ______cardia 4. Slow ______5. ______intolerance

0b6a9559f953e76292f4d8e2d8df1f12.doc 12 04/06/18 XV. Hypopituitarism: ACTH A. ACTH = handle ______B. S&S (______ACTH) 1. ______2. Weight ______3. ______4. Depigmentation of the ______5. V/S with stress a. ______temperature b. ______tension XVI. Hypopituitarism: Prolactin A. S&S (______Prolactin) 1. Absent postpartum ______XVII. Hypopituitarism: Simmond’s Disease A. AKA: 1. Panhypopitutarism B. Definitions 1. Total ______of ______pituitary hormones C. Etiology 1. ______2. ______3. Injury 4. Tumor D. Clinical manifestations 1. Weight ______2. General ______3. Weak 4. ______libido 5. ______intolerance E. Treatment 1. ______

0b6a9559f953e76292f4d8e2d8df1f12.doc 13 04/06/18 XVIII. Hypopituitarism: ADH A. Diagnosis 1. Diabetes ______B. Definition 1. ______C. Etiology 1. Injury to the ______or ______2. ______3. ______a. Lithium b. Lasix 4. ______not respond to ADH D. Clinical Manifestions 1. ______a. Specific gravity of urine ______b. Serum osmolality ______c. Serum Na+ levels ______1) ______2) ______2. Extreme ______a. ______3. Weight ______4. Dizziness 5. ______6. Fatigue E. Complications 1. ______volemia 2. Circulatory ______3. Unconsciouness 4. CNS ______F. Prognosis

0b6a9559f953e76292f4d8e2d8df1f12.doc 14 04/06/18 G. Medical treatment 1. Fluid ______2. Replace ______3. Fix ______cause H. Pharmacology 1. Desmopressin acetate (Stimate) a. Action: b. Route: c. Nursing Action: 2. Vasopressin (Pitressin) a. Action b. Route c. S/E 3. If DI is due to kidney failure a. ______will not help b. ______I. Nursing diagnosis 1. ______J. Nursing interventions 1. ______2. ______Na+ intake

0b6a9559f953e76292f4d8e2d8df1f12.doc 15 04/06/18 XIX. Small Group Questions A. Mrs. Waterfall has been diagnosed with lung cancer. She has been complaining of swelling and weight gain, she thinks it is due to the radiation treatment. The doctors check her blood values and note an elevated ADH level. 1. What would the name of this disorder be? 2. What is causing the elevated ADH levels? 3. What other lab values would coincide with this disorder? 4. What nursing diagnosis is appropriate for this disorder? 5. What interventions would you as a nurse start with this diagnosis? 6. What medications would you expect the doctor to order? B. Ms. Pealot is having severe symptoms of polyuria and polydipsia. She goes to the doctor afraid she has diabetes Mellitus, but is surprised when she is diagnosed with diabetes Insipidus. 1. Why is Ms. Pealot not started on insulin? 2. What hormonal irregularity causes diabetes Insipidus? 3. What can cause diabetes Insipidus? 4. Besides polyuria and polydipsia, what other clinical manifestation would you expect her to have? 5. What diagnostic tests would confirm the diagnosis of diabetes Insipidus? 6. What nursing diagnosis would best apply to Ms. Pealot? 7. What nursing interventions would you implement 8. What doctor’s order would you expect to see?

0b6a9559f953e76292f4d8e2d8df1f12.doc 16 04/06/18 XX. Pituitary Tumors A. Definition 1. ______B. Clinical manifestation 1. ______problems 2. ______changes 3. ______4. S&S of ______C. Medical treatment 1. ______tumor 2. Radiation 3. Cryohypophysectomy D. Pharmacology 1. ______

0b6a9559f953e76292f4d8e2d8df1f12.doc 17 04/06/18 XXI. Study Guide for Quiz #4 A. What are the hormones of the anterior pituitary? B. What are the hormones of the posterior pituitary? C. What is the function of each of the pituitary hormones? D. What is gigantism? What causes it? What are the risk factors for those with gigantism? What are the nursing considerations for gigantism? E. What is Acromegaly? What causes it? What are the risk factors for those with gigantism? What are the nursing considerations for Acromegaly? F. What is SIADH? What causes it? What are the risk factors for those with SIADH? What are the nursing considerations for SIADH? G. What is Diabetes Insipidus? What causes it? What are the risk factors for those with Diabetes Insipidus? What are the nursing considerations for Diabetes Insipidus? H. What is transsphenoid hypophysectomy? What are the pre and post op nursing considerations? I. Understand the anatomy, location and function of the pituitary J. What is SIADH? What causes it? What are the clinical manifestations? How is it treated? What nursing diagnosis and interventions are priorities in SIADH? K. What is Diabetes Insipidus? What causes it? What are the clinical manifestations? How is it treated? What nursing diagnosis and interventions are priorities in DI? L. Know the purpose, and nursing considerations for the following medications: 1. Parlodel 4. Florinef 2. Lasix 5. Stimate 3. Declomysin 6. Pitressin M. Know the following terms: 1. Hyperpituitarism 5. Hulking 2. Hyperplasia 6. Tuft 3. Epiphseal 7. Hirsutism 4. Hypertrophy

0b6a9559f953e76292f4d8e2d8df1f12.doc 18 04/06/18