Академический Документы
Профессиональный Документы
Культура Документы
Thyroid Gland
Adrenal Glands
Functions of endocrine
system
Response to stress and injury.
Reproduction.
Homeostasis
Energy metabolism.
Endocrine glands
Endocrine glands are specialized cluster of cells
that secrete hormones.
Steroid/products of
cholesterol breakdown Peptides either a large
such as glucorticoids proteins or a chain of
and mineral corticoids. proteins such ACTH,
TSH or ADH.
Hormones
Maintain homeostatic balance utilizing a
feedback mechanism that involves other
hormones, blood or chemicals,and the
nervous system.
Feedback loop mechanism.
Sensors in the endocrine system detect
changes in the hormonal levels.
T4=90% of the
Parafocicullar cells hormone secreted is
which secrete
bounded to protein as
thyrocalcitonin
a storage form; this
form is inactive until
converted to T3.
Inhibition of the conversion of
T4 to T3
Several illness Drugs such as propyl-
thoracic (PTU)
Fasting
Radiologic contrast
Malnutrition dye
Trauma Dexamethasone
Exposure to cold
Hashimoto’s thyroid
Exhaustion
Depression
Constipation
weight gain
Hypothyroidism patients
Clinical manifestation of
hypothyroidism
Cardiovascular=Bradycardia, hypotension ,
decreased contractility and cardiac output.
T3 decrease
T4 decrease
Diagnostic studies
Decreased T3 uptake Increased cholesterol:
(measure T3 the liver is unable to
remaining after excrete cholesterol in
unbounded sites have the bile so it
accumulate and leads
been filled.) to arteriosclerosis and
leads to PVD, and
Cardiomegaly CAD
Pharmacological Treatments
Liothyroid (T3)
Liotrix(T4 &T3)
Nursing responsibility
Give I hour before meals or 2 hours after a
meal.
Avoid cold
environment
Paced activities
Decrease CO in hypothyroidism
TH deficit causes a reduction of HR and
stroke volume, resulting in decreased
cardiac output.
Monitor cardiac
function.
Fluid overload
heart failure
Hypothermia
Hypothermia: lack of heat Avoid electrical
generation related to warming blanket
decreased metabolism. because it can lead to
vasodilatation and
Monitor temperature vascular collapse.
Rewarm patient gradually
and passively (plain
blanket and warm room)
Alteration in Bowel elimination
Respiratory:Hypoventilation and
respiratory failure
Thermoregulation: hypothermia
Physical assessment of
myxedema coma
Hypokalemia
Hypoglycemia
Hyperthyroidism
Define: As an excess of TH in the body
Grave’s Disease
T4 -increase
Fatigue Hoarseness
Difficulty sleeping Dyspnea
Hand tremors Tachycardia
Weight loss despite Increase blood
increase appetite volume
Skin =warm, moist, increased CO
smooth,flushed Palpitations
Amenorrhea Exophthalmos
Patients with hyperthyroidism
Treatments for hyperthyroidism
Pharmacology
Radioactive Iodine
Surgery
Drug therapy for
hyperthyroidism
Propylthiouracil (PTU)
Methimazole(Tapazole)
Propranolol
Drug therapy for
hyperthyroidism
Antithyroid drugs inhibit TH production.
they do not affect the release or activity of
hormone that is already formed.
Sodium Iodine
SSKI-Potassium iodine
Radioactive iodine
Thyroid gland takes iodine in any form,
radioactive iodine I-131 concentrates in
thyroid gland and damage or destroy thyroid
cell so that less TH is produced.
Pre-op-care
Antithyroid drugs
Iodine preparation
Answer questions
Discuss concern
Post-op -care
keep HOB 45 degrees
Sensory Perceptual/Visual
Toxic adenoma
nervousness
tremors
hyperreflexia
Clinical manifestations thyroid
storm
Hepatic Bilirubin
hepatomegaly
Alkaline phosphate
AST(aspartame
transaminase)
Bilirubin
Clinical manifestations thyroid
storm
Gastrointestinal Abdominal pain
Increased gastric
motility (diarrhea)
Nausea/ Vomiting
Increased appetite
with weight loss
Clinical manifestations thyroid
storm
Thermal
heat intolerance
Epinephrine
Norepinephrine
Disorder of the adrenal medulla
Pheochromocytoma a benign tumor of the
adrenal medulla leading to hyper production
of epinephrine and nonepinephrin.
Metanephie
Adrenal medulla
Labs and diagnostic
Shakiness,
diaphoresis
Palpitations
tachycardia
Feelings of anxiety
Treatments for
pheochromocytoma
Surgery=(will need to replace cortical
hormones)
Radiation therapy
Beta-blockers
Glucortocosteroids
Mineralcorticosteroids
Androgens
Disorders of the adrenal cortex.
Cushing’s Syndrome
Caused by excess of cortisol production or by
excessive use of cortisol or other similar steroid
(glucorticoid)
Addison’s Disease
Addison’s disease is a severe or total deficiency of
the hormones made in the adrenal cortex, cause
by a destruction of the adrenal cortex.
Adrenal glands
Adrenal diagnostic Lab values
Adrenal Cortex
Serum cortisol
correlates with sleep awake cycle
Level should be checked at 8:00am and at 4:00pm
The 4:00PM level should be one third the 8:00am level
measurement ACTH /higher 7:00am-10:00am/
lower7:00pm-10:00pm
Adrenal cortex Lab
values(cont…)
ACTH stimulation
Obtain a base line cortisol level 30 minutes before
ACTH is given.
17-Hydroxy corticosteroid(17ohcs)
17-ketosteroids(17KS)
Etiology of Cushing’s
Syndrome
Endogenous or exogenous.
Tumors: oat cell carcinomas, renal,
ovarian,lungs, thymus, pancreas or other
organs
Hypervolemia Immunosupression
Hyperglycemia Osteoporosis
Radiation
Surgery
Medications for TX, Cushing’s
syndrome
Pharmacological treatment is used :
Metyrapone (Metopirone)
Mitotane (O, p1DDD)+cytotoxic to
adrenals.
Cyprohetadine inhibits ACTH secretions.
Radiation as a treatment
Radiation therapy may be useful in
patients with primary Cushing’s syndrome.
Surgery
Adrenalectomy
Hypophysectomy
Surgery Care
Monitor V.S.
pain control
Osteoporosis
pathologic fractures
Risk for injury
Maintain a safe environment by
Abnormal ACTH
Normal ACTH
stimulation test
stimulation test
Diagnostic and lab findings in
Addison disease
Serum sodium is Adrenal scans
decreased
CT scans
Blood glucose is
decreased EKG = t peak waves,
wide QRS, and an
Increased potassium increased PR interval
Treatments
Hormone replacement therapy.
Patient education
Major adrenocortical Meds
Cortisone acetate Fludrocortisone
(Cortelan) acetate (Florinef)
Hydrocortisone Deoxycorticosterone
(Sulucortef) (Cortate)
Prednisone Dexamethasone
(Methylprednisone) (Decadron
Nursing Care
Knowledge deficit
Acute adrenal crisis
It is a medical and a nursing emergency.
Treatment must be given immediately.