Lecture 11 Hormones Role in body, use of each, side effects of each, nsg implications and teaching

Why do you give hormones? To replace when there is an inadequate amount.

Adrenal cortex hormone

- Glucocorticoids
Common drug (PO) - Prednisone
Role of hormone in body Anti-inflammatory - Prevent release of certain enzymes during vasoconstriction potentiates vasoconstriction Carb & protein metabolism - help to provide energy we need for fight or flight Fat metabolism - mobilize fatty acids and increase plasma levels of fatty acids (defensive mechanism). Role of stress and weight control Maintains BP - Potentiating vasoconstriction (keeps BP up)

Use of hormone as a drug Replaces in body when there is inadequate amount Allergic reactions (anti-inflammatory) Collagen disorders Inflammatory reactions Respiratory diseases (asthma)

S/E Euphoria (intense feelings) Anxiety Restlessness, insomnia Hirsutism (facial hair)

Adverse effects Lowered resistance Decreased growth in kids Depression Weight Gain GI problems

Teaching Take before 9AM with food If they stop taking the drug you need to wean off of it Warn about changes in appearance (extra fat on face - moon face, hirsutism) ANY S/S of infections (fever)... Why? Because the drug masks the symptoms of diseases. Report S/S of GI problems - ex. soft bleeding in stool

Adrenal cortex hormone

- Mineralocoricoids - Fludrocortisone (type of mineralcoricoids)
(Primarily aldosterone)
Role of hormone in body Sodium and H20 reabsorption - Causes us to retain sodium (where sodium goes water follows) BP control Potassium levels - if we are saving sodium we are getting rid of K+ Maintains PH NSG implications Contraindicated with CHF, HTN - why? It causes H20 and sodium retention which will make your CHF and HTN worse. Monitor weight and BP

 Monitor NA+ and K+ levels Put them on Low Na diet Make sure they supplement K+ into their diet. Perhaps with KCl (very salty)

Anti-adrenal
Drug is taken when adrenal gland is putting out too much hormone
Common drug - aminogluethimide Treats Cushings Syndrome Watch for Hypotension - lowers BP, at risk for falls Body is unable to respond to stress. Be aware that the pt needs to be off this drug before surgery. Highly recommend pt wear bracelet so that if there is an emergency and they go to the ER for surgery the healthcare professionals are aware.

Thyroid hormone
Thyroid gland deals mostly with metabolism Role of drug in body - to treat hypothyroidism

Use as a drug Treats hypothyroidism - not enough thyroid hormone in the body Prevent and treat goiter - enlarged thyroid gland Replacement of thyroid hormone after thyroidectomy Used for diagnostic tests

NSG implications Assessment of elderly patients - more sensitive to effects of drug Report heat intolerance, increased pulse, chest pain or nervousness (all signs of hyperthyroidism ...they are taking too high of a dose)

Patient teaching Daily dose should be given 1-1.5 hours before breakfast. If you miss a dose dont double up, take it the next day. Tell patient taking the drug is a lifelong therapy Needs to take BP and pulse regularly Tell them to HOLD the medication if P is >100

Is the thyroid hormone drug working? - Rather than looking at lab values monitor for mental and physical happiness. - Monitor for thyroid stimulating hormone (TSH): If TSH is high the patient needs more thyroid hormone drug. If TSH is low the patient has enough thyroid hormone in the body

Anti -thyroid hormone

Thyroid gland deals mostly with metabolism Common drug - thioamides Role of drug in body - to treat hyperthyroidism

NSG implications

 Monitor thyroid function Use cautiously in pregnant women Can cause adverse bone marrow (anemic, cant fight infection) Teaching Restrict iodized salts, restrict seafood diet (yes to freshwater fish), avoid tofu and soy products cause they have a lot of iodine Report to healthcare prof about fevers, skin problems, sore throat (these are signs of bone marrow toxicity) Take meds with snack to prevent GI problems

Female hormones
Estrogen & Progestin

Estrogen

Use as a drug Deficiency of estrogen in women Used to treat breast cancer for post-menopausal women with estrogen negative tumors Advances prostate cancer Prevent osteoporosis in post menopausal women

CAUTION! - High doses of Estrogen can increase your chances of getting endometrial cancer, use low doses for long term use and pair with progesterone to reduce chances. - Contraindicated with pregnancy. Can cause deformability in baby. - Contraindicated for breast feeding. Estrogen inhibits lactation. Administration:

PO vag supp, vag cream IM

Progestin

Use as a drug Hormone deficiency r/t amenorrhea (menopause) or dysmenorrhea (painful periods) Endometriosis (cells from the uterine wall grow outside the uterus) Treatment of endometrial cancer, breast cancer, renal cancer, prostate cancer.

S/E Fluid retention Thrombophlebitis Stroke Embolism

<--- most important

Contraception - cycle is VERY important for drug effectiveness

3 types of combination/cyclical dosages of Estrogen & Progestin: 1. 2. Biphasic: (21 - 28 day cycle) Estrogen + 2 different amounts of progestin (first 10 days) Triphasic: (21 - 28 day cycle) 3 different amounts of progestin 3. Monophasic: (28 day cycle) Same dose of progestin (contains 7 inert pills)

Extended cycle: 84 - 365 days

Administration routes: patches, vag ring progestin only IM q3 months (depo-provera) Contraindicated: known drug allergy pregnancy high risk or had thromboembolic events S/E Headaches Weight gain Hypertension Thrombophelitis - pulm embolism, stroke, MI

Patient Teaching Antibiotics, barbiturates (sleep anxiety drugs) , TB meds ... all decrease the effectiveness of contraceptions Contraceptions themselves decrease the effectiveness of: beta blockers hypnotics, hypoglycemic agents (diabetic meds), oral anticoagulants, theophylline (respiratory meds), vitamins