RETS College - School of Nursing NUR 129

Concept Mapping Endocrine

Disorders of the Anterior Pituitary Gigantism

Overproduction of growth hormone GH in the childhood
Great height Increased muscle and visceral development Increased weight Normal body proportions Weakness

Dwarfism
Underproduction of growth hormone in childhood
1. Abnormally short height 2. Normal body proportion 3. Appear younger than age 4. Dental problems due to underdeveloped jaws 5. Delayed sexual development

Acromegaly 1. Assess ability to perform ADLs

2. 3. 4. 5. Soft, easy-to-chew diet Encourage Fluids Analgesics Visual disturbances a. Risk for injury- Keep environment free from clutter b. Self-Esteem issues c. Family coping d. Cardiac dysrhythmias enlarged heart

Overproduction of growth hormone GH in the adult

Irreversible physical changes Assessment Muscle weakness Hypertrophy of the joints with pain and stiffness Femalesdeepened voice, increased facial hair, amenorrhea Partial or complete blindness with pressure on the optic nerve due to tumor Severe headaches Malocclusion of teeth

NUR129 Summer 2009

[1]

Instructor: Amber Essman RN BSN CFRN

RETS College - School of Nursing NUR 129

Concept Mapping Endocrine

Disorders of the Posterior Pituitary Diabetes Insipidus

Manifests - polydipsia and polyuria Deficiency in antidiuretic hormone (ADH) 1. Strict Intake and Output 2. Daily Weight 3. Vital Signs 4. Monitor Electrolytes Sodium levels
5. urine specific gravity <

SIADH
Excessive Antidiuretic hormone (ADH) 1. Monitor Intake and Output, Daily Weight 2. Monitor blood chemistries Hyponatremia 3. Neurological Exam 4. Restrict Fluids Fluid Restriction 800-1000 ml/day. If Hyponatremia is severe, than 500 ml/day Hypertonic Saline Solution will be ordered at a slow rate (need to avoid too rapid of rise in sodium) Need to correct sodium imbalance and pull water out of edematous brain cells

1.005 (Normal 1.003 to 1.030) 6. Limit Caffeine secondary to its diuretic properties FLUID Volume Deficit Risk for Hypernatremia

NUR129 Summer 2009

[2]

Instructor: Amber Essman RN BSN CFRN

RETS College - School of Nursing NUR 129

Concept Mapping Endocrine

Disorders of the Thyroid Gland Hypothyroidism Underproduction of thyroid hormones

Assessment: Depression, constipation, bradycardia, hypotension, fatigue, Weakness Diagnostic Tests Radioactive iodine uptake test (RAIU). Medical Management: Synthroid Know client teaching 1. Imbalanced Nutrition, more than body requirements. 1. Low calorie diet 2. Provide warm environment 3. Fluids and fiber for constipation 4. Monitor depression 5. fatigue activity intolerance

Hyperthyroidism (Thyrotoxicosis)
Overproduction of the thyroid hormones

Medications block production of thyroid hormones Propylthiouracil Methimazole Radioactive iodine non-pregnant patients Subtotal hemorrhage, hypoparathyroidism, vocal cord paralysis)
1. Provide a cool environment 2. Monitor vital signs 3. eye drops for exophthalmos Subtotal Thyroidectomy: Positioning, complications, monitoring for thyroid crisis, inadvertent removal of the parathyroid glands.

NUR129 Summer 2009

[3]

Instructor: Amber Essman RN BSN CFRN

RETS College - School of Nursing NUR 129

Concept Mapping Endocrine

Disorders of the Parathyroid Gland Hypoparathyroidism

Decreased parathyroid hormone Hypocalcemia Neuromuscular hyperexcitability Involuntary and uncontrollable muscle spasms Tetany, Laryngeal spasms, Stridor, Cyanosis Calcium gluconate or calcium chloride IV slowly Vitamin D Chvosteks (an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in patients who are hypocalcemic) Trousseaus signs assesses for latent tetany; carpal spasm is induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes; a positive result may be seen in hypocalcemia and hypomagnesemia patients.

Hyperparathyroidism Excessive parathyroid hormone hypertension, psychosis, muscle weakness, renal calculi Hypercalcemia 1. Increase fluids 2. Weight bearing ambulation 3. Monitor ECG

NUR129 Summer 2009

[4]

Instructor: Amber Essman RN BSN CFRN

RETS College - School of Nursing NUR 129

Concept Mapping Endocrine

Disorders of the Adrenal Gland Adrenal hyperfunction (Cushings) Adrenal Hypofunction (Addisons)
Excessive Cortisol Moonface, buffalo hump weakness,

easily bruised, poor wound healing, glycosuria

Adrenal glands do not secrete adequate amounts of glucocorticoids and Mineralocorticoids Adrenalectomy Long-standing steroid therapy observe for postural hypotension, syncope, Addisonian crisis
Nursing Interventions and Patient Teaching

Deficient knowledge secondary to repeated hospital admissions, 2. Disturbed body image secondary to increased androgens, abnormal fat distribution, and muscle wasting, 3. Risk for injury secondary to poor wound healing, decreased bone density, and capillary fragility. 4. Risk for fluid volume excess secondary to sodium and H2O retention from excessive glucorticords. 5. Diet low in sodium and High in Potassium

Diet high in sodium and low in potassium Steroids for adrenal crisis Orthostatic Hypotension

NUR129 Summer 2009

[5]

Instructor: Amber Essman RN BSN CFRN

RETS College - School of Nursing NUR 129

Concept Mapping Endocrine

Disorders of the Adrenal Medulla Epinephrine/Norepinephrine Avoid Stress

Pheochromocytoma-Chromaffin cell tumor
1. 2. 3. 4. 5. LOW SODIUM DIET Avoid Stress Monitor Blood pressure Administer Anti hypertensives Avoid Stimulants

Disorders of the Pancreas Insulin Dependent Diabetes Mellitus (IDDM) Type I

NUR129 Summer 2009 [6]

Diabetes Mellitus- Type II

Instructor: Amber Essman RN BSN CFRN

RETS College - School of Nursing NUR 129

Concept Mapping Endocrine

Diabetic Ketoacidosis (DKA)

(HHNC)

Hypoglycemia

Hyperglycemia

NUR129 Summer 2009

[7]

Instructor: Amber Essman RN BSN CFRN

RETS College - School of Nursing NUR 129

Concept Mapping Endocrine

Hunger Shakiness Nausea Irritability Anxiety Rapid pulse Pale, cool skin Hypotension Sweating

Insulin Monitor storage and expiration of insulin Monitor and maintain a record of blood glucose readings as prescribed Monitor food intake Oral Hypoglycemics Administer with food Assess diet and exercise Monitor for hypoglycemia and hyperglycemia Assess for side effects

NUR129 Summer 2009

[8]

Instructor: Amber Essman RN BSN CFRN