lOMoARcPSD|17509268 Exam 6-Final-Adult 2 - notes Adult Gerontological Nursing (University of South Alabama) Studocu is not sponsored or endorsed by any college or university Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 Endocrine ● Endocrine system works with nervous system ○ Primary purpose is to secrete hormones ○ Hormones work on tissues ■ No connection between endocrine gland and tissue, it's all blood flow dependent ● Disruption in blood flow can cause low levels of hormones ● Hormones go to cells with receptors, if the tissue does not have a receptor for that hormone, then the hormone cant affect the tissue ■ Hormones are not stored, and must always be produced ● Normal hormone maintenance ○ Negative feedback ■ The result of an action inhibits further performance of the action ○ Two types of negative feedback ■ Simple feedback ● Elevated BG leads to secretion of insulin ● Increase in insulin lowers BG ■ Complex feedback ● Decreased cortisol leads to production of CRH from hypothalamus ● CRH causes increase in adrenocorticotropic (ACTH) hormone from anterior pituitary ● ACTH causes increase in cortisol ● Increased cortisol causes decrease of CRH from hypothalamus ■ If hormone is low, then it does these processes to fix the imbalance ● Main hormones ○ Pituitary- base of the brain ■ TSH (thyroid stimulating hormone) ■ Growth hormone ■ Vasopressin ■ ACTH ■ Gonadotropins ○ Adrenal- top of the kidneys ■ Cortisol Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ● ● ● ■ aldosterone ○ Thyroid- neck ■ T3 ■ T4 ■ calcitonin ○ parathyroid - back side of thyroid ■ Parathyroid hormone ○ Hypothalamus- 3rd ventricle of the brain ■ Growth hormone ○ Ovaries ■ Estrogen ■ Progesterone ○ Testes ■ Testosterone Pituitary ○ Anterior pituitary ■ TSH ● Stimulates production and release of the thyroid ■ Growth ● Makes tissues and bones grow ■ ACTH ● Stimulates adrenal glands to secrete aldosterone and cortisol ■ Gonadotropins ● LH (luteinizing hormone) ● FSH (follicle stimulating hormone) ○ Posterior pituitary ■ ADH (vasopressin) ● Causes water reabsorption ● Limits diuresis and holds on to fluid Adrenal glands ○ Aldosterone ■ Maintains extracellular volume ■ Maintains sodium/potassium relationship ● Leads to sodium and water reabsorption and excretion of potassium in the urine ■ Regulated by RAAS system ○ Cortisol ■ Metabolizes carbs, fats and proteins ■ controls stress and emotional stability ● How do i get more of this sos ● ^^^ same lol - josh ■ Immune function Thyroid ○ T3 and T4 increases metabolism Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 Increases metabolism→ more consumption of oxygen Controls metabolic rate of all the cells in the body Increase in respiratory rate Increase in RBC production Widespread signs and symptoms whereas other hormones causes more localized signs and symptoms ○ Calcitonin ■ Lowers calcium and phosphorus in the serum Parathyroid ○ Regulates calcium and phosphorus metabolism and increases serum calcium ■ Can see severe decreases in calcium with this ovaries /testes ○ Responsible for ~seggsy maturation~ ■ Menstruation ■ Testosterone Hypothalamus ○ Stimulates the pituitary hormones Effects of aging on hormones ○ Decreased production of all hormones but mostly effects: ■ ovaries/testes ● No more babies→ menopause ■ Thyroid ● Thyroid abnormalities common in old people ■ Pancreatic cells ● Insulin secretion decreases ● Diabetes is very common in old people Assessment of the endocrine system ○ Get a good history ■ Genetics ■ OTC meds ■ Nutritional changes ■ GI tract disturbances ■ Weight loss ■ What's there energy levels ● Adrenal glands control this for the most part ■ Eliminations patterns ■ Sexual function ○ Physical assessment ■ Look at hair texture and distribution ● Hair growth ○ In woman look for hair on abdomen ● Hair loss ■ Fat distribution ● Trunkle obesity ■ ■ ■ ■ ■ ● ● ● ● ● Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ■ ■ ■ ■ ○ Labs ■ ■ ■ ■ ● Buffalo hump???? Muscle mass ● Is it appropriate for their age Facial structure ● Moon face ● Puffy face Eyes ● Protruded eyes Vitiligo ● Pigment loss in the skin stimulation/suppression testing ● ACTH and cortisol is the most common Assay ● Measures specific hormone levels Urine test ● 24 hour collection test ● Specimen has to be iced and protected from light ● Timed immediately after first void ○ If they void at 9 am, collect for 24 hours Radiology ● MRI with contrast for pituitary gland in the brain ● CT ○ Adrenal glands ○ Ovaries ○ Pancreas ● Ultrasound ○ Thyroid ○ ovaries/testes ● Needle biopsy ○ most commonly used for thyroid Disorders of the glands ● Disorders of the pituitary gland ○ Anterior pituitary (adenohypophysis) ■ Regulates growth, metabolism, and sexual development ■ One or more hormones may be under secreted (hypopituitarism) or oversecretion (hyperpituitarism) ■ Hypopituitarism- can be caused by a tumor, malnutrition or rapid loss of body fat, shock, severe hypotension, head trauma, infection, or idiopathic ● Growth hormone ○ Decreased bone density Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ■ ○ Pathologic fractures ○ Decreased muscle strength ○ Increased cholesterol levels ● Gonadotropins (LH/FSH) in woman ○ Amenorrhea ■ No periods during reproductive years ○ Anovulation ■ No ovulation ○ Low estrogen ○ Breast atrophy ○ Decreased hair ○ Decreased libido ● Gonadotropins in men ○ Decreased facial hair ○ Reduced muscle mass ○ Impotence ○ Decreased libido ● TSH (very similar to hypothyroidism symptoms) ○ Weight gain ○ Intolerance to cold ○ Decreased libido ○ lethargy/fatigue ○ Most dangerous!! Can be deadly ● ACTH ○ Also just as dangerous as TSH ○ Decreased cortisol ○ Pale ○ Lethargy ○ Malaise ○ Orthostatic changes in BP ○ Decreased BG and sodium ● Management of Hypopituitarism ○ Medication ■ Elederly patients need a lower dose Hyperpituitarism- causes by tumor or adenoma ● Early signs and symptoms ○ Headache ○ Visual disturbances ○ Increased ICP ■ Do not let them do things to increase ICP ● No bending over, coughing, straining, or straws ● Growth hormone ○ Thickened oily skin Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ○ ○ ○ ○ Thickened lips Deep voice Large head (acromegaly) ■ Permanent symptom Cardiac, hepatic, lung enlargement ■ Permanent symptom ● ○ TSH ○ Weight loss ○ Tachycardia ○ Heat intolerance ○ Fine tremors ● ACTH (cushing's syndrome) ○ Weight gain ○ Truncal obesity ○ Moon face ○ Muscle wasting ○ Decreased bone density ○ Elevated BP ● Gonadotropins ○ Most common feature is the tumor ○ Elevated LH and FSH ● Management of hyperpituitarism ○ Remove adenoma or tumor ○ Regulate hormones with drug therapy or along with surgery/radiation ■ Remove portion of the brain or just the tumor itself ○ After surgery ■ Don't bend over, strain, cough, or drink with a straw ● These will increase ICP which is BAD ○ Diagnosis ■ MRI Posterior pituitary (neurohypophysis) ■ Vasopressin (ADH) ● Diabetes insipidus (NOTHING to do with diabetes mellitus)underproduction of ADH ○ Massive amounts of fluid loss ■ Excess thirst and urination ○ Decreased ADH or a decrease in kidneys ability to respond to ADH ○ Renal tubules become impermeable to water ■ Water gets excreted with urine ○ VERY low urine specific gravity <1.005 ○ Low urine osmolality <300 ○ Very similar to a hangover Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ■ ○ ○ ○ Alcohol triggers diabetes insipidus like syndrome ● Hangovers are just a lil ~taste~ of this but symptoms disappear when you are rehydrated ● Patients with diabetes insipidus are unable to be rehydrated Causes ■ Nephrogenic diabetes insipidus ● Not responding to ADH and is just flushing all the water out ■ Primary ● Decreased production or secretion of ADH ■ Secondary ● Tumors ● Trauma (from head injury or trauma from surgery) ● Infection Common features ■ Decreased BP and PP ■ Tachycardia ■ Weak pulses ■ Hemoconcentration ● Increased h/h, BUN, and Na ■ Poor skin turgor ■ Dry mucous membranes ■ Increased thirst ■ Decreased LOC ■ 4-30 LITERS of urine output a day without any use of diuretics Management ■ For dehydration ● Give iv fluids at a rate to replace what they've lost in the previous hour ● Example: lost 400 mL in last hour→ give 400 mL of fluid the next hour ■ Desmopressin ● Oral or intranasal ○ Intranasal is for someone who has chronic diabetes insipidus ● IV ○ 10 times stronger than PO ○ Need a much lower dose ● Teach symptoms to report if medication is working too well or not working enough Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ● ○ Daily weights to keep track of fluids ■ NEVER restrict fluids ● Only leads to dehydration SIADH (opposite of diabetes insipidus) ○ ADH secreted when its not needed ○ ADH is usually secreted when osmo is high, but in this disorder it is secreting when osmo is normal or low ○ Primary ■ Over Secretion of ADH ○ Secondary ■ Malignancies ■ Pulmonary disorders ■ CNS trauma ■ Tumors ■ Meds ● Tricyclics ● General anesthesia ○ Key features ■ ■ ■ ● Edema N/V Hemodiluted ● Low Na, H/H, and BUN ■ Headache ■ Tachycardia ■ Decreased body temp ■ Lethargy and LOC changes ■ Decreased deep tendon reflexes ○ Management ■ Restrict fluids (500-1000 mL a day) ■ Do daily weights ■ Sodium replacement ● Hypertonic saline 3% ● Saline flushes through GI, NG, or OG tube ■ Frequent neuro checks ■ Drug therapy ● ADH antagonists ○ Tolvaptan (samsca) ○ Conivaptan (vaprisol) ○ Promotes water excretion without sodium loss Disorders of the adrenal gland ○ Hypofunctioning (addison's disease) ■ Primary Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ○ ● Idiopathic ● Metastatic cancer ● Aids ● TB ■ Secondary ● Pituitary tumors ● Radiation ● Abrupt discontinuation of glucocorticoids ■ Signs and symptoms ● Muscle weakness ● Fatigue ● Joint pain ● Anorexia N/V ● Weight loss ● Vitiligo or increase in pigmentation ● Anemia ● Hyponatremia, hypoglycemia, hyperkalemia ● Hypotension ● Changes in LOC ■ Acute adrenal insufficiency (addisonian crisis) ● LIFE threatening ● Result of stress, surgery, or trauma ● Management ○ Hydrocortisone ○ Treat hypoglycemia ○ Treat hyperkalemia ○ Always wear medic alert bracelet and carry simple carbs with them ○ ACTH stimulation test ■ Give IV ACTH and obtain cortisol levels at 30 minutes and again at 1 hour ■ If they have primary: ● Cortisol will be decreased or absent ■ If they have secondary ● Cortisol will increase Hyperfunctioning (hypercortisolism- cushing's disease) ■ Signs and symptoms ● Fat redistribution to back, face, and trunk ○ Buffalo hump ■ Fat on back of neck ● Elevated BP ● Dependent edema ● Increased thrombotic events ● Muscle atrophy Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ○ ● Osteoporosis ● Thin skin ● Increased pigmentation ● Increased risk for infection ■ Causes of cushing's disease ● Pituitary adenoma is the main cause ● Endogenous ○ Problem with adrenal gland ● Exogenous ○ Overuse of steroids, autoimmune disease, or chemo ● If glucocorticoids excess is the result of drug therapy from another health problem it is known as cushing's SYNDROME, not disease ■ Diagnostics ● Elevated cortisol ● Increased BG ● Decreased lymphocyte count ● Increased sodium ● Decreased calcium ● Decreased potassium ■ Management ● Restore fluids ● Prevent skin breakdown ● Drug therapy to decrease ACTH ● Fluid and sodium restriction ● Careful I&O and daily weights ● Prevention of infection ● Prevent gastric ulcers ● Surgery ○ Adrenalectomy ○ Pituitary removal/tumor removal Hyperaldosteronism- conn's syndrome ■ Usually caused by adrenal adenoma ■ Caused by thiazide diuretics ■ Signs and symptoms ● HTN ● Hypokalemia ● Decreased plasma renin levels ○ Negative feedback mechanisms ● Metabolic alkalosis ● Decreased urine specific gravity ■ Management ● remove the gland ● Spironolactone ○ For the potassium levels Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ● ○ Ensure potassium is corrected before going to surgery ● Steroids ○ Pheochromocytoma ■ Catecholamine producing tumor ■ Common features ● Severe HTN ○ Does not respond well to regular BP meds ■ Other signs and symptoms ● Headache ● Diaphoresis ● Tachycardia ● Anxiety ● Tremors ● Weakness ● Exhaustion ● Weight loss ● Heat intolerance ● Nausea ■ Labs ● 24 hour urine collection for VMA/metanephrines ● Hyperglycemia ● Symptomatic treatment ■ Management ● Surgical removal ○ Very dangerous ○ Any time the tumor is touched it can cause a secretion of catecholamine and cause a spike in BP ● Alpha blockade and beta blockade ○ Lowers BP ● Don't palpate the abdomen Thyroid gland ○ Hyperthyroidism- thyrotoxicosis ■ Temporary or permanent ■ Causes ● Graves disease ● Thyroid adenoma ● Thyroiditis ○ Radiation ● Cancer ■ Signs and symptoms ● Increased RR ● SOB ● Palpitations ● Weight loss Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ○ ● Muscle weakness or wasting ● Blurred vision ● Heat intolerance ● Decreased attention span ● Manic behavior ■ Physical features ● Exophthalmos ○ Eye protrusion ○ Eyelid retraction lag ○ May not be able to fully close eyes ■ Keep moisturized and use closure device when sleeping ● Increased fatty tissue behind eye ● Edema extraocular muscles ■ Diagnostic ● T3, T4, and TSH all elevated ● In graves TSH is decreased ● Ultrasound ● EKG ● Chart of page 1266 for labs ■ Thyroid storm ● Stress induced ○ Fever ○ Infection ○ Surgery ○ Trauma ○ NEVER palpate if they have a goiter→ can induce thyroid storm ● Treatment ○ PTU ■ Drugs ○ Steroids ○ Symptoms ■ Decrease fever ○ Decrease stimuli ■ I.e stress ○ Chart on page 1270 ● S&S ○ Fever ○ Tachycardia ○ Systolic HTN ○ Abdominal pain ○ Can progress to seizures, coma, and death hypothyroidism - decreased metabolism Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ■ ■ ■ ■ ■ ■ ■ ■ ■ Myxedema ● Changes appearance Non pitting edema ● Esp on hands and feet Causes ● Thyroid surgery ● Radioactive iodine Cordarone ● Can negatively impact thyroid function Key features ● Coarse features ● Edema ● Blank expression ● Cool skin ● Thick, brittle nails ● Dyspnea ● Decreased HR/BP ● Cold intolerance ● Lethargy ● Muscle ache ● Weight gain ● Anemia ● apathy/depression Diagnostic ● T3, T4, TSH: decreased TSH increased in primary, but decreased in secondary or tertiary Management ● Thyroid replacement therapy ○ If a patient has hyperthyroidism, the removal of the gland will cause hypothyroidism, and the patients will be on the same treatment ● Lifelong therapy Myxedema coma ● Hypothyroid function along with other health conditions ● Heart becomes flabby ○ Weak muscle tissue ● Chamber sizes dilates ● Decreased cardiac output and perfusion ● Decreased sodium, BG, and temp Thyroiditis ● Acute-bacterial infection ○ Pain in neck ○ Difficulty swallowing ○ fever Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ● ● sub acute-viral infection ○ Cold or respiratory infection ○ S&S ■ Fever ■ Chills ■ Difficulty swallowing ■ Muscle pain ● Chronic- hashimoto's disease ○ Triggered by viral or bacterial infection ● Thyroid cancer: single painless lump, it metastasizes Disorders of the parathyroid gland ○ Maintain calcium and phosphate ○ Increased PTH acts directly on kidney to increase calcium reabsorption and phosphate excretion ○ Increased PTH→ causes kidney stones ○ Hyperparathyroidism ■ Causes ● Adenoma ● Cancer ● Neck trauma ● Chronic renal failure ■ Key features ● Bone fractures ● Weight loss ● Kidney stones ● Anorexia ● N/V ■ Diagnostic ● Increase serum PTH ● Increase Ca ● Decreased phosphate ■ Management ● Hydration ● Lasix ● Calcitonin (adrenal gland) ○ Increases kidney excretion of calcium ● Surgical removal ○ Hypoparathyroidism ■ Causes ● Surgical removal of parathyroid ● Radiation ● Idiopathic ■ Key features ● Hypocalcemia Downloaded by Taylor Chandler (tmrussell97@gmail.com) lOMoARcPSD|17509268 ■ ■ ● Muscle cramping ● Tingling Diagnostic ● Decreased calcium, increased phosphorus, and PTH Management ● Correct calcium and phosphorus ● High calcium diet ● Low phosphorus diet ● vitamin D Downloaded by Taylor Chandler (tmrussell97@gmail.com)
