VILLANOVA UNIVERSITY
COLLEGE OF NURSING
NUR 3112
NURSING CARE OF ADULTS RELATED TO ENDOCRINE FUNCTION
Hormones Of Anterior And Posterior Pituitary
ANTERIOR HYPERPITUITARISM
Cause: Pituitary adenoma
Symptoms related to: 1. increase in hormone release 2. space occupying lesion
Increase in Hormone Release Anterior Pituitary
Acromegaly GH (Growth Hormone/Somatotropin)
Giantism in children
ACTH (Adrenocorticotropic Hormone) Symptoms of Cushing’s
Syndrome
TSH (Thyroid Stimulating Hormone) Symptoms of Hyperthyroidism
Dx: Serum tests reveal elevated hormone levels
Urine tests reveal elevated hormone
levels
CAT Scans or MRI confirm presence and size of adenoma Acromegaly also
Dx’ed with Radioimmunassay or enzyme linked immunoabsorbent assay for GH level
Treatment
Radiation
Medications: Bromocriptine (Parlodel)
Octreotride acetate (Sandostatin)
Transphenoidal Hypophysectomy “Moustache Dressing” / Packing
Teach not to blow nose, sneeze, bend over Neuro Checks
Visual Acuity,Visual Fields
Need for Frequent Monitoring of Urine Output (Diabetes
Insipidus)
Fluid Replacement if Diabetes Insipidus
Use of vasopressin (Pitressin), desmopressin acetate (DDAVP)
Hormone Replacement
POSTERIOR HYPOPITUITARISM - DIABETES INSIPIDUS
Causes: Pituitary Tumor or Post-op anterior Hypophysectomy or Trauma
Symptoms (Related to Decreased ADH)
Excessive Urine Output Low urine
specific gravity Dehydration/ Vascular Collapse
Treatment
Correct the underlying condition Fluid Replacement
ADH vasopressin (Pitressin) desmopressin acetate (DDAVP)
Replacement of
ANTERIOR HYPOPITUITARISM
Causes: Developmental Disorders, Vascular Lesions, Trauma, Tumor
Symptoms related to decrease in hormone release
GH (Growth Hormone/Somatotropin) Adult: No Change in Stature Children:
Deficits in Growth
ACTH (Adrenocorticotropic Hormone) Symptoms of Addison’s Disease
TSH (Thyroid Stimulating Hormone) Symptoms of Hypothyroidism
Gonadotropins
Sexual and Reproductive Disorders
Dx: Serum tests reveal decreased hormone levels Urine tests reveal decreased hormone
levels CAT Scans or MRI confirm presence of lesions/tumors
Treatment Hormone Replacement
HGH
Corticosteroids
Hormones Correct the Underlying Condition if Possible
Thyroid
Sex
POSTERIOR HYPERPITUITARISM - SYNDROME OF
INAPPROPRIATE (INCREASED) ADH SECRETION
Causes: Trauma, CNS Surgery, Oat Cell CA of Lung, Other Diseases
Symptoms Related to Increased ADH:
***Fluid Retention*** EDEMA Cerebral Edema (Water Intoxication) Altered
LOC Weakness/Lethargy Coma
Serum hypo-osmolarity (dilutional hyponatremia)
Oliguria / Concentrated Urine (High urine specific gravity) Hypertension
2
Treatment (SIADH usually self-limiting)
***Water/Fluid RESTRICTION*** Diuretics & Hypertonic Saline if
condition severe Neuro Checks Demeclocycline (DMC)
THYROID GLAND
SECRETES: T3 T4 Thyrocalcitonin
HYPERTHYROIDISM
Thyrotoxicosis/Grave’s Disease/Toxic Nodular Goiter
CAUSES: Autoimmune Familial Tendency Females 5-6 X’s > Males 30 - 50 year
olds (Grave’s most in 40’s) Emotional shock, stress, infection
SYMPTOMS: Grave’s Triad: 1.Goiter (& Thrill / Bruit) 2. Cardiac Symptoms 3.
Exopthalamos
Increased BMR - Increased Temp. Increased Cardiac ( Pulse, Cardiac Output, Pulse
Pressure, Small Increase in Systolic BP) Atrial Fibrillation CHF
Respiratory
Stimulation Increased Sympathetic Adrenergic Activity
Increased GI Peristalsis –
Diarrhea Hyperactive Skin moist, increased oil Amenorrhea Osteoporosis &
Fractures
Thyroid Storm - Hyperthyroidism in the Nth Degree
Severe Tachycardia Heart Failure Shock Fever (105 F) Agitation / Delirium / Coma
Nausea & Vomiting Diarrhea
DIAGNOSIS: Decreased TSH, Increased T4 (F T4)
Primary Hyperthyroidism = Increased T3 & T4 but decreased trh & decreased TSH
Thyroid Scan (6 or 24 hr radioactive iodine uptake)
ECG
Treatment:
Antithyroid Medications: Propylthiouracil (PTU) Methylthiouracil
(methimazole)
Inderal (propanalol) to Rx tachycardia
Radioactive Iodine (131I)
3
Tapazole
Nursing Care: Vital Signs Assessment (Cardiac Assessment / meds. PRN)
Clothing/ Light Blankets/ AC Eye Care Calm Approach
Light
THYROIDECTOMY Subtotal (5/6ths removed) Get patient euthyroid pre-op
POST-OP THYROIDECTOMY Position Patient –Semifowlers Neck in alignment
Prevent Hyperextension Vital Signs Assess for Hemorrhage Check for choking
sensation / Sensation of dressing tightness Check for injury to parathyroids (Decreased
Serum Calcium Positive Chvostek’s and Trousseau’s Signs Numbness and Tingling
Laryngospasm) Have Calcium Gluconate and Tracheostomy Kit on hand Teach about
Medications (Thyroid Replacement)Teach about the need to monitor for signs &
symptoms of Hypo and Hyperthyroidism
HYPOTHYROIDISM Myxedema in adults; Cretinism = Congenital
CAUSES: Most Common = Surgical or Radiative Destruction of the Gland
Idiopathic/Congenital Deficiency/Iodine Deficiency/ Drug Females > 50 years old
SYMPTOMS: Decreased BMR (Cold Intolerance Weight Gain Hair Loss) Decreased
Cardiac(CHF) Increased Cholesterol (Atherosclerosis & CAD) Slowed Intellectual
Functioning/Sleepiness/ Coma Decreased Sympathetic Adrenergic Activity Decreased
GI Peristalsis – Constipation Anemia & Bruising Menorrhagia & Infertility
DIAGNOSIS: *TSH, T4 (Increased TSH, Decreased T4 ) Primary Hypothyroidism =
Decreased T3 & T4 Thyroid Scan (6 or 24 hr radioactive iodine uptake) CT, MRI,
Ultrasound
Goal: Euthyroid
TREATMENT: Lifelong Replacement of deficient Thyroid Hormone Synthroid =
Drug of Choice
NursingCare:
Vital Signs Assessment Cardiac Assessment /Meds. For CHF prn
Need for Decreased Calories Warm Clothing / Blankets / Use of Heat Care related to
constipation Need for low intellectual level (Patient Teaching Considerations)
Nursing Care Related to Medications: Administer all Meds. With Caution AVOID
SEDATIVES Teach symptoms of Hypo & Hyperthyroidism
Cardiac - Thyroid
replacement increases O2 demands which can lead to angina (related to CAD)
4
PARATHYROID GLANDS
Secrete PTH (Parathyroid Hormone)
Maintain Serum Calcium & Phosphorus Levels
HYPOPARATHYROIDISM
Causes: After thyroid or parathyroid
surgery
Symptoms: Neuromuscular Irritability Tetany
Laryngeal Stridor Cardiac Disrhythmias
Idiopathic
Chvostek’s Sign, Trousseau’s Sign
Treatment: Calcium Gluconate Vitamin D and Supplementary Dietary & Elemental
Calcium
Teach Signs of Calcium Deficiency
HYPERPARATHYROIDISM
Causes:
Benign Adenoma
Symptoms:
Pathologic Fractures Renal Calculi
GI Symptoms Mental Changes
Treatment: Surgical Removal of 3/4 of Parathyroids Correction of Electrolyte
Imbalance IV & p.o. Fluids Diuretic Mithramycin Dietary Restriction of Calcium
Prevention of Injury Assess for and teach the patient signs & symptoms of calcium
excess and deficiency
The Adrenal Glands
Adrenal Medulla Produces: Epinephrine Norepinephrine
Effects:
Stress Response Cardiac Status, Vascular Resistance
Respirations Urine Output, Glucose Metabolism
ADRENAL MEDULLA HYPOFUNCTION
No symptoms - Handled by Sympathetic Nervous System
ADRENAL MEDULLA HYPERFUNCTION - Pheochromocytoma
5
ADRENAL CORTEX
Adrenal Cortex Produces Mineralocorticoids
Effects: Intravascular Volume Na & K reabsorption/excretion Increased
Mineralocorticoids: Increased Na Retained So increased H2O Retained Increased Blood
Volume Increased Blood Pressure Decreased K Retained (Increased K Excreted)
Decreased Mineralocorticoids: Increased Na Excreted (Decreased Na Retained) So
increased H2O Excreted Decreased Blood Volume Decreased Blood Pressure
Decreased K Excreted (Increased K Retained)
Adrenal Cortex Produces Androgen
Effects: Mostly Same as Male Sex Hormones
Adrenal Cortex Produces Glucocorticoids
Effects:
Glucose Metabolism Fat Metabolism HCl Secretion
Inflammatory Response Bone Demineralization Cartilage Development
Mental Status
ADRENAL CORTEX HYPERFUNCTION
6
CAUSES: CHRONIC CORTICOSTEROID THERAPY Causes Cushing’s
Syndrome Cushing’s Disease can also be caused by increased ACTH, adenoma or
carcinoma of cortex
CUSHINGS SYNDROME/DISEASE SYMPTOMS
Related to Increased Mineralocorticoids: Hypernatremia, Hypokalemia Fluid
Retention (Moon Face, Buffalo Hump) Truncal Obesity Hypertension
Related to Glucocorticoids: Hyperglycemia Fatigue & Muscle Weakness
Osteoporosis/Pathologic
Fractures Child: Impaired Growth
Increased Risk of Infection Altered Moods Capillary Fragility
GI Ulcers
Related to Androgens: Hirsuitism Mild Acne Menstrual Irregularities
DIAGNOSIS Increased Plasma Cortisol Increased Serum Glucose, Na Decreased K
24 hour urines for: Increased 17 ketosteroids Increased 17 hydroxyketosteroids Serum
ACTH (Increased if Hyperpituitarism) ACTH Suppression Test
NURSING:
ForvHyperglycemia Accuchecks Increased Insulin May be Needed
onset of Diabetes Mellitus - Insulin (or Oral Meds) may be needed
Can cause
For Hypernatremia, Hypokalemia & Fluid Retention:Monitor fluids &electrolytes Replace
PRN Daily Weights
Hypertension:Frequent Monitoring
Medicate PRN Notify MD PRN
For Increased Risk of Infection Need for antibiotics for Rx &/or
prophylactic purposes Protect from infected persons
For Altered Moods Support/education/consults
For Capillary Fragility Osteoporosis/Pathologic Fractures Fatigue&Muscle Weakness
Safety issues. Patient protection/education
Child: Impaired Growth
To Prevent GI Ulcers
Need for antiulcer meds. (Pepcid, Zantac, Mylanta, etc.)
7
ADRENAL CORTEX HYPOFUNCTION
CAUSES: Abrupt D/C of high dose corticosteroids
Life Threatening
Bilateral Adrenalectomy Addison’s Disease: Congenital, Secondary to hemorrhage or
infection, idiopathic, autoimmune
SYMPTOMS Related to Increased ACTH & Increased MSH: Hyperpigmentation
(Bronze-like) Related to Decreased Mineralocorticoids Hyponatremia, Hyperkalemia
Increased BUN Fluid Loss Hypotension - Shock / Circulatory Collapse
Related to Decreased Glucocorticoids:
Altered Moods Lymphocytosis
Hypoglycemia Intolerance to Stress
Related to Decreased Androgens: Decreased Hair Decreased Sex Drive in Females
Decreased Appetite
DIAGNOSIS 8 hour IV ACTH Test / Cosyntropin Stimulation Test Decreased
Plasma Cortisol Decreased Serum Glucose, Na
Increased K
24 hour urines for:
Decreased 17 ketosteroids Decreased 17 hydroxyketosteroids
NURSING Need for life-long replacement hormones: Florinef May get testosterone
for protein anabolic effect. Corticosteroids: Hydrocortisone, Prednisone, Decadron
(dexamethasone) Assess F & E (I & O, Daily Weights, labs.) Electrolyte
Replacements Monitor Glucose Levels, BP Emotional Support Teach that PRIOR
TO ANY STRESSORS - NEED INCREASED MEDICATION
BE:1/03
8