alteration in endocrine system
TRANSCRIPT
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Medical-Surgical NursingAilyn Pineda
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Review of the Anatomy and Physiology of the endocrine glands
Review of the Common Laboratory procedures
Review of the Common endocrine disorders
Review of Diabetes Mellitus
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The endocrine system is composed of ductless glands that release their hormones directly into the bloodstream
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The Hypothalamus controls most of the endocrinal activity of the pituitary gland
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The pituitary gland controls most of the activities of the other endocrine glands
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Hypothalamus
Pituitary Gland
Endocrine gland
Increased Hormones
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The HypothalamusThis part of the DIENCEPHALON is located below the thalamus and is connected to the pituitary gland by a stalk
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Secretes RELEASING HORMONES for the pituitary gland
Releasing hormones= hypothalamus
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Secretes OXYTOCIN that is stored in the Posterior pituitary gland
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Secretes Anti-Diuretic Hormone or VASOPRESSIN that is stored also in the posterior pituitary gland
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The Pituitary GlandIs a gland located below the hypothalamus at the base of the brain
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The Pituitary GlandThe optic chiasm passes over this structure
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The Pituitary GlandIs divided into two parts- the anterior or adenohypophysis and the posterior or the neurohypophysis
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Secretes the following hormones:
1. Growth hormone2. Prolactin
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Secretes the following hormones:3. Gonadotrophins- LH and FSH
4. Stimulating hormones and trophic hormones◦ACTH◦TSH◦MSH
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Stores and releases1. OXYTOCIN2. ADH/Vasopressin
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The THYROID glandLocated in the anterior neck lateral to the trachea
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The THYROID glandContains two lobes connected by the isthmus
Microscopically composed of thyroid follicles where the hormones are produced and stored
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Produces the thyroid hormones by the thyroid follicles:1. Tri-iodothyronine or T32. Tetra-iodothyronine or thyroxine or T4
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The Parafollicular cells secrete CALCITONIN
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The PARAthyroid glandsLocated at the back of the thyroid glands
Four in number
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Secretes PARATHYROID hormone (PTH) that controls calcium and phosphorus levels
PTH is stimulated by a DECREASED Calcium level
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Parathyroid Hormone is released in HYPOCALCEMIA
Calcitonin is stimulated by HYPERCALCEMIA
Parathyroid hormone is NOT secreted in HYPERCALCEMIA
Calcitonin is inhibited by HYPOCALCEMIA
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The Adrenal GlandsLocated above the kidneysComposed of two parts- the outer Adrenal Cortex and the inner Adrenal medulla
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Secretes three types of STEROID hormones
1. Glucocorticoids- like Cortisol, cortisone and corticosterone
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Secretes three types of STEROID hormones
2. Mineralocorticoids- like Aldosterone
3. Sex hormones- like estrogen and testosterone
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Essentially a part of the SYMPATHETIC autonomic system
Secretes Adrenergic Hormones:
1. Epinephrine2. Nor-epinephrine
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The PancreasThis retroperitoneal organ has both endocrine and exocrine functions
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The PancreasThe endocrine function resides in the ISLETS of Langerhans
The islets have three types of cells- alpha, beta and delta cells
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The ALPHA cells secrete GLUCAGON
The BETA cells secrete INSULIN
The DELTA cells secrete SOMATOSTATIN
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The GONADS- OvariesThese two almond-shaped glands are found in the pelvic cavity attached to the uterus by the ovarian ligament
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The GONADS- TestesThese two oval-shaped glands are found in the scrotum
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The Ovaries contains Granulosa and Theca cells which secrete ESTROGEN and Progesterone
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The testes contains Leydig cells that secrete Testosterone
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COMMON LABORATORY PROCEDURES
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Hormone Levels AssayThese are blood examinations for the levels of individual hormones
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Hormone Levels AssayMeasurements can also be done after stimulation and suppression of the secretions- Stimulation and Suppression tests
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Hormone Levels of T3/T4
Usually done to diagnose hypo/hyperthyroidism
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Hormone Levels of T3/T4
If T3 is elevated, T4 is elevated and TSH is depressed Primary HYPERthyroidism
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Hormone Levels of T3/T4
If T3 is depressed,T4 is depressed and TSH is elevated Primary HYPOthyoidism
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Radio-Active iodine uptake (RAI)
This is a thyroid function test to measure the absorption of the injected iodine isotope by the thyroid tissue
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Radio-Active iodine uptake (RAI)
Increased uptake may indicate HYPERfunctioning gland
Decreased uptake my indicate HYPOfunctioning gland
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Thyroid ScanPerformed to identify nodules or growth in the thyroid gland
RAI is used
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Thyroid ScanPretest- Check for pregnancy, Thyroid medication may be withheld temporarily, advise NPO
Post-test- Ensure proper disposal of body wastes
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The BMR has a long history in the evaluation of thyroid function. It measures the oxygen consumption under basal conditions of overnight fast and rest from mental and physical exertion. it can be estimated from the oxygen consumed over a timed interval by analysis of samples of expired air
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BMRThe test indirectly measures metabolic energy expenditure or heat production.Results are expressed as the percentage of deviation from normal after appropriate corrections have been made for age, sex, and body surface area.Low values are suggestive of hypothyroidism, and high values reflect thyrotoxicosis.
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FASTING BLOOD GLUCOSEAids in the diagnosis of Diabetes
Pre-test: NPO for 8 hoursNormal FBS- 80-109 mg/dLDM- 126 mg/dL and above
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GLUCOSE tolerance testAids in the diagnosis of DMPre-test: Provide high-carbohydrate foods x 3 days, instruct to avoid caffeine, alcohol and smoking, NPO 10 hours prior to test
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GLUCOSE tolerance testPost-test: avoid strenuous activity for 8 hours
Normal OGTT- 1 and 2 hours post-prandial- glucose is less than 200 mg/dL
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Glycosylated Hemoglobin A 1-C
Blood glucose bound to RBC hemoglobin
Reflects how well blood glucose is controlled for the past 3 months
FASTING is NOT required!
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Glycosylated Hemoglobin A 1-CNormal level- expressed as percentage of total hemoglobin
N- 4-7%Good control- 7.5%or lessFair control- 7.5 % to 8.9%Poor control- 9% and above
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Disorders are generally grouped into:
1. HYPER- when the gland secretes excessive hormones
2. HYPO- when the gland does not secrete enough hormones
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Hyper and Hypo can be classified as PRIMARY when the Gland itself is the problem or SECONDARY when the pituitary or the hypothalamus is causing the problem
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PITUITARY GLAND
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HYPOPITUITARISMHyposecretion of the anterior pituitary gland
CAUSES: Congenital, Post-partal necrosis, infection and tumor
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HYPOPITUITARISMPATHOPHYSIOLOGY:Depends on the major hormone/s depleted
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Hypopituitarism: ASSESSMENT Findings
1. Retarded physical growth due to decreased GH dwarfism
2. Low intellectual development3. poor development of secondary sexual characteristics
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NURSING INTERVENTIONS1. Provide emotional support to the family
2. Encourage client and family to express feelings
3. Administer prescribed hormonal replacement therapy
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HYPERPITUITARISMThe hyper-secretion of the gland
ACROMEGALYCAUSES: tumor, congenital disorder
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HYPERPITUITARISMPATHOPHYSIOLOGYDepends on the hormone/s that is/are increased
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ASSESSMENT FINDINGS for Hyper-pituitarism
1. Increased growth Gigantism or Acromegaly
2. large and thick hands and feet
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ASSESSMENT FINDINGS for Hyper-pituitarism
3. Visual disturbances4. Hypertension, hyperglycemia
5. Organomegaly
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NURSING INTERVENTIONS1. Provide emotional support to clients and family
2. Provide frequent skin care3. Prepare patient for surgery- removal of pituitary gland
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NURSING INTERVENTIONSPost-operative care1. Monitor VS, LOC and neurologic status
2. Place patient on Semi-Fowler’s
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NURSING INTERVENTIONSPost-operative care3. Monitor for Increased ICP, bleeding, CSF leakage
4. Instruct patient to AVOID sneezing, coughing and nose-blowing
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NURSING INTERVENTIONSPost-operative care5. Monitor development of DI- measure I and O
6. Administer prescribed medications- antibiotics, analgesics and steroids
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DIABETES INSIPIDUSA hypo-secretion of ADHCAUSES: Conditions that increase ICP, Surgical removal of post pit. tumor
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DIABETES INSIPIDUSPATHOPHYSIOLOGY Decreased ADH failure of tubular re-absorption of water increased urine volume
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ASSESSMENT findings
1. Polyuria of more than 4 liters of urine/day
2. Polydipsia
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ASSESSMENT findings3. Signs of Dehydration4. Muscle pain and weakness
5. Postural hypotension and tachycardia
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DIAGNOSTIC TEST1. Urinary Specific gravity very low, 1.006 or less
2. Serum Sodium levels high
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NURSING INTERVENTIONS1.Monitor VS, neurologic status and cardiovascular status
2. Monitor Intake and Output
3. Monitor urine specific gravity
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NURSING INTERVENTIONS4. Provide adequate fluids5. Administer Chlorpropamide or Clofibrate as prescribed to increase the action of ADH if decreased
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NURSING INTERVENTIONS6. Administer VASOPRESIN. Desmopressin or Lypressin are given intranasal. Pitressin is given IM
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SIADHHyper-secretion of ADH abnormally
CAUSES: tumor, paraneoplastic syndromes
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SIADHPATHOPHYSIOLOGYIncreased ADH water re-absorption water intoxication, hypervolemia
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DIAGNOSTIC TEST for SIADH
1. Urine specific gravity is increased (concentrated)
2. Hyponatremia3. CBC shows hemodilution
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ASSESSMENT findings1. Signs of Hypervolemia
2. Mental status changes
3. Abnormal weight gain
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ASSESSMENT findings4. Hypertension5. Anorexia, Nausea and Vomiting
6. HYPOnatremia
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NURSING INTERVENTIONS1. Monitor VS and neurologic status
2. Provide safe environment3. Restrict fluid intake (less than 500cc/day)
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NURSING INTERVENTIONS4. Monitor I and O and daily weight
5. Administer Diuretics and IVF carefully
6. Administer prescribed Demeclocycline to inhibit action of ADH in the kidney
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ADRENAL GLAND
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Hypo-secretion: ADDISON’S Disease
Decreased secretion of adrenal cortex hormones, especially glucocorticoids and mineralocorticoids
CAUSE: tumor, idopathic
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PATHOPHYSIOLOGYDecreased Glucocorticoids decreased resistance to stress
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PATHOPHYSIOLOGYDecreased mineralocorticoids decreased retention of sodium and water
Hypovolemia
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Normal functions of Cortisol
HYPO functions
1. Gluconeogenesis HYPOGLYCEMIA
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Functions of Mineralocorticoids
HYPO functions
1. Sodium Retention HYPOnatremia
2.Secondary water retention
HYPOvolema- HYPOtensionWeight LOSS
3. Potassium excretion
HYPERKALEMIA
Function of androgen:Libido
Decreased libido
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ASSESSMENT Findings for Addison’s disease
1. Weight loss2. GI disturbances3. Muscle weakness, lethargy and fatigue
4. Hyponatremia
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ASSESSMENT Findings for Addison’s disease
5. Hyperkalemia6. Hypoglycemia7. dehydration and hypovolemia
8. Increased skin pigmentation
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NURSING INTERVENTIONS1. Monitor VS especially BP 2. Monitor weight and I and O3. Monitor blood glucose level and K
4. Administer hormonal agents as prescribed
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NURSING INTERVENTIONS5. Observe for ADDISONIAN crisis
6. Educate the client regarding lifelong treatment, avoidance of strenuous activities, stress and seeking prompt consult during illness
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NURSING INTERVENTIONS7. Provide a high-protein, high carbohydrate and increased sodium intake
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ADDISONIAN crisisA life-threatening disorders caused by acute severe adrenal insufficiency
CAUSES: Severe stress, infection, trauma or surgery
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ADDISONIAN crisisPATHOPHYSIOLOGYOverwhelming stimuli mobilize body defense decreased stress hormones inadequate coping
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ASSESSMENT Findings for Addisonian Crisis= “severe lahat”
1. Severe headache2. Severe pain3. Severe weakness4. Severe hypotension5. Signs of Shock
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NURSING INTERVENTIONS1. Administer IV glucocorticoids, usually hydrocortisone
2. Monitor VS frequently3. Monitor I and O, neurological status, electrolyte imbalances and blood glucose
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NURSING INTERVENTIONS4. Administer IVF5. Maintain bed rest6. Administer prescribed antibiotics
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Hyper-secretion: CUSHING’S DISEASE
A condition resulting from the hyper-secretion of glucocorticoids from the adrenal cortex
CAUSES: Pituitary tumor, adrenal tumor, abuse of steroids
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Hyper-secretion: CUSHING’S DISEASE
PATHOPHYSIOLOGYIncreased Glucocorticoids exaggerated effects of the hormone
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Normal functions of Cortisol
Exaggerated functions
1. Gluconeogenesis HYPERGLYCEMIA
2. Protein breakdown
OSTEOPOROSISS, delayed wound healingPurplish striae , BleedingMuscle wasting
3. Fat breakdown THIN extremity, Truncal deposition
4. Decreased WBC IMMUNOSUPPRESSION
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Functions of Mineralocorticoids
Exaggerated functions
1. Sodium Retention Hypernatremia
2.Secondary water retention
Hypervolema- Hypertension
3. Potassium excretion
HYPOKALEMIA
Function of androgen: Hair growth
HIRSUTISM
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ASSESSMENT FINDINGS for Cushing
1. Generalized muscle weakness and wasting
2. Truncal obesity
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ASSESSMENT FINDINGS for Cushing
3. Moon-face4. Buffalo hump5. Easy bruisability
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ASSESSMENT FINDINGS for Cushing
6. Reddish-purplish striae on the abdomen and thighs
7. Hirsutism and acne8. Hypertension
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ASSESSMENT FINDINGS for Cushing
9. Hyperglycemia10. Osteoporosis11. Amenorrhea
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DIAGNOSTIC TESTS1. Serum cortisol level
2. Serum glucose and electrolytes
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NURSING INTERVENTIONS1. Monitor I and O , weight and VS
2. Monitor laboratory values- glucose, Na, K and Ca
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NURSING INTERVENTIONS3. Provide meticulous skin care
4. Administer prescribed medications like aminogluthetimide to inhibit adrenal hyperfunctioning
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NURSING INTERVENTIONS5. Prepare client for surgical management- pituitary surgery and adrenalectomy
6. Protect patient from infection
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NURSING INTERVENTIONS7. Improve body image8. Provide a LOW carbohydrate, LOW sodium and HIGH protein diet
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Hyper-secretion: CONN’S DISEASE
Hyper-secretion of Aldosterone from the adrenal cortex
CAUSES: pituitary tumor, adrenal tumor
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Hypersecretion: CONN’S DISEASE
PATHOPHYSIOLOGYIncreased Aldosterone exaggerated effects
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ASSESSMENT findings in CONN’S disease
1. Symptoms of HYPOkalemia
2. Hypertension3. Hypernatremia
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ASSESSMENT findings in CONN’S disease
4. Headache, N/V5. Visual changes6. Muscles weakness, fatigue and nocturia
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DIAGNOSTIC TEST1. Urine gravity- low (due to polyuria)
2. Serum Sodium- high3. Serum Potassium- very low4. Increased urinary Aldosterone
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NURSING INTERVENTIONS1. Monitor VS, I and O and urine sp gravity
2. Monitor serum K and Na3. Provide Potassium rich foods and supplements
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NURSING INTERVENTIONS4. Administer prescribed diuretic- Spironolactone
5. Maintain sodium-restricted diet
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NURSING INTERVENTIONS
6. Prepare patient for possible surgical interventions
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Hyper-secretion: Pheochromocytoma
Increased secretion of epinephrine and nor-epinephrine by the adrenal medulla
CAUSE: tumor
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Hypersecretion: Pheochromocytoma
PATHOPHYSIOLOGYIncreased Adrenergic hormones exaggerated sympathetic effects
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ASSESSMENT Findings in Pheochromocytoma
1. Hypertension2. Severe headache3. Palpitations4. Tachycardia
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ASSESSMENT Findings in Pheochromocytoma
5. Profuse sweating and Flushing
6. Weight loss, tremors7. Hyperglycemia and glycosuria
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NURSING INTERVENTIONS1. Monitor VS especially BP
2. Monitor for HYPERTENSIVE crisis
3. Avoid stimulation that can cause increased BP
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NURSING INTERVENTIONS4. Administer Anti-hypertensive agents like alpha-adrenergic blockers- Phenoxybenzamine
5. Prepare Phentolamine for hypertensive crisis
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6. Monitor blood glucose and urine glucose
7. Promote adequate rest and sleep periods
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8. provide HIGH calorie foods and Vitamins/mineral supplements
9. Prepare patient for possible surgery
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THYROID GLAND
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HYPOsecretion: HYPOTHYROIDISMA hypothyroid state characterized by decreased secretions of T3 and T4
CAUSES: Hypofunctioning tumor, IDG, Pituitary tumor, Ablation therapy, Surgical removal of thyroid
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HYPOsecretion: HYPOTHYROIDISM
PATHOPHYSIOLOGYDecreased T3 and T4 decreased basal metabolism
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ASSESSMENT findings for Hypothyroidism
1. Lethargy and fatigue2. Weakness and paresthesia
3. COLD intolerance
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ASSESSMENT findings for Hypothyroidism
4. Weight gain5. Bradycardia, constipation
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ASSESSMENT findings for Hypothyroidism
6. Dry hair and skin, loss of body hair
7. Generalized puffiness and edema around the eyes and face
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ASSESSMENT findings for Hypothyroidism
8. Forgetfulness and memory loss
9. Slowness of movement10. Menstrual irregularities and cardiac irregularities
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NURSING INTERVENTIONS1. Monitor VS especially HR2. Administer hormone replacement: usually Levothyroxine( Synthroid)-should be taken on an empty stomach
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NURSING INTERVENTIONS3. Instruct patient to eat LOW calorie, LOW cholesterol and LOW fat diet
4. Manage constipation appropriately
5. Provide a WARM environment
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NURSING INTERVENTIONS6. Avoid sedatives and narcotics because of increased sensitivity to these medications
7. Instruct patient to report chest pain promptly
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HYPERfunctioning: HYPERTHYROIDISM
Called GRAVE’S DISEASEA hyperthyroid state characterized by increased circulating T3 and T4
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HYPERfunctioning: HYPERTHYROIDISM
CAUSES: Auto-immune disorder, toxic goiter and tumor
PATHOPHYSIOLOGYIncreased hormone activity increased Basal Metabolism
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ASSESSMENT Findings for Hyperthyroidism
1. Weight loss2. HEAT intolerance3. Hypertension
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ASSESSMENT Findings for Hyperthyroidism
4. Tachycardia and palpitations
5. Exopthalmos6. Diarrhea
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ASSESSMENT Findings for Hyperthyroidism
7. Warm skin8. Diaphoresis9. Smooth and soft skin
◦Oligomenorrhea to amenorrhea
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ASSESSMENT Findings for Hyperthyroidism
10. Fine tremors and nervousness
11. Irritability, mood swings, personality changes and agitation
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NURSING INTERVENTIONS1. Provide adequate rest periods in a quiet room
2. Administer anti-thyroid medications that block hormone synthesis- Methimazole and PTU
3. Provide a HIGH-calorie diet, HIGH protein
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NURSING INTERVENTIONS 4. Manage diarrhea 5. Provide a cool and quiet environment
6. Avoid giving stimulants 7. Provide eye care
◦Hypoallergenic tape for eyelid closure
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NURSING INTERVENTIONS7. Administer PROPRANOLOL for tachycardia
8. Administer IODIONE preparation- Lugol’s solution and SSKI to inhibit the release of T3 and T4
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NURSING INTERVENTIONS9. Prepare clients for Radioactive iodine therapy
10. Prepare patient for thyroidectomy
11. Manage thyroid storm appropriately
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Thyroid stormAn acute LIFE-threatening condition characterized by excessive thyroid hormone
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Thyroid stormCAUSE: Manipulation of the thyroid during surgery causing the release of excessive hormones in the blood
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ASSESSMENT Findings for Thyroid Storm
1. HIGH fever2. Tachycardia and Tachypnea
3. Systolic HYPERtension
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ASSESSMENT Findings for Thyroid Storm
4. Delirium and coma5. Severe vomiting and diarrhea
6. Restlessness, Agitation, confusion and Seizures
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NURSING INTERVENTIONS1. Maintain PATENT airway and adequate ventilation
2. Administer anti-thyroid medications such as Lugol’s solution, Propranolol, and Glucocorticoids
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NURSING INTERVENTIONS3. Monitor VS4. Monitor Cardiac rhythms
5. Administer PARACETAMOL ( not Aspirin) for FEVER
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NURSING INTERVENTIONS
6. Manage Seizures as required.
7. Provide a quiet environment
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THYROIDECTOMYRemoval of the thyroid gland
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PRE-OPERATIVE CARE - Thyroidectomy
1. Obtain VS and weight2. Assess for Electrolyte levels, glucose levels and T3/T4 levels
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PRE-OPERATIVE CARE - Thyroidectomy
3. Provide pre-operative teaching like coughing and deep breathing, early ambulation and support of the neck when moving
4. Administer prescribed medications
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POST-OPERATIVE CARE - Thyroidectomy
1. Position patient: Semi-Fowler’s, neck on neutral position
2. Monitor for respiratory distress- apparatus at bedside- tracheostomy set, O2 tank and suction machine!
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POST-OPERATIVE CARE - Thyroidectomy
3. Check for edema and bleeding by noting the dressing anteriorly and at the back of the neck
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POST-OPERATIVE CARE - Thyroidectomy
4. LIMIT client talking5. Assess for HOARSENESS
◦Expected to be present only initially, limit excess vocalization
◦If persistent, may indicate damage to laryngeal nerve!
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POST-OPERATIVE CARE - Thyroidectomy
6. Monitor for Laryngeal Nerve damage – Respiratory distress, Dysphonia, voice changes, Dysphagia and restlessness
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POST-OPERATIVE CARE - Thyroidectomy
7. Monitor for signs of HYPOCALCEMIA and tetany due to trauma of the parathyroid
8. Prepare Calcium gluconate9. Monitor for thyroid storm
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Hypo-functioning: HYPOPARATHYROIDISM
Hypo-secretion of parathyroid hormone
CAUSES: tumor, removal of the gland during thyroid surgery
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Hypo-functioning: HYPOPARATHYROIDISM
PATHOPHYSIOLOGYDecreased PTH deranged calcium metabolism
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ASSESSMENT Findings for HypoParaThyroidism
1. Signs of HYPOCALCEMIA2. Numbness and tingling sensation on the face
3. Muscle cramps
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ASSESSMENT Findings for HypoParaThyroidism
4. (+) Trosseau’s and (+) Chvostek’s signs
5. Bronchospasms, laryngospasms, and dysphagia
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ASSESSMENT Findings for HypoParaThyroidism
6. Cardiac dysrhythmias7. Hypotension8. Anxiety, irritability ands depression
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NURSING INTERVENTIONS1. Monitor VS and signs of HYPOcalcemia
2. Initiate seizure precautions and management
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NURSING INTERVENTIONS3. Place a tracheostomy set. O2 tank and suction at the bedside
4. Prepare CALCIUM gluconate5. Provide a HIGH-calcium and LOW phosphate diet
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NURSING INTERVENTIONS6. Advise client to eat Vitamin D rich foods
7. Administer Phosphate binding drugs
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Hyper-functioning:HYPERPARATHYROIDISMHyper-secretion of the gland
CAUSE: Tumor
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Hyper-functioning:HYPERPARATHYROIDISMPATHOPHYSIOLOGYIncrease PTH increased CALCIUM levels in the body
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ASSESSMENT Findings for Hyperparathyroidism
1. Fatigue and muscle weakness/pain
2. Skeletal pain and tenderness
3. Fractures
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ASSESSMENT Findings for Hyperparathyroidism
4. Anorexia/N/V epigastric pain
5. Constipation
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ASSESSMENT Findings for Hyperparathyroidism
6. Hypertension7. Cardiac Dysrhythmias 8. Renal Stones
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NURSING INTERVENTIONS1. Monitor VS, Cardiac rhythm, I and O
2. Monitor for signs of renal stones, skeletal fractures. Strain all urine.
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NURSING INTERVENTIONS3. Provide adequate fluids- force fluids
4. Administer prescribed Furosemide to lower calcium levels
5. Administer NORMAL saline
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NURSING INTERVENTIONS6. Administer calcium chelators
7. Administer CALCITONIN8. Prepare the patient for surgery
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PHARMACOLOGY
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Anti-diuretic hormonesEnhance re-absorption of water in the kidneys
Used in DI1. Desmopressin and Lypressin intranasally
2. Pitressin IM
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Anti-diuretic hormonesSIDE-effectsFlushing and headacheWater intoxication
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Thyroid hormonesLevothyroxine (Synthroid) and Liothyroxine (Cytomel)
Replace hormonal deficit in the treatment of HYPOTHYROIDSM
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Thyroid hormonesSide-effects1. Nausea and Vomiting2. Signs of increased metabolism= tachycardia, hypertension
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Thyroid hormonesNursing responsibility1. Monitor weight, VS2. Instruct client to take daily medication the same time each morning WITHOUT FOOD
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Thyroid hormonesNursing responsibility3. Advise to report palpitation, tachycardia, and chest pain
4. Instruct to avoid foods that inhibit thyroid secretions like cabbage, spinach and radishes
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ANTI-THYROID medicationsInhibit the synthesis of thyroid hormones
1. Methimazole (Tapazole)2. PTU (prophylthiouracil)3. Iodine solution- SSKI and Lugol’s solution
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ANTI-THYROID medicationsSide-effectsN/VDiarrheaAGRANULOCYTOSIS
◦Most important to monitor
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ANTI-THYROID medicationsNursing responsibilities1. Monitor VS, T3 and T4, weight
2. Take medications WITH MEALS to avoid gastric upset
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ANTI-THYROID medicationsNursing responsibilities3. Instruct to report SORE THROAT or unexplained FEVER
4. Monitor for signs of hypothyroidism. Instruct not to stop abrupt medication
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ANTI-THYROID medicationsLugol’s SolutionUsed to decrease the vascularity of the thyroid
T3 and T4 production diminishesGiven per orem, can be diluted with juice
Use straw
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Replaces the steroids in the body
Cortisol, cortisone, betamethasone, and hydrocortisone
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Side-effects◦HYPERglycemia◦Increased susceptibility to infection
◦Hypokalemia◦Edema
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Side-effects◦If high doses- osteoporosis, growth retardation, peptic ulcer, hypertension, cataract, mood changes, hirsutism, and fragile skin
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Nursing responsibilities1. Monitor VS, electrolytes, glucose2. Monitor weight edema and I/O
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Nursing responsibilities3. Protect patient from infection4. Handle patient gently5. Instruct to take meds WITH MEALS to prevent gastric ulcer formation
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Nursing responsibilities6. Caution the patient NOT to abruptly stop the drug
7. Drug is tapered to allow the adrenal gland to secrete endogenous hormones
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Hyposecretion of thyroid hormones Common causes: Iodine deficiency, Hashimotos Manifestations: related to hypo-metabolic state:
constipation, weight gain, cold intolerance, poor appetite, mental slowness
Nursing Management:◦ Provide warm environment◦ LOW calorie diet, HIGH fiber◦ Avoid sedatives◦ Drugs: Hormone replacement
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Hyper-secretion of thyroid hormones
Common cause: Graves, Toxic goiter
Manifestation: increased metabolism: weight loss, diarrhea, heat intolerance, hypertension
Nursing Management:◦Adequate rest and sleep◦Cool environment◦HIGH calorie foods◦Eye care◦Drugs: anti-thyroid: PTU and
methimazole, propranolol◦Care of patients after thyroidectomy