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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Chapter 50: Caring for Clients with Disorders of the Endocrine System
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acromegaly (Hyperpituitarism) Acromegaly (Hyperpituitarism) • Pathophysiology and Etiology: Oversecretion of GH
due to hyperplasia
– Gigantism: Oversecretion of GH before puberty
– Dwarfism: Insufficient GH during childhood
– Acromegaly: Oversecretion of GH during adulthood
• Assessment Findings: Signs and Symptoms
– Coarse features; Huge lower jaw, thick lips, thickened tongue, bulging forehead
– Bulbous nose, large hands and feet
– Enlarged organs; Muscle weakness
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
Is the following statement true or false?
Acromegaly is caused by oversecretion of GH before puberty.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
False.
Acromegaly is caused by oversecretion of GH during adulthood. Gigantism is caused by oversecretion of GH before puberty.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acromegaly (Hyperpituitarism) Acromegaly (Hyperpituitarism) • Assessment Findings: Diagnostic Findings
– GH level; Glucose tolerance test
• Medical and Surgical Management
– Surgery; Hormone therapy; Drug therapy
• Nursing Management
– Psychological support; Pacing activities
– Pain relief; Self-care; Postoperative care
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Simmonds’ Disease (Panhypopituitarism) Simmonds’ Disease (Panhypopituitarism) • Pathophysiology and Etiology
– Anterior pituitary hormone activity stops
• Assessment Findings: Signs and Symptoms
– Hypothyroidism, hypoglycemia, adrenal insufficiency; Gonads and genitalia atrophy; Premature aging; Cachexia
• Medical Management
– Substitute hormones
• Nursing Management: Client Teaching
– Adherence: Medication schedule; Monitor: Blood hormone level
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
Is the following statement true or false?
A sign of panhypopituitarism is premature aging.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
True.
A sign of panhypopituitarism is premature aging. Also included in the signs and symptoms are hypothyroidism, hypoglycemia, adrenal insufficiency, gonads and genitalia atrophy, and cachexia.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diabetes Insipidus Diabetes Insipidus • Pathophysiology and Etiology
– Role of ADH; Neurogenic, nephrogenic DI
• Assessment Findings: Signs and Symptoms
• Polyuria; Weight loss; Thirst; Weakness; Dehydration
• Diagnostic Findings: Fluid deprivation test; Urine specific gravity
• Medical Management
– Drug therapy; IV fluids; Thiazide diuretic
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)• Pathophysiology and Etiology: Causes of SIADH,
Hyponatremia
• Assessment Findings
– Water retention; Headaches; Muscle cramps; Anorexia
– Changes in LOC
• Diagnostic Findings: Serum, urine levels; Sodium, osmolarity levels
• Medical Management: Osmotic diuretics; IV administration
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hyperthyroidism (Graves Disease)Hyperthyroidism (Graves Disease)• Pathophysiology and Etiology: Hypersecretion of
thyroid hormones
• Assessment Findings: Signs and Symptoms
– Restless; Agitated; Hand tremors; Diarrhea
– Increased appetite; Weight loss; Visual changes; Exophthalmos; Neck swelling
– Diagnostic findings: Serum T3, T4, TSH; Thyroid scan and ultrasonography
• Medical and Surgical Management: Antithyroid drugs; Radiation; Thyroidectomy
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestionIs the following statement true or false?
The etiology of Graves Disease is the hyposecretion of thyroid hormones.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswerFalse.
The etiology of Graves Disease is the hypersecretion of thyroid hormones.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Thyrotoxic Crisis (Thyroid Storm)Thyrotoxic Crisis (Thyroid Storm)• Pathophysiology and Etiology: Triggering factors; T3,
T4 oversecretion; Epinephrine release
• Assessment Findings
– High temperature; Rapid pulse; Dyspnea
– Cardiac dysrhythmias; Vomiting; Delirium
– Hyperthyroidism history; Laboratory tests
• Medical Management
– Immediate treatment; Antithyroid drugs; IV treatment
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hypothyroidism Hypothyroidism • Pathophysiology and Etiology
– Inadequate thyroid hormone secretion: Myxedema
• Assessment Findings: Signs and Symptoms
– Slow metabolic rate; Lethargy; Weight gain; Dry skin; Menstrual disorders
– Enlarged heart; Atherosclerosis; Anemia
– Diagnostic findings: Serum TSH, T3, T4; FT4; RAI uptake
• Medical Management: Thyroid replacement therapy
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Thyroid Tumors Thyroid Tumors • Pathophysiology and Etiology
– Follicular adenoma; Papillary carcinoma
• Assessment Findings
– Nodular thyroid; Hoarseness; Swallowing difficulty; Biopsy; Physical examination
• Medical and Surgical Management
– Thyroidectomy; HRT; Radiation
• Nursing Management
– Emotional support; Handling body fluids
– RAI: Postoperative; Radiation precautions
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Endemic and Multinodular Goiters Endemic and Multinodular Goiters • Pathophysiology and Etiology
– Iodine deficiency; Goitrogenic foods
• Assessment Findings
– Enlarged thyroid gland; Difficulty swallowing; Thyroid scan
• Medical Management
– Foods high in iodine; Potassium iodide; Thyroidectomy
• Nursing Management
– Monitor for and relieve respiratory symptoms; Provide appropriate diet
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Thyroiditis Thyroiditis
• Pathophysiology and Etiology
– Types: Acute; Subacute; Hashimoto’s
• Assessment Findings: Signs and Symptoms
– High fever, malaise, and swollen
– Tender thyroid gland
– Diagnostic findings: Thyroid scan; Lab tests
• Medical and Surgical Management
– Antibiotics; Analgesics; Corticosteroids; Thyroid HRT; Surgery
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hyperparathyroidism Hyperparathyroidism
• Pathophysiology and Etiology
– Primary or secondary condition
– Primary: Adenoma; Increased secretions of PTH
– Secondary: Increased secretions in response to hypocalcemia
• Assessment Findings: Signs and Symptoms
– Fatigue; Hypotonic muscles
– Skeletal tenderness and pain
– Cardiac dysrhythmias
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hyperparathyroidism Hyperparathyroidism • Assessment Findings: Diagnostic Findings
– Laboratory tests; MRI; CT scan
• Medical and Surgical Management
– Sodium, phosphorus replacements; Surgery
• Nursing Management
– Monitor I and O; Urinary calculi; Self-care; Safe environment
– Encourage fluid intake
– Provide postoperative care
– Client education: Effects of disease; Adherence to treatment
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hypoparathyroidism Hypoparathyroidism • Pathophysiology and Etiology
– Deficiency of parathormone; Trauma to the glands; Hypocalcemia
• Assessment Findings: Signs and Symptoms
– Tetany; Chvostek’s and Trousseau’s signs; Laryngeal spasm
• Assessment Findings: Diagnostic Findings
– Serum: Calcium and phosphorus; Radiographs
• Medical Management: IV calcium salt; Endotracheal intubation; Mechanical ventilation; Oral calcium
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Adrenal Insufficiency (Addison’s Disease)Adrenal Insufficiency (Addison’s Disease)
• Pathophysiology and Etiology
– Primary: Destruction of adrenal cortex
– Secondary: Surgical removal, hemorrhagic infarction, hypopituitarism, medications
• Assessment Findings: Signs and Symptoms
• Assessment Findings: Diagnostic Findings
– Laboratory tests; Radiographs; CT scan
• Medical Management
– Daily corticosteroid replacement therapy
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acute Adrenal Crisis (Addisonian Crisis)Acute Adrenal Crisis (Addisonian Crisis)• Pathophysiology and Etiology
– Abnormal stress; Trauma; Salt deprivation
• Assessment Findings
– Anorexia; Vomiting; Diarrhea; Abdominal pain; Hypotension; Fever
– Diagnosis: Symptoms; History
• Medical Management
– Corticosteroids; Antibiotics
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pheochromocytoma Pheochromocytoma • Pathophysiology and Etiology
– Benign tumor
– Excessive catecholamine secretion
• Epinephrine and norepinephrine
• Assessment Findings: Elevated BP; Tremors; Hyperglycemia; Polyuria ; Vertigo, headache, N/V
• Diagnostic Findings: 24-hour urine; CT; MRI; Ultrasonography; Retrograde pyelography
• Medical, Surgical Management: Unilateral adrenalectomy; Drug therapy
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cushing’s SyndromeCushing’s Syndrome• Pathophysiology and Etiology: Excess ACTH;
Tumors; Corticosteroids
• Assessment Findings: Signs and Symptoms
– Cushingoid syndrome; Muscle wasting
– Moon face; Buffalo hump; Wounds; Masculinization; Kyphosis
– Diagnostic findings: Dexamethasone suppression test; 24-hour urine; Blood test; Radiographs; IV pyelogram; CT; MRI
• Medical and Surgical Management : Radiation; Drug therapy; Surgery
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hyperaldosteronism Hyperaldosteronism • Pathophysiology and Etiology
– Aldosterone: Secreting adenoma
• Assessment Findings
– Muscle weakness, fatigue, cardiac dysrhythmias; Headache; Increased urine; Hypertension
– Laboratory tests; CT; MRI; Adrenal venography
• Medical and Surgical Management
– Unilateral adrenalectomy
– Drug therapy; Diet therapy
• Nursing Management
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
End of Presentation