NSG 326 Adult Health IENDOCRINE SYSTEMSlide 3Slide 4Slide 5Growth Hormone (GH)Slide 7Acromegaly (GH )Growth Hormone ExcessNursing Diagnoses: GH ↑Slide 11Growth Hormone DeficitSlide 13SIADH: Syndrome of Inappropriate Antidiuretic HormoneSIADHDiabetes InsipidusSlide 17GOITERGoiterSlide 20Slide 21Goiter ManifestationsSlide 23HYPERTHYROIDISMSlide 25HyperthyroidismGRAVES’ DISEASESlide 28Clinical Manifestations HyperthyroidismClinical ManifestationsSlide 31Slide 32Slide 33Slide 34DiagnosticsCollaborative CareSlide 37Slide 38Nursing DiagnosesThyrotoxic CrisisHYPOTHYROIDISMSlide 42HypothyroidismSlide 44Slide 45Slide 46Slide 47Slide 48Clinical Manifestation: MyxedemaSlide 50Complications of MyxedemaHypothyroidism DiagnosticsSlide 53Slide 54Cushing SyndromeCushing Syndrome Clinical ManifestationsSlide 57Slide 58Diagnostic StudiesSlide 60Slide 61Slide 62Ambulatory & Home CareSlide 64Addison’s DiseaseSlide 66ADDISON’S DISEASESlide 68Slide 69HyperpigmentationSlide 71Slide 72Slide 73Complications Addison’s DiseaseComplicationsSlide 76Nursing ManagementSlide 78Prepared by Dr. K. A. EnnenNSG 326 Adult Health IWeek #14Spring 2011Problems of the Endocrine SystemENDOCRINE SYSTEM6Growth Hormone (GH)Growth Hormone (GH)•Gigantism•Excessive GH in children•Acromegaly•Excessive GH in adultsAcromegaly (GH Acromegaly (GH ))9Growth Hormone ExcessGrowth Hormone Excess•Tufted or clubbed fingertips•Enlargement of hands and feet•Joint pain, from mild to severe•Soft tissues of the face and jaw thicken•Hirsutism - excessive hairiness •May result in speech difficulties•Sleep apnea (due to pharyngeal soft tissue growth)•Diabetic and CV complications may be permanent.10Nursing Diagnoses: GH Nursing Diagnoses: GH ↑↑•Insomnia, related to soft tissue swelling•Disturbed body image, related to enlargement of hands, feet, enlargement of bony and soft tissue on face and head•Chronic pain, related to enlargement of bones and cartilage12Growth Hormone DeficitGrowth Hormone Deficit•Truncal obesity•Decreased muscle mass•Reduced strength•Decreased energy•Flat affect•Depression•Treatment•Hormone replacement therapy•Somatropin14SIADH: Syndrome of Inappropriate Antidiuretic Hormone•Excessive serum ADH•Water Intoxication•Cellular edema•Dilutional hyponatremia•Feedback mechanism does not work on Posterior Pituitary15SIADH•Assessment•FVE: ↑BP; crackles in lung fields; JVD; taut skin; I > O•Clinical Manifestations: headache; fatigue; anorexia; nausea; muscle aches•Treatment•Restore normal fluid volume & osmolality; fluid restriction16Diabetes Insipidus•Deficient ADH production or secretion•Hypothalamus malfunction •Medications (lithium)•Excessive water intake caused by thirst center lesion•Fluid & electrolyte imbalances related to ↑urine output & increased plasma osmolality•Characterized by polydipsia & polyuria•Severe fluid volume deficit manifests in weight loss, constipation, poor tissue turgor, hypotension & shock18GOITER19Goiter•Goiter is an enlargement of your thyroid gland — a small, butterfly-shaped gland weighing less than an ounce, located just below your Adam's apple.•Hormones produced by your thyroid gland regulate all aspects of your metabolism, from the rate at which your heart beats to the speed at which you burn calories.•Although generally not uncomfortable, goiter can interfere with swallowing or breathing. •Goiters are more common in women and older adults.20Goiter•A rounded neck was considered to be a sign of great beauty during the late Renaissance. •It occurred regularly in parts of the world where iodine supplies were insufficient for normal thyroid function.21Goiter•The possible causes are numerous. •In the past, the most common cause of goiter was a shortage of iodine in the diet in areas where the soil was deficient in iodine. Without enough dietary iodine, your thyroid can't make and release enough of the two essential iodine-containing hormones. •Goiter became rare in the United States after iodized salt was introduced. •Found in Graves’ disease (hyperthyroidism)•In some parts of the world, however, goiter is still common because of iodine deficiency.•Treatment for goiter depends on the size of the enlargement, signs and symptoms, and the underlying cause.22Goiter Manifestations•Enlargement of thyroid gland, resulting in swelling of neck •A tight feeling in throat •Coughing •Difficulty swallowing •Difficulty breathing •May experience other signs and symptoms depending on the underlying cause of the goiter.24HYPERTHYROIDISM•A sustained increase in synthesis and release of thyroid hormones by thyroid gland•Occurs more often in women•Highest frequency in 20- to 40-year-olds26Hyperthyroidism•Most common form •Graves’ disease•Other causes•Thyroiditis•Toxic nodular goiter•Exogenous iodine excess•Pituitary tumors•Thyroid cancer•Thyrotoxicosis•Physiologic effects/clinical syndrome of hypermetabolism resulting from increased circulating levels of T3, T4•Hyperthyroidism and thyrotoxicosis usually occur together as Graves’ disease27GRAVES’ DISEASE•Autoimmune disease of unknown etiology•Diffuse thyroid enlargement •Excessive thyroid hormone secretion•Precipitating factors•Insufficient iodine supply•Infection•Stressful life events interacting with genetic factors•Accounts for 75% of cases of hyperthyroidism•Antibodies are developed to TSH receptor•Leads to clinical manifestations of thyrotoxicosis •May progress to destruction of thyroid tissue causing hypothyroidism29Clinical Manifestations Hyperthyroidism•Related to effect of thyroid hormone excess•↑ Metabolism•↑ Tissue sensitivity to stimulation by sympathetic nervous system•Ophthalmopathy•Abnormal eye appearance or function•Exophthal mos•Protrusion of eyeballs from the orbits•Impaired drainage from orbit•Increased fat and edema in retroorbital tissues•Seen in 20% to 40% of patients30Clinical Manifestations•Cardiovascular system•Bruit over thyroid gland•Systolic hypertension•↑ Cardiac output•Dysrhythmias•Cardiac hypertrophy•Atrial fibrillation •GI system•↑ Appetite, thirst•Weight loss•Diarrhea•Splenomegaly •Hepatomegaly31Clinical Manifestations•Integumentary system•Warm, smooth, moist skin•Thin, brittle nails•Hair loss•Clubbing of fingers•Diaphoresis•Vitiligo •Musculoskeletal