Lincoln Memorial UniversityCaylor School of NursingNursing 241Fall 2007 TITLE: Nursing Strategies: Alterations of Endocrine Function DATES: See SyllabusTIMES: See Syllabus OBJECTIVES: Upon completion of this unit, the student will be able to demonstrate, in the clinical/campus laboratory setting, in individual and group conferencesand on written material the ability to: 1. Using the four adaptive modes of Roy’s Adaptation Model (RAM), recognize human adaptive responses to behavior or stimuli that affect endocrine function.2. Describe the parameters appropriate for determining the status of endocrine functioning including the characteristics and functions of hormone and the basic regulatory mechanisms of hormones. 3. Describe the pathophysiology, clinical manifestations, management and associated use of the RAM nursing process to provide care for adults with alterations of the pituitary, thyroid, parathyroid, and adrenal glands. 4. Identify the physical and psychosocial discharge planning needs of adults with compromised endocrine functioning. 5. Explain how the following diagnostic tests are performed, pre- and post-test nursing responsibilities, and recognize the implications of abnormal results:a. Resin T3 Uptakeb. T3, T4, TSHc. radioactive iodine uptaked. total serum calciume. ACTH testf. thyroid scang. water deprivation test 6. Describe the surgical procedures, postoperative nursing care, postoperative complications, and discharge planning needs of adults undergoing surgery of the pituitary, thyroid, parathyroid, and adrenal glands. 7. Identify the stimuli of emotional stress and its relationship to the adult with endocrine disorders. 8. Identify the stimuli and behaviors which are common to endocrine disorders: hypopituitarism, hyperpituitarism, hypothyroidism, hyperthyroidism, hypoparathyroidism, hyperparathyroidism, Addison’s disease, and Cushing’s disease. 9. Discuss acute and chronic complications of diabetes mellitus and explain their relationship to adaptive versus ineffective behaviors in the four adaptive modes.10. Identify the medications on the drug list by generic name, classification, mechanism of action, clinically significant side effects, normal dosage, and nursing implications and be able to correctly calculate IV, IM and oral dosages.1TOPICAL OUTLINEI. Anatomic and physiologic reviewA. Glands of the endocrine system1. Pituitary gland2. Thyroid gland3. Parathyroid gland4. Adrenal glandsB. Function and regulation of hormonesC. Classification and action of hormones1. Posterior pituitary hormonesa. Vasopressin (ADH)2. Anterior pituitary hormonesa. Adrenocorticotropic hormone (ACTH)b. Thyroid-stimulating hormone (TSH)3. Thyroid hormonesa. Thyroid hormone --thyroxine (T4) and triiodothyronine (T3)b. Calcitonin4. Parathyroid hormonesa. Parathyroid hormone or parathormone5. Adrenal gland hormonesa. Adrenal medulla hormones- catecholaminesi. Epinephrine ii. Norepinephrineb. Adrenal cortexi. Glucocorticoidsii. MineralcorticoidsII. Health history and physical assessmentIII. Diagnostic evaluationIV. Nursing care of adults with disorders of the pituitary glandA. Hypopituitarism – diabetes insipidusB. Hyperpituitarism - SIADHC. Pituitary tumors – Transsphenoidal HypophysectomyV. Nursing care of adults with disorders of the thyroid glandA. HypothyroidismB. Hyperthyroidism – Grave’s Disease (Thyroid storm, thyroiditis)C. Thyroid cancer - (Thyroidectomy)VI. Nursing care of adults with disorders of the parathyroid glandA. HypoparathyroidismB. HyperparathyroidismVII. Nursing care of adults with disorders of the adrenal glandA. Adrenal Medulla - Pheochromocytoma B. Adrenal Cortex1. Adrenocortical insufficiency - Addison’s disease2. Adrenocortical excess - Cushing’s syndrome (Adrenalectomy)2C. Corticosteroid therapyVIII. Complications of diabetes A. Acute Complications 1. Hypoglycemia (insulin reaction) 2. Diabetic ketoacidosis (DKA) 3. Hypergylcemic hyperosmolar nonketotic syndrome B. Chronic complications 1. Macrovascular complications 2. Microvascular complicationsa. Diabetic retinopathyb. Nephropathyc. Neuropathies 4. Foot and leg problems 5. Special issues in diabetes carea. Diabetic patient undergoing surgeryb. Care of hospitalized diabetic patientREQUIRED READINGS:Smeltzer, S. and Bare, B. (2007). Brunner & Suddarth's Medical surgical nursing. (11th ed.). Philadelphia: Lippincott. Chapters 41 (pp. 1410 -1438), 42, 61 (p. 2189-2190).CLINICAL SKILLS:1. Identify potential endocrine/metabolic abnormalities utilizing appropriate assessment skills. 2. Manage care for selected clients experiencing commonly occurring alterations in endocrine function. VOCABULARY LIST:See Smeltzer & Bare, pp. 1376 and 1440: Glossary of TermsDrug List:Desmopressin (DDAVP MithramycinVasopressin tannate in oil CalcitoninClofibrate Etidronate (Didronel)Chlopropamide (Diabinese) Pamidronate (Aredia)Thiazide diuretics Calcium gluconateLevothyroxine (Synthroid, Levothroid) Phentolamine (Regitine)Radioisotope iodine 131 (I 131) Sodium nitroprusside (Nipride)Propylthiouracil (PTU) Nifedipine (Procardia)Methimazole (Tapazole) Hydrocortisone (Solu-Cortef)Liothyroxine (Cytomel) CortisoneSodium iodine PrednisonePotassium iodine PrednisoloneSaturated solution of potassium iodine (SSKI) Methylprednisolone (solu-Medrol)Dexamethasone (Decadron) Beclomethasone (Vancenase)Propanolol (Inderal)3OVERVIEW OF ENDOCRINE HORMONES1. POSTERIOR PITUITARY (neurohypophysis)- smaller - stores and secretes 2 hormones (only covering one)ADH - Antidiuretic Hormone {Diabetes insipidus, SIADH}causes renal and collecting tubules to be more permeable to water altering urine concentration 2. ANTERIOR PITUITARY secretes 6 hormones TSH, FSH, LH, ProlactinGH, ACTH – We are only covering the following:ACTH - Adrenocorticotropic Hormone (corticotropin)- adrenal cortex to produce glucocorticoids (cortisol) 3 Factors regulate ACTH secretion1. circulating cortisol levels (negative feedback)2. stress3. diurnal variation (circadian rhythm)> cortisol levels peak at 8AM>