NURS 324 Exam 4 levels of thyroid hormone TRH TSH thyroid hormone ANS levels of thyroid hormone TRH TSH thyroid hormone Local Administration of Glucocorticoids ANS Inhalation or intra articular On the skin Since steroids are very lipid soluble some of the locally administered dose will get into the bloodstream but concentrations will be lower than if it were administered systemically Because blood levels are lower with these routes of administration side effects are lessened Acromegaly Clinical Manifestations ANS Enlargement of hands and feet broad and bulbous nose protruding jaw and slanting forehead Bone overgrowth kyphosis arthralgias arthritis Organ enlargement Deepening of voice Nerve entrapment Many negative metabolic changes Hyperglycemia IGT overt type 2 diabetes mellitus hypertension CV risk muscle weakness decreased libido obesity Increased FFA from adipose promotes IGT impaired glucose tolerance insulin resistance then increased blood Acute Intestinal Obstruction ANS Acute or chronic Can affect small intestines or colon Chronic can last weeks to months usually of the colon Acute are normally of the small intestines severe and potentially lethal PTs will need to be NPO ADH ANS Hormone produced by the hypothalamus transported along neural pathway stored hypothalamus osmoreceptors stimulated by serum osmolality and volume and other factors released from the posterior pituitary gland Acts on collecting ducts and tubules of kidney ADH conserves water to maintain blood pressure ADH secreted in response to ANS Increased serum osmolality hemo concentration Decreased plasma volume Decreased blood pressure Stress pain trauma surgery some narcotics and some anesthetic agents Adrenal cortex secretes ANS glucocorticoids mineralocorticoids and adrenal androgens Adrenal Cortical Hormones Glucocorticoids CORTISOL ANS Protein metabolism Fat metabolism Carbohydrate metabolism Increase Na retention Increase K excretion Suppress inflammatory and immune response Strong anti inflammatory effect Adrenal Cortical Hormones MINERALOCORTICOIDS aldosterone ANS Increase Na retention Increase K excretion Adrenal Cortical Insufficiency ANS AKA Addison s Disease Primary adrenal failure ACTH level high rare Usually autoimmune process Excess ACTH causes hyperpigmenation Decreased glucocorticoid Decreased gluconeogenesis Hypoglycemia Weakness Decreased ability to cope with stress Decreased mineralocorticoids Decreased K excretion Decreased Na retention Water loss Decreased BP Dehydration Hypovolemic shock Elevated BUN Adrenal Glands ANS a pair of endocrine glands that sit just above the kidneys and secrete hormones epinephrine and norepinephrine that help arouse the body in times of stress Adrenal medulla secretes ANS epinephrine and norepinephrine Adrenal Suppression Physiologic Stress What is important to know ANS Patient taking glucocorticoids long term require increased doses at times of stress Patients should carry an identification to inform emergency personnel Patients should always have emergency supply of glucocorticoids on hand Anorexia ANS Lack of appetite Hunger contraction of stomach Hunger center hypothalamus R T smell Anorexia Etiology Emotional factors depression fear anxiety Medical causes uremia distention of stomach and intestines Often the precursor to nausea Another name for primary HYPOthyroidism is ANS myxedema Autoimmune Gastritis ANS Not common 10 of cases of gastritis Can be r t other autoimmune processes Hashimoto s thyroiditis type 1 DM etc Slow onset Vit B12 pernicious anemia deficiency C Diff Symptoms ANS Watery diarrhea 10 to 15 times a day Blood or pus in the stool 3 unformed stools in 1 day should prompt an investigation can alternate with constipation Abdominal cramping and pain which may be severe hyperactive peristalsis Fever Nausea dehydration Loss of appetite Weight loss Swollen abdomen Kidney failure Increased white blood cell count Causes of growth hormone deficiency in adults ANS Decreased GH production IGF 1 somatomedin C deficiency Pituitary adenoma or damage hypopituitarism Chemoreceptor trigger zone CTZ ANS The area of the brain that is involved in the sensation of nausea and the action of vomiting Cholangitis ANS an acute inflammation of the bile duct characterized by pain in the upper right quadrant of the abdomen fever and jaundice Cholecystectomy ANS surgical removal of the gallbladder Choledocholithiasis ANS condition of stones in the common bile duct Cholelithiasis ANS gallstones in the gallbladder Cholelithiasis Clinical Manifestations ANS Symptoms occur when bile flow is obstructed Indigestion biliary colic RUQ epigastric pain Referred to R shoulder upper back mid scapular region Abrupt onset with steady increase in intensity Nausea vomiting Change in stool color and consistency as bile flow is blocked clay colored stool Complete obstruction can cause jaundice Chronic Activation of the Stress Response may EXACERBATE several diseases List them ANS Cardiovascular heart disease stroke Immune Autoimmune Diseases GI Ulcers IBS colitis vomiting diarrhea Endocrine Diabetes mellitus metabolic syndrome CNS fatigue eating disorders depression insomnia PTSD Clinical Manifestations of Cushing Syndrome ANS Obesity Hyperglycemia glycosuria Hypertension Fluid electrolyte disturbances Osteoporosis Muscle weakness Cataracts Hirsutism Menstrual irregularities Decreased resistance to infection Moon face Buffalo hump Psychiatric changes Clinical manifestations of GH deficiency in adults ANS Dwarfism in children Osteoporosis in adults Clinical manifestations of HYPERpituitarism ANS depends on which hormone is being produced extra or excreted extra Functional produces excess prolactin inhibits normal LH secretion leads to infertility and amenorrhea in women and ED in men May also have visual field changes due to impingement of optic chiasm Clinical Manifestations of Obstruction ANS Alterations in bowel sounds Borborygmus high pitched peristalsis and peristaltic rushes mechanical Decreased bowel sounds early absent bowel sounds later for non mechanical Nausea vomiting large quantities belching Dehydration loss of fluids and electrolytes Abdominal distention progressive Pain varies according to location for mechanical Pain constant and diffuse for non mechanical as distention continues due to accumulation of gas fluid decrease blood flow increase pain increase distention increased distention decrease blood flow possible strangulation perforation of the bowel Peritonitis