Lincoln Memorial University Caylor School of Nursing NURS 241 Fall 2008 TITLE Nursing Strategies Alterations of Endocrine Function DATES TIMES See Syllabus See Syllabus OBJECTIVES 1 2 3 4 5 6 7 8 9 Upon completion of this unit the student will be able to demonstrate in the clinical campus laboratory setting in individual and group conferences and on written material the ability to Using the four adaptive modes of Roy s Adaptation Model RAM recognize human adaptive responses to behavior or stimuli that affect endocrine function 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 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 Identify the physical and psychosocial discharge planning needs of adults with compromised endocrine functioning Explain how the following diagnostic tests are performed pre and post test nursing responsibilities and recognize the implications of abnormal results a Resin T3 Uptake b T3 T4 TSH c radioactive iodine uptake d total serum calcium e ACTH test f thyroid scan g water deprivation test 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 Identify the stimuli of emotional stress and its relationship to the adult with endocrine disorders Identify the stimuli and behaviors which are common to endocrine disorders hypopituitarism hyperpituitarism hypothyroidism hyperthyroidism hypoparathyroidism hyperparathyroidism Addison s disease and Cushing s disease 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 1 TOPICAL OUTLINE I Anatomic and physiologic review general brief overview of hormone function and regulation II Health history and physical assessment III Diagnostic evaluation IV Nursing care of adults with disorders of the pituitary gland A Anatomy and physiology overview of the pituitary gland 1 Posterior pituitary hormones a Vasopressin ADH 2 Anterior pituitary hormones a Adrenocorticotropic hormone ACTH b Thyroid stimulating hormone TSH B Disorders of the pituitary gland 1 Hypopituitarism diabetes insipidus 2 Hyperpituitarism SIADH 3 Pituitary tumors Transsphenoidal Hypophysectomy V Nursing care of adults with disorders of the thyroid gland A Anatomy and physiology overview of the thyroid gland 1 Thyroid hormones thyroxine T4 and triiodothyronine T3 2 Calcitonin B Disorders of the thyroid gland 1 Hypothyroidism 2 Hyperthyroidism Grave s Disease Thyroid storm thyroiditis 3 Thyroid cancer Thyroidectomy VI Nursing care of adults with disorders of the parathyroid gland A Anatomy and physiology overview of the parathyroid gland 1 Parathyroid hormone or parathormone B Disorders of the parathyroid gland 1 Hypoparathyroidism 2 Hyperparathyroidism VII Nursing care of adults with disorders of the adrenal gland A Anatomy and physiology overview of the adrenal gland 1 Adrenal medulla hormones catecholamines a Epinephrine b Norepinephrine 2 Adrenal cortex hormones a Glucocorticoids b Mineralcorticoids B Disorders of the adrenal gland 1 Adrenal Medulla Pheochromocytoma 2 Adrenal Cortex a Adrenocortical insufficiency Addison s disease b Adrenocortical excess Cushing s syndrome Adrenalectomy C Corticosteroid therapy 2 REQUIRED READINGS Smeltzer S C Bare B G Hinkle J L and Cheever K H 2008 Brunner Suddarth s Medical surgical nursing 11th ed Philadelphia Lippincott Williams Wilkins Chapters 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 p 1440 Glossary of Terms DRUG LIST Desmopressin DDAVP Vasopressin tannate in oil Clofibrate Chlopropamide Diabinese Thiazide diuretics Levothyroxine Synthroid Levothroid Radioisotope iodine 131 I 131 Propylthiouracil PTU Methimazole Tapazole Liothyroxine Cytomel Sodium iodine Potassium iodine Saturated solution of potassium iodine SSKI Dexamethasone Decadron Propanolol Inderal Mithramycin Calcitonin Etidronate Didronel Pamidronate Aredia Calcium gluconate Phentolamine Regitine Sodium nitroprusside Nipride Nifedipine Procardia Hydrocortisone Solu Cortef Cortisone Prednisone Prednisolone Methylprednisolone solu Medrol Beclomethasone Vancenase OVERVIEW OF ENDOCRINE HORMONES 1 POSTERIOR PITUITARY neurohypophysis 3 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 Prolactin GH ACTH We are only covering the following ACTH Adrenocorticotropic Hormone corticotropin adrenal cortex to produce glucocorticoids cortisol 3 Factors regulate ACTH secretion 1 circulating cortisol levels negative feedback 2 stress 3 diurnal variation circadian rhythm cortisol levels peak at 8AM lowest point 9PM 12MN TSH Thyroid Stimulating Hormone thyrotropin stimulates thyroid gland to release T3 T4 thyroid hormone 3 THYROID GLAND Hyper hypothyroidism below larynx in front of trachea butterfly shape 2 lobes joined by isthmus highly vascular T3 triiodothyronine T4 thyroxine together called thyroid hormone metabolic function of all body tissue rate of nutrient use CV function GI function mental processes accelerate growth in children activity of other endocrine glands calcitonin thyrocalcitonin also produced by parathyroid gland inhibits calcium loss from bone renal excretion of calcium serum calcium levels 4 PARATHYROID GLANDS Hyper hypoparathyroidism usually 4 glands below larynx in front of trachea imbedded in 4 corners of thyroid PTH parathyroid hormone parathormone opposite of calcitonin promotes loss of calcium from bone 4 kidney excretion of calcium serum calcium levels 5 ADRENAL GLANDS ADRENAL MEDULLA Pheochromocytoma smaller inner portion of the adrenal gland which produces catecholamines also produced as neurotransmitters in the nervous system