ALTERATION IN REGULATIONENDOCRINE DISORDERS

C. Washington RN, MSNEd

Thyroid Gland

Thyroid Disorders Thyroid Gland

produces three hormones: Thyroxine (T4) Triiodothyronine (T3) Calcitonin T3 + T4 are referred to

collectively as thyroid hormone.

Thyroid-iodine connection Iodine is used by the thyroid to produce

its hormones T4 - thyroxineT3 - triiodothyronineCalcitonin

Calcitonin Secreted by the thyroid gland. Secreted in response to high plasma

levels of calcium Decreases circulating plasma Ca++ levels

by increasing its deposition in bone

Thyroid Hormone: HypofunctionSubjective:• Fatigue, weakness, forgetfulness, Objective:• Labile BP, CO, bradycardia, MI d/t

hyperlipidemia, constipation, weight gain, cold intolerance, prone to infections, depression, anxiety,

Thyroid Hormone: HyperfunctionSubjective:• Palpitations, fatigueObjective:• HTN, HR, RR & CO, arrythmias, diarrhea,

weight loss, heat intolerance, fine tremors, labile moods, insomnia, exhaustion,

• Goiter, exothalmus

Goiter

Nursing Diagnosis of Thyroid Dysfunction

Altered metabolic function

Activity intolerance Impaired cardiac

output Imbalanced

nutrition

Anxiety Potential for injury Hypo/hyperthermia Disturbed thought

process Knowledge deficit

Nursing Management of Thyroid Dysfunction

Goal: Restore normal/optimal metabolic state Prevent complications

Abnormal Thyroid Function Hypothyroidism

the thyroid releases too little hormone so the body's metabolism goes too slowly

Hyperthyroidism where the thyroid releases too much

hormone and the body's metabolism goes too fast

Abnormal Thyroid Function Thyroid nodules and swellings

overgrowth of thyroid tissue resulting in a nodule or small lump, in

part of the gland a small percentage of the inactive lumps

may be cancerous

Hypothyroidism Hypothyroidism

The body's normal rate of functioning slows, causing mental and physical sluggishness

Thyroiditis

Inflammation of the thyroid gland

Hashimoto’s Disease Chronic thyroiditis Reaction of the

immune system against the thyroid gland

Hypothyroidism Fatigue or lack of

energy Weight gain Feeling cold Dry skin and hair

Heavy menstrual periods

Constipation Slowed thinking

Hyperthyroidism 2nd most common endocrine disorder (after diabetes

mellitus)

Graves’ Disease Excessive output of thyroid hormone caused by abnormal

stimulation of the thyroid gland by circulating immunoglobulins

Other causes Thyroiditis Excessive ingestion of thyroid hormone

Hyperthyroidism Jitteriness, shaking,

increased nervousness, irritability

Rapid heart beat or palpitations

Feeling hot Weight loss

Fatigue, feeling exhausted

More frequent bowel movements

Shorter or lighter menstrual periods

Nursing Management: Hyperthyroidism

Reducing thyroid hyperactivity to relieve symptoms and accompanying complications

Radioactive Iodine (RAI) Disrupts the function of some of the thyroid cells Given as a single dose Low side effects

Collaborative Management: Hyperthyroidism

Medications Require long-term compliance High rate of relapse

Surgery Subtotal thyroidectomy

Thyroidectomy

Parathyroid Glands

Parathyroid Glands

Secretes parathormone (PTH)

PTH regulates calcium and phosphorous

Parathyroid and Calcium Regulation

Calcium most closely regulated element in our bodies! 

important in conduction of electrical impulses in nervous and muscular systems

ONLY element / mineral that has its own regulatory system the parathyroid glands

Hyperparathyroidism Increase in the production of PTH

Due to a benign growth of 1:4 parathyroid glands

Induces: abnormally high serum Ca++ levelsbone decalcificationdevelopment of kidney stones

Hyperparathyroidism Fatigue Apathy muscle weakness Vomiting Hypertension Bone

demineralization kidney stones

Symptoms of have become

known as: "moans, groans,

stones, and bones...with psychic overtones".

Hypoparathyroidism Accidental removal

of parathyroid glands during thyriod surgery

Symptoms r/t hypocalcemia & hyperphosphatemia Neuromuscular

irritability

TetanyNumbness,

tingling, cramps Bronchospasm,

laryngeal spasm, carpopedal spasm

Ca+ Gluconate

Hypoparathyroidism Trousseau’s Sign of latent tetany

Compression of the forearm in clients having undue neuromuscular excitability due to hypocalcaemia produces spasm in the hand and wrist.

Hypoparathyroidism Chvostek’s sign of latent tetany

contraction of the muscles of the eye, mouth or nose, elicited by tapping along the course of the facial nerve.

The examiner taps gently over the facial nerve in front of the ear.

Nursing care of parathyroid dysfunction

Subjective & objective data similar to thyroid dysfunction

Blood level >10 or < 3 very significant

Nursing Diagnosis Altered metabolism Altered cardiac

output Anxiety Altered comfort Impaired memory

Corticosteroid Therapy “Steroids” Used to treat adrenal insufficiency

Suppress inflammation & autoimmune reactions, control allergic reactions & reduce organ transplant rejection

Side effects of high doses over long-term turned steroid use into “scare-oids”

“Steroids” - How do they work?

Cortisol controls salt & water balance in the body Stress pituitary gland releases

adrenocorticotropic hormone (ACTH) which stimulates adrenals to produce cortisol

Extra cortisol allows body to cope with stress of infections, trauma, surgery, or emotional problems

When stressful situation resolves, adrenal hormone function returns to normal

Corticosteroid Therapy Block production of substances that trigger

allergic and inflammatory actions (i.e. prostaglandins).

Impede the function of WBC’s which help keep the immune system functioning properly

Undesirable side effect: susceptibility to infection