Adrenal Gland

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Study Tools For Adrenal Gland

Cross Section of Adrenal Gland (Image)
Adrenal Gland location (Image)
Adrenal Gland Hormones (Mnemonic)
Adrenal Gland (Basic) (Picmonic)
Adrenal Gland (Advanced) (Picmonic)
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Outline

Overview

  1. Adrenal Gland
    1. Location: on top  of kidney
    2. Tissues/structure
      1. Inner = adrenal medulla
        1. Catecholamines
      2. Outer = adrenal cortex
        1. Adrenocorticosteroid hormones
          1. Mineralocorticoids
          2. Glucocorticoids
          3. Androgens

Nursing Points

General

  1. Adrenal medulla
    1. Location – internal aspect of gland
    2. Composition
      1. Specialized sympathetic neurons – chromaffin cells
        1. No axons and dendrites
    3. When stimulated, chromaffin cells secrete catecholamines
      1. Norepinephrine = neurotransmitter
      2. Epinephrine (aka Adrenaline)
      3. Effects (fight or flight response)
        1. Increased BP, HR, circulation to skeletal muscles, lung ventilation
        2. Inhibits less important functions (digestion/excretion)
        3. Hyperglycemic effect:
          1. Glycogenolysis, gluconeogenesis →  increase glucose in blood
          2. Inhibits insulin
            1. Ensures glucose to brain
            2. Decreased uptake of glucose
          3. Glucose-sparing
    4. Association w/ adrenal cortex
      1. Stress stimulates medullary cells to secrete catecholamines which stimulate the cortex to secrete corticosterone
  2. Adrenal cortex
    1. Location – around outside border of gland
    2. Secretions → steroid hormones (corticosteroids or corticoids)
      1. Mineralocorticoids
        1. Act on kidneys to control electrolyte balance
        2. Aldosterone
          1. Sodium retention
            1. Water follows
          2. Potassium excretion
      2. Glucocorticoids
        1. Cortisol, hydrocortisone
        2. Stimulate
          1. Fat & Protein breakdown
          2. Gluconeogenesis
          3. Release of fatty acids and glucose into blood
        3. Anti-inflammatory effect
        4. Long term secretion suppresses immune system
          1. See lesson on Cushing’s Syndrome
        5. Lack of secretion leads to fluid and electrolyte imbalances
          1. See lesson on Addison’s Disease
      3. Sex steroids
        1. Androgens – control aspects of male development and reproductive anatomy
          1. Male
            1. Dehydroepiandrosterone (DHEA)
              1. Naturally weak
              2. Converted to testosterone in other tissues
              3. This source is minor – testes make most of testosterone
          2. Female
            1. Adrenal androgens comprise 50% of androgen needs
          3. Both
            1. Stimulate development of pubic and axillary hair
            2. Apocrine scent glands at puberty
            3. Sustain libido

References:

Betts, J.G., et al. (2017). Anatomy and physiology. Houston, TX: OpenStax, Rice University. Retrieved from https://openstax.org/details/books/anatomy-and-physiology?Book%20details

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Transcript

Alright we’re gonna talk about the adrenal gland. The adrenal glad is incredibly important to our body. It’s a very small gland that sits on top of either kidney that you probably don’t think about every day. But we’re gonna talk about it and help give you a better understanding of what it is, what it does, and why it really matters. The adrenal glad is this triangular-shaped gland sitting on top of either kidney. And it’s made up of two different elements. We have our adrenal medulla that’s in the center, this kinda horseshoe-shaped piece in the center. And then we have the adrenal cortex, which is the outer portion that surrounds the adrenal medulla. The adrenal medulla again is the inner layer. It’s responsible for excreting catecholamines, things like norepinephrine, epinephrine. And we’ll talk about that in just a second. The adrenal cortex, or the outer layer, is responsible for excreting mineralocorticoids, glucocorticoids, and androgens. So the adrenal medulla, again the adrenal medulla is the center layer, this horseshoe-shaped center layer of the adrenal glad. It’s made of the specialized sympathetic neurons called chromaffin cells. They don’t have any axons, they don’t have any dendrites. And what they do is when it’s stimulated, epinephrine and norepinephrine are released. Now you’ve probably heard of epinephrine and norepinephrine before. Norepinephrine is a neurotransmitter. Epinephrine, aka adrenaline, plays a role in this fight-or-flight response. So it’s gonna do things like increase our heart rate, increase our blood pressure. It’s going to shift circulation to the skeletal muscle, increase ventilation in the lungs, and it’s going to inhibit some of these quote unquote less important functions. Things like digestion and excretion. The whole purpose of this is to prepare our body for this fight-or-flight response, to get us ready to move. Stop all these things that don’t need to be going on for us to fight or for us to run, and those things would be digestion and excretion. Imagine you’re being chased by a lion. The last thing you want is to be going through the digestive process or the excretion process. You need your heart to be going faster, you need your blood pressure, you need your lungs going. And that’s what is really important in this fight-or-flight response, and epinephrine plays a huge role in that. It also creates this hyperglycemic effect through gluconeogenesis and glycogenolysis. Both of those kinda leading to increasing glucose in our blood. Now why would we want that? It’s going to inhibit insulin, increase glucose in our blood, all for the purpose of increasing the amount of glucose that can get to our brain. We want our brain to be able to function. It’s a massive consumer of glucose, and so we’re really trying to create more glucose, get it all up into the brain. Alright, now how is this associated with the adrenal cortex? So, stress stimulates this medullary cells to secrete all these catecholamines, epinephrine, norepinephrine. And this stimulates the cortex, the adrenal cortex, to release corticosterone. So with that, let’s get into what the adrenal cortex does. Again, the adrenal cortex is this outer layer of the adrenal gland. It’s main purpose is to excrete or release steroid hormones, corticosteroids and corticoids. Now, we have a couple of different kinds of these. We have mineralocorticoids, glucocorticoids, and androgens. Mineralocorticoids act on the kidneys to control electrolyte balance. So aldosterone, what it does is it leads to sodium retention. Now water follows sodium, and so we’re retaining sodium, we’re retaining H20, retaining water. At the same time, this leads to potassium excretion. Retain sodium, water follows sodium, potassium leaves. So that’s kinda the big role of aldosterone with electrolyte balance. Then we also have our glucocorticoids. We have cortisol and hydrocortisone. The main role of these is fat and protein breakdown. It also plays a role in gluconeogenesis which is the creation of glucose. And it has a huge anti-inflammatory effect. Now what you’re gonna see with this is long-term secretion of glucocorticoids, of cortisol and hydrocortisone, is going to lead to a suppression of our immune system. And now if we have this long-term suppression of our immune system, it can lead to something called Cushing’s syndrome. Now we have a whole lesson on that. I invite you to go watch that. Now the lack of secretion over long-term can lead to fluid and electrolyte imbalances. And it can also lead to Addison’s disease. Again we have a whole lesson on that, and I invite you to go watch that. Now we also have the sex steroids, called androgens. They play a role in reproductive anatomy. For males, it plays a role in DHEA which is naturally weak, but it’s converted to testosterone in other tissues. Now the testes are the main source of testosterone and make most of the testosterone in the male body. For females, the adrenal androgens comprise about 50% of all the female needs for androgen. For both male and females, it stimulates the development of secondary sex characteristics like pubic and axillary hair, and it plays a role in sustained libido. So let’s review some of the key points really quick. The… Adrenal glad sits on top of the kidneys. It’s this triangular-shaped gland with two pieces. You have your adrenal medulla in the middle. And you have your adrenal cortex as the outer layer. The adrenal medulla plays a role in catecholamine release, epinephrine, norepinephrine, that plays a role in fight-or-flight. And then we also have our adrenal cortex which plays a role in mineralocorticoids, glucocorticoids, and androgen release. We talked about how those play a role in the body. A big thing to keep in mind here is that the adrenal gland is a main source of our flight-or-fight response. It’s the result of this catecholamine release, again this norepinephrine and epinephrine release, that creates this fight-or-flight response. This is an incredibly important gland. I hope this helps make it a little bit more clear for you guys, and kinda get those key points. Now, like we always say here at NRSNG, go out and be your best self today. Happy nursing.

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MS2EXAM1

Concepts Covered:

  • Circulatory System
  • Emergency Care of the Cardiac Patient
  • Cardiac Disorders
  • Medication Administration
  • Central Nervous System Disorders – Brain
  • Shock
  • Shock
  • Urinary System
  • Adult
  • Respiratory Emergencies
  • Cardiovascular Disorders
  • Postpartum Complications
  • Emergency Care of the Neurological Patient
  • Neurological Emergencies
  • Emergency Care of the Respiratory Patient
  • Pregnancy Risks
  • Vascular Disorders
  • Noninfectious Respiratory Disorder
  • Respiratory System
  • Cardiovascular
  • Endocrine and Metabolic Disorders
  • Hematologic Disorders
  • Disorders of the Adrenal Gland
  • Neurologic and Cognitive Disorders
  • Upper GI Disorders
  • Lower GI Disorders
  • Nervous System
  • Labor Complications
  • Liver & Gallbladder Disorders
  • Oncology Disorders
  • Substance Abuse Disorders
  • Renal and Urinary Disorders
  • Integumentary Disorders
  • Renal Disorders
  • Gastrointestinal Disorders
  • Acute & Chronic Renal Disorders
  • Respiratory Disorders
  • Disorders of Pancreas
  • Disorders of the Posterior Pituitary Gland
  • Endocrine
  • Gastrointestinal
  • Renal
  • Endocrine System
  • Disorders of the Thyroid & Parathyroid Glands
  • Integumentary Disorders
  • Musculoskeletal Trauma
  • Urinary Disorders

Study Plan Lessons

EKG Basics – Live Tutoring Archive
Dysrhythmia Emergencies
Electrical Activity in the Heart
EKG (ECG) Waveforms
The EKG (ECG) Graph
Normal Sinus Rhythm
Sinus Tachycardia
Sinus Bradycardia
Supraventricular Tachycardia (SVT)
Atrial Flutter
Atrial Fibrillation (A Fib)
Premature Ventricular Contraction (PVC)
Ventricular Tachycardia (V-tach)
Ventricular Fibrillation (V Fib)
Procainamide (Pronestyl) Nursing Considerations
Sympatholytics (Alpha & Beta Blockers)
Verapamil (Calan) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Dysrhythmias Labs
Dysrhythmias for Certified Emergency Nursing (CEN)
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Electrolytes Involved in Cardiac (Heart) Conduction
Nursing Care Plan (NCP) for Cardiomyopathy
3rd Degree AV Heart Block (Complete Heart Block)
2nd Degree AV Heart Block Type 2 (Mobitz II)
1st Degree AV Heart Block
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Advanced Cardiovascular Life Support (ACLS)
Acute Coronary Syndrome (ACS)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Obstructive Heart (Cardiac) Defects
Heart (Heart) Failure Exacerbation
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
02.09 12 Lead EKG- Leads 1, 2, 3, aVL, and aVF for CCRN Review
02.14 Shock Stages for CCRN Review
02.15 Hypovolemic Shock for CCRN Review
02.16 Cardiogenic Shock for CCRN Review
02.17 Septic Shock for CCRN Review
Disseminated Intravascular Coagulation (DIC)
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for Distributive Shock
Sepsis Labs
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Sepsis Concept Map
Ischemic (CVA) Stroke Labs
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)
ACLS (Advanced cardiac life support) Drugs
Electrical A&P of the Heart
02.10 12 Lead EKG- Lead V1-V6 for CCRN Review
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
ARDS Case Study (60 min)
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Acute Respiratory Distress
HELLP Syndrome
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology for Heart Failure (CHF)
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Rapid Sequence Intubation
Trach Suctioning
Trach Care
Pacemakers
Myocardial Infarction (MI) Case Study (45 min)
02.12 Myocardial Infarction- Inferior Wall for CCRN Review
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
02.13 Myocardial Infarction – Anterior Septal Wall for CCRN Review
Fluid Volume Deficit
Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)
Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)
02.02 Cardiomyopathy for CCRN Review
Hydralazine
Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)
Nursing Case Study for Rheumatic Heart Disease
06.04 Differentiating Ectopy and Aberrancy for CCRN Review
Coronary Artery Disease Concept Map
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Anti-Platelet Aggregate
Nursing Care Plan (NCP) for Cardiogenic Shock
Mixed (Cardiac) Heart Defects
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Angina
Hemodynamics
Preload and Afterload
Nursing Care and Pathophysiology for Cardiogenic Shock
MI Surgical Intervention
Heart Failure for Certified Emergency Nursing (CEN)
02.05 Calculating PAWP on PEEP for CCRN Review
Heart Failure 2 – Live Tutoring Archive
Nitro Compounds
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Nursing Care and Pathophysiology for Valve Disorders
Cortisone (Cortone) Nursing Considerations
Dexamethasone (Decadron) Nursing Considerations
Famotidine (Pepcid) Nursing Considerations
Gastritis
Gastrointestinal (GI) Bleed Concept Map
Methylprednisolone (Solu-Medrol) Nursing Considerations
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
Parasympathomimetics (Cholinergics) Nursing Considerations
Peptic Ulcer Disease Case Study (60 min)
Tocolytics
Cholecystitis for Certified Emergency Nursing (CEN)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care Plan (NCP) for Cholecystitis
Cirrhosis Case Study (45 min)
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Cirrhosis for Certified Emergency Nursing (CEN)
Esophageal Varices for Certified Emergency Nursing (CEN)
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Hepatitis for Certified Emergency Nursing (CEN)
Liver Cancer
Liver Function Tests
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care Plan (NCP) for Encephalopathy
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan for Liver Cancer
Bowel Obstruction Concept Map
Epispadias and Hypospadias
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan for Hiatal Hernia
Cirrhosis Case Study (45 min)
Colorectal Cancer (colon rectal cancer)
Encephalopathy Case Study (45 min)
Fluid Shifts (Ascites) (Pleural Effusion)
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Liver Cancer
Nephrotic Syndrome
Nephrotic Syndrome Case Study (Peds) (45 min)
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan (NCP) for Nephrotic Syndrome
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan for Liver Cancer
Nursing Case Study for Hepatitis
Stomach Cancer (Gastric Cancer)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care Plan (NCP) for Cholecystitis
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Acute Abdomen for Certified Emergency Nursing (CEN)
Appendicitis
Appendicitis for Certified Emergency Nursing (CEN)
Dialysis & Other Renal Points
Nursing Care and Pathophysiology for Diverticulosis – Diverticulitis
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Peritoneal Dialysis (PD)
Peritonitis for Certified Emergency Nursing (CEN)
Cystic Fibrosis (CF)
Diabetes Mellitus (DM) Module Intro
Diabetes Mellitus & Those Dang Blood Sugars! – Live Tutoring Archive
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Metabolic Acidosis (interpretation and nursing diagnosis)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Chronic Kidney Disease
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Case Study for Diabetic Foot Ulcer
Nursing Case Study for Type 1 Diabetes
Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)
03.02 Diabetes Insipidus for CCRN Review
Diabetes Insipidus Case Study (60 min)
Diabetes Insipidus Nursing Mnemonic (DDD)
Enuresis
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Diabetes Insipidus
03.04 DKA vs HHNK for CCRN Review
05.01 Pancreatitis and Large Bowel Obstruction for CCRN Review
09.05 Chronic Renal Failure for CCRN Review
Adrenal Gland
Diabetes Management
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetic Emergencies for Certified Emergency Nursing (CEN)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
End-Stage Renal Disease (ESRD) for Progressive Care Certified Nurse (PCCN)
Gestational Diabetes (GDM)
Glipizide (Glucotrol) Nursing Considerations
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hyperglycemia for Progressive Care Certified Nurse (PCCN)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Hypoglycemia
Injectable Medications
Insulin
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin Drips
Insulin Mixing
Insulin Mnemonic (Ready, Set, Inject, Love)
IV Infusions (Solutions)
IV Pump Management
Hyperthyroidism Case Study (75 min)
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
09.02 Acute Tubular Necrosis for CCRN Review
Burn Injuries
Burn Injuries
Burn Injury Case Study (60 min)
Burns for Certified Emergency Nursing (CEN)
Compartment Syndrome for Certified Emergency Nursing (CEN)
Electrolyte Imbalances for Progressive Care Certified Nurse (PCCN)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)
Nursing Care Plan for Gastritis
Wound Care – Assessment
Wound Care – Selecting a Dressing