Endocrine System

transcript

Care of the Client with Problems Care of the Client with Problems Related to the Endocrine Related to the Endocrine

SystemSystem

Earl Francis R. Sumile, RNEarl Francis R. Sumile, RNInstructor, College of NursingInstructor, College of Nursing

University of Santo TomasUniversity of Santo Tomas

Endocrine SystemEndocrine System

1.1. PituitaryPituitary

2.2. ThyroidThyroid

3.3. ParathyroidParathyroid

4.4. ThymusThymus

5.5. AdrenalAdrenal

6.6. PancreasPancreas

7.7. GonadsGonads

1.1. Pituitary GlandPituitary Gland

A.A. Anterior lobe Anterior lobe – AdenohypophysisAdenohypophysis– Releases and synthesizes hormonesReleases and synthesizes hormones

B.B. Posterior lobePosterior lobe– NeurohyphosisNeurohyphosis– Does not produce but stores and releasesDoes not produce but stores and releases

A.A. Anterior PituitaryAnterior Pituitary

a.a. Gonadotropic Gonadotropic oror Somatropic Hormone Somatropic Hormone– Stimulates growth of body tissues or bonesStimulates growth of body tissues or bones

b.b. Thryrotropic Thryrotropic oror Thyroid Stimulating Hormone Thyroid Stimulating Hormone (TSH)(TSH)

– Stimulates thyroid gland and secretionsStimulates thyroid gland and secretions

c.c. Adreno-Cortico Tropic Hormone (ACTH)Adreno-Cortico Tropic Hormone (ACTH)– Stimulates steroid production by adrenal cortexStimulates steroid production by adrenal cortex

d.d. Melanocyte Stimulating Hormone (MSH)Melanocyte Stimulating Hormone (MSH)– Stimulates pigmentationStimulates pigmentation

A.A. Anterior PituitaryAnterior Pituitary

e. Luteinizing Hormone (LH)e. Luteinizing Hormone (LH)- In females, ovulation and luteinization of ovarian In females, ovulation and luteinization of ovarian

folliclesfollicles

f. Follicle Stimulating Hormone (FSH)f. Follicle Stimulating Hormone (FSH)- Growth of ovarian follicle in femalesGrowth of ovarian follicle in females- Spermatogenesis in malesSpermatogenesis in males

g. Interstitial Cell Stimulating Hormone (ICSHg. Interstitial Cell Stimulating Hormone (ICSH))- In males, production of testosteroneIn males, production of testosterone

h. Prolactinh. Prolactin- Stimulates mammary tissues and lactationStimulates mammary tissues and lactation

B. Posterior PituitaryB. Posterior Pituitary

a.a. Anti-Diuretic Hormone (ADH) or Anti-Diuretic Hormone (ADH) or VasopressinVasopressin

- Reabsorption of waterReabsorption of water- Decreases urinary outputDecreases urinary output

b.b. OxytocinOxytocin- Ejection of milkEjection of milk- Uterine contractionUterine contraction- Sperm transportSperm transport

2. Thyroid2. Thyroid

a.a. Thryroxin TThryroxin T44

– Metabolism (catabolic phase)Metabolism (catabolic phase)

b.b. Triiodothryronin TTriiodothryronin T33

– Cellular metabolismCellular metabolism

c.c. ThryrocalcitoninThryrocalcitonin– Calcium balanceCalcium balance

3. Parathyroid3. Parathyroid

a.a. ParathormoneParathormone– Regulates calcium and phosphate levelsRegulates calcium and phosphate levels

4. Thymus4. Thymus

a.a. ThymosinThymosin– Incubator of T-lymphocytesIncubator of T-lymphocytes– Cornered mainly with:Cornered mainly with:

GrowthGrowth

MaturationMaturation

Metabolic processesMetabolic processes

Reproduction of target cell or tissueReproduction of target cell or tissue

5. Adrenal 5. Adrenal A. CortexA. Cortex

a.a. GlucocorticoidsGlucocorticoids– GluconeogenesisGluconeogenesis– Regulates blood sugar by conserving glucose and Regulates blood sugar by conserving glucose and

cortisonecortisone

b.b. MineralocorticoidsMineralocorticoids– Aldosterone, corticosteroneAldosterone, corticosterone– Regulates electrolyte balance by Na retention and Regulates electrolyte balance by Na retention and

K excretionK excretion

c.c. Androgens and EstrogensAndrogens and Estrogens– Secondary sex characteristicsSecondary sex characteristics

5. Adrenal 5. Adrenal B. MedullaB. Medulla

a.a. Epinephrine or AdrenalineEpinephrine or Adrenaline– Increases blood pressureIncreases blood pressure– Increases cardiac rateIncreases cardiac rate– Dilates bronchiolesDilates bronchioles

6. Pancreas6. Pancreas

A.A. Islets of LangerhansIslets of Langerhansa.a. InsulinInsulin

Hypoglycemic agentHypoglycemic agent

Metabolism of carbohydrates, proteins and fatsMetabolism of carbohydrates, proteins and fats

b.b. GlucagonGlucagonHyperglycemic agentHyperglycemic agent

Mobilizes glycogen storesMobilizes glycogen stores

Increases blood glucose levelIncreases blood glucose level

7. Gonads7. Gonads

A.A. OvariesOvariesa.a. Estrogen and ProgesteroneEstrogen and Progesterone

Stimulates development of secondary sex Stimulates development of secondary sex characteristicscharacteristics

B.B. TestesTestesa.a. TestosteroneTestosterone

For normal functioning of male reproductive For normal functioning of male reproductive organsorgans

Development male secondary sex characteristicsDevelopment male secondary sex characteristics

Nursing AssessmentNursing Assessment

a.a. Nursing historyNursing historyb.b. Growth and DevelopmentGrowth and Development

– Developmental historyDevelopmental history

c.c. Sexual functioningSexual functioning– Loss of libidoLoss of libido– ImpotenceImpotence– Menstrual cycle or irregularitiesMenstrual cycle or irregularities

d.d. Hair growth; VoiceHair growth; Voicee.e. Changes in the skinChanges in the skinf.f. Emotional stateEmotional stateg.g. Nutritional stateNutritional state

Physical AssessmentPhysical Assessment

1.1. InspectionInspection• HeightHeight• WeightWeight• Body statureBody stature• Muscle wastingMuscle wasting• Hair growth and Hair growth and

distributiondistribution• Skin pigmentationSkin pigmentation

2. Palpation- 2. Palpation- e.g. e.g. thyroid glandthyroid gland• SizeSize• ShapeShape• SymmetrySymmetry• TendernessTenderness• GrowthGrowth

Pituitary GlandPituitary Gland

Diagnostic AssessmentDiagnostic Assessment1.1. HematologicHematologic

Interrelated with adrenal and gonadsInterrelated with adrenal and gonads

2.2. RadiologicRadiologicSkull; CT; MRI; PneumoencephalographySkull; CT; MRI; Pneumoencephalography

3.3. Water Deprivation Test-Water Deprivation Test- no water 4-18 hrs no water 4-18 hrs(+) diabetes insipidus- (+) diabetes insipidus- ↑in volume, no ↑ in urine ↑in volume, no ↑ in urine osmolality; ↓specific gravityosmolality; ↓specific gravity

Disorders of the Pituitary GlandDisorders of the Pituitary Gland

1.1. HyperpituitarismHyperpituitarism a.a. GigantismGigantism

b.b. AcromegalyAcromegaly

2.2. HypopituitarismHypopituitarisma.a. DwarfismDwarfism

b.b. Diabetes InsipidusDiabetes Insipidus

1.1. HyperpituitarismHyperpituitarism

oversecretion because of pituitary tumoroversecretion because of pituitary tumor

A.A.GigantismGigantism• sustained hypersecretion of growth hormone sustained hypersecretion of growth hormone

in childrenin children• General overgrowth of long bones, skeleton General overgrowth of long bones, skeleton

and tissueand tissue• Marked increase in height and weightMarked increase in height and weight

1.1. HyperpituitarismHyperpituitarism

B . AcromegalyB . Acromegaly sustained hypersecretion of growth hormone in sustained hypersecretion of growth hormone in

adults after epiphyseal closureadults after epiphyseal closure• Bone grows wider and thickerBone grows wider and thicker• Extremities are enlargedExtremities are enlarged

Soft tissues on hands or feet enlarged and coarseSoft tissues on hands or feet enlarged and coarse• PrognathismPrognathism

Lengthened lower jawLengthened lower jaw• Bridge of nose broaderBridge of nose broader

a.a. Oily skin and excessive sweatingOily skin and excessive sweating• Hypertrophy of sebacious glandHypertrophy of sebacious gland

b.b. Thickening of vocal chordsThickening of vocal chords• Voice changeVoice change

c.c. Visual impairmentVisual impairment• Pressure on visual pathwayPressure on visual pathway

d.d. Headache, diplopia, blindness, lethargyHeadache, diplopia, blindness, lethargye.e. Gonadotropic hormone increasedGonadotropic hormone increased

• Sexual promiscuity in childrenSexual promiscuity in children

f.f. Increased prolactinIncreased prolactin• Amenorrhea and galactorrheaAmenorrhea and galactorrhea

Management of Management of HyperpituitarismHyperpituitarism

Management of choiceManagement of choice• Surgery (removal of tumor) Surgery (removal of tumor) transpheinoidal transpheinoidal

hypophysectomyhypophysectomy

Nursing interventions post op:Nursing interventions post op:– Proper oral hygiene; no brushing; encourage use of Proper oral hygiene; no brushing; encourage use of

HH22OO22 1;1 gargle 1;1 gargle– No chewing on affected siteNo chewing on affected site– No rough/coarse foodNo rough/coarse food– No sneezing and blowing of nose for 2 weeksNo sneezing and blowing of nose for 2 weeks– No dentures for 10 daysNo dentures for 10 days

2. Hypopituitarism2. Hypopituitarism

• deficiency of pituitary hormonesdeficiency of pituitary hormones• PanhypopituitarismPanhypopituitarism

When both both anterior and posterior lobes fail to secrete When both both anterior and posterior lobes fail to secrete hormoneshormones

Causes:Causes:– HypophysectomyHypophysectomy– Nonsecreting pituitarytumorsNonsecreting pituitarytumors– Pituitary dwarfismPituitary dwarfism– Postpartum pituitary necrosisPostpartum pituitary necrosis– Functional disordersFunctional disorders

Starvation, anorexia nervosa, severe anemia, GI disordersStarvation, anorexia nervosa, severe anemia, GI disorders

A.A. DwarfismDwarfism

Secondary to congenital lack of growth Secondary to congenital lack of growth hormone or space occupying tumorshormone or space occupying tumors• Retardation of growth on 1Retardation of growth on 1stst year, chubby year, chubby• Lack muscular development, delayed pubertyLack muscular development, delayed puberty

• Nursing managementNursing management• Injection of growth hormoneInjection of growth hormone

B. Diabetes InsipidusB. Diabetes Insipidus

Passage of excessive amounts of highly diluted Passage of excessive amounts of highly diluted urineurine

• Diagnostic AssessmentDiagnostic Assessment• (+) water deprivation test(+) water deprivation test

• Nursing ManagementNursing Management• Surgery (removal of tumor)- Surgery (removal of tumor)- transphenoidal transphenoidal

hypophysectomyhypophysectomy• Pitressine tannatePitressine tannate- vasopressin tannate in oil- vasopressin tannate in oil• Salt and protein restricted dietSalt and protein restricted diet

Adrenal GlandAdrenal Gland

• Diagnostic Assessment:Diagnostic Assessment:1.1. Adrenal cortex functionsAdrenal cortex functions

a.a. Hematologic level of steroids Hematologic level of steroids • cortisol, aldosterone, and testosterone levelcortisol, aldosterone, and testosterone level

b.b. Urinary level- 24 hr urine collectionUrinary level- 24 hr urine collection• 17-ketosteroid test17-ketosteroid test

2.2. Adrenal medulla functionAdrenal medulla function• Vanillylmandelic acidVanillylmandelic acid VMA- 24 hrs. urine VMA- 24 hrs. urine

collectioncollection

Disorders of the Adrenal CortexDisorders of the Adrenal Cortex

Addison’s Disease-Addison’s Disease- chronic adreno-cortical chronic adreno-cortical insufficiencyinsufficiency

• Nursing assessment:Nursing assessment:

1.1. Aldosterone deficiencyAldosterone deficiency• Polyuria, dehydration, hypotension, Polyuria, dehydration, hypotension,

decreased cardiac outputdecreased cardiac output

2.2. Glucocorticoid deficiencyGlucocorticoid deficiency• Hypoglycemia, weakness, exhaustion, Hypoglycemia, weakness, exhaustion,

anorexia, weight loss,nausea, vomiting anorexia, weight loss,nausea, vomiting

Disorders of the Adrenal CortexDisorders of the Adrenal Cortex

Nursing assessment:Nursing assessment:

3.3. Androgen deficiencyAndrogen deficiency• Decreased pubic hairDecreased pubic hair

4.4. Increased melanin stimulating hormone, Increased melanin stimulating hormone, increased adenocorticotropic hormone-increased adenocorticotropic hormone-cortisol deficiency-cortisol deficiency-external tan or bronzed external tan or bronzed appearanceappearance

Addison’s CrisisAddison’s Crisis

CausesCauses• surgery, pregnancy, injury, infection, salt loss, surgery, pregnancy, injury, infection, salt loss,

second degree profuse diaphoresissecond degree profuse diaphoresis• Sudden profound astheniaSudden profound asthenia• Severe abdominal, back and leg painSevere abdominal, back and leg pain• Hyperpyrexia followed by hypothermiaHyperpyrexia followed by hypothermia• Peripheral vascular collapse, comaPeripheral vascular collapse, coma• Renal shutdownRenal shutdown

Nursing management:Nursing management:

• Hydrocortisone (solu-cortef) IVHydrocortisone (solu-cortef) IV• Monitor vital signsMonitor vital signs• Prevent infectionPrevent infection• Daily weightDaily weight• Electrolyte balanceElectrolyte balance• High carbohydrate and protein dietHigh carbohydrate and protein diet

Disorders of Adrenal CortexDisorders of Adrenal Cortex

• AldosteronismAldosteronism- aldosterone excess- aldosterone excessa.a. Primary (Primary (Conn’s syndromeConn’s syndrome))

b.b. Secondary Secondary • Results from the presence of exogenous Results from the presence of exogenous

conditions that stumulates renin-angiotensin-conditions that stumulates renin-angiotensin-aldosterone systemaldosterone system

a.a. Muscular weakness, paralysis, edemaMuscular weakness, paralysis, edemab.b. Intermittent paresthesiaIntermittent paresthesiac.c. Increased cardiac output, increased KIncreased cardiac output, increased K

• ECG changesECG changes

d.d. Diminished deep tendon reflexesDiminished deep tendon reflexese.e. Increased blood volumeIncreased blood volumef.f. Decreased concentrating kidney abilityDecreased concentrating kidney abilityg.g. Polyuria, polydipsia, nocturiaPolyuria, polydipsia, nocturia

Nursing ManagementNursing Management

a.a. K-sparing diureticsK-sparing diuretics

b.b. K replacementK replacement

c.c. Na restrictionNa restriction

Disorders of Adrenal CortexDisorders of Adrenal Cortex

Cushing’s syndromeCushing’s syndromeoveractivity of adrenal glands with overactivity of adrenal glands with

hypersecretion of glucocorticoidshypersecretion of glucocorticoids

Etiology:Etiology:Adrenal tumor, adrenal hyperplasia, ectopic Adrenal tumor, adrenal hyperplasia, ectopic

adrenocorticotropic hormone-secreting tumor, adrenocorticotropic hormone-secreting tumor, intake of synthetic glucocorticoids-intake of synthetic glucocorticoids- iatrogenic iatrogenic cushing’s syndromecushing’s syndrome

Nursing AssesmentNursing Assesment

a.a. Persistent hyperglycemia- Leads to diabetes Persistent hyperglycemia- Leads to diabetes mellitusmellitus

b.b. Protein tissue wasting- Stunted growth in Protein tissue wasting- Stunted growth in childrenchildren

c.c. Capillary fragility- EcchymosisCapillary fragility- Ecchymosisd.d. Osteoporosis- Pathogenic fractures; kyphosis; Osteoporosis- Pathogenic fractures; kyphosis;

height lossheight losse.e. Potassium depletion- Hypokalemia, arrythmiasPotassium depletion- Hypokalemia, arrythmias

Nursing AssesmentNursing Assesment

f.f. Sodium and water retention- edema and Sodium and water retention- edema and hypertensionhypertension

g.g. Abnormal fat distribution- moon faceAbnormal fat distribution- moon face• Buffalo humpBuffalo hump- cervico-dorsal fat pad on - cervico-dorsal fat pad on

neck neck truncal obesitytruncal obesity with slender limbs with slender limbsh.h. Increased susceptibility to infectionIncreased susceptibility to infectioni.i. Increased production of androgens- mild Increased production of androgens- mild

virilism, virilism, acne, thinning of scalp and hair andacne, thinning of scalp and hair and hirsutismhirsutism

Nursing managementNursing management

a.a. Surgery Surgery • hypophysectomy, hypophysectomy, adrenalectomyadrenalectomy, total or , total or

bilateral bilateral

b.b. IrradiationIrradiation

c.c. PharmacotherapeuticsPharmacotherapeutics• Chlorophenyl dichloroethane (Chlorophenyl dichloroethane (DDDDDD); );

aminoglutethimide (aminoglutethimide (eliptenelipten); metyrapone ); metyrapone ((metapironemetapirone)-long term)-long term

Disorders of the Adrenal Disorders of the Adrenal MedullaMedulla

• PheochromocytomaPheochromocytoma• Tumor which results in ypersecretion of Tumor which results in ypersecretion of

adrenal medullaadrenal medulla• Typically benign; curable if detected earlyTypically benign; curable if detected early• Precipitating factors: pregnancy and stressPrecipitating factors: pregnancy and stress

Nursing Assessment and Nursing Assessment and ManagementManagement

• Nursing AssessmentNursing Assessment• Hypertension- main symptomHypertension- main symptom• Persistent, fluctuating, pounding headachePersistent, fluctuating, pounding headache• Sweating palpitations, nausea or vomitingSweating palpitations, nausea or vomiting• Hyperglycemia and glycosuriaHyperglycemia and glycosuria• Shock-like stateShock-like state

• Pupils dilate, cold extremities, diaphoresisPupils dilate, cold extremities, diaphoresis

• Management or choiceManagement or choice• Surgical excisionSurgical excision

Thyroid GlandThyroid Gland

• Iodine regulates body metabolism (oxygen Iodine regulates body metabolism (oxygen consumption and heat production)consumption and heat production)

• Regulate growth and developmentRegulate growth and developmentTSHTSH- from anterior pituitary stimulates thyroid - from anterior pituitary stimulates thyroid

gland to release thyroxine, triiodothyromine, gland to release thyroxine, triiodothyromine, thyrocalcitoninthyrocalcitonin

EuthyroidEuthyroid- normal thyroid function and - normal thyroid function and secretionsecretion

Diagnostic Assessment:Diagnostic Assessment:

1.1. Thyroid functionThyroid functiona.a. Serum thryroxineSerum thryroxineb.b. Serum triiodothyronineSerum triiodothyronine

c.c. Triiodothyronin (TTriiodothyronin (T33) resin uptake test) resin uptake test

d.d. Radioactive iodine (Radioactive iodine (131131I) uptake and excretion testI) uptake and excretion teste.e. Serum TSHSerum TSHf.f. Thyrotropin- releasing hormoneThyrotropin- releasing hormoneg.g. Serum cholesterol- increase in patients with Serum cholesterol- increase in patients with

myxedemia or hypothyrodismmyxedemia or hypothyrodism

Diagnostic AssessmentDiagnostic Assessment

h. PBI (h. PBI (Protein Bound IodineProtein Bound Iodine)- measures the )- measures the amount of iodine binded in blood protein.amount of iodine binded in blood protein.

• Preparation: Preparation: no food or drug containing iodine 24 no food or drug containing iodine 24 hours before the testhours before the test

i. BMR (i. BMR (Basal Metabolic RateBasal Metabolic Rate)- indirect measure )- indirect measure of amount of oxygen consumed in the body of amount of oxygen consumed in the body under basal conditions during given time.under basal conditions during given time.

• Preparation:Preparation: proper sleep or rest night before the proper sleep or rest night before the preocedurepreocedure

• Fasting for 6-8 hoursFasting for 6-8 hours• Done before getting out of bedDone before getting out of bed

Disorders of the Thyroid GlandDisorders of the Thyroid Gland

• GoiterGoiter- enlargement of the Thyroid Gland- enlargement of the Thyroid Gland• EtiologyEtiology

a.a. lack of iodinelack of iodine• (simple goiter), pregnancy, lactation, iodine deficient areas(simple goiter), pregnancy, lactation, iodine deficient areas

b.b. Intake of too much Intake of too much goitrogenic foodsgoitrogenic foods• Nutritional goitrogens that inhibit thyroxine productionNutritional goitrogens that inhibit thyroxine production• Such as cabbage, soybeans, peanuts, spinach, peaches, Such as cabbage, soybeans, peanuts, spinach, peaches,

radish, strawberriesradish, strawberries

c.c. Inflammation- thyroiditisInflammation- thyroiditis

d.d. Thyroid cancerThyroid cancer

a.a. PreventionPrevention• Iodized salt, avoid goitrogenic foodsIodized salt, avoid goitrogenic foods

b.b. Lugol’s solutionLugol’s solution or or Potassium Iodide Potassium Iodide Saturated SolutionSaturated Solution (KISS) (KISS)

• Dose comes in drops; mixed with cold water and Dose comes in drops; mixed with cold water and given with a strawgiven with a straw

c.c. Thryroid hormone replacementThryroid hormone replacement• Watch for thyrotoxicosisWatch for thyrotoxicosis

• Tachycardia, increase appetite, diarrhea, Tachycardia, increase appetite, diarrhea, sweating, tremor, palpitations, shortness of breathsweating, tremor, palpitations, shortness of breath

Disorders of the Thyroid GlandDisorders of the Thyroid Gland

• Hyperthyroidism; Grave’s DiseaseHyperthyroidism; Grave’s Disease (Basedow’s disease)(Basedow’s disease)• Excessive production of TExcessive production of T33 or T or T44 or both or both

• Toxic diffuse goiter or exophthalmic goiterToxic diffuse goiter or exophthalmic goiter

• Incidence:Incidence: females females

a.a. Agitated, nervous, irritableAgitated, nervous, irritable

b.b. Goiter (excessive thyroid hormone in Goiter (excessive thyroid hormone in blood)blood)

c.c. Heat intoleranceHeat intolerance

d.d. Increased appetiteIncreased appetite

e.e. AmenorrheaAmenorrhea

f.f. ExophthalmusExophthalmus• Abnormal protrusion of eyesAbnormal protrusion of eyes

a.a. Antithyroid therapyAntithyroid therapy• To suppress thyroid secretionsTo suppress thyroid secretions• ProphylthiouracilProphylthiouracil PTU; PTU; methimazolemethimazole tapazole tapazole

b.b. Iodine- lugol’s solution or KISSIodine- lugol’s solution or KISS• To decrease the vascularity and size of the thyroidTo decrease the vascularity and size of the thyroid

c.c. Radioactive Iodine Therapy Radioactive Iodine Therapy • to middle aged and elderly clientsto middle aged and elderly clients

d. Surgeryd. Surgery

• When patient is euthyroidWhen patient is euthyroid• Post-operativePost-operative

• Semifowler’s position when consciousSemifowler’s position when conscious

• tracheostomy set at bedsidetracheostomy set at bedside

• Ambulate 2Ambulate 2ndnd post-operative day post-operative day

• ComplicationsComplications• HemorrhageHemorrhage

• Check dressings by sliding hand on the Check dressings by sliding hand on the patient’s napepatient’s nape

• Respiratory obstructionRespiratory obstruction• Laryngeal edema- observe for sudden Laryngeal edema- observe for sudden

difficulty in breathingdifficulty in breathing• Keep tracheostomy set at bedsideKeep tracheostomy set at bedside

Nursing Management: complicationsNursing Management: complications

• Accidental injury to the laryngeal nerveAccidental injury to the laryngeal nerve• Watch for decreasing voiceWatch for decreasing voice

• Hypocalcemia or tetanyHypocalcemia or tetany• Accidental removal of parathyroid glandAccidental removal of parathyroid gland• (+) (+) Chovstek’s signChovstek’s sign

• Spasms of the facial muscles when tappedSpasms of the facial muscles when tapped• (+) (+) Troussaeu’s signTroussaeu’s sign

• Carpopedal spasms upon constriction of Carpopedal spasms upon constriction of the extremitiesthe extremities

Nursing Management: complicationsNursing Management: complications

• Management on HypocalcemiaManagement on Hypocalcemia• Increase Ca – 100% sol of calcium carbonate Increase Ca – 100% sol of calcium carbonate

or gluconate or calcium lactateor gluconate or calcium lactate• Calcium supplement and Vit DCalcium supplement and Vit D

*Thyroid storm*Thyroid storm

• Overactivity of thryroid characterized by Overactivity of thryroid characterized by increased temperature, severe tachycardia, increased temperature, severe tachycardia, delirium, dehydration and irritability, hypotensiondelirium, dehydration and irritability, hypotension

• Nursing management:Nursing management:• Cool darkened quiet roomCool darkened quiet room• Antipyretic oral or parenteral antithyroid drug followed Antipyretic oral or parenteral antithyroid drug followed

by K iodine; corticosteroids, propanolol- to relieve by K iodine; corticosteroids, propanolol- to relieve heart arrythmiasheart arrythmias

HypothyroidismHypothyroidism

• CretinismCretinism• Usually silent babyUsually silent baby• Severe hypothyroid condition of infancy due Severe hypothyroid condition of infancy due

to deficiency of thyroid hormone synthesis to deficiency of thyroid hormone synthesis during fetal life or soon after birthduring fetal life or soon after birth

• Nursing assessment:Nursing assessment:a.a.Physical and mental retardationPhysical and mental retardationb.b.Shunted statureShunted staturec.c.Wide open mouth and lolling tongueWide open mouth and lolling tongued.d.Small eyes and half closed with swollen lidsSmall eyes and half closed with swollen lidse.e.Stolid expressionless faceStolid expressionless facef.f. Squat figureSquat figureg.g.Muddy dry skinMuddy dry skin

• MyxedemaMyxedema- deficiency in thyroid synthesis in adult- deficiency in thyroid synthesis in adult• Asymptomatic to full blownAsymptomatic to full blown

• Nursing management:Nursing management:• Fatigue and apatheticFatigue and apathetic• Obesity: puffy and edematous with course featuresObesity: puffy and edematous with course features• Dry and sparse hair, dry flaky skinDry and sparse hair, dry flaky skin• Severe intolerance to cold decreased metabolic rateSevere intolerance to cold decreased metabolic rate• Fecal impaction, hypersensitive to narcotics, Fecal impaction, hypersensitive to narcotics,

barbiturates, and anestheticsbarbiturates, and anesthetics• MANAGEMENT:MANAGEMENT:

• Hormone therapy for life (synthroid, cytomel)Hormone therapy for life (synthroid, cytomel)

Pancreas- Islets of LangerhansPancreas- Islets of Langerhans

• Controls endocrine functionsControls endocrine functions

• Insulin- from beta cells- fat or protein Insulin- from beta cells- fat or protein metabolism- hypoglycemic agentmetabolism- hypoglycemic agent

• Glucagon- from alpha-cells- hyperglycemic Glucagon- from alpha-cells- hyperglycemic agentagent

Diabetes MellitusDiabetes Mellitus

• Chronic disorder of carbohydrate metabolism Chronic disorder of carbohydrate metabolism (imbalance between the supply and demand)(imbalance between the supply and demand)

• Types:Types:• Type I- insulin dependent (!DDM or juvenile diabetes)Type I- insulin dependent (!DDM or juvenile diabetes)• Type II- non-insulin dependent (NIDDM or maturity Type II- non-insulin dependent (NIDDM or maturity

onset)onset)

1.1. PolyuriaPolyuria• Water not reabsorbed by renal tunules because Water not reabsorbed by renal tunules because

osmotic activity of glucoseosmotic activity of glucose

2.2. PolydipsiaPolydipsia• Severe dehydration, causes thirstSevere dehydration, causes thirst

3.3. PolyphagiaPolyphagia• Tissue breakdown and wasting causes starvationTissue breakdown and wasting causes starvation

4.4. Weight lossWeight loss (IDDM)- no glucose available to (IDDM)- no glucose available to cells, therefore body breaks down fat and cells, therefore body breaks down fat and protein stores for energyprotein stores for energy

Hematologic studiesHematologic studiesFasting Blood SugarFasting Blood Sugar (FBS)- (FBS)-

N=80-120 mgs%N=80-120 mgs%Post Prandial Blood Sugar Post Prandial Blood Sugar (PPBS)(PPBS)

Ability to dispose of glucose load in 2 hrsAbility to dispose of glucose load in 2 hrsN= 150%N= 150%

Oral Glucose Tolerance Test Oral Glucose Tolerance Test (OGTT)(OGTT)Prep: NPO 10-12 hrs; baseline sugar in blood and urine; Prep: NPO 10-12 hrs; baseline sugar in blood and urine;

100gms glucose diet is given; blood or urine is taken after 30 100gms glucose diet is given; blood or urine is taken after 30 mins; 1 hr; 1 ½ hrs and 2 hrs after- N=150mgs/dlmins; 1 hr; 1 ½ hrs and 2 hrs after- N=150mgs/dl

Glucosylated HGBGlucosylated HGBGlucose bonds to hemoglobin – measures blood glucose Glucose bonds to hemoglobin – measures blood glucose

levels120 dayslevels120 daysN= 3.5-8.5%N= 3.5-8.5%

Urine testUrine testa.a. Benedict’s testBenedict’s test

• use of benedict’s solutionuse of benedict’s solution

b.b. ClinitestClinitest• use of clinitest tabletuse of clinitest tablet

c.c. Testape-Testape-• use of tes-tapeuse of tes-tape

d.d. Diastix-Diastix-• use of urine stripuse of urine strip

1.1. Activity (exercise)Activity (exercise)

2.2. DietDiet

3.3. DrugsDrugs• A. Oral hypoglycemicsA. Oral hypoglycemics

• Triggers the islets of langerhans to produce insulin; Triggers the islets of langerhans to produce insulin; sulfonylureassulfonylureas

a.a. First generation- Orinase, Tolinase, Diabenese, First generation- Orinase, Tolinase, Diabenese, DymelorDymelor

b.b. Second generation- Diabeta, Glucotrol, MicronaseSecond generation- Diabeta, Glucotrol, Micronase

• Complication (oral hypoglycemic):Complication (oral hypoglycemic):• HHNK- hyperglycemic, Hyperosmolar, Non-HHNK- hyperglycemic, Hyperosmolar, Non-

Ketotic ComaKetotic Coma• Non-insulin dependent diabetics who have enough Non-insulin dependent diabetics who have enough

insulin but unable to use insulin to combat insulin but unable to use insulin to combat hyperglycemiahyperglycemia

• Nursing AssessmentNursing Assessment• Same as DKA but no kussmaul breathing and Same as DKA but no kussmaul breathing and

acetone breathacetone breath

B. Insulin- B. Insulin- Lower blood sugar by transport of Lower blood sugar by transport of glucose to cells and inhibits conversion of glucose to cells and inhibits conversion of glucogen to glucoseglucogen to glucose

TypeType InsulinInsulin ColorColor PeakPeak

Rapid actingRapid acting RegularRegular

SemilenteSemilente

ClearClear

CloudyCloudy

2-4 hrs2-4 hrs

Intermediate Intermediate actingacting

NPHNPH

LenteLente

CloudyCloudy

6-8 hrs6-8 hrs

Long actingLong acting Protamine/ZincProtamine/Zinc

UltralenteUltralente

CloudyCloudy

18+ hrs18+ hrs

8-12 hrs8-12 hrs

PremixedPremixed

(NPH/Req)(NPH/Req)

Humulin 50/50Humulin 50/50

Humulin 70/30Humulin 70/30

CloudyCloudy

2-8 hrs2-8 hrs

2-12 hrs2-12 hrs

Complications (insulin)Complications (insulin)• Tissue hyperthrophy or atrophy or Tissue hyperthrophy or atrophy or lipodystrophylipodystrophy• Diabetic KetoacidosisDiabetic Ketoacidosis

• Fatty acids are broken down to ketone bodies because of Fatty acids are broken down to ketone bodies because of absolute or relative deficiency in insulinabsolute or relative deficiency in insulin

EtiologyEtiology• too little insulin dosetoo little insulin dose• Omitting insulin doseOmitting insulin dose• Increase need for insulin due to surgery, trauma, pregnancy, Increase need for insulin due to surgery, trauma, pregnancy,

puberty, or febrile illnesspuberty, or febrile illness• Insulin resistance secondary to development of insulin Insulin resistance secondary to development of insulin

antibodies or severe emotional stressantibodies or severe emotional stress

Nursing AssessmentNursing Assessmenta.a. Polyuria, thirst, nausea or vomiting, dry mucus Polyuria, thirst, nausea or vomiting, dry mucus

membrane, cracked lipsmembrane, cracked lipsb.b. Hot flushed skin, weight lossHot flushed skin, weight lossc.c. Abdominal pain, and rigidity (Na deficiency)Abdominal pain, and rigidity (Na deficiency)d.d. Kussmaul respirationsKussmaul respirationse.e. Acetone breathAcetone breathf.f. Weakness, paralysis, paresthesiaWeakness, paralysis, paresthesiag.g. Hypotension, oliguria, coma, stuporHypotension, oliguria, coma, stuporh.h. ABG’s, metabolic acidosis, with compensated ABG’s, metabolic acidosis, with compensated

respiratory alkalosisrespiratory alkalosis

Nursing management:Nursing management:a.a. InsulinInsulin

b.b. IVF-NS or1/2 NSIVF-NS or1/2 NS

c.c. K phosphate when urine is adequateK phosphate when urine is adequate

d.d. Na HCONa HCO33, if pH < 7.0, if pH < 7.0

Hypoglycemia (insulin reaction)Hypoglycemia (insulin reaction)

Etiology:Etiology:a.a. Overdose of insulin or sulfonylureaOverdose of insulin or sulfonylurea

b.b. Omission of meals or eating less than prescribed Omission of meals or eating less than prescribed foodfood

c.c. Overexertion without compensating with increase in Overexertion without compensating with increase in carbohydratescarbohydrates

d.d. Nutritional and fluid imbalance secondary to nausea Nutritional and fluid imbalance secondary to nausea and vomitingand vomiting

HypoglycemiaHypoglycemia

Nursing assessmentNursing assessment::a.a. Headache, weakness, irritability, apprehensionHeadache, weakness, irritability, apprehensionb.b. Lack of muscular coordinationLack of muscular coordinationc.c. DiaphoreticDiaphoreticd.d. Behaves in bizarre, psychotic fashionBehaves in bizarre, psychotic fashione.e. Palor, bradycardia, visual disturbancesPalor, bradycardia, visual disturbancesf.f. Alterations in mental or level of consciousnessAlterations in mental or level of consciousnessg.g. Confusion or hallucinationsConfusion or hallucinations

HypoglycemiaHypoglycemia

Nursing managementNursing managementa.a.Candy, glucose paste, sugar cubes, orange Candy, glucose paste, sugar cubes, orange

juice if awakejuice if awakeb.b. DD5050W IVP or glucagonW IVP or glucagon

c.c. Epinephrine, steroids, diaoxide if with insulinemiaEpinephrine, steroids, diaoxide if with insulinemia

Long term complicationsLong term complications

1.1. Degenerative vascular changesDegenerative vascular changes1.1.AtherosclerosisAtherosclerosis2.2.MicroangiopathyMicroangiopathy- major hallmark of DM - major hallmark of DM

destruction of small blood vessels (eyes and destruction of small blood vessels (eyes and kidneys)kidneys)

2.2. Ocular disordersOcular disorders1.1.Blurred visionBlurred vision2.2.CataractsCataracts3.3.Diabetic retinopathyDiabetic retinopathy

• -major cause of blindness in diabetes-major cause of blindness in diabetes4.4.Retinal detachmentRetinal detachment

Long term complicationsLong term complications

3.3. Kidney diseaseKidney disease• Current pyelonephritisCurrent pyelonephritis• Nephropathy (kimmelsteil-wilson syndrome)Nephropathy (kimmelsteil-wilson syndrome)

4.4. NeuropathyNeuropathy• Peripheral nerve degenerationPeripheral nerve degeneration

5.5. infectionsinfections

Endocrine System

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