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FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 11
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 22
MEtaBoliC MEtaBoliC aLteRaTiONsaLteRaTiONs
Francis Jordan Ramos Cusi, RNFrancis Jordan Ramos Cusi, RN
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ENDOENDOCRINE SYSTEMCRINE SYSTEM
Glands Glands HormonesHormones ReceptorsReceptors
Amines
Polypeptides
Steroids
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GLANDS OF GLANDS OF THE THE ENDOCRINE ENDOCRINE SYSTEMSYSTEM
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HYPOTHALAMUSHYPOTHALAMUS
Lies dorsalLies dorsal to the pituitary to the pituitary gland gland
Nervous-EndoNervous-Endo RegulatorRegulator ata ako! : A-PTH ata ako! : A-PTH Hypophyseal stalkHypophyseal stalk TRH, GnRH, GHRH, CRH, TRH, GnRH, GHRH, CRH,
Dopamine Dopamine
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FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 77
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PINEAL GLANDPINEAL GLAND
ConeCone-shaped-shaped Back of the Back of the thirdthird ventricle of ventricle of
the brain the brain Mystery-mystery!Mystery-mystery! MelatoninMelatonin
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PITUITARY GLANDPITUITARY GLAND
UUnder (below) nder (below) hypothamalushypothamalus BBi-functional lobes + 1i-functional lobes + 1
Anterior and Posterior Anterior and Posterior
+ pars intermedia+ pars intermedia AAKA: KA: HypophysisHypophysis SSmall (1 gram)mall (1 gram)
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ANTERIOR PITUITARYANTERIOR PITUITARY
ADENOADENOhypophysis hypophysis Hormones: Hormones: Proteins; 2Proteins; 2ndnd-messanger system; -messanger system;
regulated by hormonal stimuliregulated by hormonal stimuli TT – Thyroid stimulating hormone – Thyroid stimulating hormone (TSH; (TSH;
Thyrotropin)Thyrotropin) FF – Follicle stimulating hormone – Follicle stimulating hormone LL – Luteinizing hormone – Luteinizing hormone AA – Adrenocorticotropic hormone – Adrenocorticotropic hormone PP - Prolactin - Prolactin SS – Somatotropin (Growth Hormone) – Somatotropin (Growth Hormone)
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POSTERIOR PITUITARYPOSTERIOR PITUITARY
Pede na rinPede na rin Hamak na Hamak na imbakanimbakan OOXYTOCIN XYTOCIN AANTIDIURETIC HORMONE NTIDIURETIC HORMONE
(Vasopressin)(Vasopressin)
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TTHHYROID GLAND YROID GLAND
HH urray! urray! HHurray! urray! Le – Le – HH – eg – eg HH – either side – either side HH – ist – istHHmus connectedmus connected TriiodotTriiodotHHyronine (T3) yronine (T3)
– – more potent more potent TTHHyroxine – lessyroxine – less Calcito-Calcito-HH-nin-nin
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FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 1414
PARATHYROID GLANDSPARATHYROID GLANDS
Tagong kabit Tagong kabit Kaya hanggang 8, Kaya hanggang 8,
4 ang legal (daw)4 ang legal (daw) PARATHORMONE:PARATHORMONE:
most popular regulator of most popular regulator of calcium ions calcium ions
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THYMUS GLANDTHYMUS GLAND
Upper thoraxUpper thorax Immuno-Immuno-endoendoThymosin : T-lymphocytesThymosin : T-lymphocytes
maturation maturation
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ENDOCRINE PANCREASENDOCRINE PANCREAS
Pancreatic Pancreatic
islets : New-islets : New-NSONSO reg reg
GA-BIDSGA-BIDS
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ADRENAL GLANDS ADRENAL GLANDS
ADRENALINE:ADRENALINE: RR – esembles bean (each) – esembles bean (each) UU – ri’y pituitary (glandular – ri’y pituitary (glandular
; neural); neural) SS – ituated top of the kidney – ituated top of the kidney H H – ati: Cortex(co), Medulla(mines)– ati: Cortex(co), Medulla(mines)
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GONADSGONADS
OVARIES: OVARIES:
mainly mainly estradiolestradiolTESTES: TESTES: testosteronetestosterone
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These are blood examinations These are blood examinations for the levels of individual for the levels of individual hormoneshormones
Measurements can also be done Measurements can also be done after stimulation and after stimulation and suppression of the secretions- suppression of the secretions- Stimulation and Suppression Stimulation and Suppression teststests
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Usually done to diagnose Usually done to diagnose hypo/hyperthyroidismhypo/hyperthyroidism
If T3 is elevated, T4 is elevated If T3 is elevated, T4 is elevated and TSH is depressedand TSH is depressed Primary HYPERthyroidismPrimary HYPERthyroidism
If T3 is depressed,T4 is If T3 is depressed,T4 is depressed and TSH is depressed and TSH is elevatedelevated Primary Primary HYPOthyoidismHYPOthyoidism
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This is a thyroid function test This is a thyroid function test to measure the absorption of to measure the absorption of the injected iodine isotope by the injected iodine isotope by the thyroid tissuethe thyroid tissue
Increased uptake may indicate Increased uptake may indicate HYPER functioning glandHYPER functioning gland
Decreased uptake my indicate Decreased uptake my indicate HYPO functioning glandHYPO functioning gland
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Performed to identify nodules Performed to identify nodules or growth in the thyroid glandor growth in the thyroid gland
RAI is usedRAI is used Pretest- Check for pregnancy, Pretest- Check for pregnancy,
Thyroid medication may be Thyroid medication may be withheld temporarily, advise withheld temporarily, advise NPO NPO
Post-test- Ensure proper Post-test- Ensure proper disposal of body wastesdisposal of body wastes
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Aids in the diagnosis of Aids in the diagnosis of DiabetesDiabetes
Pre-test: NPO for 8 hoursPre-test: NPO for 8 hours Normal FBS- 80-109 mg/dLNormal FBS- 80-109 mg/dL DM- 126 mg/dL and aboveDM- 126 mg/dL and above
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Aids in the diagnosis of DMAids in the diagnosis of DM Pre-test: Provide high-carbohydrate foods Pre-test: Provide high-carbohydrate foods
x 3 days, instruct to avoid caffeine, x 3 days, instruct to avoid caffeine, alcohol and smoking, NPO 10 hours prior alcohol and smoking, NPO 10 hours prior to testto test
Post-test: avoid strenuous activity for 8 Post-test: avoid strenuous activity for 8 hourshours
Normal OGTT- 1 and 2 hours post-Normal OGTT- 1 and 2 hours post-prandial- glucose is less than 200 mg/dLprandial- glucose is less than 200 mg/dL
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Blood glucose bound to Blood glucose bound to RBC hemoglobinRBC hemoglobin
Reflects how well blood Reflects how well blood glucose is controlled for the glucose is controlled for the past 3 monthspast 3 months
FASTING is NOT required!FASTING is NOT required!
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Normal level- Normal level- expressed as expressed as percentage of total percentage of total hemoglobinhemoglobin
N- 4-7%N- 4-7% Good control- 7.5%or Good control- 7.5%or
lessless Fair control- 7.5 % to Fair control- 7.5 % to
8.9%8.9% Poor control- 9% and Poor control- 9% and
aboveabove
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DISORDERS OF THE DISORDERS OF THE ENDOCRINE GLANDENDOCRINE GLAND
Disorders are generally Disorders are generally grouped into:grouped into:
HYPERHYPER- when the gland - when the gland secretes excessive hormonessecretes excessive hormones
HYPOHYPO- when the gland does - when the gland does not secrete enough hormonesnot secrete enough hormones
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Hyper and Hypo can be Hyper and Hypo can be classified as classified as PRIMARYPRIMARY when when the Gland itself is the problem the Gland itself is the problem or or SECONDARYSECONDARY when the when the pituitary or the hypothalamus pituitary or the hypothalamus is causing the problemis causing the problem
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THYROID THYROID DISORDERSDISORDERS
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HYPERTIREDDYTIESHYPERTIREDDYTIES
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A hypothyroid state A hypothyroid state characterized by decreased characterized by decreased secretions of T3 and T4secretions of T3 and T4
CAUSES: CAUSES: Hypofunctioning tumor, IDG, Hypofunctioning tumor, IDG,
Pituitary tumor, Ablation Pituitary tumor, Ablation therapy, Surgical removal of therapy, Surgical removal of thyroidthyroid
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Decreased T3 and T4Decreased T3 and T4 decreased basal decreased basal metabolism metabolism
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1. Lethargy and fatigue1. Lethargy and fatigue 2. Weakness and 2. Weakness and
paresthesiaparesthesia 3. COLD intolerance3. COLD intolerance 4. Weight gain4. Weight gain 5. Bradycardia, 5. Bradycardia,
constipationconstipation
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6. Dry hair and skin, loss of 6. Dry hair and skin, loss of body hairbody hair
7. Generalized puffiness 7. Generalized puffiness and edema around the eyes and edema around the eyes and face8. Forgetfulness and face8. Forgetfulness and memory lossand memory loss
9. Slowness of movement9. Slowness of movement 10. Menstrual irregularities 10. Menstrual irregularities
and cardiac irregularitiesand cardiac irregularities
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1. Monitor VS especially HR1. Monitor VS especially HR 2. Administer hormone 2. Administer hormone
replacement: usually replacement: usually Levothyroxine( Synthroid)-should Levothyroxine( Synthroid)-should be taken on an empty stomachbe taken on an empty stomach
3. Instruct patient to eat 3. Instruct patient to eat LOW LOW calorie, LOW cholesterol and LOW calorie, LOW cholesterol and LOW fat dietfat diet
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4. Manage constipation 4. Manage constipation appropriatelyappropriately
5. Provide a 5. Provide a WARM environmentWARM environment 6. Avoid sedatives and narcotics 6. Avoid sedatives and narcotics
because of because of increased sensitivity increased sensitivity to these medicationsto these medications
7. Instruct patient to report 7. Instruct patient to report chest pain promptlychest pain promptly
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Called GRAVE’S Called GRAVE’S DISEASEDISEASE
A hyperthyroid A hyperthyroid state characterized state characterized by increased by increased circulating T3 and circulating T3 and T4 T4
CAUSES:CAUSES: Auto-immune Auto-immune
disorder, toxic disorder, toxic goiter and tumorgoiter and tumor
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Increased hormone Increased hormone activityactivity increased Basal increased Basal MetabolismMetabolism
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1. 1. Weight lossWeight loss 2. HEAT intolerance2. HEAT intolerance 3. Hypertension3. Hypertension 4. Tachycardia and 4. Tachycardia and
palpitationspalpitations 5. Exopthalmos5. Exopthalmos 6. Diarrhea6. Diarrhea
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7. Warm skin7. Warm skin 8. Diaphoresis8. Diaphoresis 9. Smooth and soft skin9. Smooth and soft skin
Oligomenorrhea to amenorrheaOligomenorrhea to amenorrhea 10. Fine tremors and 10. Fine tremors and
nervousnessnervousness 11. Irritability, mood swings, 11. Irritability, mood swings,
personality changes and personality changes and agitationagitation
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1. Provide adequate rest 1. Provide adequate rest periods in a quiet room periods in a quiet room
2. Administer anti-thyroid 2. Administer anti-thyroid medications that block medications that block hormone synthesis- hormone synthesis- Methimazole and PTUMethimazole and PTU
3. Provide a 3. Provide a HIGH-calorie HIGH-calorie diet, HIGH proteindiet, HIGH protein
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4. Manage diarrhea4. Manage diarrhea 5. Provide a cool and quiet 5. Provide a cool and quiet
environmentenvironment 6. Avoid giving stimulants6. Avoid giving stimulants 7. Provide eye care7. Provide eye care
Hypoallergenic tape for eyelid Hypoallergenic tape for eyelid closureclosure
8. Administer PROPRANOLOL 8. Administer PROPRANOLOL for tachycardiafor tachycardia
9. Administer IODIONE 9. Administer IODIONE preparation- Lugol’s solution preparation- Lugol’s solution and SSKI to inhibit the release and SSKI to inhibit the release of T3 and T4of T3 and T4
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10. Prepare clients for 10. Prepare clients for Radioactive iodine therapyRadioactive iodine therapy
11. Prepare patient for 11. Prepare patient for thyroidectomythyroidectomy
12. Manage thyroid storm 12. Manage thyroid storm appropriatelyappropriately
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An acute LIFE-threatening An acute LIFE-threatening condition characterized by condition characterized by excessive thyroid hormoneexcessive thyroid hormone
CAUSE: CAUSE: Manipulation of the thyroid Manipulation of the thyroid
during surgery causing the during surgery causing the release of excessive release of excessive hormones in the bloodhormones in the blood
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1. 1. HIGH feverHIGH fever 2. 2. TachycardiaTachycardia and and TachypneaTachypnea 3. Systolic HYPERtension3. Systolic HYPERtension 4. Delirium and coma4. Delirium and coma 5. Severe vomiting and diarrhea5. Severe vomiting and diarrhea 6. Restlessness, Agitation, 6. Restlessness, Agitation,
confusion and Seizuresconfusion and Seizures
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1. Maintain PATENT airway 1. Maintain PATENT airway and adequate ventilationand adequate ventilation
2. Administer anti-thyroid 2. Administer anti-thyroid medications such as Lugol’s medications such as Lugol’s solution, Propranolol, and solution, Propranolol, and GlucocorticoidsGlucocorticoids
3. Monitor VS3. Monitor VS
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4. Monitor Cardiac rhythms4. Monitor Cardiac rhythms 5. Administer PARACETAMOL ( 5. Administer PARACETAMOL (
not Aspirin) for FEVERnot Aspirin) for FEVER 6. Manage Seizures as required.6. Manage Seizures as required. 7. Provide a quiet environment7. Provide a quiet environment
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Removal of the thyroid glandRemoval of the thyroid gland
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1. Obtain VS and weight1. Obtain VS and weight 2. Assess for Electrolyte levels, 2. Assess for Electrolyte levels,
glucose levels and T3/T4 levelsglucose levels and T3/T4 levels 3. Provide pre-operative teaching 3. Provide pre-operative teaching
like coughing and deep like coughing and deep breathing, early ambulation and breathing, early ambulation and support of the neck when movingsupport of the neck when moving
4. Administer prescribed 4. Administer prescribed medicationsmedications
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1. Position patient: 1. Position patient: Semi-Semi-Fowler’s, neck on neutral positionFowler’s, neck on neutral position
2. Monitor for respiratory 2. Monitor for respiratory distress- apparatus at bedside- distress- apparatus at bedside- tracheostomy set, O2 tank and tracheostomy set, O2 tank and suction machine!suction machine!
3. Check for edema and bleeding 3. Check for edema and bleeding by noting the dressing anteriorly by noting the dressing anteriorly and at the back of the neckand at the back of the neck
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4. LIMIT client talking4. LIMIT client talking 5. Assess for 5. Assess for HOARSENESSHOARSENESS
Expected to be present only Expected to be present only initially, limit excess initially, limit excess vocalizationvocalization
If persistent, may indicate If persistent, may indicate damage to laryngeal nerve!damage to laryngeal nerve!
6. Monitor for Laryngeal Nerve 6. Monitor for Laryngeal Nerve damage – Respiratory distress, damage – Respiratory distress, Dysphonia, voice changes, Dysphonia, voice changes, Dysphagia and restlessnessDysphagia and restlessness
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7. Monitor for signs of 7. Monitor for signs of HYPOCALCEMIAHYPOCALCEMIA and tetany and tetany due to trauma of the due to trauma of the parathyroidparathyroid
8. Prepare 8. Prepare Calcium Calcium gluconategluconate
9. Monitor for thyroid storm9. Monitor for thyroid storm
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PARATHYROID DISORDERSPARATHYROID DISORDERS
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Hypo-secretion of Hypo-secretion of parathyroid hormoneparathyroid hormone
CAUSES: CAUSES: Tumor, removal of the Tumor, removal of the
gland during thyroid gland during thyroid surgerysurgery
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Decreased PTHDecreased PTH deranged deranged calcium metabolismcalcium metabolism
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1. Signs of HYPOCALCEMIA1. Signs of HYPOCALCEMIA 2. Numbness and tingling 2. Numbness and tingling
sensation on the facesensation on the face 3. Muscle cramps 3. Muscle cramps 4. (+) Trosseau’s and (+) 4. (+) Trosseau’s and (+)
Chvostek’s signsChvostek’s signs 5. Bronchospasms, 5. Bronchospasms,
laryngospasms, and laryngospasms, and dysphagiadysphagia
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6. Cardiac dysrhythmias6. Cardiac dysrhythmias 7. Hypotension7. Hypotension 8. Anxiety, irritability ands 8. Anxiety, irritability ands
depressiondepression
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Monitor VS and signs of Monitor VS and signs of HYPOcalcemiaHYPOcalcemia
Initiate seizure precautions Initiate seizure precautions and managementand management
Place a tracheostomy set. O2 Place a tracheostomy set. O2 tank and suction at the bedsidetank and suction at the bedside
Prepare CALCIUM gluconatePrepare CALCIUM gluconate Provide a HIGH-calcium and Provide a HIGH-calcium and
LOW phosphate diet LOW phosphate diet
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Advise client to eat Vitamin Advise client to eat Vitamin D rich foodsD rich foods
Administer Phosphate Administer Phosphate binding drugsbinding drugs
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Hyper-Hyper-secretion of secretion of the glandthe gland
CAUSE:CAUSE: TumorTumor
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Increase PTHIncrease PTH increased increased CALCIUM levels in the CALCIUM levels in the bodybody
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Fatigue and muscle Fatigue and muscle weakness/painweakness/pain
Skeletal pain and tendernessSkeletal pain and tenderness FracturesFractures Anorexia/N/V epigastric painAnorexia/N/V epigastric pain ConstipationConstipation
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HypertensionHypertension Cardiac Dysrhythmias Cardiac Dysrhythmias Renal StonesRenal Stones
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Monitor VS, Cardiac rhythm, I and OMonitor VS, Cardiac rhythm, I and O Monitor for signs of renal stones, Monitor for signs of renal stones,
skeletal fractures. Strain all urine.skeletal fractures. Strain all urine. Provide adequate fluids- force fluidsProvide adequate fluids- force fluids Administer prescribed Furosemide to Administer prescribed Furosemide to
lower calcium levels lower calcium levels Administer NORMAL salineAdminister NORMAL saline
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Administer calcium Administer calcium chelatorschelators
Administer CALCITONINAdminister CALCITONIN Prepare the patient for Prepare the patient for
surgerysurgery
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ADRENOCORTICAL ADRENOCORTICAL DISORDERSDISORDERS
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Decreased secretion of Decreased secretion of adrenal cortex hormones, adrenal cortex hormones, especially glucocorticoids especially glucocorticoids and mineralocorticoidsand mineralocorticoids
CAUSE: CAUSE: Tumor, idopathicTumor, idopathic
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Decreased GlucocorticoidsDecreased Glucocorticoids decreased resistance to stressdecreased resistance to stress
Decreased Decreased mineralocorticoidsmineralocorticoids decreased retention of decreased retention of sodium and water sodium and water
HypovolemiaHypovolemia
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Weight lossWeight loss
GI disturbancesGI disturbances
Muscle weakness, lethargy Muscle weakness, lethargy and fatigueand fatigue
HyponatremiaHyponatremia
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HyperkalemiaHyperkalemia
HypoglycemiaHypoglycemia
dehydration and hypovolemiadehydration and hypovolemia
Increased skin pigmentationIncreased skin pigmentation
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Monitor VS especially BP Monitor VS especially BP Monitor weight and I and OMonitor weight and I and O Monitor blood glucose level Monitor blood glucose level
and Kand K Administer hormonal agents Administer hormonal agents
as prescribedas prescribed
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Observe for ADDISONIAN Observe for ADDISONIAN crisiscrisis
Educate the client regarding Educate the client regarding lifelong treatment, lifelong treatment, avoidance of strenuous avoidance of strenuous activities, stress and seeking activities, stress and seeking prompt consult during illnessprompt consult during illness
Provide a Provide a high-protein, high high-protein, high carbohydrate and increased carbohydrate and increased sodium intakesodium intake
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A life-threatening disorders A life-threatening disorders caused by acute severe caused by acute severe adrenal insufficiencyadrenal insufficiency
CAUSES:CAUSES: Severe stress, infection, Severe stress, infection,
trauma or surgerytrauma or surgery
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Overwhelming stimuliOverwhelming stimuli mobilize body defensemobilize body defense decreased stress decreased stress hormoneshormones inadequate inadequate copingcoping
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Severe headacheSevere headache Severe painSevere pain Severe weaknessSevere weakness Severe hypotensionSevere hypotension Signs of ShockSigns of Shock
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Administer IV glucocorticoids, Administer IV glucocorticoids, usually hydrocortisoneusually hydrocortisone
Monitor VS frequentlyMonitor VS frequently Monitor I and O, neurological Monitor I and O, neurological
status, electrolyte imbalances status, electrolyte imbalances and blood glucoseand blood glucose
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Administer IVFAdminister IVF Maintain bed restMaintain bed rest Administer prescribed Administer prescribed
antibioticsantibiotics
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A condition resulting from the A condition resulting from the hyper-secretion of hyper-secretion of glucocorticoids from the glucocorticoids from the adrenal cortexadrenal cortex
CAUSES: CAUSES: Pituitary tumor, adrenal tumor, Pituitary tumor, adrenal tumor,
abuse of steroidsabuse of steroids
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Increased GlucocorticoidsIncreased Glucocorticoids exaggerated effects of the exaggerated effects of the hormonehormone
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Normal functions of Normal functions of CortisolCortisol
Exaggerated Exaggerated functions functions
1. Gluconeogenesis1. Gluconeogenesis HYPERGLYCEMIAHYPERGLYCEMIA
2. Protein 2. Protein breakdownbreakdown
OSTEOPOROSISS, OSTEOPOROSISS, delayed wound delayed wound healinghealing
Purplish striae , Purplish striae , BleedingBleeding
Muscle wastingMuscle wasting
3. Fat breakdown3. Fat breakdown THIN extremity, THIN extremity, Truncal depositionTruncal deposition
4. Decreased WBC4. Decreased WBC IMMUNOSUPPRESSIOIMMUNOSUPPRESSIONN
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Functions of Functions of MineralocorticoidsMineralocorticoids
Exaggerated functionsExaggerated functions
1. Sodium Retention1. Sodium Retention HypernatremiaHypernatremia
2.Secondary water 2.Secondary water retentionretention
Hypervolema- Hypervolema- HypertensionHypertension
3. Potassium excretion3. Potassium excretion HYPOKALEMIAHYPOKALEMIA
Function of androgen: Function of androgen: Hair growthHair growth
HIRSUTISMHIRSUTISM
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Generalized muscle Generalized muscle weakness and wastingweakness and wasting
Truncal obesityTruncal obesity Moon-faceMoon-face Buffalo humpBuffalo hump Easy bruisabilityEasy bruisability
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Reddish-purplish striae on Reddish-purplish striae on the abdomen and thighsthe abdomen and thighs
Hirsutism and acneHirsutism and acne HypertensionHypertension HyperglycemiaHyperglycemia OsteoporosisOsteoporosis AmenorrheaAmenorrhea
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 9393
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 9494
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 9595
Serum cortisol levelSerum cortisol level
Serum glucose and Serum glucose and electrolyteselectrolytes
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 9696
Monitor I and O , weight and Monitor I and O , weight and VSVS
Monitor laboratory values- Monitor laboratory values- glucose, Na, K and Caglucose, Na, K and Ca
Provide meticulous skin careProvide meticulous skin care Administer prescribed Administer prescribed
medications like medications like aminogluthetimide to inhibit aminogluthetimide to inhibit adrenal hyperfunctioningadrenal hyperfunctioning
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 9797
Prepare client for surgical Prepare client for surgical management- pituitary management- pituitary surgery and adrenalectomysurgery and adrenalectomy
Protect patient from infectionProtect patient from infection Improve body imageImprove body image Provide a LOW carbohydrate, Provide a LOW carbohydrate,
LOW sodium and HIGH proteinLOW sodium and HIGH protein
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 9898
ADRENOMEDULLARY ADRENOMEDULLARY DISORDERDISORDER
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 9999
Increased secretion of Increased secretion of epinephrine and nor-epinephrine and nor-epinephrine by the adrenal epinephrine by the adrenal medullamedulla
CAUSE: TumorCAUSE: Tumor
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 100100
Increased Adrenergic Increased Adrenergic hormoneshormones exaggerated exaggerated sympathetic effectssympathetic effects
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 101101
HypertensionHypertension Severe headacheSevere headache PalpitationsPalpitations TachycardiaTachycardia Profuse sweating and FlushingProfuse sweating and Flushing Weight loss, tremorsWeight loss, tremors Hyperglycemia and glycosuriaHyperglycemia and glycosuria
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 102102
Monitor VS especially BPMonitor VS especially BP Monitor for HYPERTENSIVE Monitor for HYPERTENSIVE
crisiscrisis Avoid stimulation that can Avoid stimulation that can
cause increased BPcause increased BP Administer Anti-hypertensive Administer Anti-hypertensive
agents like alpha-adrenergic agents like alpha-adrenergic blockers- Phenoxybenzamineblockers- Phenoxybenzamine
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 103103
Prepare Phentolamine for Prepare Phentolamine for hypertensive crisishypertensive crisis
Monitor blood glucose and Monitor blood glucose and urine glucoseurine glucose
Promote adequate rest and Promote adequate rest and sleep periodssleep periods
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 104104
Provide HIGH calorie foods Provide HIGH calorie foods and Vitamins/mineral and Vitamins/mineral supplementssupplements
Prepare patient for Prepare patient for possible surgerypossible surgery
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 105105
ANTERIOR PITUITARY ANTERIOR PITUITARY DISORDERSDISORDERS
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 106106
Hyposecretion of the anterior Hyposecretion of the anterior pituitary glandpituitary gland
CAUSES: Congenital, Post-partal CAUSES: Congenital, Post-partal necrosis, infection and tumornecrosis, infection and tumor
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 107107
Depends on the major Depends on the major hormone/s depletedhormone/s depleted
FindingsFindingsRetarded physical growth due Retarded physical growth due to decreased GHto decreased GH dwarfism dwarfismLow intellectual developmentLow intellectual developmentPoor development of Poor development of secondary sexual secondary sexual characteristicscharacteristics
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 108108
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 109109
Provide emotional support Provide emotional support to the familyto the family
Encourage client and family Encourage client and family to express feelingsto express feelings
Administer prescribed Administer prescribed hormonal replacement hormonal replacement therapytherapy
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 110110
The hyper-secretion of the The hyper-secretion of the glandgland
ACROMEGALYACROMEGALY CAUSES: tumor, congenital CAUSES: tumor, congenital
disorderdisorder
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 111111
Depends on the Depends on the hormone/s that hormone/s that is/are increasedis/are increased
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 112112
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 113113
Increased growthIncreased growth Gigantism Gigantism or Acromegalyor Acromegaly
Large and thick hands and feetLarge and thick hands and feet Visual disturbancesVisual disturbances Hypertension, hyperglycemiaHypertension, hyperglycemia OrganomegalyOrganomegaly
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 114114
Provide emotional support Provide emotional support to clients and familyto clients and family
Provide frequent skin careProvide frequent skin care Prepare patient for surgery- Prepare patient for surgery-
removal of pituitaryremoval of pituitary gland gland
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 115115
Monitor VS, LOC and Monitor VS, LOC and neurologic statusneurologic status
Place patient on Semi-Place patient on Semi-Fowler’sFowler’s
Monitor for Increased ICP, Monitor for Increased ICP, bleeding, CSF leakagebleeding, CSF leakage
Instruct patient to AVOID Instruct patient to AVOID sneezing, coughing and sneezing, coughing and nose-blowingnose-blowing
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 116116
Monitor development of DI- Monitor development of DI- measure I and Omeasure I and O
Administer prescribed Administer prescribed medications- antibiotics, medications- antibiotics, analgesics and steroidsanalgesics and steroids
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 117117
POSTERIOR PITUITARY POSTERIOR PITUITARY DISORDERSDISORDERS
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 118118
A hypo-secretion of ADHA hypo-secretion of ADH
CAUSES: CAUSES: Conditions that increase Conditions that increase
ICP, Surgical removal of ICP, Surgical removal of post pit. tumorpost pit. tumor
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 119119
Decreased ADHDecreased ADH failure of failure of tubular re-absorption of tubular re-absorption of waterwater increased urine volume increased urine volume
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 120120
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 121121
Polyuria of more than 4 liters Polyuria of more than 4 liters of urine/dayof urine/day
PolydipsiaPolydipsia Signs of DehydrationSigns of Dehydration Muscle pain and weaknessMuscle pain and weakness Postural hypotension and Postural hypotension and
tachycardiatachycardia
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 122122
Urinary Specific gravityUrinary Specific gravity very low, 1.006 or lessvery low, 1.006 or less
Serum Sodium levelsSerum Sodium levels high high
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 123123
Monitor VS, neurologic status and Monitor VS, neurologic status and cardiovascular statuscardiovascular status
Monitor Intake and OutputMonitor Intake and Output
Monitor urine specific gravityMonitor urine specific gravity
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 124124
Provide adequate fluidsProvide adequate fluids
Administer Chlorpropamide Administer Chlorpropamide or Clofibrate as prescribed or Clofibrate as prescribed to increaseto increase the action of the action of ADH if decreasedADH if decreased
Administer VASOPRESIN. Administer VASOPRESIN. Desmopressin or Lypressin Desmopressin or Lypressin are given intranasal. are given intranasal. Pitressin is given IMPitressin is given IM
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 125125
Hyper-secretion of ADH Hyper-secretion of ADH abnormallyabnormally
CAUSES: CAUSES: Tumor, paraneoplastic Tumor, paraneoplastic
syndromessyndromes
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 126126
Increased ADHIncreased ADH water re- water re-absorptionabsorption water water intoxication, hypervolemiaintoxication, hypervolemia
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 127127
Urine specific gravity is Urine specific gravity is increased (concentrated)increased (concentrated)
HyponatremiaHyponatremia
CBC showsCBC shows hemodilutionhemodilution
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 128128
Signs of HypervolemiaSigns of Hypervolemia
Mental status changesMental status changes
Abnormal weight gainAbnormal weight gain
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 129129
HypertensionHypertension
Anorexia, Nausea and Anorexia, Nausea and VomitingVomiting
HYPOnatremiaHYPOnatremia
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 130130
Monitor VS and neurologic Monitor VS and neurologic statusstatus
Provide safe environmentProvide safe environment
Restrict fluid intake (less Restrict fluid intake (less than 500cc/day)than 500cc/day)
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 131131
Monitor I and O and daily Monitor I and O and daily weightweight
Administer Diuretics and IVF Administer Diuretics and IVF carefullycarefully
Administer prescribed Administer prescribed DemeclocyclineDemeclocycline to inhibit action to inhibit action of ADH in the kidneyof ADH in the kidney
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 132132
ENDO-PANCREAS ENDO-PANCREAS DISORDERDISORDER
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 133133
General informationGeneral information Diabetes mellitus represents a Diabetes mellitus represents a
heterogeneous group of chronic heterogeneous group of chronic disorders characterized by disorders characterized by hyperglycemia.hyperglycemia.
Hyperglycemia is due to total or partial Hyperglycemia is due to total or partial insulin deficiency or insensitivity of the insulin deficiency or insensitivity of the cells to insulin.cells to insulin.
Characterized by disorders in the Characterized by disorders in the metabolism of carbohydrates, fat and metabolism of carbohydrates, fat and protein, as well as changes in the protein, as well as changes in the structure and function of blood vesselsstructure and function of blood vessels
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 134134
Most common endocrine problem; Most common endocrine problem; affects over 11 million people in affects over 11 million people in the USthe US
Exact etiology unknown, Exact etiology unknown, causative factors may includecausative factors may include Genetics, viruses, and/or Genetics, viruses, and/or
autoimmune response in type Iautoimmune response in type I Genetics and obesity in type IIGenetics and obesity in type II
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 135135
TypesTypes Type I (insulin-Type I (insulin-
dependent dependent diabetes diabetes mellitus mellitus [IDDM])[IDDM]) cells in cells in the islets of the islets of Langerhans in Langerhans in the pancreas the pancreas resulting in little resulting in little or no insulin or no insulin production; production; requires insulin requires insulin injectionsinjections
Usually occurs in Usually occurs in children or in children or in nonobese adultsnonobese adults
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 136136
Type II (non-insulin-dependent Type II (non-insulin-dependent diabetes mellitus [NIDDM])diabetes mellitus [NIDDM])
May result from a partial deficiency of insulin May result from a partial deficiency of insulin production and/or an insensitivity of the cells to production and/or an insensitivity of the cells to insulininsulin
Usually occurs in obese adults over 40Usually occurs in obese adults over 40
Diabetes associated with other conditions Diabetes associated with other conditions or syndromes, e.g., pancreatic disease, or syndromes, e.g., pancreatic disease, Cushing’s syndrome, use of certain drugs Cushing’s syndrome, use of certain drugs (steroids, thiazide diuretics, oral (steroids, thiazide diuretics, oral contraceptives)contraceptives)
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 137137
Lack of insulin causes hyperglycemia Lack of insulin causes hyperglycemia (insulin is necessary for the transport of (insulin is necessary for the transport of glucose across the cell membrane).glucose across the cell membrane).
Hypergycemia leads to osmotic diuresis Hypergycemia leads to osmotic diuresis as large amounts of glucose pas through as large amounts of glucose pas through the kidney; results in polyuria and the kidney; results in polyuria and glycosuriaglycosuria
Diuresis leads to cellular dehydration and Diuresis leads to cellular dehydration and fluid and electrolyte depletion causing fluid and electrolyte depletion causing polydipsia (excessive thirst).polydipsia (excessive thirst).
Polyphagia (hunger and increased Polyphagia (hunger and increased appetite) results from cellular starvation appetite) results from cellular starvation
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 138138
The body turns to fats and protein for energy; The body turns to fats and protein for energy; but in the absence of glucose in the cell, fats but in the absence of glucose in the cell, fats cannot be completely metabolized and ketones cannot be completely metabolized and ketones (intermediate products of fat metabolism) are (intermediate products of fat metabolism) are produced.produced.
This leads to ketonemia, ketonuria (contributes This leads to ketonemia, ketonuria (contributes to osmotic diuresis), and metabolic acidosis to osmotic diuresis), and metabolic acidosis (ketones are acid bodies)(ketones are acid bodies)
Ketones act as CNS depressants and can cause Ketones act as CNS depressants and can cause coma.coma.
Excess loss of fluids and electrolytes leads to Excess loss of fluids and electrolytes leads to hypovolemia, hypotension renal failure, and hypovolemia, hypotension renal failure, and decreased blood flow to the brain resulting in decreased blood flow to the brain resulting in coma and death unless treated.coma and death unless treated.
Acute complications of diabetes include diabetic Acute complications of diabetes include diabetic ketoacidosis insulin reaction hyperglycemic ketoacidosis insulin reaction hyperglycemic insulin reaction hyperglycemicinsulin reaction hyperglycemic
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 139139
Type I: insulin, diet, exercise Type I: insulin, diet, exercise Type II: ideally managed by diet and Type II: ideally managed by diet and
exercise; may need oral exercise; may need oral hypoglycemic or occasionally insulin hypoglycemic or occasionally insulin if diet and exercise are not effective if diet and exercise are not effective in controlling hyperglycemia; insulin in controlling hyperglycemia; insulin needed for acute stresses, e.g., needed for acute stresses, e.g., surgery, infectionsurgery, infection
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 140140
Diet Diet Type I: consistency is imperative to Type I: consistency is imperative to
avoid hypoglycemiaavoid hypoglycemia Type II: weight loss is important since it Type II: weight loss is important since it
decreases insulin resistance decreases insulin resistance High fiber, low fat diet also High fiber, low fat diet also
recommendedrecommended
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 141141
Drug therapyDrug therapy Insulin: used for Type I diabetes (also Insulin: used for Type I diabetes (also
occasionally used in Type II diabetes)occasionally used in Type II diabetes) short acting: used in treating ketoacidosis; short acting: used in treating ketoacidosis;
during surgery, infection, trauma; during surgery, infection, trauma; management of poorly controlled diabetes; management of poorly controlled diabetes; to supplement longer-acting insulin’sto supplement longer-acting insulin’s
intermediate; used for maintenance intermediate; used for maintenance therapy therapy
Long acting: used for maintenance therapy Long acting: used for maintenance therapy in clients who experience hyperglycemia in clients who experience hyperglycemia during the night with intermediate-acting during the night with intermediate-acting insulin insulin
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 142142
Various preparations of short-, Various preparations of short-, intermediate-, and long acting insulins intermediate-, and long acting insulins are available are available
Insulin preparations can consist of Insulin preparations can consist of mixture of beef and pork insulin, pure mixture of beef and pork insulin, pure beef, pure pork, or human insulin. beef, pure pork, or human insulin. Human insulin is the purest insulin and Human insulin is the purest insulin and has the lowest antigenic effect.has the lowest antigenic effect.
Human insulin is recommended for all Human insulin is recommended for all newly diagnosed Type I diabetics, Type newly diagnosed Type I diabetics, Type II diabetics who need short-term insulin II diabetics who need short-term insulin therapy, the pregnant client, and therapy, the pregnant client, and diabetic clients with insulin allergy or diabetic clients with insulin allergy or severe insulin resistance.severe insulin resistance.
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 143143
Insulin pumpsInsulin pumps are small, externally are small, externally worn devices that worn devices that closely mimic closely mimic normal pancreatic functioningnormal pancreatic functioning. . Insulin pumps contain a 3 ml sringe Insulin pumps contain a 3 ml sringe attached to a long (42 inch), attached to a long (42 inch), narrow-lumen tube with a needle or narrow-lumen tube with a needle or Teflon catheter is inserted into the Teflon catheter is inserted into the subcutaneous tissue (usually on the subcutaneous tissue (usually on the abdomen) and secured with tape or abdomen) and secured with tape or a transparent dressing. The needle a transparent dressing. The needle or catheter is changed at least or catheter is changed at least every 3 days. The pump is worn every 3 days. The pump is worn either on a belt or in a pocket. The either on a belt or in a pocket. The pump uses only regular insulin. pump uses only regular insulin. Insulin can be administered via the Insulin can be administered via the basal rate (usually 0.5-2.0 units/hr) basal rate (usually 0.5-2.0 units/hr) and by a bolus dose (which is and by a bolus dose (which is activated by a series of button activated by a series of button pushes) prior to each meal.pushes) prior to each meal.
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 144144
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 145145
All types: polyuria, polydipsia, All types: polyuria, polydipsia, polyphagia, fatigue, blurred vision, polyphagia, fatigue, blurred vision, susceptibility to infection susceptibility to infection
Type I: anorexia, nausea, vomiting, Type I: anorexia, nausea, vomiting, weight lossweight loss
Type II: obesity; frequently no other Type II: obesity; frequently no other symptoms symptoms
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 146146
Diagnostic testsDiagnostic tests Fasting blood sugarFasting blood sugar
a level of 140 mg/dl or greater on at least a level of 140 mg/dl or greater on at least two occasions confirms diabetes mellitus two occasions confirms diabetes mellitus
may normal in Type II diabetes may normal in Type II diabetes Postprandial blood sugar: elevated Postprandial blood sugar: elevated Oral glucose tolerance test (most Oral glucose tolerance test (most
sensitive test): elevatedsensitive test): elevated Glycosolated hemoglobin (hemoglobin Glycosolated hemoglobin (hemoglobin
A) elevatedA) elevated
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 147147
Administer insulin or oral hypoglycemic agents Administer insulin or oral hypoglycemic agents as ordered; monitor for hypoglycemia, as ordered; monitor for hypoglycemia, especially during period of drug’s speak action especially during period of drug’s speak action
Provide special diet as orderedProvide special diet as ordered Ensure that the client is eating all meals.Ensure that the client is eating all meals. If all food is not ingested, provide appropriate If all food is not ingested, provide appropriate
substitutes according to the exchange lists or give substitutes according to the exchange lists or give measured amount of orange juice to substitute for measured amount of orange juice to substitute for leftover food; provide snack later in the day.leftover food; provide snack later in the day.
Monitor urine sugar and acetone (freshly Monitor urine sugar and acetone (freshly avoided specimen)avoided specimen)
Perform finger sticks to monitor blood glucose Perform finger sticks to monitor blood glucose levels as ordered (more accurate than urine levels as ordered (more accurate than urine tests).tests).
Observe for signs of hypo/hyperglycemia.Observe for signs of hypo/hyperglycemia.
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 148148
Provide meticulous skin care and Provide meticulous skin care and prevent injury.prevent injury.
Maintain I&O; weight daily.Maintain I&O; weight daily. Provide emotional support; assist Provide emotional support; assist
client in adapting to change n life-client in adapting to change n life-style and body image.style and body image.
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 149149
Observe for chronic complications and Observe for chronic complications and plan care accordingly.plan care accordingly. Atherosclerosis: leads to coronary artery Atherosclerosis: leads to coronary artery
disease, MI, CVA, and peripheral vascular disease, MI, CVA, and peripheral vascular disease.disease.
Microangiopathy: most commonly affects eyes Microangiopathy: most commonly affects eyes and kidneys and kidneys
Kidney disease Kidney disease recurrent pyelonephritis recurrent pyelonephritis diabetic nephropathy diabetic nephropathy
Ocular disorders Ocular disorders 1. premature cataracts1. premature cataracts 2. diabetic retinopathy2. diabetic retinopathy
Peripheral neuropathyPeripheral neuropathy 1. affects peripheral and autonomic nervous 1. affects peripheral and autonomic nervous
systems.systems. 2. causes diarrhea, constipation, neurogenic 2. causes diarrhea, constipation, neurogenic
bladder, impotence, decreased sweating bladder, impotence, decreased sweating
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 150150
Provide client teaching and Provide client teaching and discharge planning concerningdischarge planning concerning Disease processDisease process DietDiet
Client should be able to plan meals using Client should be able to plan meals using exchange lists before discharge exchange lists before discharge
emphasize importance of regularity of emphasize importance of regularity of meals; never skip mealsmeals; never skip meals
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 151151
Insulin Insulin How to draw up into syringe How to draw up into syringe
gently roll vial between palms of handsgently roll vial between palms of hands draw up insulin using sterile technique.draw up insulin using sterile technique.
Injection technique Injection technique systematically rotate sites to prevent systematically rotate sites to prevent
lipodystrophy (hypertrophy or atrophy of tissue)lipodystrophy (hypertrophy or atrophy of tissue) insert needle at a 45˚ or 90˚ angle depending insert needle at a 45˚ or 90˚ angle depending
on amount of adipose tissueon amount of adipose tissue May store current vial of insulin at room May store current vial of insulin at room
temperature; refrigerate extra supplies.temperature; refrigerate extra supplies. Provide many opportunities for return Provide many opportunities for return
demonstration demonstration Oral hypoglycemic agentsOral hypoglycemic agents
stress importance of taking the drug stress importance of taking the drug regularly regularly
avoid alcohol intake while on medication avoid alcohol intake while on medication
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 152152
Urine testing (not very accurate Urine testing (not very accurate reflection of blood glucose level) reflection of blood glucose level) May be satisfactory for Type II diabetics May be satisfactory for Type II diabetics
since therapy are more stable.since therapy are more stable. Use Clinitest, Test-tape, Diastix for glucose Use Clinitest, Test-tape, Diastix for glucose
testingtesting Perform tests before meals and at bedtime.Perform tests before meals and at bedtime. Use freshly voided specimen.Use freshly voided specimen.
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 153153
Be consistent in brand of urine test used.Be consistent in brand of urine test used. Report result in percentages.Report result in percentages. Report results to physician if results are Report results to physician if results are
greater than 1%, especially if experiencing greater than 1%, especially if experiencing symptoms of hyperglycemiasymptoms of hyperglycemia
Urine testing for ketones should be done Urine testing for ketones should be done by Type I diabetic clients when there is by Type I diabetic clients when there is persistent glycosuria, increased blood persistent glycosuria, increased blood glucose levels, or if the client is not feeling glucose levels, or if the client is not feeling well (Acetestwell (Acetest
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 154154
Blood glucose Blood glucose monitoring monitoring Instruct 1. Use Instruct 1. Use
for Type I for Type I diabetic clients diabetic clients since it gives since it gives exact blood exact blood glucose level and glucose level and also detects also detects hypoglycemia.hypoglycemia.
client in finger-client in finger-stick technique, stick technique, use of monitor use of monitor device (if used), device (if used), and recording and recording and utilization of and utilization of test results.test results.
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 155155
General careGeneral care perform good oral hygiene and have perform good oral hygiene and have
regular dental exams.regular dental exams. have regular eye exams.have regular eye exams. care for “sick days” (e.g., cold or flu)care for “sick days” (e.g., cold or flu)
a. do not omit insulin or oral hypoglycemic a. do not omit insulin or oral hypoglycemic agents since infection causes increased blood agents since infection causes increased blood sugar.sugar.
b. notify physician.b. notify physician. c. monitor urine or blood glucose levels and c. monitor urine or blood glucose levels and
urine ketones frequently.urine ketones frequently. d. if nausea and/or vomiting occurs, sip on clear d. if nausea and/or vomiting occurs, sip on clear
liquids with simple sugars.liquids with simple sugars.
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 156156
Foot careFoot care wash feet with mild soap and wash feet with mild soap and
water and p at dry.water and p at dry. apply lanolin to feet to prevent apply lanolin to feet to prevent
drying and cracking drying and cracking cut toenails straight acrosscut toenails straight across avoid constricting garments avoid constricting garments
such s garters.such s garters. wear clean, absorbent socks wear clean, absorbent socks
(cotton or wool)(cotton or wool) purchase properly fitting shoes purchase properly fitting shoes
and bread new shoes in and bread new shoes in graduallygradually
never go barefootnever go barefoot inspect feet daily and notify inspect feet daily and notify
physician if cuts, blisters, or physician if cuts, blisters, or breaks in skin occur.breaks in skin occur.
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 157157
Exercise Exercise undertake regular exercise; avoid sporadic, undertake regular exercise; avoid sporadic,
vigorous exercisevigorous exercise food intake may need to be increased food intake may need to be increased
before exercisingbefore exercising exercise is best performed after meals exercise is best performed after meals
when the blood sugar is risingwhen the blood sugar is rising
ComplicationsComplications learn to recognize signs and symptoms of learn to recognize signs and symptoms of
hypo/hyperglycemia hypo/hyperglycemia eat candy or drink orange juice with sugar eat candy or drink orange juice with sugar
added for insulin reaction (hypoglycemia).added for insulin reaction (hypoglycemia).
Need to wear a Medic- Alert braceletNeed to wear a Medic- Alert bracelet
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 158158
Selected EndocrineSelected EndocrinePHARMACOLOGYPHARMACOLOGY
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 159159
Enhance re-absorption of water in Enhance re-absorption of water in the kidneysthe kidneys
Used in DIUsed in DI Desmopressin and Lypressin Desmopressin and Lypressin
intranasallyintranasally Pitressin IMPitressin IM
Endocrine MedicationsEndocrine Medications
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 160160
Endocrine MedicationsEndocrine Medications
SIDE-effectsSIDE-effects Flushing and headacheFlushing and headache Water intoxicationWater intoxication
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 161161
Thyroid MedicationsThyroid Medications
Levothyroxine (Synthroid) Levothyroxine (Synthroid) and Liothyroxine (Cytomel)and Liothyroxine (Cytomel)
Replace hormonal deficit in Replace hormonal deficit in the treatment of the treatment of HYPOTHYROIDSMHYPOTHYROIDSM
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 162162
Thyroid MedicationsThyroid Medications
Nausea and VomitingNausea and Vomiting
Signs of increased Signs of increased metabolism= metabolism= tachycardia, tachycardia, hypertensionhypertension
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 163163
Thyroid MedicationsThyroid Medications
Monitor weight, VSMonitor weight, VS Instruct client to take daily Instruct client to take daily
medication the same time medication the same time each morning each morning WITHOUT WITHOUT FOODFOOD
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 164164
Thyroid MedicationsThyroid Medications
Advise to report palpitation, Advise to report palpitation, tachycardia, and chest paintachycardia, and chest pain
Instruct to avoid foods that Instruct to avoid foods that inhibit thyroid secretions inhibit thyroid secretions like cabbage, spinach and like cabbage, spinach and radishesradishes
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 165165
ANTI-Thyroid MedicationsANTI-Thyroid Medications
Methimazole (Tapazole)Methimazole (Tapazole) PTU (prophylthiouracil)PTU (prophylthiouracil) Iodine solution- SSKI and Iodine solution- SSKI and
Lugol’s solutionLugol’s solution
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 166166
ANTI-Thyroid MedicationsANTI-Thyroid Medications
N/VN/V DiarrheaDiarrhea AGRANULOCYTOSISAGRANULOCYTOSIS
Most important to monitorMost important to monitor
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 167167
ANTI-Thyroid MedicationsANTI-Thyroid Medications
Monitor VS, T3 and T4, weightMonitor VS, T3 and T4, weight The medications The medications WITH MEALSWITH MEALS to to
avoid gastric upsetavoid gastric upset Instruct to report SORE Instruct to report SORE
THROAT or unexplained THROAT or unexplained FEVERFEVER
Monitor for signs of Monitor for signs of hypothyroidism. Instruct not hypothyroidism. Instruct not to stop abrupt medicationto stop abrupt medication
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 168168
Used to decrease the Used to decrease the vascularity of the thyroidvascularity of the thyroid
T3 and T4 production T3 and T4 production diminishesdiminishes
Given per orem, can be Given per orem, can be diluted with juicediluted with juice
Use strawUse straw
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 169169
STEROIDSSTEROIDS
Replaces the steroids Replaces the steroids in the bodyin the body
Cortisol, cortisone, Cortisol, cortisone, betamethasone, and betamethasone, and hydrocortisonehydrocortisone
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 170170
STEROIDSSTEROIDS
Side-effectsSide-effectsHYPERglycemiaHYPERglycemia Increased susceptibility Increased susceptibility to infectionto infection
HypokalemiaHypokalemiaEdemaEdema
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 171171
STEROIDSSTEROIDS
Side-effectsSide-effectsIf high doses- If high doses- osteoporosis, growth osteoporosis, growth retardation, peptic retardation, peptic ulcer, hypertension, ulcer, hypertension, cataract, mood cataract, mood changes, hirsutism, changes, hirsutism, and fragile skinand fragile skin
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 172172
STEROIDSSTEROIDS
Nursing responsibilitiesNursing responsibilities
1. Monitor VS, electrolytes, 1. Monitor VS, electrolytes, glucoseglucose
2. Monitor weight edema 2. Monitor weight edema and I/Oand I/O
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 173173
STEROIDSSTEROIDS
3. Protect patient from 3. Protect patient from infectioninfection
4. Handle patient gently4. Handle patient gently
5. Instruct to take meds 5. Instruct to take meds WITH MEALSWITH MEALS to prevent to prevent gastric ulcer formationgastric ulcer formation
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 174174
STEROIDSSTEROIDS
Nursing responsibilitiesNursing responsibilities
6. Caution the patient NOT 6. Caution the patient NOT to abruptly stop the drugto abruptly stop the drug
7. Drug is tapered to allow 7. Drug is tapered to allow the adrenal gland to the adrenal gland to secrete endogenous secrete endogenous hormoneshormones
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 175175
HypothyroidismHypothyroidism
Hyposecretion of thyroid hormonesHyposecretion of thyroid hormones Common causes: Iodine deficiency, Common causes: Iodine deficiency,
HashimotosHashimotos Manifestations: related to hypo-metabolic Manifestations: related to hypo-metabolic
state: constipation, weight gain, cold state: constipation, weight gain, cold intolerance, poor appetite, mental intolerance, poor appetite, mental slownessslowness
Nursing Management:Nursing Management: Provide warm environmentProvide warm environment LOW calorie diet, HIGH fiberLOW calorie diet, HIGH fiber Avoid sedativesAvoid sedatives Drugs: Hormone replacementDrugs: Hormone replacement
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 176176
HyperthyroidismHyperthyroidism Hyper-secretion of thyroid hormonesHyper-secretion of thyroid hormones Common cause: Graves, Toxic goiterCommon cause: Graves, Toxic goiter Manifestation: increased Manifestation: increased
metabolism: weight loss, diarrhea, metabolism: weight loss, diarrhea, heat intolerance, hypertensionheat intolerance, hypertension
Nursing Management:Nursing Management: Adequate rest and sleepAdequate rest and sleep Cool environmentCool environment HIGH calorie foodsHIGH calorie foods Eye careEye care Drugs: anti-thyroid: PTU and Drugs: anti-thyroid: PTU and
methimazole, propranololmethimazole, propranolol Care of patients after thyroidectomyCare of patients after thyroidectomy
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 177177
EXO-PANCREATIC AND EXO-PANCREATIC AND BILIARY DISORDERSBILIARY DISORDERS
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 178178
PANCREATITISPANCREATITIS
Acute inflammation of the pancreas Acute inflammation of the pancreas associated with auto-digestion associated with auto-digestion
Enzymes secreted destroy the tissue of Enzymes secreted destroy the tissue of the pancreas the pancreas
Consistent alcohol intake is the most Consistent alcohol intake is the most causative factor causative factor
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 179179
CHOLECYSTITIS/CHOLECYSTITIS/CHOLELITHIASISCHOLELITHIASIS
Cholecystitis: inflammation of the Cholecystitis: inflammation of the gallbladder gallbladder
Cholelithiasis: occurs when gallstones Cholelithiasis: occurs when gallstones are formed due to bile that is usually are formed due to bile that is usually stored in the gallbladder hardening into stored in the gallbladder hardening into stonelike material stonelike material
Cholesterol, bilirubin, and calcium Cholesterol, bilirubin, and calcium precipitates precipitates
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 180180
HEPATIC DISORDERSHEPATIC DISORDERS
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 181181
FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 182182