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THE ENDOCRINE SYSTEM

Endocrine System
parathyroid, adrenals, the islets of
Langerhans in the pancreas and the gonads.
Functions
use and storage of nutrients.



Hormones
messengers to specific cells and organs,
stimulating and inhibiting various processes.

specific effect on the area of
secretion.
transported in the blood to
distant sites where they exert their effect.
Hormone Regulation
- major means of
regulating hormone levels.
ng
hormone triggers production of a
stimulating hormone from the pituitary
gland. This in turn stimulates its target
organs to produce hormones.
inhibits the production of the stimulating
hormone, resulting to decreased secretion
of the target organ.
specific substances like calcium and glucose.
patterns of secretion e.g. cortisol and
female reproductive hormones.
ontrol
Assessment
duration, alleviating or aggravating factors,
chronology of events, associated symptoms,
quantity and intensity of symptoms.
Health History

Change in appearance
Change in energy levels
Temperature intolerance
characteristics.




insomnia, weight loss or weight gain
of increased or decreased pigmentation,
hair loss, brittle nails.
eyes, voice changes, enlarging neck
Potential symptoms:

polydipsia, dysphagia

polyuria
and
weakness
Objective general assessment:
body proportions
fat distribution.
warmth, moisture and pigmentation.
growth and distribution.

of voice.
characteristics.

HYPOPITUITARISM
gland.
omplete
deficiency of hormone production.
Cause







Assessment




- Dwarfism
Diagnostic Tests




r muscle function
gland has to be destroyed before signs and
symptoms occur.
Therapeutic Management



-60mg

otropins
Pituitary Apoplexy
enlargement and hemorrhage
Temporary stabilization with high dose
corticosteroids.
Nursing Management

irradiation.
ng and planning for
discharge.

gastric problems
adrenal function least when givn early
morning. )
on control.

HYPERPITUITARISM
gland resulting in oversecretion of one or
more of the anterior pituitary hormone.
Acromegaly hypersecretion of the growth
hormone occurs after puberty resulting in
bone and connective tissue continuing to
grow which results to enlarged face, hand
and feet.
Gigantism hypersecretion of the growth
hormone occurs prior to puberty resulting in
the person becoming excessively tall.
Causes:

grows rapidly but
contains less GH
grows slower but have
more GH
Systemic pathologic processes and disease
follows:

ing
joints.
entrapment.
assessment

jaws)

ridges



Diagnostic tests


increased
Goal of therapeutic management

metabolic abnormalities
enlargement


CARE OF THE PATIENT UNDERGOING
TRANSSPHENOIDAL HYPOPHYSECTOMY 1.
Preoperative Management
necessary.
preoperatively because the source of ACTH
is being removed.
emotionally for surgery.
-breathing exercises.
d coughing and sneezing
postoperatively to prevent CSF leak.
Protecting Against Complications
neurologic status frequently for signs of
increasing intracranial pressure.
report any increase in output and decrease
in specific gravity, which may indicate DI.
increasing headache; could signal CSF leak.
to report them immediately and to follow-
up as scheduled.
analgesic or supervise patient-controlled
analgesia.
Preventing Infection
incision within inner aspect of upper lip for
drainage or bleeding.
f nasal dressing changes
and character of drainage. Prepare patient
for packing removal one to several days
postoperatively.
prevent drying from mouth breathing.
Nursing care


attitude in body image disturbance.

DIABETES INSIPIDUS
deficiency of ADH, also called vasopressin,
secreted by the posterior pituitary or by
inability of the kidneys to respond to ADH
Causes:

tumors (intracranial or metastatic), vascular
disease (aneurysms, infarct), infection
(meningitis, encephalitis).
-standing renal
disease, hypokalemia, some medications
Assessment
- daily output of 5 to 20 L
of dilute urine; appearance of urine like that
of water
- drinks 4 to 40 L
of fluid daily; has craving for cold water.
and high serum sodium level (greater than
145 mEq/L).
Diagnostic Tests



Therapeutic Management
of ADH or its derivative.
-
vasopressin derivative administered into
the nose through a soft, flexible nasal tube
or by nasal spray.

hypothalamic ADH (determined by low
levels of circulating ADH).
- potentiates
action of vasopressin on renal-
concentrating mechanism.
-S) - probably acts by
augmenting ADH secretion from posterior
pituitary.
e (Tegretol) - potentiates
action of endogenous vasopressin.
Maintaining Adequate Fluid Volume
accurately.

indicated, via frequent BP, heart rate,
central venous pressure, and other
measurements.
and administer I.V. fluids as indicated.
osmolality and serum sodium tests.
-administration of
medication as prescribed and document
patient response
Patient Education and Health Maintenance
must be monitored on a long-term basis
because the severity of DI changes from
time to time.
decrease urine output; thirst is a protective
function.
bracelet stating that the wearer has DI.
signs of
dehydration decreased weight, decreased
urine output, increased thirst, dry skin and
mucous membranes; and overhydration
increased weight and edema and report
these to the health care provider.
coffee and tea from die tmay have an
exaggerated diuretic effect.
administration. Have the patient
demonstrate intranasal and injection
technique.
HYPERPARATHYROIDISM
age 50.
hyperparathyroidism.
common cause (approximately 80% of
cases).


Assessment

ight-
bearing, pathologic fractures, deformities,
formation of bony cysts.
osteoclasts.
-containing kidney
stones.

how
general fatigue, lose memory for recent
events, experience emotional instability,
have changes in level of consciousness, with
stupor and coma.
standstill.
Diagnostic Tests




Therapeutic Management
-
furosemide (Lasix) and ethacrynic acid
(Edecrin) to increase urinary excretion of
calcium in patients not in renal failure.
antihypercalcemic agent.
disodium (Didronel) are effective in treating
hypercalcemia by inhibiting bone
resorption.

Dietary calcium is restricted, and all drugs
that might cause hypercalcemia (thiazides,
vitamin D) are discontinued.
Dialysis may be necessary in patients with
resistant hypercalcemia or those with renal
failure.
Digoxin is reduced because patient with
hypercalcemia is more sensitive to toxic
effects of this drug.
Monitoring of daily serum calcium, blood
urea nitrogen (BUN), potassium, and
magnesium levels.

Achieving Fluid and Electrolyte Balance
Monitor fluid intake and output.
Provide adequate hydration administer
water, glucose, and electrolytes orally or I.V.
as prescribed.
Prevent or promptly treat dehydration by
reporting vomiting or other sources of fluid
loss promptly.
Help patient understand why and how to
avoid dietary sources of calcium dairy
products, broccoli, calcium-containing
antacids.
Promoting Urinary Elimination

maintain hydration and prevent
precipitation of calcium and formation of
stones.
recommendations for restriction of calcium.
(UTI), hematuria, and renal colic.
creatinine and BUN levels.
Increasing Physical Mobility
if bone pain is severe or if the patient
experiences musculoskeletal weakness.

extremities gently to avoid fractures.

response to analgesia.
mild exercise gradually as symptoms
subside.
mechanics to reduce strain, backache, and
injury.

HYPOPARATHYROIDISM
removal or destruction of parathyroid tissue
or its blood supply during thyroidectomy or
radical neck dissection for malignancy.
hypoparathyroidism); may be autoimmune
or familial in origin.
the parathyroid glands.
Assessment
- general muscular hypertonia;
attempts at voluntary movement result in
tremors and spasmodic or uncoordinated
movements; fingers assume classic tetanic
position.




has history of stones; preexisting stones
loosen and migrate into the ureter.
Diagnostic Tests



Therapeutic Management
solution (calcium chloride, calcium
gluceptate, calcium gluconate) are to be
kept at the bedside at all times.
ionized calcium chloride (10%).
infusion carried out every 10 minutes.
administered slowly. It is highly irritating,
stings, and causes thrombosis; patient
experiences unpleasant burning flush of
skin and tongue.

mL) as indicated by serum calcium;
administer at rate of less than 1 mL/minute
of 10% solution.
mL) at a rate of less than 0.5 mL/minute of a
10% solution.
a rate of less than 1 mL/minute.
A slow drip of I.V. saline containing calcium
gluconate is given until control of tetany is
ensured; then I.M. or oral administration of
calcium is prescribed.
Later, vitamin D is added to calcium intake
increases absorption of calcium and also
induces a high level of calcium in the
bloodstream.
Thiazide diuretics may also be added
because of their calcium-retaining effect on
the kidney; doses of calcium and vitamin D
may be lowered.
Maintaining Calcium Levels
patients with hypoparathyroidism and in
those at risk for hypocalcemia (patients in
the immediate postoperative period after
thyroidectomy, parathyroidectomy, radical
neck dissection).
and notify health care provider if tests
results are positive.
ss respiratory status frequently in
acute hypocalcemia and postoperatively.
levels.
-calcium diet if
prescribeddairy products, green, leafy
vegetables.
symptoms of hypo- and hypercalcemia that
should be reported.
to the patient with hypocalcemia.
digoxin (Lanoxin); as hypocalcemia is
reversed, the patient may rapidly develop
digitalis toxicity.
normal parathyroid function, especially with
renal failure, which increases the risk of
hypocalcemia.
DIABETES MELLITUS
variety of physiologic systems, the most
critical of which involves glucose
metabolism.

Abnormality causes:



Risk factors:




estational diabetes
Major classification:
1. Type 1 Diabetes Mellitus ( Insulin
Dependent/Juvenile DM)
injections of insulin to control diabetes and
prevent ketoacidosis.
certain histocompatibility antigens as well
as a genetic component.
symptoms of polydipsia, polyphagia,
polyuria, and weight loss.
age 30 but can be seen in older adults
Type 2 Diabetes Mellitus ( Non insulin
Dependent/Adult onset DM )
resistance and relative insulin deficiency
some individuals have predominantly
insulin resistance, whereas others have
predominantly deficient insulin secretion,
with little insulin resistance.
have type 2.
commonly associated with obesity.
al presentation is slow and typically
insidious with symptoms of fatigue, weight
gain, poor wound healing, and recurrent
infection.
however, may be seen in younger adults
and adolescents who are overweight.
Gestational Diabetes Mellitus
defined as carbohydrate intolerance
occurring during pregnancy.
and usually disappears after delivery.
diabetes at a later date.
fetal morbidity.
other than those at lowest risk (under age
25, of normal body weight, have no family
history of diabetes, are not a member of an
ethnic group with high prevalence of
diabetes) should occur between the 24th
and 28th weeks of gestation.
Diabetes Associated with Other Conditions
resulting in hyperglycemia corticosteroids,
thiazide diuretics, estrogen, phenytoin.
insulin receptors pancreatitis, cancer of the
pancreas, Cushing's disease or syndrome,
acromegaly, pheochromocytoma, muscular
dystrophy, Huntington's chorea.
Pathophysiology
causes:
body cells resulting in increased serum
glucose levels.
resulting in abnormal fat metabolism
tissues due to lack of protein anabolism
which insuin promotes under normal
circumstances.
Assessment





skin
Diagnostic Tests

has maintained 8-hour fast overnight; sips
of water are allowed.
before the glucose sampling because this
affects the test results.
For postprandial test, advise patient that no
food should be eaten during the 2-hour
interval. For random blood glucose, note
the time and content of the last meal.
Interpret blood values as diagnostic for
diabetes mellitus as follows: FBS greater
than or equal to 126 mg/dL on two
occasions Random blood sugar greater than
or equal to 200 mg/dL and presence of
classic symptoms of diabetes (polyuria,
polydipsia, polyphagia, and weight loss)
Fasting blood glucose result of greater than
or equal to 100 mg/dL demands close
follow-up and repeat monitoring.
Oral Glucose Tolerance Test
evaluates insulin response to glucose
loading. FBS is obtained before the
ingestion of a 50- to 200-g glucose load
(usual amount is 75 g), and blood samples
are drawn at , 1, 2, and 3 hours (may be 4-
or 5-hour sampling).
certain instructions must be followed:
cise pattern must be
followed for 3 days before OGTT.
from smoking and remain seated.
phenytoin, and nicotinic acid can impair
results and may be withheld before testing
based on the advice of the health care
provider.
-hour
value is 200 mg/dL or greater.
Glycated Hemoglobin (Glycohemoglobin,
HbA1c)
- to
120-day period by measuring the
irreversible reaction of glucose to
hemoglobin through freely permeable
erythrocytes during their 120-day lifecycle.
withholding insulin, is necessary.
cell disorders (eg, thalassemia, sickle cell
anemia), room temperature, ionic charges,
and ambient blood glucose values.
test, making it necessary to consult the
laboratory for normal values.
Therapeutic Management
ion of glycemia.



regimen
Relatively normal
blood glucose until about 3am when the
level begins to rise.
Effect Nocturnal hypoglycemia
followed by a rebound hyperglycemia.
Treatment Modality
1.Diet
carbohydrates and saturated fats to
maintain ideal body weight.
blood glucose and lipid levels
Meal Planning Guidelines
carbohydrates, proteins, and fats.
amounts of food eaten on a day-to-day
basis help regulate blood glucose levels.
the intake of soluble and
insoluble fiber.

minerals and reduce fats.
depending on insulin/medication regimens,
physical activity, and lifestyle
alcohol only in moderation
sweeteners in moderation
Exercise
performed for at least 30 minutes most
days of the week promotes the utilization of
carbohydrates, assists with weight control,
enhances the action of insulin, and
improves cardiovascular fitness.
Oral Hypoglycemics
1.Sulfonylureas glipizide, glimepiride
2.Biguanides metformin ( Glucophage )
3.Glucosidase inhibitors acarbose, miglitol
4.Thiazolidinediones rosigitazone,
pioglitazone

INSULIN ONSET PEAK DURATION
Immediate-acting
(lispro,
aspart)
0.25
hour
0.5-1
hour
5 hours
Short-acting
(regular,
semilente)
0.5-1
hour
2-4
hours
5-7 hours
Intermediate-acting
(NPH,
lente)
1-3
hours
6-12
hours
18-24
hours


DANGER!!!

50mg/dL
onset.
Assessment: headache, dizziness, slurred
speech
Nursing care: Administer oral sugar
D5050
Nursing Care
signs of hypo/hyperglycemia
by monitoring.


exchange list.
meals; never skip meals.

erve insulin therapy guidelines:




lipodystrohy.

and water.






agent.
atient the perceived
effect of diabetes on lifestyle, finances,
family life, occupation.
in diabetes self-care regimen to foster
confidence.

COMPLICATIONS OF DIABETES MELLITUS
DIABETIC KETOACIDOSIS
mellitus (usually type 1 diabetes)
characterized by hyperglycemia, ketonuria,
acidosis, and dehydration.

Clinical Manifestations
Early
Polydipsia, polyuria
Fatigue, malaise, drowsiness
Anorexia, nausea, vomiting
Abdominal pains, muscle cramps
Later
Kussmaul respiration (deep respirations)
Fruity, sweet breath
Hypotension, weak pulse
Stupor and coma
Restoring Fluid and Electrolyte Balance
ss BP and heart rate frequently,
depending on patient's condition; assess
skin turgor and temperature.

peripheral I.V. line.
fluid changes.

hypokalemiafatigue, anorexia, nausea,
vomiting, muscle weakness, decreased
bowel sounds, paresthesia, arrhythmias, flat
T waves, ST-segment depression.
Administer replacement electrolytes and
insulin as ordered. Flush the entire I.V.
infusion set with solution containing insulin
and discard the first 50 mL because plastic
bags and tubing may absorb some insulin
and the initial solution may contain
decreased concentration of insulin.
Monitor serum glucose, bicarbonate, and
pH levels periodically.
Provide reassurance about improvement
of condition and that correction of fluid
imbalance will help reduce discomfort.

HYPEROSMOLAR HYPERGLYCEMIC
NONKETOTIC SYNDROME
mellitus (particularly type 2 diabetes)
characterized by hyperglycemia,
dehydration, and hyperosmolarity, but little
or no ketosis.

Clinical Manifestation








Nursing Care
a life-threatening condition.
nces
giving isotonic and colloid solutions and
correct potassium deficits.
Lower glucose with regular insulin.