Astrid VP Moreno

UPCN 2005

UP COLLEGE OF NURSING
MEDICAL-SURGICAL NURSING
Endocrine System
Lecturer: Mr. Ferdinand B. Valdez
OVERVIEW OF THE ENDOCRINE SYSTEM
Pituitary gland (Hypophysis Cerebri) main organ
o Located at the Sella turcica
o Master clock or master gland of the body
o Divisions

Anterior pituitary (adenohypophysis)

Posterior pituitary (neurohypophysis)

Oxytocin
o Promotes uterine contractions

Milk let down reflex with the help of

PROLACTIN (lactogenic hormone)
o Administered after placental expulsion
ADH prevents urination thereby conserving
fluids
o Pitressin (vasopressin)ADH replacement

Contraction of smooth muscles

o Involved in Diabetes insipidus and SIADH
o

SELECTED DISORDERS OF THE POSTERIOR PITUITARY

Definition
Predisposing
Factors

Signs and
Symptoms

DIABETES INSIPIDUS
DECREASED secretion of ADH; IDIOPATHIC
1.
Pituitary surgery
2.
Inflammation
3.
Trauma
4.
Tumor
1.
2.

3.
4.
5.
6.
7.

Diagnostics
Nursing
Management

1.
2.
1.
2.
3.
4.
5.

Polyuria
Dehydration
a.
Thirst adults
b.
Tachycardia- pedia
c.
Agitation
d.
Poor skin turgor
e.
Dry mucus
Weakness and fatigue
Tachycardia & Palpitations
Hypotension d/t dec. circulating BV
Weight loss
Hypovolemic shock if left untreated
a.
Early sign: cool clammy skin
b.
Late sign of shock renal shock anuria
Urine specific gravity (N= 1.015-1.030) decreased
Serum Na (N= 135-145) - increased
Forced fluids
Administer isotonic fluids as ordered
Monitor VS and IO strictly
Administer medications as ordered Pitressin (vasopressin) IM
prevent complications : hypovolemic shock

ANTERIOR PITUITARY GLAND/ADENOHYPOPHYSIS

1. Growth hormones/somatotrophic hormones
elongation of long bones or growth
DWARFISM hyposecretion of GH in children
GIGANTISM hypersecretion of GH in children
ACROMEGALY hypersecretion of GH in adults
i. Sandostatine (Oereotide) drug of choice
for acromegaly (SE: seizure activity,
HTN)
MS3

SIADH
INCREASED secretion of ADH (idiopathic)
1.
Head injury
2.
Bronchogenic cancer (Chest XRAY non-invasive procedure
that confirms lung CA) common in men; early sign:
nonproductive cough
3.
Hyperplasia of Pituitary gland
1.
Fluid retention
a.
Hypertension
b.
Edema
c.
Weight gain
2.
Water intoxication cerebral edema increased ICP
seizure activity

1.
2.
1.
2.
3.
4.
5.
6.

Urine specific gravity increased

Serum Na hyponatremia
Restrict fluids
Administer meds as ordered (loop and osmotic)
Monitor IO strictly
Wt pt daily and assess for edema
Meticulous skin care
prevent complications increased ICP and H20 intoxication

Pancreas
i. Insulin
ii. Glucagon
iii. Somatostatin antagonizes effect of GH
Adenocorticotrophic Hormone (ACTH) maturation and
development of adrenal cortex
Thyroid Stimulating Hormone (TSH) stimulates the
thyroid gland to secrete thyroid hormones
Prolactin/Lactogenic/leuteotrophic Hormone

2.
3.
4.
1

UPM

Promotes development of mammary glands

Initiates milk ejection reflex
Melanocyte Stimulating Hormone (MSH) for skin
pigmentation
ALBINISM hyposecretion of MSH;
Complications: skin CA, blindness
VITILIGO hypersecretion of MSH; characterized
by white patches
The brown race has the most sufficient amount of
melanin
Leutenizing Hormone (LH)
Secretes estrogen, promotes development of
secondary sexual characteristics
Follicle Stimulating Hormone (FSH)
Secretes progesterone

5.

6.
7.

THYROID GLAND

NON-PALPABLE during swallowing!!! Thyroid cartilages

ang palpable

Nodular in consistency
Metabolic/ Calorigenic Hormones:

T3 TRIIODOTHYRONINE 90% more potent

T4 TETRAIODOTHYRONINE or THYROXINE 5%

THYROCALCITONIN - its action is opposite to that of

parathyroid hormone in that calcitonin increases deposition of
calcium and phosphate in bone and lowers the level of calcium
in the blood; its level in the blood is increased by glucagon
and by Ca2+, and thus opposes postprandial Hypercalcemia

Antagonizes effect of parathormone restrict Ca

breakdown restricts Ca absorption
o T3 and T4 are metabolic or calorigenic hormones
o Increased T3 and T4

Increased cerebration or thinking

Increased vs

Irritabilityblah blah hallucinations

o Decreased T3 and T4

Lethargy

Memory impairment

Loss of appetite but (+) weight gain (-)

metabolism increased lypolysis CAD

Menorrhagia

THELARCHE breast enlargement

ADRENARCHE - Axillary and pubic hair growth during puberty
induced by hyperactivity of the adrenal cortex.
MENARCHE first menstruation
Males enlargement of repro organs deepening of voice
LEYDIG cells production of sperms
CRYPTORCHIDISM undescended testes
SPERMATOGENESIS requires at least a temperature which is a
degree lower from the body temp.

PINEAL GLAND secretes Melatonin which inhibits LH

secretion and regulates circadian rhythm/body clock
THYROID DISORDERS
Definition

Predisposing
Factors

SIMPLE GOITER
Enlargement of the thryroid gland due
to iodine deficiency; increased TSH

1.

2.

3.

Goiter belt area (d/t increased

intake of goitrogenic foods)
a.
Places far from the
sea
b.
Mountainous regions
Goitrogenic foods
a.
Contains
PROGOITRIN antithyroid agent that has
no IODINE
b.
Ex: spinach, cabbage,
turnips,
radish,
strawberries,
nuts,
broccoli,
potato,
camote (root crops
common in mountain
region

soil
erosion iodine is
washed away
Goitrogenic drugs
a.
Anti-thyroid
agent
(PTU)
b.
Lithium
c.
ASA (SE: tinnitus,
heartburn, dyspepsia)
d.
Phenylbutazone
e.
Cobalt

HYPOTHYROIDISM
Decreased T3 and T4
Only endocrine d.o leading to metal
retardation
Myxedema Adultsnon-pitting
CretinismChildren mental retardation
1.
Iatrogenic causes diseases
caused by medical intervention
2.
Atrophy of the thyroid gland
a.
Irradiation
b.
Tumor
c.
Trauma
d.
Inflammation
3.
Iodine deficiency
4.
Autoimmune (Hashimotos disease)

HYPERTHYROIDSM
Increased secretion of T3 and T4
Graves disease, Thyrotoxicosis, toxic goiter
IDIOPATHIC

1.
2.
3.

Autoimmune release of LATS (long acting

thyroid stimulants) exophthalmos
Excessive iodine intake
hyperplasia of thyroid gland

ENOPHTHALMOS late sign of severe dehydration

in children

#1 endemic goiter
#2-3 causes sporadic goiter

MS3

UPM

Signs and
Symptoms

1.
2.
3.

Enlarged thyroid gland

Mild dysphagia
Mild restlessness

ALL ARE DEC. EXCEPT WEIGHT &

MENSTRUATION
Early Signs
1.
Weakness and fatigue
2.
Loss of appetite but (+) weight gain
d/t increased lipolysis
3.
Dry skin
4.
Cold intolerance->myxedema coma
5.
Constipation
6.
Menorrhagia

ALL ARE INC. EXCEPT WEIGHT &

MENSTRUATION
1.
2.
3.
4.
5.
6.

8.
9.
10.

Hyperphagia increased appetite

(+) weight loss d/t increased metabolism
heat intolerance
moist skin
diarrhea
increased VS tachycardia, HPN, tachypnea,
hyperventilation, hyperthermia
CNS changes
a.
Irritability
b.
agitation
c.
Tremors
d.
Restlessness
e.
Insomnia
f.
Hallucinations
Goiter
Exophthalmos
Amenorrhea

1.
2.
3.

elevated T3 and T4
RAIU elevated
Thyroid Scan enlarged thyroid gland

1.

Monitor VS and IO strictly to determine

presence of THYROID STORM/Crisis
Administer medications as ordered
a.
Anti-Thyroid Agents: PTU toxic
effects is AGRANULOCYTOSIS
fever and chills, sore throat (throat
CS pls!), LEUKOCYTOSIS (CBC pls!)
b.
Methimazole (Tapazole)
High calorie diet to correct weight loss
Provide comfortable and cool environment
Institute meticulous skin care
Maintain side rails
Bilateral eye patch to prevent drying of eyes
Assist in surgical procedure: subtotal
thyroidectomy
a.
PRE-OP
i. Administer lugols solutions/ SSRI
to promote decreased vasculature
and promote atrophy of the thyroid
gland to prevent/minimize bleeding
and hemorrhage
b. POST-OP
i. WOF
signs
of
THYROID
STORM agitation, hyperthermia, HPN. If (+) thyroid storm:
administer anti-pyretics and betablockers as Propanolol/Inderal SE:
PNS; VS, IO and NVS strictly,
siderails up, provide hypothermic
blanket
ii. WOF: inadvertent or accidental
removal of parathyroid gland
hypocalcemia or tetany [(+)
trousseus signs, (+) chvosteks
Give Ca Gluc slowly to prevent
arrhythmia and arrest
iii. WOF accidental laryngeal nerve
damage hoarness of voice
instruct client to talk immediately
post-op if (+) notify MD

7.

Diagnostics

1.
2.
3.

Nursing
Management

1.

2.

MS3

Serum T3 and T4 normal or

below normal
Thyroid Scan enlarged
thyroid gland
Serum
TSH
increased:
confirmatory
Administer
medications
as
ordered
a.
Iodine Solution: Lugols
Solution saturated
solution of potassium
iodine; 1 liter of water to
2-3 drops, use straw to
prevent staining of teeth
b.
Thyroid
agents
of
hormones

Levothyroxine
(Synthoid)

Liothyronine
(Cytomel)

Thyroid extracts

NURSING MGMT
when giving these:

Instruct client
to take it best
at early AM to
prevent
insomnia

Monitor
VS
especially HR
(mlt
tachycardia
and
palpitaitons

Monitor SE:
insomnia,
tachycardia,
palpitations,
HPN,
heat
intolerance
Encourage increased intake of
foods rich in iodine
a.
Seaweeds
b.
Seafoods: oysters, clams,
crabs, lobster, shrimps
(have low iodine content)

Late Signs
1.
Brittleness of hair
2.
Non-pitting edema d/t excessive
accumulation
of
mucopolysaccharides in sq
3.
Hoarseness of voice
4.
Decreased libido
5.
Decreased VS
a.
Hypotension
b.
Bradycardia
c.
Bradypnea
d.
Hypothermia
6.
CNS changes
a.
Lethargy
b.
Memory impairment
c.
Psychosis
1.
Serum T3 and T4 decreased
2.
Radioactive Iodine Uptake (RAIU)
decreased
3.
Serum Cholesterol elevated

1.

2.
3.

4.
5.
6.
7.
8.

Monitor STRICTLY VS, IO to

determine
presence
of
MYXEDEMA
COMA
a
complication
of
severe
hypothyroidism characterized by:
a.
Severe hypotension
b.
Bradycardia
c.
Bradypnea
d.
Hypoventilation
e.
Hypoglycemia
f.
Hyponatremia
g.
Hypothermia

Might lead to progressive

stupor and coma

Assist
in
mechanical
ventilation, administer thyroid
hormones as ordered and
force fluids, IV fluids
replacement
Administer isotonic fluids as
ordered
Administer medications as ordered
thyroid hormones or agents as
Levothyroxine/Liothyroxine/
Thyroid extract-give in am (may
cause
insomnia
and
heat
intolerance)
Provide dietary intake low in
calories to prevent weight gain
institute meticulous skin care
provide comfortable and warm
environment
forced fluids
health teaching and d/c planning
a.
avoidance of precipitating
factors leading to myxedema
coma

stress

infection

exposure
to
cold

2.

3.
4.
5.
6.
7.
8.

UPM

c.

Iodized salt (served on the

table, (-) effect with
cooking)
Institute CBR
Assist in surgery subtotal
thyroidectomy

3.
4.

b.
c.
d.
e.

SIMPLE GOITER

environment
Anesthetics, sedatives
and narcotics respi
distress
prevent
complications
(hypovolemic shock and
myxedema coma)
hormonal
replacement
therapy for lifetime
importance of ff-up
wearing
of
medic-alert
bracelet
HYPOTHYROIDISM

iv.

9.
10.
11.

WOF signs of bleeding (+)

feeling of fullness at incision site,
(+) soiled dressings at back or nape
area, notify MD
v. WOF signs of laryngeal spasm
DOB and SOB prep trache set
Hormonal Replacement therapy for life
importance of FFup care
wearing of medic-alert bracelet

HYPERTHYROIDISM

PARATHYROID pair of small nodules located behind the thyroid gland parathormone for Ca reabsorption
PARATHYROID DISEASES
Definition

Predisposing
Factors

Signs and
Symptoms

Diagnostics

Nursing
Management

HYPOPARATHYROIDISM
A condition due to diminution or absence of the secretion of
the parathyroid hormones, with low serum calcium and tetany,
and sometimes with increased bone density.

Hypocalcemia/tetany

Hyperphosphatemia

Decreased parathormone
1. Following subtotal thyroidectomy
2. Atrophy of parathyroid d/t
a. Inflammation
b. Trauma
c. Irradiation
1. Acute tetany
a. Tingling sensation/numbness
b. Paresthesia
c. Dysphagia
d. (+) laryngospasm/bronchospasm
e. (+) Trousseus sign/carpopedal spasm
f.
(+) Chvosteks sign
g. arrhythmia
h. seizures
2. Chronic tetany
a. Cataract and photophobia
b. Loss of tooth enamel
c. Anorexia and general body malaise
d. Agitation, Irritability and memory impairment

HYPERPARATHYROIDISM
Increased parathormone
1. Hypercalcemia (blood)
a. Bone demineralization bone fracture
b. Kidney stones
2. Hypophosphatemia

1.
2.
3.
4.
A.

Apricot high
in potassium

B.
C.

MS3

Serum Ca decreased (N= 8.5-11/100ml)

Serum Phosphate increased (N= 2.5 -4.5 mg/100ml)
X-ray decreased bone density (long bones)
CT Scan degeneration of basal ganglia
Administer medications as ordered
a. Ca gluconate slowly for acute tetany, slow IV
(Toxicity: dec. UO, RR, BP, patellar reflex;
Antidote: MgSO4)
b. Oral calcium supplement
i. Ca gluconate
ii. Ca lactate
iii. Ca carbonate
c. Vit D (Cholecalciferol)
i. Calcidiol from food
ii. Calcitrol from sun
d. Phosphate binder (aluminum OH gel
Amphogel) binds Phosphate in intestines
constipation
i. Maalox given 1 hour before meals
Avoid precipitating stimulus such as bright glaring
lights and noises photophobia seizure
Diet which is increased in Ca and decreased phosphate
a. Salmon, anchovies, green turnips

1.
2.

Hyperplasia of parathyroid glands

Over compensation of parathyroid gland d/t Vitamin D
deficiency Ricketts Children (Osteomalacia
Adults)

1.
2.
3.
4.
5.
6.
7.

Bone pain especially at the back bone fracture

Kidney stones
a. Renal colic
b. Cool moist skin initial Sx of shock
Interaction elevated Ca and
Anorexia and general body malaise
Irritability and memory impairment
Presence of ulceration
Complication: renal failure

1.
2.
3.

Serum Ca increased
Serum Phosphate decreased
Bone Xray Bone demyelination

1.
2.
3.
4.

Force fluids; Administer Isotonic solutions as ordered

Strain all the urine with gauze pad
Provide warm sitz bath for comfort
Provide acid-ash in the diet to acidify the urine
(cranberries)
Administer medications as ordered
a. narcotic analagesics
i. Morphine sulfate tremors
naloxone
ii. Demerol respiratory depression
Maintain siderails
Ambulate with assistance
Diet: high Phosphate and low Ca (lean meat)
Assist in surgical procedure parathyroidectomy
Prevent complications renal failure
Hormonal replacement therapy
Importance of ffup care
Wear medic alert bracelet

5.

6.
7.
8.
9.
10.
11.
12.
13.

UPM

D.
E.
F.
G.
H.
I.
J.

Institute seizure and safety precautions

Prepare trache set at bedside
Encourage the client to breath using paperbag mild
acidosis increased ionized Ca levels
Prevent complications
a. Arrhythmia
b. Seizures
Hormonal replacement for lifetime
Importance of ffup care
Wear medic alert bracelet

ANTACIDS
Aluminum Containing
Aluminum OHgel (Ampho
gel)
Constipation

ADRENAL GLAND
-atop of each kidney

Magnesium Containing
Milk of Magnesia

I.

Diarrhea

PHEOCHROMOCYTOMA catecholamine producing tumor;

elevated Epinephrine vasoconstriction HPN resistant to
medications stroke
Tx: beta blockers
Avoid valsalva maneuver

II.

Adrenal Cortex (outer)

A. Zona faciculata glucocorticoids (cortisol: glucose
metabolism) SUGAR
B. Zona reticularis secretes traces of glucocorticoids and
androgenic hormones testosterone, estrogen (LH) and
progestin (FSH) SEX
C. Zona glomerulosa mineralocorticoids aldosterone
promotes Na and H2O reabsorption and excretes potassium
SALT
Adrenal Medulla secretes catecholamines
A. Epinephrine
B. Norepinephrine

ADRENAL GLAND DISORDERS

Definition

Predisposing
Factors
Signs and
Symptoms

ADDISONS DISEASE
Hyposecretion of adrenocortical hormones leading to:

Metabolic disturbances (sugar)

Fluid and electrolyte imbalances (salt)

Deficiency of neuromuscular function (salt and sex)

1.
Atrophy of the Adrenal gland
2.
Fungal infections

CUSHINGS DISEASE
Hypersecretion of adrenocortical hormone

1.

1.

2.
3.

4.

5.
6.
7.

Diagnostics

Nursing
Management

1.
2.
3.
4.
1.

2.

MS3

hypoglycemia (TIRED)
a.
Tremors and tachycardia
b.
Irritability
c.
Restlessness
d.
Extreme fatigue
e.
Diaphoresis and depression
Decreased tolerance to stress (d/t decreased cortisol) Addisonian Crisis
Hyponatremia
a.
Hypotension
b.
Signs of dehydration
c.
Weight loss
Hyperkalemia
a.
Irritability and agitation
b.
Diarrhea
c.
Arrhythmias
Decreased Libido
Loss of pubic and axillary hair
Bronze-like skin pigmentation d/t decreased cortisol stimulation of MSH
from pituitary gland

FBS decreased (N= 80-120 mg/dl)

Serum Na decreased (N= 135-145)
Serum K elevated (N=3.5-5.5meq/L)
Plasma cortisol decreased
Monitor strictly VS, IO to determine presence of Addisonian crisis which
results from acute exacerbation of Addisons disease characterized by:
a.
Hyponatremia
b.
Hypovolemia
c.
Dehydration
d.
Severe Hypotension
e.
Weight loss Which may lead to progressive stupor coma.

Assist in mech vent, steroids as ordered, forced fluids

Administer medications as ordered
a.
Corticosteroids

1.
2.

2.
3.

4.
5.

6.
7.
8.
9.
1.
2.
3.
4.
1.
2.
3.
4.
5.
6.

Hyperplasia of Adrenal gland

Tubercular infection (MILIARY TB to
adjacent organs)
Hyperglycemia can lead to DM
a.
Polyuria
b.
Polydipsia
c.
Polyphagia
d.
Wt. Gain
e.
Glucosuria
Increased susceptibility to infection (Reverse
isolation!)
Hypernatremia
a.
HPN
b.
Edema
c.
Wt. gain
Moonface appearance, buffalo hump, obese
trunk, pendulous abdomen, thin extremities
Hypokalemia
a.
Weakness and fatigue
b.
Constipation
c.
U wave on ECG tracing
Hirsutism
Easy brusing
Acne and Striae
increased masculinity in females
FBS elevated
Elevated Na
Decreased K
Elevated Cortisol
Monitor IO, VS
Restrict Na and Fluids
Weigh pt. daily and assess for pitting edema
(ANASARCA generalized edema nephritic
syndrome)
Measure abdominal girth daily, notify MD
Diet: low CHO, NA, High CHON and K
Administer medications as ordered
a. K-sparing diuretics - Spironolactone
(Aldactone); excretes sodium but

UPM

Universal rule: administer 2/3 dose in AM and 1/3 dose

in PM to mimic the N diurnal rhythm of the body
Taper the dose. Withdraw gradually from the drug
Inc. steroids the morning before surgery
Monitor SE: Cushingoid Sx

HPN, Increased susceptibility to infection,

Weight gain, Hirsutism, Moon face
appearance
Ex: Hydrocortisone, Dexamethasone, Prednisone
b.
Mineralocorticoids fluorocortisone
Forced fluids
Maintain patent IV line
Diet: high CHO/calories, Na and CHON, low K
Meticulous skin care
Provide health teaching and d/c planning
a.
Avoidance of precipitating factors leading to addisonian crisis:
Stress, Infection, Sudden withdrawal to steroids
b.
Prevent Complications hypovolemic shock
c.
Hormonal replacement therapy for life
d.
Importance of ffup care
Wear medic alert bracelet

3.
4.
5.
6.
7.

8.

PANCREAS

Behind the stomach

Mixed gland: exocrine and endocrine at the same time

Pancreatitis inflammation edema hemorrhage

autodigestion

Stomach doesnt undergo autodigestion despite

acidic environment d/t gastric juices that protects it

Chronic hemorrhagic pancreatitis death during sleep

A.
B.

7.
8.
9.
10.
11.
12.

retains potassium
Prevent Feared Complications DM
Provides meticulous skin care
Assist in Surgical Procedure Bilateral
Adrenalectomy
Hormonal replacement for life
Importance of ffup care
Wear medic alert bracelet

Acinar Cells
1. secretes pancreatic juices
2. aids in digestion
Islets of Langerhans
1. Alpha cells

Glucagon hyperglycemia
2. Beta cells

Insulin hypoglycemia
3. Delta cells

Somatostatin antagonizes effect of gh

DIABETES MELLITUS

metabolic disorder characterized by non-utilization of CHO, CHON and FAT metabolism

Definition
Incidence Rate
Predisposing
Factors
Signs and
Symptoms

Treatment

Complications

MS3

DM I (IDDM)
Juvenile Onset/ Non-obese; children; BRITTLE DISEASE
10% of general population

DM II (NIDDM)
Adult Onset/Obese (40 yo above) Maturity-onset type
90% of the general population

Hereditary total destruction of pancreatic cells

Viruses
Toxicities (CCl4)
Drugs, steroids and loop diuretics (furosemide)
Polyuria, polydipsia, polyphagia
Glucosuria
Weight loss, anorexia, nausea and vomiting
Blurring of vision
Increased susceptibility to infection
Poor/delayed wound healing (lower extremity distal to
the heart)
1. Insulin
2. Exercise
3. Diet
4. Sodium Bicarbonate for acidosis
DKA that may lead to diabetic coma
Acute complication of type 1 DM due to hyperglycemia
leading to severe CNS depression
Predisposing Factors:

Hyperglycemia

Stress

Infection
Signs and symptoms

3Ps and G

Weight loss

Anorexia, nausea and vomiting

Obesity lack of insulin receptor binding sites

1.
2.
3.
4.
1.
2.
3.
4.
5.
6.

Usually asymptomatic (3Ps +1G, weight gain)

Absence of lypolysis

OHA
Diet
Exercise
Insulin used during emergency situation
HONK
1.
2.
3.
4.

1st priority: Airway

2nd priority for HONKC (hyperosmolar-dehydration)/ DKA
(Acidic): force fluids

UPM

Acetone breath, kussmauls, decreased LOC

coma
Dx: elevated FBS, BUN, Crea and Hct

GESTATIONAL DM

d/t maternal hormones

Infant hypogly signs: high pitch cry and poor sucking reflex
DM ASSOCIATED WITH ILLNESS

Pancreatic Ca

Cushings Syndrome
Main food
Stuff
CHO
CHON
FATS

Glucose
Amino acids
Fatty acids

Monitor strictly VS, CBG, I/O

Monitor for s/sx of hypogly (cold,clammy) and hypergly
(Admin. Insulin) and notify MD
5. Diabetic diet: CHO 50%, CHON 30%, Fats 20%
a. Offer alternative food substitutes
b. Give orange juice if patient refuses to eat
6. Exercise after meals when blood glucose is rising to
facilitate utilization of glucose
7. Monitor for Sx complications
a. Atherosclerosis HPN MI or CVA
b. Microangiopathies- affects the small/minute
vessels in the eyes & kidneys

Eyes

Blindness or Retinopathy

Premature Cataract hazy

vision,
decreased
color
vision; use mydriatics (3045)

Kidneys

Recurrent
pyelonephritis
(inflammation
of
renal
pelvis)

Renal
failure
(common
causes: HPN, DM)

Gangrene formation

Shock

Peripheral neuropathy

Diarrhea, constipation

Sexual impotence (HPN,

DM)
8. Foot care management
a. Avoid walking barefooted
b. Cut toenails straight
c. Apply lanolin to prevent skin breakdown
d. (-) constricting garments
9. Encourage annual eye and kidney exam
10. Monitor for signs of DKA or HONK
11. Assist in surgical wound debridement
a. Administer analgesics prior to debridement
12. Assist in surgical procedures
a. BKA
b. AKA

Catabolism
Glycogen
Nitrogen
Free fatty acids ketones and cholesterol

Food CHO glucose insulin aids in absorption of glucose

Cells ATP (main fuel of the cells)
GLUCONEOGENESIS formation of glucose from noncarbohydrate sources (CHON and fats)

Liver glycogenesis and glycogenolysis glucose in

bloodstream
Increased fat metabolism release of FFA

Cholesterol deposition in arteries HPN CVA,

MI death

Increased CHON catabolism -N balance tissue

wasting cachexia

Ketones (CNS depressant) DKA Kussmauls

respiration acetone breath diabetic coma
DM hyperglycemia increased osmotic diuresis

Polyuria cellular dehydration stimulates thirst

center polydipsia

Glucosuria cellular starvation stimulate appetite

center polyphagia
DIAGNOSTICS:
1. FBS if elevated 3 consecutive times +3Ps and G = DM
2. OGTT (oral glucose tolerance test) most sensitive test
3. Alpha Glycosylated Hgb increased
DM management
1. Monitor for peak action of OHA and insulin
2. Administer insulin/OHA as ordered
a. Brain can tolerate elevated glucose levels but not
decreased glucose

Definition
Precipitating
Factors
Signs and
Symptoms

Diagnostics
Nursing
Management

MS3

Anabolism

3.
4.

DIABETIC KETOACIDOSIS (DKA)

Acute complication of IDDM d/t hyperglycemia leading to CNS
depression and coma
1. Hyperglycemia (n: 80-120 g/dL)
2. Stress
3. Infection --glycosuria
Early signs:
1. 3Ps +1G, weight loss
2. Anorexia, nausea and vomiting
3. Weakness & Fatigue
Late Signs:
4. Acetone/fruity breath
5. Kussmauls respirations
6. CNS depression/ dec. LOC
7. Coma
Elevated FBS
Elevated BUN, CREA (.8-1) and Hct d/t severe dehydration
1. Assist in mechanical ventilation
2. SOP in hospitals: administer 0.9 NaCl, PNSS, isotonic, followed by
0.45 NaCl hypotonic to counteract dehydration
3. Monitor VS, IO, CBG
4. Administer medications as ordered
a.
Rapid Acting regular

HYPEROSMOTIC NON-KETOTIC (HONKC)

HO increased osmolality severe dehydration
NK absence of lypolysis no ketosis

1.
2.
3.
4.

Headache
Confusion
Seizures difference of HONKC & DKA
Decreased LOC coma

Same but (-) NaHCO3

*1st 24 hours, burn, shock, renal failure, DKA Increased
Hematocrit

UPM

b.
c.

Sodium Bicarb to counteract acidosis (SE: diarrhea,

arrythmia)
Antimicrobials to prevent infection

INSULIN THERAPY
I. Sources
A. Animal pork and beef : rarely used because it can cause
severe allergic reactions
B. Human less antigenicity, less allergic reactions; most
frequently used eg: Humulins
C. Artificial
II. Types of Insulin
C.
D.
E.
F.
G.
H.
I.
J.
K.

A.

Rapid (SAI) clear, peak: 2-4 hours , Regular insulin; can

be given be given IV eg: RAI
B. Intermediate AI NPH (Non-Protamine Hagedorn)
cloudy, peak : 6-12 hours
C. Long AI Ultra lente cloudy, peak 12-24 hours
III. Nursing Management
A. Administer insulin at room temp to prevent
lipodystrophy atrophy/hypertrophy of SQ tissue
B. Insulin only refrigerated once opened

Avoid shaking insulin, roll between palms only

Accuracy of administration is important
Rotate insulin sites to prevent lipodystrophy
Use short bore needle gauge 25-26
No need to aspirate
Administer insulin 45/90 degrees angle depending on
amount to pts SQ tissue
Most accessible route: abdomen; less painful
Aspirate CLEAR before CLOUDY to prevent
contamination and promote accurate calibration
Monitor for local complications:
1. Allergic reactions
2. Lipodystrophy
3. SOMOGYIS PHENOMENON rebound effect of
insulin characterized by hypoglycemia,
hyperglycemia: To prevent Somogyis Phenomenon,
always monitor for peak action of Insulin

ORAL HYPOGLYCEMICS for Type 1 DM

MOA stimulates the pancreas to secrete insulin
I. Classification
A. First generation sulfonylureas
1. Chlorpropamide (Diabenase)
2. Talbutamide (Orinase)
3. Tolazamide (Tolinase)
B. Second generation sulfonylureas
1. Glipzide (glucotrol)
2. Diabeta (Micronase)
II. Nursing Management
A. Administer with food to decrease GIT irritation and to
prevent hypoglycemia
B. Instruct pt not to take alcohol
1. Alcohol + OHA severe hypoglycemic reaction
2. Disulfiram +OHA toxicity
VACCINES
Rabies- brain of goat
Tetanus- horse
Chicken- measles

MS3

UPM