NCLEX REVIEW: THE ENDOCRINE SYSTEM

The endocrine system includes the:

HYPOTHALAMUS
The hypothalamus is an area of the brain that produces hormones that control:

BODY TEMPERATURE

HUNGER

MOODS

RELEASE OF HORMONES FROM MANY GLANDS, ESPECIALLY THE PITUITARY GLAND

SEX DRIVE

SLEEP

PITUITARY GLAND composed of two lobes (anterior & posterior)

ADRENAL GLANDS
Secretes three hormones:
Mineralocorticoids
Glucocorticoids (cortisol)
Sex Hormones (estrogen, androgens and progesterone)

THYROID GLANDS
Located in the anterior portion of the neck, behind the trachea.
Controls the secretion of the TSH and secretion of T3 and T4.

PARATHYROID GLANDS

REGULATE THE CALCIUM LEVEL IN OUR BODIES.

PANCREAS
Excretes the enzymes, aids w/ digestion
Lipase
Amylase
Trypsin
Diagnostic Tests for Endocrine Diseases:

RADIOACTIVE IODINE UPTAKE

THYROID SCAN

GLUCOSE TOLERANCE TEST

ANTERIOR PITUITARY GLAND

GROWTH HORMONE (GH)

THYROID-STIMULATING HORMONE (TSH)

ADRENOCORTICOTROPHIC HORMONE (ACTH)

FOLLICLE-STIMULATING HORMONE

(FSH)LUTEINIZING HORMONE

(LH)PROLACTIN (PRL)

NCLEX 26 REVIEW ON PITUITARY GLAND DISORDERS

Pituitary Gland Disorders

HYPOPITUITARISM
Insuffecient quantities of anterior pituitary gland hormones.
ASSESSMENT

LETHARGY

HYPOTHERMIA

WEIGHT LOSS

AMENORRHEA

DRY SKIN

HYPOTENSION

Monitor the patients risk for infection.

Treatment
Surgery: if hypopituitarism is caused by a tumor.
Hormone therapy

CORTICOSTEROIDS (CORTISOL)

GROWTH HORMONE

SEX HORMONES (TESTOSTERONE FOR MEN AND ESTROGEN FOR WOMEN)

THYROID HORMONE

HYPERPITUITARISM
Also called A C R O M E G A LY and Cushingss Disease
ACROMEGALY
Often a result of a benign tumor
ASSESMENT

LARGE HANDS AND FEET

PROTRUDING JAW AND FOREHEAD

TREATMENT

HYPOPHYSECTOMY

CORTICOSTEROIDS

ELEVATE HEAD AT LEAST 30 DEGREES.

GLUCOCORITCOIDS

HORMONES

* SURGERY ( TRANSSPHENOIDAL PITUITARY SURGERY) TO REMOVE THE PITUITARY TUMOR MIGHT BE THE BEST
TREATMENT.

Meds. used to control increased GH:

OCTREOTIDE (SANDOSTATIN)

BROMOCRIPTINE (PARLODEL)
DISORDER OF THE POSTERIOR PITUITARY GLAND.

DIABETES INSIPIDUS

Hyposecretion of the ADH hormone.

Assessment:

POLYURIA (4-24 L/DAY)

POLYDIPSIA

DEHYDRATION

LOW URINE SPECIFIC GRAVITY 1.006 OR LOWER

FATIGUE

HYPOTENSION

TACHYCARDIA

* Fluid Deficit is a priority

Medication:

VASOPRESSIN (PITRESSIN) *USED AS AN ANTIDIURETIC HORMONE

Examples of Antidiuretic Hormones:

DESMOPRESSIN ACETATE

VASOPRESSIN (PITRESSIN)

S I D E E F F E C T S (Antidiuretic Hormones)

HEADACHE

NAUSEA & VOMITING

WATER INTOXICATION

HYPERTENSION

Vasopressin
ITS AN ANTIDIURETIC HORMONE

PREVENT THE LOSS OF WATER FROM THE BODY BY REDUCING URINE OUTPUT AND REABSORBING WATER IN THE
BODY

(INCREASES BP)= BY CONSTRICTING (NARROWING) BLOOD VESSELS

Side Effects (VASOPRESSIN)

THROBBING HEADACHE

STOMACH PAIN, BLOATING

DIZZINESS, NAUSEA

BLANCHING OF THE SKIN

Due to increase urine output -> pt. is in risk of HYPOVOLEMIC SHOCK.

SIADH
S Y N D R O M E O F I N A P P R O P R I AT E A N T I DI U R E T I C H O R M O N E ( S I A D H )
excess ADH is being released
Assessment:

FLUID OVERLOAD

WEIGHT GAIN

HYPERTENSION

TACHYCARDIA

HYPONATREMIA

Interventions:

MONITOR FLUID & ELECTROLYTE IMBALANCE

FLUID RESTRICTION.

ADRENAL GLAND DISORDERS

ADDISONS DISEASE
Hyposecretion of Adrenal Cortex Hormones

GLUCOCORTICOIDS

MINERALOCORTICOIDS

Assessment:

NAUSEA, VOMITING, DIARRHEA.

INABILITY TO COPE WITH STRESS.

MOODINESS, IRRITABILITY, DEPRESSION.

LETHARGY, FATIGUE

FATIGUE AND WEIGHT LOSS

HYPOTENSION

HYPOGLYCEMIA

HYPERKALEMIA

* Hyperkalemia
* Hypoglycemia
* Patients with Addisons Disease are usually fatigued due to low metabolic energy production.
* Patients can also encounter a fluid deficit disorder to the decreased mineralocorticoid.
STRESS can lead to an Addisonian Crisis.
Remind patients to monitor their salt intake.
To prevent hypotension, remind pt. to increase sodium & fluid intake.
BE CAREFUL: Can lead to Addisonian Crisis
ADDISONIAN CRISIS
Severe Mineralocorticoid Deficiency.
Addisonian Crisis Assessment

SEVERE HEADACHE
WEAKNESS AND IRRITABILITY
SEVERE HYPOTENSION
SHOCK

TREATMENT (MEDS)
C O RT I C O S T E R O I D S (Glucocorticoids)

SUPPRESSES INFLAMMATION

AN ANTI-INFLAMMATORY

USED FOR ADRENOCORTICAL INSUFFICIENCY

Side Effects:

HYPOKALEMIA

HYPERGLYCEMIA

EDEMA

WATER RETENTION

CUSHINGS SYNDROME
Cushings Syndrome
An excess of cortisol.
What is Cortisol:

A STEROID HORMONE

A GLUCOCORTICOID

PRODUCED BY THE ADRENAL GLAND.

RELEASED IN RESPONSE TO STRESS.

PRIMARY FUNCTIONS ARE TO INCREASE BLOOD SUGAR.

SUPPRESSES THE IMMUNE SYSTEM.

ASSESSMENT:

UPPER BODY OBESITY

THIN ARMS AND LEGS

SEVERE FATIGUE AND MUSCLE WEAKNESS

HIGH BLOOD PRESSURE

HIGH BLOOD SUGAR

EASY BRUISING

Buffalo Hump: thin extremities, obese truncal area

Low-dose dexamethasone suppression Test:
is done to DIAGNOSE Cushings Syndrome.
Patient is susceptible to injury or infection.
TREATMENT:
IF CAUSED BY A TUMOR: SURGERY MAY BE NECESSARY.

NCLEX 26 REVIEW THYROID GLAND DISORDERS

THYROID HORMONES
Lets go over some of the hormones secreted by the thyroid gland.
1.

SYNTHROID

2.

LEVOTHROID

(levothyroxine) synthetic thyroxine (T4)

MOA: Increase metabolic activity of body
Uses: Drug of choice for long-term
hypothyroidism, simple goiter.

SIDE EFFECTS
S/S of hyperthyroidism
tachycardia, sweating, intolerance to heat,
diarrhea, abd. cramping, weight loss,
decreased bone density in the hip & spine.
ANTITHYROID DRUGS

PTU (PROPYLTHIOURACIL)

TAPAZOLE (METHIMAZOLE)

LUGOLS SOLUTION.

INTERFERE WITH SYNTHESIS OF THYROID HORMONE AND INHIBITS

CONVERSION OF T4 TO THE MORE ACTIVE T3.
LUGOLS INHIBITS THE RELEASE OF THYROID HORMONE, CAUSING THEM TO ACCUMULATE IN THE THYROID GLAND.

Side Effects:

HYPOTHYROIDISM

HAIR LOSS
ALLERGIC REACTION

HYPOTHYROIDISM

HYPOSECRETION OF THE PARATHYROID HORMONE

HYPOSECRETION OF THE THYROID HORMONES T3 AND T4

DECREASED RATE IN THE BODYS METABOLISM

Can lead to M Y X E D E M A C O M A
Myxedema Coma can be life threatening
A S S E S S M E N T:

HYPOTENSION

BRADYCARDIA

HYPOGLYCEMIA

EDEMA

Common Drugs used for Hypothyroidism.

LIOTHYRONINE SODIUM (CYTOMEL)

LIOTRIX (EUTHROID)

HYPERTHYROIDISM
Hypersectretion of the hormones T3 and T4
can lead to thyroid storm
Assessment
Enlarged thyroid gland (goiter)
THIS CLIENTS WILL TAKE LIFELONG THYROID REPLACEMENTS.
COMMON MEDS (Hyperthyroidism):

LEVOTHYROXINE (LEVOTHROID): WATCH OUT FOR TACHYCARDIA (SIDE EFFECT)

METHIMAZOLE (TAPAZOLE)

POTTASIUM IODINE, SATURATED SOLUTION (SSKI)

RADIOACTIVE IODINE (SODIUM IODIDE) 131

SURGERY:
Thyroidectomy: During a thryoidectomy it is very important for the nurse to have a tracheostomy set
at the bedside just in case of a respiratory emergency.
C O RT I C O S T E R O I D S
Mineralocorticoids
Example: Florinef (fludrocortisone)
*PROMOTE NA AND WATER RETENTION. HELP
MAINTAIN FLUID AND ELECTROLYTE BALANCE.
ALDOSTERONE IS THE MAIN MINERALOCORTICOID.
USES: CHRONIC ADRENOCORTICAL INSUFFICIENCY.

Adverse Effects:
HYPOKALEMIA, FLUID RETENTION

Glucocorticoids
Common Examples:
1.

DECADRON (DEXAMETHASONE)

2.

SOLU-MEDROL (METHYLPREDINISOLONE)

3.

PREDNISONE, CELESTONE (BETAMETHASONE)

4.

ARISTOCORT (TRIANCINOLONE)

5.

NASONEX

6.

AZMACORT

*Affect CHO, protein and lipid metabolism

Antiinflammatory response protects cells from
damage related to immune response.
G L U C O C O RT I C O I D S (Remember the Side Effects).
SIDE EFFECTS:

EDEMA
HYPERGLYCEMIA
HYPOKALEMIA
MUSCLE WASTING
PEPTIC ULCER
HYPERTENSION

IMMUNOSUPPRESSION

INCREASED WBC

CAN MASKS SIGNS OF INFECTION

NCLEX 26 REVIEW ON PARATHYROID GLAND DISORDERS

HYPERPARATHYROIDISM

THERE IS AN EXCESSIVE SECRETION OF PTH, THAT CAN RESULT IN HYPERCALCEMIA.

EXCESSIVE AMOUNT OF PTH CAN LEAD TO HYPERCALCEMIA AND BONE DAMAGE.

ASSESSMENT:
Symptoms is associated with the effects of an increased level of calcium.

WEAKNESS AND FATIGUE

DEPRESSION, BONE PAIN

MUSCLE SORENESS (MYALGIAS)

DECREASED APPETITE

NAUSEA AND VOMITING

CONSTIPATION, POLYURIA

DIAGNOSIS:

BEST DIAGNOSTIC TEST: PARATHYROID IMMUNOASSAY

TREATMENT:
Increase amount of fluid intake in order to decrease level of serum calcium.
If caused by a tumor: SURGERY may be necessary.

HYPOPARATHYROIDISM
HYPOPARATHYROIDISM
A decrease in the PTH level in the body, resulting in an elevation in phosphate levels and
Hypocalcemia.
ASSESSMENT

MUSCLE WEAKNESS

MUSCLE SPASMS

CARDIAC DYSRHYTMIAS

POSITIVE CHVOSTEKS SIGN

POSITIVE TROUSEAUS SIGN

O

DRY, COARSE SKIN

BRITTLE NAILS

ANXIETY OR NERVOUSNESS

HEADACHES

DEPRESSION, MOOD SWING

DIAGNOSIS:
BLOOD TESTS (will show)

A LOW BLOOD-CALCIUM LEVEL

A LOW PARATHYROID HORMONE LEVEL

A HIGH BLOOD-PHOSPHORUS LEVEL

A LOW BLOOD-MAGNESIUM LEVEL

OTHER DIAGNOSTIC TESTS:

ELECTROCARDIOGRAM (ECG)

URINE TEST

X-RAYS AND BONE DENSITY TESTS

TREATMENTS:

ORAL CALCIUM CARBONATE TABLETS.

VITAMIN D, WHICH CAN HELP YOUR BODY ABSORB CALCIUM AND ELIMINATE PHOSPHORUS.

BE CAREFUL:
At high doses, calcium supplements can cause gastrointestinal side effects, such as constipation, in
some people
Diet should be:

RICH IN CALCIUM.
LOW IN PHOSPHORUS-RICH ITEMS. THIS MEANS AVOIDING CARBONATED SOFT DRINKS, WHICH CONTAIN
PHOSPHORUS IN THE FORM OF PHOSPHORIC ACID. EGGS AND MEATS ALSO TEND TO BE HIGH IN PHOSPHORUS.

NCLEX REVIEW: THE PANCREAS

THE PANCREAS

Located in the upper left side of the abdominal cavity.

Enzymes produced by the pancreas includes:

TRYPSIN

AMYLASE

LIPASE
1.

ALPHA CELLS SECRETES GLUCAGON

2.

BETA CELLS SECRETES INSULIN

3.

DELTA CELLS SECRETES SOMATOSTATIN

NCLEX 26 REVIEW ON DIABETES MELLITUS

(Diabetes would be a big topic in the NCLEX)
REMEMBER THAT:

GLUCAGON- INCREASES BLOOD SUGAR.

INSULIN- DECREASES THE BLOOD SUGAR.

CLASSES:

TYPE 1 AND TYPE 2

GESTATIONAL

HYPERGLYCEMIA (3 Ps)

POLYURIA (EXCESS URINATION)

POLYDIPSIA (EXCESS THIRST)

POLYPHAGIA (EXCESS EATING)

C O M P L I C AT I O N S O F D I A B E T E S :

DKA
HHNC

DKA
It is also called Diabetec ketoacidosis
It is usually a complication of Type 1 Diabetes
SYMPTOMS

POLYDIPSIA

POLYURIA

DEHYDRATION (FLUSHED POOR SKIN TURGOR)

TACHYPNEA

KASSMAULS BREATHING (ACETONE BREATH)

NAUSEA & VOMITING

HYPOVOLEMIA

LAB Values
Blood Glucose: 300- 800 mg/ dl
pH: less than 7.30
Ketones in Blood and Urine

T R E AT M E N T:
Fluids, Insulin, Potassium
* Make sure to administer regular insulin intravenously)
HHNC
Usually a complication of Type 2 Diabetes
There is no ketoacidosis, because of some circulating insulin in the body.
SYMPTOMS:

WEAKNESS

FATIGUE

FLUSHED SKIN/ DRY MUCUS

BLOOD SUGAR: 600-3,000 MG/DL

LACK OF KETOSIS

T R E AT M E N T S :

FLUIDS, INSULIN, POTTASIUM

D51/2 NS

INSULIN

Chronic Complications of Diabetes Mellitus

MICROVASCULAR:

RETINOPATHY

NEPROPATHY

NEUROPATHY

MACROVASCULAR

CAD

PVD (DIABETIC FEET)

HYPERLIPIDEMIA

HYPERTENSION

Screening for Diabetes Mellitus:

TESTING:

FASTING BLOOD SUGAR

GTT AT 2 HRS IS GREATER THAN 200

HBA1C

Complications Insulin Treatment

HYPOGLYCEMIA
S M O Y G I E F F E C T:

A REBOUND HYPERGLCEMIA

TREATMENT: DECREASE THE INSULIN AND GIVE EVENING SNACK

A situation can include:

3 a.m. pt. glucose level is normal

6- 7 a.m suddenly the glucose is elevated

Treatment: Give insulin later at 10 pm
Bed time Snack
D AW N P H E N O M E N O N :

AN EARLY AM HYPERGLYCEMIA

TREATMENT: ADD 10 PM INTERMEDIATE INSULIN

TREATMENT FOR DIABETES MELLITUS

Goal: Blood Sugar 60-150 mg/dl
No Ketonuria
TYPES OF MEDS:
1.

INSULIN

2.

SULFONYLUREAS (USED TO CONTROL BLOOD GLUCOSE)

NCLEX 26 REVIEW ON TYPES OF INSULIN

INSULIN

PROMOTES THE TRANSPORT OF GLUCOSE INTO THE CELLS SO IT CAN BE USED AS ENERGY SOURCE.

PROMOTES CONVERSION OF GLUCOSE TO GLYCOGENFOR STORAGE IN THE LIVER

Treatment for:

TYPE 1 DIABETES,
TYPE 2 DIABETES THAT IS UNCONTROLLED WITH DIET, EXERCISE AND
ORAL MEDICATIONS
HYPERGYLCEMIA CAUSED BY TPN
TREAT HYPERKALEMIA (CAUSES K TO MOVE FROM BLOOD
INTO CELLS).

SIDE EFFECTS:
hypoglycemia

Contraindications:

HYPOGLYCEMIA

HYPERSENSITIVITY TO PORK FOR PORK INSULIN

SHORT ACTING INSULIN

Regular: Regular Inletin II, Humulin R,
Novolin R (the only IV insulin).
Rapid acting.
ONSET -1 hour, PEAK 2-3 hr, DURATION 5-7hr.
INTERMEDIATE ACTING INSULIN

ISOPHANE INSULIN SUSPENSION NPH, NPH

ILETIN II, HUMULIN N, NOVOLIN N.

INSULIN ZINC SUSPENSION LENTE, ILENTIN II,

LENTE L, , HUMULIN L, NOVOLIN L.

O N S E T 1-11/2 hr, peak 8-12 hr, duration 18-24

hr.
LONG ACTING INSULIN

HUMULIN U,

ULTRALENTE

Route SC
Onset 4-8 hr, peak 10-30 hr, duration > 36 hr.
Rarely used.
MIXED INSULIN
NPH 70%, Regular 30% Humulin 70/30,
Novolin 70/30.
NPH 50%, Regular 50% Humulin 50/50
Stable mixtures with onset, peak and duration
of action the same as the N and R
components.
Route SC
Frequently used when patients have trouble
mixing N and R insulin accurately
themselves.

H Y P O G LY C E M I A
A decrease in the amount of serum glucose level
ASSESMENT

confusion
headaches
tachycardia
hypotension

Liver Disease