medical surgical - hepatobiliary / endocrine system

FJRC.MS.MetabolicAlterationsFJRC.MS.MetabolicAlterations 11


MEtaBoliC MEtaBoliC aLteRaTiONsaLteRaTiONs

Francis Jordan Ramos Cusi, RNFrancis Jordan Ramos Cusi, RN


ENDOENDOCRINE SYSTEMCRINE SYSTEM

Glands Glands HormonesHormones ReceptorsReceptors

Amines

Polypeptides

Steroids


GLANDS OF GLANDS OF THE THE ENDOCRINE ENDOCRINE SYSTEMSYSTEM


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


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


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)


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)


POSTERIOR PITUITARYPOSTERIOR PITUITARY

Pede na rinPede na rin Hamak na Hamak na imbakanimbakan OOXYTOCIN XYTOCIN AANTIDIURETIC HORMONE NTIDIURETIC HORMONE

(Vasopressin)(Vasopressin)


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


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


THYMUS GLANDTHYMUS GLAND

Upper thoraxUpper thorax Immuno-Immuno-endoendoThymosin : T-lymphocytesThymosin : T-lymphocytes

maturation maturation


ENDOCRINE PANCREASENDOCRINE PANCREAS

Pancreatic Pancreatic

islets : New-islets : New-NSONSO reg reg

GA-BIDSGA-BIDS


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)


GONADSGONADS

OVARIES: OVARIES:

mainly mainly estradiolestradiolTESTES: TESTES: testosteronetestosterone


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


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


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


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


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


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


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!


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


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


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


THYROID THYROID DISORDERSDISORDERS


HYPERTIREDDYTIESHYPERTIREDDYTIES


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


Decreased T3 and T4Decreased T3 and T4 decreased basal decreased basal metabolism metabolism


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


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


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


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


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


Increased hormone Increased hormone activityactivity increased Basal increased Basal MetabolismMetabolism


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


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


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


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


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


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


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


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


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


Removal of the thyroid glandRemoval of the thyroid gland


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


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


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


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


PARATHYROID DISORDERSPARATHYROID DISORDERS


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


Decreased PTHDecreased PTH deranged deranged calcium metabolismcalcium metabolism


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


6. Cardiac dysrhythmias6. Cardiac dysrhythmias 7. Hypotension7. Hypotension 8. Anxiety, irritability ands 8. Anxiety, irritability ands

depressiondepression


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


Advise client to eat Vitamin Advise client to eat Vitamin D rich foodsD rich foods

Administer Phosphate Administer Phosphate binding drugsbinding drugs


Hyper-Hyper-secretion of secretion of the glandthe gland

CAUSE:CAUSE: TumorTumor


Increase PTHIncrease PTH increased increased CALCIUM levels in the CALCIUM levels in the bodybody


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


HypertensionHypertension Cardiac Dysrhythmias Cardiac Dysrhythmias Renal StonesRenal Stones


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


Administer calcium Administer calcium chelatorschelators

Administer CALCITONINAdminister CALCITONIN Prepare the patient for Prepare the patient for

surgerysurgery


ADRENOCORTICAL ADRENOCORTICAL DISORDERSDISORDERS


Decreased secretion of Decreased secretion of adrenal cortex hormones, adrenal cortex hormones, especially glucocorticoids especially glucocorticoids and mineralocorticoidsand mineralocorticoids

CAUSE: CAUSE: Tumor, idopathicTumor, idopathic


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


Weight lossWeight loss

GI disturbancesGI disturbances

Muscle weakness, lethargy Muscle weakness, lethargy and fatigueand fatigue

HyponatremiaHyponatremia


HyperkalemiaHyperkalemia

HypoglycemiaHypoglycemia

dehydration and hypovolemiadehydration and hypovolemia

Increased skin pigmentationIncreased skin pigmentation


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


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


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


Overwhelming stimuliOverwhelming stimuli mobilize body defensemobilize body defense decreased stress decreased stress hormoneshormones inadequate inadequate copingcoping


Severe headacheSevere headache Severe painSevere pain Severe weaknessSevere weakness Severe hypotensionSevere hypotension Signs of ShockSigns of Shock


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


Administer IVFAdminister IVF Maintain bed restMaintain bed rest Administer prescribed Administer prescribed

antibioticsantibiotics


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


Increased GlucocorticoidsIncreased Glucocorticoids exaggerated effects of the exaggerated effects of the hormonehormone


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


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


Generalized muscle Generalized muscle weakness and wastingweakness and wasting

Truncal obesityTruncal obesity Moon-faceMoon-face Buffalo humpBuffalo hump Easy bruisabilityEasy bruisability


Reddish-purplish striae on Reddish-purplish striae on the abdomen and thighsthe abdomen and thighs

Hirsutism and acneHirsutism and acne HypertensionHypertension HyperglycemiaHyperglycemia OsteoporosisOsteoporosis AmenorrheaAmenorrhea


Serum cortisol levelSerum cortisol level

Serum glucose and Serum glucose and electrolyteselectrolytes


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


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


ADRENOMEDULLARY ADRENOMEDULLARY DISORDERDISORDER


Increased secretion of Increased secretion of epinephrine and nor-epinephrine and nor-epinephrine by the adrenal epinephrine by the adrenal medullamedulla

CAUSE: TumorCAUSE: Tumor


Increased Adrenergic Increased Adrenergic hormoneshormones exaggerated exaggerated sympathetic effectssympathetic effects


HypertensionHypertension Severe headacheSevere headache PalpitationsPalpitations TachycardiaTachycardia Profuse sweating and FlushingProfuse sweating and Flushing Weight loss, tremorsWeight loss, tremors Hyperglycemia and glycosuriaHyperglycemia and glycosuria


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


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


Provide HIGH calorie foods Provide HIGH calorie foods and Vitamins/mineral and Vitamins/mineral supplementssupplements

Prepare patient for Prepare patient for possible surgerypossible surgery


ANTERIOR PITUITARY ANTERIOR PITUITARY DISORDERSDISORDERS


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


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


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


The hyper-secretion of the The hyper-secretion of the glandgland

ACROMEGALYACROMEGALY CAUSES: tumor, congenital CAUSES: tumor, congenital

disorderdisorder


Depends on the Depends on the hormone/s that hormone/s that is/are increasedis/are increased


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


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


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


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


POSTERIOR PITUITARY POSTERIOR PITUITARY DISORDERSDISORDERS


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


Decreased ADHDecreased ADH failure of failure of tubular re-absorption of tubular re-absorption of waterwater increased urine volume increased urine volume


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


Urinary Specific gravityUrinary Specific gravity very low, 1.006 or lessvery low, 1.006 or less

Serum Sodium levelsSerum Sodium levels high high


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


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


Hyper-secretion of ADH Hyper-secretion of ADH abnormallyabnormally

CAUSES: CAUSES: Tumor, paraneoplastic Tumor, paraneoplastic

syndromessyndromes


Increased ADHIncreased ADH water re- water re-absorptionabsorption water water intoxication, hypervolemiaintoxication, hypervolemia


Urine specific gravity is Urine specific gravity is increased (concentrated)increased (concentrated)

HyponatremiaHyponatremia

CBC showsCBC shows hemodilutionhemodilution


Signs of HypervolemiaSigns of Hypervolemia

Mental status changesMental status changes

Abnormal weight gainAbnormal weight gain


HypertensionHypertension

Anorexia, Nausea and Anorexia, Nausea and VomitingVomiting

HYPOnatremiaHYPOnatremia


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)


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


ENDO-PANCREAS ENDO-PANCREAS DISORDERDISORDER


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


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


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


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)


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


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


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


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


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


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.


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.


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


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


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.


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.


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


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


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


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.


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


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.


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.


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.


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


Selected EndocrineSelected EndocrinePHARMACOLOGYPHARMACOLOGY


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


Endocrine MedicationsEndocrine Medications

SIDE-effectsSIDE-effects Flushing and headacheFlushing and headache Water intoxicationWater intoxication


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



Nausea and VomitingNausea and Vomiting

Signs of increased Signs of increased metabolism= metabolism= tachycardia, tachycardia, hypertensionhypertension



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



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


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



N/VN/V DiarrheaDiarrhea AGRANULOCYTOSISAGRANULOCYTOSIS

Most important to monitorMost important to monitor



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


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


STEROIDSSTEROIDS

Replaces the steroids Replaces the steroids in the bodyin the body

Cortisol, cortisone, Cortisol, cortisone, betamethasone, and betamethasone, and hydrocortisonehydrocortisone


STEROIDSSTEROIDS

Side-effectsSide-effectsHYPERglycemiaHYPERglycemia Increased susceptibility Increased susceptibility to infectionto infection

HypokalemiaHypokalemiaEdemaEdema


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


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


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


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


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


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


EXO-PANCREATIC AND EXO-PANCREATIC AND BILIARY DISORDERSBILIARY DISORDERS


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


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


HEPATIC DISORDERSHEPATIC DISORDERS

medical surgical - hepatobiliary / endocrine system

Documents

metabolicalterations

thyroid gland rai

h isthmus

luteinizing hormone

thyroid medication

pituitar y gland

kidney h ati

thyroid function test