physiologic adaptation disturbance in metabolism responses to altered endocrine function paul for...

8/10/2019 Physiologic Adaptation Disturbance in Metabolism Responses to Altered Endocrine Function Paul for Review

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Physiologic Adaptation: Disturbance in

Metabolism- Responses to Altered Endocrine

Functions

John Paul M. Tagapan


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Disorder of the Thyroid Gland

1.Hyperthyroidism

2.Hypothyroidism


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Hyperthyroidism

Graves disease is an autoimmune disorder that leads

to over activity of the thyroid gland(hyperthyroidism)


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Manifestation


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Laboratory Findings

Test Normal Values Findings

Serum TA Negative to 1:20 increased

Serum TSH 2-10 mU/ ml Decreased in primary

Serum T4 5-12 mcg/dL Increased

Serum T3 80-200 mg/dL Increased

T3uptake 25-35 relative

percentage

Increased

Thyroid

suppression

Increase RAI uptake

and T4levels


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Nursing Diagnosis Risk for Decreased Cardiac Output

Disturbed sensory Perception: Visual

Imbalanced Nutrition: Less than body requirement

Disturbed Body Image


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MedicationIodine Sources

a) Strong Iodine Solution (lugolsSolution)

b) Potassium Iodide ( SSKI, Thyro-Block, Pima)

Antithyroid Drugs

a) Methimazole ( Tapazole)

b) Propylthiouracil ( PTU, Propyl-thyracil)


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Radio Iodine Therapy

Radioactive iodine is a medicine that you take one time.

After you swallow it, it is taken up by your thyroid gland.Depending on the dosage used, the radioactivity in the iodine

destroys most or all of the tissue in your thyroid gland, but it does

not harm any other parts of your body.


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Surgery

a) thyroidectomy


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HYPOTHYROIDISM

Hypothyroidism is a disorder that results when the thyroid

glands produces an insufficient amount of TH (Lemone 2008)

Hypothyroidism is a condition in which the thyroid gland does

not make enough thyroid hormone (Medline Plus)


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Manifestation


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Nursing Diagnosis Decreased Cardiac Output

Constipation

Risk for Impaired Skin Integrity


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Disorder of the Parathyroid Gland

1. Hyperparathyroidim

2. Hypoparathyroidism


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Disorder in Parathyroid Gland

HYPERPARATHYROIDISM

Result from an increase in secretion of parathyroid hormone

(PTH) which regulates normal serum calcium. The increase in

PTH affects the kidney and bones ( Lemone, 2008)


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Manifestation Musculoskeletal: bone pain (back, joint, shins); pathologic

fracture ( women); muscle weakness; muscle atrophy

Renal effects: renal calculi; polyuria; polydipsia

Gastrointestinal: abdominal pain, peptic ulcers, pancreatitis;

nausea; constipation

Cardiovascular: arrhythmias; Hypertension

CNS: parenthesia; depression; psychosis

Metabolic effects: Acidosis; weight loss


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Laboratory Findings Serum electrolytes shows total serum calcium greater than

10.0 mg/dL

ECG changes in hypercalcemia include a shortened QT

interval, shortened and depressed ST segment and wined T

wave. Bradycardia or heart block may be identified on ECG

Bone density scan may be done to monitor bone reabsorption

and effect of treatment measure on mineralization.


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Medication

Biphosphonate ( pamidronate and etidronate)


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Nursing Intervention Risk for injury

Risk for Excess Fluid Volume


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Laboratory Findings Serum electrolytes shows total serum calcium greater than

10.0 mg/dL

ECG changes in hypercalcemia include a shortened QT

interval, shortened and depressed ST segment and wined T

wave. Bradycardia or heart block may be identified on ECG

Bone density scan may be done to monitor bone reabsorption

and effect of treatment measure on mineralization.


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HYPOPARATHYROID

Result from abnormally low PTH levels. The most common

cause is damage to or removal of the parathyroid glands during

thyroidectomy. The lack of circulating PTH cause

hypocalcemia and an elevated blood phosphate levels (

Lemone, 2008).


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Manifestation Chvostek's sign- Contraction of the lateral facial muscles in

response to tapping the face in front of the ear; caused by

decreased blood calcium levels.

Trousseau's sign- Contraction of the hand and fingers in

response to occlusion of the blood supply by a blood pressure

cuff; caused by decreased blood calcium levels.


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Medication

Calcium salts ( Calcium carbonate, calcium chloride, calcium

citrate, calcium glubionate, calcium gluceptate, calcium

gluconate, calcium lactate)


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Nursing Diagnosis Risk for Injury


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DISORDER OF THE ADRENAL GLAND

1. HYPERCORTISOLISM ( Cushings Syndrome)

2. ADDISONS DISEASE


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HYPERCORTISOLISM ( Cushings Syndrome)

Cushing's syndrome is a disease caused by increased

production of cortisol, or by excessive use of cortisol or other

steroid hormones.


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Manifestation


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Laboratory Findings

Test Normal Values Findings

Serum Cortisol 8am-10am

5-23 mcg/dL

4pm-6pm

3-13 mcg/dL

increased

Blood Urea nitrogen 5-25 mg/dl Normal

Sodium 135-145 mEq/L Increased

Potassium 3.4-5.0 mEq/L Increased

Glucose 70-100 mg/dL Increased

Urine 17-KS Male: 5-25 mg/24h

Female: 5-15 mg/24h

Age 65:4 -

8mg/24h

Increase


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Medication Mitotate directly suppresses activity of adrenal cortex and

decrease peripheral metabolism of corticosteroid.

Aminoglutemide or ketoconazole

Somastostatin


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Nursing Diagnosis Fluid Volume Excess

Risk for injury

Disturbed Body Image

Risk for Infection


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ADDISONS DISEASE

Addison's disease is a disorder that occurs when the adrenal

glands do not produce enough of their hormones

Addison's disease results from damage to the adrenal cortex.

The damage causes the cortex to produce less of its hormones.


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Manifestation


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Laboratory FindingsTest

Normal Values

Findings

Serum Cortisol 8am-10am

5-23 mcg/dL

4pm-6pm

3-13 mcg/dL

Decreased

Blood Urea nitrogen

5-25 mg/dl

Increased

Sodium 135-145 mEq/L Decreased

Potassium 3.4-5.0 mEq/L Increased

Glucose 70-100 mg/dL Decreased

Urine

17-KS

Male: 5-25 mg/24hFemale: 5-15 mg/24h

Age 65:4 -8mg/24h

Low or absent


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Medication The primary medical treatment of Addisons disease is

replacement of corticosteroid, accompanied by increase

sodium diet. Hydrocortisone is given orally to replace cortisol.Fludrocortisone is given orally to replace mineralocorticoids.


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Nursing Diagnosis Deficient Fluid Volume

Risk for Ineffective regimen management


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DISORDER OF THE PITUITARY GLANDS

1. Anterior Pituitary Gland

Hyper function of the pituitary gland, characterized by excess

production and secretion of one or more tropic hormones is

usually the result of pituitary tumor or pituitary hyperplasia.(Gigantism)

Hypo function of anterior glands results in deficiency of one or

more of the glands hormone. ( Acromegaly)


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Posterior Pituitary Gland

SYNDROME OF THE INAPPROPRIATE ADH

PRODUCTION

High levels of ADH in the absence of serum hypo-osmolality.

This order is often caused by the ectopic production of ADH

by malignant tumors ( Lemone 2008).


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DIABETES INSIPIDUS

Result of ADH insufficiency

a) Neurogenic Diabetes Insipidus: disruption of Hypothalamus

and pituitary gland

b) Neprogenic Diabetes Insipidus: renal tubules are sensitive to

ADH.

May result to a brain tumor or infections of pituitary surgery,

cerebral vascular accidents and renal and organ failure.


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Interdisciplinary Care

SIADH is treated by correcting underlying causes, treating the

hyponatremia with intravenous hypertonic saline, and restricting oral fluids

to less than 800 mL/day

Diabetes Insipidus is also treated by correcting the underlying cause. If

possible. Other medical intervention includes administering IV hypotonic

saline, Increase Fluid intake and replacing ADH hormone. Desmopressin

acetate, administration intranasally orally, or parenterally.


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DISORDERS IN PANCREAS

DIABETES MELLITUS

Type 1 DM is the result of pancreatic islet cell destruction and

a total deficit of circulating insulin;

Type 2 DM results from insulin resistance with a defect incompensatory insulin secretion.


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CLASSIFICATION AND TYPES OF DIABETES


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CLASSIFICATION AND TYPES OF DIABETES


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