2 - Endocrine notes/ medsurge PDF

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CONCEPT: ENDOCRINE SYSTEM

I. ANATOMY

II. PHYSIOLOGY POSTERIOR PITUITARY GLAND

_____________ _ stimulates uterine contractions milk ejection during lactation _____________ _____ controls the excretion of water by the kidneys

HYPOTHALAMUS

ANTERIOR PITUITARY GLAND

______________________ stimulates growth ______________ stimulates development of mammary gland and secretion of milk _____________________________ stimulates production of melanin

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

II. PATHOLOGY A. Posterior Pituitary Gland Disorders DIABETES INSIPIDUS (DI) Problem:

_________ ADH

SYNDROME OF INAPPROPRIATE ADH (SIADH) Problem:

________ ADH

Assessment:

Assessment:

Fluid

Fluid

Weight

Weight

Hemo___________

Hemo___________

____Sodium

____Sodium

____BUN, ___CREA, ___URIC ACID

____BUN, ___CREA, ___URIC ACID

____BP, ____Fluid volume – can lead to ____

____BP, ____Fluid volume WOF: Cerebral Edema

Meds:

Meds:

Desmopressin (DDAVP, Stimate)

Demeclocycline (Declomycin) – Tetracycline antibiotic

Lypressin (Diapid)

IV hypertonic saline (3%) – causes the cells to shrink

Vasopressin (Pitressin)

Diuretics – removes excessive fluid

B. Anterior Pituitary Gland Disorders Hypopituitarism

Hyperpituitarism

Other names:

Other names:

Sheehan’s Syndrome – post-partum pituitary gland necrosis due to hypovolemic shock

Gigantism

Simmonds’ Disease – panhypopituitarism

Acromegaly

Dwarfism – decrease in growth hormone

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

Causes: Stress Tumor Autoimmune Trauma Encephalitis

Causes: Adenoma Hyperplasia

MANIFESTATIONS: Depends on which part is affected MANIFESTATIONS: Depends on which part is affected POSTERIOR

ANTERIOR

ADH LH AND FSH - L ANTERIOR: O LH AND FSH – “Precocious Puberty” I D GROWTH HORMONE ADRENOCORTICOTROPIC HORMONE THYROID STIMULATING HORMONE

ADRENOCORTICOTROPIC HORMONE THYROID STIMULATING HORMONE GROWTH HORMONE EARLY ONSET happens before the closure of the epiphyseal plate (growth plate)

POSTERIOR ADH OXYTOCIN – Manifestation will occur during: C B

LATE ONSET happens after the closure of the epiphyseal plate (growth plate)

Meds:

Meds: Somatrem (Protropin) Somatropin (Humatrope, Nutropin) Hormonal Replacement Therapy

Bromocriptine (Parlodel) -Dopamine AgonistOctreotide (Sandostatin) -Somatostatin Analog-

Growth hormone inhibitor

Surgery: HYPOPHYSECTOMY 1. Craniotomy - Opening the _______ 2. Transphenoidal Surgery Pituitary gland lies directly behind the nose. Operative site: Teaching Prior:

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

SURGERY: HYPOPHYSECTOMY – Removal of the Pituitary gland (Hypophysis) COMPLICATIONS DISTURBANCE OF THE HYPOPITUITARISM CSF LEAK (RHINORRHEA) OPERATIVE SITE

D

Check for the presence of _________ in the fluid draining out of the patients ______

A

Avoid:

INCREASE INTRACRANIAL PRESSURE (ICP) Position:

Brushing the teeth Using straw Vigorous & frequent flossing Commercial Mouthwash Allow:

H Use toothette Do non-vigorous and infrequent flossing Gargle with saline solution

C. Thyroid Gland Disorders 1. Thyroxine (T4) 2. Triiodothyronine (T3) 3. Calcitonin

THYROXINE T4 MAINTAINS METABOLIC RATE AT A STEADY STATE

TRIIODOTHYRONINE T3 UNSTABLE 5X MORE POTENT THAN T4

CALCITONIN CALCIUM METABOLISM BRINGS CALCIUM INTO THE BONE

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

HYPOTHYROIDISM

HYPERTHYROIDISM

PRIMARY WITHIN THE THYROID SECONDARY ANTERIOR PITUITARY GLAND

Hypothyroidism Problem:

____ ____

Thyroid Hormone Metabolic Rate

Common Cause: Hashimoto’s Disease (Thyroiditis) – Inflammation of the thyroid gland / Autoimmune Types: 1. Myxedema – long standing hypothyroidism 2.Cretinism – thyroid deficiency at birth 3.Simple Goiter – due to lack of iodine

- Myxedema coma (severe form) Priority: AIRWAY!

CLINICAL MANIFESTATIONS: Generally low except for:

Cholesterol Weight Menstruation

P -eristalsis

U – rine output

S - weating

H – eat production

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

MEDICATIONS: LEVOTHYROXINE (LEVOTHROID,LEVOXYL,SYNTHROID) LIOTHYRONINE (CYTOMEL) WOF: CHEST PAIN – CAN LEAD TO BEST TIME TO TAKE: 1. Morning before breakfast 2. Same time each day 3. Life long compliance ADVERSE EFFECT: S/SX HYPERTHYROIDISM Hyperthyroidism Problem:

____ ____

Thyroid Hormone Metabolic Rate

Common Type: Graves Disease – Toxic Goiter CLINICAL MANIFESTATIONS: Generally high except for:

Cholesterol Weight Menstruation

P - eristalsis

U – rine output

S - weating

H –eat production

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

Treatment Propylthiouracil (PTU)

Prevents the conversion of t4 to t3

Methimazole (Tapazole) Adverse Effect: Beta-Adrenergic Blocker

SSKI (saturated solution of potassium iodide) , Lugol’s Solution (Strong Iodine Solution) Pre-op medication: to achieve euthyroid state – to prevent thyrotoxicosis (thyroid storm) * Use straw, causes teeth _________ Radioactive Iodine (RAI 131)

Surgery: THYROIDECTOMY COMPLICATIONS: 1. BLEEDING 2.

SWELLING/ EDEMA/ HEMATOMA

PRIORITY:

3. HYPOCALCEMIA – WOF: SPASMS AND PARESTHESIA 4. LARYNGEAL NERVE DAMAGE ASSESS:

5. THYROID STORM (Thyrotoxicosis) Causes: a. infection b. stress c. hyperthyroidism

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

Signs and Symptoms of Thyrotoxicosis:

D. Parathyroid Gland Disorders 1. Parathyroid Hormone (Parathormone) – BRINGS CALCIUM IN THE BLOOD Controls Calcium and Phosphorus Metabolism

Hypoparathyroidism

Hyperparathyroidism

CAUSES:

CAUSES:

Autoimmune

Adenoma – benign tumor

Thyroidectomy

Hyperplasia – increase in size

PROBLEM:

PROBLEM

_____PARATHYROID HORMONE

_____PARATHYROID HORMONE

_____CALCIUM

_____CALCIUM

WOF: *Calcium and Phosphorus Levels

WOF:*Calcium and Phosphorus Levels

MEDICATIONS:

MEDICATIONS:

CALCIUM SUPPLEMENTS – to increase Calcium VITAMIN D WITH VITAMIN C – to improve intestinal absorption of Calcium PHOSPHATE BINDERS –to decrease phosphorus

DIURETICS –to eliminate excessive Calcium PNSS IV - to dilute Calcium PHOSPHATE IV – to increase phosphorus CALCITONIN – to bring the Calcium back to the bones

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

E. Adrenal Gland Disorders

Adrenal Cortex

Adrenal Medulla

Addison’s Disease Problem:

____ Glucocorticoid ____Mineralocorticoid

ASSESSMENT:

Management:

LIFE LONG REPLACEMENT THERAPY: FLUDROCORTISONE (FLORINEF) – “Mineralocorticoid” - releases Aldosterone Increases the reabsorption of water and sodium Increases urinary potassium excretion GLUCOCORTICOIDS (PREDNISONE, DEXAMETHASONE, BECLOMETHASONE) ***WEAR MEDICAL ALERT BRACELET – To provide emergency treatment To alert people that patient needs steroid replacement

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

Cushing’s Disease Problem:

____ Glucocorticoid ____Mineralocorticoid

ASSESSMENT:

DUE TO STEROIDS USE: 1. SUPPRESS IMMUNE SYSTEM Avoid exposure to infection and large crowds 2. COMPENSATORY INCREASE WBC – presence of infection 3. PHOTOSENSITIVITY – sensitive to light 4. DECREASE ABSORPTION OF CALCIUM IN GIT - Prone: 5. CATABOLIC TO SKIN, CONNECTIVE TISSUE AND MUSCLE

WOF: POOR WOUND HEALING

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

Cushingoid Appearance:

Conn’s Syndrome Problem: ____Mineralocorticoid

Management: Diuretics Anti-hypertensive drugs Potassium supplements

Pheochromocytoma Problem: _____Catecholamines

Management:

Cause:

Anti-hypertensives

T H H H Diagnostic Test: Vanillylmandelic Acid Test (VMA) – byproduct of catecholamines Specimen: Pre-test: Clonidine Suppression Test Total Catecholamine Plasma

- Specimen:

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

F. Pancreas

TYPE I

MODIFIABLE

NON MODIFIABLE

Obesity Hypertension Cholesterol

Family History Age Gestational Diabetes Ethnicity

TYPE II

GESTATIONAL DIABETES MELLITUS High blood sugar that starts or is first diagnosed during pregnancy Usually happens during 2nd – 3rd trimester

NORMAL BLOOD SUGAR: ___________ 1.FASTING BLOOD GLUCOSE (FBG) NPO: 2. ORAL GLUCOSE TOLERANCE TEST (GTT) USUALLY FOR: FASTING: ________ WITHDRAW blood for baseline comparison Give oral glucose concentrate Then WITHDRAW blood AFTER

FASTING BASELINE: 70-110MG/DL 30-MINUTE SAMPLE:110-170MG/DL 60-MINUTE SAMPLE:120-170MG/DL 90-MINUTE SAMPLE:100-140MG/DL 120-MINUTE SAMPLE:70-120MG/DL

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

3. CAPILLARY BLOOD GLUCOSE (CBG) Random blood glucose testing – No NPO needed 4. GLYCOSYLATED HEMOGLOBIN MEASURES: the glucose stuck in the RBC’s REFLECTS HOW DM is controlled IN THE LAST _____MONTHS AND SHOWS drug compliance NORMAL: 3.5-6% GOOD DIABETIC CONTROL: 7.5% OR LOWER FAIR DIABETIC CONTROL : 7.6-8.9% POOR DIABETIC CONTROL : 9% OR HIGHER Acute Complications of DM 1.HYPOGYLCEMIA MILD

Tremors

MODERATE

“CNS SYMPTOMS”

SEVERE

LOSS OF CONSCIOUSNESS

Irritability

Headache

SEIZURES

Restlessness

Blurred vision

Management:

Excessive Hunger

Slurred speech

GLUCAGON

Diaphoresis

Dizziness / Drowsiness

**If the patient remains unconscious ________ given and ________

Irritability

MANAGEMENT for MILD and MODERATE: 10-15 grams of fast acting simple carbohydrates

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

2.) DKA -An absence or markedly inadequate amount of insulin

3.)HHNS -Extreme hyperglycemia without ketosis and acidosis

ASSESSMENT: Blurred vision Polyuria Dehydration Headache Weakness Thirst

ASSESSMENT: Blurred vision Polyuria Dehydration Headache Weakness Thirst

*Sick Day Rule! -continue to take medications -continue compliance to diet -increase frequency of glucose monitoring -drink fluids every hour to prevent DKA

*Sick Day Rule! -continue to take medications -continue compliance to diet -increase frequency of glucose monitoring -drink fluids every hour to prevent HHNS

Chronic Complications Of DM Macrovascular Myocardial Infarction (MI)

Microvascular NEPHROPATHY - Damages the kidneys

Neuropathy PERIPHERAL NEUROPATHY - Damages the nerves

RETINOPATHY Cerebrovascular Accident (CVA)

-

Damages small blood vessels in the eyes (retina), which might lead to blindness

Diabetic Foot

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

FOOT CARE: AVOID CROSSING THE LEGS APPLICATION OF LOTION IN BETWEEN THE TOES HEATING PAD FOR SORE FEET SHOES HALF SIZE LARGER Management of DM: 1. Diet

ALLOWED CUT TOE NAILS STRAIGHT ACROSS CLEAN AND INSPECT DAILY

2. Exercise – recommendation 3 times a week 3. Insulin - (Type 1) 4. Oral Hypoglycemic Agents (OHA) - (Type 2) INSULIN RAPID ACTING INSULIN (HUMALOG,NOVOLOG)

SHORT ACTING INSULIN (HUMULIN R,NOVOLIN R)

INTERMEDIATE ACTING INSULIN (HUMULIN N,NOVOLIN N,LENTE)

LONG ACTING INSULIN (ULTRALENTE)

VERY LONG ACTING GLARGINE(LANTUS)

NO PEAK HOURS

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

ORAL HYPOGLYCEMIC AGENTS CLASSIFICATION SULFONYLUREAS First Generation

MECHANISM OF ACTION

NURSING CONSIDERATION

Acetohexamide (Dymelor)

STIMULATES INSULIN RELEASE

TAKE IT WITH MEALS

DELAYS THE CONVERSION OF CARBOHYDRATES INTO SIMPLE SUGAR

TAKE IT WITH THE FIRST BITE OF A MEAL

Chlorpropamide (Diabinase) Second Generation

NON-SULFONYLUREAS Alpha Glucosidase Inhibitors

Biguanide Metformin (Glucophage)

INHIBITS GLUCONEOGENESIS

Meglitinides TAKE IT WITH MEALS STIMULATES INSULIN RELEASE Thiazolidinediones DECREASE INSULIN RESISTANCE

“Success is a state of mind. If you want success, start thinking of yourself as a success.”

Complications: DAWN PHENOMENON -results from a nocturnal release of growth hormone which may cause blooD glucose to begin to rise at around _______

INSULIN WANING

SOMOGYI’S PHENOMENON

-rebound phenomenon that occurs -progressive rise in blood glucose during the initial period of blood from bedtime to morning. glucose control; develops at peak insulin times and during the night. Rebound phenomenon counterregulatory ______@bed time then ______@3am then ______@7am

due

to:

MANAGEMENT:

MANAGEMENT:

MANAGEMENT:

Evening dose of intermediate insulin at around 10pm

Decreasing evening dose of Increasing evening dose of intermediate insulin or increasing bed intermediate insulin or long acting time snack insulin or giving a dose of insulin before the evening meal.

PROPER ORDER OF MIXING TWO TYPES OF INSULIN Invert and roll the bottle of intermediate or long-acting insulin between your hands, to mix the insulin. Do not shake the bottle. Clean the top of both insulin vials with alcohol prep pads and allow them to dry. Measure the same volume of air as you need of the intermediate or long-acting insulin and inject into the insulin vial. Withdraw the needle. Measure the same volume of air as you need of the regular insulin and inject into the insulin vial. Leave the needle in the vial, invert the bottle and withdraw the correct dosage, maintaining asepsis. (Rapid and short acting insulin are clear in color). Expel any air bubbles, recheck the volume of insulin for accuracy, then remove the needle from vial. Turn the bottle of intermediate or long-acting insulin upside down and reinsert the needle into this vial, maintaining asepsis. Slowly pull the plunger to withdraw the correct dosage of insulin. Remove the needle from the vial. Replace the needle cap on the sterile needle

“Success is a state of mind. If you want success, start thinking of yourself as a success.”...