Medical-Surgical Nursing

Endocrine System Reviewer

Endocrine system
1.
2.
3.
4.
5.

hormones released into the bloodstream travel throughout the body

target is usually far from site of synthesis
binds to receptors on or in target
targets = cells throughout the body
results may take hours, but last longer

Functions of Hormones

Helps regulate:
1. extracellular fluid
2. metabolism
3. biological clock
4. contraction of cardiac & smooth muscle
5. glandular secretion
6. some immune functions

Growth & development

Reproduction
Endocrine glands in the human head and their hormones

Exocrine glands
1.
2.
Endocrine glands
1.
2.
3.

secrete products into ducts which empty into

body cavities or body surface
sweat, oil, mucous, & digestive glands
secrete products (hormones) into bloodstream
pituitary, thyroid, parathyroid, adrenal, pineal
other organs secrete hormones as a 2nd function

hypothalamus, thymus, pancreas,ovaries,testes, kidneys, stomach, liver, small intestine, skin, heart & placenta

DISORDERS OF THE ENDOCRINE SYSTEM

DIABETIS INSIPIDUS hyposecretion of ADH
Cause: idiopathic/ unknown
Predisposing factor:
1. Pituitary surgery

2.
3.
4.

Trauma/ head injury

Tumor
Inflammation

Signs and Symptoms

1. Polyuria
2. Signs of dehydration
-1st sign of dehydration in children-tachycardia)
- Excessive thirst (adult)
- Agitation
- Poor skin turgor
- Dry mucus membrane
3. Weakness & fatigue
4. Hypotension if left untreated
5. Hypovolemic shock
6. Anuria late sign hypovolemic shock
Diagnostic
1. Decrease urine specific gravity- concentrated urine
N= 1.015 1.035
2. Serum Na = increase (N=135 -145 meq/L) Hypernatremia
Nursing Management
1. Force fluid 2,000 3,000ml/day
2. Administer IV fluid replacement as ordered
3. Monitor VS, I&O
4. Administer meds as ordered
a.) Pitresin (vasopressin) IM
5. Prevent complications
Most feared complication Hypovolemic shock

SIADH - Syndrome of Inappropriate Anti-Diuretic Hormone

- Increase ADH
- Idiopathic/ unknown
Predisposing factor
1. Head injury
2. Related to Bronchogenic cancer or lung caner3. Hyperplasia of Pituitary gland
4. Increase size of organ
Signs and Symptoms
1. Fluid retention
2. Increase BP HPN
3. Edema
4. Wt gain
5. Danger of H2O intoxication Complications:
1. cerebral edema
2.
increase ICP
3. 2. seizure
Diagnostic
1. Urine specific gravity increase diluted urine
2. Hyponatremia Decreased Na
Nursing Management
1. Restrict fluid
2. Administer meds as ordered eg. Diuretics: Loop and Osmotic
3. Monitor strictly V/S, I&O, neurologic check increase ICP
4. Weigh daily
5. Assess for presence edema
6. Provide meticulous skin care
7. Prevent complications increase ICP & seizures activity

SIMPLE GOITER enlarged thyroid gland - iodine deficiency

Predisposing factors
1. Age over 40 years
2.
3.
4.

Family history of goiter

Female gender
Not getting enough iodine in the diet

Signs and Symptoms

1.
Breathing difficulties (may rarely occur with very large goiters)
2. Cough
3. Hoarseness
4. Swallowing difficulties
Diagnostic
1. Thyroid scan reveals enlarged Thyroid Gland
2. Serum TSH increase (confirmatory)
3. Serum T3, T4
Nursing Management
1. Administer meds
a.) Iodine solution Logols solution or saturated solution of K iodide(SSKI)
1. use straw to prevent staining teeth
2. Prophylaxis 2 -3 drops for Treatment 5 to 6 drops
b.) Thyroid hormone Agents
1. Levothyroxine (Synthroid)
2. Liothyronine (cytomel)
3. Thyroid extract
a.
Monitor vs. HR due tachycardia & palpitation
b. Take it early AM SE insomnia
c.
Monitor s/e

2.Encourage increase intake of iodine

Seafood- highest iodine content :oysters, clams, crabs, lobster
Lowest iodine shrimps
Iodized salt easily destroyed by heat take it raw not cooked
3.Assist in surgery: Sub Total ThyroidectomyComplications:
1. Tetany
2. laryngeal nerve damage
3.Hemorrhage-feeling of fullness at incision site.Check nape for wet blood
4.Laryngeal spasm DOB, SOB tracheostomy set ready at bedside

HYPOTHYROIDISM AND HYPERTHYROIDISM

HYPOTHYROIDISM
All body systems are DECREASED
except WEIGHT and MENSTRUATION!
decreased CNS: drowsiness, memory problems
(forgetfulness)
decreased v/s: hypotension, bradycardia, bradypnea,
low body temp
decreased GI motility: constipation
decreased appetite (anorexia) but with WEIGHT
GAIN
[low metabolism causes decreased burning of fats and
carbs]

HYPERTHYROIDISM
All body systems are INCREASED
except WEIGHT and MENSTRUATION!
increased CNS: tremors, insomnia
increased v/s: hypertension, tachycardia, tachypnea,
fever
increased GI motility: diarrhea
increased appetite (hyperphagia) but with WEIGHT
LOSS [high metabolism causes increased burning of fats
and carbs]

 This leads to increased serum cholesterol

atherosclerosis (hardening of arteries due to cholesterol
deposits)
Because of increased cholesterol, hypothyroid patients
are prone to hypertension, myocardial infarction, CHF
and stroke

decreased metabolism causes decreased

perspiration
DRY SKIN and COLD INTOLERANCE
Menorrhagia (excessive bleeding during
menstruation)
Nursing Management for hypothyroidism:
Low calorie diet
Warm environment

increased metabolism causes increased perspiration

MOIST SKIN and HEAT INTOLERANCE

Amenorrhea (absence of menstruation)
Pathognomic sign: EXOPHTHALMOS (bulging eyeballs)
Nursing Management for hyperthyroidism:
High calorie diet
Cool environment

HYPOPARATHYROIDISM
- parathyroid glands in the neck do not produce enough parathyroid hormone
Predisposing factors
1. Following subtotal thyroidectomy
2. Atrophy of parathyroid gland due to
a. Irradiation
b. Trauma
Signs and Symptoms
1. Abdominal pain
2. Brittle nails
3. Cataracts
4. Dry hair
5. Dry, scaly skin
6. Muscle cramps
7. Muscle spasms called tetany (can affect the larynx, causing breathing difficulties)
8. Pain in the face, legs, and feet
9. Seizures
10. Tingling lips, fingers, and toes
11. Weakened tooth enamel (in children)
Diagnostic
1. Serum calcium decrease
2. Serum phosphate increase
3. X-ray of long bone decrease bone density
4. CT Scan reveals degeneration of basal ganglia
Nursing Management
1. Administration of meds:
a.
Oral calcium carbonate tablets
b. Vitamin D, which can help your body absorb calcium and eliminate phosphorus
2. Avoid precipitating stimulus such as bright lights & noise: photophobia leading to seizure
3. Diet increase Ca & decrease phosphorus
4. Prepare tracheostomy set due to laryngospasm
5. Encourage to breath with paper bag in order to produce mild respiratory acidosis to promote increase ionized Ca levels
6. Most feared complication : Seizure & arrhythmia
7. Hormonal replacement therapy - lifetime
8. Important follow up care

HYPERPARATHYROIDISM
-overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH)
-parathyroid hormone regulates and maintains calcium and phosphate levels

Classification
a.
Primary
b. Secondary
Predisposing Factors
1. vitamin D deficiency
2. people who take lithium
3. growth on the parathyroid glands
4. enlargement of 2 or more of the parathyroid glands or medical conditions such as kidney failure and rickets
Signs and Symptoms
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.

Back pain
Blurred vision (because of cataracts)
Bone pain or tenderness
Decreased height
Depression
Fatigue
Fractures of long bones
Increased urine output
Increased thirst
Itchy skin
Joint pain
Loss of appetite
Nausea
Muscle weakness and pain
Personality changes
Stupor and possibly coma
Upper abdominal pain

Diagnostic
1. Serum Ca increase
2. Serum phosphorus decreases
3. X-ray long bones reveals bone demineralization
Nursing Management: Kidney Stone
1.
2.
3.
4.
5.
6.

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

Force fluids 2,000 3,000/day or 2-3L/day

Isotonic solution
Warm sitz bath for comfort
Strain all urine with gauze pad
Acid ash diet cranberry, plum, grapefruit, vit C, calamansi to acidify urine
Administer medications as ordered
a.
Narcotic analgesic Morphine SO4, Demerol (Meperidine Hcl)
1. Narcan/ Naloxone antidote
2. Naloxone toxicity tremors
Put siderails
Assist in ambulation
Diet low in Ca, increase phosphorus lean meat
Prevent complication
Most feared renal failure
Assist surgical procedure parathyroidectomy
Importance of ff up care
Hormonal replacement- lifetime

ADDISONS DISEASE AND CUSHINGS SYNDROME

Addisons disease
Hyposecretion of adrenal hormones
Sugar : hypoglycemia
Salt : hyponatremia, with hyperkalemia
Sex : decreased libido

Cushings syndrome
Hypersecretion of adrenal hormones
Sugar : hyperglycemia
Salt : hypernatremia, with hypokalemia
Sex : hirsutism, acne, striae

Hypoglycemia (T-I-R-E-D)
Tremors/Tachycardia
Irritability
Restlessness
Extreme fatigue
Diaphoresis/Depression
Decreased tolerance to stress due to decreased steroids
can lead to ADDISIONIAN CRISIS

Hyperglycemia (P-P-P)
Polyuria
Polydypsia
Polyphagia
Note: DM is a complication of Cushings
Increased steroids cause decreased WBC (Leukopenia)
IMMUNODEFICIENCY
Note: Steroids takers (athletes,body builders) experience ssx of
Cushings
Hypernatremia with Fluid Volume Excess
Hypertension
Edema
Weight Gain
Pathognomonic Sx of Cushings:
Moon-face
Buffalo hump
Obese trunks
Pendulous Abdomen
Thin extremeties
Hypokalemia
Weakness, fatigue
Constipation
Prominent U wave can also lead to arrhythmia
Hirsutism, acne and striae due to increased sex hormones
Other signs:
Depression
Easy bruising
Increased masculinity in women
Management:
Potassium-sparing diuretics: Aldactone [Spironolactone] promotes
excretion of sodium while retaining potassium
DO NOT GIVE LASIX
Limit fluids
Increase potassium in the diet

Hyponatremia
Hypotension
Dehydration
Weight Loss

Hyperkalemia
Irritability, agitation
Diarrhea, abdominal cramps
Peak T waves arrhythmia
Decreased sexual urge and loss of pubic and axillary hair
Pathognomonic sx: Bronze-like skin
Decreased cortisol causes pituitary gland to secrete
Melanocyte-stimulating hormone
Management:
Steroids (2/3 dose in AM and 1/3 dose in PM)

PANCREATITIS acute inflammation of pancreas leading to pancreatic edema, hemorrhage & necrosis due to Autodigestion (selfdigestion)
Cause: unknown/idiopathic
Pathognomonic sign
1. (+) Cullens sign - Ecchymosis of umbilicus (bluish color)
2. (+) Grey turners sign ecchymosis of flank area

CHRONIC HEMORRHAGIC PANCREATITIS-

bangugot

Predisposing factors - unknown

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

History of hepatobiliary disorder

Alcohol
Drugs thiazide diuretics, oral contraceptives, aspirin, penthan
Obesity
Hyperlipidemia
Hyperthyroidism
High intake of fatty food saturated fats

DIABETES MELLITUS

Typ e I DM

Typ e I I DM

Insulin-dependent

Non Insulin-dependent

Juvenile onset type (common among children)

Adult/Maturity onset type (common among 40 y.o. & above)

Non-obese
Brittle disease
Etiology: Hereditary
Symptomatic

Obese
Non-brittle disease
Etiology: Obesity
Asymptomatic

Characterized by Weight Loss

Characterized by Weight Gain

Treatment: Insulin

Treatment: Oral Hypoglycemic Agents (OHA)

Complications: Diabetic Ketoacidosis (DKA)

Sodium Bicarbonate (NaHCO3) administered to treat acidosis

Complications: Hyper-Osmolar Non-Ketotic Coma (HONCK)

Non-ketotic, so no lipolysis

Can lead to coma

Can also lead to coma

Can lead to seizure

GESTATIONAL DM
occurs during pregnancy & terminates upon delivery of child
Predisposing Factors
1. Unknown/ idiopathic
2. Influence of maternal hormones
Signs and Symptoms
Same as type II
1. Asymptomatic
2. 3 Ps & 1G
Type of delivery CS due to large baby
Signs of hypoglycemia on infant
1. High pitched shrill cry
2. Poor sucking reflex

DIABETIC KETOACIDOSIS (DKA)

-

Acute complication of Type I DM due to severe hyperglycemia leading to CNS depression & Coma.
Ketones- a CNS depressant

Predisposing factor
1. Stress between stress and infection, stress causes DKA more.
2. Hyperglycemia
3. Infection
Signs and Symptoms
3 Ps & 1G
1. Polyuria
2. Polydipsia
3. Polyphagia
4. Glycosuria
5. Wt loss
6. Anorexia, Nausea/vomiting
7. (+) Acetone breath odor- fruity odor
8. Kussmaul's resp-rapid shallow respiration
9. CNS depression
10. Coma

pathognomonic sign

Nursing Management
1.
Assist in mechanical ventilation
2. Administer 0.9NaCl isotonic solution
Followed by .45NaCl hypotonic solution to counteract dehydration.
3. Monitor VS, I&O, blood sugar levels
4. Administer meds as ordered:

a.) Insulin therapy IV push

Regular Acting Insulin clear (2-4hrs, peak action)
b.) To counteract acidosis Na HCO3
c.) Antibiotic to prevent infection
Insulin Therapy
Sources
1. Animal source beef/ pork-rarely used. Because it causes severe allergic reaction
2. Human has less antigenecity property ,cause less allergic reaction ex. Humulin
3. Artificially compound
Types of Insulin
1. Rapid Acting Insulin - Ex. Regular acting I
2. Intermediate acting I - Ex. NPH (non-protamine Hagedorn I)
3. Long acting I - Ex. Ultra lente
Types of Insulin
1. Rapid
2. Intermediate
3. Long acting

color & consistency onset

clear
cloudy
cloudy

peak
-

duration
2-4h
6-12h
12-24h

Nursing Management:
upon injection of insulin:
1.Administer insulin at room temperature to prevent lipodystrophy
2. Insulin is only refrigerated once opened
3. Gently roll vial bet palms. Avoid shaking to prevent formation of bubbles
4. Use gauge 25 26needle tuberculin syringe
5. Administer insulin at either 45(for skinny pt) or 90 depending on the client tissue deposit
6. Dont aspirate after injection
7. Rotate injection site to prevent lipodystrophy
8. Most accessible site abdomen
9. When mixing 2 types of insulin, aspirate
1st regular/ clear before cloudy to prevent contaminating clear insulin & to promote accurate calibration
10. Monitor signs of complications:
a. Allergic reactions lipodystrophy
b. Somogyis phenomenon hypoglycemia followed by periods of hyperglycemia or rebound effect of insulin.
11. 1ml or cc of tuberculin = 100 units of insulin