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UNIVERSITY OF SAN CARLOS


COLLEGE OF NURSING
ENDOCRINE NOTES

Endocrine glands and its hormones:

PITUITARY GLAND – master gland since it controls all the other glands of the endocrine system

1.) Anterior Pituitary Gland ( adenohypophysis) – outgrowth of the pharynx


G H (somatotropine) - stimulation of somatic growth
TSH - stimulates synthesis and release of thyroid hormones
PROLACTIN - regulation of milk production
ACTH - stimulates the adrenal cortex to secrete adrenal hormones
LH - in women stimulate ovarian follicular development and ovulation, LH stimulates testosterone
biosynthesis in men
FSH – female egg cell production or male sperm production
MSH - cause hyperpigmentation of skin

2.) Posterior Pituitary Gland ( neurohypophysis) – extension of the hypothalamus


Oxytocin - stimulates contraction of uterine smooth muscle cells, stimulates milk delivery from the breast
during lactation.

ADH ( Vasopressin) - promotes water conservation by the kidney

ADRENAL GLANDS – a pair of glands located on top of the kidney poles

1.)adrenal cortex – outer part of the adrenal gland

Sugar – glucocorticoids ( cortisone)

Salt – mineralocorticoids ( aldosterone)

Sex – gonadal hormones ( androgen, estrogen)

2.) adrenal medulla – inner part of the adrenal gland

CATECHOLAMINES – fight or flight response of the body

Epinephrine ( adrenalin)

Norepinephrine ( noradrenalin)

THYROID GLAND

T3 ( TRIIDOTHYRONINE) – metabolically active form of T4

T4 (THYROXINE) – contains iodine essential for normal growth and metabolism

THYROCALCITONIN – decreases calcium concentration in the blood

PARATHYROID GLAND

PARATHYROID HORMONE( PARATHORMONE, PTH)

- increases calcium concentration in the blood

PANCREAS

2 FUNCTIONS:

1. EXOCRINE – Produces pancreatic juices which are used in the duodenum as an important part in the
digestive system

2. ENDOCRINE – ISLETS OF LANGERHANS -

ALPHA CELLS (GLUCAGON) – increases blood glucose by glycogenolysis


2

BETA CELLS (INSULIN) – decreases blood glucose by glycogenesis, transports glucose into cells for
utilization

DELTA CELLS (SOMATOSTATIN) – inhibits the secretion of glucagon and insulin

Disorders of the Pituitary Gland

HYPOPITUITARISM HYPERPITUITARISM
( dwarfism) ( gigantism, acromegaly)
DEFINITION Hyposecretion of GH Hypersecretion of GH
gigantism – before closure of
epiphyseal plate
acromegaly – after closure of
epiphyseal plate

S/S Retarded physical growth Coarse facial features


Premature aging Large hands and feet
Low intellectual devt Thickening and protrusion of
Poor devt of secondary sex the jaw
characteristics Arthritic changes
Organomegaly

MANAGEMENT
provide emotional support provide emotional support r/t
altered body image
encourage expression of
feelings r/t altered body image provide frequent skin care

prepare to administer human provide pharmacological and


growth hormone(hGH) nonpharmacological
interventions for joint pain

prepare the client for radiation


of the pituitary gland as
prescribe

SURGERY HYPOPHYSECTOMY

COMPLICATION/S

Increase ICP
Bleeding
CSF leakage
Temporary DI

DIABETES INSIPIDUS SYNDROME OF


(DI) INAPPROPRIATE
SECRETION OF ADH
(SIADH)
DEFINITION Hyposecretion of ADH Hypersecretion of ADH

LAB/DX (+) fluid deprivation test

S/S Polyuria of 4 to 24 L/day Signs of fluid overload


Polydipsia • Weight gain
Dehydration • Hypertension
Inability to concentrate urine Dilutional Hyponatremia
A low urinary specific • Changes in LOC and
gravity:1.006 or less mental status changes
Postural hypotension

MANAGEMENT monitor electrolyte values and provide a safe envt, particularly


for signs of dehydration for the client with changes in
LOC
monitor I&O, weights, specific
gravity of urine monitor I&O and obtain daily
weights
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instruct the client to avoid foods


or liquids with a diuretic type monitor fluid and electrolyte
action(e.g caffeinated beverages) balance

administer vasopressin restrict fluid intake as prescribed


tannate( Pitressin Tannate),
desmopressin acetate(DDVAP, administer diuretics and IV fluids
Stimate) or lypressin(Diapid) as as prescribed; monitor IV fluids
prescribed carefully because of the risk for
water intoxication
administer
chlorpropamide(Diabenese) or
clofibrate(Atromid-S) as
prescribed – augments the action
of ADH if partial deficit of ADH
exists

Disorders of the Adrenal Gland

ADDISON’S DISEASE CUSHING’S SYNDROME


DEFINITION Hyposecretion of adrenal Hypersecretion of adrenal
hormones hormones

S/S
Hypoglycemia Elevated blood glucose
Hyperkalemia Hypokalemia
Hyponatremia Hypernatremia
Postural hypotension Hypertension
Emotional disturbances Truncal obesity with thin
Lethargy, fatigue, and muscle extremities
weakness Moonface
Dark pigmentation Buffalo hump
Supraclavicular fat pads
Fragile skin that easily bruises
Hirsutism

MANAGEMENT
monitor v/s, particularly BP, monitor v/s particularly BP
weight, and I&O monitor I&O
monitor lab values provide good
monitor blood glucose and skin care
potassium levels allow the client to discuss
feelings r/t body appearance
administer glucocorticoids or
mineralocorticoid meds as administer
prescribed aminoglutethimide(Elipten,
Cytadren)- an adrenal enzyme
low potassium, high sodium inhibitor as prescribed
diet
low sodium, high potassium diet
Patient Education:

avoid individuals with infection

avoid stress

avoid strenuous exercise

SURGERY Hypophysectomy – if the


condition results from increase
ACTH secretion by the pituitary
gland

Adrenalectomy – if the condition


results from adrenal adenoma
COMPLICATION ADDISONIAN CRISIS
acute adrenal insufficiency
precipitated by stress, illness
and infection

S/S:
hyponatremia, hyperkalemia
hypoglycemia
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shock

Mgt:
administer IV glucocorticoids as
prescribed - hydrocortisone
sodium succinate(Solu- cortef)

PHEOCHROMOCYTOMA

DEFINITION Catecholamine- producing tumor in the adrenal


medulla
S/S HPN
Severe headaches
Palpitations
Pain in the chest or abdomen with n & v

MANAGEMENT monitor v/s (BP)

avoid stimuli (increased abdominal pressure,


micturition, and vigorous abdominal palpation)

instruct the client not to smoke, drink caffeinated


beverages

promote rest and a nonstressful envt

provide a diet high in calories, vitamins and


minerals

avoid tyramine- rich foods ( e. g. aged cheese, ripe


banana, wine, gravies)

COMPLICATION HYPERTENSIVE CRISIS


DOC : phentolamine(Regitine)
SURGERY ADRENALECTOMY
• lifelong glucocorticoid replacement is
necessary with a bilateral adrenalectomy

• temporary glucocorticoid replacement, up


to 2 years is necessary for a unilateral
adrenalectomy

POST OP:
monitor for signs of shock and hemorrhage,
particularly during first 24 to 48 hours

DISORDERS OF THE THYROID GLAND

HYPOTHYROIDISM HYPERTHYROIDISM
(GRAVE’S DSE)
DEFINITION hyposecretion of thyroid hormone hypersecretion of thyroid
Normal lab values: hormone
T3 = 80 to 230 ng/dL decreased rate of body
T4 = 5 to 12 ug/dL metabolism increased rate of body
metabolism
S/S Intolerance to cold Enlarged thyroid gland (goiter)
Weight gain Protruding eyeballs
Bradycardia (exophthalmos)
Constipation Heat intolerance
Generalized puffiness and edema Diaphoresis
around the eyes and face Weight loss
Forgetfulness and loss of memory Diarrhea
Dry skin and hair Smooth, soft skin and hair
Personality changes
tachycardia and palpitations
MANAGEMENT monitor vital signs provide adequate rest

provide a warm environment for provide a cool and quiet


the client environment
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instruct the client in low calorie, provide a high calorie diet


low cholesterol, low saturated fat
diet avoid the administration of
stimulants
assess the client for constipation;
provide roughage and fluids to administer antithyroid
prevent constipation medications that block thyroid
synthesis as prescribed
e.g. propylthiouracil(PTU)
administer thyroid replacement; methimazole( Tapazole)
levothyroxine sodium A/R: agranulocytosis
(Synthroid) is most commonly
prescribed administer iodine preparations
S/E: tachycardia, restlessness, that inhibit the release of thyroid
nervousness and insomnia hormone as prescribed

NSG RESPONSIBILITY:
Administer in the morning to e.g.
prevent insomnia SSKI (Lugol’s Solution)
Instruct the client about thyroid - given preop to decrease
replacement therapy for a lifetime vascularity of thyroid gland

prepare the client for radioactive


iodine therapy as prescribed, to
destroy thyroid cells

administer propanolol (Inderal)


for tachycardia

COMPLICATION Myxedema Coma Thyroid Storm


- results from persistently low - occurs in a client with
thyroid production uncontrollable hyperthyroidism

- occurs from manipulation of the


- can be precipitated by acute thyroid gland during surgery and
illness, rapid withdrawal of the release of thyroid hormone
thyroid medications, anesthesia into the bloodstream
and surgery, hypothermia or the
use of sedatives and narcotics S/S: Fever
Tachycardia
S/S: Hypotension Systolic hypertension
Bradycardia Agitation, tremors and
Hypothermia anxiety
Hyponatremia Delirium and coma
Hypoglycemia
Respiratory failure MGT:
maintain a patent airway and
MGT: adequate ventilation
maintain a patent airway
administer antithyroid
administer levothyroxine medications, sodium iodide
sodium(Synthroid) IV as solution, propanolol (Inderal) and
prescribed glucocorticoids as prescribed

keep client warm monitor continually for cardiac


dysrhythmias

use a cooling blanket to decrease


temperature

SURGERY THYROIDECTOMY

PRE- OP:
instruct the client in how to
perform coughing and deep
breathing exercises by supporting
the neck

POST OP:
monitor for respiratory distress

have a tracheostomy set, oxygen,


and suction at the bedside
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monitor surgical site for edema


and for signs of
bleeding(anteriorly and
posteriorly)

monitor for laryngeal nerve


damage:
(dysphonia, high pitched voice,
stridor, dysphagia, and
restlessness)

monitor for signs of


hypocalcemia and tetany:
(Positive chvostek’s sign,
Positive trousseau’s sign)

DISORDERS OF THE PARATHYROID GLAND

HYPOPARATHYROIDISM HYPERPARATHYROIDISM
(HYPOCALCEMIA, (HYPERCALCEMIA)
HYPERPHOSPHATEMIA)
DEFINITION hyposecretion of parathyroid hormone hypersecretion of parathyroid hormone

S/S (+) trousseaus’s sign – carpal spasm induced by Fatigue and muscle weakness
arterial occlusion of the arm with a BP cuff
Skeletal pain and tenderness
(+) chvostek’s sign – facial nerve irritability
elicited by tapping the nerve Bone deformities that result in pathological fractures

bronchospasm Renal stones


laryngospasm
carpopedal spasm
dysphagia
photophobia
cardiac dysrhythmias
seizures

MGT prepare to administer IV calcium gluconate or monitor for cardiac dysrhythmias


calcium chloride for hypocalcemia
cmonitor for I&O and for signs of renal stones

place a tracheostomy set, oxygen, and suctioning monitor for skeletal pain; move client slowly and
at the bedside carefully

encourage fluids
provide a high calcium and low phosphorus
diet(milk and dairy products) administer furosemide (Lasix) as prescribed to lower
calcium levels
instruct client in the administration of calcium
supplements as prescribed administer phosphates as prescribed, which interfere
with calcium absorption
instruct client in the administration of vitamin D
supplements as prescribed administer calcitonin ( Calcimar) as prescribed, to
decrease skeletal calcium release and increase renal
instruct the client in the administration of clearance of calcium
phosphate binders – promotes excretion of
phospate administer calcium chelators(calcium EDTA)
as prescribed to lower calcium levels
SURGERY HYPERPARATHYROIDECTOMY
PRE – OP:
ensure that calcium levels are decreased to near normal

inform the client that talking may be painful for the first
day or two after surgery

POST OP:
place a tracheostomy set, oxygen, and suctioning at the
bedside
assess neck dressing for bleeding
monitor for hypocalcemic crisis as evidenced by
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tingling and twitching in the extremities and face


monitor for laryngeal nerve damage

DISORDERS OF THE PANCREAS

DIABETES MELLITUS

DEFINITION Impaired carbohydrate, protein, and lipid


metabolism

TYPES TYPE 1 – INSULIN DEPENDENT DM


( IDDM)
• also referred to as juvenile diabetes
• characterized by no insulin production
by the islets of langerhands caused by
autoimmune disease

TYPE 2 – NON – INSULIN DEPENDENT


DIABETES MELLITUS
• common among obese
• characterized by insulin resistance or
impaired insulin receptors
S/S Polyuria
Polydipsia
Polyphagia
Weight loss
Blurred vision
Slow wound healing
Vaginal infections
Weakness and paresthesias
Signs of inadequate circulation to the feet

LAB/DX FINDINGS:

NORMAL FINDINGS:
Blood glucose level = 60 – 120 mg/dl
RANDOM BLOOD SUGAR
> 200 mg/dl
FBS = 70 – 110 mg/dl
FASTING BLOOD SUGAR(FBS)
> 110 mg/dl but < 126 mg/dl
Postprandial glucose = 70 – 110 mg/dl
POSTPRANDIAL GLUCOSE
> 140 mg/dl but < 200 mg/dl
OGT – glucose returns to normal in 2 – 3 hours and
urine is negative for glucose ORAL GLUCOSE TOLERANCE(OGT)
- blood glucose level returns to normal slowly
HbA1c: and urine is positive for glucose

diabetic with good control: 7.5% or less GLYCOSYLATED HEMOGLOBIN


diabetic with fair control:7.6% to 8.9% (HbA1c)
diabetic with poor control: 9% or greater - used to assess the effectiveness of treatment
regimen and client’s compliance for 3 months
> 7.0 %

MANAGEMENT D - iet 50 - 60 % CHO, 20 - 30 % FATS, 10 - 20%


CHON
I - nsulin
A - ntidiabetic agents
B - blood sugar monitoring
E - xercise
T - transplant of the pancreas
E - nsure adequate food intake
S - crupulous foot care
COMPLICATIONS A. CX OF INSULIN THERAPY
1. INSULIN LIPODYSTROPHY
- caused by repeated use of an injection site
2. DAWN PHENOMENON
• Results in the nocturnal release of growth
hormone, which may cause the blood
glucose to begin to rise at about 3 AM
• TX :evening dose of intermediate acting
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insulin at 10 PM
3. SOMOGYI’S PHENOMENON
• normal or elevated blood glucose levels are
present at bedtime, a decrease occurs at
about 2 AM to 3 AM to hypoglycemic
levels and a subsequent increase occurs as
a result of the production of
counterregulatory hormones
• Tx: decrease intermediate insulin at
suppertime, moving the intermediate
insulin dose to bedtime or increasing
bedtime snack

B. ACUTE COMPLICATION OF DM
1. Hypoglycemia
- occurs when the blood glucose level falls to less
than 50 to 60 mg/Dl
fast acting simple carbohydrate:
• three or four commercially prepared
glucose tablets
• 4 to 6 ounces of fruit juice or regular soda
• 6 to 10 life savers or hard candy
• 2 to 3 teaspoons of sugar or honey.
2. Diabetic Ketoacidosis
• Common in type 2 DM
• S/S include hyperglycemia, dehydration
and electrolyte loss, and acidosis
• Tx : fluids, insulin ( IV Regular ), and
electrolyte replacement ( K)
3. Hyperglycemic hyperosmolar nonketotic
syndrome (HHNS)
• Common in type 2 DM
• extreme hyperglycemia without ketosis and
acidosis
• Tx: same with DKA

C. CHRONIC COMPLICATIONS OF DM

1. Diabetic Retinopathy
• permanent vision changes and blindness
can occur
• Mgt : maintain safety

2. Diabetic nephropathy
• a progressive decrease in kidney function
Mgt:
• monitor I & O
• monitor BUN and creatinine levels and for
albuminuria

3. Diabetic neuropathy
• general deterioration of the nervous system
• development of ulcers
Mgt:
• cut toenails straight across
• apply moisturizing lotion to the feet but not
between the toes

INSULIN PREPARATIONS

ONSET(HR) PEAK ( HR) DURATION(HR)


Short Acting 30 min – 1 hr 2-4 6 -12
e. g. regular insulin
(Humulin R, Novolin R)
Intermediate Acting 2-4 6 - 12 18 - 24
e. g. isophane insulin
( NPH, Humulin N, Novolin N)
Long Acting 6 - 12 18 - 24 48 - 72
e. g. zinc suspension (Ultralente,
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Humulin U)

MYRAY 04/07/08 Lean 03