Endocrine

COMMON LAB TESTS FOR ENDOCRINE AND HORMONAL DISORDERS 1. Blood or serum a. Serum electrolytes b. c. d. e. f. g. h. i. j. A. Glucose fasting • adults 65-110 mg/dl • children 51-85 mg/dl Plasma Fasting ACTH • newborns 30-80 mg/dl; >24 • 8 AM <60 pg/ml hrs. 42-68 mg/dl • 4 PM 10-50 pg/ml B. Plasma Aldosterone Concentration (PAC) Glucose (two hour postprandial) < 140 mg/dl C. Glucose Tolerance Test • Supine 10-160 ng/liter • fasting 70-105 mg/dl; 30 • Upright 8.9-58 ng/dl minute < 200 mg/dl Plasma Renin Activity (PRA) • one hour < 200 mg/dl Plasma Cortisol • two hours < 140 mg/dl Catecholamines Thyroid hormone levels: TSH 0.35-6.20 µU/ml • three hours 70-105 mg/dl • four hours 70-105 mg/dl Fasting Blood Sugar D. Thyroid tests Blood insulin levels E. Thyroxine T4 4.5-12.0 µg/dl Growth hormone F. TSH 0.35-6.20 µU/ml • Male: <5 ng/dl • Female: <10 ng/dl Cosyntropin ESR CRP

k. l. m. 2. Urine a. 17-hydroxysteroids b. Free catecholamines c. Osmolality d. Glucose tolerance test 3. Karyotyping 4. Water deprivation study

. neurological and mental functions 3. functions as the communication system for the body B. reproduction b. Alters the rate of many physiologic activities a. changes in concentrations of specific substances in plasma c. metabolism c. Endocrine glands secrete hormones 1.I. Regulated by several methods a. growth and development d. together with the neurological system. Glands A. feedback system C. Secreted into the blood 4. Secreted in very small amounts 2. Anatomy and Physiology The endocrine system. autonomic nervous system b.

Two small glands lying in the retroperitoneal region . 3. Controls calcium and phosphorus metabolism G. Parathyroid glands . Adrenal glands 1. E. 1.D. 3. 1. 4. 2. Pituitary Lies in sella turcica above the sphenoid bone Consists of two lobes connected by the hypothalamus Regulates the other endocrine glands by stimulating target organs Controlled by releasing and inhibiting hormones from the hypothalamus Thyroid gland Located at the level of the cricoid cartilage in front of the trachea Two highly vascular lobes Controls the rate of the body metabolism and blood calcium levels F.parathormone (PTH) 1. Four small glands located near the thyroid gland 2. 2.

progesterone. Lies retroperitoneally. inhibin . The testes are the pair of male sex organs that form within the abdomen but descend into the scrotum 2. medulla . estrogen. testosterone 1. responds to stress H. testes. an endocrine function 2.promotes organic metabolism. preadolescent growth spurt.Functions a. Excretion of enzymes and bicarbonate that aid digestion and controls carbohydrate metabolism as an exocrine function I. cortex . with the head of the gland in the duodenal cavity and the tail lying against the spleen 2. Gonads .stimulation of sympathetic nervous system. glucagon secretion into the blood. regulates sodium and potassium. response to stress.ovaries.decreases secretion of folliclestimulating hormone (FSH). Location: two ovaries are situated in the lower abdomen on each side of the uterus. steroid production b. . Responsible for secondary sex characteristics and reproductive function 3. Insulin. Pancreas 1.

classifications of pituitary tumors i. Unlike the endocrine.underactivity of the front (anterior) pituitary gland a. Definition . if the hormone concentrate lowers in some cases. Endocrine Glands and their Secretions C. Hypopituitarism 1. B. reproduction. exocrine glands secrete their products through duct(s) into the body's cavities or onto its surface. the hormone production is increased – positive feedback 3. metabolism. These hormones regulate growth. Disorders of the Anterior Pituitary A. if the hormone concentration rises further. the pancreas in its exocrine function).II. maturation. Exocrine glands produce sweat (sweat glands). Concentration in the bloodstream of most hormones is maintained at a constant level 1. production of that hormone is inhibited negative feedback 2. Endocrine glands are ductless. and digestive juices (for example. functioning: hormone present in insufficient quantities . the balances of electrolytes. III. skin oils (sebaceous glands). mucus (mucous membranes). General Concepts A. water. each hormone may be governed by positive or negative feedback E. and the balances of behavior and energy D. Endocrine glands must maintain homeostasis of about 50 billion cells. and secrete many hormones directly into the blood or lymph. and nutrients.

contact health care provider. neuro-ophthalmological exam c. Avoid other people with infections or shopping malls. soft testicles iv. 4.corresponds to biorhythms and reduces gastric irritation.decreased growth hormone results in dwarfism Etiology . history and physical exam b.fluid overload and dilutional hyponatremia related to increased ADH levels Diagnostics a. hypoadrenalism (because pituitary regulates adrenal glands by ACTH production) e. sex hormone replacement c. thyroid hormone replacement iii. male i. hypogonadism. SIADH . radioimmunoassays of anterior pituitary hormones e. loss of axillary and pubic hair c. 8.could precipitate acute crisis. neck rotation. 3. etc in times when the flu or colds are most evident. Always take medication with a meal or a snack. provide for CARE OF THE CLIENT WITH INCREASED INTRACRANIAL PRESSURE i. flexion. loss of axillary and pubic hair vi. vaginal dryness b. may see signs of increased intracranial pressure (ICP) f. infertility iii. hypothyroidism (because pituitary regulates thyroid glands by thyroid stimulating hormone (TSH)) d. extension. 4. surgical removal of tumor 6. non-functioning: hormone absent iii. 7. 2. Carry extra medication on self during travel. vomiting. 7. x-rays of pituitary fossa d.2. 3. Wear medical identification jewelry or carry medical card . anxiety Observe for herniation syndrome Monitor intracranial pressure Administer oxygen as ordered Seizure precautions 1. . Nursing interventions a. any restrictive clothing around neck. expected outcome: hormone deficiency corrected b. corticosteroid therapy CARE OF CLIENT ON STEROID THERAPY Teach client to: 1. impotence iii. 6. 2. decreased libido ii. computerized tomogram (CT) scan Management a. amenorrhea ii. decreased libido iv. female: i. care of the client with increased ICP Monitor neuro vital signs as ordered Maintain fluid restriction as ordered Raise head of bed at 30-45 degrees Prevent any activities that increase ICP such as straining at stool. 3. 6.result from hormone deficiency (hypogonadism) a. 5. hypogonadism. 8. Never discontinue medications abruptly. grocery stores. ii. hormone replacement therapy i.most common cause: neoplasms. coughing. Take higher dose in AM and lower doses in PM. if in childhood . Take medication with breakfast . 4. small. usually benign as a pituitary adenoma Findings . 5. Adjust medications during periods of acute or chronic stress such as pregnancy or infections. 5. breast and uterine atrophy v. ii.

increase in density and size of organs and soft tissue c. prominent tongue i. ACTH overproduction leads adrenal gland to overproduce cortisone: Cushing's disease 3. history and physical exam b.drastic fluid loss c. inflammation. Body loses too much water in the urine. expected outcome: remove tumor and restore hormonal balance b. irradiation of gland d. change in ring or shoe size drastically over short period of time 4. c. prognathism d. care of the client undergoing radiation therapy iv. medications desired effects and side effects ii. emotional support b. Management a. provide i. excessive thirst (polydipsia) b.B. Findings a. care of the client with increased ICP ii. Diabetes insipidus 1. plasma osmolality and sodium levels increase. computerized tomogram (CT) scan c. need for lifelong hormone replacement therapy and regular checks of serum levels Hyperpituitarism 1. giantism . Disorders of the Posterior Pituitary A. 2. may see signs of increased ICP b. acromegaly . Nursing interventions a. acromegaly: excess longitudinal bone growth. Etiology a. physical changes of acromegaly are irreversible 6. usually caused by benign neoplasm b. assess for signs of diabetes insipidus. spade-like hands g. nocturia d. polyuria: as much as 20 liters per day with specific gravity below 1. pharmacologic: growth hormone suppressant: bromocriptine (parlodel) e. Etiology can include tumor. arthritis.if growth plates closed ii.006 c. ACTH 5. signs of dehydration IV. Definition . trauma. Posterior pituitary gland makes too little antidiuretic hormone (ADH). d.if growth plates open c. prominent forehead and orbital ridge f. 3. care of the client undergoing surgery iii. Diagnostics a. or psychogenic causes. . coarse facial features e.anterior pituitary secretes too much growth hormone and/or ACTH 2. broad. care of the client undergoing surgery monitor for desired effects of administered medications as ordered provide emotional support with referral to support groups teach client i. growth hormone overproduction i. ii. plasma hormone levels: increased growth hormone. kyphosis h. surgical removal of tumor c. Findings a. large. teach client that treatment usually produces hypopituitarism so lifelong hormone replacement therapy with regular check-ups are required b. since removal of a pituitary tumor may injure the posterior pituitary glands and decrease antidiuretic hormone (ADH) secretions .

weigh client daily f. carbamazapine (mazepine) c. constipation Diagnostics a. thyroid surgery . monitor fluids and give IV fluids as ordered d. age group: 30 to 50 years of age b. hypoventilation IV. monitor for findings of dehydration. chloropropamide (chloronase) v. potentially life threatening condition 2. Definition .an underactive thyroid resulting in a lessened secretion of thyroid hormone a. administration of vasopressin (pitressin) or desmopressin acetate (stimate) d. water deprivation tests: inability to concentrate urine.antidiuretic hormone iii. overdosage of thyroid medications d. pharmacotherapy i. desmopressin acetate (stimate) ii. expected outcomes: to correct underlying cause and restore hormonal balance b. cognitive impairment b. measure intake and output e. specific gravity b. teach client i. to record intake and output ii. care of the client undergoing surgery h. lypressin (diapid) iv. hypothyroidism without myxedema: mild thyroid failure iii. fatigue.4. vasopressin (pitressin) . to check urine specific gravity iv. 5. myxedema coma I. deficiency of thyroid hormones causing decreased metabolic rate i. precipitated by stress III. most severe type of hypothyroidism II. also differentiates between primary DI and nephrogenic DI b.may cause hypothyroid state after surgery depending on extent of thyroid removal b. deficiency in dietary iodine 3. IV fluid replacement therapy d. leads to mental retardation ii. affects more women ii. Etiology a. hypothyroidism with myxedema: severe thyroid failure. constipation. measure urine. usually seen in older adults iv. e. depression c. about medications and side effects iii. altered LOC leading to coma IV. 6. Findings a. findings include: I. clofibrate (claripex) vi. care of the client with increased ICP g. surgical removal of tumor Nursing interventions a. hypothermia II. administer medications as ordered c. cretinism: hypothyroidism in children. computerized tomogram (CT) scan Management a. Disorders of the Thyroid Gland A. bradycardia III. intolerance to cold . the need to wear disease identification jewelry V. treatment for hyperthyroid condition c. Hypothyroidism 1. classifications i. osmotic stimulation c.

IV fluids as ordered ii.increased menstrual flow g. Thyrotropin. about the medications and side effects . Hyperthyroidism (Graves' disease. anemia e. expected outcomes: to restore hormonal balance and prevent complications b. menstrual changes . heat intolerance c. thyrotoxicosois) 1.4. brittle nails bradycardia. how to avoid stress iii. Thyroid autoantibodies B. Thyroid scan 3. periorbital edema. A.synthyroid is to be taken in the morning on an empty stomach at least one hour before any other medications or vitamins or ingestion of milk iv. decreased serum T3 and T4 d. myxedema coma: i. Serum Triiodothyronine (T3) 4. age group: 30 to 50 years 3. women affected more than men b. Free Thyroid Index (FTI) 6. increased diastolic pressure f. Serum Thyroxine (T4) 2. Thyroid ultrasound a. watch client for signs of myxedema c. decreased basal metabolic rate (BMR) f. diarrhea b. dry skin. Radiologic and imaging tests 1. thick. Thyrotropin-Releasing Hormone (TRH) stimulation test 8. give synthetic thyroid hormone Nursing interventions a. protect client from cold 5. give medications as ordered b. hypoglycemia Management a. Thyroid-Stimulating Hormone (TSH) 7. coarse. T3 Resin Uptake 5. Blood tests 1.considered autoimmune response a. exophthalmos . Thyroid-Binding Globulin (TBG) 3. e. correct hypothermia iii. 6. weight loss. fluid retention Diagnostics TESTS OF THYROID FUNCTION d. and causes increased basal metabolic rate or hyperactivity of thyroid as a primary disease state 2. teach client i. weight gain i. provide restful environment d. Etiology . Radioactive Iodine Uptake (RAIU) I 131 uptake 2. B. elevated cholesterol and triglycerides g. Findings a.overactive thyroid over secretes hormones. the importance of lifelong therapy e. loss of the outer one-third of eyebrows h. history and physical exam b. Definition . hyperphagia. how to conserve energy ii. increased TSH c. administer synthetic thyroid hormone: levothyroxine sodium (levothroid) c.

reduced tolerance for stress 4. brittle hair. g. state of extreme hypermetabolism d. diaphoresis l. Radioactive iodine (131I) 5. presence of thyroid autoantibodies e. findings include: 1. infarction or heart failure 5.d. Diagnostics a. decreased TSH (thyroid-stimulating hormone. Saturated solution of potassium iodide 4. comes from pituitary) levels 5. insomnia m. Levothyroxine sodium (SYNTHROID) 6. Management a. protein. restful. monitor diet therapy d. rare but potentially fatal b. Methimazole (TAPAZOLE) 3. history and physical exam: palpable thyroid enlargement: (goiter) b. diet high in calories. systolic hypertension 2. administer medications as ordered . pregnancy e. cool environment c. Liothyronine sodium (CYTOMEL) 7. expected outcomes: to reduce the excess hormone secretion and to prevent complications b. j. provide emotional support f. Propythiouracil (PTU) 2. Strong iodine solution (Lugol's solution) 8. carbohydrates 7. i. sodium131I 2. Nursing interventions a. elevated serum T3 and T4 levels c. iodides: useful adjunct to decrease vascularity of thyroid presurgical removal c. angina 4. antithyroid agents: propylthiouracil (PTU) 3. palpitations increased systolic BP difficulty concentrating irritability hyperactivity thin. surgical: thyroidectomy: partial or total removal of thyroid gland d. IV sodium iodide 9. Propranolol (Inderal) f. provide quiet. tachycardia e. even psychosis 6. pliable nails: plummer's nails k. elevated radioactive iodine uptake d. beta-adrenergic blocking agents: propranolol (inderol) 4. especially blood pressure and heart rate b. infection. precipitating factors: stress. monitor vital signs. Complication: thyrotoxic crisis (thyroid storm) a. h. 1. breakdown of body's tolerance to chronic hormone excess c. hyperthermia 3. provide extra fluids e. pharmacologic PHARMACOLOGIC INTERVENTIONS FOR THYROID DISORDERS 1. extreme anxiety 6.

a. decreased serum calcium e. total Serum calcium. carpopedal spasms vii. calcium replacement therapy: ideal serum calcium level 8.g. laryngospasms viii. Findings (mild to severe order) a. calcium gluconate kept at bedside f. Diagnostics TESTS OF PARATHYROID FUNCTION 1. . dry. about medications and side effects ii. institute seizure precautions d. Hypoparathyroidism 1. teach client 1. teach client i. numbness of fingers v. care of the client undergoing surgery i. monitor carefully for signs of tetany b. stress avoidance measures 3. place airway. 2. assess for laryngeal nerve damage post-surgery j. personality changes iii. administer medications as ordered e. expected outcomes: to restore hormonal balance and prevent complications b. assess for excessive swallowing or pooling of blood behind neck indicating hemorrhage VI. irritability ii. positive Trousseau's sign (carpopedal spasm as inflated BP cuff is released) d. 4. energy conservation measures h. 6. results in hypocalcemia 2. to consume more calcium and get vitamin D from sun exposure to skin b. hair loss d. possibly an autoimmune disorder b. tetany vi. history and physical exam positive Chvostek's sign (facial muscle twitching when cheek is stroked) c. most often results from surgical removal of parathyroid glands 3. Disorders of the Parathyroid Gland A. Etiology unknown a. Parathyroid hormone (PTH) Serum calcium. scaly skin c. calcium-rich diet Nursing interventions a. about medications and side effects 2. seizures b. increased serum phosphate Management a. neuromuscular i. Definition . vitamin D preparations facilitate uptake of calcium d. ionized Serum phosphate 5.parathyroid produces too little parathormone. suction and tracheotomy tray at bedside c. abdominal cramping 4. muscular weakness or cramping iv. signs of vitamin D toxicity iii. 3.6mg/dl c.

Calcium supplement 12. Nursing interventions a. diarrhea or constipation iv. acute adrenal insufficiency (Addisonian crisis) i. and sex hormones c. Hydration with 0. Disorders of the Adrenal Gland A. to reduce phosphorus intake: minimize intake of fish. care of the client undergoing surgery b. Glucocorticoids 6. gastrointestinal: constipation. anorexia c. irritability e. surgery: removal of parathyroid glands . Etiology a. Plicamycin 4. severe headache or back pain ii. secondarily as result of kidney disease or osteomalacia c. skeletal: bone pain. after surgery. Phosphate-binding antacid 11. incidence increases dramatically in both sexes after age 50 3. confusion v. Calcitonin 8. Didronel 5. Definition . Phosphate as antihypercalcemic agent 7. Etidronate disodium 10. muscle weakness and fatigue 4.parathyroid secretes too much parathormone. teach client to consume diet rich in calcium VII. after surgery observe for signs of hypocalcemia c. Definition a. vomiting. glucocorticoids. severe generalized muscle weakness iii.parathyroidectomy 6. benign growth in parathyroid b. relatively rare Etiology . cheese and cereals B. eggs. decreases secretion of other adrenal products: mineralocorticoid.9% normal saline solution 2. Hyperparathyroidism 1. history and physical exam b. elevated serum calcium c. decreased serum phosphate level d. Findings a. lethargy 2. 3.autoimmune adrenalitis Findings a. Addison's disease 1. Vitamin D a. pathological fractures d. . Estrogen 9. Diagnostics a.iv. results in increased serum calcium (hypercalcemia) 2. adrenal cortex secretes too little adrenocorticotropic hormone (ACTH) b. expected outcomes: to restore hormonal balance and prevent complications b. demineralization. nausea. Management PHARMACOLOGIC INTERVENTIONS FOR HYPERPARATHYROIDISM 1. x-rays reveal bone demineralization 5. many clients are asymptomatic b. Diuretics 3.

17-ketosteroids 5. Urinary cortisol level 7. nausea. Diagnostics A. diet high in protein. Betamethasone (CELESTONE) 3. Methylprednisone (MEDROL) 7. b. administer medications as ordered b. Desoxycorticosterone (DOCA PERCORTEN) 11. Cortisone (CORTONE) 4. c. b. circulatory collapse adrenal insufficiency i. Management Pharmacologic Interventions for Adrenal Insufficiency 1. personality changes vi. fatigue iii. history and physical exam ACTH stimulation test: low cortisol level low blood levels of sodium and glucose and high levels of potassium 24-hour urine collection: decreased levels of free cortisol 5. Radiologic and Imaging: Angiography of Adrenals a. liquid) 9. carbohydrates. c. Hydrocortisone 6. glucocorticoid replacement therapy: hydrocortisone (cortef) ii. Prednisolone (DELTA-CORTEF) 8.b. Dexamethasone (DECADRON) 5. skin pigmentation darkens Test of Adrenal Function 4. vomiting v. Fludrocortisone (FLORINEF) a. and sodium 6. Dexamethasone suppression test for cortisol levels 2. Mineralocorticoids 10. severe hypotension vii. manipulate the environment to reduce stressors . vague abdominal complaints: anorexia. expected outcome: to return to hormonal balance Addisonian crisis i. Fasting prephlebotomy for cortisol plasma level 3. Captopril test B. Renin level ACTH 8. vi. vague complaints or findings ii. Blood and Urine Tests 1. intravenous hydrocortisone chronic insufficiency i. muscle weakness iv. 17-hydroxycorticosterone (Porter-Silber test) 17-OCHS 4. Nursing interventions during hospitalization a. emergency management of circulatory collapse ii. Glucocorticoids 2. d. Prednisone (DELTASONE tablets. mineralocorticoid replacement therapy: fludrocortisone acetate (florinef acetate) iii. Aldosterone 6.

muscle weakness m. Findings f. the need for lifelong treatment ii. Diagnostics f. teach client i. surgical treatment may cause adrenal or pituitary insufficiency . metyrapone iii. moon face l. the need for medical-alert jewelry iv. amenorrhea. how to avoid or minimize stress vi. pharmacologic j. preserve the client's energy by assisting with ADL as indicated d. or menstrual irregularities n. buffalo hump. hypernatremia i. change in libido k. Cushing's syndrome 1. weight gain. hypertension h. monitor diet therapy e. virilization in women. primary syndrome caused by tumor of adrenal cortex i. long term steroid therapy 3. average age of onset 20 to 40 years of age g. secondary syndrome caused by an ACTH-producing tumor of pituitary j. adrenal enzyme inhibitors that block enzymes needed for cortisol synthesis i. and hypoglycemia. increased levels of cortisol. 24-hour urine collection: i. high protein diet with sodium restriction 6. body changes may reverse but may take months to years j. Nursing interventions f. elevated 17-hydroxycorticosterone 5. mitotane k. hyperkalemia. about medications and side effects iii. about medications and side effects ii. metabolic alkalosis i. osteoporosis o. truncal obesity j. how to conserve energy v. elevated free cortisol ii. the need for medical alert jewelry iv. monitor for signs of hypokalemia. increased sodium and glucose. irradiation therapy i.c. the need for lifelong hormone-replacement therapy iii. acne or hyperpigmentation 4. surgery for adrenal or pituitary tumor h. measure intake and output and observe for signs of hyponatremia. aminogluthemide ii. administer medications as ordered g. Etiology f. decreased potassium h. guidelines for diet: high sodium 2. monitor diet therapy h. elevated 17-ketosteroids iii. history and physical exam g. expected outcome: to restore hormonal balance g. f. teach client i. Management f. potassium supplements l. affects women more often than men h. iii. Definition: adrenal gland secretes too much cortisol 2. ii. personality changes g. blood tests show i.

Blood glucose . generally benign tumor of the adrenal medulla b. Serum sodium and potassium 9. Findings a) severe stress response b) panic metabolic state c) hypertensive crisis d) headache.fasting b.a condition in which the pancreas produces too little insulin. increased BMR b. provide care of the client undergoing surgery i. type 1 diabetes mellitus: genetic. curable. c. norepinephrine levels 2. Fructosamine Assay Diagnostics 6. high and sustained k) hyperglycemia l) dysrhythmias 4. Urine glucose and ketone monitoring 11. alpha-adrenergic blocking agent and beta adrenergic blocking agent (beta blockers): phentolamine (regitine). cells stop responding to insulin 4. glucose monitoring . Disorders of the Pancreas A.finger sticks 7. Definition Adrenal medulla secretes too much epinephrine and norepinephrine (called the catecholamines). severe insulin average glucose level for prior two to three months deficiency from beta cells stop production of insulin 3. Radiologic and imaging: angiography of adrenals a. type 2 diabetes mellitus: obesity. if bilateral adrenalectomy performed. Etiology a. computerized tomogram (CT) scan 24-hour urine collection: increased urinary catecholamines expected outcomes: to remove the tumor and correct the imbalance surgical removal of the tumor: scheduled only after client has been normotensive for at least one week h. Blood tests 1. auto-immune respones. administer medications as ordered h. Definition .gives a. lifelong steroid therapy required j. Diagnostics TESTS OF ADRENAL MEDULLA FUNCTION A. monitor vital signs. Epinephrine. nitroprusside (nitropress). teach client i. C-Peptide Assay (Connecting Peptide Assay) 5. BUN and creatinine 10. 5. Glycated Hemoglobin (Glycohemoglobin. TESTS FOR DIABETES MELLITUS (FUNCTION OF PANCREAS) Diabetes mellitus 1. results in hyperglycemia 2. Glycosylated Hemoglobin. antidysrhythmic agents as needed preop 6. Pheochromocytoma 1. tyrosine inhibitors: alphamethylparatyrosine decreases circulating catecholamines k. usually severe e) orthostatic hypotension f) tachycardia g) pallor or flushing h) diaphoresis i) palpitations j) anxiety. or cells 1. Management f. Blood 2. antihypertensive agents as needed preop i. especially blood pressure g.3. Vanillylmandelic acid (VMA) B. Causes excessive stimulation of the sympathetic nervous system 2. HbA) . need for lifelong followup VIII. Glucose Tolerance Test (GTT) stop responding to insulin. Serum glucose and osmolarity 8. Nursing interventions f. but fatal if untreated 3. g. propranolol (inderal) j. Urine specific gravity . about medications and side effects ii.

fasting blood sugar: elevated serum glucose levels c. 4. exercise I. regular insulin. and stress increase the need for insulin V. lowers glucose level and improves circulation II. if needed for better control of blood glucose levels II. insulin I. hyperglycemia b. before exercise. islet cell transplant VII.3. polyuria. as prescribed by the care provider. additional findings: fatigue. monitor blood glucose levels III.post-prandial glucose e. blood glucose monitoring . jet injectors. is used for ketoacidosis III. history and physical exam b. diet therapy and weight loss I. weight loss d. instruct the client to recognize manifestations for hypoglycemia and hyperglycemia V. clients who require insulin should eat a carbohydrate snack with protein to prevent hypoglycemia c. hunger. check other medications the client is taking IV. the client may be advised to follow dietary guidelines for Americans (food guide pyramid) or individualized food exchanges from the American Diabetic Association b. 5. used in type 1 diabetes mellitus (DM) and type 2 DM.with different self-check systems Medications a. insulin pens. instruct client about the importance of rotating injection within one region (the abdomen absorbs insulin the most rapidly) VI. the only insulin that is given IV. check other medications the client is taking IV. prescribed for clients with type 2 DM II. serum glucose is elevated . blurred vision e. glycosylated hemoglobin test (A1c test) Data collection a. type 1 DM: insulin therapy . a. pancreas transplant VI. instruct client to monitor glucose before exercising IV. slow wound healing Management a. oral glucose tolerance test (GTT) d. the total number of calories is individualized according to the client's weight II. oral antidiabetic medications I. polyphagia c. after meal. the 3 "polys" of diabetes mellitus: polydipsia. decreases total cholesterol and triglycerides III. insulin administration: see Pharmacology section of this course VII. infections. illness. and insulin pumps are used to administer insulin d.

cold. anxiety. vomiting VIII. altered LOC . hyperglycemic. clammy skin II. flushed appearance. thirst V. elevated ketone levels: sweet odor to breath may also have odor of someone drinking alcohol III. management: I. late disease insulin may be added to maintain glycemic control Complications a. diaphoresis. occurs more often in the elderly. findings I.IV fluids II. tremor.6. drowsiness VII. inadequacy of prescribed therapy for diabetes mellitus III. correct electrolyte depletion . nausea V. weakness IV.decreased V. exercise. other chronic complications I. IV or subcutaneous (SC). management of hypoglycemia I. absence of ketoacidosis III. jelly. or vomiting IV. may result from delayed meals. physical stress such as surgery. and electrolyte imbalance d. hypoglycemia (insulin shock) I. correct fluid depletion . polyuria VI. undiagnosed diabetes mellitus II. correct metabolic acidosis . caused by too much insulin. illness. may lead to shock and coma IX. potentially fatal II. type 2 DM: oral hypoglycemic agents. findings of insulin shock I. mental confusion. severe hyperglycemia. expected: to correct fluid depletion. hyperosmolar nonketotic coma (HHNKC) I. IV.an acute complication I. altered LOC VI. honey. juice II. dry skin IV. Karo syrup. in non-diabetics can be due to tube feedings without supplemental water. if unconscious: give one mg glucagon IM. give oral simple sugar: hard candy. usually precipitated by physical stress such as an infection. dehydration IV.replacement particularly of potassium III. or excessive physical activity III. diabetic ketoacidosis (DKA) . typically VI. usually > 600 mg/dl II. or trauma in person with diabetes mellitus IV. rapid onset V. cola. results from severe insulin deficiency II. usual causes: I. personality changes. anorexia.insulin IV c. findings I. blood sugar falls below 50 mg / dl II. caused by increased gluconeogenesis from amino acids and glycogenolysis in the liver X. insulin deficiency. plasma hyperosmolarity III. or 20 to 50 ml 50% dextrose IV push b. diabetic triopathy b. headache VI. . if client is conscious. too little food. slurred speech III. metabolic acidosis: Kussmaul's respirations. or too rapid rate of infusion for parenteral nutrition V. blood sugar levels > 350 mg/dl II.

4. or sores on feet. early reporting of complications of I. 14. blisters. long term issues about insulin administration about the need to: I. VII. Avoid shoes that fit poorly. coronary artery II. Do not wear circular garters or anything that constricts blood flow to feet. VI. V. macrovascular disease in the I. teach client I. 11. wear medical-alert jewelry IV. III. Exploration of a number of new delivery systems for insulin is ongoing. 9. retinopathy nephropathy neuropathy II. 13. help client monitor blood glucose d. Cut toenails straight across. 2. Call health care provider for any sign of infection. Wear cotton socks and change them several times each day if feet perspire. do not rub. redness. Without sufficient insulin. Never cut corns or calluses. 8. and corns. beta cells secrete insulin-the islet-cell hormone of major physiological importance. the importance of balanced. Check for ingrown toenails. carry extra rapid-absorbing carbohydrate on person at all times III. 6. peripheral vascular Nursing interventions a. 15. in bright light. Observe feet every day. consider emergency care for insulin shock Points to Remember About Insulin • • • In the pancreas's islets of Langerhans. swelling. 5. sores. eat more before strenuous exercise II. 3. about medications and side effects I. calluses. insulin shock III. VIII. consistent daily focus of diet. ketoacidosis II.7. Treat cuts and scratches right away with antiseptic and topical antibiotic. self blood-glucose monitoring III. monitor for findings of hyperglycemia or hypoglycemia c. If one appears. 7. Use lotion to prevent dryness but do not use lotion in between toes. consult a foot health care provider. dietary exchange system or refer to appropriate resources IV. Pat dry thoroughly especially in between toes. refer client to dietician for planing of meals e. II. 10. Trim toenails only after bathing. support client emotionally f. medication and exercise II. have regular eye exams V. for dryness. 12. Never go barefoot. give medications as ordered b. 1. Do not soak feet. . the body develops diabetes mellitus. when they are soft and pliable. foot care FOOT CARE Wash feet daily with mild soap with tepid water.

Monitor for signs of tetany for up to three days after surgery. Positive Trousseau's sign: carpopedal spasm results during the deflation of a blood pressure cuff that has been inflated for at least one minute. Following thyroid surgery." Exercise increases the body's metabolic rate to result in a decrease in blood sugar and an increase in insulin sensitivity. in combination with a glucose sensor may create an "artificial pancreas. which results in an increased need for insulin. Signs of hypoglycemia often occur. About the Thyroid • • Following neck surgery. Monitor for respiratory distress. Insulin-dependent clients should be well controlled for at least one week prior to any surgery. About the Parathyroid • • Positive Chvostek's sign: contraction of facial muscle near mouth occurs when light tap is given over facial nerve in front of ear.• • • • • Implanted insulin delivery systems. Illness can disrupt metabolic control and raise blood sugar. many clients suffer transient hypocalcemia from hyporfunction or removal of the parathyroids. . Special care for any client with either type of diabetes mellitus should be taken to monitor blood glucose during and after surgery and adjust insulin accordingly. potentially life-threatening complications such as laryngeal edema and tracheal obstruction can occur.

Sign up to vote on this title
UsefulNot useful