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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 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 Endocrine glands in the human head and their hormones

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 – Logol’s 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. 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

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

ADDISON’S DISEASE AND CUSHING’S SYNDROME
Addison’s disease Hyposecretion of adrenal hormones Sugar : hypoglycemia Salt : hyponatremia, with hyperkalemia Sex : decreased libido Cushing’s 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 Cushing’s Increased steroids cause decreased WBC (Leukopenia)  IMMUNODEFICIENCY Note: Steroids takers (athletes,body builders) experience ssx of Cushing’s 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. (+) Cullen’s sign - Ecchymosis of umbilicus (bluish color) 2. (+) Grey turner’s sign – ecchymosis of flank area

CHRONIC HEMORRHAGIC PANCREATITISPredisposing factors - unknown Risk factors 1. 2. 3. 4. 5. 6. 7.

“bangugot”

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
Insulin-dependent Juvenile onset type (common among children) Non-obese “Brittle disease” Etiology: Hereditary Symptomatic Characterized by Weight Loss Treatment: Insulin Complications: Diabetic Ketoacidosis (DKA)  Sodium Bicarbonate (NaHCO3) administered to treat acidosis  Can lead to coma

Typ e I I DM
Non Insulin-dependent Adult/Maturity onset type (common among 40 y.o. & above) Obese “Non-brittle disease” Etiology: Obesity Asymptomatic Characterized by Weight Gain Treatment: Oral Hypoglycemic Agents (OHA) Complications: Hyper-Osmolar Non-Ketotic Coma (HONCK)  Non-ketotic, so no lipolysis  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 P’s & 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 P’s & 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

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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. Don’t 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. Somogyi’s phenomenon – hypoglycemia followed by periods of hyperglycemia or rebound effect of insulin. 11. 1ml or cc of tuberculin = 100 units of insulin