QUICK REVIEW ENDOCRINE SYSTEM: Pancreas – Endocrine and Exocrine gland Hormones produced Insulin Decrease blood sugar

by Stimulating active transport of glucose into muscle and adipose tissue Promoting the conversion of glucose to glycogen for storage Promoting conversion of fatty acids into fat Stimulating protein synthesis GLUCAGON Increases blood sugar by promoting conversion of glycogen to glucose Beta cells of Islets of langerhans Insulin Transcellular membrane transport of glucose Inhibits breakdown of fats and protein Requires Na for transport of glucose Diabetes Mellitus – is a metabolic disease characterized by elevated levels of glucose in the blood, resulting from defects in insulin secretion , insulin action or both Manifestations 1) Polyuria 2) Polydypsia 3) Polyphagia 4) Weight loss Diagnostic test FBS ( Fasting Blood Sugar ) = or > than 126 mg/dl ( 7.0 mmol/L) on two separate occasion Normal – < 100 mg/dl ( < 5.6 mmol/L) Impaired Fasting Glucose – 100 –125 mg/dl (5.6-6.9 mmol/L) 2 Hours post prandial blood sugar - Following ingestion of 75 gm of glucose = or > 200mg/dl 11.1mmol/L Oral Glucose Tolerance test (OGTT/GTT) Initial urine and blood specimen are collected 150 – 300 g of CHO/p.o. Series of blood specimen is collected · 30 min · 1 hour · 2 hours – returns to Normal · 3,4,5 as required Done when results of FBS/ 2 hours PPBS are borderline ( High normal) Glycosylated Hgb Most accurate Reflects sugar levels for the past 3 – 4 mos Normal 4- 6 % Cause – Unknown Predisposing factors Stress – Stimulates secretion of epinephrine , norephineprine , glucocorticoids Heredity Obesity Viral Infection

which inhibit the action of insulin Above-normal risk for perinatal complications. if needed. Sulfonylureas . or increased with insulin resistance · Most patients can control blood glucose through weight loss if obese · Oral antidiabetic agents may improve blood glucose levels if dietary modification and exercise are unsuccessful · May need insulin on a short or long term basis to prevent hyperglycemia · Ketosis.30%-40% will develop overt diabetes (usually type 2) within 10 years (esp. Dawn Phenomenon. tolazamide. except in stress or infection · Gestational Diabetes Onset during pregnancy.In subsequent pregnancies . These agents improve insulin action at the cellular level. glimeperide 2. family history of diabetes. if obese) Risk factors include obesity. Apha Glucosidase Inhibitors they work by delaying the absorption of glucose in the intestinal system resulting in a lower postprandial blood glucose level. glyburide. 1st generation: Acetohexamide. Ex.produces its antidiabetioc effects by facilitating insulin’s action on peripheral receptor sites. Ex. Metformin.characterized by a relatively normal blood glucose level when blood glucose level begins to rise. Have no effect on pancreati c beta cells. chlorpropamide. especially macrosomia (abnormally large babies) Treated with diet. previous large babies (over 9 lb. Somogyi Effect. insulin to strictly maintain normal blood glucose levels Occurs in about 2%-5% of all pregnancies Glucose intolerance transitory but may recur: . OHA (Oral Hypoglycemic Agents) 1. usually in the second or third trimester Due to hormones secreted by the placenta. Thiazolidineones . heredity or environmental factors · No islet cell antibodies · Decrease in endogenous insulin.95%) · Onset usually over 30 years · Usually obese at diagnosis · Causes include obesity.Autoimmune disorders TYPES Type I ( 5%-10 % ) IDDM Onset any age ( < 30 yrs) Often have islet cells antibody Absolute Insulin deficiency Prone to DKA Often have antibodies to insulin even before insulin treatment Type II ( 90 %. glucophage 3. Biguamides used with sulfonylurea may enhance the glucose lowering effect more than either medication used alone. The phenomenon is thought to result from nocturnal surges in growth hormone secretion that create a greater need for insulin in the early morning hours in patient with Type 1 2. rare. Acarbose 4.) Screening tests (glucose challenge test) should be performed on all pregnant women between 24 and 28 weeks gestation Causes of Morning Hyperglycemia 1.Directly stimulating the pancreas to secrete insulin. a decrease at 2-3 am to hypocglycemic levels and subsequent increase caused by the production of counter regulatory hormones Medications A. tolbutamide 2nd generation: glipizide.normal or elevated blood glucose at bedtime. age older than 30 years. Biguanides . The common side effects are GI symptoms and dermatologic reactions Ex.

Rapid-Acting: Clear Insulin .promote growth of body tissue Gonadotropic hormones and estrogen secretion.Duration: 6-8 hrs.Duration: 18-24 hrs.Peak: 6-8 hrs. controls release rate of thyroxine. no cream between toes.Regular . anovulatory women. .NPH .they are indicated for patients with Type 2 diabetes who take insulin injections and whose blood glucose control is inadequate. rinse and dry carefully. Meglitinides .Humulin-N . Ex.controlled primarily by the hypothalamus. Repaglinide Nateglinide . soapy water.Onset: 3-4 hrs.Actrapid . target is thyroid gland Somatotropic hormones (STH or GH). . inspect visually daily NCLEX 2. no crossing of the legs.concerned with growth and secretory activity of adrenal cortex. Quit smoking Stress management (stress increases blood sugar) PITUITARY GLAND: HORMONES PRODUCED AND FUNCTIONS . Foot care: daily cleanse feet in warm. Women should be informed can cause resumption of ovulation in peri-menopausal.Monotard .Peak: 2-4 hrs.Lente . Long-Acting: cloudy .Humulin-R . trim nails to follow natural curve of toe. Insulin 1.Ultralente .Peak: 16-20 hrs. Ex. always wear breathable shoes such as leather. don’t break blisters. Health Teaching 1. .Onset: 30 mins. Intermediate-Acting: cloudy .stimulate development of ovarian . .lowers the blood glucose level by stimulating insulin release from beta cells. follicle stimulating hormone (FSH).Onset: 1-2 hrs .1 hr. which controls rate of most chemical reaction in the body.Semilente . . inspect. Enhance insulin action at the receptor sites without increasing insulin secretions from beta cells. which produces steroids Thyrotropic hormone (TSH) – for growth and secretory activity of thyroid. Pioglitazone Rosiglitazone 5.PZI . Injection techniques (intra site rotation) 3. termed “master gland” as it directly affects the function of other endocrine glands Anterior Lobe Adrenocorticotropic hormone (ACTH). 2.Crystalline zinc ..Duration: 30-36 hrs. Dietary management 4.

Retarded symmetrical physical growth b. Transphenoidal hypophysectomy: removal of pituitary gland 1. Slow intellectual development Treatment 1. Teaching and nursing responsibilities same with acromegaly 3.works with FSH in final maturation of follicles.hypersecretion of GHthat occurs in adulthood.assessment question “ are you buying larger size shoes” One of the earliest manifestation is increase in shoe size b. promotes ovulation and progesterone secretion Prolactin. Visual problems. Acromegaly. Human growth hormone injections (HGH) .signs of adrenal insufficiency. Removal of the causative factor (for ex. hands. Provide emotional support b. Enlargement of external extremeties (e. labor and lactation Disorders of Anterior Pituitary 1.influnces water absorption by kidney Oxytocin-influences the menstrual cycle. nose.follicles. Avoid coughing.hypersecretion of GH that occurs in childhood Manifestations: a.. Protrusion of the jaw and orbital ridges c. Dwarfism. blowing nose 2. Proportional overgrowth in all body tissue b. jaw. hypothyroidism and temporary diabetes insipidus 2. Gigantism.hyposecretion of GH during childhood Manifestations: a.for milk production Melanocyte stimulating hormone (MSH). sneezing. Assess for signs of increased cranial pressure. Hyperglycemia. Premature body aging processes c. Tumors) 2. feet) NCLEX . Hypercalcemia Treatment a. Check for CSF in nasal packing c. Bromocriptine (Parlodel) with surgery or radiation Nursing Interventions a. blindness e. semeniferous tubules and sperm maturation Luteinizing hormone (LH). Overgrowth of long bones: height in childhood may reach 8 or 9 feet c. Coarse features d.g. commonly associated with benign pituitary tumors Manifestations: a. Elevate head of bed 30 degrees 1. Directed toward symptomatic care 2.produces the characteristic skin darkening Posterior Lobe Vasopressin (ADH). Irradiation of pituitary b. insulin resistance f.

chemotherapy) 4. Syndrome of Inappropriate Antidiuretic Hormone (SIADH). diuretics 5. Dilutional hyponatremia d.004) 2. Specific gravity (should be greater that 1. Monitor intake and output: report any changes. very common following neurosurgery or head trauma Manifestations a. Dehydration/dry skin Treatment a.inappropriate. Hypernatremia d. Vasopressin tannate (Pitressin Tannate) in Oil (IM for chronic severe cases) c. Daily weights 5. Mental confusion/irritability b. Fluid restriction (less than 500 mL/24 hrs) with hypertonic solutions to treat the hyponatremia 2. respiratory disorders. Maintain adequate fluids 2.Nursing Responsibilities. (insufficiency of cortisol. Polyuria b. Diabetes Insipidus.same with acromegaly Disorders of Posterior Pituitary 1.hyposecretion ofADH. Treat underlying cause (surgery. Lethargy/seizures c. Weight loss e. radiation. Strict intake and output 3. discontinuing steroid medication abruptly without weaning off them Causes 1) Autoimmune or idiopathic atrophy of the adrenal glands 2) Surgical removal of Adrenal glands 3) Infection ( Tuberculosis . caused by neoplastic tumors. Desmopressin acetate (DDAVP) nasal spray b. may be idiopathic. Polydipsia c. Weight gain e. Histoplasmosis) 4) Decreased ACTH . drugs Manifetstions a. may be genetic. aldosterone and androgen).hyposecretion of adrenal cortex hormones. Lypressin (diapid) nasal spray Nursing Interventions 1. Weakness Treatment a. Avoid foods with diuretic-type action 3. due to a tumor or damage of the posterior lobe of the pituitary. Daily weight Adrenal Gland Disorders of Adrenal Cortex Addison’s disease. Anorexia. nausea and vomiting f. continued release of antidiuretic hormone resulting in water intoxication. can sometimes have 800mL output per hour 4.

Hypotension. illness. Hypertension (edema. hyperkalemia) g. Weight loss h. Cushing’s Syndrome. Hypokalemia (may cause arrythmias) f. low-carbohydrate. Peptic ulcer Treatment a. Malaise and muscular weakness (increase preotein catabolism) d. Lifelong steroid replacement. Decrease emotional and physical stress Nursing Interventions a. nausea. moon face. coma. overdose of steroid medications Manifestations a. Monitor fluid and electrolyte balance regularly NCLEX. Anorexia. Electrolyte imbalance (hyponatremia. Hypoglycemia j. Chemotherapy: bromocriptine (Parlodel) . High-protein. Adrenalectomy: unilateral or bilateral b. thin skin with ecchymosis k. Loss of libido i. hyperpyrexia. Provide emotional support d. legs) i. stress management) e. Hyperglycemia (insulin resistant) g. mitotane (Lysodren). Osteoporosis. Mood swings c. Protect from infection . insidious onset b.“eternal tan” e.Manifestations a. Increase pigmentation of the skin. Observe for Addisonian crisis (sudden extreme weakness. complications of long-term steroid therapy include osteoporosis b. Acne (striae on chest. low sodium diet with potassium supplement Nursing Interventions a. Amenorrhea j. may lead to CHF or CVAs) h. Teaching (lifelong medications. Central-type obesity. Monitor fluid and electrolytes routinely d. severe abdominal. hypovolemia from increased sodium excretion d. 2. High protein. hydrocortisone (Florinef). Bronze skin. Increased susceptibility to infections l. vomiting f. high carbohydrate diet may increase sodium intake ( low potassium intake) c. death) b.Common Complication is Shock CGFNS – Initial manifestation . back and leg pain. prompt treatment of infection. Slow. Masculine characteristics in females (hirsutism) e. Observe for side effects of hormone replacement c. Hypotension.hypersecretion of the glucocorticoids. or aminoglutethimide (Cytadren) c. Personality changes Treatment a. buffalo hump and obese trunk with thin extremities b. abdomen. Malaise and generalized weakness from increased potassium restriction c.

Client education concerning lifelong self-administration of hormone suppression therapy Steroid replacement (similar to Cushing’s syndrome but in lesser effect) Purpose: a. Symptomatic if surgery not feasible Nursing Interventions: a. Long-term therapy (for ex. leukemia) 3.Nausea . Post-adrenalectomy. Surgical removal of tumor/adrenal gland b.Vomiting .Orthostatic hypotension . Aldosteronism (Conn’s syndrome). Provide quiet environment b. nutritious diet (avoid caffeine) b. arthritis.Tachycardia c.Headache . Hypertension (principal manifestation): very high crisis b.Apprehension . Enables one to tolerate high degree of stress Indications: a. Surgical excision of tumor or adrenal gland b. Hypertension from hypernatremia c. Provide high-calorie. Hyperglycemia Treatment a. Monitor BP and cardiac activity c. Monitor potassium level Disorders of Adrenal Medulla 1. Crisis (fro ex. Preoperative: control hypertension . Sudden attackes resemble manifestations of overstimulation of sympathetic nervous system .hypersecretion of aldosterone from adrenal cortex (usually due to tumor) Manifestations: a. anti-inflammatory and anti-allergic reaction b.b. Shock. Hypokalemia and hypernatremia b. Potassium replacement c.hypersecretion of the hormones of adrenal medulla (exact cause unknown) Manifestations (sudden onset): seen in young women and men a. Antihypertensive drugs: spinolactone (Aldactone) Nursing Interventions a.Sweating . bronchial obstruction) b.Palpitations . Pheochromocytoma. Protect from accidents and falls due to osteoporosis c. Muscle weakness and cardiac problems related to hypokalemia Treatment a.

Menstrual disorders in women Treatment: drug therapy: Levothyroxine (Synthroid) a. monitor for cardiac symptoms of angina at initiation of therapy Nursing Interventions a. Husky voice from swelling of vocal cords j. Cretinism.Low-calorie. Hyperthyroidism (Grave’s disease.requires lifelong hormone replacement therapy 3.can lead to severe. Observe for overdosage manifestations of thyroid preparations 2. Anorexia and constipation e. puffy appearance (nonpitting) p. Thin hair l.Increase roughage . Slow rate of metabolism b. Weight gain o. Decreased sweating g. Generalized weakness m.hyposecretion of thyroid hormones in the fetus or neonate . Coarse. Anemia q. low saturated fat diet .Moderate fluids . highest incidence between ages 50 & 60. low cholesterol. Myxedema: hyposecretion of throid hormone in adulthood.hypersecretion of thyroid hormone. if not treated . Thyroid replacement hormones should be taken on an empty stomach b. diffuse toxic goiter). Generalized interstitial edema i. Personality changes c. Goiter n. Increased cholesterol and lipids r. dry skin k. Increased rate of body metabolism b. Monitor heart rate: fewer than 100 beats per minute is desirable. over treatment of hypothyroidism Manifestations a.Plan rest periods . Intolerance to cold f.diagnosed shortly after birth thru newborn screening . Directed toward manifestations of decreased metabolism . Personality changes (depression) c. Hypersensitivity to barbiturates and narcotics h. “Dull” appearance d. Enlargement of the thyroid gland .Weigh client b. more often in women Manifestations a.Avoid sedatives . irreversible mental retardation.Thryroid Gland Disorders of Thyroid Gland 1.provide warm environment .

activities f.gradually increase range of motion to neck. Iodides: decrease vascularity. decrease sodium and water g.heart disease .Important to assess temperature routinely . Easy fatigability j. Propanolol (inderal). relief of tachycardia b. Weigh client daily e. Check dressing esp. Talking limited. Provide cool.client must have frequent CBCs performed 3. Semi-Fowler’s position b. may indicate injury to laryngeal nerve f. Be alert for complications . quiet environment c. Anxiety/insomnia k. Provide adequate rest b. Thyroidectomy: subtotal or total Nursing Interventions: a.Tachycardia . carbohydrate. Exopthalmos (never goes away) e. use prior to thyroidectomy 4.Fever . elevate head of bed h.d. Diaerrhea h. Provide emotional support. note any hoarseness.removal of the thyroid gland. high protein. extra fluids d. inhibit release of thyroid hormones . tape eyes at night. Observe for Thryoid Storm (life threatening) .Irritability . vitamin diet without stimulants.day).Lugol’s solution ( use is decreasing because this medication is expensive and inactivates thyroid medications in the bowel) .Delirium .corneal abrasion . tracheostomy tray. Provide eye protection: ophthalmic medicine. Provide high calorie (4000-5000cal. Methimazole (Tapazole): blocks thyroid hormone production 2. back of neck c. Be alert for signs of hemorrhage e. Cardiac dysrhytmia and hypertension f. Nervous appearance l. Radioiodinetherapy: slowly destroys hyperfunctioning thyroid tissue c. oxygen and suction apparatus at bedside d. Diaphoresis and heat intolerance i. Drug therapy 1. Amenorrhea Treatment a.Saturated solution of potassium iodide (SSKI). Calcium gluconate IV at bedside h.Thyroid Storm (usually occurs after thyroid surgery) Thyroidectomy. Observe for signs of tetany: Chvostek’s sign and Trousseau’s sigh (parathyroid glands may accidentally be removed) g. Propylthiouracil (Propyl-Thyracil): blocks thyroid hormone production . support when sitting up . Observe for repiratory distress. Increased appetite (but weight loss) g.can cause agranulocytosis . either total or partial Nursing Interventions a.

Chronic: . Provide quiet room. Polyuria j. Hypercalcemia d. Prevent constipation and fecal impaction d. accidental removal during thyroid surgery Manifestations a. Provide a low-calcium.Thin hair. Bone deformities (susceptible to fractures b.Mental retardation . Hypertension Treatment a. low phosphorous diet Nursing Interventions a. Hypocalcemia b.hyposecretion of the parathyroid hormone. weakness. Joint and bone pain i. Plicamycin (Mithracin) or gallium nitrate (Ganite) Nursing Interventions a. no stimulus b. Assess for increased signs of neuromuscular irritability 2. Hyperparathyroidism (causes are tumor or renal disease). brittle nails . Acute: increased neuromuscular irritability tetany (positive Chvostek and positive Trousseau) c. Hydration and diuretics.Circumoral paresthesia with numbness and tingling of fingers Treatment a.oral calcium salts . low Vit. anorexia g.Lethargic . Apathy.Parathyroid Gland Disorders of Parathyroid Gland 1. Constipation. Hypoparathyroidism. Subtotal surgical resection of parathyroid gland b.Vitamin D and aluminum hydroxide gel (Amphojel) . Gastric ulcers and GI disturbances e.High calcium. vomiting. fatigue.Poor development of tooth enamel . Polydipsia k. D diet c. Strain all urine . Azotemia l. Calcium deposits in various body organs c. abdominal pain h.hypersecretion of parathyroid hormone Manifestations (causes loss of calcium from the bones to the serum) a. depression f.furosemide (Lasix) excretes excess calcium c. Chronic: . Nausea. Force fluids b. Acute: IV Calcium Gluconate b.

which produces steroids Thyrotropic hormone (TSH) – for growth and secretory activity of thyroid. promotes ovulation and progesterone secretion Prolactin. termed “master gland” as it directly affects the function of other endocrine glands Anterior Lobe Adrenocorticotropic hormone (ACTH). controls release rate of thyroxine.concerned with growth and secretory activity of adrenal cortex.works with FSH in final maturation of follicles. semeniferous tubules and sperm maturation Luteinizing hormone (LH).influnces water absorption by kidney Oxytocin-influences the menstrual cycle. in renal failure PITUITARY GLAND: HORMONES PRODUCED AND FUNCTIONS . which controls rate of most chemical reaction in the body. Safety measures to prevent breaks f.controlled primarily by the hypothalamus.stimulate development of ovarian follicles. binds phosphate. labor and lactation .promote growth of body tissue Gonadotropic hormones and estrogen secretion.e. Calcitonin.produces the characteristic skin darkening Posterior Lobe Vasopressin (ADH).for milk production Melanocyte stimulating hormone (MSH). follicle stimulating hormone (FSH). target is thyroid gland Somatotropic hormones (STH or GH).

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