Professional Documents
Culture Documents
C. Glands
D. Pituitary (illustration 1 illustration 2 )
1. Lies in sella turcica above the sphenoid bone
2. Consists of two lobes connected by the hypothalamus
3. Regulates the other endocrine glands by stimulating target organs
4. Controlled by releasing and inhibiting hormones from the hypothalamus
E. Thyroid gland (illustration )
1. Located at the level of the cricoid cartilage in front of the trachea
2. Two highly vascular lobes
3. Controls the rate of the body metabolism
F. Parathyroid glands - parathormone (PTH)
1. Four small glands located near the thyroid gland
2. Controls calcium and phosphorus metabolism
G. Adrenal glands (illustration )
1. Two small glands lying in the retroperitoneal region
2. Functions
a. cortex - promotes organic metabolism, regulates sodium and potassium,
response to stress, preadolescent growth spurt
b. medulla - stimulation of sympathetic nervous system, responds to stress
H. Pancreas - insulin, glucagon secretion into the blood, an endocrine function (illustration )
1. Lies retroperitoneally, with the head of the gland in the duodenal cavity and the tail lying
against the spleen
2. Excretion of enzymes and bicarbonate that aid digestion and controls carbohydrate
metabolism as an exocrine function
I. Gonads - ovaries, estrogen, progesterone, inhibin - decreases secretion of follicle-stimulating
hormone (FSH); testes, testosterone
1. Located: two ovaries are situated in the lower abdomen on each side of the uterus. The
testes are the pair of male sex organs that form within the abdomen but descend into the
scrotum
2. Responsible for secondary sex characteristics and reproductive function
2. General Concepts
C. Endocrine glands must maintain homeostasis of about 50 billion cells.
D. Endocrine glands are ductless, and secrete many hormones directly into the blood or lymph.
A. Blood tests
1. Serum Thyroxine (T4)
2. Thyroid-Binding Globulin (TBG)
3. Serum Triiodothyronine (T3)
4. T3 Resin Uptake
5. Free Thyroid Index (FTI)
6. Thyrotropin, Thyroid-Stimulating Hormone (TSH)
7. Thyrotropin-Releasing Hormone (TRH) stimulation test
8. Thyroid autoantibodies
B. Radiologic and imaging tests
1. Radioactive Iodine Uptake (RAIU) I 131 uptake
2. Thyroid scan
3. Thyroid ultrasound
1. Propythiouracil (PTU)
2. Methimazole (TAPAZOLE)
3. Saturated solution of potassium iodide
4. Radioactive iodine (131I)
5. Levothyroxine sodium (SYNTHROID)
6. Liothyronine sodium (CYTOMEL)
7. Strong iodine solution (Lugol's solution)
8. IV sodium iodide
9. Propranolol (Inderal)
1. sodium131I
2. antithyroid agents: propylthiouracil (PTU)
3. beta-adrenergic blocking agents: propranolol (inderol)
4. iodides: useful adjunct
c. surgical: thyroidectomy: partial or total removal of thyroid gland
d. diet high in calories, protein, carbohydrates
7. Nursing interventions
a. monitor vital signs, especially blood pressure and heart rate
b. provide quiet, restful, cool environment
c. monitor diet therapy
d. provide extra fluids
e. provide emotional support
f. administer medications as ordered
g. teach client
1. about medications and side effects
2. stress avoidance measures
3. energy conservation measures
h. care of the client undergoing surgery
2. Disorders of the Parathyroid Gland
B. Hypoparathyroidism
1. Definition - parathyroid produces too little parathormone; results in hypocalcemia
2. Etiology unknown
a. possibly an autoimmune disorder
b. most often results from surgical removal of parathyroid glands
3. Findings (mild to severe order)
a. neuromuscular
1. irritability
2. personality changes
3. muscular weakness or cramping
4. numbness of fingers
5. tetany
6. carpopedal spasms
7. laryngospasms
8. seizures
b. dry, scaly skin
c. hair loss
d. abdominal cramping
4. Diagnostics
Here's how to remember hyponatremia: "hypo" means "beneath" and "Na" is the chemical abbreviation for sodium.
And if "K" is the chemical abbreviation for potassium, what's "hypokalemia"?
B. Cushing's syndrome
1. Definition: adrenal gland secretes too much cortisol
2. Etiology
a. average age of onset 20 to 40 years of age
b. affects women more often than men
c. primary syndrome caused by tumor of adrenal cortex
d. secondary syndrome caused by an ACTH-producing tumor of pituitary
e. long term steroid therapy
3. Findings
a. personality changes
b. hypertension
c. metabolic alkalosis
d. weight gain, buffalo hump, truncal obesity
e. change in libido
f. moon face
g. muscle weakness
h. virilization in women, amenorrhea, or menstrual irregularities
i. osteoporosis
j. acne or hyperpigmentation
4. Diagnostics
a. history and physical exam
b. blood tests show
1. increased levels of cortisol,
2. increased sodium and glucose,
3. decreased potassium
c. 24-hour urine collection:
1. elevated free cortisol
2. elevated 17-ketosteroids
3. elevated 17-hydroxycorticosterone
5. Management
a. expected outcome: to restore hormonal balance
b. surgery for adrenal or pituitary tumor
c. irradiation therapy
d. pharmacologic
e. adrenal enzyme inhibitors that block enzymes needed for cortisol synthesis
1. aminogluthemide
2. metyrapone
3. mitotane
f. potassium supplements
g. high protein diet with sodium restriction
6. Nursing interventions
a. administer medications as ordered
b. monitor diet therapy
c. monitor for signs of hypokalemia, hypernatremia
d. teach client
When reading the stem of the question, give special attention to words such as: BEST, MOST, LEAST, FIRST,
PRIORITY, INITIAL.
4. Diagnostics
a.increased BMR
b. computerized tomogram (CT) scan
c. 24-hour urine collection: increased urinary catecholamines
5. Management
a. expected outcomes: to remove the tumor and correct the imbalance
b. surgical removal of the tumor: scheduled only after client has been
normotensive for at least one week
c. antihypertensive agents as needed preop
d. alpha-adrenergic blocking agent and beta adrenergic blocking agent (beta
blockers): phentolamine (regitine), nitroprusside (nitropress), propranolol
(inderal)
e. tyrosine inhibitors: alphamethylparatyrosine decreases circulating
catecholamines
f. antidysrhythmic agents as needed preop
6. Nursing interventions
a. monitor vital signs, especially blood pressure
b. administer medications as ordered
c. provide care of the client undergoing surgery
d. if bilateral adrenalectomy performed, lifelong steroid therapy required
e. teach client
i. about medications and side effects
ii. need for lifelong followup
2. Disorders of the Pancreas
1. Diabetes mellitus
4. Definition - a condition in which the pancreas produces too little insulin, or cells stop
responding to insulin; results in hyperglycemia
a. type 1 diabetes mellitus: genetic, auto-immune respones; severe insulin
deficiency from beta cells stop production of insulin
b. type 2 diabetes mellitus: obesity; cells stop responding to insulin
Be cautious of “absolute” words: ONLY, MUST, ALWAYS, NEVER which signal that the option is wrong.
It's oversimplified, but if it helps you, think of the relation between insulin and glucose as a see-saw. When one is
higher, the other tends to be lower.
4. Management
a. diet therapy and weight loss
i. the total number of calories is individualized according to the client's
weight
ii. as prescribed by the care provider, the client may be advised to
follow dietary guidelines for Americans (food guide pyramid) or
individualized food exchanges from the American Diabetic
Association
b. exercise
i. lowers glucose level and improves circulation
ii. decreases total cholesterol and triglycerides
iii. instruct client to monitor glucose before exercising
iv. before exercise, clients who require insulin should eat a carbohydrate
snack with protein to prevent hypoglycemia
c. insulin
i. used in type 1 diabetes mellitus (DM) and type 2 DM, if needed for
better control of blood glucose levels
ii. regular insulin, the only insulin that is given IV, is used for
ketoacidosis
iii. check other medications the client is taking
iv. illness, infections, and stress increase the need for insulin
v. instruct client about the importance of rotating injection within one
region (the abdomen absorbs insulin the most rapidly)
vi. insulin administration: see Pharmacology section of this course
vii. insulin pens, jet injectors, and insulin pumps are used to administer
insulin
d. oral antidiabetic medications
i. prescribed for clients with type 2 DM
ii. monitor blood glucose levels
iii. check other medications the client is taking
iv. instruct the client to recognize manifestations for hypoglycemia and
hyperglycemia
v. pancreas transplant
vi. islet cell transplant
vii. blood glucose monitoring - with different self-check systems
5. Medications
a. type 1 DM: insulin therapy
b. type 2 DM: oral hypoglycemic agents
6. Complications
a. hypoglycemia (insulin shock)
i. blood sugar falls below 50 mg / dl
ii. caused by too much insulin, too little food, or excessive physical
activity
iii. may result from delayed meals, exercise, or vomiting
iv. rapid onset
v. findings of insulin shock
1. diaphoresis; cold, clammy skin
2. anxiety, tremor, slurred speech
3. weakness
4. nausea
5. mental confusion, personality changes, altered LOC
6. headache
vi. management of hypoglycemia
1. if client is conscious, give oral sugar: hard candy, honey,
Karo syrup, jelly, cola
2. if unconscious: give one mg glucagon IM, IV or
subcutaneous (SC); or 20 to 50 ml 50% dextrose IV push
b. diabetic ketoacidosis (DKA) - an acute complication
i. results from severe insulin deficiency
ii. findings
1. blood sugar levels > 350 mg/dl
2. elevated ketone levels: sweet odor to breath may also have
odor of someone drinking alcohol
3. metabolic acidosis: Kussmaul's respirations, flushed
appearance, dry skin
4. thirst
5. polyuria
6. drowsiness
7. anorexia, vomiting
8. may lead to shock and coma
9. usual causes:
1. undiagnosed diabetes mellitus
2. inadequacy of prescribed therapy for diabetes
mellitus
3. physical stress such as surgery, illness, or trauma
in person with diabetes mellitus
4. caused by increased gluconeogenesis from amino
acids and glycogenolysis in the liver
10. management:
1. correct fluid depletion - IV fluids
2. correct electrolyte depletion - replacement
particularly of potassium
3. correct metabolic acidosis - insulin IV
c. hyperglycemic, hyperosmolar nonketotic coma (HHNKC)
i. potentially fatal
ii. findings
1. severe hyperglycemia; usually > 600 mg/dl
2. plasma hyperosmolarity
3. dehydration
4. altered LOC - decreased
5. absence of ketoacidosis
iii. usually precipitated by physical stress such as an infection;
iv. in non-diabetics can be due to tube feedings without supplemental
water, or too rapid rate of infusion for parenteral nutrition
v. occurs more often in the elderly, typically
vi. expected: to correct fluid depletion, insulin deficiency, and electrolyte
imbalance
d. other chronic complications
i. diabetic triopathy
1. retinopathy
2. nephropathy
3. neuropathy
ii. macrovascular disease in the
1. coronary artery
2. peripheral vascular
7. Nursing interventions
a. give medications as ordered
b. monitor for findings of hyperglycemia or hypoglycemia
c. help client monitor blood glucose
d. refer client to dietician for planing of meals
e. support client emotionally
f. teach client
i. the importance of balanced, consistent daily focus of diet, medication
and exercise
ii. self blood-glucose monitoring
iii. dietary exchange system or refer to appropriate resources
iv. about medications and side effects
v. foot care
vi. early reporting of complications of
1. ketoacidosis
2. insulin shock
3. long term issues
vii. about insulin administration
viii. about the need to:
1. eat more before strenuous exercise
2. carry extra rapid-absorbing carbohydrate on person at all
times
3. wear medical-alert jewelry
4. have regular eye exams
5. consider emergency care for insulin shock
About Insulin
• In the pancreas's islets of Langerhans, beta cells secrete insulin-the islet-cell hormone of major physiological
importance;
• Without sufficient insulin, the body develops diabetes mellitus.
• Exploration of a number of new delivery systems for insulin is ongoing.
• Implanted insulin delivery systems, in combination with a glucose sensor may create an "artificial pancreas."
• Exercise increases the body's metabolic rate to result in a decrease in blood sugar and an increase in insulin
sensitivity. Signs of hypoglycemia often occur.
• Illness can disrupt metabolic control and raise blood sugar, which results in an increased need for insulin.
• Insulin-dependent clients should be well controlled for at least one week prior to any surgery.
• 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.
• Following neck surgery, potentially life-threatening complications such as laryngeal edema and tracheal
obstruction can occur. Monitor for respiratory distress.
• Following thyroid surgery, many clients suffer transient hypocalcemia from hyporfunction or removal of the
parathyroids. Monitor for signs of tetany for up to three days after surgery.
• Positive Chvostek's sign: contraction of facial muscle near mouth occurs when light tap is given over facial
nerve in front of ear.
• Positive Trousseau's sign: carpopedal spasm results during the deflation of a blood pressure cuff that has been
inflated for at least one minute.
Calcitonin
Corpus luteum
Hashimoto's thyroiditis
Hyperplasia
Medullary carcinoma
Microangiopathy
NPH insulin
Papillary adenoma
Polyphagia
Endocrine
• Adrenal glands
• Endocrine system
• Pancreas and its relation to the duodenum
• Pituitary gland and hypothalamus
• Pituitary gland
• Thyroid gland and related structures