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ENDOCRINE SYSTEM

STRUCTURE AND FUNCTION OF THE
ENDOCRINE AND METABOLIC
SYSTEMS

A. Hormones: are chemicals substances
secreted by endocrine glands directly into
the blood stream to act on specific target
cells. Hormones regulate growth and
development, fluid and electrolyte balance,
reproduction, adaptation to stress, and
metabolism.

1. Types of hormones
a. Protein or peptide hormones- act on
cell membranes by binding to receptors.
Examples include insulin, vasopressin,
growth hormone (GH), and
adrenocorticotropic hormone (ACTH)

b. Amine hormones or amino acids-act
on cell membranes. Examples include
derivatives, epinephrine, and
norepinephrine.

Steroids. its cations or metabolites inhibit secretion. c. Hormone regulation.e. 2. and testosterone.act intracellularly to modify protein synthesis. Hormone secretion is regulated through feedback mechanisms (i. decreased levels stimulate secretion). for increased levels of a specific hormone. estrogen. Examples include cortisol. .

e. which secretes releasing and inhibiting hormones. Release of these hormones is regulated by the hypothalamus. Located at the inferior aspect of the brain within the sella turcica (i. The anterior lobe synthesizes and releases hormones. the pituitary gland consists of anterior and posterior lobes.B. small recess in the sphenoid bone). . Pituitary gland. 1.

Thyroid stimulating hormone  d. Luteinizing hormone . Prolactin  c. ACTH  e. a. Follicle stimulating hormone  f. GH  b.

ADH .2. Oxytocin b. The posterior lobe stores and releases hromones synthesized in the hypothalamus. a.

2. the thyroid produces three hormones. Thyrocalcitonin is secreted in response to high blood calcium levels.C. Thyroid gland. 1. A butterfly-shaped gland located in the neck behind the trachea. Secretion of T4 and T3 is under the control of TSH. It lowers blood calcium levels by inhibting bone resorption. . Thyroxine (T4) and triiodothyronine (T3) regulate cellular metabolic activity T3 is produced predominantly from peripheral conversion of T4.

usually four. These small glands.D. . intestines. Parathyroid glands 1. the parathyroids produce parathromone. and bones. they are often difficult to locate and may be removed accidentally during thyroid or other neck surgery. which raises blood calcium levels by increasing calcium resorption from kidneys. In response to a low blood calcium level. surround the posterior thyroid gland. 2.

1. The adrenal medulla in the center of the gland. reacts to autonomic nervous system signals to release catecholamines.E. Epinephrine-which accounts for approximately 90% of adrenal medulla secretions. . Adrenal glands. prepares the body for the fight- or-flight response by converting glycogen. the adrenals contain two distinct types of endocrine tissue. to glucose and increasing cardiac output. a. Located at the upper poles of both kidneys. stored in the liver.

. a. b. 2. which are released in response to angiotensin II and ACTH. Norepinephrine produces effects similar to epinephrine and produces extensive vasoconstriction. the outer portion of the gland. is stimulated by ACTH to produce corticosteroids. Minelacorticoids (primarily aldosterone). The adrenal cortex.increase sodium reabsorption and potassium loss primarily through the renal tubules.

androgens and estrogen) govern development of certain secondary sex characteristics. c.e. which are released in response to ACTH. and promote sodium retention and potassium loss. Adrenal sex hormones (i. Glucocorticoids (primarily cortisol). increase blood glucose by stimulating gluconeogensis and lipolysis and decrease protein synthesis. suppress the inflammatory response. b. Secretion of adrenal androgens is controlled by ACTH. .

Endocrine functions are controlled by the alpha. 2. . Exocrine functions involve secretion of pancreatic digestive enzymes by specialized cells.F. delta cells of the islets of Langerhans. Pancreas. beta. 1. the pancreas functions as an exocrine and an endocrine gland. A slender elongated organ lying horizontally in the posterior abdomen behind the stomach.

Although the gonads exert some systemic metabolic effects. . Gonads 1. 2. The gonads consist of the ovaries and testes.G. their primary function is reproduction.

ENDOCRINE SYSTEM .

DIABETES MELLITUS I. Metabolic disorder characterized by hyperglycemia resulting from lack of insulin. Four general classifications as recognized: 1. b. Pre-diabetes (fasting blood glucose > 100 mg/dl and < 126 mg/dl or postprandial blood glucose > 140mg/dl and 200 < 200 mg/dl) . lack of insulin effect. Definition a. or both.

Type 2 (insulin resistance with varying degrees of insulin secretory defects) 4. Type 1 (absolute insulin insufficiency) 3. Gestational (develops during pregnancy) . 2.

Insulin deficiency leads to hyperglycemia. Resultant destruction of beta cells leads to a decline in and an ultimate lack of insulin 3. causes production of autoantibodies against beta cells of the pancreas 2.and protein metabolism .II. Underlying pathophysiology a. possibly a viral infection. A triggering event. enhanced lipolysis (decomposition of fat). Type 1 1.

or peripheral insulin receptor insensitivity leads to hyperglycemia. These characteristics occur when more than 90 % of beta cells have been destroyed. . b. Type 2 1. inappropriate hepatic glucose production. 4. Impaired insulin secretion.

Gestational 1.Occurs when a woman not previously diagnosed with diabetes shows glucose intolerance during pregnancy 2. This intolerance may occur if placental hormones counteract insulin. causing insulin resistance .c.

III. Autoimmune process triggered by viral or environmental factors 2. Type 1 1. Causes A. Idiopathic (no evidence of autoimmune process) .

Beta cell exhaustion due to lifestyle choices or hereditary factors 2. Type 2 1. Age . d. Obesity b. Pregnancy ending in birth of neonate weighing more than 9 lb.B. Risk factors a. Hypertension e. Family history c.

and recurrent monilial infections of the vagina or anus due to hyperglycemia . diarrhea. Polyphagia c. reduced energy level e. Slow-healing skin infections or wounds. Nausea. Weight loss d. fatigue. Headaches.IV. and emotional lability due to electrolyte imbalance f. Pathophysiologic changes a. Abdominal discomfort h. lethargy. or constipation i. Muscle cramps. Polyuria and polydipsia b. itching of skin. Numbness and tingling due to neural tissue damage g. irritability.

Hyperosmolar hyperglycemic nonketotic syndrome f. Amputation i. d. Complications a. and cerebral artery disease. Skin ulcerations h. and neuropathy b. Macrovascular disease.V. Excessive weight gain g. Dyslipidemia c. nephropathy. peripheral. Chronic renal failure . including coronary. Microvascular disease. Diabetic ketoacidosis (DKA) e. including retinopathy.

random blood glucose level of 200 mg/dl or more. Urinalysis reveals elevated acetone and glucose . 2-hour blood glucose test results of 200 mg/dl or more (2 hours after ingesting 75 g of oral dextrose). Ophthalmologic examination may show diabetic retinopathy c.VI. and increased glycosylated hemoglobin (HbA1c). b. Diagnostic test findings a. reflecting glycemic control during the previous 2 to 3 months. Blood testing reveals fasting plasma glucose level of 126 mg/dl or more on at least two occasions.

Regular exercise c. Insulin replacement 2. Pancreas transplantation (requires chronic immunosuppression) d. Careful monitoring of blood glucose and HbA1c levels b. Oral antidiabetic drugs .VII. Treatment a. Type 2 1. Type 1 1.

Injectable insulin if glucose level isn’t achieved with diet alone 3. Postpartum counseling to address the high risk of gestational diabetes in subsequent pregnancies and type 2 diabetes later in life.Medical nutrition therapy 2. . Gestational 1.e.

Watch for complications. diaphoresis. weakness. Teach the patient and his family about possible adverse effects of medications 3. blood glucose monitoring recognition and treatment of hypoglycemia and hyperglycemia) 2. Nursing considerations 1. pallor. Stress the importance of complying with prescribed treatment program (diet. tachycardia. seizures and coma) .VIII. exercise. especially hypoglycemia (dizziness.

Monitor diabetes control by obtaining blood glucose. stupor). HbA1c level. 5. Stay alert for signs of ketoacidosis (acetone breath. 6. weak and rapid pulse. . thirst.4. Teach the patient and his family how to recognize hypoglycemia and ketoacidosis. these hyperglycemic crises require I. fluids and regular insulin. neurologic abnormalities. how to respond. dehydration. Kussmaul’s respirations) and Hyperosmolar coma (polyuria.V. annd blood pressure measurements regularly. and when to seek medical attention.

Stay alert for signs of UTI and renal disease 8. and blisters b. Urge the patient to get regular ophthalmologic examinations to detect diabetic retinopathy. Monitor for signs and symptoms of cellulitis (skin reddening and edema. Meticulously treat all injuries. Watch for diabetic effects on the cardiovascular system and the peripheral and autonomic nervous system a. . possible blistering or ulceration) c. cuts.7.

Stress the need for personal safety precautions. b. Minimize complications by maintaining strict blood glucose control .9. Assess the patient for signs of diabetic neuropathy (changes in sensation or in motor strength or agility in an extremity) a.

Disorders of the Anterior
Pituitary

Pituitary gland. Located at the inferior
aspect of the brain within the sella turcica
(i.e. small recess in the sphenoid bone),
the pituitary gland consists of anterior and
posterior lobes.

The anterior lobe synthesizes and
releases hormones. Release of these
hormones is regulated by the
hypothalamus, which secretes releasing
and inhibiting hormones.

Prolactin C. Follicle stimulating hormone F. Thyroid stimulating hormone D. GH B.A. ACTH E. Luteinizing hormone .

a. The posterior lobe stores and releases hromones synthesized in the hypothalamus.2. Oxytocin b. ADH .

underactivity of the front (anterior) pituitary gland a.Disorders of the Anterior Pituitary A. classifications of pituitary tumors i. functioning: hormone present in insufficient quantities ii. non-functioning: hormone absent iii. Hypopituitarism 1. Definition .decreased growth hormone results in dwarfism . if in childhood .

female: i. amenorrhea ii. infertility iii.result from hormone deficiency (hypogonadism) a. usually benign as a pituitary adenoma 3. decreased libido iv. Etiology .2. vaginal dryness . hypogonadism. breast and uterine atrophy v. Findings .most common cause: neoplasms. loss of axillary and pubic hair vi.

b. male i. decreased libido ii. loss of axillary and pubic hair c. small. soft testicles iv. hypothyroidism (because pituitary regulates thyroid glands by thyroid stimulating hormone (TSH)) . impotence iii. hypogonadism.

SIADH .d. may see signs of increased intracranial pressure (ICP) f. hypoadrenalism (because pituitary regulates adrenal glands by ACTH production) e.fluid overload and dilutional hyponatremia related to increased ADH levels .

sex hormone replacement c. surgical removal of tumor . corticosteroid therapy ii. thyroid hormone replacement iii. Management a. expected outcome: hormone deficiency corrected b. hormone replacement therapy i.

x-rays of pituitary fossa d. history and physical exam b. neuro-ophthalmological exam c.Diagnostics a. radioimmunoassays of anterior pituitary hormones e. computerized tomogram (CT) scan .

Raise head of bed at 30-45 degrees . provide for i.• Nursing interventions a. Monitor neuro vital signs as ordered 2. care of the client with increased ICP CARE OF THE CLIENT WITH INCREASED INTRACRANIAL PRESSURE 1. Maintain fluid restriction as ordered 3.

4. anxiety 5. vomiting. coughing. Monitor intracranial pressure 7. Observe for herniation syndrome 6. neck rotation. extension. any restrictive clothing around neck. Prevent any activities that increase ICP such as straining at stool. flexion. Administer oxygen as ordered .

monitor for desired effects of administered medications as ordered c.8. provide emotional support with referral to support groups d. care of the client undergoing surgery b. Seizure precautions ii. teach client i. need for lifelong hormone replacement therapy and regular checks of serum levels . medications desired effects and side effects ii.

if growth plates closed ii. acromegaly . Hyperpituitarism 1. usually caused by benign neoplasm b. Etiology a. Definition .anterior pituitary secretes too much growth hormone and/or ACTH 2. ACTH overproduction leads adrenal gland to overproduce cortisone: Cushing's disease . growth hormone overproduction i. giantism .B.if growth plates open c.

 3. Findings
 a. may see signs of increased ICP
 b. acromegaly: excess longitudinal bone
growth, increase in density and size of organs
and soft tissue
 c. prognathism
 d. coarse facial features
 e. prominent forehead and orbital ridge
 f. large, broad, spade-like hands
 g. arthritis, kyphosis
 h. prominent tongue
 i. change in ring or shoe size drastically over
short period of time

Diagnostics
a.history and physical exam
b.computerized tomogram (CT) scan
c.plasma hormone levels: increased growth
hormone, ACTH

physical changes of acromegaly are irreversible .Management a.surgical removal of tumor c.pharmacologic: growth hormone suppressant: bromocriptine (parlodel) e.irradiation of gland d.expected outcome: remove tumor and restore hormonal balance b.

Nursing interventions a. care of the client undergoing surgery iii. care of the client undergoing radiation therapy iv. provide i. care of the client with increased ICP ii. emotional support .

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b. assess for signs of diabetes insipidus,
since removal of a pituitary tumor may
injure the posterior pituitary glands and
decrease antidiuretic hormone (ADH)
secretions - drastic fluid loss
c. teach client that treatment usually
produces hypopituitarism so lifelong
hormone replacement therapy with regular
check-ups are required

Disorders of the
Posterior Pituitary

Disorders of the Posterior Pituitary
A. Diabetes insipidus
1. Posterior pituitary gland makes too little
antidiuretic hormone (ADH). Body loses
too much water in the urine; plasma
osmolality and sodium levels increase.

which causes reduced vasopressin secretion . Diabetes Insipidus (DI) Etiology Excessive output of dilute urine  Nephrogenic DI Inherited defect: renal tubules do not respond to ADH. serum osmolality decreases. resulting in inadequate water reabsorption Neurogenic DI A defect in either the production or secretion of ADH Dipsogenic DI A disorder of thirst stimulation When patient ingests water.

signs of dehydration e. excessive thirst (polydipsia) b. constipation . polyuria: as much as 20 liters per day with specific gravity below 1.006 c.3. Findings a. nocturia d.

osmotic stimulation c. computerized tomogram (CT) scan . water deprivation tests: inability to concentrate urine. administration of vasopressin (pitressin) or desmopressin acetate (stimate) d. also differentiates between primary DI and nephrogenic DI b.4. Diagnostics a.

pharmacotherapy A. lypressin (diapid) D. vasopressin (pitressin) - antidiuretic hormone C. desmopressin acetate (stimate) B.Management A. expected outcomes: to correct underlying cause and restore hormonal balance B. chloropropamide (chloronase) .

C. surgical removal of tumor . IV fluid replacement therapy D.

measure intake and output E. administer medications as ordered C. monitor fluids and give IV fluids as ordered D. monitor for findings of dehydration.Nursing interventions A. measure urine. weigh client daily . specific gravity B.

care of the client undergoing surgery H. about medications and side effects C. to record intake and output B. the need to wear disease identification jewelry . to check urine specific gravity D.F. teach client A. care of the client with increased ICP G.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH). results in excessive water conservation .B.oversecretion of ADH.

Ectopic ADH production asociated with some disorders 6. Overuse of vasopressin therapy 5.Etiology 1. Stimulation due to hypoxia or decreased left atrial filling pressure 3. Nausea or opioid use. Pharmacologic agents 4. Central nervous system disorders 2. which can stimulate ADH secretion .

kidneys retain excessive water Plasma volume expands.Pathophysiology When ADH is elevated despite normal or low serum osmolality. causing the blood pressure to rise. and water intoxication develops . Body sodium is diluted (hyponatremia).

 Signs and symptoms 1. Altered mental status (e. confusion. lethargy. headache.g. Decreased urine output 2. Weight gain 3. Delayed deep tendon reflexes . seizures. and coma in severe hyponatremia) 4.

2. Urinalysis detects elevated urine sodium and osmolality. 3. Plasma osmolality and serum sodium levels are decreased. Laboratory and diagnostic study findings 1. Serum ADH level is elevated. .

Administer prescribed medications. . but lithium may be prescribed. achieving a change in water balance diuretics. Nursing care 1. Drugs that render the kidneys less sensitive to ADH may be prescribed. Restrict fluid intake as indicated. demeclocycline is preferred. 2. isotonic urine is exreted. 3. which may include furosemide (Lasix) to prevent concentration of urine. Regularly assess mental status.

affects more women ii. deficiency of thyroid hormones causing decreased metabolic rate i. age group: 30 to 50 years of age . DISORDERS OF THE THYROID GLAND I.an underactive thyroid resulting in a lessened secretion of thyroid hormone a. Definition . Hypothyroidism 1.

leads to mental retardation ii. hypothyroidism without myxedema: mild thyroid failure iii. hypothyroidism with myxedema: severe thyroid failure. classifications i. cretinism: hypothyroidism in children. usually seen in older adults .b.

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iv. myxedema coma • most severe type of hypothyroidism • precipitated by stress • findings include: o hypothermia o bradycardia o hypoventilation o altered LOC leading to coma • potentially life threatening condition .

thyroid surgery .may cause hypothyroid state after surgery depending on extent of thyroid removal b. treatment for hyperthyroid condition c. deficiency in dietary iodine .Etiology a. overdosage of thyroid medications d.

brittle nails e. increased diastolic pressure f. intolerance to cold d.increased menstrual flow g. coarse. depression c. dry skin. menstrual changes . fluid retention . fatigue. Findings a. loss of the outer one-third of eyebrows h. bradycardia. weight gain i. constipation. cognitive impairment b. periorbital edema. thick.

tertiary hypothyroidism (hypothalamic hyposecretion of TRH) . secondary hypothyroidism (pituitary hyposecretion of TSH). Blood testing reveals increased TSH level when hypothyroidism is caused by thyroid disorder and decreased TSH when the cause is hypothalamic or pituitary disorder c. Radioimmunoassay shows low T3 and T4 levels b. Diagnostic test findings a. Thyroid panel differentiates between primary hypothyroidism (thyroid gland hypofunction).

Arterial blood gas (ABG) analysis shows decreased pH and increased partial pressure of carbon dioxide (indicating respiratory acidosis) . and triglyceride levels and low serum sodium level. Blood testing reveals elevated serum cholesterol. alkaline phosphatase.d. e.

IV fluids as ordered ii. Management a. give synthetic thyroid hormone . expected outcomes: to restore hormonal balance and prevent complications b. administer synthetic thyroid hormone: levothyroxine sodium (levothroid) c. myxedema coma: i. correct hypothermia iii.

 Nursing interventions  a. provide restful environment  d. the importance of lifelong therapy e. how to conserve energy ii. protect client from cold . about the medications and side effects - 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. how to avoid stress iii. teach client i. give medications as ordered  b. watch client for signs of myxedema  c.

Hyperthyroidism (Graves' disease. thyrotoxicosois) Definition . and causes increased basal metabolic rate or hyperactivity of thyroid as a primary disease state Etiology .B.considered autoimmune response women affected more than men age group: 30 to 50 years .overactive thyroid over secretes hormones.

Findings a. increased systolic BP g. heat intolerance c. diarrhea b. weight loss. exophthalmos d. Palpitations f. tachycardia e. hyperphagia. difficulty concentrating .3.

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insomnia m. thin. diaphoresis l. reduced tolerance for stress . brittle hair. pliable nails: plummer's nails k.h. hyperactivity j. irritability i.

elevated serum T3 and T4 levels 3. elevated radioactive iodine uptake 4. presence of thyroid autoantibodies 5. Diagnostics 1. comes from pituitary) levels . decreased TSH (thyroid-stimulating hormone. history and physical exam: palpable thyroid enlargement: (goiter) 2.

findings include: 1. precipitating factors: stress. even psychosis . rare but potentially fatal 2. hyperthermia 3. extreme anxiety 6. state of extreme hypermetabolism 4. systolic hypertension 2. Complication: thyrotoxic crisis (thyroid storm) 1. angina 4. infarction or heart failure 5. breakdown of body's tolerance to chronic hormone excess 3. pregnancy 5. infection.

iodides: useful adjunct to decrease vascularity of thyroid pre-surgical removal . beta-adrenergic blocking agents: propranolol (inderol) iv. expected outcomes: to reduce the excess hormone secretion and to prevent complications b. pharmacologic i. sodium131I ii. antithyroid agents: propylthiouracil (PTU) iii. Management a.

diet high in calories. carbohydrates . protein. c. surgical: thyroidectomy: partial or total removal of thyroid gland d.

provide emotional support f. restful.provide quiet.monitor vital signs. administer medications as ordered .monitor diet therapy d. especially blood pressure and heart rate b.provide extra fluids e.Nursing interventions a. cool environment c.

assess for laryngeal nerve damage post-surgery j. energy conservation measures h. assess for excessive swallowing or pooling of blood behind neck indicating hemorrhage . stress avoidance measures iii. care of the client undergoing surgery i. teach client i. about medications and side effects ii.g.

Etiology unknown  a. results in hypocalcemia  2. Hypoparathyroidism  1.most often results from surgical removal of parathyroid glands . Disorders of the Parathyroid Gland A.parathyroid produces too little parathormone. possibly an autoimmune disorder  b. Definition .

Findings (mild to severe order) a. carpopedal spasms vii. neuromuscular i. irritability ii. muscular weakness or cramping iv. personality changes iii. numbness of fingers v. tetany vi. seizures .3. laryngospasms viii.

Serum phosphate . dry. ionized 4. scaly skin c. Parathyroid hormone (PTH) 2. total 3.b. abdominal cramping Diagnostics 1. hair loss d. Serum calcium. Serum calcium.

positive Chvostek's sign (facial muscle twitching when cheek is stroked) c. positive Trousseau's sign (carpopedal spasm as inflated BP cuff is released) d.a. decreased serum calcium e. increased serum phosphate . history and physical exam b.

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vitamin D preparations facilitate uptake of calcium d.Management a.calcium-rich diet .6mg/dl c.calcium replacement therapy: ideal serum calcium level 8.expected outcomes: to restore hormonal balance and prevent complications b.

place airway. suction and tracheotomy tray at bedside c.institute seizure precautions d.monitor carefully for signs of tetany b.administer medications as ordered e.Nursing interventions a.calcium gluconate kept at bedside .

to consume more calcium and get vitamin D from sun exposure to skin iv. to reduce phosphorus intake: minimize intake of fish. teach client i.f. about medications and side effects ii. eggs. cheese and cereals . signs of vitamin D toxicity iii.

secondarily as result of kidney disease or osteomalacia c.parathyroid secretes too much parathormone. incidence increases dramatically in both sexes after age 50 . results in increased serum calcium (hypercalcemia) 2.B. Hyperparathyroidism 1. Definition . Etiology a. benign growth in parathyroid b.

irritability e. muscle weakness and fatigue . nausea.3. anorexia c. gastrointestinal: constipation. pathological fractures d. Findings a. demineralization. many clients are asymptomatic b. vomiting. skeletal: bone pain.

history and physical exam b.Diagnostics a. x-rays reveal bone demineralization . elevated serum calcium c. decreased serum phosphate level d.

Plicamycin 4. Didronel 5. Diuretics 3. Phosphate as antihypercalcemic agent . Glucocorticoids 6.9% normal saline solution 2.PHARMACOLOGIC INTERVENTIONS FOR HYPERPARATHYROIDISM 1. Hydration with 0.

7. Estrogen 9.parathyroidectomy . expected outcomes: to restore hormonal balance and prevent complications b.Vitamin D a. surgery: removal of parathyroid glands . Etidronate disodium 10. Calcitonin 8.Phosphate-binding antacid 11.Calcium supplement 12.

care of the client undergoing surgery b. such as laryngeal edema or.Nursing interventions a. teach client to consume diet rich in calcium d. Check frequently for respiratory distress and keep a tracheotomy tray at the bedside.after surgery observe for signs of hypocalcemia c. rarely.After parathyroidectomy 1. hemorrhage . watch for postoperative complications.after surgery.

.V. place the patient in semi-Fowler’s position. these symptoms should subside quickly but may be prodromal signs of tetany. Check for swelling at the postoperative site. which may cause pressure on the trachea. Watch for signs of mild tetany such as complaints of tingling in the hands and around the mouth. 4. available for emergency administration. Monitor intake and output 3. so keep calcium gluconate or calcium chloride I. and support his head and neck with sandbags to decrease edema.2.

Disorders of the Adrenal Gland .

Addison's disease 1. relatively rare . decreases secretion of other adrenal products: mineralocorticoid. adrenal cortex secretes too little adrenocorticotropic hormone (ACTH) b. Definition a.Disorders of the Adrenal Gland A. glucocorticoids. and sex hormones c.

acute adrenal insufficiency (Addisonian crisis) i. diarrhea or constipation iv. severe generalized muscle weakness iii. severe headache or back pain ii. Findings a. confusion . Etiology .autoimmune adrenalitis 3.2.

circulatory collapse . lethargy vi.v. severe hypotension vii.

vague complaints or findings ii. muscle weakness iv. fatigue iii. personality changes vi. adrenal insufficiency i. vague abdominal complaints: anorexia. skin pigmentation darkens . nausea. vomiting v.b.

ACTH stimulation test: low cortisol level c. low blood levels of sodium and glucose and high levels of potassium d.Diagnostics a. 24-hour urine collection: decreased levels of free cortisol . history and physical exam b.

Management Pharmacologic Interventions for Adrenal Insufficiency 1. Betamethasone (CELESTONE) 3. Methylprednisone (MEDROL) . Glucocorticoids 2. Hydrocortisone 6. Dexamethasone (DECADRON) 5. Cortisone (CORTONE) 4.

Mineralocorticoids 10.Desoxycorticosterone (DOCA PERCORTEN) 11.7. Prednisolone (DELTA-CORTEF) 8. liquid) 9. Prednisone (DELTASONE tablets.Fludrocortisone (FLORINEF) .

chronic insufficiency i. diet high in protein. carbohydrates. mineralocorticoid replacement therapy: fludrocortisone acetate (florinef acetate) iii. Addisonian crisis i. emergency management of circulatory collapse ii. expected outcome: to return to hormonal balance  b. and sodium . glucocorticoid replacement therapy: hydrocortisone (cortef) ii. intravenous hydrocortisone  c. a.

. hyperkalemia. administer medications as ordered b. and hypoglycemia.Nursing interventions during hospitalization a. measure intake and output and observe for signs of hyponatremia. manipulate the environment to reduce stressors c. preserve the client's energy by assisting with ADL as indicated d. monitor diet therapy e.

Cushing's syndrome 1.A. affects women more often than men c. Etiology a. average age of onset 20 to 40 years of age b. Definition: adrenal gland secretes too much cortisol 2. primary syndrome caused by tumor of adrenal cortex .

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secondary syndrome caused by an ACTH-producing tumor of pituitary e.d. long term steroid therapy .

moon face . buffalo hump. metabolic alkalosis d. truncal obesity e. weight gain. change in libido f. personality changes b.3. Findings a. hypertension c.

osteoporosis j. or menstrual irregularities i. acne or hyperpigmentation . virilization in women. muscle weakness h. amenorrhea.g.

24-hour urine collection: i. elevated 17-ketosteroids iii. ii. blood tests show i. iii. decreased potassium c. increased levels of cortisol. elevated free cortisol ii.Diagnostics a. history and physical exam b. elevated 17-hydroxycorticosterone . increased sodium and glucose.

pharmacologic . irradiation therapy d. surgery for adrenal or pituitary tumor c. expected outcome: to restore hormonal balance b.Management a.

adrenal enzyme inhibitors that block enzymes needed for cortisol synthesis i. mitotane f. high protein diet with sodium restriction . potassium supplements g. aminogluthemide ii.e. metyrapone iii.

hypernatremia d. monitor diet therapy c. teach client . administer medications as ordered b. monitor for signs of hypokalemia.Nursing interventions a.

 2. Take medication with breakfast - corresponds to biorhythms and reduces gastric irritation.  3. Always take medication with a meal or a snack. . Never discontinue medications abruptly- could precipitate acute crisis.  5.  4. Carry extra medication on self during travel. CARE OF CLIENT ON STEROID THERAPY  Teach client to:  1. Take higher dose in AM and lower doses in PM.

Avoid other people with infections or shopping malls. contact health care provider. about medications and side effects  iii. the need for lifelong treatment  ii. Adjust medications during periods of acute or chronic stress such as pregnancy or infections.  7. 6. Wear medical identification jewelry or carry medical card . the need for medical alert jewelry  iv. body changes may reverse but may take months to years  e. surgical treatment may cause adrenal or pituitary insufficiency .  i. etc in times when the flu or colds are most evident.  8. grocery stores.

Causes excessive stimulation of the sympathetic nervous system 2.Pheochromocytoma 1. generally benign tumor of the adrenal medulla b. Etiology a. but fatal if untreated . Definition Adrenal medulla secretes too much epinephrine and norepinephrine (called the catecholamines). curable.

severe stress response b. pallor or flushing . Findings a. usually severe e. orthostatic hypotension f. tachycardia g. headache. hypertensive crisis d. panic metabolic state c.3.

h. high and sustained k. dysrhythmias . palpitations j. hyperglycemia l. anxiety. diaphoresis i.

24-hour urine collection: increased urinary catecholamines . increased BMR b. computerized tomogram (CT) scan c. Diagnostics a.

nitroprusside (nitropress). antidysrhythmic agents as needed preop . expected outcomes: to remove the tumor and correct the imbalance  b. alpha-adrenergic blocking agent and beta adrenergic blocking agent (beta blockers): phentolamine (regitine). antihypertensive agents as needed preop  d. surgical removal of the tumor: scheduled only after client has been normotensive for at least one week  c. propranolol (inderal)  e. tyrosine inhibitors: alphamethylparatyrosine decreases circulating catecholamines  f. Management  a.

administer medications as ordered c. teach client i. especially blood pressure b. lifelong steroid therapy required e. monitor vital signs. about medications and side effects ii. if bilateral adrenalectomy performed.Nursing interventions a. provide care of the client undergoing surgery d. need for lifelong follow up .

Cortisol D. Glucocorticoid . The nurse recognizes that lowered blood glucose stimulates the release of which hormone from the pancreas? A.1. Glycogen B. Glucagon C.

Weight loss . Polydipsia C. Hyperglycemia B.2. In evaluating a patient with suspected diabetes mellitus (DM). which of the following clinical manifestations is seen in type I and not type II DM? A. Polyuria D.

3. flushed skin and confusion D. Increased urine output and thirst C. the nurse correlates which clinical manifestations to hypoglycemia? A. Diaphoresis and hunger B. Dry. Hyperventilation and tachycardia . In monitoring a patient response to insulin therapy.

Nervousness.4. Abdominal pain. constipation. slurred speech. anorexia C. weight loss. weight gain. Fatigue. heat intolerance D. Decreased pulse rate. The nurse correlates which clinical manifestations with the diagnosis of hyperthyroidism? A. tachycardia . cold intolerance B.

5. Increasing blood glucose . Weight loss C. Decreasing heart rate D. Elevated body temperature B. The nurse monitors for which of the following as indicative of effective treatment of hyperthyroidism? A.

Weight gain C. Increasing energy level . Decreased sweating B.6. Decreasing heart rate D. The nurse monitors for which of the following as indicative of effective treatment of hypothyroidism? A.

Constipation . Which finding in the client receiving treatment for hypoparathyroidism indicates the need for further evaluation? A. Circumoral numbness D. Increasing serum calcium B. Muscle weakness C.7.

Weight gain . Diarrhea  B. A client receiving propylthiouracil should be instructed to stop the medication immediately and call the health care provider if which sign occurs?  A. Palpitations  C.8. Fever  D.

Sodium D.9. Potassium . Calcium B. the nurse monitors which laboratory value? A. Magnesium C. In assessing parathyroid function.

 D.10. . Analgesics are not needed because the client already is lethargic. Increased dosages will be needed because of the hypermetabolic state.  B. Decreased dosages are needed because of prolonged drug degradation rates.  C. Increase dosage will be needed because the client is overweight. Which statement about analgesic therapy for a client with hypothyroidism would be appropriate to use as a basis for developing the client’s plan?  A.

Which client behavior would support the nursing diagnosis deficient knowledge for the client with insulin-dependent diabetes mellitus?  A. Skipping insulin doses when feeling ill  D. Crying whenever diabetes is mentioned . Failure to monitor blood glucose level  C.11. Recent weight gain of 15lb  B.

. The client displays a glycosylated hemoglobin level within normal range.  B. The client reports urine ketone levels reflecting no ketonuria  D. The client reports urine glucose levels indicating no glucosuria.  C. Which outcome represents the best indicator of good overall diabetes control?  A.12. The client records home glucose test results daily.

Morning dose of regular insulin  B.13. Morning dose of NPH insulin  D. The results of blood glucose monitoring for a client with diabetes who takes regular and NPH insulin in the morning and evening reveals that the client is hyperglycemic before breakfast. Evening dose of regular insulin . Evening dose of NPH insulin  C. Which dose of insulin would the nurse expect to be increased?  A.

Dyspnea and chest pain  D. Delirium  C. Bradycardia  B. Hyperpyrexia .14. Signs of thyroid storm include all of the following except:  A.

15. Obesity at diagnosis  D. Ketosis-prone  B. . The nurse knows that all of the are probable clinical characteristics except:  A. Younger than 30 years of age. A patient is diagnosed with type 1 diabetes. Little or endogenous insulin  C.

16. Oral glucose tolerance test  D. The most sensitive test for diabetes mellitus is the:  A. Urine glucose . Fasting plasma glucose  B. Glycosylated hemoglobin  C.

17. The nurse would secure a specimen of:  A. The nurse is asked to assess a patient for glucosuria. Urine . Sputum  C. Stool  D. Blood  B.

develops an infection with fever  B. Undergoes major surgery  D. Suffers trauma  C. Develops any of the above condition . The nurse should expect that insulin therapy will be temporarily substituted for oral antidiabetic therapy if the diabetic:  A.18.

ENDS .