CARE OF CLIENTS WITH

ENDOCRINE DISORDERS

WILFREDO S. ISRAEL JR., RN, RM,MAN, PhD, FRIN

Professor, NCM116
 Thesecond great controlling
system of the body.

 It
coordinates and directs the
activity of the body’s cells

 It
allows communication within
the distant sites of the body

ENDOCRINE 2
 A collection of glands that produce hormones
that regulate the body’s growth, metabolism
and sexual development and function.
 Hormones are released into the bloodstream

and transported to tissues and organs

throughout the body.

ENDOCRINE 3
THREE COMPONENTS OF THE ENDOCRINE
SYSTEM

1. Endocrine glands
2. The Chemical Messengers called HORMONES
3. Target cells or organs

ENDOCRINE 4
 The ENDOCRINE GLANDS are organs that
synthesize, store and secrete hormones into
the blood stream.

HOW MANY ENDOCRINE GLANDS DO WE HAVE?

ENDOCRINE 5
ENDOCRINE 6
 A small cone-
shaped gland that
hangs from the roof
of the third
ventricle of the
brain.
 Secretes melatonin

which is believed to
be a “sleep trigger”

ENDOCRINE 7
 Is a small area of
the brain located in
the section of the
forebrain called the
diencephalon.
 It is concerned with

HOMEOSTASIS.

ENDOCRINE 8
 Activates and
controls the part of
the nervous system
that controls
involuntary body
functions, the
hormonal system &
regulates sleep and
stimulates appetite
 Secretes
hypothalamic
hormones
ENDOCRINE 9
 Approximately the
size of a pea.
 It hangs by a stalk
from the inferior
surface of the
hypothalamus.
 It has two
functional lobes:
1. Anterior
pituitary
2. Posterior
pituitary
ENDOCRINE 10
Anterior Pituitary
 Follicle Stimulating
hormone
 Luteinazing Hormone
 Adrenocorticotropic
Hormone
 Thyroid Stimulating
Hormone
 Growth Hormone
 Pro lactin

ENDOCRINE 11
 POSTERIOR
PITUITARY

Oxytocin

Antidiuertic Hormone

ENDOCRINE 12
 Produces hormones
that stimulate body
heat production,
bone growth, and
the body’s
metabolism.

ENDOCRINE 13
 Secretes a hormone
that maintains the
calcium level in the
blood

ENDOCRINE 14
 Plays a role in the
body’s immune
system

ENDOCRINE 15
 Secretes hormones
that influence the
body’s metabolism,
blood chemicals &
body characteristics
 Influence the NS

involved in the
response & defense
against stress.

ENDOCRINE 16
 Secretes a hormone
(insulin) that
controls the use of
glucose by the
body.

ENDOCRINE 17
 Secretes hormones
that influence
female and male
characteristics

ENDOCRINE 18
 FUNCTIONS
1. Maintainance and regulation of vital functions
2. Response to stress and injury
3. Growth and development
4. Energy metabolism
5. Reproduction
6. Fluid, electrolyte and acid-base balance
HORMONES
 ENDOCRINE GLANDS
1. Pituitary
2. Adrenal
3. Thyroid
4. Parathyroid
5. Pancreas
Ovaries
6.
7. Testes Negative Feedback
ENDOCRINE 19
SOURCE Hormone Function
Releasing or Inhibiting
Hypothalamus Hormones
Controls the
•Corticotropin-releasing release of
hormone (CRH) pituitary
•Thyrotropin-releasing
hormone (TRH) hormones
•Growth hormone-
releasing hormone
(GHRH)
•Gonadotropin-releasing
hormone (GnRH)

ENDOCRINE 20
Source Hormone Function
Growth Hormone (GH) •Stimulates growth of bone and
Anterior muscle, promotes protein synthesis
and fat metabolism,  CHO
Pituitary metabolism

Adrenocorticotropic Hormone
•Stimulates synthesis and secretion
(ACTH)
of adrenal cortical hormones

Thyroid-stimulating hormone (TSH)

•Stimulates the synthesis and
secretion of thyroid hormone

Follicle-stimulating hormone (FSH) •Females:growth of ovarian follicle

for ovulation
Males: sperm production

Luteinizing Hormone (LH) •Females: development of corpus

luteum, release of oocyte, production
of estrogen and progesterone
Males: secretion of testosterone,
development of interstitial tissue of
testes

ENDOCRINE 21
Source Hormone Function
Posterior Pituitary Antidiuretic Hormone (ADH)  Water reabsorption by the
kidney
Oxytocin Contracts pregnant uterus,
milk ejection from breast after
childbirth
Adrenal Cortex Mineralocorticoids (aldosterone) • Na reabsorption, K- loss by
the kidney
Glucocorticoid (cortisol) •Influences metabolism of all
nutrients; regulates blood
glucose, affects growth, has
anti-inflammatory action, and
decreases effects of stress
Androgen •Androgenistic activity
Adrenal Medulla Epinephrine Neurotransmitters of the SNS
Norepinephrine

ENDOCRINE 22
Source Hormone Function
Thyroid Gland Thyroid Hormones:  metabolic rate;
(Follicular Cells) triiodothyronine (T3), CHON and bone
Thyroxine (T4) turnover; 
responsiveness to
catecholamines; impt.
for fetal and infant
growth and
development

Thyroid Gland Calcitonin  Blood calcium

(Follicular Cells)
Parathyroid glands Parathyroid hormone Regulates calcium in
the blood
ENDOCRINE 23
Source Hormone Function

Pancreatic Islet cells Insulin  Blood glucose by facilitating glucose transport

across cell membranes of the muscle, liver, and
adipose tissue
Glucagon
 blood glucose concentration by stimulation of
glyconolysis and glyconeogenesis

Somatostatin

•Delays intestinal absorption of glucose

ENDOCRINE 24
Source Hormone Function
Ovaries Estrogen •Development of sex organs and
sex characteristics
Progesterone •Influences menstrual cycle;
stimulates growth of uterine wall;
maintains pregnancy
Inhibin
•Inhibits FSH secretion by the ant.
pituitary

Testes Androgens: testosterone •Develops males sex organ and

secondary sex characteristics;
sperm production
•Inhibits FSH secretion by the ant.
Inhibin
pituitary

ENDOCRINE 25
Source Hormone Function
Placenta Human Chorionic •Maintains pregnancy
Gonadotropin

Adipose Tissue Leptin •Decreases appetite and

food intake, 
sympathetic activity and
metabolic rate, insulin
secretion to  fat storage
Resistin •Suppresses insulin’s
ability to stimulate
glucose uptake by
adipose cells.

ENDOCRINE 26
1 . Anterior Pituitary (Adenohypophysis)
Growth hormone (Somatotropin)
Hypersecretion :
Children - Gigantism
Adult – Acromegaly
Hyposecretion :
Dwarfism
Prolactin (Mammotropic / Lactotropic
Hormone)
Hypersecretion – Galactorrhea
Hyposecretion - X milk during lactation
ACTH (Adrenocorticotropic Hormone)
Hypersecretion - Sec. Cushing’s Disorder
Hyposecretion - Sec. Addison’s Disorder

ENDOCRINE 27
TSH (Thyroid – Stimulating Hormone)
Hyposecretion – Sec. Hyperthyroidism
Hypersecretion - Sec. Hypothyroidism

Gonadotropin (FSH / LH)

Hypersecretion – Precocious Puberty
Hyposecretion

ENDOCRINE 28
Males: Females:
Small phallus and Failure to develop
testicles the breasts
X growth of body X growth of body
hair hair
Libido X ovulation
Impotence X menstruation
Aspermia Infertility

ENDOCRINE 29
MSH (Melanocyte – Stimulating
Hormone)
Hypersecretion
“Eternal tan” / bronze appearance of the skin
Hyposecretion
Albinism

ENDOCRINE 30
2. Posterior Pituitary (Neurohypophysis)
ADH (Antidiuretic Hormone)
Hypersecretion SIADH
Edema, wt. Gain
HPN
Dilutional hyponatremia
Hyposecretion Diabetes Insipidus
Polyuria
Retarded growth
Dehydration
Constipation
Dilute urine,  sp. gr.
Oxytocin

ENDOCRINE 31
 After several diagnostic tests, a client is
diagnosed with diabetes insipidus. A
nurse performs an assessment on the
client, knowing that which symptom is
indicative of this disorder?
 A. Diarrhea
 B. Polydipsia
 C. Weight gain
 D. Fatigue

ENDOCRINE 32
 THYROID GLAND
1. T3 (Triidothyronine)
• Metabolism, growth
2. T4 (Thyroxine)
• Catabolism , body heat prod.
3. Thyrocalcitonin
• Regulates s. Ca levels

ENDOCRINE 33
THYROID GLAND

s. Ca

Thyrocalcitonin

Deposits Ca into the bones

 s. Ca levels

ENDOCRINE 34
 Diagnostic Tests
1. T3 T4 levels
  - hyperthyroidism
  - hypothyroidism
2. PBI (Protein – Bound Iodine)
• Preparation
 X Foods, drugs, test dyes with I 7 – 10 days
before the test

ENDOCRINE 35
3. RAIU (Radioactive I Uptake)
• Tracer dose of I131, p.o.
• 2, 6, 24  exposure to scintillation camera
• X Foods, drugs, test dyes with I 7 – 10 to days
before the test
• Temporarily discontinue contraceptive pills
 Uptake – hyperthyroidism
 Uptake – hypothyroidism

ENDOCRINE 36
4. Thyroid Scan
◦ Radioisotope / IV
◦ Exposure to scintillation camera
5. FNB (Fine Needle Biopsy)
6. BMR (Basal Metabolic Rate)
◦ Measures 02 consumption at the lowest cellular
activity

ENDOCRINE 37
6. BMR (Basal Metabolic Rate)
◦ Preparation
 NPO 10 – 12
 Night Sleep 8 - 10
 X get up from the bed the following morning until
the test is done
 A device with a noseclip and a mouthpiece is used;
the client performs deep breathing exercises
 Normal :  20% (euthyroid)

ENDOCRINE 38
7. Reflex Testing (Kinemometry)
Tendon of Achilles Reflex

Hyperthyroidism Hypothyroidism
(hypoCa) (hyperCa)

Hyperactive Hypoactive
TAR TAR

ENDOCRINE 39
 HYPERTHYROIDISM
 Grave’s Disorder/ Exophthalmic Goiter /
TOXIC Diffuse Goiter
  - females , below 40 yrs.
 Severe emotional stress
 Autoimmune Disorder

a. Increased metabolic rate

b. Increased body heat production
c. Hypocalcemia
ENDOCRINE 40
 ASSESSMENT
1. Thyroidal disturbances
• Restlessness, nervousness, irritability, agitation
• Fine tremors
• Tachycardia
• Hypertension
  appetite to eat
• Weight loss
• Diaphoresis
• Diarrhea
• Heat intolerance
• Amenorrhea
• Fine silky hair
• Pliable nails

ENDOCRINE 41
ENDOCRINE 42
 Which of the following is a symptom of
hyperthyroidism?
a. cold intolerance
b. weight loss
c. hypotension
d. buffalo hump

ENDOCRINE 43
 ASSESSMENT
2. Ophthalmopathy
◦ Exophthalmos
 Accumulation of fluids at the fat pads behind the
eyeballs, pushing the eyeballs forward.
CORNEAL ULCERATION
OPHTHALMITIS
BLINDNESS
-Von Graefe’s sign (LID LAG)
 Long and deep palpebral fissure when one looks down

ENDOCRINE 44
 ASSESSMENT
 Jeffrey’s sign
 Forehead remains smooth when one looks up
 Dalyrimple’s sign (Thyroid stare)
 Bright – eyed stare
 Infrequent blinking
3. Dermopathy
Warm, flushed sweaty skin
Thickened hyperpigmented skin at the pretibial area

ENDOCRINE 45
 MANAGEMENT
1. Rest.
◦ Non – stimulating cool
environment
2. Diet
◦  caloric
◦  fiber
3. Promote safety
4. Protect the eyes
◦ Artificial tears at regular
intervals
◦ Wear dark sunglasses when
going out under the sun.
5. Replace fluid – electrolyte
losses

ENDOCRINE 46
 MANAGEMENT
6. Pharmacotherapy
a. Beta – blockers : Inderal
– To control tachycardia, HPN
b. Iodides : Lugol’s solution
c. SSKI
– To inhibit release of thyroid
– Mix with fruit juice with ice or glass of water
– Provide drinking straw
– Side effects
 Allergic reaction, Increased salivation, Coryza

ENDOCRINE 47
 MANAGEMENT
c. Thioamides:
– PTU (Propylthiouracil) & Tapazole (Methimazole)
 To inhibit synthesis of thyroid hormones
– Side effects:
 AGRANULOCYTOSIS / NEUTROPENIA
– Fever, Sore throat, Skin rashes
d. Ca – channel blockers
e. Dexamethasone
– Inhibit the action of thyroid hormones
7. Radiation therapy (I131) – Isolation for few days
8. Surgery
◦ Subtotal Thyroidectomy
 5/6 of the gland is removed

ENDOCRINE 48
 A nurse is performing an assessment on a
client following a thyroidectomy. The
nurse notes that the client has developed
hoarseness and a weak voice. Which
nursing action is most appropriate?
 A. Notify the physician immediately
 B. Reassure the client that this is usually a
temporary condition
 C. Check for signs of bleeding
 D. Administer calcium gluconate

ENDOCRINE 49
 Pre-op Care
1. Promote euthyroid state
• Control of thyroid disturbance
• Stable VS
2. Administer Iodides as ordered
• To reduce the size & vascularity of thyroid
gland, thereby prevent postop
hemorrhage ,thyroid crisis
3. ECG
• Heart failure / cardiac damage results from
HPN / tachycardia

ENDOCRINE 50
 Post-op Care
1. Position : Semi – Fowler’s with head, neck &
shoulder erect.
2. Prevent Hemorrhage
• Ice collar over the neck
3. Keep tracheostomy set available for the first 48
postop.

Parathyroid damage

Hypocalcemia

Laryngospasm

AW Obstruction
ENDOCRINE 51
Post-op Care
4. Ask the patient to speak q hr.
• To assess for recurrent laryngeal
nerve damage
5. Keep Ca gluconate readily
available
• Tetany occurs if hypoCa is present
6. Monitor B. Temperature
• Hyperthermia is an initial sign of
thyroid crisis
7. Monitor BP
• To assess for Trousseau’s sign
(hypocalcemia)

ENDOCRINE 52
 Post-op Care
8. Steam inhalation to soothe irritated
airways.
9. Advise to support neck with interlaced
fingers when getting up from bed
10. Observe for s/sx of potential
complications
a. Hemorrhage
b. Airway obstruction
c. Tetany
d. Recurrent laryngeal nerve damage
e. Thyroid crisis / storm / thyrotoxicosis
f. myxedema

ENDOCRINE 53
 Post-op Care

11. Client Teaching

a. ROM exercises of the neck 3 – 4 x / day
after discharge.
b. Massage incision site with cocoa butter
lotion to minimize scarring
c. Regular follow – up care

ENDOCRINE 54
 A nurse develops a plan of care for a client
with Grave’s disease and includes which of
the following in the plan?
 A. Provide small meals
 B. Provide extra blankets
 C. Provide a high-fiber diet
 D. Provide a restful environment

ENDOCRINE 55
 HYPOTHYROIDISM
 Myxedema (Adult)
 Cretinism (Children)
 Causes
◦ Autoimmune
◦ Surgery
◦ Radiation therapy
◦ Antithyroid drugs

1. Decreased metabolic rate

2. Decreased body heat production
3. Hypercalcemia
ENDOCRINE 56
ENDOCRINE 57
ENDOCRINE 58
 ASSESSMENT
 Slowed physical, mental reactions
 Dull look
 Anorexia
 Obesity
 Bradycardia
 Hyperlipidemia
 Cold intolerance
 Constipation
 Coarse, dry, sparse hair
 Brittle nails
 Irregular menstruation

ENDOCRINE 59
ENDOCRINE 60
 MANAGEMENT
1. Monitor VITAL SIGNS. Be alert for s & sx of CV
disorders
2. Diet
◦  caloric
◦  fiber

3. Provide warm environment during cold climate.

4. Pharmacotherapy
◦ Proloid (Thyroglobulin)
◦ Synthroid (Levothyroxine)
◦ Dessicated Thyroid Extract
◦ Cytomel (Liothyronine)
 BP , PR before administration
 Start with low dose , gradually increase

ENDOCRINE 61
 Mr. Tonkin is admitted to an emergency
room, and a diagnosis of myxedema coma is
made. Which action would the nurse prepare
to carry out initially?
 A. Warm the client
 B. Administer fluid replacement
 C. Maintain an airway
 D. Administer thyroid hormone

ENDOCRINE 62
PARATHYROID GLAND
PTH (Parathormone)

S. Ca levels

PTH release

Withdraws Ca from the bones

s. Ca levels

Hyperparathyroidism : Hypercalcemia
Hypoparathyroidism : Hypocalcemia

ENDOCRINE 63
Essential for the regulation of Ca2+ levels
Stimulates an increase in osteoclasts numbers,
resulting in increased breakdown of bone.
Promotes Ca2+ reabsorption by the kidneys and the
formation of active vitamin D by the kidneys.
Active vitamin D increases calcium absorption by
the intestine.
These small glands, usually four, surround the posterior
thyroid tissue, they are often difficult to locate and maybe
removed accidentally during thyroid or other surgery

In response to a low blood calcium level, the parathyroids

produce PARATHORMONE, which raises blood calcium
levels by increasing calcium resorption from kidneys,
intestines and bones
 is a disorder caused by over activity of one or more of the
parathyroid glands
is classified as primary, secondary, and tertiary
hyperparathyroidism
usually occurs in clients 60 years of age, and those with renal
failure
affects women twice as men
 develops when the normal regulatory
relationship between serum calcium levels
and PTH secretion is interrupted
 occurs when the glands are hyperplastic
because of malfunction of another organ
system
usually the result of renal failure but may
also occurs as a result of cancer which
includes:
- Multiple Myeloma
-Carcinoma with bone
metastasis
 occurs when PTH production is irrepressible
(autonomous) in clients with normal or low
serum calcium levels.
 fatigue, muscular weakness, restlessness
height loss and frequent fractures
renal calculi
anorexia, nausea, abdominal discomfort, and constipation
memory impairment
polyuria, polydipsia
back and joint pain
hypertension
 Osteitis Fibrosa with: Renal stones
 subperiosteal Nephrocalcinosis
resorptions Polyuria
 osteoclastomas Polydipsia
 bone cysts
Radiological
“osteoporosis”
Osteomalacia or rickets
Arthritis

BONES STONES
 Constipation  Lethargy, fatigue
 indigestion, nausea,  depression
vomiting  memory loss
 peptic ulcer
 psychoses-paranoia
 pancreatitis
 personality change,
neuroses
 confusion, stupor,
coma

ABDOMINAL GROANS PSYCHIC MOANS

OTHERs

 Proximal muscle
weakness
 keratitis, conjunctivitis
 hypertension
 itching
 ↓ serum phosphate level
hypercalciuria
hyperphosphaturia
bone demineralization
↑PTH level
parathyroid scan possibly detects abnormal
findings
↑ total and ionized calcium level
 prepare client for surgical treatment
prevent dehydration, constipation, kidney
stone formation
reduce added calcium by eliminating over-
the-counter antacids

assess for renal calculi: report hematuria or

flank pain as necessary
provide relief of constipation as indicated
reinforce the health care follow-up schedule
 Impaired urinary elimination r/t renal involvement secondary to hypercalcemia and
hyperphosphaturia resulting in urolithiasis, painful urination, hematuria, and spasms
Risk for injury r/t preoperative drug sensitivities and post-operative complications
is a parathyroid hormone (PTH) deficiency
characterized by abnormally low serum calcium levels
(hypocalcemia), abnormally high phosphate levels
(hyperphosphotemia), and neuromuscular
hyperexcitability (tetany).
1. Acute Hypoparathyroidism
it is caused by accidental damage to parathyroid tissues
during thyroidectomy.
it is characterized by greatly increased neuromuscular
irritability, which results in tetany.

2. Chronic Hypoparathyroidism
it is usually idiopathic, resulting in lethargy; thin , patchy
hair; brittle nails, scaly skin and personality changes.
1. Hypoparathyroidism may be iatrogenic; caused by accidental
removal of or trauma to parathyroid glands during
thyroidectomy, parathyroidectomy or radical head or neck
surgery

2. It can also result from autoimmune genetic dysfunction

(affects more women than men).

3. A reversible form may be associated with hypomagnesemia,

which interfere with PTH secretion.
ACUTE:
Iatrogenic:
Anxiety and irritability
Numbness, tingling and cramps in extremities
Dysphagia
Evidence of neuromuscular hyperexcitability, such as
(+)Chvostek’s and Trosseau’s signs, carpopedal spasms,
bronchospasms, laryngeal spasms, arrythmias and convulsions
Hyperactive deep tendon reflexes (DTRs)
CHRONIC:
Idiopathic:
Lethargy
Thin patchy hair
Brittle nails
Dry and scaly skin
Personality changes
Ectopic or unexpected calcification may appear in the eyes
and basal ganglia
Total and ionized serum calcium levels are low
Serum parathyroid hormone level is low
Serum phosphate levels are elevated and decreased
urine calcium
Radiographic studies of the skull or computed
tomography (CT) of the head showing areas of
calcification
Opthalmic examination revealing calcification of the
ocular lens, which may lead to cataract formation
o Vitamin D
o Calcium Gluconate
o Oral calcium replacements
o Parathyroid Hormone
o High-Calcium, Low Phosphate Diet
 Risk For Injury: Muscle Tetany Related To Decreased
Serum Calcium Levels

1. Intervene for life-threatening tetany as indicated.

Administer IV Calcium gluconate to prevent calcium depletion
Be alert for possible laryngeal spasm resulting respiratory
obstruction, keep a tracheostomy set available.
Institute seizure precautions as per hospital protocol (padded
side rails and bite blocks are controversial)
Minimize environmental stimuli
After crisis resolves, closely monitor Calcium levels, keep IV
Calcium gluconate in the client’s room.
3. Provide client and family teaching about the
medication regimen, including purpose, dosage
schedule, and signs & symptoms of hypocalcemia and
hypercalcemia. Inform the client that dosage will be
adjusted periodically based on laboratory findings.
2. Provide care for chronic hypoparathyroidism
Encourage diet high in Calcium and low in phosphorus. Milk,
milk products and egg yolks must be avoided because they are
high in phosphorus
Administer Vitamin D and Magnesium Supplementation, as
indicated. In clients receiving magnesium. Observe for
symptoms of hypermagnesemia
Administer oral calcium preparations, such as calcium
gluconate to supplement the diet
 Assessment:
 Hypo – low Ca & high P

- Trousseau or Chvostek sign

- hypotension
 Hyper – high Ca & low P

- cardiac dysrhythmias
- hypertension

ENDOCRINE 91
 PANCREAS
 Glucagon
◦ Alpha cells of Islets of Langerhans
◦  s. glucose levels (gluconeogenesis)

 Insulin
◦ Beta cells of Islets of Langerhans
◦  s. glucose levels:
 Transcellular membrane transport of glucose
 Inhibits breakdown of fats and protein

ENDOCRINE 92
DIABETES MELLITUS
 Diagnostic Tests
◦ FBS:
 80 – 120 mg / dl
 DM:  140 mg / dl for 2 readings
◦ 2PPBS
 Initial blood specimen is withdrawn
 100 g. of carbohydrate in diet
 2 after meal blood specimen is withdrawn – blood
sugar returns to normal level

ENDOCRINE 93
• Diagnostic Tests
– OGTT / GTT (Oral Glucose Tolerance Test)
• Take high CHO diet (200- 300 g) for 3 days
• Avoid alcohol, coffee, and smoking for 36 hours
• NPO for10- 16 hours
• Initial urine & blood specimen are collected
• 150 – 300 g. of CHO / p.o./IV
• Series of blood specimen is collected:
• 30 mins.
• 1
• 2 - S. CHO returns to normal
• 3
• 4
• 5
• Done when results of FBS / 2PPBS are borderline
(high normal) As required

ENDOCRINE 94
 Glycosylated Hgb
◦ Most accurate
◦ Reflects s. CHO levels for the past 3 – 4 mos.

excess glucose in the blood


attach to hemoglobin

hgb (component of rbc)
 Lifespan is 90 – 120 days

ENDOCRINE 95
 Cause – Unknown
 Predisposing Factors
◦ Stress
◦ Heredity
◦ Obesity
◦ Viral infection
◦ Autoimmune Disorder
◦ Women
 Multigravida with Large babies

ENDOCRINE 96
 Type I Types Type II
 IDDM  NIDDM
 Juvenile – onset  Maturity – onset Stable
 Brittle DM DM
 Unstable DM  Ketosis – resistant DM
  30 yrs.   40 yrs.
 Absolute Insulin  With insulin sec., 
deficiency demands
 Thin  Obese
 Prone to DKA
 Management:
 Prone to HHNC
 Diet  Management:
 Activity/ Exercise  Diet
 Insulin  Activity/ Exercise
 OHA
 Insulin – stress, surgery,
infections, pregnancy

ENDOCRINE 97
 Pathophysiology
INSULIN DEFICIENCY

Hyperglycemia

A.  blood osmolarity
• Cell dehydration
B. Glycosuria
• Glucose level exceeds renal threshold
C. Polyuria
• Glucose exerts high osmotic pressure within the
renal tubules
• Osmotic diuresis occurs
• Hypovolemia
• ECF dehydration
D. Polydipsia
• Results from cell dehydration
E.  blood viscosity
 Sluggish circulation
 Proliferation of microorganisms

ENDOCRINE 98
 
Infections
 Periodontal
 UTI
 Vasculitis
 Cellulitis
 Vaginitis
 Furuncles
 Carbuncles
 Retarded Wound
 Healing
F. Polyphagia - the cells are starved

 lipolysis

A. Hyperlipidemia

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Atherosclerosis
 Macroangiopathy
 Brain : CVA
 Heart : MI
 Peripheral arteries: PVD’s
 Microangiopathy
 Kidneys : RF
 Eyes : Retinopathy / cataract
 Neuropathy
 Peripheral neuropathy
 Numbness / tingling
 Paralysis
 Gastroparesis
 Neurogenic bladder
  libido, impotence

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 
B. Ketonemia
Acetone, Aceto – acetic acid, Beta – hydroxy –
butyric acid
  blood ph - KETOACIDOSIS
 Ketonuria

  CHON breakdown

(-) Nitrogen balance
A. BUN, s. creatinine
B. Tissue wasting
C. Weight loss
D. Debilitation

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 Education for Self – care
Diet
Activity / Exercise
Medications: OHA & Insulin
 Diet
◦  caloric diet
◦ 20% CHON, 30% HCHO, 50% CHO
◦  fiber diet
◦ Complex carbohydrates
 Activity
◦  CHO uptake by the cells
◦  Insulin requirements
◦ Allows additional sources of CHO
 Snacks
◦ Maintains IBW, S. CHO & S. Lipids
◦ Done 1 – 2 p.c.
◦ Regular pattern

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 Medications
1. OHA.
– Stimulates I of L to secrete insulin
– Indicated only in Type II DM
– E.g.
 Diabenese
 Orinase
 Tolinase
 Micronase
 Dymelor
 Glucotrol
 Daonil
 Diamicron
 Glucophage
 Glucobay
– Observe for s/sx of G.I. Upset
 Hypoglycemia

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  Intermediate – Acting:
 Medications cloudy
 NPH
2. Insulin  Humulin – N
 Rapid – Acting : Clear  Lente
insulin  Monotard
 Regular Onset : 1 - 2
 Humulin – R Peak : 6 - 8
 Semilente Duration : 18 - 24
 Crystalline zinc  Long Acting : Cloudy
 Actrapid  PZI
 Ultralente
Onset : 30 mins. - 1
Onset : 3 - 4
Peak : 2 – 4
Peak : 16 - 20
Duration : 6 – 8
Duration : 30 – 36

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1. Route : SC – slow absorption
- less painful
IV – DKA
SC - 90L thin: 3/8”
obese: ½”, 5/8”
X massage site of injection
2. Administer insulin at room temperature
• Cold Insulin  LIPODYSTROPHY
3. Rotate the site of injection
• X lipodystrophy

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4. Store vial of insulin in current use @ room
temperature
• Other vials should be refrigerated.
5. Gently roll vial in between the palms to
redistribute insulin particles.
• X Shake; bubbles make it difficult to aspirate exact
amount.

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6. Observe for side – effects:
a. Localized :
– Induration or Redness
– Swelling
– Lesion at the site
– Lipodystrophy

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b. Generalized
– Edema
 Sudden resolution of hyperglycemia

retention of water
– Hypoglycemia
– Somogyi phenomenon
 Prolonged
 doses of INSULIN Tx

 s. CHO levels

Stress responses are triggered
Counterregulatory hormones are secreted
(EPI, NE, Glucocorticoid)

REBOUND HYPERGLYCEMIA

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HYPOGLYCEMIA HYPERGLYCEMIA

(Insulin Shock) (DKA)

 Causes  Causes

◦ Omission of meals ◦ Infections

◦ Overdose of insulin ◦ Overeating
◦ Strenuous exercise ◦ Underdose of insulin
◦ Stress
◦ G.I. upset
◦ Surgery

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 A nurse is assisting a client with diabetes
mellitus who is recovering from diabetic
ketoacidosis (DKA) to develop a plan to
prevent a recurrence. Which of the following
is most important to include in the plan of
care?
a. eat six small meals per day
b. receive appropriate follow-up health care
c. monitor blood glucose levels frequently
d. test urine for ketone levels

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 Hypoglycemia

 Restlessness  Cold, clammy skin

 Hunger pangs  H/A
 Yawning
 Dizziness
 Faintness
 Weakness
 Tachycardia
 Tremors
 Abdominal pain
 Pallor  Blurred vision
 Diaphoresis  Slurred speech
 Altered LOC  Urine (-)
CHO,ketones

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 Hyperglycemia

 Polyuria  n/v
 Polydipsia  Abdominal pain

 Polyphagia  Kussmaul’s resp.

 Warm, flushed dry  Fruity odor of

skin breath
 Soft eyeballs  Urine (+) CHO,

 Tachycardia Ketones
 Altered LOC

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 A nurse is caring for a client with type 1
diabetes mellitus. Which client complaint
would alert the nurse to the presence of a
possible hypoglycemic reaction?
a. hot, dry skin c. anorexia
b. Muscle cramps d. tremors

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A nurse is monitoring a client diagnosed with
diabetes mellitus for signs of complications.
Which of the following, if exhibited in the
client, would indicate hyperglycemia &
warrant physician notification?
a. hypertension c. polyuria
b. diaphoresis d. increased pulse rate

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 Hypoglycemia
1. Simple Sugars p.o. 2. D50W 20 –50 mls /
 3 – 4oz. regular IV push
softdrink 3. Monitor BS
 8 oz. Fruit juice
4. Patient teaching
 5 – 7 pcs. Lifesaver’s
◦ Causes
candies
◦ S & Sx
 3 – 4 pcs. hard candies
◦ Prevention
 1 tbsp. Sugar
 5 mls. Pure honey / Karo◦ Management
syrup
 10 – 15 gms. CHO
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 Hyperglycemia

1. Patent AW 5. KCl / Slow IV drip,

2. O2 therapy once urine
output is
3. NSS + regular
adequate
insulin / IV
6. Monitor BS
4. D10 W once
7. Patient teaching
s. CHO reaches
◦ Causes
250 mg / dl level
◦ S & Sx
◦ Prevention
◦ Management
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 Bella Flores is taking NPH daily every
morning. The nurse instructs that the most
likely time for a hypoglycemic reaction to
occur is:
1. 2-4 hrs after administration.
2. 4-12 hrs after administration.
3. 12-16 hrs after administration.
4. 18-24 hrs after administration.

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1. Inspect the feet daily.
2. Wash feet with warm water and mild soap.
3. Pat dry the feet – X rub
4. Wear comfortable properly – fitted pair of shoes
(leather/ canvass)
5. Break – in new pair of shoes for 1 – 2 only until
it becomes comfortable.
6. Use white cotton socks (males)
7. X go barefooted
8. Trim the toenails straight across. Do not cut at
lateral edges, ingrowns may develop.

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9. Apply lotion on the feet ( X interdigital
spaces)
10. Exercise / massage the feet.
11. X wear knee – high / stay – up stockings
12. For any s & sx of injury; consult a
PODIATRIST.

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 A client with DM asks the nurse to
recommend something to remove corns from
his toes. The nurse should advice him to
a. apply a high quality corn plaster to the
area
b. consult his physician or podiatrist about removing corns
c. apply iodine to the corns before peeling them off
d. soak his feet in borax solution to peel off the corns

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ADRENAL CORTEX
Addison’s Disease
Causes
Autoimmune
TB
Fungal
Signs and Symptoms
fatigue
muscle weakness
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•Hyperkalemia •Weak pulse
•Anorexia
•Bronze pigmentation
•Nausea and of the skin
vomiting •Inability to cope with
•Weight loss stress
•Hypoglycemia

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 Greatly increased plasma ACTH
 Low than normal serum cortisol level or in

the low normal range

 Decreased blood glucose and sodium levels
 Increased serum potassium concentration

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MANAGEMENT
• restore blood circulation; administer
fluids and corticosteroids; monitor
v/s
• Administer IV hydrocortisone
followed by 5% dextrose
• monitor I & O, Wt.
• moderate Na intake
• restrict/low K-rich foods
• x exposure to infection
• monitor urine & blood glucose levels
• gradual withdrawal of the drug

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 MINERALOCORTICOID-Florinef
 CORTICOSTEROID-Prednisone

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 Which of the following is the priority for a
client in Addisonian crisis?
a. controlling hypertension
b. preventing irreversible shock
c. preventing infection
d. relieving anxiety

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 Which of the following findings would be
typical of Addison’s disease?
a. hypokalemia
b. hypernatremia
c. hypoglycemia
d. decreased blood urea nitrogen level

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CUSHING’S SYNDROME

CAUSES
TUMOR
PROLONGED STEROID
THERAPY

SIGNS AND SYMPTOMS

MUSCLE WEAKNESS
FATIGUE
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OBESED TRUNK, THIN
ARMS AND LEGS

MOON FACE
BUFFALO HUMP
PURPLE STRIAE ON TRUNK
MOOD SWINGS, IRRITABILITY
ACNE
MASCULINIZATION (WOMEN)
OSTEOPOROSIS
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LOW RESISTANCE TO
INFECTION
POOR WOUND HEALING
HYPERTENSION, EDEMA
HYPERGLYCEMIA

IMPLEMENTATION
ADRENALECTOMY
HYPOPHYSECTOMY
RADIATION THERAPY
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 A nurse instructor asks a student to describe
the pathophysiology that occurs in Cushing’s
disease. Which statement by the student
indicates an accurate understanding of this
disorder?
a. It is characterized by an oversecretion of glucocorticoid
hormones
b. It is characterized by an undersecretion of glucocorticoid
hormones
c. It is characterized by an oversecretion of insulin
d. It is characterized by an undersecretion of corticotropic
hormones

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 “Don’taim for success if you
want it; just do what you love
and believe in, and it will
come naturally.”
- DAVID
FROST

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 “ Destiny is not a matter of chance, it is a
matter of choice; it is not a thing to be waited
for, it is a thing to be achieved.”
- WILLIAM JENNINGS BRYAN

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