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2 - Endocrine (WWW - Cmecde.com) PDF
2 - Endocrine (WWW - Cmecde.com) PDF
I. ANATOMY
II. PHYSIOLOGY
_____________ _ stimulates uterine contractions
POSTERIOR
milk ejection during lactation
PITUITARY GLAND
_____________ _____ controls the excretion of
water by the kidneys
HYPOTHALAMUS ANTERIOR
______________________ stimulates growth
PITUITARY
GLAND ______________ stimulates development of
mammary gland and secretion of milk
_____________________________ stimulates
production of melanin
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
II. PATHOLOGY
Assessment: Assessment:
Fluid Fluid
Weight Weight
Hemo___________ Hemo___________
____Sodium ____Sodium
Meds: Meds:
Hypopituitarism Hyperpituitarism
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
Causes: Stress Causes: Adenoma
Tumor Hyperplasia
Autoimmune
Trauma
Encephalitis
MANIFESTATIONS: Depends on which part is affected
MANIFESTATIONS: Depends on which part is affected
POSTERIOR
ANTERIOR
ADH
LH AND FSH - L
ANTERIOR:
O
LH AND FSH – “Precocious Puberty”
I
D
ADRENOCORTICOTROPIC HORMONE
GROWTH HORMONE THYROID STIMULATING HORMONE
ADRENOCORTICOTROPIC HORMONE GROWTH HORMONE
THYROID STIMULATING HORMONE
EARLY ONSET happens before the closure of the
epiphyseal plate (growth plate)
POSTERIOR
ADH
LATE ONSET happens after the closure of the
OXYTOCIN – Manifestation will occur during: epiphyseal plate (growth plate)
C
B
Meds:
Meds:
Bromocriptine (Parlodel)
Somatrem (Protropin)
-Dopamine Agonist- Growth hormone
Somatropin (Humatrope, Nutropin)
Octreotide (Sandostatin) inhibitor
Hormonal Replacement Therapy
-Somatostatin Analog-
Surgery:
HYPOPHYSECTOMY
1. Craniotomy - Opening the _______
2. Transphenoidal Surgery
Pituitary gland lies directly behind the nose.
Operative site:
Teaching Prior:
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
SURGERY: HYPOPHYSECTOMY – Removal of the Pituitary gland (Hypophysis)
COMPLICATIONS
DISTURBANCE OF THE INCREASE
HYPOPITUITARISM CSF LEAK (RHINORRHEA) OPERATIVE SITE INTRACRANIAL
PRESSURE (ICP)
Allow:
H
Use toothette
Do non-vigorous and
infrequent flossing
Gargle with saline solution
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
HYPOTHYROIDISM HYPERTHYROIDISM
PRIMARY
SECONDARY
Hypothyroidism
Common Cause:
Types:
1. Myxedema – long standing hypothyroidism - Myxedema coma (severe form) Priority: AIRWAY!
2.Cretinism – thyroid deficiency at birth
3.Simple Goiter – due to lack of iodine
CLINICAL MANIFESTATIONS:
U – rine output
S - weating
H – eat production
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
MEDICATIONS:
LEVOTHYROXINE (LEVOTHROID,LEVOXYL,SYNTHROID)
LIOTHYRONINE (CYTOMEL)
Hyperthyroidism
Common Type:
Graves Disease –
Toxic Goiter -
CLINICAL MANIFESTATIONS:
U – rine output
S - weating
H –eat production
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
Treatment
Methimazole (Tapazole)
Adverse Effect:
Beta-Adrenergic Blocker
SSKI (saturated solution of potassium iodide) , Lugol’s Solution (Strong Iodine Solution)
-
-
Pre-op medication: to achieve euthyroid state – to prevent thyrotoxicosis (thyroid storm)
Surgery: THYROIDECTOMY
COMPLICATIONS:
1. BLEEDING
ASSESS:
Causes: a. infection
b. stress
c. hyperthyroidism
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
Signs and Symptoms of Thyrotoxicosis:
Hypoparathyroidism Hyperparathyroidism
CAUSES: CAUSES:
PROBLEM: PROBLEM
_____CALCIUM _____CALCIUM
MEDICATIONS: MEDICATIONS:
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
E. Adrenal Gland Disorders
Addison’s Disease
ASSESSMENT:
Management:
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
Cushing’s Disease
ASSESSMENT:
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
Cushingoid Appearance:
Conn’s Syndrome
Anti-hypertensive drugs
Potassium supplements
Pheochromocytoma
Cause: Anti-hypertensives
H
Diagnostic Test: Vanillylmandelic Acid Test (VMA) – byproduct of catecholamines
Specimen:
Pre-test:
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
F. Pancreas
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
3. CAPILLARY BLOOD GLUCOSE (CBG)
Random blood glucose testing – No NPO needed
4. GLYCOSYLATED HEMOGLOBIN
NORMAL: 3.5-6%
GOOD DIABETIC CONTROL: 7.5% OR LOWER
FAIR DIABETIC CONTROL : 7.6-8.9%
POOR DIABETIC CONTROL : 9% OR HIGHER
Acute Complications of DM
1.HYPOGYLCEMIA
MANAGEMENT for MILD and MODERATE: 10-15 grams of fast acting simple carbohydrates
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
2.) DKA 3.)HHNS
-An absence or markedly inadequate amount of -Extreme hyperglycemia without ketosis and acidosis
insulin
ASSESSMENT: ASSESSMENT:
Blurred vision Blurred vision
Polyuria Polyuria
Dehydration Dehydration
Headache Headache
Weakness Weakness
Thirst Thirst
Chronic Complications Of DM
RETINOPATHY
Cerebrovascular Accident
(CVA) - Damages small blood vessels
in the eyes (retina), which
might lead to blindness
Diabetic Foot
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
FOOT CARE:
AVOID ALLOWED
CROSSING THE LEGS
APPLICATION OF LOTION IN BETWEEN THE TOES CUT TOE NAILS STRAIGHT ACROSS
HEATING PAD FOR SORE FEET CLEAN AND INSPECT DAILY
SHOES HALF SIZE LARGER
Management of DM:
1. Diet
3. Insulin - (Type 1)
INSULIN
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
ORAL HYPOGLYCEMIC AGENTS
Chlorpropamide (Diabinase)
Second Generation
NON-SULFONYLUREAS
Alpha Glucosidase Inhibitors
DELAYS THE CONVERSION OF TAKE IT WITH THE FIRST BITE OF A
CARBOHYDRATES INTO SIMPLE MEAL
SUGAR
Biguanide
Metformin (Glucophage) INHIBITS GLUCONEOGENESIS
Meglitinides
TAKE IT WITH MEALS
STIMULATES INSULIN RELEASE
Thiazolidinediones
“Success is a state of mind. If you want success, start thinking of yourself as a success.”
Complications:
-results from a nocturnal release of -rebound phenomenon that occurs -progressive rise in blood glucose
growth hormone which may cause during the initial period of blood from bedtime to morning.
blooD glucose to begin to rise at glucose control; develops at peak
around _______ insulin times and during the night.
Evening dose of intermediate insulin Decreasing evening dose of Increasing evening dose of
at around 10pm intermediate insulin or increasing bed intermediate insulin or long acting
time snack insulin or giving a dose of insulin
before the evening meal.
Clean the top of both insulin vials with alcohol prep pads and allow them to dry.
Measure the same volume of air as you need of the intermediate or long-acting insulin and inject into the
insulin vial. Withdraw the needle.
Measure the same volume of air as you need of the regular insulin and inject into the insulin vial. Leave the
needle in the vial, invert the bottle and withdraw the correct dosage, maintaining asepsis. (Rapid and short
acting insulin are clear in color). Expel any air bubbles, recheck the volume of insulin for accuracy, then
remove the needle from vial.
Turn the bottle of intermediate or long-acting insulin upside down and reinsert the needle into this vial,
maintaining asepsis. Slowly pull the plunger to withdraw the correct dosage of insulin. Remove the needle
from the vial.
“Success is a state of mind. If you want success, start thinking of yourself as a success.”