ENDOCRINE DISORDERS

CARE FOR ENDOCRINE DISORDERS AND DISEASES

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ANATOMY AND PHYSIOLOGY: • Commonly

THE ENDOCRINE SYSTEM referred to as the
▪ The endocrine system goes along with the master gland, the
nervous system, coordinates and directs the pituitary secretes
activity of the body’s cells. Nervous is fast “built hormones that
for speed” and runs through the nerves and control the
uses nerve impulses while endo is slow and secretion of
runs through the bloodstream and uses hormones by the
chemical messengers called hormones; endocrine glands.
mobilization of body defenses against • It is controlled by the hypothalamus.
stressors, homeostasis: maintains electrolyte, • It is approximately the size of a grape.
water and nutrient balance of the blood; • It hangs by a stalk from the inferior surface of the
regulating cellular metabolism and energy hypothalamus of the brain, where it is snugly
balance. surrounded by the “turk’s saddle” of the sphenoid
▪ Second great controlling system of the bone.
▪ body.
▪ Ductless glands 2 functional lobes:
▪ Produces hormones that they release • Anterior pituitary (glandular tissue)
into the blood or lymph • Posterior pituitary (nervous tissue)
▪ Very rich blood supply
▪ The major endocrine organs: Anterior Pituitary Gland
o Pituitary gland • Growth Hormone (GH) or somatotropin
o Thyroid gland • Prolactin (PRL)
o Parathyroid glands • Adrenocorticotropic Hormone (ACTH)
o Adrenal gland • Thyroid-Stimulating Hormone (TSH)
o Pineal gland • Gonadotropic Hormones
o Thymus gland • Follicle-Stimulating Hormone (FSH)
o Pancreas • Luteinizing Hormone (LH)
o Gonads (Ovaries and Testes)
o Hypothalamus Posterior Pituitary Gland
• Oxytocin
• Antidiuretic Hormone (ADH) or vasopressin

THYROID GLAND
• Is a butterfly-shaped organ located in the lower
neck, anterior to the trachea.
• The gland is about 5 cm long and 3 cm wide and
weighs about 30 g.
• The blood flow to the thyroid is very high (about
5ml/min per gram of thyroid tissue.
• Easily palpated during PE
• It is a fairly large gland consisting of two lobes joined
by a central mass, or isthmus.

• Hormones:
Thyroid Hormone
Thyroxine (T4)
Triiodothymine (T3)
Calcitonin or thyrocalcitonin

PITUITARY GLAND
• The pituitary gland or hypophysis is a round structure
about 1.27 cm (1/2 inch) in diameter located on the
inferior aspect of the brain.
PARATHYROID GLANDS
• Are tiny masses of glandular tissue found on the
posterior surface of the
thyroid gland.
• There are two (2) glands on each thyroid lobe
• Secretes parathyroid hormone or parathormone

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CARE FOR ENDOCRINE DISORDERS AND DISEASES
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ADRENAL GLANDS THYMUS GLAND

• Two bean- • Located in the upper thorax posterior to the
shaped glands, sternum.
which curve over • Large in infants and children, but decreases in
the top of the size throughout adulthood. By old age, it is
kidneys composed mostly of fibrous connective tissue
• It is structurally and fat.
and functionally • During childhood, the thymus acts as an
two (2) endocrine incubator for the maturation of T lymphocytes,
organs: which is very important in the immune
response.
• Secretes the hormone thymosin.

▪ Adrenal cortex (glandular tissue)

➢ Corticosteroids
• Mineralocorticoids
▪ Aldosterone
▪ Renin
• Glucocorticoids

▪ Cortisone
▪ Cortisol
• Sex hormones
▪ Androgen GONADS
▪ Estrogen Male gonads (Testes)
• The paired oval testes of
▪ Adrenal medulla (neural tissue) the male are suspended
➢ Catecholamines in a sac, the
▪ Epinephrine scrotum, outside the
(Adrenaline) pelvic cavity.
▪ Norepenephrine • Produces male sex
(Noradrenaline) hormones (sperm) or
androgens.
PANCREAS • Hormone:
• The pancreas ▪ Testosterone
is located close
to the stomach
in the
abdominal Female gonads (Ovaries)
cavity. • Paired almond-sized
• Probably the organs located in the
best-hidden pelvic cavity.
endocrine • Produces female sex
glands in the cells or ova
body are the • Do not really begin to
pancreatic function until puberty,
islets, formerly known as when the anterior
the islets of Langerhans pituitary
• These little masses of hormone-producing tissue gonadotropic hormones
are scattered among the enzyme-producing tissue stimulate their activity.
of the pancreas. • Hormones:
• Composed of: • Estrogen
• Alpha cells ▪ Estrone
• Beta cells ▪ Estradiol
• Delta cells • Progesterone
• Important hormones:
• Insulin
• Glucagon
• Somatostatin
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CARE FOR ENDOCRINE DISORDERS AND DISEASES
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SELECTED DISORDERS OF THE POSTERIOR PITUITARY Diagnostics 1. Urine specific 1. Urine specific gravity
gravity (N= 1.015- increased
GLAND 1.030) – decreased 2. Serum Na –
2. Serum Na (N= 135- hyponatremia
DIABETES SYNDROME OF 145) – increased
INSIPIDUS INAPPROPRIATE 3. WATER Measurements of urine
ANTIDIURETIC DEPRIVATION TEST and serum osmolality
HORMONE (SIADH) (Diagnoses Central - Dilutional
Definition DECREASED or INCREASED DI) Hyponatremia: serum
deficiency of secretion of ADH - before test; measure sodium <135 mEq/L;
production/secretion (idiopathic) the weight, serum osmolality <280
of ADH; IDIOPATHIC. urineosmolality, mOsm/kg and urine
Hyperfunctioning of volume and specific specific gravity >1.030.
May be TRANSIENT, posterior pituitary gravity.
CHRONIC or gland that causes - No/deprived water for
LIFELONG. OVERPRODUCTION 8-12hrs then give
of ADH or the release desmopressin acetate
TYPES: of ADH despite normal (DDAVP)
CENTRAL DI- most or low plasma subcutaneously or
common, decreased osmolarity. nasally.
ADH production; brain - Central DI- increased
tumor. urine osmolality from
NEPHROGENIC DI- 100- 600 mOsm/kg;
appropriate ADH decreased urine
production but kidneys volume
do not respond - Nephrogenic DI- will
appropriately to ADH; not able to increase
renal damage. urine osmolality to
PRIMARY DI- excess greater than 300
water intake. mOsm/kg.
Predisposin 1. Pituitary surgery 1. Head injury, trauma Nursing 1. Forced fluids 1. Restrict fluids
g Factors 2. Inflammation or stroke Management 2. Administer isotonic 2. Administer meds as
3. Trauma 2. Bronchogenic fluids as ordered. ordered (loop and
4. Tumor cancer (Chest XRAY – 3. Monitor VS and IO osmotic)
non-invasive strictly. 3. Monitor IO strictly
procedure 4. Administer 4. Wt pt daily and
that confirms lung CA) medications as assess for edema
- MALIGNANCIES; ordered – Pitressin 5. Meticulous skin care
most common (vasopressin) IM 6. prevent
3. Hyperplasia of 5. prevent complications->
Pituitary gland complications : increased ICP and H20
4. Medications and hypovolemic shock intoxication
stress 7. Position low-fowlers
Signs and 1. Polyuria and 1. Fluid retention (promotes venous
symptoms polyuria(key a. Hypertensio return and decrease
features) n and baroreceptor -induced
2. Dehydration tachycardia ADH release)
a. Thirst – b. Edema
adults c. Weight gain
b. Tachycardia
ANTERIOR PITUITARY GLAND
- pedia 2. Water intoxication 1. Growth hormones/somatotrophic hormones
c. Agitation ->hyponatremia • elongation of long bones or growth
d. Poor skin ->cerebral edema-> • DWARFISM – hyposecretion of GH in children
turgor increased ICP -> • GIGANTISM – hypersecretion of GH in children
e. Dry mucus seizure activity -> • ACROMEGALY – hypersecretion of GH in adults
3. Weakness and possible coma (severe - Sandostatine (Oereotide) – drug of choice for acromegaly
fatigue hyponatremia)
4. Hypotension • Pancreas
5. Weight loss 3. Low urine output i. Insulin
6. Hypovolemic shock and concentrated urine ii. Glucagon
- if left untreated iii. Somatostatin – antagonizes effect of GH
a. Early sign: cool
clammy skin 2. Adenocorticotrophic Hormone (ACTH) – maturation and
b. Late sign of shock - development of adrenal cortex
> renal shock -> anuria
7. Increased serum 3. Thyroid Stimulating Hormone (TSH) – stimulates the thyroid
osmolality due to gland to secrete thyroid hormones
hypernatremia
8. Headache (possible 4. Prolactin/Lactogenic/leuteotrophic Hormone
intracranial bleeding if • Promotes development of mammary glands
hypernatremia is not • Initiates milk ejection reflex
corrected.
5. Melanocyte Stimulating Hormone (MSH) – for skin pigmentation
• ALBINISM – hyposecretion of MSH
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CARE FOR ENDOCRINE DISORDERS AND DISEASES
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• VITILIGO – hypersecretion of MSH 2. Mild dysphagia

• The brown race has the most sufficient amount of melanin 3. Mild restlessness

6. Leutenizing Hormone (LH) Diagnostics:

• Secretes estrogen, promotes development of secondary
sexual characteristics 1. Serum T3 and T4 -> normal or below normal
2. Thyroid Scan -> enlarged thyroid gland
7. Follicle Stimulating Hormone (FSH) 3. Serum TSH increased
• Secretes progesterone
Nursing Management:
PINEAL GLAND – secretes Melatonin which inhibits LH secretion and
regulates circadian rhythm/body clock. 1. Administer medications as ordered
a. Iodine Solution: Lugol’s Solution –saturated solution of
THYROID GLAND potassium iodine; 1 liter of water to 2-3 drops, use straw to prevent
• NON-PALPABLE during swallowing!!! Thyroid cartilages staining of
ang palpable teeth
• Nodular in consistency
• T3 – TRIIODOTHYRONINE -> 90% -> more potent b. Thyroid agents of hormones
• T4 – TETRAIODOTHYRONINE or THYROXINE -> 5% • Levothyroxine (Synthoid)
• THYROCALCITONIN - its action is opposite to that of • Liothyronine (Cytomel)
• parathyroid hormone in that calcitonin increases deposition • Thyroid extracts
of calcium and phosphate in bone and lowers the level of • NURSING MNGMT when giving these:
calcium in the blood; its level in the blood is increased by
glucagon and by Ca2+, and thus opposes postprandial ▪ Instruct client to take it best at early AM to
Hypercalcemia prevent insomnia
▪ Antagonizes effect of parathormone -> restrict Ca ▪ Monitor VS especially HR (mlt tachycardia and
breakdown -> restricts Ca absorption palpitaitons
▪ Monitor SE: insomnia, tachycardia, palpitations,
• T3 and T4 are metabolic or calorigenic hormones HPN, heat intolerance
• Increased T3 and T4
2. Encourage increased intake of foods rich in iodine
▪ Increased cerebration or thinking
a. Seaweeds
▪ Increased vs
b. Seafoods: oysters, clams, crabs, lobster, shrimps (have
▪ Irritability -> hallucinations
low iodine content)
c. Iodized salt (served on the table, (-) effect with cooking)
• Decreased T3 and T4
3. Institute CBR
▪ Lethargy
4. Assist in surgery – subtotal thyroidectomy
▪ Memory impairment
▪ Loss of appetite but (+) weight gain -> (-)
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metabolism -> increased lypolysis -> CAD
▪ Menorrhagia
HYPOTHYROIDISM HYPERTHYROIDSM

-Decreased T3 and T4 Increased secretion of

THYROID DISORDERS Myxedema – Adults T3 and T4
Cretinism–Children-> Grave’s disease,
SIMPLE GOITER mental retardation Thyrotoxicosis, toxic
- Enlargement of the thryroid gland due to iodine deficiency; goiter IDIOPATHIC
increased TSH Predisposin 1. Iatrogenic causes -> 1. Autoimmune –
g Factors diseases caused release of LATS (long
Predisposing Factors: by medical intervention acting thyroid
2. Atrophy of the stimulants) ->
1. Goiter belt area (d/t increased intake of goitrogenic foods) thyroid gland exophthalmos
a. Places far from the sea a. Irradiation 2. Excessive iodine
b. Mountainous regions b. Tumor intake
2. Goitrogenic foods c. Trauma 3. hyperplasia of
a. Contains PRO-GOITRIN ->anti-thyroid agent that has d. Inflammation thyroid gland
no 3. Iodine deficiency
IODINE 4. Autoimmune ENOPHTHALMOS –
b. Ex: spinach, cabbage, turnips, radish, strawberries, (Hashimoto’s disease) late sign of severe
nuts, dehydration in
broccoli, potato, camote (root crops – common in children
mountain Signs and Early Signs 1. Hyperphagia –
region -> soil erosion-> iodine is washed away Symptoms 1. Weakness and increased appetite
3. Goitrogenic drugs fatigue 2. (+) weight loss d/t
a. Anti-thyroid agent (PTU) 2. Loss of appetite but increased metabolism
b. Lithium (+) weight gain 3. heat intolerance
c. ASA (SE: tinnitus, heartburn, dyspepsia) d/t increased lipolysis 4. moist skin
d. Phenylbutazone e. Cobalt 3. Dry skin 5. diarrhea
4. Cold intolerance 6. increased VS –
#1 -> endemic goiter 5. Constipation tachycardia, HPN,
#2-3 -> causes sporadic goiter 6. Menorrhagia tachypnea,
hyperventilation,
Signs and Symptoms: Late Signs hyperthermia
1. Enlarged thyroid gland
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CARE FOR ENDOCRINE DISORDERS AND DISEASES
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1. Brittleness of hair 7. CNS changes a. avoidance of i. WOF signs of

2. Non-pitting edema -> a. Irritability precipitating THYROID
d/t excessive b. agitation factors leading to STORM -> agitation,
accumulation of c. Tremors myxedema hyper-thermia, HPN. If
mucopolysaccharides d. Restlessnes coma, (+) thyroid storm:
in sq s ▪ stress administer anti-
3. Hoarseness of voice e. Insomnia ▪ infection pyretics
4. Decreased libido f. Hallucinatio ▪ exposure to and beta-blockers;
5. Decreased VS ns cold VS, IO and NVS
a. Hypotension 8. Goiter environment strictly, siderails up,
b. Bradycardia 9. Exophthalmos ▪ Anesthetics, provide hypothermic
c. Bradypnea 10. Amenorrhea sedatives blanket
d. Hypothermia and
6. CNS changes narcotics -> ii. WOF: inadvertent
a. Lethargy respi distress or
b. Memory b. Prevent accidental removal
impairment complications of
c. Psychosis (hypovolemic shock parathyroid gland ->
Diagnostics 1. Serum T3 and T4 1. elevated T3 and T4 and hypocalcemia or
decreased 2. RAIU elevated myxedema coma) tetany
2. Radioactive Iodine 3. Thyroid Scan -> c. Hormonal (+) trousseu’s signs,
Uptake (RAIU) enlarged thyroid replacement therapy (+)
decreased gland for lifetime chvostek’s Give Ca
3. Serum Cholesterol d. Importance of ff-up Gluc slowly to
elevated e. Wearing of medic- prevent
Nursing 1. Monitor STRICTLY 1. Monitor VS and IO alert bracelet arrhythmia and
Manageme VS, IO to determine strictly to determine arrest
nt presence of presence of THYROID
MYXEDEMA COMA a STORM/Crisis iii. WOF accidental
complication of severe 2. Administer laryngeal nerve
hypothyroidism medications as damage
characterized by: ordered ->hoarness of voice ->
a. Severe instruct client to talk
hypotension a. Anti-Thyroid immediately post-op -
b. Bradycardia Agents: PTU -> toxic > if (+) notify MD
c. Bradypnea effects is
d. Hypoventilati AGRANULOCYTOSIS iv. WOF signs of
on -> bleeding ->(+) feeling
e. Hypoglycemi fever and chills, sore of fullness
a throat at incision site, (+)
f. Hyponatremi (throat CS pls!), soiled dressings at
a LEUKOCYTOSIS back or nape area,
g. Hypothermia (CBC pls!) notify MD
- Might lead to b. Methimazole
progressive stupor and (Tapazole) v. WOF signs of
coma laryngeal
- Assist in mechanical 3. High calorie diet to spasm -> DOB and
ventilation, correct weight loss SOB ->prep trache set
administer thyroid 4. Provide comfortable
hormones as ordered and cool environment 9. Hormonal
and force fluids, IV 5. Institute meticulous Replacement therapy
fluids replacement. skin care for life
6. Maintain side rails 10. importance of
2. Administer isotonic 7. Bilateral eye patch FFup care
fluids as ordered to prevent drying of 11. wearing of medic-
3. Administer eyes alert bracelet
medications as ordered 8. Assist in surgical
– procedure: subtotal
thyroid hormones or Thyroidectomy
agents (may cause
insomnia and heat a. PRE-OP
intolerance) i. Administer lugol’s
4. Provide dietary solutions/ SSRI to
intake low in calories to promote decreased
prevent weight gain vasculature and
5. institute meticulous promote
skin care atrophy of the thyroid
6. provide comfortable gland to
and warm environment prevent/minimize
7. Forced fluids bleeding and
8. health teaching and hemorrhage.
d/c planning
b. POST-OP

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PARATHYROID DISEASES b. Seizures

H. Hormonal replacement for lifetime
PARATHYROID – pair of small nodules located behind the thyroid I. Importance of ff. check-up care
gland -> parathormone -> for Ca reabsorption.
HYPERPARATHYROIDISM
HYPOPARATHYROIDISM
- Increased parathormone
A condition due to diminution or absence of the secretion of
the parathyroid hormones, with low serum calcium and tetany, 1. Hypercalcemia (blood)
and sometimes with increased bone density. a. Bone demineralization -> bone fracture
▪ Hypocalcemia b. Kidney stones
▪ Hyperphosphatemia 2. Hypophosphatemia
▪ Decreased parathormone
Predisposing Factors:
Predisposing Factors: 1. Hyperplasia of parathyroid glands
2. Over compensation of parathyroid gland d/t Vitamin D deficiency
1. Following subtotal thyroidectomy -> Ricketts -> Children (Osteomalacia – Adults)
2. Atrophy of parathyroid d/t
a. Inflammation Signs and Symptoms:
b. Trauma
c. Irradiation 1. Bone pain especially at the back -> bone fracture
2. Kidney stones
Signs and Symptoms: a. Renal colic
b. Cool moist skin -> initial Sx of shock
1. Acute tetany 3. Interaction – elevated Ca and
a. Tingling sensation 4. Anorexia and general body malaise
b. Paresthesia 5. Irritability and memory impairment
c. Dysphagia 6. Presence of ulceration
d. (+) laryngospasm
e. (+) Trousseu’s sign Diagnostics:
f. (+) Chvostek’s sign
g. arrhythmia 1. Serum Ca increased
h. seizures 2. Serum Phosphate decreased
2. Chronic tetany 3. Bone Xray – Bone demyelination
a. Cataract and photophobia
b. Loss of tooth enamel Nursing Management:
c. Anorexia and general body malaise
d. Agitation, Irritability and memory impairment 1. Force fluids
2. Strain all the urine with gauze pad
3. Provide warm sitz bath for comfort
Diagnostics: 4. Provide acid-ash in the diet to acidify the urine (cranberries)
5. Administer medications as ordered
1. Serum Ca decreased (N= 8.5-11/100ml) a. narcotic analagesics
2. Serum Phosphate increased (N= 2.5 -4.5 mg/100ml) i. Morphine sulfate -> tremors ->naloxone
3. X-ray – decreased bone density (long bones) ii. Demerol -> respiratory depression
4. CT Scan – degeneration of basal ganglia 6. Maintain siderails
7. Ambulate with assistance
8. Diet: high Phosphate and low Ca (lean meat)
Nursing Management: 9. Assist in surgical procedure – parathyroidectomy
10. Prevent complications – renal failure
A. Administer medications as ordered 11. Hormonal replacement therapy
a. Ca gluconate slowly for acute tetany, slow IV 12. Importance of ff. check-up care
b. Oral calcium supplement
i. Ca gluconate
ii. Ca lactate ADRENAL GLAND DISORDERS
iii. Ca carbonate
c. Vit D (Cholecalciferol) ANTACIDS
i. Calcidiol – from food Aluminum Containing Magnesium Containing
ii. Calcitrol – from sun Aluminum OHgel (Ampho gel) Milk of Magnesia
d. Phosphate binder (aluminum OH gel – Constipation Diarrhea
Amphogel) – binds Phosphate in intestines->
constipation PHEOCHROMOCYTOMA – catecholamine producing tumor;
i. Maalox given 1 hour before meals elevated NE -> HPN resistant to medications -> stroke
B. Avoid precipitating stimulus such as bright -> glaring lights and ▪ Tx: beta blockers
noises -> photophobia -> seizure ▪ Avoid valsalva maneuver
C. Diet which is increased in Ca and decreased phosphate
a. Salmon, anchovies, green turnips ADRENAL GLAND
D. Institute seizure and safety precautions -atop of each kidney
E. Prepare trache set at bedside I. Adrenal Cortex (outer)
F. Encourage the client to breath using paperbag -> mild acidosis-> A. Zona faciculata -> glucocorticoids (cortisol: glucose
increased ionized Ca levels metabolism) SUGAR
G. Prevent complications B. Zona reticularis -> secretes traces of glucocorticoids
a. Arrhythmia and
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CARE FOR ENDOCRINE DISORDERS AND DISEASES
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androgenic hormones -> testosterone, estrogen (LH) and -HPN, Increased susceptibility to
progestin (FSH) SEX infection,
C. Zona glomerulosa -> mineralocorticoids -> Weight gain, Hirsutism, Moon face appearance
aldosterone ->promotes Na and H2O reabsorption and
excretes potassium SALT ▪ Ex: Hydrocortisone, Dexamethasone,
Prednisone
II. Adrenal Medulla – secretes catecholamines b. Mineralocorticoids – fluorocortisone
A. Epinephrine
B. Norepinephrine 3. Forced fluids
4. Maintain patent IV line
ADDISON’S DISEASE 5. Diet: high CHO/calories, Na and CHON, low K
Definition INADEQUATE production of adrenal hormones 6. Meticulous skin care
OR Hyposecretion of adrenocortical hormones 7. Provide health teaching and d/c planning
leading to: a. Avoidance of precipitating factors
- Metabolic disturbances (sugar) leading to Addisonian crisis:
- Fluid and electrolyte imbalances (salt) ▪ Stress, Infection, Sudden withdrawal to
- Deficiency of neuromuscular function (salt and steroids
sex) b. Prevent Complications – hypovolemic
shock
DEFICIENCY IN GLUCOCORTICOIDS c. Hormonal replacement therapy for life
(CORTISOL) d. d. Importance of ff. up care.
Predisposing 1. Atrophy of the Adrenal gland
Factors 2. Fungal infections CBR: ADDISONIAN CRISIS – MNGMT: avoid
Signs and 1. hypoglycemia (TIRED) stimuli, high dose of hydrocortisone; trea shock
Symptoms a. Tremors and tachycardia Medication - Androgen replacement with
b. Irritability dehydroepiandrosterone (DHEA) for women.
c. Restlessness - Lifelong hormonal therapy, exogenous therapy;
d. Extreme fatigue glucocorticoids (fludrocortisones) which is taken
e. Diaphoresis and depression with food or milk or antacids to prevent GI
distress.
2. Decreased tolerance to stress (d/t decreased
cortisol) -> Addisonian Crisis CUSHING SYNDROME
3. Hyponatremia Definition OVER PRODUCTION of the adrenocorticotropic
a. Hypotension hormone (ACTH).
b. Signs of dehydration
Predisposing 1. Hyperplasia of Adrenal gland
c. Weight loss
Factors 2. Tubercular infection (MILIARY – TB to adjacent
4. Hyperkalemia
organs)
a. Irritability and agitation
3. Iatrogenic administration of exogenous
b. Diarrhea
corticosteroids (most common)
c. Arrhythmias
4. ACTH- secreting pituitary adenoma (cushing
5. Decreased Libido
disease)
6. Loss of pubic and axillary hair
7. BRONZE-COLORED SKIN
EXCESSIVE GLUCOCORTICOIDS(CORTISOL)
HYPERPIGMENTATION (Inhibition of melanocyte
OR SUGAR
stimulating hormone)->stimulation of MSH
Signs and 1. Hyperglycemia -> can lead to DM
from pituitary gland
Symptoms a. Polyuria
8. Deficiency in Mineralocorticoids (Aldosterone)
b. Polydipsia
9. Deficiency in Androgen
c. Polyphagia
Diagnostics 1. FBS decreased (N= 80-120 mg/dl)
d. Wt. Gain
2. Serum Na decreased (N= 135-145)
e. Glucosuria
3. Serum K elevated (N=3.5-5.5meq/L)
2. Increased susceptibility to infection (Reverse
4. Plasma cortisol decreased
isolation!)
Nursing 1. Monitor strictly VS, IO to determine presence of 3. Hypernatremia
Management Addisonian crisis which a. HPN
results from acute exacerbation of Addison’s b. Edema
disease characterized by: c. Wt. gain
a. Hyponatremia 4. Moon-faced appearance, buffalo hump, obese
b. Hypovolemia trunk, pendulous abdomen, thin extremities
c. Dehydration 5. Hypokalemia
d. Severe Hypotension a. Weakness and fatigue
e. Weight loss-> Which may lead to b. Constipation
progressive stupor -> coma. c. U wave on ECG tracing
▪ Assist in mech vent, steroids as 6. Hirsutism
ordered, forced fluids 7. Easy brusing
2. Administer medications as ordered 8. Acne and Striae
a. Corticosteroids
9. Increased masculinity in females
▪ Universal rule: administer 2/3 dose in 10. Excessive mineralocorticoids (aldosterone) or
AM and 1/3 dose in PM to mimic the N salt
diurnal rhythm of the body 11. Excessive androgen (sex)
▪ Taper the dose. Withdraw gradually
Diagnostics 1. FBS elevated
from the drug
2. Elevated Na
▪ Monitor SE: Cushingoid Sx
3. Decreased K

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4. Elevated Cortisol (URINE CORTISOL LEVELS Definition Juvenile Onset/ Non- Adult
HIGHER THAN 100mcg/24hr indicates obese; children; Onset/Obese (40
CUSHING SYNDROME) BRITTLE DISEASE yo above)
Nursing 1. Monitor IO, VS - also known as Maturity-onset
Management 2. Restrict Na and Fluids INSULIN-DEPENDENT type
3. Weigh pt. daily and assess for pitting edema DIABETES MELLITUS - also known as
(ANASARCA – generalized edema nephritic NON INSULIN-
syndrome) DEPENDENT
4. Measure abdominal girth daily, notify MD DIABETES
5. Diet: low CHO, NA, High CHON and K MELLITUS
6. Administer medications as ordered - most common
a. K-sparing diuretics - Spironolactone type of DM
(Aldactone); excretes sodium but - client may
retains potassium develop
7. Prevent Complications – DM hyperosmolor
8. Provides meticulous skin care hyperglycmeic
9. Assist in Surgical Procedure – Bilateral state
Adrenalectomy Predisposing 1. Hereditary – total Obesity -> lack of
10. Hormonal replacement for life Factors destruction of pancreatic insulin receptor
11. Importance of ffup care cells binding sites
Medication - Aminoglutethimide (cytadren) 2. Viruses
- Trilostane (modastane) 3. Toxicities (CCl4)
- Mitotane (lysodrane) 4. Drugs, steroids and
• These medications are to decrease loop diuretics
cortisol production. (furosemide)
Signs and 1. Polyuria, polydipsia, Usually
Symptoms polyphagia (3P’s)- asymptomatic
cardinal signs (3P’s +1G, weight
PANCREAS 2. Glucosuria gain)
3. Weight loss, anorexia, Absence of
• Behind the stomach
nausea and vomiting lipolysis
• Mixed gland: exocrine and endocrine at the same time
4. Blurring of vision
• Pancreatitis -> inflammation -> edema -> hemorrhage -> 5. Increased
autodigestion susceptibility to infection
• Stomach doesn’t undergo autodigestion despite 6. Poor/delayed wound
acidic environment d/t gastric juices that protects it healing (lower extremity
• Chronic hemorrhagic pancreatitis -> death during sleep – distal to
the heart)
Acinar Cells Treatment 1. Insulin 1. OHA
1. secretes pancreatic juices 2. Exercise 2. Diet
2. aids in digestion 3. Diet 3. Exercise
4. Sodium Bicarbonate 4. Insulin used
B. Islets of Langerhans for acidosis during emergency
1. Alpha cells situation
• Glucagon -> hyperglycemia Complications DKA that may lead to - HONK
2. Beta cells diabetic coma
• Insulin ->hypoglycemia - Acute complication of
3. Delta cells type 1 DM due to
• Somatostatin -> antagonizes effect of gh hyperglycemia
leading to severe CNS
depression
DIABETES MELLITUS
- Metabolic disorder characterized by glucose intolerance resulting - Predisposing Factors:
from an imbalance between insulin supply and demand. • Hyperglycemia
• Stress
TYPES OF DIABETES MELLITUS • Infection
1. TYPE 1 Diabetes Mellitus
2. TYPE 2 Diabetes Mellitus -Signs and symptoms
3. Gestational Diabetes Mellitus • 3P’s and G
• Weight loss
Others: • Anorexia,
DM occurs secondary to other conditions: nausea and
1. Cushing syndrome vomiting
2. Hyperthyroidism • Acetone
3. Recurrent pancreatitis breath,
4. Cystic fibrosis kussmaul’s,
5. Hemochromatosis (also known as BRONZE DIABETES) decreased
6. Parental Nutrition LOC-> coma
TYPE 1 DM (IDDM) TYPE 2 DM -Dx: elevated FBS, BUN,
(NIDDM) Crea and Hct

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LONG TERM COMPLICATIONS: • DO NOT exercise the are where you injected the insulin
(speeds up absorption)
• Retinopathy and cataract
• Nephropathy
• Neuropathy ORAL HYPOGLYCEMICS
• Arteriosclerosis and atherosclerosis MOA – stimulates the pancreas to secrete insulin
• Cardiac complications I. Classification
• Vascular changes A. First generation sulfonylureas
1. Chlorpropamide (Diabenase)
GESTATIONAL DM 2. Talbutamide (Orinase)
3. Tolazamide (Tolinase)
• d/t maternal hormones B. Second generation sulfonylureas
• Infant hypoglycemia signs: high pitch cry and poor sucking 1. Glipzide (glucotrol)
reflex 2. Diabeta (Micronase)
II. Nursing Management
______________________________________________________ A. Administer with food to decrease GIT irritation and to
prevent hypoglycemia
B. Instruct pt not to take alcohol
LABORATORY TESTS
1. Alcohol + OHA -> severe hypoglycemic reaction
Random Blood Fasting Blood Post Prandial
2. Disulfiram +OHA -> toxicity
Sugar Sugar Blood Sugar
INSULIN THERAPY
200 mg/dl Normal Value: 70- Normal Value: 140
suspicious DM 99mg/dl mg/dl
I. Sources
Prediabetes: 100- Prediabetes: 140-
A. Animal – pork and beef : rarely used because it can
125 mg/dl 200 mg/dl
cause
Diabetes: >126 Diabetes:
severe allergic reactions
md/dl >200md/dl
B. Human – less antigenicity, less allergic reactions
ORAL GLUCOSE GLYCOSLATED C. Artificial
TOLERANCE TEST HEMOGLOBIN II. Types of Insulin
-BEST METHOD - Glucose attach to Hgb and A. Rapid (SAI) – clear, peak: 2-4 hours , Regular insulin
- involves measuring blood never dissociate! B. Intermediate AI – NPH (Non-Protamine Hagedorn) –
glucose level before and after - Glycosylated Hgb is the cloudy, peak : 6-12 hours
intake of glucose (8 ounces of average of blood glucose C. Long AI – Ultra lente – cloudy, peak 12-24 hours
syrupy glucose containing 2.6 over previous 3 months. III. Nursing Management
ounces of sugar) A. Administer insulin at room temp to prevent
RESULTS: NON-DIABETIC: 6% Lipodystrophy-> atrophy/hypertrophy of SQ tissue
If being tested for type II DM: PREDIABETES: 6-6.4% B. Insulin only refrigerated once opened
DIABETES: 6.5% C. Avoid shaking insulin, roll between palms only
Normal Value: 140 mg/dl D. Accuracy of administration is important
Prediabetes: 140-200 mg/dl E. Rotate insulin sites to prevent lipodystrophy
Diabetes: >200md/dl F. Use short bore needle gauge 25-26
G. No need to aspirate
*Diabetes take longer (or does H. Administer insulin 45/90 degrees angle depending on
not) return to normal. amount to pt’s SQ tissue
I. Most accessible route: abdomen
CRITERIA FOR GOOD CONTROL OF DIABETES J. Aspirate CLEAR before CLOUDY to prevent
contamination and promote accurate calibration
• Optimal weight and enjoys good health K. Monitor for local complications:
• Glycosylated Hemoglobin is in normal range: Good 1. Allergic reactions
diabetes control= 2.5- 6% 2. Lipodystrophy
• FBS under 140 mg/dl (NO CALORIC INTAKE FOR AT 3. SOMOGYI’S PHENOMENON – rebound
LEAST 8 HOURS BEFORE TEST) effect of insulin characterized by hypoglycemia,
• Post-prandial blood glucose level not higher than 180 hyperglycemia.
mg/dl 4. Dawn Phenomenon
5. Insulin Waning
MANAGEMENT 6. Hypoglycemia

DIET IS CONSIDERED A CORNERSTONE! * To differentiate hypoglycemia and hyperglycemia:

• CARBOHYDRATE (50-60% mostly complex); “HOT and DRY, SUGAR HIGH, COLD and CLAMMY needs SOME
• PROTEIN (20%); CANDY!”
• FATS (30% to which 90% should be unsaturated fats)
• HIGH SOLUBLE FIBER – it adds bulk and does not DIABETIC KETOACIDOSIS (DKA)
contribute to blood sugar
• Limited refined sugars, and high fructose sources. -Acute complication of IDDM d/t hyperglycemia leading to CNS
depression and coma
EXERCISE: lowers blood sugar (increase carbohydrate
metabolism); facilitates weight reduction; decreases BP and stress. Precipitating Factors:
• BUT NOT recommended to clients with blood glucose 1. Hyperglycemia
level of >250 mg/dl and presence of urinary ketones, 2. Stress
UNTIL absent. 3. Infection
• Exercise at the SAME TIME each day and when glucose
from meal is peaking. Signs and Symptoms:
1. 3Ps +1G, weight loss
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2. Anorexia, nausea and vomiting

3. Acetone/fruity breath
4. Kussmaul’s respirations
5. CNS depression
6. Coma

Diagnostics:
• Elevated FBS
• Elevated BUN, CREA and HcT

Nursing Management:
1. Assist in mechanical ventilation
2. SOP in hospitals: administer 0.9 NaCl, PNSS, isotonic,
followed by 0.45 NaCl hypotonic to counteract dehydration
3. Monitor VS, IO, CBG
4. Administer medications as ordered
a. Rapid Acting – regular
b. Sodium Bicarb to counteract acidosis
c. Antimicrobials

HYPEROSMOTIC NON-KETOTIC SYNDROME (HONKS)

HO -> increased osmolality -> severe dehydration

NK -> absence of lipolysis -> no ketosis

Precipitating Factors:
1. Hx of type II DM

Signs and Symptoms:

1. Headache
2. Confusion
3. Seizures
4. Decreased LOC -> coma

Diagnostics:
• Elevated FBS
• Elevated BUN, CREA and HcT

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PRACTICE QUESTIONS: c. Take half of the prescribed does for the next 24
hours
1. A client with a diagnosis of Diabetic Ketoacidosis (DKA) is d. Withhold the medication for the next 24 hours then
being treated in an emergency room. Which finding would a continue as prescribed.
nurse EXPECT to not see as confirming this diagnosis?
8. Which of the following lab results would be EXPECTED in
a. Increased respiration and increase Ph a client suspected of having Cushing’s Disease?
b. Comatose state
c. Decreased urine output a. Decreased urinary calcium level
d. Elevated blood glucose level and low plasma b. Hypoglycemia
bicarbonate level c. Hypokalemia
d. Hyponatremia
2. A factor learned while obtaining the nursing history that
probably predisposed a client to type II Diabetes would be: 9. An order of oral glucocorticoid has been ordered to a client
diagnosed with Addison’s disease. Which of the following
a. Being 20 pounds overweight statements made by the client does not need further
b. Having diabetes insipidus teaching?
c. Eating low cholesterol foods
d. Drinking a daily alcoholic beverage a. “I will take the drug after I have eaten something or
with antacid.”
3. A client is suspected to develop tetany after subtotal b. “I will take the drug after bedtime to increase
thyroidectomy. Which of the following symptoms if absorption.”
experienced by the client might indicate tetany? c. “I should take the drug on an empty stomach.”
d. “I must remember to take the drug with a full glass
a. Bleeding on the back of the dressing of water.”
b. Tingling of the fingers
c. Pain in hands and feet 10. Before procedure, the nurse is reviewing the potential
d. Tension on the suture lines. complications after hypophysectomy. Which of the following
should the nurse teach the client to monitor as a sign of
4. A client with hypothyroidism who experiences trauma, complication after the procedure?
emergency surgery or severe infection is at risk for
developing which of the following conditions? a. Diabetes Mellitus
b. Acromegaly
a. Hepatitis B c. Hypopituitarism
b. Malignant hyperthermia d. Cushing’s disease
c. Myxedema coma
d. Thyroid storm

5. A physician has prescribed propylthiouracil (PTU) for a

client with hyperthyroidism and the nurse assigned to this
client develops a plan of care for the client. A priority nursing
assessment to be INCLUDED in the plan regarding this
medication is to assess for:

a. Relief of pain
b. Signs of renal toxicity
c. Signs and symptoms of hyperglycemia
d. Signs and symptoms of hypothyroidism

6. The nurse assess for the major symptom associated with

pheochromocytoma when he:

a. Takes the client’s blood pressure

b. Obtains the clients weight
c. Tests the client’s urine for glucose
d. Palpates the skin for its temperature

7. Potassium iodide (Lugol’s solution) is prescribed for a

client with thyrotoxic crisis. The client calls the clinic nurse
and complains of the brassy taste in the mouth. Which of the
following is an APPROPRIATE instruction to the client?

a. Continue the medication

b. Withhold the medication and notify the physician

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ANSWER KEY with the five H's: hypertension, headache, hyperhidrosis,

1. Answer: A. DKA is caused by an absence or markedly
inadequate amount of insulin, This deficit in available insulin
results in disorders in the metabolism of carbohydrate, protein
and fat. The three main clinical features of DKA are:
Hyperglycemia, dehydration and electrolyte loss and acidosis.
Acidosis causes a decrease in the blood pH, alkalosis causes
an increase in the blood pH.
2. Answer: A. Diabetes mellitus is a group of metabolic
diseases characterized by elevated levels of glucose in the
blood resulting from defects in insulin secretion, insulin action,
or both. Type lI Diabetes is a metabolic disorder characterized
by the relative deficiency of insulin production and a
decreased insulin action and increased insulin resistance.
Formerly called noninsulin dependent or adult onset. Patients
are usually obese at diagnosis. Causes include obesity,
heredity or environmental factors.
3. Answer: B. Occasionally in thyroid surgery the parathyroid
glands are injured or removed, producing a disturbance in
calcium metabolism. As the blood calcium level falls
hyperirritability of the nerves occurs, with spasms of the hands
and feet and muscle twitching. This group of symptoms is
termed tetany, and the nurse must immediately report its
appearance because laryngospasm, although rare, may
Occur and obstruct the airway. Tetany of this type is usually
treated with intravenous calcium gluconate. This calcium
abnormality is usually temporary after thyroidectomy.
4. Answer: C. Myxedema coma describes the most extreme
severe stage of hypothyroidism, in which the patient is
hypothermic and unconscious. Myxedema coma may follow
increasing lethargy, progressing to stupor and depressed,
resulting in alveolar hypoventilation, progressive CO2
retention, narcosis and coma. These symptoms along with
Cardiovascular collapse and shock, require aggressive and
intensive therapy if the patient is to survive. Even with early
vigorous therapy, however, mortality is high.
hypermetabolism and hyperglycemia.
7. Answer: B. Potassium iodide inhibits thyroid hormone
release, reduces thyroid vascularity, and decreases thyroid
uptake o radioactive iodine after radiation emergencies or
administration of radioactive iodine isotopes. In long term use,
check for signs and symptoms of iodism (lo dine toxicity)
which includes metallic taste (brassy taste), sore teeth and
gums, sore throat, burning of mouth and throat, cold-like
headache. productive cough, Gl irritation, diarrhea,
angioedema, rash, fever and cutaneous or mucosal
hemorrhage. Discontinue drug immediately if these occur.
8. Answer: C. Cushing's syndrome results from excessive
adrenocortical activity. The signs s and symptoms of the
disease are primarily a result of over secretion of
glucocorticoids and androgens (sex hormones), secretion
also may be affected. Indicators of Cushing’s syndrome
include an increase in serum sodium and blood glucose levels
and a decreased serum concentration of potassium, a
reduction in the number of blood eosinophils and
disappearance of lymphoid tissue.
9. Answer: A. Oral steroids can cause gastric irritation and
ulcers and should be administered with meals, if possible or
otherwise with an antacid. Glucocorticoids should be taken in
the morning not at bedtime.
10. Answer: C. Hypophysectomy is the removal of the
pituitary gland, may be performed to treat primary pituitary
gland tumors. It is the treatment of choice in patients with
Cushing's syndrome due to excessive production of ACTH by
a tumor of the pituitary gland. The absence of the pituitary
gland alters the function of many body systems. Menstruation
ceases and infertility occurs after total or near-total ablation of
the pituitary gland. The client should be taught to monitor for
change in mental status, energy level, muscle strength and
cognitive function. Acromegaly and Cushing's disease are
conditions of hypersecretion.

5. Answer: D. Antithyroid agents block the utilization of iodine

by interfering with iodination of thyrosine the coupling
iodothyrosines in the synthesis of thyroid hormones. This
prevents the synthesis of thyroid hormone. The most
commonly used medications are propylthoiuracil or
methimazole until the patient is euthyroid. These medications
block extrathyroidal conversion of T4 to T3. The objective of
pharmacotherapy is to inhibit one or more stages in thyroid
hormone synthesis a hormone release; another goal may be
to reduce the amount of thyroid tissue, with resulting
decreased thyroid hormone production.

6. Answer: A. Pheochromocytoma is a tumor that is usually

benign in and originates from the chromaffin cells of the
adrenal medulla. The typical triad of symptoms comprises
headache, diaphoresis ds and palpitations. Hypertension and
other cardiovascular is disturbances are common.
Pheochromocytoma is suspected if its signs of sympathetic
nervous system overactivity occur in association with marked
elevation of blood pressure. These signs can be associated

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