ENDOCRINE

A PRESENTATION OF GROUP 7 (BSN 4-6)

SYSTEM
LIFE THREATENING HYPER/HYPOFUNCTION OF THE ENDOCRINE SYSTEM
TOPIC OUTLINE
Assessment of Selected Endocrine Function
Thyroid Function Test
Test of Glucose Metabolism
Test of Adrenal Function
Selected Problems
Thyroid Crisis
Adrenal Crisis
Insulin Shock and Diabetic Ketoacidosis
Hyperosmolar Hyperglycemic Nonketotic Coma
ASSESSMENT
OF SELECTED ENDOCRINE FUNCTION
THYROID FUNCTION
TEST
 THYROID FUNCTION TEST
Thyroid function tests are a
series of blood tests that
measure the levels of
hormones produced by the
thyroid gland, including
triiodothyronine (T3) and
thyroxine (T4).

Presented by: MANIKIS, Maria Xandra V.

Free Thyroxine ( FT4 )
COMPONENTS
TSH is produced by the pituitary gland
and stimulates the thyroid gland to Total Thyroxine ( Total T4 ) and Total
release T4 and T3. Triiodothyronine ( Total T3)
These tests measure the total amount of T4
and T3 in the blood, including both bound
Free Triiodothyronine (FT3)
and unbound forms.
FT3 measures the amount of unbound or
"free" T3 in the blood. T3 is the more Thyroid Peroxidase Antibodies (TPOAb) and
active form of thyroid hormone. Thyroglobulin Antibodies (TgAb)
These tests help diagnose autoimmune
Thyroid Stimulating Hormone (TSH)
thyroid conditions
TSH is produced by the pituitary gland
and stimulates the thyroid gland to
release T4 and T3.

Presented by: MANIKIS, Maria Xandra V.

 VALUES
UNIT NORMAL

Free Thyroxine ( FT4) ng/dl 0.8 - 2.8

Free Triiodothyronine (FT3) pmol/L 2.0 - 7.0

TSH mIU/L 0.5 - 5.0

Total Triiodothyronine ( T3 ) nmol/L 0.9 - 2.8

Total Thyroxine ( T4 ) mcg/d 5 - 12

Thyroid Peroxidase Antibodies (TPOAb) IU/mL 0 - 34

Thyroglobulin Antibodies (TgAb) IU/mL 0 - 40

Presented by: MANIKIS, Maria Xandra V.

 T3 & T4 Renin Uptake Test
The T3 and T4 resin uptake test
is a blood test used to measure
the amount of protein in the
blood that binds to thyroid
hormones T3 and T4. This
protein, called thyroid
hormone-binding globulin
(TBG), transports thyroid
hormones throughout the body.

Presented by: MANIKIS, Maria Xandra V.

Thyroid Stimulating Hormone

A TSH test is a blood test

that measures TSH
hormone. These let see
how well the thyroid or
pituitary are working .

Presented by: MANIKIS, Mariai Xandra V.

 NURSING CONSIDERATIONS
Assess the patient's medical history and current medications.
Assess for contraindications or potential risks associated with the tests
Assess vital signs and general health
Monitor patients for signs of anxiety or discomfort during blood
collection.
Monitor patients during and after blood collection for any adverse
reactions.
Obtain informed consent from the patient.
Explain the purpose of the test, the procedure involved, and any
potential discomfort
Explain the procedure to the patient and answer any questions they
may have
Presented by: MANIKIS, Maria Xandra V.
TEST OF GLUCOSE
METABOLISM
 DESCRIPTION
Glucose metabolism tests
assess how the body
processes glucose, a primary
energy source. It looks at the
body’s capability to regulate
blood sugar, which can aid in
diagnosing conditions like
diabetes mellitus.

Presented by: ARCILLA, Claire Ysabel C.

 TYPES
1. Fasting Plasma Glucose (FPG) Test 4. Oral Glucose Tolerance Test (OGTT)
8-hour fast, except water sensitive for DM diagnosis, esp.
diagnoses diabetes in non- GDM
pregnant adults not routinely recommended due to
inconvenience
2. Random Blood Sugar (RBS) Test
no need to fast, can be done 5. C-Peptide Test
anytime differentiates Type 1 and Type 2
diagnoses DM in those with severe DM
hyperglycemia or hyperglycemic measures the level of C-peptide, a
crisis byproduct of insulin production
3. Glycosylated Hemoglobin A1c
(HbA1c) Test
accurate and precise
measures the percentage of
glucose attachment to hemoglobin

Presented by: ARCILLA, Claire Ysabel C.

 VALUES
ABNORMAL
TEST NORMAL
Pre-diabetes Diabetes

Fasting Plasma Glucose Test <100 mg/dL >100 - <126 mg/dL >126 mg/dL

Random Blood Sugar Test <140 mg/dL 140 - 200 mg/dL >200 mg/dL

Glycosylated Hemoglobin A1c Test <5.7% 5.7 - 6.4% ≥6.5%

Oral Glucose Tolerance Test <140 mg/dL >140 - <200 mg/dL >200 mg/dL

C-Peptide Test 0.8 - 3.85 ng/ml - <0.6 ng/mL

Presented by: ARCILLA, Claire Ysabel C.

NURSING CONSIDERATIONS
Assess for diabetes symptoms.
Obtain family history.
Instruct fasting for relevant tests.
Ensure no caffeine or gum before testing.
Monitor pregnant women for preeclampsia.
Certain factors like carbohydrate restriction, bedrest, acute illness,
and specific drugs can impact the test.
Blood samples should be taken at 30-minute intervals over 2 hours.

Presented by: ARCILLA, Claire Ysabel C.

TEST OF ADRENAL
FUNCTION
 ACTH STIMULATION TEST
Also known as Cosyntropin
Stimulation Test
Test to assess how adrenal glands
respond to adrenocorticotropic
hormone (ACTH).

A standard dose of 250 mcg

cosyntropin is given and the
expected response is an increase
cortisol level of 7 to 9 mcg/dL
from the baseline.

Presented by: GONZALO, Kate Li-Anne

 NORMAL VALUES
Normal values for a blood sample taken are 5 to 25 mcg/dL or
140 to 690 nmol/L.

Cortisol level after ACTH stimulation should be higher than 13

to 14 mcg/dL (358 to 386 nmol/L) depending on the type of
cortisol assay used and on the dose of ACTH used.

Presented by: GONZALO, Kate Li-Anne

 NURSING CONSIDERATIONS
Observe/Assess for side effects of cosyntropin administration which
includes nausea, sweating, dizziness, blurry vision, difficulty in breathing
Monitor the injection site note if there are redness, itchy skin, swelling
Observe/Assess for ACTH suppression. Administration of dexamethasone is
usually well tolerated
Monitor fluid and electrolyte imbalance, promote adequate fluid volume.

Presented by: GONZALO, Kate Li-Anne

PROBLEMS
OF SELECTED ENDOCRINE FUNCTION
THYROID CRISIS
OVERVIEW OF HYPOTHYROIDISM
Hyperthyroidism happens when the thyroid
gland makes too much thyroid hormone.
This condition also is called overactive
thyroid. Hyperthyroidism speeds up the
body's metabolism. That can cause many
symptoms, such as weight loss, hand
tremors, and rapid or irregular heartbeat.

The thyroid gland produces two main

hormones: thyroxine (T-4) and triiodothyronine
(T-3).

Presented by: TRINIDAD, Trixia Mae D.

 Thyroid Storm
A THYROID STORM, or an increased
heart rate, blood pressure, and body
temperature, may occur in people with
hyperthyroidism. Thyroid storm is a
life-threatening health condition that is
associated with untreated or
undertreated hyperthyroidism.

Presented by: TRINIDAD, Trixia Mae D.

 ASSESSMENT
Causes of this condition include:
severe undertreated hyperthyroidism
untreated overactive thyroid gland
infection associated with hyperthyroidism

Symptoms of thyroid storm are similar to those of hyperthyroidism,

but they are more sudden, severe, and extreme.
Common symptoms include:
racing heart rate that exceeds 140 beats per minute
high fever
persistent sweating
shaking
agitation
restlessness
confusion
diarrhea
unconsciousness

Presented by: TRINIDAD, Trixia Mae D.

INTERVENTIONS
If needed, immediately provide supplemental oxygen,
ventilatory support, and intravenous fluids. Dextrose
solutions are the preferred intravenous fluids to cope with
continuously high metabolic demand.
Monitor vital signs.
Correct electrolyte abnormalities.
Monitor continually for cardiac dysrhythmias.
Treat cardiac arrhythmia, if necessary.
Aggressively control hyperthermia by applying ice packs
and cooling blankets and by administering acetaminophen
(15 mg/kg orally or rectally every 4 hours).

Presented by: TRINIDAD, Trixia Mae D.

ADRENAL CRISIS
 DESCRIPTION
Addisonian crisis is also known as an adrenal
crisis or acute adrenal insufficiency. It is a rare
and potentially fatal condition where the
adrenal glands stop working properly and
there is not enough cortisol in the body.
When the body experiences stress due to
specific factors or triggers, the adrenal glands
may find it difficult to produce cortisol
effectively.

Presented by: BUIZA, Francis Albert B.

 ASSESSMENT
A low cortisol level (< 3 mcg/dL) is sufficient to diagnose adrenal
insufficiency.
Signs and Symptoms
Hypovolemia
Hyperkalemia
Hypotension
Decreased cardiac output
ECG changes
severe weakness
Decreased digestive enzymes, intestinal motility, and digestion
Reduced renal perfusion and glomerular filtration rate

Presented by: BUIZA, Francis Albert B.

 INTERVENTION
Get ready to give the recommended intravenous high-dose
hydrocortisone replacement.
Give IV fluids as directed to substitute in support replenishing the
electrolyte balance.
After resolving the issue, provide oral glucocorticoids and
mineralocorticoids following guidance.
Observe your vital signs, especially your blood pressure.
In particular, keep an eye on the blood glucose, potassium, and sodium
levels in the laboratory.

Presented by: BUIZA, Francis Albert B.

INSULIN SHOCK
 DESCRIPTION
Hypoglycemia occurs when the blood glucose level falls below 70 mg/dL
(3.9 mmol/L).
Also known as Diabetic shock or Insulin shock.
Hypoglycemia is caused by too much insulin or too large an amount of an
oral hypoglycemic agent, too little food, or excessive activity.
High risk for hypoglycemia are patients taking insulin, children and
pregnant women with type 1 DM, patients with autonomic diabetic
neuropathy, and elderly persons with type 1 or type 2 DM.

Presented by: FABABIER, Aldrin Chris L.

 ASSESSMENT
Mild Hypoglycemia - <70 mg/dL. Client remains fully awake but displays
adrenergic symptoms.
Moderate Hypoglycemia - <40 mg/dL. Client displays symptoms of
worsening hypoglycemia.
Severe Hypoglycemia - <20 mg/dL. Client displays severe
neuroglycopenic symptoms.

Presented by: FABABIER, Aldrin Chris L.

 INTERVENTIONS
Checks the client’s blood glucose level.
Use the 15/15 method.
Withhold temporarily rapid-acting and short-acting insulin to patients.
Neurological assessments are done to detect any changes in cerebral
function related to hypoglycemia.
Seizure precautions should be instituted.
Patients with severe hypoglycemia, do not attempt to administer oral
food or fluids.

Presented by: FABABIER, Aldrin Chris L.

 DIABETIC
KETOACIDOSIS
 DESCRIPTION
Diabetic Ketoacidosis (DKA) is a life-threatening complication of type 1
diabetes mellitus that develops when a severe insulin deficiency occurs.

Onset Sudden

Precipitating Factors Infection

Inadequate insulin dose
Stress
High caloric parenteral or enteral
nutrition

Presented by: LABANG, Daniela Mae C.

 ASSESSMENT
Manifestations Laboratory findings:
Ketosis Serum glucose: >300 mg/dl (>16.7 mmol/L)
Kussmaul’s respirations Serum Ketones: Positive at 1:2 dilution
“Fruity” breath
Serum pH: <7.35
Nausea
Serum HCO3: <15mEq/L
Abdominal pain
Serum Na: Low, normal, or high
Polyuria
Serum K: Normal; elevated with acidosis,
Polydipsia
decreases following dehydration
Weight loss
BUN: >20 mg/dL (>7.1 mmol/L); elevated
Dehydration or electrolyte loss:
because of dehydration
Dry skin
Sunken eyes Creatinine: >1.5 mg/dL (>132.5 mcmol/L);
Soft eyeballs elevated because of dehydration
Lethargy Positive urine ketones
Coma

Presented by: LABANG, Daniela Mae C.

ASSESSMENT

Presented by: LABANG, Daniela Mae C.

 INTERVENTIONS
Restore circulating blood volume and protect against cerebral, coronary,
and renal hypoperfusion.
Treat dehydration with rapid IV infusions of 0.9% or 0.45% NS as
prescribed; dextrose is added to IV fluids when the blood glucose level
reaches 250 to 300 mg/dL (14 to 17 mmol/L).
Correct electrolyte
Monitor potassium level closely
Cardiac monitoring should be in place.

Presented by: LABANG, Daniela Mae C.

 INTERVENTIONS
Treat hyperglycemia with insulin IV.
Use short-duration insulin only.
An IV bolus dose of short-duration regular U-100 insulin (usually 5 to 10 units) may be prescribed
before a continuous infusion is begun.
The prescribed IV dose of insulin for continuous infusion is prepared in 0.9% or 0.45% NS as
prescribed.
Always place the insulin infusion on an IV infusion controller.
Insulin is infused continuously until subcutaneous administration resumes, to prevent a rebound
of the blood glucose level.
Monitor vital signs.
Monitor urinary output, and monitor for signs of fluid overload.
Monitor potassium and glucose levels and for signs of increased intracranial pressure (ICP).
The potassium level will fall rapidly within the first hour of treatment as the dehydration and the
acidosis are treated.
Potassium is administered intravenously in a diluted solution as prescribed; ensure adequate
renal function before administering potassium.

Presented by: LABANG, Daniela Mae C.

HYPERGLYCEMIC
HYPEROSMOLAR SYNDROME
 DESCRIPTION
Hyperglycemic Hyperosmolar Nonketotic Coma (HHNK) aka
Hyperosmolar Hyperglycemic Syndrome (HHS)
Extreme hyperglycemia occurs without ketosis or acidosis.
The syndrome occurs most often in individuals with type 2 diabetes
mellitus.
The major difference between HHS and DKA is that ketosis and acidosis
do not occur with HHS; enough insulin is present with HHS to prevent the
breakdown of fats for energy, thus preventing ketosis.
Onset: Gradual
Precipitating factors: Infection, Stress, Poor fluid intake

Presented by: LABANG, Daniela Mae C.

 ASSESSMENT
Manifestations Laboratory findings:
Altered central nervous system Laboratory findings:
function with neurological Serum glucose: >800 mg/dl (>44.57 mmol/L)
symptoms Osmolarity: >350 mOsm/L
Polyuria Serum Ketones: Negative
Polydipsia Serum pH: >7.4
Weight loss Serum HCO3: <20mEq/L (>20 mmol/L)
Dehydration or electrolyte loss: Serum Na: Normal or low
Dry skin Serum K: Normal or low
Sunken eyes
BUN: Elevated
Soft eyeballs
Creatinine: Elevated
Lethargy
Negative urine ketones
Coma

Presented by: LABANG, Daniela Mae C.

 INTERVENTIONS
Treatment is similar to that for DKA.
Treatment includes fluid replacement, correction of electrolyte
imbalances, and insulin administration.
Fluid replacement in the older client must be done very carefully
because of the potential for heart failure.
Insulin plays a less critical role in the treatment of HHS than it does in the
treatment of DKA because ketosis and acidosis do not occur; rehydration
alone may decrease glucose levels.

Presented by: LABANG, Daniela Mae C.

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