Professional Documents
Culture Documents
Med Surg Endocrine
Med Surg Endocrine
Endocrine System
Pituitary gland
Thyroid gland
Parathyroid glands
Adrenal gland
Pineal gland
Thymus gland
Pancreas
Gonads (Ovaries and Testes)
Hypothalamus
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.
• Commonly referred to as the master gland, the pituitary
secretes hormones that control the secretion of
hormones by the endocrine glands.
• It is controlled by the hypothalamus.
• It is approximately the size of a grape.
• It hangs by a stalk from the inferior surface of the
hypothalamus of the brain, where it is snugly
surrounded by the “turk’s saddle” of the sphenoid bone.
• 2 functional lobes:
• Anterior pituitary (glandular tissue)
• Posterior pituitary (nervous tissue)
MS 1 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Oxytocin
Antidiuretic Hormone (ADH) or vasopressin
Thyroid Gland
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
MS 2 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Adrenal Glands
• Two bean-shaped glands, which curve over the top of the kidneys
• It is structurally and functionally two (2) endocrine organs:
Adrenal cortex (glandular tissue)
Corticosteroids
Mineralocorticoids
Aldosterone
Renin
Glucocorticoids
Cortisone
Cortisol
Sex hormones
Androgen
Estrogen
Adrenal medulla (neural tissue)
Catecholamines
Epinephrine (Adrenaline)
Norepenephrine
(Noradrenaline)
Pancreas
Thymus Gland
MS 3 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Gonads
MS 4 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Endocrine System
Posterior pituitary (neurohypophysis)
Lecturer: Mark Fredderick R. Abejo RN,MAN Oxytocin
o Promotes uterine contractions
o Milk let down reflex with the help of
PROLACTIN (lactogenic hormone)
o Administered after placental expulsion
ADH – prevents urination thereby conserving
OVERVIEW OF THE ENDOCRINE SYSTEM
Pituitary gland (Hypophysis Cerebri) – main organ fluids
o Located at the Sella turcica o Pitressin (vasopressin)–ADH replacement
o Master clock or master gland of the body Contraction of smooth muscles
o Divisions o Involved in Diabetes insipidus and SIADH
Anterior pituitary (adenohypophysis)
MS 5 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
THYROID DISORDERS
MS 6 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
#1 endemic goiter
#2-3 causes sporadic goiter
Signs and 1. Enlarged thyroid gland Early Signs 1. Hyperphagia – increased appetite
Symptoms 2. Mild dysphagia 1. Weakness and fatigue 2. (+) weight loss d/t increased
3. Mild restlessness 2. Loss of appetite but (+) weight gain metabolism
d/t increased lipolysis 3. heat intolerance
3. Dry skin 4. moist skin
4. Cold intolerance 5. diarrhea
5. Constipation 6. increased VS – tachycardia, HPN,
6. Menorrhagia tachypnea, hyperventilation,
hyperthermia
7. CNS changes
Late Signs a. Irritability
1. Brittleness of hair b. agitation
2. Non-pitting edema d/t excessive c. Tremors
accumulation of mucopolysaccharides d. Restlessness
in sq e. Insomnia
3. Hoarseness of voice f. Hallucinations
4. Decreased libido 8. Goiter
5. Decreased VS 9. Exophthalmos
a. Hypotension 10. Amenorrhea
b. Bradycardia
c. Bradypnea
d. Hypothermia
6. CNS changes
a. Lethargy
b. Memory impairment
c. Psychosis
Diagnostics 1. Serum T3 and T4 normal or below 1. Serum T3 and T4 decreased 1. elevated T3 and T4
normal 2. Radioactive Iodine Uptake (RAIU) 2. RAIU elevated
2. Thyroid Scan enlarged thyroid gland decreased 3. Thyroid Scan enlarged thyroid
3. Serum TSH increased 3. Serum Cholesterol elevated gland
Nursing 1. Administer medications as ordered 1. Monitor STRICTLY VS, IO to 1. Monitor VS and IO strictly to
Management a. Iodine Solution: Lugol’s Solution – determine presence of MYXEDEMA determine presence of THYROID
saturated solution of potassium COMA a complication of severe STORM/Crisis
iodine; 1 liter of water to 2-3 drops, hypothyroidism characterized by: 2. Administer medications as ordered
use straw to prevent staining of teeth a. Severe hypotension a. Anti-Thyroid Agents: PTU
b. Thyroid agents of hormones b. Bradycardia toxic effects is
Levothyroxine (Synthoid) c. Bradypnea AGRANULOCYTOSIS
Liothyronine (Cytomel) d. Hypoventilation fever and chills, sore throat
Thyroid extracts e. Hypoglycemia (throat CS pls!),
NURSING MGMT when f. Hyponatremia LEUKOCYTOSIS (CBC pls!)
giving these: g. Hypothermia b. Methimazole (Tapazole)
Instruct client to take it Might lead to progressive stupor 3. High calorie diet to correct weight loss
best at early AM to and coma 4. Provide comfortable and cool
prevent insomnia Assist in mechanical ventilation, environment
Monitor VS especially administer thyroid hormones as 5. Institute meticulous skin care
HR (mlt tachycardia and ordered and force fluids, IV 6. Maintain side rails
palpitaitons fluids replacement 7. Bilateral eye patch to prevent drying
Monitor SE: insomnia, 2. Administer isotonic fluids as ordered of eyes
tachycardia, palpitations, 3. Administer medications as ordered – 8. Assist in surgical procedure: subtotal
HPN, heat intolerance thyroid hormones or agents (may thyroidectomy
2. Encourage increased intake of foods rich in cause insomnia and heat intolerance) a. PRE-OP
iodine 4. Provide dietary intake low in calories i. Administer lugol’s
a. Seaweeds to prevent weight gain solutions/ SSRI to
b. Seafoods: oysters, clams, crabs, 5. institute meticulous skin care promote decreased
lobster, shrimps (have low iodine 6. provide comfortable and warm vasculature and promote
content) environment atrophy of the thyroid
c. Iodized salt (served on the table, (-) 7. forced fluids gland to prevent/minimize
effect with cooking) 8. health teaching and d/c planning bleeding and hemorrhage
3. Institute CBR a. avoidance of precipitating b. POST-OP
4. Assist in surgery – subtotal thyroidectomy factors leading to myxedema i. WOF signs of THYROID
coma STORM agitation,
MS 7 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
PARATHYROID – pair of small nodules located behind the thyroid gland parathormone for Ca reabsorption
PARATHYROID DISEASES
HYPOPARATHYROIDISM HYPERPARATHYROIDISM
Definition A condition due to diminution or absence of the secretion of Increased parathormone
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 1. Following subtotal thyroidectomy 1. Hyperplasia of parathyroid glands
Factors 2. Atrophy of parathyroid d/t 2. Over compensation of parathyroid gland d/t Vitamin D
a. Inflammation deficiency Ricketts Children (Osteomalacia –
b. Trauma Adults)
c. Irradiation
Signs and 1. Acute tetany 1. Bone pain especially at the back bone fracture
Symptoms a. Tingling sensation 2. Kidney stones
b. Paresthesia a. Renal colic
c. Dysphagia b. Cool moist skin initial Sx of shock
d. (+) laryngospasm 3. Interaction – elevated Ca and
e. (+) Trousseu’s sign 4. Anorexia and general body malaise
f. (+) Chvostek’s sign 5. Irritability and memory impairment
g. arrhythmia 6. Presence of ulceration
h. seizures
2. Chronic tetany
a. Cataract and photophobia
b. Loss of tooth enamel
c. Anorexia and general body malaise
d. Agitation, Irritability and memory impairment
MS 8 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
MS 9 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
3. Hyponatremia isolation!)
a. Hypotension 3. Hypernatremia
b. Signs of dehydration a. HPN
c. Weight loss b. Edema
4. Hyperkalemia c. Wt. gain
a. Irritability and agitation 4. Moonface appearance, buffalo hump, obese
b. Diarrhea trunk, pendulous abdomen, thin extremities
c. Arrhythmias 5. Hypokalemia
5. Decreased Libido a. Weakness and fatigue
6. Loss of pubic and axillary hair b. Constipation
7. Bronze-like skin pigmentation d/t decreased cortisol stimulation of MSH c. U wave on ECG tracing
from pituitary gland 6. Hirsutism
7. Easy brusing
8. Acne and Striae
9. increased masculinity in females
Diagnostics 1. FBS decreased (N= 80-120 mg/dl) 1. FBS elevated
2. Serum Na decreased (N= 135-145) 2. Elevated Na
3. Serum K elevated (N=3.5-5.5meq/L) 3. Decreased K
4. Plasma cortisol decreased 4. Elevated Cortisol
Nursing 1. Monitor strictly VS, IO to determine presence of Addisonian crisis which 1. Monitor IO, VS
Management results from acute exacerbation of Addison’s disease characterized by: 2. Restrict Na and Fluids
a. Hyponatremia 3. Weigh pt. daily and assess for pitting edema
b. Hypovolemia (ANASARCA – generalized edema nephritic
c. Dehydration syndrome)
d. Severe Hypotension 4. Measure abdominal girth daily, notify MD
e. Weight loss Which may lead to progressive stupor coma. 5. Diet: low CHO, NA, High CHON and K
Assist in mech vent, steroids as ordered, forced fluids 6. Administer medications as ordered
2. Administer medications as ordered a. K-sparing diuretics - Spironolactone
a. Corticosteroids (Aldactone); excretes sodium but
Universal rule: administer 2/3 dose in AM and 1/3 dose retains potassium
in PM to mimic the N diurnal rhythm of the body 7. Prevent Complications – DM
Taper the dose. Withdraw gradually from the drug 8. Provides meticulous skin care
Monitor SE: Cushingoid Sx 9. Assist in Surgical Procedure – Bilateral
Adrenalectomy
HPN, Increased susceptibility to infection, 10. Hormonal replacement for life
Weight gain, Hirsutism, Moon face
11. Importance of ffup care
appearance
Ex: Hydrocortisone, Dexamethasone, Prednisone
b. Mineralocorticoids – fluorocortisone
3. Forced fluids
4. Maintain patent IV line
5. Diet: high CHO/calories, Na and CHON, low K
6. Meticulous skin care
7. Provide health teaching and d/c planning
a. Avoidance of precipitating factors leading to addisonian crisis:
Stress, Infection, Sudden withdrawal to steroids
b. Prevent Complications – hypovolemic shock
c. Hormonal replacement therapy for life
d. Importance of ffup care
MS 10 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
DIABETES MELLITUS
metabolic disorder characterized by non-utilization of CHO, CHON and FAT metabolism
DM I (IDDM) DM II (NIDDM)
Definition Juvenile Onset/ Non-obese; children; BRITTLE DISEASE Adult Onset/Obese (40 yo above) Maturity-onset type
Incidence Rate 10% of general population 90% of the general population
Predisposing 1. Hereditary – total destruction of pancreatic cells Obesity lack of insulin receptor binding sites
Factors 2. Viruses
3. Toxicities (CCl4)
4. Drugs, steroids and loop diuretics (furosemide)
Signs and 1. Polyuria, polydipsia, polyphagia Usually asymptomatic (3P’s +1G, weight gain)
Symptoms 2. Glucosuria Absence of lypolysis
3. Weight loss, anorexia, nausea and vomiting
4. Blurring of vision
5. Increased susceptibility to infection
6. Poor/delayed wound healing (lower extremity – distal to
the heart)
Treatment 1. Insulin 1. OHA
2. Exercise 2. Diet
3. Diet 3. Exercise
4. Sodium Bicarbonate for acidosis 4. Insulin used during emergency situation
Complications DKA that may lead to diabetic coma HONK
Acute complication of type 1 DM due to hyperglycemia
leading to severe CNS depression
Predisposing Factors:
Hyperglycemia
Stress
Infection
Signs and symptoms
3P’s and G
Weight loss
Anorexia, nausea and vomiting
Acetone breath, kussmaul’s, decreased LOC
coma
Dx: elevated FBS, BUN, Crea and Hct
Increased CHON catabolism -N balance tissue
wasting cachexia
Ketones (CNS depressant) DKA Kussmaul’s
respiration acetone breath diabetic coma
GESTATIONAL DM DM hyperglycemia increased osmotic diuresis
d/t maternal hormones Polyuria cellular dehydration stimulates thirst
Infant hypogly signs: high pitch cry and poor sucking reflex center polydipsia
DM ASSOCIATED WITH ILLNESS Glucosuria cellular starvation stimulate appetite
Pancreatic Ca center polyphagia
Cushing’s Syndrome DIAGNOSTICS:
1. FBS if elevated 3 consecutive times +3Ps and G = DM
Main food Anabolism Catabolism 2. OGTT (oral glucose tolerance test) most sensitive test
Stuff 3. Alpha Glycosylated Hgb increased
CHO Glucose Glycogen
CHON Amino acids Nitrogen DM management
FATS Fatty acids Free fatty acids ketones and cholesterol 1. Monitor for peak action of OHA and insulin
2. Administer insulin/OHA as ordered
Food CHO glucose insulin aids in absorption of glucose a. Brain can tolerate elevated glucose levels but not
Cells ATP (main fuel of the cells) decreased glucose
GLUCONEOGENESIS – formation of glucose from non- 3. Monitor strictly VS, CBG, I/O
carbohydrate sources (CHON and fats) 4. Monitor for s/sx of hypogly and hypergly and notify MD
Liver glycogenesis and glycogenolysis glucose in 5. Diabetic diet: CHO 50%, CHON 30%, Fats 20%
bloodstream a. Offer alternative food substitutes
Increased fat metabolism release of FFA b. Give orange juice if patient refuses to eat
Cholesterol deposition in arteries HPN CVA, 6. Exercise after meals when blood glucose is rising
MI death
MS 11 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
INSULIN THERAPY
I. Sources
A. Animal – pork and beef : rarely used because it can cause
severe allergic reactions
B. Human – less antigenicity, less allergic reactions
C. Artificial
II. Types of Insulin
A. Rapid (SAI) – clear, peak: 2-4 hours , Regular insulin
B. Intermediate AI – NPH (Non-Protamine Hagedorn) –
cloudy, peak : 6-12 hours
C. Long AI – Ultra lente – cloudy, peak 12-24 hours
III. Nursing Management
A. Administer insulin at room temp to prevent
lipodystrophy atrophy/hypertrophy of SQ tissue
B. Insulin only refrigerated once opened
C. Avoid shaking insulin, roll between palms only
D. Accuracy of administration is important
E. Rotate insulin sites to prevent lipodystrophy
F. Use short bore needle gauge 25-26
G. No need to aspirate
H. Administer insulin 45/90 degrees angle depending on
amount to pt’s SQ tissue
I. Most accessible route: abdomen
J. Aspirate CLEAR before CLOUDY to prevent
contamination and promote accurate calibration
K. Monitor for local complications:
1. Allergic reactions
2. Lipodystrophy
3. SOMOGYI’S PHENOMENON – rebound effect of insulin
characterized by hypoglycemia, hyperglycemia
MS 12 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN
MS 13 Abejo