MS-Endo-Macel.ppt ENDOCRINE system including the health management of the patients with endocrine problems

ENDOCRINE system including the health management of the patients with endocrine problems

1. ENDOCRINE
By: Anna Michelle T. Delos Reyes RN, MAN

3. Scope
•Physiology
•Disorders
PITUITARY DISEASES
ADH DISEASES
ADRENAL GLANDS DISEASES
THYROID DISEASES
PARATHYROID DISEASES
PANCREAS DISEASES

4. Major Hormone Secreting Glands

5. “The Sequence”
•Hypothalamus
↓
•Pituitary Gland or Hypophysis
Anterior or Adenohypophysis
Posterior or Neurohypophysis
↓
•Target Glands

6. The ANATOMY of the Endocrine
System
The Hypothalamus
•This part of the
DIENCEPHALON is located
below the thalamus and is
connected to the pituitary gland
by a stalk

7. The PHYSIOLOGY of the
Endocrine System: Hypothalamus
•Secretes RELEASING
HORMONES for the
pituitary gland
•Releasing hormones= hypothalamus

8. The ANATOMY of the Endocrine
System
The Pituitary Gland
•Is a gland located below
the hypothalamus at the
base of the brain

10. APG
Adenohypophysis
•TSH - target  thyroid gland

•ACTH - target  adrenal gland
•ICSH - target  testes
(maturation of spermatozoa)
•GH - target  epiphyseal plate
(bone growth)

11. APG
Adenohypophysis
•FSH target  ovary-estrogen
(maturation of graafian follicles to
release mature ovum)
•LH target  graafian follicle
(formation of corpus luteum to
maturation of ova)
•MSH → skin (pigmentation)
•PROLACTIN → (maturation of mammary gland
and production of milk)

12. PPG
Neurohypophysis
•ADH - target kidney tubules
(H2O reabsorption)
•OXYTOCIN – uterine contraction and
ejection of milk

13. Pituitary Gland and Its Hormones

14. TARGET GLANDS
•Thyroid
•Adrenal
•Mammary
•Skin
•Bone plates
•Ovaries
•Testes
•Kidney tubules
•Uterus

15. The ANATOMY of the Endocrine
System
The THYROID gland
•Located in the anterior neck
lateral to the trachea

17. The ANATOMY of the Endocrine
System
The THYROID gland
•Contains two lobes connected
by the isthmus
•Microscopically composed of
thyroid follicles where the
hormones are produced and
stored

18. The ANATOMY of the Endocrine
System
The PARAthyroid glands
•Located at the back of the
thyroid glands
•Four in number

20. Thyroid Gland
•Follicular Cells- T3, T4- ↑BMR, and
↑ CHON and bone turnover
T3- metabolism, growth
T4- catabolism, body heat production
•C Cells- Calcitonin - ↓calcium &
phosphate levels
Parathyroid Gland
•Parathormone -calcium & phosphorus
regulation, osteoclast

21. The PHYSIOLOGY of the
Endocrine System: Parathyroid
gland
Parathyroid Hormone
is released in
HYPOCALCEMIA
-↑ calcium level
Calcitonin is
stimulated by
HYPERCALCEMIA
-↓calcium level
Parathyroid hormone
is NOT secreted in
HYPERCALCEMIA
Calcitonin is inhibited
by HYPOCALCEMIA

22. The ANATOMY of the Endocrine
System
The Adrenal Glands
•Located above the kidneys
•Composed of two parts- the outer
Adrenal Cortex and the inner
Adrenal medulla

24. Adrenal Glands
• Cortex
Mineralocorticoid:Aldosterone
-Na & water reabsorption,
K loss
Glucocorticoid: Cortisol
-blood glucose
regulation Androgen: DHEA
- sex hormones- testosterone
• Medulla (catecholamines)
stress or sympathetic effect
Epinephrine and Nor-epinephrine
- neurotransmitters

25. The ANATOMY of the Endocrine
System
The GONADS- Ovaries
•These two almond-shaped
glands are found in the pelvic
cavity attached to the uterus by
the ovarian ligament

26. The ANATOMY of the Endocrine
System
The GONADS- Testes
•These two oval-shaped
glands are found in the
scrotum

27. Ovary
- estrogen- affects devt of female sex
organs and secondary sexual characteristics
- progesterone- influences menstrual
cycle, stimulates the growth of uterine wall,
and maintains pregnancy
Testes
- testosterone- affects the devt of
male sex organs and secondary sexual
characteristics
Pineal Gland
Melatonin (dec skin pigmentation,
inhibit gonadotropic hormone)

28. The ANATOMY of the Endocrine
System
The Pancreas
•This retroperitoneal organ
has both endocrine and
exocrine functions

29. The ANATOMY of the Endocrine
System
The Pancreas
•The endocrine function resides
in the ISLETS of Langerhans
•The islets have three types of
cells- alpha, beta and delta cells

30. The PHYSIOLOGY of the
Endocrine System: The Pancreas
•The ALPHA cells secrete
GLUCAGON
•The BETA cells secrete
INSULIN
•The DELTA cells secrete
SOMATOSTATIN

31. •Placenta
- HCG- maintains pregnancy
- estrogen, progesterone, human
placental lactogen
•Pancreas: Islet of langerhans
Alpha- glucagon- ↑blood sugar
(hyperglycemia) by stimulating
glycogenolysis & gluconeogenesis
Beta- insulin- ↓blood sugar
(hypoglycemia) by facilitating transport of
glucose across cell membranes of
muscle, liver, adipose tissue, inhibits
breakdown of proteins

33. DISORDERS OF THE
ENDOCRINE GLAND
Disorders are generally grouped
into:
•1. HYPER- when the gland
secretes excessive hormones
•2. HYPO- when the gland does
not secrete enough hormones

34. DISORDERS OF THE
ENDOCRINE GLAND
•Hyper and Hypo can be
classified as PRIMARY when
the Gland itself is the problem
or SECONDARY when the
pituitary or the hypothalamus is
causing the problem

35. PITUITARY GLAND
DISORDERS
•HYPOPITUITARISM
•HYPERPITUITARISM
•PITUITARY TUMORS

36. Hypopituitarism
•Hypopituitarism
•Hypofunction of the pituitary gland
•Caused by:
•trauma, tumor at the hypothalamus or pituitary
gland
•complication from radiation therapy (head and
neck)
•Panhypopituitarism (Simmonds’ Disease)- total
absence of pituitary secretions
•Sheehan’s Syndrome – postpartum pituitary
necrosis (bleeding)

37. Hypopituitarism
•Manifestations:
•Related to hypofunction of:
thyroid – hypometabolism
gonads – amenorrhea, impotence
adrenal glands - adrenal insufficiency
growth hormone – dwarfism,
hypoglycemia
•Hemianopsia and headache – (if due to tumor)
•Increased ICP (if due to tumor)

39. DISORDERS OF the PITUITARY
GLAND
Hypopituitarism: ASSESSMENT
Findings
•1. Retarded physical growth due to
decreased GH dwarfism
•2. Low intellectual development
•3. poor development of secondary
sexual characteristics

40. Hypopituitarism
•Management:
•Surgical removal of tumor
•Radiation
•HRT hormonal replacement
therapy

41. PITUITARY GLAND
DISORDERS
•Pituitary Tumors
•Usually benign
•3 Types
• Eosinophilic Tumors
• Basophilic Tumors
• Chromophobic Tumors (most
common)

42. Pituitary Tumors
•Eosinophilic Tumors
- Gigantism (before puberty)
- Acromegaly (after puberty)
- Visual disturbance (compression
from tumor)

43. HYPERPITUITARISM
•hyper-secretion of the
gland
•ACROMEGALY-after
15-16 yo
•Gigantism-before 15-
16 yo
CAUSES: tumor,
congenital disorder

45. DISORDERS OF the PITUITARY
GLAND
•ASSESSMENT FINDINGS for
Hyper-pituitarism
•1. Increased growth Gigantism
or Acromegaly
•2. large and thick hands and feet

47. DISORDERS OF the PITUITARY
GLAND
•ASSESSMENT FINDINGS for
Hyper-pituitarism
•3. Visual disturbances
•4. Hypertension, hyperglycemia
•5. Organomegaly

49. Pituitary Tumors
•Basophilic Tumors
- Cushing’s Syndrome
- Musculinization and
amenorrhea (female)

50. Pituitary Tumors
•Chromophobic Tumors (COMMON)
•Destroy the rest of the pituitary
gland
•No hormones except for prolactin
(galactorrhea)
•Blindness
•Increased ICP

51. Pituitary Tumors
•Diagnostic:
•CT scan
•MRI
•Assessment Findings

52. Pituitary Tumors
•Management:
•Drug
Bromocriptine (Parlodel) – to lower
GH and Prolactin
•Radiation
•Surgery (transsphenoidal
hypophysectomy)
Octreotide (Sandostatin) = preop drug
to reduce tumor

54. Pituitary Tumors
•Post op Care: HYPOPHYSECTOMY
•Head elevation for 2 weeks/ Semi- Fowlers
position
•Nasal packing, Avoid sneezing, coughing
•Oral care
•Monitor LOC and neurologic status
•No activity that will increase ICP
•Watchout Diabetes Insipidus, Monitor I & O
•Observe for CSF leakage
•Administer prescribed medications

55. DISORDERS OF THE
POSTERIOR PITUITARY
GLAND: ADH Abnormality
•SIADH
•DI

56. SIADH Syndrome of Inappropriate
Anti Diuretic Hormone
•Increased secretion of ADH
•Increased tubular reabsorption of water
= water intoxication and increased blood volume
(hypervolemia): (low Hct, hypoosmolality, edema)
•Decreased urine output
= concentrated urine
(high S.G., dark urine)
•Watch out for manifestations of Fluid Volume
Excess
•Cause: over medication of vasopressin and benign
pituitary tumor

57. DISORDERS OF the PITUITARY
GLAND: Posterior gland
ASSESSMENT findings
•1. Signs of Hypervolemia
•2. Mental status changes
•3. Abnormal weight gain

58. DISORDERS OF the PITUITARY
GLAND: Posterior gland
ASSESSMENT findings
•4. Hypertension
•5. Anorexia, Nausea and
Vomiting
•6. HYPOnatremia

59. DISORDERS OF the PITUITARY
GLAND: Posterior gland
DIAGNOSTIC TEST for SIADH
•1. Urine specific gravity is
increased (concentrated)
•2. Hyponatremia
•3. CBC shows hemodilution

60. SIADH
Management:
• FVE intervention
• Stop vasopressin
• Surgery (tumor excision)
Critical conditions:
• Pulmonary edema
• Cerebral edema
• Heart failure
• Hypertension
• Renal Failure

61. DISORDERS OF the PITUITARY
GLAND: Posterior gland
NURSING INTERVENTIONS
•1. Monitor VS and neurologic
status
•2. Provide safe environment
•3. Restrict fluid intake (less than
500cc/day)

62. DISORDERS OF the PITUITARY
GLAND: Posterior gland
NURSING INTERVENTIONS
•4. Monitor I and O and daily weight
•5. Administer Diuretics and IVF
carefully
•6. Administer prescribed
Demeclocycline to inhibit action of
ADH in the kidney

63. DI Diabetes Insipidus
•Decreased ADH secretion
•Decreased tubular reabsorption of water
= decreased blood volume
(high Hct, hyperosmolality, thrombosis)
•Increased urine output
= diluted urine (low S.G., clear urine)
•Watch out for manifestations of Fluid Volume
Deficit
•Cause: trauma or injury to pituitary gland,
resection of hypophysis, insensitivity of kidney to
ADH

65. DISORDERS OF the PITUITARY
GLAND: Posterior gland
•ASSESSMENT findings
•1. Polyuria of more than
4 liters of urine/day
•2. Polydipsia

66. DISORDERS OF the PITUITARY
GLAND: Posterior gland
•ASSESSMENT findings
•3. Signs of Dehydration
•4. Muscle pain and weakness
•5. Postural hypotension and
tachycardia

67. DISORDERS OF the PITUITARY
GLAND: Posterior gland
DIAGNOSTIC TEST
•1. Urinary Specific gravity
very low, 1.006 or less
•2. Serum Sodium levels
high

68. Management:
•FVD intervention
•Synthetic ADH administration (vasopressin)
Desmopressin (DDAVP) spray intranasal OD
or BID
• Vasopressin tannate in oil = IM OD or every
4 days
Critical conditions:
•Thrombosis – thromboembolism – pulmonary
embolism
•Ischemia
•Infarction
•Necrosis (CVA, MI, RF)

69. DISORDERS OF the PITUITARY
GLAND: Posterior gland
NURSING INTERVENTIONS
•1.Monitor VS, neurologic status
and cardiovascular status
•2. Monitor Intake and Output
•3. Monitor urine specific gravity

70. DISORDERS OF the PITUITARY
GLAND: Posterior gland
NURSING INTERVENTIONS
•4. Provide adequate fluids
•5. Administer Chlorpropamide or
Clofibrate as prescribed to
increase the action of ADH if
decreased

71. DISORDERS OF the PITUITARY
GLAND: Posterior gland
NURSING INTERVENTIONS
•6. Administer VASOPRESIN.
Desmopressin or Lypressin are
given intranasal. Pitressin is
given IM

72. ADRENAL GLAND
Abnormality
•Conn’s
•Cushing’s Disease
•Cushing’s Syndrome
•Addison’s Disease
•Pheochromocytoma

74. Conn’s Disease or
Primary Hyperaldosteronism
•Adrenal cortex disorder
•Over secretion of aldosterone or
mineralocorticoid
•Increased Na and H2O reabsorption=FVE
•Increased K urinary excretion=hypokalemia
•Watch out for manifestations of:
• SIADH
• Hypervolemia or FVE / Hypertension
• Hypokalemia (arrhythmias)
• Hypernatremia
•Caused:
• tumor and trauma of the adrenal cortex

75. Conn’s
•Management:
•FVE intervention
•Stop sodium intake
•Critical conditions:
•Arrhythmias
•Hypertension
•Same with SIADH

76. DISORDERS OF the ADRENAL
GLAND
•NURSING INTERVENTIONS
•1. Monitor VS, I and O and
urine sp gravity
•2. Monitor serum K and Na
•3. Provide Potassium rich foods
and supplements

77. DISORDERS OF the ADRENAL
GLAND
•NURSING INTERVENTIONS
•4. Administer prescribed
diuretic- Spironolactone- K
sparer
•5. Maintain sodium-restricted
diet

78. DISORDERS OF the ADRENAL
GLAND
•NURSING
INTERVENTIONS
•6. Prepare patient for
possible surgical
interventions

79. Cushing’s Disease
•Primary
•Adrenal cortex disorder/ tumor, pituitary tumor
•Over secretion of
- Mineralocorticoid: Aldosterone = Na and H2O
retention, K excretion
- Glucocorticoid = hyperglycemia
- Androgen
•Female: hoarseness of voice, hirsutism, ↑
clitoris
•Steroids = buffalo neck, trunkal obesity

80. Pathophysiology
Normal functions of
Glucocorticoids: Cortisol
Exaggerated functions
1. Gluconeogenesis HYPERGLYCEMIA
2. Protein breakdown OSTEOPOROSISS,
delayed wound healing
Purplish striae ,
Bleeding
Muscle wasting
3. Fat breakdown THIN extremity, Truncal
deposition
4. Decreased WBC IMMUNOSUPPRESSION

81. Pathophysiology
Functions of
Mineralocorticoids
Exaggerated
functions
1. Sodium RetentionHypernatremia
2.Secondary water
retention
Hypervolema-
Hypertension
3. Potassium
excretion
HYPOKALEMIA
Function of
androgen: Hair
growth
HIRSUTISM

82. Assessment
1. Generalized muscle weakness and
wasting
2. Truncal obesity
3. Moon-face
4. Buffalo hump
5. Easy bruisability

83. DISORDERS OF the ADRENAL
GLAND
ASSESSMENT FINDINGS for
Cushing
•6. Reddish-purplish striae on
the abdomen and thighs
•7. Hirsutism and acne
•8. Hypertension

85. DISORDERS OF the ADRENAL
GLAND
ASSESSMENT FINDINGS for
Cushing
•9. Hyperglycemia
•10. Osteoporosis
•11. Amenorrhea

87. Cushing’s Disease
•Management:
Diet: Low Sodium, High Potassium
FVE intervention
Replace potassium
Insulin administration
Hypertension
Surgery is adrenalectomy
•Critical conditions:
Arrhythmias due to hypoK
Hypertensive crisis
Fluid overload
Hyperglycemia

88. Cushing’s Syndrome
•Secondary
•Pituitary gland disorder
•Same with Cushing’s Disease
•Surgery is hypophysectomy

89. Addison’s Disease
•Adrenal cortex disorder/ tumor, idiopathic
•Hyposecretion of:
- Mineralocorticoid: Aldosterone=Na and H2O
excretion (hyponatremia, hypovolemia,
hypotension), K reabsorption (hyperkalemia)
- Glucocorticoid=hypoglycemia
- Androgen=decreased libido
• MSH=bronzing of the skin (primary)

90. Addison’s Disease
•Management
FVD intervention
Increase potassium excretion
Glucagon or simple sugar
administration
Steroid medication

91. DISORDERS OF the ADRENAL
GLAND
•NURSING INTERVENTIONS
•1. Monitor VS especially BP
•2. Monitor weight and I and O
•3. Monitor blood glucose level and
K
•4. Administer hormonal agents as
prescribed

92. DISORDERS OF the ADRENAL
GLAND
•NURSING INTERVENTIONS
•5. Observe for ADDISONIAN crisis
•6. Educate the client regarding
lifelong treatment, avoidance of
strenuous activities, stress and
seeking prompt consult during
illness

93. DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
•7. Provide a high-protein,
high carbohydrate and
increased sodium intake

94. DISORDERS OF the ADRENAL
GLAND
ADDISONIAN crisis
•A life-threatening disorders
caused by acute severe adrenal
insufficiency
CAUSES: Severe stress,
infection, trauma or surgery

95. DISORDERS OF the ADRENAL
GLAND
ADDISONIAN crisis
PATHOPHYSIOLOGY
•Overwhelming stimuli mobilize
body defense decreased
stress hormones inadequate
coping

96. DISORDERS OF the ADRENAL
GLAND
ASSESSMENT Findings for Addisonian
Crisis= “severe lahat”
•1. Severe headache
•2. Severe pain
•3. Severe weakness
•4. Severe hypotension
•5. Signs of Shock

97. Addison’s Disease
Critical Conditions:
•Addisonian crisis – cyanosis, with
signs of circulatory shock: pallor,
apprehension, rapid and weak pulse,
↑ RR, and acute hypotension
•Dehydration
•Arrhythmias due to hyperkalemia
•Hypoglycemia
•Same with DI

98. DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
•1. Administer IV glucocorticoids,
usually hydrocortisone
•2. Monitor VS frequently
•3. Monitor I and O, neurological
status, electrolyte imbalances and
blood glucose

99. DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
•4. Administer IVF
•5. Maintain bed rest
•6. Administer prescribed
antibiotics

100. Steroid
•Dose is variable
•Best time to give between 7-8 AM
(active gland) to prevent side effects
•Steroid-induced adrenal insufficiency =
TAPERING the DOSE
•Pituitary adrenal suppresion = DOSAGE
CONTROL

101. Steroid
•Hypertension, thromboembolism
•Prone to infection
•Glaucoma, corneal ulceration
•Muscle wasting, poor wound healing
•Osteoporosis,
•Hyperglycemia
•Weight gain, moon face, trunkal obesity, buffalo
hump
•Acne
•MEDIC-ALERT CARD

102. Addison’s Disease
•Critical Conditions
•Dehydration
• Arrhythmias due to hyperK
•Hypovolemic shock
•Hypoglycemia
•Same with DI

103. Addison’s Disease
•inc ACTH, inc cortisol = pituitary
problem (benign tumor)
•normal ACTH, inc cortisol = adrenal
problem (benign tumor)
•dec ACTH, dec cortisol = atrophy of the
pituitary gland
•normal ACTH, dec cortisol = atrophy of
the adrenal gland

104. Pheochromocytoma
•Hyperfunction of adrenal medulla
•Cause: Tumor usually benign
•catecholamines (nor E and E)
•S/sx:
•5 H: HPN, Headache, Hypermetabolism
Hyperglycemia, Hyperhidrosis(sweat),, n&v,
anorexia, dilated pupils, weight loss, tremors,
cold extremities, CHF and cerebral bleeding.

106. •Dx
•VMA vanilly mandelic acid (urine
specimen)
•catecholamines (blood specimen)
•blood sugar and glycosuria
•Monitor VS esp BP
•Give antihypertensive drugs:Phentolamine
•Provide high calorie foods
•Prepare pt forSurgical Intervention
(adrenalectomy)
Pheochromocytoma

108. THYROID GLAND
Abnormality
•GOITER
•Iodine-deficient
•Goitrogenic = cabbage, beans
•Compensatory hypertrophy
•No s/sx, compression of the trachea
•SSKI to suppress pituitary’s TSH secretions
•Less than 40 fg/day of iodine = goiter
•Iodized salt = 1:100,000
•PREVENTION = iodized salt

109. THYROID GLAND
Abnormality
•Hypothyroidism
•Hyperthyroidism
–Note:
–inc T3, inc T4, dec TSH = thyroid problem
–inc T3, inc T4, inc TSH = pituitary tumor
(benign)

110. Hypothyroidism
•Caused by:
•Autoimmune Disease (Hashimoto’s
Thyroiditis)
•Use of radioactive iodine
•Destruction or removal of thyroid tissue
•Overtreatment of antithyroid drug
MYXEDEMA- Adults
CRETINISM- Children

111. 3 Basic Concepts:
•Decreased metabolic rate due to
hyposecretion of T3
•Decreased body heat production due
to hyposecretion of T4
•Hypercalcemia due to hyposecretion
of calcitonin

114. ASSESSMENT
1. Lethargy and fatigue
2. Weakness and paresthesia
3. COLD intolerance
4. Weight gain
5. Bradycardia,
constipation

115. ASSESSMENT
6. Dry hair and skin,
loss of body hair
7. Generalized puffiness
and edema around
the eyes and face

116. Con’t of s/sx
•SQ swelling, puffy skin, puffy eyelids
•Thinning of hair, loss of lateral 1/3 of the
eyebrow
•Menorrhagia or amenorrhea, decreased
libido, abortions
•Myxedema = severe complication leads
to coma

117. Management
•Symptomatic
•Monitor VS and daily weights
•Provide warm environment
•Diet: low calorie, high fiber
•Thyroid hormone replacement
T4 Synthroid, Levothyroid
T3 Cytomel
T3 & T4 Proloid
T3 given NGT, faster than T4
T4 given parenterally(S.E. adrenal insuf.)
•Note: 3-12 wks S/Sx must disappear

118. Hyperthyroidism
•Caused by:
•Grave’s Disease: Autoimmune
–TSAb thyroid stimulating antibody duplicate
–TSH, which increases thyroid hormone
secretion ( ↑T3 and T4)
•Toxic nodular goiter (benign, hot spot)
•Overmedication of thyroid hormone
•Severe emotional stress

119. 3 Basic Concepts:
•Increased metabolic rate due to
hypersecretion of T3
•Increased body heat production due
to hypersecretion of T4
•Hypocalcemia due to hypersecretion
of calcitonin

121. •Manifestations:
•Nervousness, tremors, emotional
lability
•Weight loss, emaciated
•Flushed skin, warm and moist
•Increased temp and palpitation to
atrial fibrillation
•Heat intolerance
•Hypertension
•Difficulty in sitting quietly

122. •Thyroid gland may be palpable and a (+) bruit
•Diarrhea
•Bulging eyes (exophthalmus), startled
expression
•Amenorrhea, oligomenorrhea, decreased
libido
•Delirium, disorientation, extreme
nervousness
•Arrhythmias
•Thyroid storm = hyperpyrexia, diarrhea,
dehydration,
•tachycardia, arrhythmias, delirium, coma,
shock, death

123. Exophthalmus

124. Thyroid Scan

125. MANAGEMENT
•Beta blockers- Metoprolol: Inderal
- to control tachycardia and hypertension
•Thiomides- PTU (propylthiouracil) and
Tapazole ( Methimazole)
-to inhibit synthesis of thyroid hormone
side effects: Agranulocytosis and
neutrpenia
•Radioactive Iodine – isolation for a few days,
body secretions are radioactive contaminated

126. MANAGEMENT
Surgery:Thyroidectomy: 5/6 of the gland is removed
•SSKI (Lugol’s) is given preop to dec thyroid
vascularity & to inhibit release of thyroid hormone
•Given with juice to disguise taste
•Given with straw to prevent staining of teeth
Postop:
•Position: Semi-fowlers, neck at the midline
•Monitor for bleeding, prevent hemorrhage by placing
ice collar over the neck
•Monitor blood pressure- to assess for
TROUSSEAU’S Sign ( hypocalcemia)
•Check for tetany and monitor for signs of
hypocalcemia (parathyroid gland is severed)
- give calcium gluconate
•Hoarseness of voice-laryngeal nerve damage- ask
the client to speak every hour
•Watchout thyroid crisis

127. THYROIDECTOMY
•Removal of the thyroid gland

128. DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
•1. Provide adequate rest periods in a
quiet room
•2. Administer anti-thyroid medications
that block hormone synthesis-
Methimazole and PTU
•3. Provide a HIGH-calorie diet, HIGH
protein

129. DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
•4. Manage diarrhea
•5. Provide a cool and quiet
environment
•6. Avoid giving stimulants
•7. Provide eye care
–Hypoallergenic tape for eyelid
closure

130. DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
•7. Administer PROPRANOLOL
for tachycardia
•8. Administer IODIONE
preparation- Lugol’s solution and
SSKI to inhibit the release of T3
and T4

131. DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
•9. Prepare clients for Radioactive
iodine therapy
•10. Prepare patient for
thyroidectomy
•11. Manage thyroid storm
appropriately

132. DISORDERS OF the THYROID
GLAND
Thyroid storm
•An acute LIFE-threatening
condition characterized by
excessive thyroid hormone

133. DISORDERS OF the THYROID
GLAND
Thyroid storm
CAUSE: Manipulation of the
thyroid during surgery causing
the release of excessive
hormones in the blood

134. ASSESSMENT Findings for
Thyroid Storm
•1. HIGH fever
•2. Tachycardia and
Tachypnea
•3. Systolic HYPERtension
DISORDERS OF the THYROID
GLAND

135. ASSESSMENT Findings for Thyroid
Storm
•4. Delirium and coma
•5. Severe vomiting and diarrhea
•6. Restlessness, Agitation,
confusion and Seizures
DISORDERS OF the THYROID
GLAND

136. DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
•1. Maintain PATENT airway and
adequate ventilation
•2. Administer anti-thyroid
medications such as Lugol’s
solution, Propranolol, and
Glucocorticoids

137. DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
•3. Monitor VS
•4. Monitor Cardiac rhythms
•5. Administer PARACETAMOL
( not Aspirin) for FEVER

138. DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
•6. Manage Seizures as
required.
•7. Provide a quiet
environment

139. Parathyroid Gland
Abnormality
•Hypoparathyroidism
•Hyperparathyroidism

141. Parathyroid Gland
- produce parathyroid hormone/parathormone which
regulates calcium and phosphorus balance
dec serum Ca level
↓
PTH release
↓
withdraws Ca from bones
↓
↑ serum Ca levels
Therefore: Hyperparathyroidism: Hypercalcemia
Hypoparathyroidism: Hypocalcemia

142. Hypoparathyroidism
•Caused:
•Accidental removal or destruction of
parathyroid gland
•Thyroidectomy
•Radical neck dissection
•Idiopathic
•Autoimmune

143. •Diagnostic:
•Decreased PTH
•Decreased serum Ca (7.5 mg/100 ml)
•Increased PO4

144. •Manifestation:
•Hypocalcemia
•Tetany
•Numbness of fingers
•+Chvostek’s sign
•+Trousseau’s sign
•+Laryngeal spasm
•Severe anxiety and apprehension
•Muscle cramps
•Cardiac dysrhythmias

146. •Management:
•Treat the cause
•IV calcium gluconate
-Syringe and ampule of Ca
sol. on bedside
•Oral Ca with vit D

147. Hyperparathyroidism
Caused:
•Primary
•Tumor/adenoma
•hyperplasia
Diagnostic:
•Increased vit D
•Increased PTH
•Increased serum Ca (11 mg/100 ml)
•Decreased PO4

148. •Manifestation:
•Hypercalcemia
•Decalcification of bone
•Fracture
•Deep bone pain
•Depression of neuromuscular
function
•Generalized fatigue
•Memory loss
•Dec LOC, stupor coma

149. •Management:
•Treat the cause
•Hydration (IV saline)
•Diuretics (Ca excretion)
•Calcitonin (inhibits bone resorption)
•Dietary Ca restriction
•Avoid thiazide and vit D (may increase Ca)
•Dialysis
•Digitalis is withdrawn (may increase Ca)

150. •Pancreas: Islet of langerhans
Alpha- glucagon- ↑blood sugar
(hyperglycemia) by stimulating
glycogenolysis & gluconeogenesis
Beta- insulin- ↓blood sugar
(hypoglycemia) by facilitating transport
of glucose across cell membranes of
muscle, liver, adipose tissue, inhibits
breakdown of proteins, requires Na for
transport of CHO and requires K for
production

151. Diabetes Mellitus
•DM is a disorder of glucose intolerance
caused by a deficiency in insulin
production and action resulting in
hyperglycemia and abnormal
CHO, CHON and fat metabolism.

152. Types
•Type I or IDDM
no insulin
diseased pancreas (beta cell)
•Type II NIDDM
decreased insulin
inadequate insulin

153. IDDM- Juvenile Onset DM, Brittle
DM, Unstable DM
•Genetic and hereditary
•Zero insulin
•Coxsackie virus
•Onset: Young age before 30 y/o
•5-10% of persons with diabetes
•3 P’s with weight loss
•Thin
•DKA

154. MANAGEMENT
•Diet
•Activity/Exercise
•Insulin

155. NIDDM- Maturity Onset DM,
Stable DM, Ketosis Resistant DM
•Adult onset
•Genetic
•90-95% of persons with diabetes
•Insulin resistance
•Obesity
•3 P’s
•HHNK Coma or HONK Coma

156. Manifestations
•Polyuria- glucose exert high osmotic pressure w/in
the renal tubules, osmotic diuresis occurs,
hypovolemia, ECF/ICF dehydration
•Polydipsia- results from ECF/ICF dehydration
•Polyphagia- the cells are starved
•Glycosuria- glucose level exceed renal threshold
(180mg/dl)
•Inc Blood Viscosity- sluggish circulation,
microorganism proliferation, infection
•Ketonuria
•Tissue wasting
•Weight Loss

157. COMPLICATIONS
•Macroangiopathies
brain: CVA
heart: Myocardial Infarction
peripheral arteries: peripheral
vascular disease
•Microangiopathies
kidneys: renal failure
eyes: retinopathy/cataract
•Neuropathy
spinal cord/ ANS
paralysis
peripheral neuropathy
numbness/tingling sensation
neurogenic bladder

158. MANAGEMENT
•Diet
•Activity/Exercise
•Oral Hypoglycemic Agents
•Insulin- in case of stress, surgery,
infection, pregnancy---these conditions
trigger stress response and stimulate the
secretion of epi, norepi, glucocorticoids
thereby causing hyperglycemia

159. •DIET- CHO 50%, Fats 30%, CHON 20%
- ↓ calorie specially if obese
•ACTIVITY/EXERCISE- ↑ CHO uptake by
the cells, ↓ insulin requirements,
maintains ideal body weight
- done 1-2 hours after meals to prevent
hypoglycemia
- regular pattern
•MEDICATIONS: Oral Hypoglycemic
Agents- indicated only in type II DM
•INSULIN

160. OHA = oral hypoglycemic agents
•Sulfonylureas - stimulates insulin secretions and
increases tissue sensitivity to insulin (Glipizide,
Euglucon)
•Biguanides – decreases intestinal uptake and
hepatic production of glucose and increases tissue
sensitivity
(Glucophage) Alpha
•Glucosidase Inhibitor – slows CHO carbohydrate
absorption (Glucobay)
•Thiazolidinediones – insulin sensitizer, increases
tissue sensitivity to insulin (Avandia)

161. TYPES OF INSULIN
ONSET PEAK DURATION
•Immediate 5-15 min 30-90 min 3-5 hours
Acting, Lispro
•Rapid Acting
- clear insulin 30-60min 2-4 hours 6-8 hours
Humulin R,
Regular,
Semilente
Actrapid
•Intermediate 1-2 hours 6-8 hours 18-24 hours
Acting-cloudy
NPH
Lente,
Humulin N
Monotard
•Long Acting 3-4hours 16-20hours 30-36 hours
- cloudy
UltraLente

162. •Mixture of NPH and Regular
•Humulin 70/30
•Novolin 70/30
•Humulin 50/50
•Onset 2 hours
•Peak 8-12 hours
•Duration 12-16 hours

163. About Insulin!
•Hyperinsulinism – tremors, hunger and
diaphoresis will manifest
•Somogyi Phenomenon – rebound hyperglycemia
after insulin administration
(gradual reduction of insulin is the key to manage
it)
•Lipodystrophy is a complication if the site of
injection is not rotated properly, it can also alter
the rate of insulin absorption.
•Insulin Pump – external battery operated,
needle is inserted SQ that delivers
regular insulin (monitor hypokalemia)

164. NURSING INTERVENTIONS
•Site – abdomen (best site), upper arms,
upper buttocks- rotate the site of injection
•Route – SQ, only REGULAR insulin can
be given as IV bolus esp in case of DKA
(flush the line first it will absorb insulin)
•IV bolus – mixed with D5W if
hypoglycemic, or PNSS ideal for
DKA and HONKS
•Subcutaneous-Pinch or 45 for thin
patient, 90 for regular client
•Good site must be supple skin.

165. •Mixed Insulin – regular (clear) first to be
drawn followed by NPH (cloudy)
•Administer at room temp- cold insulin
leads to lipodystrophy
•Refrigerate after use.

166. Diagnostic Evaluation
•Fasting Blood Sugar –80-120mg/dl
 140 mg/dl for 2 readings
•2H Postprandial Blood Sugar Test –
 200 mg/dl
100 gm of sugar orally
then check after 2H
•OGTT - 200 mg/dl
blood is withdrawn initially
150-300 gm of CHO/sugar PO
every hour bloos specimen is taken (1H,2H,3H
after)
- done when results of FBS and 2H PPBS
are borderline

167. •Random Blood Sugar –
 200 mg/dl for 2x + 3 P’sblood is
withdrawn anytime
•Glycosylated Hg A1C -
can detect average serum
glucose level over preceding
2-3 months (most reliable)
Adult 2.2%-4.0%
Children 1.8%-4.0%

168. END