Medical-Surgical Nursing Endocrine System Reviewer
Endocrine system 1. 2. 3. 4. 5.
hormones released into the bloodstream travel throughout the body target is usually far from site of synthesis binds to receptors on or in target targets = cells throughout the body results may take hours, but last longer
Functions of Hormones Helps regulate: 1. extracellular fluid 2. metabolism 3. biological clock 4. contraction of cardiac & smooth muscle 5. glandular secretion 6. some immune functions Growth & development Reproduction •
• •
Endocrine glands in the human head and their hormones
Exocrine glands
1. 2. Endocrine glands 1. 2. 3.
secrete products into ducts which empty into body cavities or body surface sweat, oil, mucous, & digestive glands secrete products (hormones) into bloodstream pituitary, thyroid, parathyroid, adrenal, pineal other organs secrete hormones as a 2nd function hypothalamus, thymus, pancreas,ovaries,testes, kidneys, stomach, liver, small intestine, skin, heart & placenta
DISORDERS OF THE ENDOCRINE SYSTEM DIABETIS INSIPIDUS – hyposecretion of ADH Cause: idiopathic/ unknown Predisposing factor: 1. Pituitary surgery
2. 3. 4.
Trauma/ head injury Tumor Inflammation
Signs and Symptoms 1. Polyuria 2. Signs of dehydration st -1 sign of dehydration in children-tachycardia) - Excessive thirst (adult) - Agitation - Poor skin turgor - Dry mucus membrane 3. Weakness & fatigue 4. Hypotension – if left untreated 5. Hypovolemic shock 6. Anuria – late sign hypovolemic shock Diagnostic 1. Decrease urine specific gravity- concentrated urine N= 1.015 – 1.035 2. Serum Na = increase (N=135 -145 meq/L) Hypernatremia Nursing Management 1. Force fluid 2,000 – 3,000ml/day 2. Administer IV fluid replacement as ordered 3. Monitor VS, I&O 4. Administer meds as ordered a.) Pitresin (vasopressin) IM 5. Prevent complications Most feared complication – Hypovolemic shock
SIADH - Syndrome of Inappropriate Anti-Diuretic Hormone - Increase ADH - Idiopathic/ unknown Predisposing factor 1. Head injury 2. Related to Bronchogenic cancer or lung caner3. Hyperplasia of Pituitary gland 4. Increase size of organ Signs and Symptoms 1. Fluid retention 2. Increase BP – HPN 3. Edema 4. Wt gain 5. Danger of H2O intoxication –Complications: 1. cerebral edema 2. increase ICP 3. 2. seizure Diagnostic 1. Urine specific gravity increase – diluted urine 2. Hyponatremia – Decreased Na Nursing Management 1. Restrict fluid 2. Administer meds as ordered eg. Diuretics: Loop and Osmotic 3. Monitor strictly V/S, I&O, neurologic check – increase ICP 4. Weigh daily 5. Assess for presence edema 6. Provide meticulous skin care 7. Prevent complications – increase ICP & seizures activity
SIMPLE GOITER – enlarged thyroid gland - iodine deficiency Predisposing factors Age over 40 years 1. 2.
Family history of goiter
3.
Female gender
4.
Not getting enough iodine in the diet
Signs and Symptoms 1. Breathing difficulties (may rarely occur with very large goiters) 2. Cough 3. Hoarseness 4. Swallowing difficulties Diagnostic 1. Thyroid scan – reveals enlarged Thyroid Gland 2. Serum TSH – increase (confirmatory) 3. Serum T3, T4 Nursing Management 1. Administer meds a.) Iodine solution – Logol’s solution or saturated sol ution of K iodide(SSKI) 1. use straw to prevent staining teeth 2. Prophylaxis 2 -3 drops for Treatment – 5 to 6 drops
b.) Thyroid hormone Agents 1. Levothyroxine (Synthroid) 2. Liothyronine (cytomel) 3. Thyroid extract a. Monitor vs. – HR due tachycardia & palpitation b. Take it early AM – SE insomnia c. Monitor s/e
2.Encourage increase intake of iodine Seafood- highest iodine content :oysters, clams, crabs, lobster Lowest iodine – shrimps Iodized salt –easily destroyed by heat take it raw not cooked 3.Assist in surgery: Sub Total ThyroidectomyComplications: 1. Tetany 2. laryngeal nerve damage 3.Hemorrhag e-feeling of fullness at incision site.Check nape for wet blood 4.Laryngeal spasm – DOB, SOB – tracheostomy set ready at bedside
HYPOTHYROIDISM AND HYPERTHYROIDISM
HYPOTHYROIDISM All body sy stem s ar e DECR EAS ED ex cept WEI GH T and MENS TRUATIO N! decreased CNS: drowsiness, memory problems (forgetfulness) decreased v/s: hypotension, bradycardia, bradypnea, low body temp decreased GI motility: constipation decreased appetite ( anorexia ) but with WEIGHT GAIN [low metabolism causes decreased burning of fats and carbs]
HYPERTHYROIDISM All body sy stem s ar e IN CRE AS ED except WEI GH T and MENS TRUATIO N! increased CNS: tremors, insomnia
increased v/s: hypertension, tachycardia, tachypnea, fever increased GI motility: diarrhea increased appetite ( hyperphagia) but with WEIGHT LOSS [high metabolism causes increased burning of fats and carbs]
This leads to increased serum cholesterol atherosclerosis (hardening
of arteries due to cholesterol
deposits) Because of increased cholesterol, hypothyroid patients are prone to hypertension, myocardial infarction, CHF and stroke
decreased metabolism causes decreased perspiration
increased metabolism causes increased perspiration
DRY SKIN and COLD INTOLERANCE Menorrhagia (excessive bleeding during menstruation)
MOIST SKIN and HEAT INTOLERANCE
Nursing Management for hypothyroidism: Low calorie diet Warm environment
Amenorrhea (absence of menstruation) Pathognomic sign: EXOPHTHALMOS (bulging eyeballs) Nursing Management for hyperthyroidism: High calorie diet Cool environment
HYPOPARATHYROIDISM - parathyroid glands in the neck do not produce enough parathyroid hormone Predisposing factors 1. Following subtotal thyroidectomy 2. Atrophy of parathyroid gland due to a. Irradiation b. Trauma Signs and Symptoms 1. Abdominal pain 2. Brittle nails 3. Cataracts 4. Dry hair 5. Dry, scaly skin 6. Muscle cramps 7. Muscle spasms called tetany (can affect the larynx, causing breathing difficulties) 8. Pain in the face, legs, and feet 9. Seizures 10. Tingling lips, fingers, and toes 11. Weakened tooth enamel (in children) Diagnostic 1. Serum calcium – decrease 2. Serum phosphate increase 3. X-ray of long bone – decrease bone density 4. CT Scan – reveals degeneration of basal ganglia Nursing Management 1. Administration of meds: a. Oral calcium carbonate tablets b. Vitamin D, which can help your body absorb calcium and eliminate phosphorus 2. Avoid precipitating stimulus such as bright lights & noise: photophobia leading to seizure 3. Diet – increase Ca & decrease phosphorus 4. Prepare tracheostomy set due to laryngospasm 5. Encourage to breath with paper bag in order to produce mild respiratory acidosis – to promote increase ionized Ca levels 6. Most feared complication : Seizure & arrhythmia 7. Hormonal replacement therapy - lifetime 8. Important follow up care
HYPERPARATHYROIDISM -overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH) -parathyroid hormone regulates and maintains calcium and phosphate levels
Classification a. Primary b. Secondary Predisposing Factors
1. 2. 3.
vitamin D deficiency people who take lithium growth on the parathyroid glands enlargement of 2 or more of the parathyroid glands or medical conditions such as kidney failure and rickets
4. Signs and Symptoms 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.
Back pain Blurred vision (because ( because of cataracts) of cataracts) Bone pain or tenderness Decreased height Depression Fatigue Fractures of long of long bones Increased urine output Increased thirst Itchy skin Joint pain Loss of appetite Nausea Muscle weakness and pain Personality changes Stupor and possibly coma Upper abdominal pain
Diagnostic 1. Serum Ca increase 2. Serum phosphorus decreases 3. X-ray long bones – reveals bone demineralization
Nursing Management: Kidney Stone 1. 2. 3. 4. 5. 6.
7. 8. 9. 10. 11. 12. 13.
Force fluids – 2,000 – 3,000/day or 2-3L/day Isotonic solution Warm sitz bath – for comfort Strain all urine with gauze pad Acid ash diet – cranberry, plum, grapefruit, vit C, calamansi – to acidify urine Administer medications as ordered a. Narcotic analgesic – Morphine SO4, Demerol (Meperidine Hcl) 1. Narcan/ Naloxone – antidote 2. Naloxone toxicity – tremors Put siderails Assist in ambulation Diet – low in Ca, increase phosphorus lean meat Prevent complication Most feared – renal failure Assist surgical procedure – parathyroidectomy Importance of ff up care Hormonal replacement- lifetime
ADDISON’S DISEASE AND CUSHING’S SYNDROME Addison’s disease Hyposecretion of adrenal hormones
Sugar : hypoglycemia Salt : hyponatremia, with hyperkalemia Sex : decreased libido
Cushing’s syndrome Hypersecretion of adrenal hormones
Sugar : hyperglycemia Salt : hypernatremia, with hypokalemia Sex : hirsutism, acne, striae
Hypoglycemia (T-I-R-E-D) Tremors/Tachycardia Irritability Restlessness Extreme fatigue Diaphoresis/Depression
Hyperglycemia (P-P-P) Polyuria Polydypsia Polyphagia Note: DM is a complication of Cushing’s
Decreased tolerance to stress due to decreased steroids
Increased steroids cause decreased WBC (Leukopenia)
can lead to ADDISIONIAN CRISIS
IMMUNODEFICIENCY Note: Steroids takers (athletes,body builders) experience ssx of Cushing’s
Hyponatremia
Hypernatremia with Fluid Volume Excess Hypertension Edema Weight Gain Pathognomonic Sx of Cushings: Moon-face Buffalo hump Obese trunks Pendulous Abdomen Thin extremeties Hypokalemia Weakness, fatigue Constipation Prominent U wave can also lead to arrhythmia Hirsutism, acne and striae due to increased sex hormones Other signs: Depression Easy bruising Increased masculinity in women Management: Potassium-sparing diuretics: Aldactone [Spironolactone] – promotes excretion of sodium while retaining potassium DO NOT GIVE LASIX Limit fluids Increase potassium in the diet
Hypotension Dehydration Weight Loss
Hyperkalemia Irritability, Irritability, agitation Diarrhea, abdominal cramps Peak T waves arrhythmia Decreased sexual urge and loss of pubic and axillary hair Pathognomonic sx: Bronze-like skin Decreased cortisol causes pituitary gland to secrete Melanocyte-stimulating hormone
Management: 2 1 Steroids ( /3 dose in AM and /3 dose in PM)
PANCREATITIS – acute inflammation of pancreas leading to pancreatic edema, hemorrhage & necrosis due to Autodigestion (selfdigestion) Cause: unknown/idiopathic Pathognomonic sign 1. (+) Cullen’s sign - Ecchymosis of umbilicus (bluish color) 2. (+) Grey turner’s sign – ecchymosis of flank area
CHRONIC HEMORRHAGIC PANCREATITIS -
“bangugot”
Predisposing factors - unknown Risk factors
1. 2. 3. 4. 5. 6. 7.
History of hepatobiliary disorder Alcohol Drugs – thiazide diuretics, oral contraceptives, aspirin, penthan Obesity Hyperlipidemia Hyperthyroidism High intake of fatty food – saturated fats
DIABETES MELLITUS
Type I DM
Type II DM
Insulin-dependent
Non Insulin-dependent
Juvenile onset type (common among children)
Adult/Maturity onset type (common among 40 y.o. & above)
Non-obese
Obese
“Brittle disease”
“Non-brittle disease”
Etiology: Hereditary
Etiology: Obesity
Symptomatic
Asymptomatic
Characterized by Weight Loss
Characterized by Weight Gain
Treatment: Insulin
Treatment: Oral Hypoglycemic Agents (OHA)
Complications: Diabetic Ketoacidosis (DKA) Sodium Bicarbonate (NaHCO 3) administered to treat acidosis
Complications: Hyper-Osmolar Non-Ketotic Coma (HONCK) Non-ketotic, so no lipolysis
Can lead to coma
Can also lead to coma Can lead to seizure
GESTATIONAL DM – occurs during pregnancy & terminates upon delivery of child Predisposing Factors 1. Unknown/ idiopathic 2. Influence of maternal hormones Signs and Symptoms Same as type II – 1. Asymptomatic 2. 3 P’s & 1G
Type of delivery – CS – due to large baby Signs of hypoglycemia on infant 1. High pitched shrill cry 2. Poor sucking reflex
DIABETIC KETOACIDOSIS (DKA) -
Acute complication of Type I DM due to severe hyperglycemia leading to CNS depression & Coma. Ketones- a CNS depressant
Predisposing factor 1. 2. 3.
Stress – between stress and infection, stress causes DKA more. Hyperglycemia Infection
Signs and Symptoms 3 P’s & 1G 1. Polyuria 2. Polydipsia 3. Polyphagia 4. Glycosuria 5. Wt loss 6. Anorexia, Nausea/vomiting 7. (+) Acetone breath odor- fruity odor 8. Kussmaul's resp-rapid shallow respiration 9. CNS depression 10. Coma
pathognomonic sign
Nursing Management 1. Assist in mechanical ventilation 2. Administer 0.9NaCl – isotonic solution Followed by .45NaCl hypotonic solution to counteract dehydration. 3. Monitor VS, I&O, blood sugar levels 4. Administer meds as ordered:
a.) Insulin therapy – IV push Regular Acting Insulin – clear (2-4hrs, peak action) b.) To counteract acidosis – Na HCO3 c.) Antibiotic to prevent infection Insulin Therapy Sources 1. Animal source – beef/ pork-rarely used. Because it causes severe allergic reaction 2. Human – has less antigenecity property ,cause less allergic reaction ex. Humulin 3. Artificially compound Types of Insulin 1. Rapid Acting Insulin - Ex. Regular acting I 2. Intermediate acting I - Ex. NPH (non-protamine Hagedorn I) 3. Long acting I - Ex. Ultra lente Types of Insulin 1. Rapid 2. Intermediate Intermediate 3. Long acting
color & consistency onset clear cloudy cloudy
peak -
duration 2-4h 6-12h 12-24h
-
Nursing Management: upon injection of insulin: 1.Administer insulin at room temperature to prevent lipodystrophy 2. Insulin is only refrigerated once opened 3. Gently roll vial bet palms. Avoid shaking to prevent formation of bubbles 4. Use gauge 25 – 26needle – tuberculin syringe 5. Administer insulin at either 45(for skinny pt) or 90 depending on the client tissue deposit 6. Don’t aspirate after injection 7. Rotate injection site to prevent lipodystrophy 8. Most accessible site – abdomen 9. When mixing 2 types of insulin, aspirate st 1 regular/ clear – before cloudy to prevent contaminating clear insulin & to promote accurate calibration 10. Monitor signs of complications: a. Allergic reactions – lipodystrophy b. Somogyi’s phenomenon – phenomenon – hypoglycemia followed by periods of hyperglycemia or rebound effect of insulin. 11. 1ml or cc of tuberculin = 100 units of insulin
