Endocrine Disorders and Pancreatic Function

Endocrine Disorders: Promoting Health in Patients

• Objectives: Determine objective and subjective data for endocrine function assessment, compare and contrast alterations in endocrine function, create individualized nursing care plans, identify medication classifications and side effects for endocrine alterations, develop teaching strategies for endocrine dysfunction, describe the role of nursing in coordinating endocrine surgery care, prioritize nursing assessments and interventions, and review anatomy and physiology related to the endocrine system, specifically the pancreas.

Endocrine Function of the Pancreas

• Endocrine Function: Secretion of insulin and glucagon.

• Exocrine Function: Secretion of enzymes to aid in food digestion.

• Glucose Homeostasis: Cells require glucose for energy; inability to absorb glucose triggers the liver to release glucagon, stimulating gluconeogenesis and glycogenolysis to increase blood glucose levels.

Hyperglycemia: Manifestations, Diagnostics and Comorbidities

• Manifestations: Fasting blood glucose exceeding 126 mg/dL; symptoms like polyuria, polyphagia, polydipsia, weight loss, and dry mucous membranes, and potential complications including Kussmaul breathing.

• Diagnostics: Blood glucose testing (fasting >126 mg/dL; postprandial >180 mg/dL), Hemoglobin A1C (HbA1c), CT scans, US, and MRI.

• Comorbidities: Autoimmune disorders, hyperlipidemia, hypertension, gestational diabetes, Polycystic ovary syndrome (PCOS), metabolic syndrome, Cushing's syndrome, and pheochromocytoma.

Hyperglycemia: Risk Factors and Causes

• Risk Factors: Steroid use, phenytoin, estrogen medications, illness, infections, chronic stress, insomnia, and genetic predispositions, missing/insufficient diabetic medication, poor injection technique, and expired insulin.

Hyperglycemia: Complications

• Complications: Metabolic syndrome, fluid imbalances (hypokalemia and hyponatremia), depression, coma, and death.

Hyperglycemia: Treatment

• Treatment: Restore fluid and electrolyte balance, lower glucose levels via diet, exercise, and medications (insulin, sulfonylureas, thiazolidinediones, biguanides, DPP-4 inhibitors, and SGLT2 inhibitors). Includes monitoring glucose, medication education, monitoring electrolytes, and monitoring for dehydration.

Hypoglycemia

• Definition: Low blood glucose (<70 mg/dL).

• Causes: Insufficient glucose to meet cellular needs, frequent events leading to a poorer quality of health, and potential complications including seizures, coma, cardiac arrhythmia, or death.

• Risks: Type 1 diabetes, type 2 diabetes, medications (insulin), insulin pump malfunction, lack of oral intake, increased exercise, trauma, surgery, pancreatitis, liver/kidney malignancies, and medications that cause hypoglycemia (antiarrhythmic and antibiotics).

• Interventions: Monitor vital signs, physical assessment, emotional support, and education; Implement glucose monitoring , administration of 15-20 g of fast-acting carbohydrates, administer glucagon (IV, subcutaneous, intranasal, or IM) if unable to swallow.

Medical Management of Diabetes

• Insulin Delivery Types: Insulin pens and pumps.

• Insulin Therapy: Basal and bolus insulin therapy, subcutaneous injection sites.

• DKA Treatment: Hydrate, decrease blood glucose, monitor potassium, and correct acid-base imbalances with IV fluids, beginning with 0.9% normal saline and increasing as indicated, also use 0.45% NS, which can have 5% dextrose added when glucose is around 250-300 mg/dL to lower blood sugar and insulin to bring it down correctly.

Management of Type 1 and Type 2 Diabetes

• Type 1 Diabetes: Insulin therapy is needed as there is a lack of or no insulin in the body.
• Type 2 Diabetes: Relative insulin deficiency due to insulin resistance and decreased insulin production; lifestyle changes and medications (oral antidiabetics and/or insulin) are used for management.

Thyroid Gland Function and Disorders

• Thyroid Gland Hormones: Triiodothyronine (T3), thyroxine (T4), and calcitonin.

• Hypothyroidism: Decreased metabolism state, caused by autoimmune diseases, thyroid surgery, radioactive iodine therapy, iodine deficiencies, and medications. Symptoms include fatigue, lethargy, weight gain, and cold intolerance. Potential complications include myxedema coma.

• Diagnosis: Low T3 and T4, and elevated TSH.

• Hyperthyroidism: Accelerated metabolism state due to excessive thyroid hormone production; Clinical manifestations: Tachycardia, heat intolerance, increased appetite, exophthalmos, goiter and/or weight loss.

• Treatment (both hypo and hyper): Management should focus on managing the clinical manifestations, including medication (beta blockers, antithyroid medications, lithium carbonate, iodine).

• Surgical intervention may include a total or subtotal thyroidectomy. Continuous monitoring of calcium levels and daily weights are also crucial.

Other Potential Complications

• Complications of Diabetes in general: Heart failure, fertility problems, osteoporosis, and thyroid storm.

• Thyroidectomy: Surgical removal of the thyroid gland is followed by potential complications, most of which are related to the use of and management of the hormones and medications that are necessary to manage the thyroid condition.

Explore the critical aspects of endocrine disorders with a focus on the pancreas's endocrine functions. This quiz will cover data assessment, care planning, medication classifications, and glucose homeostasis. Enhance your understanding of nursing roles and interventions related to endocrine health.