Endocrine Disorders (Week 2) PDF

DISORDERS OF PARATHYROID GLAND RESOURCE PERSONMrs.SANGEETA JAMES PARATHYROID GLAND • These are the small glands , usually four & surrounds the posterior thyroid tissue. • In response to the low blood calcium level, the parathyroid produce parathormone ( PT H ) which raises blood calcium levels by...

DISORDERS OF PARATHYROID GLAND RESOURCE PERSONMrs.SANGEETA JAMES PARATHYROID GLAND • These are the small glands , usually four & surrounds the posterior thyroid tissue. • In response to the low blood calcium level, the parathyroid produce parathormone ( PT H ) which raises blood calcium levels by increasing reabsorbtion from kidney , intestine and bones. HYPERPARATHYROIDISM Hyperparathyroidism is excessive production of parathyroid hormone which controls calcium, phosphorus & vitamin D in the blood and bone. TYPES 1.Primary- Occurs after the age of 60 years. - Common in women. -Due to adenoma or hyperplasia 2.Secondary- due to chronic hypocalcemia. CLINICAL MANIFESTATIONS 1.Fatigue ,muscular weakness , listlessness. 2.Height loss & frequent fractures. 3.Renal stones. 4.Anorexia,nausea,abdominal discomfort, constipation. 5.Back & joint pain. 6.Hypertension. 7.Memory impairment INVESTIGATIONS 1.Increased serum calcium level. 2.Decreased serum phosphate level. 3.Hypercalciuria. 4.X-Ray – weak bone (Porous bone ) 5.Elevated parathyroid hormone level in the blood. 6.C T Scan of parathyroid gland will be abnormal. TREATMENT 1.Drink more fluid to prevent kidney stones 2.Regular monitoring of symptoms. 3.DRUG THERAPYCinacalcet drugsIt helps to reduce calcium & parathyroid hormone levels and increase the phosphate levels in the blood. 4.Surgery- PARATHYROIDECTOMY HYPOPARATHYROIDISM Hypoparathyroidism is a endocrine disorder in which the parathyroid glands in neck do not produce enough parathyroid hormone (PTH ). CAUSES 1.Accidental removal of or trauma to parathyroid gland during thyroidectomy, parathyroidectomy, head and neck surgery. 2.An autoimmune disorder. 3.Radioactive iodine treatment for hyperthyroidism. CLINICAL MANIFESTATIONS 1.Anxiety & irritability. 2.Abdominal pain. 3.Brittle nails. 4.Dry hair 5.Dry & scaly skin. 6.Muscle cramps. 7.TETANY- Severe muscle spasm of all muscle. 8.Pain in the face ,legs & feets. 9.seizures INVESTIGATIONS 1.Low serum calcium. 2.High blood phosphorus level. 3.Low parathyroid hormone level. 4.C.T Scan- Shows absence or damage of parathyroid gland. TREATMENT 1.Administer calcium carbonate and vitamin D supplements. 2.Blood calcium levels are monitored at frequent interval. 3.Observe for nausea, vomiting, headache & mental confusion. 4.High calcium and low phosphorus diet is recommended. TREATMENT CON’T 5.Heart rate is monitored regularly. 6.Exercise at least for 30 minutes. 7.Avoid coffee and other stimulants. 8.If life threatening TETANY presenta. Administer Intravenously calcium gluconate. b. Prevent the patient from injuries during seizures. THANK YOU DIABETES MELLITUS 1- DIABETES MELLITUS DIABETES MELLITUS is a group of metabolic diseases characterized by elevated level of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action or both. CAUSES OF DIABETES MELLITUS Cause is unknown, PREDISPOSING FACTORS are1.Stress 2.Heredity 3.Obesity 4.Viral infection 5.Autoimmune Disorder CAUSES OF DM - TYPES OF DIABETES MELLITUS 1. Type I 2. Type II 3.Gestational diabetes :Occurs when a pregnant woman who doesn’t have diabetes before pregnancy has high blood sugar levels as a result of the pregnancy. 1- TYPES TYPE I TYPE II 1.IDDM 1.NIDDM 2.Juvenile onset 2.Maturity onset 3.Occurs at less than 30 years 3.Occurs more than 40 years of age 4.Complete insulin deficiency 4.With less insulin secretion & increase Insulin demand, 5.Patient remain obese 5.Patient become thin. 6.MANAGEMENT6.MANAGEMENTa. DIET CONTROL a. DIET CONTROL b. ACTIVITY/EXERCISE b.ACTIVITY/ EXERCISE c.OHA c. INSULIN ADMINISTRATON d.Insulin administration TYPES OF DM CLINICAL MANIFESTATIONS 1.POLYUREA ( Increase urine output). 2.POLYPHAGIA ( EXCESSIVE HUNGER). 3.POLYDIPSIA ( EXCESSIVE THIRST) 4.PRURITIS (ITCHING OF SKIN) 5.FATIGUE 6.WEAKNESS. - DIAGNOSTIC TESTS 1.Fasting blood sugar (FBS) Normal-80-120 mg/dl In DM it is more than 140 mg/dl for 2 readings 2.POST PARANDIAL BLOOD SUGAR (PPBS) First sample is taken empty stomach Meals are given. After 2 hours blood sample is taken and blood sugar is measured. 3.OGTT/GTT ( Oral Glucose GTT is done Tolerance to detect gestational Test)diabetes and Type II diabetes mellitus. PREPARATION1.Continue to eat a normal diet in the day leading upto the test. 2.Consult with your doctor about any medication you are currently taking . Some medications such as corticosteroids, beta blockers or diuretics. PREPARATION CONT’ED 3.Abstain from food for at least 8 hours before the scheduled test. 4.Avoid going to bathroom just before the procedure because you may need to provide a urine sample. PROCEDURE: 1.A blood sample will be collected when you arrive .This is patients fasting blood glucose value. 1- PROCEDURE CONT’ED 2.Patient will be asked to drink a sweet liquid containing a measured amount of glucose.For standard GTT patient will drink 75 grams to 100 grams. 3.Blood samples will be collected at timed interval of 1,2 and sometimes 3 hours after patient drink the glusose . 1- 4.Glycosylated Hemoglobin A .Most accurate test. B .Reflects S. Glucose level for past 3-4 months. Excess glucose in the blood attach to hemoglobin hemoglobin (component of RBC) 1. TREATME Nutrition managementNT Nutritional management of the diabetic patient include the following goals1.Providing all the essential food constituents(e.g.Vitamins ,minerals)necessary for optimal nutrition. 2.Meeting energy needs. 3.Achieving and maintaining a reasonable weight. 4.Decreasing serum lipid levels. Diet advice1.Calorie distribution50-60 % of calorie should derived from carbohydrtes,20-30% from fat and remaining 10-20% from protein. 2.Fiber useIncreasing fiber in the diet may improve blood glucose levels and decrease the need for exogenous insulin. 2. EXERCISE – Brisk walking is best exercise as it increases carbohydrate uptake by cells & decreases 1- GENERAL PRECAUTIONS FOR EXERCISE IN DIABETICS 1.Use proper footwear . 2.Avoid exercise in extreme heat or cold. 3.Inspect feet daily after exercise. 4.Exercise at the same time and in the same amount each day. 5.Avoiding trauma to the lower extremities is especially important in the patient with numbness. 1- EXERCISE-BRISK WALKING is best 1- 1- 3.MEDICATIONS A. OHA (ORAL HYPOGLYSEMIC AGENTS) 1.It stimulates I of L to secrete insulin. 2.Indicated only in type II DM. Eg. – Diabenese -- Orinase --Micronase -- Dionil -- Glucotrol These are Sulphonylureas group of drugs ---Glucophage (Metformin)-A Biguanide group. 3.Obsreve for sign & symptoms of G.I upset and hypogycemia. B.INSULIN ADMINISTRATION There are 3 types of Insulin1.Rapid Acting : clear insulin Eg.-Regular - Humulin-R - Semilente - Crystalline zinc - Actrapid Onset:30 min to 1 hour Peak : 2-4 hour Duration: 6-8 hours TYPES OF INSULIN - 2.INTERMEDIATE ACTING INSULIN • Eg.—NPH ( CLOUDY) -- Humulin-N -- Lente --Monotard Onset: 1-2 hour • Peak: 6-8 hours • Duration-18-24 hours. 3. LONG ACTING INSULIN Eg. Ultralente (CLOUDY) • Onset-3-4 hours • Peak-16-20 hours • Duration-30-36 hours NURSING RESPONSIBILITIES INSULIN THERAPY1. Route is SC-Slow absorption -less painful -SC-90 degree angle. IN INJECT INSULIN S/C,AT 90 degree NURSING RESPONSIBILITIES 2.Administer insulinCON’T at room temperature as cold insulin may cause LIPODYSTROPHY. 3.Rotate the site of injection to prevent LIPODYSTROPHY as it may inhibit absorption. 4.Store vial of insulin in current use at room temperature -Other vials should be refrigerated. 5.Gently roll the vial in between the palms to redistribute insulin particals. NOTE- DO NOT SHAKE: BUBBLES MAKE IT DIFFICULT TO ASPIRATE EXACT 1- NURSING RESPONSIBILITIES CON’T 6.Observe for side- effectsA.LOCALISED-REDNESS - SWELLING -LIPODYSTROPHY B.GENERALIZED- EDEMA -HYPOGLYCEMIA COMPLICATIONS 1.HYPOGLYCEMIA 2.HYPERGLYCEMIA 3.DIABETIC FOOT COMPLICATIONS HYPOGLYCEMIA ( INSULIN SHOCK) CAUSES 1.Omission of meals. 2.Overdose of insulin 3.Straneous exercise 4.G.I upset HYPERGLYCEMIA ( DKA) CAUSES 1.Infections 2.Overeating 3.Under dose of insulin 4.Stress 5.Surgery CLINICAL MANIFESTATIONS OF HYPOGLYCEMIA 1.Restlessness 2.Hunger Pangs 3. Weakness 4.Tremors 5.Pallor 6.Diaphorosis 7.Altered LOC 8.Cold and clammy skin. 9.Tachycardia 10.Abdominal pain 11.Faintness 12.Blurred vision 1- MANAGEMENT OF HYPOGLYCEMIA 1.Simple Sugar p.o. - 3-4 oz. regular soft drinks. - 8 oz. Fruit juice - 5-7 pcs. Candies. -1 tbsp. sugar -5 ml. pure honey. - 10-15 gms of CHO. If patient is unconscious 2.Dextrose 50% 20-50 ml Intravenously . 3.Monitor blood sugar level. 4.Teach the patient to keep diabetic card or identification band when goes out. 1- CLINICAL MANIFETATIONS OF HYPERGLYCEMIA 1.Polyuria. 2.Polydipsia. 3.Polyphagia. 4.Warm,flushed dry skin 5.Tachycardia 6.Abdominal Pain 7.Kussmaul’s respiration. 8.Sweet, fruity odor from breath. 9.Altered LOC. 10.Urine – ketones present 1- MANAGEMENT OF HYPERGLYCEMIA 4.Once sugar level 1.Maintain patent reaches 250 mg/dl ,Dextrose 10% with airway. balanced dose of 2.Oxygen therapy. insulin is 3.NORMAL administered. 5.Monitor blood sugar. SALINE + 6.Teach Patient causes, REGULAR Prevention & INSULIN is management. given 1- 1- DAIBETIC FOOT DIABETIC foot is a condition where foot get the wound which cannot heal for long period of time ,sometime amputation is needed. 1- FOOT CARE 1. Inspect the feet daily , preferably in mirror. 2. Wash feet with warm water & mild soap. 3. Pat dry the feet, Don't rub. 4. Wear comfortable ,proper fitted shoes. it should not be too tight. 5.Don’t go bare footed. 6.Trim the toe nails straight across. 7.Apply lotion on the feet. 8.Exercise/Massage the feet daily. 1- 1- 1- (chapter 51 page3844) (page 1228 &3843) 1-