Endocrine System Part II PDF

ENDOCRINE SYSTEM Part II Dr. Soheir Tawfeek Shaheen Prof. of Medical Surgical Nursing  Pituitary disorders (DIABETES INSIPIDUS) Etiology and Pathophysiology It is disorder of the posterior pituitary gland in which a deficiency of production...

ENDOCRINE SYSTEM Part II Dr. Soheir Tawfeek Shaheen Prof. of Medical Surgical Nursing  Pituitary disorders (DIABETES INSIPIDUS) Etiology and Pathophysiology It is disorder of the posterior pituitary gland in which a deficiency of production or secretion of ADH or a decreased renal response to ADH. The decrease in ADH results in fluid and electrolyte imbalances caused by increased urine output and increased plasma osmolality. Depending on the cause, DI may be transient or a chronic, lifelong condition. Causes:  Tumors, trauma, or other problems in the hypothalamus or posterior pituitary gland  Surgery in the area of the pituitary  certain drugs, such as glucocorticoids or alcohol.  Damage the kidneys from pyelonephritis, polycystic disease.  Clinical Manifestations.  Polyuria and nighttime urination.  Urine specific gravity is decreased.  Loss of weight and polydipsia  Dehydration, electrolyte imbalances and hypovolemic shock  Hypotension  Poor skin turgor, and weakness.  Decrease in level of consciousness and death if the problem is not corrected.  Diagnostic studies: Urine test Plasma and urine osmolality Sodium level in the blood. CT scanning or (MRI) may show a pituitary tumor The urine glucose level may also be checked  Collaborative Care:  Hypotonic intravenous (IV) fluids  Antidiuretic hormone replacement therapy  Hypophysectomy to remove posterior pituitary tumor.  Nursing Assessment: A- Data Collection.  Assess fluid balance.  Monitor skin turgor and daily weight,  Monitor vital signs for signs of shock.  Monitor changes in level of consciousness. B- Complete physical examination  Nursing Management It includes early detection, maintenance of adequate hydration, and patient teaching for long-term management. A therapeutic goal is maintenance of fluid and electrolyte balance through:  Monitor daily weight,  Measure Intake & Output.  Monitor vital signs, and urine specific gravity.  Assess skin turgor and condition of oral mucous membranes.  Monitor patient for restlessness and weakness.  Apply moisturizing lotion to skin.  Increase patient education  Decrease patient stress  ADRENAL DISORDERS (CUSHING SYNDROME) Cushing syndrome is a clinical condition that results from chronic exposure to excess corticosteroids, particularly glucocorticoids. Several conditions can cause Cushing syndrome. The most common cause is iatrogenic administration of exogenous corticosteroid Etiology  long-term, high-dose use of the cortisol-like glucocorticoids  Pituitary tumors  Ectopic ACTH-producing tumors  Adrenal tumors  Clinical Manifestations:  Buffalo hump  Supraclavicular fat pad  Thin extremities with muscle atrophy  Thin Red cheeks and Moon face  Increased body and facial hair.  Ecchymosis resulting from easy bruising.  Purple striae  Impaired wound healing  Weight gain  risk for kidney stones.  Hyperglycemia  Hypervolemia, hypertension, edema of lower extremities. Diagnostic Studies:  Measure hormone levels in urine and blood  Plasma cortisol (levels may be elevated  CT scan and MRI of the pituitary and adrenal gland  Hypokalemia, hyperglycemia, differntional WBCs Nursing Assessment: A-Subjective Data  Important Health Information (Past health history)  Functional Health Patterns (nutritional metabolic; elimination; activity & exercise; sleep pattern; sexuality and coping stress. B-Objective Data:  A physical exam based on looking for signs of Cushing syndrome.  Comprehensive physical assessment  Possible Diagnostic Findings Nursing diagnosis  Risk for infection related to lowered resistance to stress and suppression of immune system  Imbalanced nutrition: more than body requirements related to increased appetite, high caloric content of foods, and inactivity  Disturbed body image related to change in appearance from disease process  Impaired skin integrity related to excess corticosteroids, immobility, and altered skin fragility Nursing planning  experience relief of symptoms,  avoid serious complications,  maintain a positive self-image, and  actively participate in the therapeutic plan Nursing intervention  Assess signs and symptoms of hormone Complications and drugs side effects  Osteoporosis and  Monitoring emotional disturbance unusual bone fractures.  Monitoring weight changes.  Hypertension  Decrease risk for injury and infection.  Type 2 diabetes  Encourage rest and activity.  Frequent or unusual  Promoting skin integrity. infections  Improving body image  Loss of muscle mass  Prevent and managing potential and strength complications  2- HYPERTHYROIDISM (Graves’ Disease) It is an autoimmune disease of unknown etiology characterized by diffuse thyroid enlargement and excessive thyroid hormone secretion.  Clinical Manifestations: √ Sign of Exophthalmos, √ Excessively high metabolic rate, increase appetite and weight loss. Nausea and vomiting √ Rapid and irregular heart rate, elevated blood pressure. Dysrhythmias Palpitations √ Increased respiratory rate , dyspnea √ In women, irregular menstrual cycle. √ In men, breast development √ Nervousness, restlessness and inability to concentrate.. √ Difficulty focusing eyes. Personality changes of irritability, agitation √ Weakness, Difficulty sleeping  Nursing Assessment A-Subjective data  Complete health information.  Functional health patterns B- Objective data:  Complete physical assessment for all systems  Ophthalmologic examination. C- Diagnostic measures:  Thyroid function tests: T4, free T4, T3  Thyroid stimulating hormone level test (TSH) is a pituitary gland hormone that stimulates the thyroid gland to produce hormones.  Cholesterol test  Triglyceride test  Ultrasound:  Radioactive Iodine Uptake (RAIU) scanning.  Needle or open biopsy  Electrocardiogram (ECG) Nursing Diagnoses  Activity intolerance related to fatigue and heat intolerance  Imbalanced nutrition: less than body requirements related to hypermetabolism and inadequate food intake Nursing Planning  (1) experience relief of symptoms,  (2) have no serious complications related to the disease or treatment,  (3) maintain nutritional balance, and  (4) cooperate with the therapeutic plan Nursing Management: Provide a cool and quiet environment. Provide adequate rest. Obtain weight daily. Provide a high-calorie diet. Avoid the administration of stimulants. Collaborative Care: Drug therapy: Anti-thyroid medications Beta-blockers (help control rapid pulse, sweating, anxiety, and hypertension). Radioactive iodine: Surgery: Subtotal or total thyroidectomy. Nutritional Therapy (High-calorie, high-protein Complications: Thyrotoxicosis (also called thyrotoxic crisis or thyroid storm). is an acute, severe, and rare condition that occurs when excessive amounts of thyroid hormones are released into the circulation. It result from stressors (e.g., infection, trauma, surgery) Severe tachycardia, Heart failure Shock, hyperthermia (up to 105.3° F [40.7° C]), Restlessness, irritability, seizures, Abdominal pain, vomiting, diarrhea, Delirium & coma.  PANCREATIC DISORDERS Diabetes Mellitus Is a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization, or both. It characterized by abnormal carbohydrate metabolism and altered fat and protein metabolism  Type 1 Diabetes Mellitus It is known as juvenile-onset diabetes or insulin-dependent diabetes, accounts for approximately 5% of all people with diabetes. It is occurring more frequently in younger children.  Etiology: Autoimmune destruction of the pancreatic β cells A genetic predisposition A virus agent. Risk factors  Family history.  Genetics. The presence of certain genes indicates an increased risk of developing type 1 diabetes.  Age. Although type 1 diabetes can appear at any age, it appears at two noticeable peaks. The first peak occurs in children between 4 and 7 years old, and the second is in children between 10 and 14 years old. Clinical Manifestations: Once this occurs, the onset of symptoms is usually rapid, Impending or actual ketoacidosis. Rapid onset of hyperglycemia Recent and sudden weight loss Polydipsia (excessive thirst), polyuria (frequent urination), and polyphagia (excessive hunger). Treatment for type 1 diabetes includes: Taking insulin Carbohydrate, fat and protein counting Frequent blood sugar monitoring Eating healthy foods Exercising regularly and maintaining a healthy weight  Type 2 Diabetes Mellitus Is a chronic condition that affects the way body metabolizes sugar (glucose). It is known as adult-onset diabetes or non insulin-dependent diabetes. With type 2 diabetes, the body either resists the effects of insulin a hormone that regulates the movement of sugar into cells or doesn't produce enough insulin to maintain normal glucose levels.  Four major metabolic abnormalities have a role in the development of type 2 diabetes  A first factor Insulin resistance, a condition in which body tissues do not respond to the action of insulin because insulin receptors are unresponsive, are insufficient in number, or both.  A second factor is a marked decrease in the pancreas’s ability to produce insulin, as the β cells become fatigued  A third factor is inappropriate glucose production by the liver.  A fourth factor is altered production of hormones and cytokines by adipose tissue (adipokines).. Risk Factors:  Overweight and Obesity, and age.  Family history.  Age The risk of type 2 diabetes increases as get older, especially after age 45.  Gestational diabetes.  Polycystic ovarian syndrome  Chronic disease (hypertension, cardiac disease).  Prediabetes. It is an intermediate stage between normal glucose homeostasis and diabetes where the blood glucose levels are elevated, but not high enough to meet the diagnostic criteria for diabetes Clinical Manifestations: Impending or actual ketoacidosis. Rapid onset of hyperglycemia Recent and sudden weight loss Polydipsia, polyuria and polyphagia Blurred vision Slow-healing sores Frequent infections Areas of darkened skin, usually in the armpits and neck Nursing Assessment: A- History B- Physical examination Blood pressure and ECG (if indicated). Funduscopic examination (dilated eye examination). Dental examination. Neurologic examinations (test for sensation to lower extremities). Monitoring of weight. C- Diagnostic tests: Fasting plasma glucose (FPG) (126 mg/dL). Two-hour plasma glucose level (200 mg/dL). Random plasma glucose (200 mg/dL). Collaborative Care: Control blood glucose level. Patient and caregiver teaching and follow-up programs Nutritional therapy Exercise therapy Self-monitoring of blood glucose. Drug therapy (Insulin regimen, Oral hypoglycemic).  Insulin Exogenous (injected) insulin is needed when a patient has inadequate insulin to meet specific metabolic needs. Types of Insulin.( Insulins differ by their onset, peak action, and duration)  Rapid-acting insulin (clear solution)  Short-acting insulin (clear solution)  Intermediate-acting insulin (cloudy solution)  Long-acting insulin (clear solution)  Combination therapy (premixed) (cloudy solution) Storage of Insulin requires special storage considerations Prolonged exposure to direct sunlight should be avoided. Unopened insulin vials and insulin pens should be stored in the refrigerator Injection sites for insulin. Complications: Controlling blood sugar levels can help prevent these complications.  Hypoglycemia or hyperglycemia.  Heart and peripheral vascular diseases. Diabetes increases the risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis).  Neuropathy. cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward  Kidney damage.  Eye and hearing damage  Slow healing. Wounds and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.  Sleep apnea.  Alzheimer's disease.  Prevention Healthy lifestyle choices can help prevent type 2 diabetes. A healthy lifestyle includes:  Eating healthy foods.  Getting active.  Losing weight.  Avoiding being sedentary for long periods  Nursing Management  Engage in self-care behaviors to actively manage his or her diabetes,  Prevent episodes of acute hyperglycemic or hypoglycemic emergencies.  Maintain blood glucose levels at normal or near-normal levels,  Prevent or minimize chronic complications of diabetes, ACUTE COMPLICATIONS OF DIABETES MELLITU  The acute complications of diabetes mellitus arise from events associated with hyperglycemia and hypoglycemia.  It is important for the health care provider to distinguish between hyperglycemia and hypoglycemia because hypoglycemia worsens rapidly and constitutes a serious threat if action is not immediately taken.  Hyperglycemia Hypoglycemia Manifestations Elevated blood glucose† Increase in urination Blood glucose < 70 mg/dl. Cold, clammy skin Increase in appetite followed by lack of appetite Numbness of fingers, toes, mouth Rapid heartbeat Weakness, fatigue Blurred vision Headache Emotional changes Headache Nervousness, Glycosuria Nausea and vomiting Abdominal cramps tremors Faintness, dizziness Unsteady gait, slurred speech Hunger Changes in vision, coma Causes Illness, infection Corticosteroids Too much food Too Too little food—delayed, omitted, inadequate little or no diabetes medication Inactivity Emotional, intake Too much diabetic medication Too much physical stress Poor absorption of insulin exercise without adequate food intake Diabetes medication or food taken at wrong time Loss of weight without change in medication Treatment Get medical care Continue diabetes medication as Subcutaneous or IM injection of 1 mg glucagon. ordered Check blood glucose frequently and check IV administration of 25-50 mL of 50% glucose. urine for ketones record results Drink fluids at least on an hourly basis Contact health care provider regarding ketonuria Preventive Take prescribed dose of medication at proper time Take prescribed dose of medication at proper time. Measures Accurately administer insulin, noninsulin injectables, Accurately administer insulin OA Maintain diet Adhere to sick-day rules when ill Provide adequate food intake needed for calories Check blood for glucose as ordered Wear diabetic for exercise. Be able to recognize and know identification symptoms and treat them immediately. Check blood glucose as ordered Diabetic Management  PATIENT & CAREGIVER TEACHING GUIDE  Appropriate information about disease process  Discuss the effect of regular exercise on the management of blood glucose, improvement of cardiovascular function, and general health  Stress the importance of a well-balanced diet as part of a diabetes management plan.  Explain the impact of carbohydrates on the glycemic index and blood glucose levels.  Ensure that the patient understands the proper use of prescribed medication  inabilities for self-medication. If necessary, involve the family or the caregiver in proper use of medication.  Discuss all side effects and safety issues regarding medication.  PATIENT & CAREGIVER TEACHING GUIDE cont.  Teach correct blood glucose monitoring.  Include when blood glucose levels should be checked, how to record them, and how to adjust insulin levels if necessary.  Ensure that the patient understands and appropriately responds to the signs and symptoms of hypoglycemia and hyperglycemia  Stress the importance of proper foot care  Inform the patient about the effect that stress can have on blood glucose  References Lewis Sharon L. and et. al.,( 2014): Medical Surgical Nursing. 9th. Edition, ELSEVIER. Canada.  Thank You Your With my success wishes for