Professional Documents
Culture Documents
Endocrine glands
Specialized cluster of cells that secure
that secretes hormone chemical
messengers
Hormones
Secreted by the endocrine organs body
target cells
Regulator of tissue responses
Mechanism of hormones
Hormones interact with high affinity
receptor
Some receptors are located on the
surface of cell
Others are located in the cell
Maintain homeostasis
Hypothalamus
Pituitary gland (Hypophysis)
APG (Adenohypophysis
PPG (Neurohypophysis)
Target cells/organs
Hypothalamus
Below the thalamus above the brain
stem
Link Nervous system to Endocrine
system via pituitary gland
Stimulating
hormones and
Trophic hormones
*ACTH
-Adrenal Cortex
*TSH
-Thyroid gland (T3,
T4)
*MSH
-Melanin (skin
pigment)
Common Laboratory and Diagnostic
Procedures
RAUI (Radio Active Iodine Uptake)
Oral Intake, measurement after 24 hours
Administration of iodine
Measurement by a counter of the I 123, I
131
Increase uptake may indicate HYPER
functioning gland
Decrease uptake may indicate HYPO
functioning gland
Normal value : 5-30% in 24 hours
Avoid cough syrup (contains iodine) before
test (10 day before)
Temporarily discontinue contraceptive pills
No to pregnancy (teratogenic)
Not radioactive after procedure
Treatment : radioactive after procedure
Diagnostic : not radioactive
Thyroid Scan
Administration of radioactive isotope
(Oral/IV) and scanner will be use
Releasing hormones
Pre- Op
Routine Pre op Care
Post Op
Monitor VS : Increased ICP (increased
systolic, decreased all , widened pulse
pressure), LOC and neurologic status
(monitor packing and reinforce as
needed)
Place patient on Semi Fowlers (airway
and drainage)
LOC (Pedia : High pitch, shrill cry)
(Adult: Irritability and Restlessness)
Monitor for bleeding and CSF
leakage : Check for the fluid , for
the presence of glucose (increase
20 mg)
Instruct patient to avoid sneezing,
coughing and nose blowing
Deep breathing is good just avoid
coughing
Provide mouth care with saline or
toothes (avoid toothbrush)
Sneezing, mouth open technique
Monitor development of DI/SIADH:
measure Input and output
Administer prescribed medications :
Antibiotics, analgesics, steroids
Medical Therapy
Growth Hormone Inhibitors
DOC: Sandostatin (SQ : 20-30 mg)
- Effectively inhibits GH secretion for
30 days with just one injection of
20-30 mg
Bromocriptine (long acting dopamine
agonist) : can reduce GH levels
Octretide Acetate (SQ : 3x/week) :
analog of somastatin, produce
feedback inhibition on GH
Hypopituitarism
Hyposecretion of APG
Causes
Congenital
Post Partal necrosis (Sheehans
syndrome)
Infection
Surgery
Radiation Therapy
Assessment
Retarded physical growth due to
decrease Growth hormone Dwarfism!
Low intellectual development
Poor development of secondary sexual
characteristics
Diagnostic
Physical Examination and History
CT Scan
MRI
Hormone level determination
Nursing Intervention
Provide emotional support to the family
Encourage client and family to express
feelings
Administer prescribed growth hormone
supplements
Sermorelin (Geref) IV
Somatren (Protropin) IM/SC
Somatropin (Humatrope) IM/SC
Oral route is inactivated by enzymes use
cautiously to diabetic patient
Disorder of Anti Diuretic Hormone
Diabetes Insipidus
Hypofunctioning of the Posterior
Pituitary gland (ADH)
Hyposecretion of ADH
Signs and Symptoms
Polyuria
Dehydration
Polydipsia
Muscle pain and weakness (excretes
potassium)
Hypotension and tachycardia
Diagnostic
Fluid Deprivation Test :
Confirmatory
8-12 hours or 3-5% weight loss :
inability to increase specific gravity
and osmolarity
WOF Hypovolemic Shock
Priority Intervention : Monitor the VS
Specific Gravity : inversely proportional
to urine (very low)
Decrease/low specific gravity : 1.006
and below
High Serum Na levels
Nursing Interventions
Monitor VS, neurologic status and
cardiovascular status
Monitor I and O/ Daily weight
Monitor urine specific gravity
Provide adequate fluids
No to Diuretics
Avoid coffee, tea, alcohol
Meds :
DOC Desmopressin (Inhalation)
- Vasopressin
Hypervolemia
Hypertension
Hyponatremia
Anorexia/ N and V
Diagnostic
Increase Urine Specific Gravity
Hyponatremia
CBC shows Hemodilution
Nursing Intervention
Priority : Monitor VS and neurologic
status (WOF crackles it signifies
Pulmonary Edema
Restrict FI : <50cc/day
Monitor I and O and daily weight
Provide safe environment (Siderails
up!)
Administer Diuretics and IVF
DOC: Demeclocycline (Tetracycline
Antibiotic) : because of its side
effect that makes you urinate
Tube feedings, NGT irrigation used
SALINE!
Hypothyroidism
Everything is low, slow and dry
Hypofunctioning of the thyroid gland
Hyposecretion of thyroid hormones
Decrease T3 and T4 Decrease basal
metabolism
Causes
Autoimmune (Hashimotos Thyroiditis)
Iodine deficiency
Congenital
Radiation Therapy
Pituitary Disorder
Thyroid Surgery
Signs and symptoms
Lethargy and fatigue
Weakness and paresthesia
COLD intolerance
Weight gain
Bradycardia
Constipation
Dry hair and skin
Generalized puffiness and edema around
the eyes and face
Menstrual irregulation
Diagnostics
Decrease Serum T3 and T4 level
Increase Serum cholesterol level
<5% RAUI (decreased)
Nursing Interventions
Monitor VS especially HR
DOC: Levothyroxine (Synthetic
Thyroid Hormone Supplement)
o Must be given morning on an empty
stomach for best absorption
o Can cause insomnia
o Get baseline VS and weight
o Can cause hypertension and
tachycardia
o Assess for complains of chest
pain
o Manage weight
Diet : low calories, low cholesterol,
low fat
Provide warm environment
Manage constipation appropriately
o Give high fiber
Complication : Myxedema coma
Avoid stress, infection, sedatives,
anesthetic, narcotics and exposure to
extreme cold
How will you know if the patient is
improving? The patient can already
defecate everyday
Pheochromocytoma
Benign tumor of the chromaffin cells of
the adrenal medulla
Peak incidence is ages 20-50 years
Stimulates hypersecretion
5 Hs symptoms
Hypertension
Headache
Hyperhydrosis
Hypermetabolism
Hyperglycemia
Diagnostics
VMA (Vanillylmandelic Acid Test)
o Normal : 0.7 6.8 mg in 24 hours
o 24 hour urine specimen
o Instruct the patient to avoid the
following medications and foods which
may alter the results
- Coffee
- Tea
- Bananas
- Chocolate
- Vanilla
- Aspirin
CT scan , MRI and UTZ : To localize the
pheochromocytoma
Nursing Interventions
Monitor VS especially BP
Position ; Head of bed elevated
Administer meds as ordered to control
BP
o DOC: Phentolamine (Regitine)
o Na Nitroprusside (Nipride)
Provide adequate rest
Monitor urine test for glucose and
acetone
Provide high calorie, well balanced diet
Administer prescribed
phenoxybenzamine
Administer alpha adrenergic Blocker
Prepare for Adrenalectomy : Avoid
Abdominal palpation
Diabetes Mellitus
Chronic disorder of impaired glucose,
metabolism, protein and fat metabolism
Risk Factors
Family history of Diabetes
Obesity
Race / Ethnicity
Hypertension
Hyperlipidemia
History of gestational DM
Age of more than 45
Complications
DKA (Diabetic Ketoacidosis) :
Kussmauls breathing (deep, rapid and
labored breathing)
o NSS
o Regular Insulin IV
HHNK (Hyperglycemic
HyperosmoticNon Ketoacidosis)
Diagnostic Test
FBS : >126
RBS : >200
OGTT : >200
HGBa1c: above 7 %
Urine Glucose
Nursing Interventions
GOAL: Normalize
o Proper Medication
o Proper diet
o Proper exercise
Insulin Administration
Route : S
Q
Rotate the injection sites to prevent
lipodystrophy
Place it in the refrigerator : multiple
doses
Warm it at room temperature
Clear (regular) first before cloudy (NPH)
Inject air in the NPH insulin vial before
regular
Do not shake! Roll into the palm!
Insulin Types and Action : Type I
Types
IDDM (DM Type I)
Juvenile onset
Adult onset
Zero insulin
Decrease insulin
Genetic, hereditary
Genetic, Hereditary
Autoimmune
Insulin resistance
DM Type II
Polydipsia
Polydipsia
Polyphagia
Polyphagia
Polyuria
Polyuria
Pruritus
Pruritus
Weight loss
Onse
t
Peak
Durati
on
Rapid
Lispro
Aspart
<15
minut
es
45
minutes
-2
hours
3 hrs
4
hrs
Short
Soluble
Regular
-1
hr
2-4 hrs
6-8 hrs
1-2
hrs
1-3
hrs
6-12
hrs
18-24
hrs
Intermed
iate
NPH
Lente
Long
Acting
OHA is teratogenic
(contraindicated during
pregnancy)
Diet/ Nutritional Modifications
Balanced diet is the best diet for DM
Carefully follow the exchange list of
the diet
Do not skip meals
Exercise
Exercise everyday to facilitate glucose
control
30 minutes jogging 1 hour of walking
Blood glucose monitoring before and
after exercise
Do not exceed for 30 minutes
Before doing strenuous activity have a
light snack