Medical-Surgical Nursing

Ailyn Pineda
 Review of the Anatomy and
Physiology of the endocrine
glands
 Review of the Common Laboratory

procedures
 Review of the Common endocrine

disorders
 Review of Diabetes Mellitus
The endocrine system
is composed of
ductless glands that
release their hormones
directly into the
bloodstream
TheHypothalamus
controls most of the
endocrinal activity of
the pituitary gland
The pituitary gland
controls most of the
activities of the other
endocrine glands
 Hypothalamus

Pituitary Gland

Endocrine gland

Increased Hormones
The Hypothalamus
 This part of the

DIENCEPHALON is located
below the thalamus and is
connected to the pituitary
gland by a stalk
Secretes RELEASING
HORMONES for the
pituitary gland
 Releasing hormones= hypothalamus
Secretes OXYTOCIN
that is stored in the
Posterior pituitary
gland
SecretesAnti-Diuretic
Hormone or
VASOPRESSIN that is
stored also in the
posterior pituitary
gland
The Pituitary Gland
Is a gland located

below the
hypothalamus at the
base of the brain
The Pituitary Gland
The optic chiasm

passes over this

structure
The Pituitary Gland
Isdivided into two
parts- the anterior or
adenohypophysis and
the posterior or the
neurohypophysis
Secretes the following
hormones:
1. Growth hormone
2. Prolactin
Secretes the following hormones:
 3. Gonadotrophins- LH and
FSH
 4. Stimulating hormones and

trophic hormones
◦ ACTH
◦ TSH
◦ MSH
Stores and releases
1. OXYTOCIN
2. ADH/Vasopressin
The THYROID gland
Located in the anterior

neck lateral to the

trachea
The THYROID gland
 Contains two lobes

connected by the isthmus

 Microscopically composed

of thyroid follicles where

the hormones are
produced and stored
 Produces the thyroid
hormones by the thyroid
follicles:
1. Tri-iodothyronine or T3
2. Tetra-iodothyronine or
thyroxine or T4
TheParafollicular cells
secrete CALCITONIN
The PARAthyroid glands
 Located at the back of the

thyroid glands
 Four in number
 Secretes PARATHYROID
hormone (PTH) that
controls calcium and
phosphorus levels
 PTH is stimulated by a

DECREASED Calcium level

Parathyroid Hormone Calcitonin is
is released in stimulated by
HYPOCALCEMIA HYPERCALCEMIA

Parathyroid hormone Calcitonin is inhibited

is NOT secreted in by HYPOCALCEMIA
HYPERCALCEMIA
The Adrenal Glands
 Located above the kidneys
 Composed of two parts- the

outer Adrenal Cortex and

the inner Adrenal medulla
Secretes three types of
STEROID hormones
1. Glucocorticoids- like

Cortisol, cortisone and

corticosterone
 Secretes three types of
STEROID hormones
 2. Mineralocorticoids- like

Aldosterone
 3. Sex hormones- like

estrogen and testosterone

 Essentiallya part of the
SYMPATHETIC autonomic
system
 Secretes Adrenergic

Hormones:
 1. Epinephrine
 2. Nor-epinephrine
The Pancreas
This retroperitoneal

organ has both

endocrine and exocrine
functions
The Pancreas
 The endocrine function

resides in the ISLETS of

Langerhans
 The islets have three

types of cells- alpha, beta

and delta cells
 The ALPHA cells secrete
GLUCAGON
 The BETA cells secrete

INSULIN
 The DELTA cells secrete

SOMATOSTATIN
The GONADS- Ovaries
 These two almond-shaped

glands are found in the

pelvic cavity attached to
the uterus by the ovarian
ligament
The GONADS- Testes
These two oval-shaped

glands are found in the

scrotum
TheOvaries contains
Granulosa and Theca cells
which secrete ESTROGEN
and Progesterone
Thetestes contains
Leydig cells that
secrete Testosterone
 COMMON
LABORATORY
PROCEDURES
Hormone Levels Assay
These are blood

examinations for the

levels of individual
hormones
Hormone Levels Assay
 Measurements can also be

done after stimulation and

suppression of the
secretions- Stimulation and
Suppression tests
Hormone Levels of
T3/T4
Usually done to

diagnose
hypo/hyperthyroidism
Hormone Levels of
T3/T4
If T3 is elevated, T4 is

elevated and TSH is

depressed Primary
HYPERthyroidism
Hormone Levels of T3/T4
If T3 is depressed,T4 is

depressed and TSH is

elevated Primary
HYPOthyoidism
Radio-Active iodine uptake
(RAI)
 This is a thyroid function

test to measure the

absorption of the injected
iodine isotope by the
thyroid tissue
Radio-Active iodine uptake
(RAI)
 Increased uptake may

indicate HYPERfunctioning
gland
 Decreased uptake my

indicate HYPOfunctioning
gland
Thyroid Scan
Performed to identify

nodules or growth in
the thyroid gland
RAI is used
Thyroid Scan
 Pretest- Check for pregnancy,
Thyroid medication may be
withheld temporarily, advise NPO
 Post-test- Ensure proper disposal
of body wastes
The BMR has a long history in the evaluation
of thyroid function.
It measures the oxygen consumption under
basal conditions of overnight fast and rest
from mental and physical exertion.
it can be estimated from the oxygen
consumed over a timed interval by analysis of
samples of expired air
BMR
The test indirectly measures metabolic energy
expenditure or heat production.
Results are expressed as the percentage of
deviation from normal after appropriate
corrections have been made for age, sex, and
body surface area.
Low values are suggestive of
hypothyroidism, and high values reflect
thyrotoxicosis.
FASTING BLOOD GLUCOSE
 Aids in the diagnosis of

Diabetes
 Pre-test: NPO for 8 hours
 Normal FBS- 80-109 mg/dL
 DM- 126 mg/dL and above
GLUCOSE tolerance test
 Aids in the diagnosis of DM
 Pre-test: Provide high-

carbohydrate foods x 3 days,

instruct to avoid caffeine,
alcohol and smoking, NPO 10
hours prior to test
GLUCOSE tolerance test
 Post-test: avoid strenuous

activity for 8 hours

 Normal OGTT- 1 and 2

hours post-prandial-
glucose is less than 200
mg/dL
Glycosylated Hemoglobin A 1-
C
 Blood glucose bound to RBC
hemoglobin
 Reflects how well blood
glucose is controlled for the
past 3 months
 FASTING is NOT required!
Glycosylated Hemoglobin A 1-C
 Normal level- expressed as
percentage of total hemoglobin
 N- 4-7%
 Good control- 7.5%or less
 Fair control- 7.5 % to 8.9%
 Poor control- 9% and above
Disorders are generally
grouped into:
 1. HYPER- when the gland

secretes excessive hormones

 2. HYPO- when the gland does

not secrete enough hormones

 Hyperand Hypo can be
classified as PRIMARY when
the Gland itself is the
problem or SECONDARY when
the pituitary or the
hypothalamus is causing the
problem
PITUITARY GLAND
HYPOPITUITARISM
 Hyposecretion of the

anterior pituitary gland

CAUSES: Congenital, Post-
partal necrosis, infection
and tumor
HYPOPITUITARISM
PATHOPHYSIOLOGY:
Depends on the major

hormone/s depleted
Hypopituitarism: ASSESSMENT
Findings
 1. Retarded physical growth due to
decreased GH dwarfism
 2. Low intellectual development
 3. poor development of secondary
sexual characteristics
NURSING INTERVENTIONS
 1. Provide emotional support

to the family
 2. Encourage client and family

to express feelings
 3. Administer prescribed

hormonal replacement
therapy
HYPERPITUITARISM
The hyper-secretion of the
gland
 ACROMEGALY

CAUSES: tumor, congenital

disorder
HYPERPITUITARISM
PATHOPHYSIOLOGY
Depends on the

hormone/s that is/are

increased
 ASSESSMENT FINDINGS for
Hyper-pituitarism
 1. Increased growth

Gigantism or Acromegaly
 2. large and thick hands

and feet
 ASSESSMENT FINDINGS for
Hyper-pituitarism
 3. Visual disturbances
 4. Hypertension,

hyperglycemia
 5. Organomegaly
 NURSING INTERVENTIONS
1. Provide emotional support
to clients and family
2. Provide frequent skin care
3. Prepare patient for surgery-
removal of pituitary gland
 NURSING INTERVENTIONS
 Post-operative care
 1. Monitor VS, LOC and neurologic
status
 2. Place patient on Semi-Fowler’s
 NURSING INTERVENTIONS
 Post-operative care
 3. Monitor for Increased ICP,
bleeding, CSF leakage
 4. Instruct patient to AVOID
sneezing, coughing and nose-
blowing
 NURSING INTERVENTIONS
 Post-operative care
 5. Monitor development of DI-

measure I and O
 6. Administer prescribed

medications- antibiotics,
analgesics and steroids
DIABETES INSIPIDUS
A hypo-secretion of ADH

CAUSES: Conditions that

increase ICP, Surgical removal
of post pit. tumor
DIABETES INSIPIDUS
PATHOPHYSIOLOGY
 Decreased ADH failure

of tubular re-absorption of
water increased urine
volume
ASSESSMENT findings
1. Polyuria of more

than 4 liters of
urine/day
2. Polydipsia
 ASSESSMENT findings
 3. Signs of Dehydration
 4. Muscle pain and

weakness
 5. Postural hypotension

and tachycardia
DIAGNOSTIC TEST
1. Urinary Specific

gravity very low,

1.006 or less
2. Serum Sodium

levels high
NURSING INTERVENTIONS
 1.Monitor VS, neurologic
status and cardiovascular
status
 2. Monitor Intake and
Output
 3. Monitor urine specific
gravity
NURSING INTERVENTIONS
 4. Provide adequate fluids
 5. Administer
Chlorpropamide or
Clofibrate as prescribed to
increase the action of ADH
if decreased
NURSING INTERVENTIONS
 6. Administer
VASOPRESIN.
Desmopressin or Lypressin
are given intranasal.
Pitressin is given IM
SIADH
 Hyper-secretion of ADH

abnormally

CAUSES: tumor,
paraneoplastic syndromes
SIADH
PATHOPHYSIOLOGY
Increased ADH water

re-absorption water
intoxication,
hypervolemia
DIAGNOSTIC TEST for
SIADH
 1. Urine specific gravity is

increased (concentrated)
 2. Hyponatremia
 3. CBC shows

hemodilution
ASSESSMENT findings
1. Signs of Hypervolemia
2. Mental status changes
3. Abnormal weight gain
ASSESSMENT findings
4. Hypertension
5. Anorexia, Nausea

and Vomiting
6. HYPOnatremia
NURSING INTERVENTIONS
 1. Monitor VS and neurologic

status
 2. Provide safe environment
 3. Restrict fluid intake (less

than 500cc/day)
NURSING INTERVENTIONS
 4. Monitor I and O and daily

weight
 5. Administer Diuretics and IVF

carefully
 6. Administer prescribed

Demeclocycline to inhibit action

of ADH in the kidney
ADRENAL GLAND
Hypo-secretion: ADDISON’S
Disease
 Decreased secretion of adrenal
cortex hormones, especially
glucocorticoids and
mineralocorticoids
 CAUSE: tumor, idopathic
PATHOPHYSIOLOGY
 Decreased

Glucocorticoids
decreased resistance to
stress
PATHOPHYSIOLOGY
 Decreased

mineralocorticoids
decreased retention of
sodium and water
Hypovolemia
Normal functions of HYPO functions
Cortisol
1. Gluconeogenesis HYPOGLYCEMIA
Functions of HYPO functions
Mineralocorticoids
1. Sodium Retention HYPOnatremia
2.Secondary water HYPOvolema-
retention HYPOtension
Weight LOSS
3. Potassium HYPERKALEMIA
excretion
Function of Decreased libido
androgen:
Libido
ASSESSMENT Findings for
Addison’s disease
 1. Weight loss
 2. GI disturbances
 3. Muscle weakness,
lethargy and fatigue
 4. Hyponatremia
ASSESSMENT Findings for
Addison’s disease
 5. Hyperkalemia
 6. Hypoglycemia
 7. dehydration and hypovolemia
 8. Increased skin pigmentation
 NURSING INTERVENTIONS
 1. Monitor VS especially BP
 2. Monitor weight and I and O
 3. Monitor blood glucose

level and K
 4. Administer hormonal

agents as prescribed
 NURSING INTERVENTIONS
 5. Observe for ADDISONIAN
crisis
 6. Educate the client
regarding lifelong treatment,
avoidance of strenuous
activities, stress and seeking
prompt consult during illness
NURSING INTERVENTIONS
7.Provide a high-protein,
high carbohydrate and
increased sodium intake
ADDISONIAN crisis
 A life-threatening disorders caused by
acute severe adrenal insufficiency
CAUSES: Severe stress, infection,
trauma or surgery
ADDISONIAN crisis
PATHOPHYSIOLOGY
 Overwhelming stimuli
mobilize body defense
decreased stress hormones
inadequate coping
ASSESSMENT Findings for Addisonian
Crisis= “severe lahat”
 1. Severe headache
 2. Severe pain
 3. Severe weakness
 4. Severe hypotension
 5. Signs of Shock
NURSING INTERVENTIONS
 1. Administer IV glucocorticoids, usually
hydrocortisone
 2. Monitor VS frequently
 3. Monitor I and O, neurological status,
electrolyte imbalances and blood glucose
NURSING INTERVENTIONS
 4. Administer IVF
 5. Maintain bed rest
 6. Administer prescribed

antibiotics
Hyper-secretion: CUSHING’S DISEASE
 A condition resulting from the hyper-
secretion of glucocorticoids from the
adrenal cortex
CAUSES: Pituitary tumor, adrenal
tumor, abuse of steroids
Hyper-secretion: CUSHING’S
DISEASE
PATHOPHYSIOLOGY
 Increased Glucocorticoids

exaggerated effects of the

hormone
Normal functions of Exaggerated
Cortisol functions
1. Gluconeogenesis HYPERGLYCEMIA
2. Protein breakdown OSTEOPOROSISS,
delayed wound
healing
Purplish striae ,
Bleeding
Muscle wasting
3. Fat breakdown THIN extremity,
Truncal deposition
Functions of Exaggerated
Mineralocorticoids functions
1. Sodium Retention Hypernatremia
2.Secondary water Hypervolema-
retention Hypertension
3. Potassium HYPOKALEMIA
excretion
Function of HIRSUTISM
androgen: Hair
growth
ASSESSMENT FINDINGS for
Cushing
 1. Generalized muscle

weakness and wasting

 2. Truncal obesity
ASSESSMENT FINDINGS
for Cushing
3. Moon-face
4. Buffalo hump
5. Easy bruisability
ASSESSMENT FINDINGS for
Cushing
 6. Reddish-purplish striae on
the abdomen and thighs
 7. Hirsutism and acne
 8. Hypertension
ASSESSMENT FINDINGS for
Cushing
 9. Hyperglycemia
 10. Osteoporosis
 11. Amenorrhea
DIAGNOSTIC TESTS
1. Serum cortisol

level
2. Serum glucose

and electrolytes
 NURSING INTERVENTIONS
 1. Monitor I and O , weight

and VS
 2. Monitor laboratory

values- glucose, Na, K and

Ca
 NURSING INTERVENTIONS
 3. Provide meticulous skin care
 4. Administer prescribed
medications like
aminogluthetimide to inhibit
adrenal hyperfunctioning
 NURSING INTERVENTIONS
 5. Prepare client for

surgical management-
pituitary surgery and
adrenalectomy
 6. Protect patient from

infection
 NURSING INTERVENTIONS
 7. Improve body image
 8. Provide a LOW

carbohydrate, LOW
sodium and HIGH protein
diet
Hyper-secretion: CONN’S
DISEASE
 Hyper-secretion of

Aldosterone from the adrenal

cortex
CAUSES: pituitary tumor,
adrenal tumor
Hypersecretion: CONN’S
DISEASE
PATHOPHYSIOLOGY
 Increased Aldosterone

exaggerated effects
ASSESSMENT findings in CONN’S
disease
 1. Symptoms of HYPOkalemia
 2. Hypertension
 3. Hypernatremia
ASSESSMENT findings in
CONN’S disease
 4. Headache, N/V
 5. Visual changes
 6. Muscles weakness,

fatigue and nocturia

DIAGNOSTIC TEST
 1. Urine gravity- low (due to

polyuria)
 2. Serum Sodium- high
 3. Serum Potassium- very low
 4. Increased urinary

Aldosterone
 NURSING INTERVENTIONS
 1. Monitor VS, I and O and

urine sp gravity
 2. Monitor serum K and Na
 3. Provide Potassium rich

foods and supplements

NURSING INTERVENTIONS
4. Administer prescribed

diuretic- Spironolactone
5. Maintain sodium-

restricted diet
NURSING

INTERVENTIONS
6. Prepare patient for

possible surgical
interventions
Hyper-secretion: Pheochromocytoma
 Increased secretion of epinephrine and
nor-epinephrine by the adrenal medulla
CAUSE: tumor
Hypersecretion:
Pheochromocytoma
PATHOPHYSIOLOGY
Increased Adrenergic

hormones exaggerated
sympathetic effects
ASSESSMENT Findings in
Pheochromocytoma
 1. Hypertension
 2. Severe headache
 3. Palpitations
 4. Tachycardia
ASSESSMENT Findings in
Pheochromocytoma
 5. Profuse sweating and

Flushing
 6. Weight loss, tremors
 7. Hyperglycemia and

glycosuria
NURSING INTERVENTIONS
 1. Monitor VS especially

BP
 2. Monitor for

HYPERTENSIVE crisis
 3. Avoid stimulation that

can cause increased BP

NURSING INTERVENTIONS
 4. Administer Anti-

hypertensive agents like

alpha-adrenergic blockers-
Phenoxybenzamine
 5. Prepare Phentolamine for

hypertensive crisis
6. Monitor blood glucose
and urine glucose
7. Promote adequate

rest and sleep periods

 8. provide HIGH calorie
foods and
Vitamins/mineral
supplements
 9. Prepare patient for

possible surgery
THYROID GLAND
HYPOsecretion: HYPOTHYROIDISM
 A hypothyroid state characterized by
decreased secretions of T3 and T4
 CAUSES: Hypofunctioning tumor, IDG,
Pituitary tumor, Ablation therapy, Surgical
removal of thyroid
HYPOsecretion:
HYPOTHYROIDISM
PATHOPHYSIOLOGY
Decreased T3 and T4

decreased basal
metabolism
ASSESSMENT findings for
Hypothyroidism
 1. Lethargy and fatigue
 2. Weakness and

paresthesia
 3. COLD intolerance
ASSESSMENT findings for
Hypothyroidism
 4. Weight gain
 5. Bradycardia,

constipation
ASSESSMENT findings for
Hypothyroidism
 6. Dry hair and skin, loss

of body hair
 7. Generalized puffiness

and edema around the

eyes and face
ASSESSMENT findings for
Hypothyroidism
 8. Forgetfulness and

memory loss
 9. Slowness of movement
 10. Menstrual irregularities

and cardiac irregularities

NURSING INTERVENTIONS
 1. Monitor VS especially HR
 2. Administer hormone
replacement: usually
Levothyroxine( Synthroid)-should
be taken on an empty stomach
NURSING INTERVENTIONS
 3. Instruct patient to eat LOW

calorie, LOW cholesterol and

LOW fat diet
 4. Manage constipation

appropriately
 5. Provide a WARM environment
NURSING INTERVENTIONS
 6. Avoid sedatives and

narcotics because of
increased sensitivity to
these medications
 7. Instruct patient to report

chest pain promptly

HYPERfunctioning:
HYPERTHYROIDISM
 Called GRAVE’S DISEASE
 A hyperthyroid state

characterized by increased
circulating T3 and T4
HYPERfunctioning: HYPERTHYROIDISM
CAUSES: Auto-immune disorder, toxic
goiter and tumor
PATHOPHYSIOLOGY
 Increased hormone activity increased
Basal Metabolism
ASSESSMENT Findings
for Hyperthyroidism
1. Weight loss
2. HEAT intolerance
3. Hypertension
ASSESSMENT Findings for
Hyperthyroidism
 4. Tachycardia and
palpitations
 5. Exopthalmos
 6. Diarrhea
ASSESSMENT Findings for
Hyperthyroidism
 7. Warm skin
 8. Diaphoresis
 9. Smooth and soft skin

◦ Oligomenorrhea to amenorrhea
ASSESSMENT Findings for
Hyperthyroidism
 10. Fine tremors and

nervousness
 11. Irritability, mood

swings, personality
changes and agitation
NURSING INTERVENTIONS
 1. Provide adequate rest periods in
a quiet room
 2. Administer anti-thyroid
medications that block hormone
synthesis- Methimazole and PTU
 3. Provide a HIGH-calorie diet,
HIGH protein
NURSING INTERVENTIONS
 4. Manage diarrhea
 5. Provide a cool and quiet
environment
 6. Avoid giving stimulants
 7. Provide eye care

◦ Hypoallergenic tape for eyelid

closure
NURSING INTERVENTIONS
 7. Administer PROPRANOLOL

for tachycardia
 8. Administer IODIONE

preparation- Lugol’s solution

and SSKI to inhibit the
release of T3 and T4
NURSING INTERVENTIONS
 9. Prepare clients for

Radioactive iodine therapy

 10. Prepare patient for

thyroidectomy
 11. Manage thyroid storm

appropriately
Thyroid storm
An acute LIFE-

threatening condition
characterized by
excessive thyroid
hormone
Thyroid storm
CAUSE: Manipulation of
the thyroid during
surgery causing the
release of excessive
hormones in the blood
ASSESSMENT Findings for
Thyroid Storm
 1. HIGH fever
 2. Tachycardia and

Tachypnea
 3. Systolic HYPERtension
ASSESSMENT Findings for
Thyroid Storm
 4. Delirium and coma
 5. Severe vomiting and

diarrhea
 6. Restlessness, Agitation,

confusion and Seizures

NURSING INTERVENTIONS
 1. Maintain PATENT airway

and adequate ventilation

 2. Administer anti-thyroid

medications such as
Lugol’s solution,
Propranolol, and
Glucocorticoids
NURSING INTERVENTIONS
 3. Monitor VS
 4. Monitor Cardiac

rhythms
 5. Administer

PARACETAMOL ( not
Aspirin) for FEVER
NURSING
INTERVENTIONS
6. Manage Seizures as

required.
7. Provide a quiet

environment
THYROIDECTOMY
 Removal of the thyroid

gland
PRE-OPERATIVE CARE -
Thyroidectomy
 1. Obtain VS and weight
 2. Assess for Electrolyte

levels, glucose levels and

T3/T4 levels
PRE-OPERATIVE CARE -
Thyroidectomy
 3. Provide pre-operative
teaching like coughing and
deep breathing, early
ambulation and support of
the neck when moving
 4. Administer prescribed
medications
POST-OPERATIVE CARE -
Thyroidectomy
 1. Position patient: Semi-
Fowler’s, neck on neutral
position
 2. Monitor for respiratory
distress- apparatus at
bedside- tracheostomy set,
O2 tank and suction machine!
POST-OPERATIVE CARE -
Thyroidectomy
 3.Check for edema and
bleeding by noting the
dressing anteriorly and at
the back of the neck
POST-OPERATIVE CARE -
Thyroidectomy
 4. LIMIT client talking
 5. Assess for HOARSENESS
◦ Expected to be present only
initially, limit excess
vocalization
◦ If persistent, may indicate
damage to laryngeal nerve!
POST-OPERATIVE CARE - Thyroidectomy
 6.
Monitor for Laryngeal Nerve
damage – Respiratory distress,
Dysphonia, voice changes,
Dysphagia and restlessness
POST-OPERATIVE CARE -
Thyroidectomy
 7. Monitor for signs of
HYPOCALCEMIA and tetany due
to trauma of the parathyroid
 8. Prepare Calcium gluconate
 9. Monitor for thyroid storm
Hypo-functioning:
HYPOPARATHYROIDISM
 Hypo-secretion of

parathyroid hormone
CAUSES: tumor, removal of
the gland during thyroid
surgery
Hypo-functioning:
HYPOPARATHYROIDISM

PATHOPHYSIOLOGY
 Decreased PTH deranged

calcium metabolism
ASSESSMENT Findings for
HypoParaThyroidism
 1. Signs of HYPOCALCEMIA
 2. Numbness and tingling
sensation on the face
 3. Muscle cramps
ASSESSMENT Findings for
HypoParaThyroidism
 4. (+) Trosseau’s and (+)
Chvostek’s signs
 5. Bronchospasms,
laryngospasms, and
dysphagia
ASSESSMENT Findings for
HypoParaThyroidism
 6. Cardiac dysrhythmias
 7. Hypotension
 8. Anxiety, irritability
ands depression
 NURSING INTERVENTIONS
 1. Monitor VS and signs of
HYPOcalcemia
 2. Initiate seizure
precautions and
management
 NURSING INTERVENTIONS
 3. Place a tracheostomy set. O2
tank and suction at the bedside
 4. Prepare CALCIUM gluconate
 5. Provide a HIGH-calcium and
LOW phosphate diet
 NURSING INTERVENTIONS
 6. Advise client to eat

Vitamin D rich foods

 7. Administer Phosphate

binding drugs
Hyper-functioning:
HYPERPARATHYROIDISM
Hyper-secretion of the

gland
CAUSE: Tumor
Hyper-functioning:
HYPERPARATHYROIDISM
PATHOPHYSIOLOGY
 Increase PTH increased

CALCIUM levels in the

body
ASSESSMENT Findings for
Hyperparathyroidism
 1. Fatigue and muscle
weakness/pain
 2. Skeletal pain and
tenderness
 3. Fractures
ASSESSMENT Findings for
Hyperparathyroidism
 4. Anorexia/N/V epigastric
pain
 5. Constipation
ASSESSMENT Findings for
Hyperparathyroidism
 6. Hypertension
 7. Cardiac Dysrhythmias
 8. Renal Stones
 NURSING INTERVENTIONS
 1. Monitor VS, Cardiac

rhythm, I and O
 2. Monitor for signs of

renal stones, skeletal

fractures. Strain all urine.
 NURSING INTERVENTIONS
 3. Provide adequate fluids-

force fluids
 4. Administer prescribed

Furosemide to lower calcium

levels
 5. Administer NORMAL saline
 NURSING INTERVENTIONS
 6. Administer calcium

chelators
 7. Administer CALCITONIN
 8. Prepare the patient for

surgery
PHARMACOLOGY
Anti-diuretic hormones
 Enhance re-absorption of

water in the kidneys

 Used in DI
 1. Desmopressin and

Lypressin intranasally
 2. Pitressin IM
Anti-diuretic hormones
 SIDE-effects
 Flushing and headache
 Water intoxication
Thyroid hormones
 Levothyroxine (Synthroid)

and Liothyroxine (Cytomel)

 Replace hormonal deficit in

the treatment of
HYPOTHYROIDSM
Thyroid hormones
 Side-effects
 1. Nausea and Vomiting

2. Signs of increased
metabolism= tachycardia,
hypertension
Thyroid hormones
 Nursing responsibility
 1. Monitor weight, VS
 2. Instruct client to take

daily medication the same

time each morning
WITHOUT FOOD
Thyroid hormones
 Nursing responsibility
 3. Advise to report palpitation,
tachycardia, and chest pain
 4. Instruct to avoid foods that
inhibit thyroid secretions like
cabbage, spinach and radishes
ANTI-THYROID medications
 Inhibit the synthesis of
thyroid hormones
 1. Methimazole (Tapazole)
 2. PTU (prophylthiouracil)
 3. Iodine solution- SSKI and
Lugol’s solution
ANTI-THYROID medications
Side-effects
 N/V
 Diarrhea
 AGRANULOCYTOSIS
◦ Most important to monitor
ANTI-THYROID medications
 Nursing responsibilities
 1. Monitor VS, T3 and T4,
weight
 2. Take medications WITH
MEALS to avoid gastric
upset
ANTI-THYROID medications
 Nursing responsibilities
 3. Instruct to report SORE THROAT
or unexplained FEVER
 4. Monitor for signs of
hypothyroidism. Instruct not to
stop abrupt medication
ANTI-THYROID medications
Lugol’s Solution
 Used to decrease the vascularity of
the thyroid
 T3 and T4 production diminishes
 Given per orem, can be diluted
with juice
 Use straw
Replaces the steroids
in the body
Cortisol, cortisone,

betamethasone, and
hydrocortisone
Side-effects
◦HYPERglycemia
◦Increased susceptibility
to infection
◦Hypokalemia
◦Edema
Side-effects
◦If high doses-
osteoporosis, growth
retardation, peptic
ulcer, hypertension,
cataract, mood
changes, hirsutism,
and fragile skin
Nursing

responsibilities
1. Monitor VS,
electrolytes, glucose
2. Monitor weight
edema and I/O
 Nursingresponsibilities
3. Protect patient from
infection
4. Handle patient gently
5. Instruct to take meds
WITH MEALS to prevent
gastric ulcer formation
 Nursingresponsibilities
6. Caution the patient NOT
to abruptly stop the drug
7. Drug is tapered to
allow the adrenal gland to
secrete endogenous
hormones
 Hyposecretion of thyroid hormones
 Common causes: Iodine deficiency, Hashimotos
 Manifestations: related to hypo-metabolic state:
constipation, weight gain, cold intolerance, poor
appetite, mental slowness
 Nursing Management:
◦ Provide warm environment
◦ LOW calorie diet, HIGH fiber
◦ Avoid sedatives
◦ Drugs: Hormone replacement
 Hyper-secretion of thyroid hormones
 Common cause: Graves, Toxic goiter
 Manifestation: increased metabolism:
weight loss, diarrhea, heat intolerance,
hypertension
 Nursing Management:
◦ Adequate rest and sleep
◦ Cool environment
◦ HIGH calorie foods
◦ Eye care
◦ Drugs: anti-thyroid: PTU and methimazole,
propranolol
◦ Care of patients after thyroidectomy