.

CONCEPT: ENDOCRINE SYSTEM

I. ANATOMY

II. PHYSIOLOGY
_____________ _ stimulates uterine contractions
POSTERIOR
milk ejection during lactation
PITUITARY GLAND
_____________ _____ controls the excretion of
water by the kidneys
HYPOTHALAMUS ANTERIOR
______________________ stimulates growth
PITUITARY
GLAND ______________ stimulates development of
mammary gland and secretion of milk
_____________________________ stimulates
production of melanin

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
II. PATHOLOGY

A. Posterior Pituitary Gland Disorders

DIABETES INSIPIDUS (DI) SYNDROME OF INAPPROPRIATE ADH (SIADH)

Problem: _________ ADH Problem: ________ ADH

Assessment: Assessment:

Fluid Fluid

Weight Weight

Hemo___________ Hemo___________

____Sodium ____Sodium

____BUN, ___CREA, ___URIC ACID ____BUN, ___CREA, ___URIC ACID

____BP, ____Fluid volume – can lead to ____ ____BP, ____Fluid volume

WOF: Cerebral Edema

Meds: Meds:

Desmopressin (DDAVP, Stimate) Demeclocycline (Declomycin) – Tetracycline antibiotic

Lypressin (Diapid) IV hypertonic saline (3%) – causes the cells to shrink

Vasopressin (Pitressin) Diuretics – removes excessive fluid

B. Anterior Pituitary Gland Disorders

Hypopituitarism Hyperpituitarism

Other names: Other names:

Sheehan’s Syndrome – post-partum pituitary gland Gigantism

necrosis due to hypovolemic shock
Acromegaly
Simmonds’ Disease – panhypopituitarism

Dwarfism – decrease in growth hormone

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
 Causes: Stress Causes: Adenoma
Tumor Hyperplasia
Autoimmune
Trauma
Encephalitis
MANIFESTATIONS: Depends on which part is affected
MANIFESTATIONS: Depends on which part is affected
POSTERIOR
ANTERIOR
ADH
LH AND FSH - L
ANTERIOR:
O
LH AND FSH – “Precocious Puberty”
I

D
ADRENOCORTICOTROPIC HORMONE
GROWTH HORMONE THYROID STIMULATING HORMONE
ADRENOCORTICOTROPIC HORMONE GROWTH HORMONE
THYROID STIMULATING HORMONE
EARLY ONSET happens before the closure of the
epiphyseal plate (growth plate)
POSTERIOR

ADH
LATE ONSET happens after the closure of the
OXYTOCIN – Manifestation will occur during: epiphyseal plate (growth plate)
C

B
Meds:
Meds:
Bromocriptine (Parlodel)
Somatrem (Protropin)
-Dopamine Agonist- Growth hormone
Somatropin (Humatrope, Nutropin)
Octreotide (Sandostatin) inhibitor
Hormonal Replacement Therapy
-Somatostatin Analog-

Surgery:
HYPOPHYSECTOMY
1. Craniotomy - Opening the _______
2. Transphenoidal Surgery
Pituitary gland lies directly behind the nose.
Operative site:
Teaching Prior:

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
SURGERY: HYPOPHYSECTOMY – Removal of the Pituitary gland (Hypophysis)
COMPLICATIONS
DISTURBANCE OF THE INCREASE
HYPOPITUITARISM CSF LEAK (RHINORRHEA) OPERATIVE SITE INTRACRANIAL
PRESSURE (ICP)

Check for the presence of Avoid: Position:

_________ in the fluid
draining out of the Brushing the teeth
D patients ______ Using straw
Vigorous & frequent
flossing
A Commercial Mouthwash

Allow:
H
Use toothette
Do non-vigorous and
infrequent flossing
Gargle with saline solution

C. Thyroid Gland Disorders

1. Thyroxine (T4)
2. Triiodothyronine (T3)
3. Calcitonin

THYROXINE TRIIODOTHYRONINE CALCITONIN

T4 T3
MAINTAINS METABOLIC RATE AT A UNSTABLE CALCIUM METABOLISM
STEADY STATE 5X MORE POTENT THAN T4 BRINGS CALCIUM INTO THE BONE

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
 HYPOTHYROIDISM HYPERTHYROIDISM
PRIMARY

WITHIN THE THYROID

SECONDARY

ANTERIOR PITUITARY GLAND

Hypothyroidism

Problem: ____ Thyroid Hormone

____ Metabolic Rate

Common Cause:

Hashimoto’s Disease (Thyroiditis) – Inflammation of the thyroid gland / Autoimmune

Types:

1. Myxedema – long standing hypothyroidism - Myxedema coma (severe form) Priority: AIRWAY!
2.Cretinism – thyroid deficiency at birth
3.Simple Goiter – due to lack of iodine

CLINICAL MANIFESTATIONS:

Generally low except for: Cholesterol

Weight
Menstruation
P -eristalsis

U – rine output

S - weating

H – eat production

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
MEDICATIONS:

LEVOTHYROXINE (LEVOTHROID,LEVOXYL,SYNTHROID)

LIOTHYRONINE (CYTOMEL)

WOF: CHEST PAIN – CAN LEAD TO

BEST TIME TO TAKE:

1. Morning before breakfast

2. Same time each day

3. Life long compliance

ADVERSE EFFECT: S/SX HYPERTHYROIDISM

Hyperthyroidism

Problem: ____ Thyroid Hormone

____ Metabolic Rate

Common Type:

Graves Disease –

Toxic Goiter -

CLINICAL MANIFESTATIONS:

Generally high except for: Cholesterol

Weight
Menstruation
P - eristalsis

U – rine output

S - weating

H –eat production

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
Treatment

Propylthiouracil (PTU) Prevents the conversion of t4 to t3

Methimazole (Tapazole)

Adverse Effect:

Beta-Adrenergic Blocker

SSKI (saturated solution of potassium iodide) , Lugol’s Solution (Strong Iodine Solution)
-
-
Pre-op medication: to achieve euthyroid state – to prevent thyrotoxicosis (thyroid storm)

* Use straw, causes teeth _________

Radioactive Iodine (RAI 131)

Surgery: THYROIDECTOMY

COMPLICATIONS:

1. BLEEDING

2. SWELLING/ EDEMA/ HEMATOMA PRIORITY:

3. HYPOCALCEMIA – WOF: SPASMS AND PARESTHESIA

4. LARYNGEAL NERVE DAMAGE

ASSESS:

5. THYROID STORM (Thyrotoxicosis)

Causes: a. infection

b. stress

c. hyperthyroidism

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
 Signs and Symptoms of Thyrotoxicosis:

D. Parathyroid Gland Disorders

1. Parathyroid Hormone (Parathormone) – BRINGS CALCIUM IN THE BLOOD
Controls Calcium and Phosphorus Metabolism

Hypoparathyroidism Hyperparathyroidism

CAUSES: CAUSES:

Autoimmune Adenoma – benign tumor

Thyroidectomy Hyperplasia – increase in size

PROBLEM: PROBLEM

_____PARATHYROID HORMONE _____PARATHYROID HORMONE

_____CALCIUM _____CALCIUM

WOF: *Calcium and Phosphorus Levels WOF:*Calcium and Phosphorus Levels

MEDICATIONS: MEDICATIONS:

CALCIUM SUPPLEMENTS – to increase Calcium DIURETICS –to eliminate excessive Calcium

VITAMIN D WITH VITAMIN C – to improve intestinal PNSS IV - to dilute Calcium
absorption of Calcium PHOSPHATE IV – to increase phosphorus
PHOSPHATE BINDERS –to decrease phosphorus CALCITONIN – to bring the Calcium back to the bones

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
 E. Adrenal Gland Disorders

Adrenal Cortex Adrenal Medulla

Addison’s Disease

Problem: ____ Glucocorticoid

____Mineralocorticoid

ASSESSMENT:

Management:

LIFE LONG REPLACEMENT THERAPY:

FLUDROCORTISONE (FLORINEF) – “Mineralocorticoid” - releases Aldosterone

Increases the reabsorption of water and sodium
Increases urinary potassium excretion
GLUCOCORTICOIDS (PREDNISONE, DEXAMETHASONE, BECLOMETHASONE)

***WEAR MEDICAL ALERT BRACELET – To provide emergency treatment

To alert people that patient needs steroid replacement

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
 Cushing’s Disease

Problem: ____ Glucocorticoid

____Mineralocorticoid

ASSESSMENT:

DUE TO STEROIDS USE:

1. SUPPRESS IMMUNE SYSTEM

Avoid exposure to infection and large crowds

2. COMPENSATORY INCREASE WBC – presence of infection

3. PHOTOSENSITIVITY – sensitive to light

4. DECREASE ABSORPTION OF CALCIUM IN GIT - Prone:

5. CATABOLIC TO SKIN, CONNECTIVE TISSUE AND MUSCLE

WOF: POOR WOUND HEALING

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
Cushingoid Appearance:

Conn’s Syndrome

Problem: ____Mineralocorticoid Management: Diuretics

Anti-hypertensive drugs

Potassium supplements

Pheochromocytoma

Problem: _____Catecholamines Management:

Cause: Anti-hypertensives

H
Diagnostic Test: Vanillylmandelic Acid Test (VMA) – byproduct of catecholamines
Specimen:
Pre-test:

Clonidine Suppression Test

Total Catecholamine Plasma - Specimen:

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
F. Pancreas

MODIFIABLE NON MODIFIABLE

Obesity Family History

Hypertension Age
Cholesterol Gestational Diabetes
Ethnicity

TYPE I TYPE II GESTATIONAL DIABETES MELLITUS

High blood sugar that starts or is first

diagnosed during pregnancy

Usually happens during 2nd – 3rd

trimester

NORMAL BLOOD SUGAR: ___________

1.FASTING BLOOD GLUCOSE (FBG)
FASTING BASELINE: 70-110MG/DL
NPO:
30-MINUTE SAMPLE:110-170MG/DL
2. ORAL GLUCOSE TOLERANCE TEST (GTT)
60-MINUTE SAMPLE:120-170MG/DL
USUALLY FOR:
90-MINUTE SAMPLE:100-140MG/DL
FASTING: ________
120-MINUTE SAMPLE:70-120MG/DL
WITHDRAW blood for baseline comparison
Give oral glucose concentrate
Then WITHDRAW blood AFTER

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
3. CAPILLARY BLOOD GLUCOSE (CBG)
Random blood glucose testing – No NPO needed

4. GLYCOSYLATED HEMOGLOBIN

MEASURES: the glucose stuck in the RBC’s

REFLECTS HOW DM is controlled IN THE LAST _____MONTHS
AND SHOWS drug compliance

NORMAL: 3.5-6%
GOOD DIABETIC CONTROL: 7.5% OR LOWER
FAIR DIABETIC CONTROL : 7.6-8.9%
POOR DIABETIC CONTROL : 9% OR HIGHER

Acute Complications of DM
1.HYPOGYLCEMIA

MILD MODERATE SEVERE

Tremors “CNS SYMPTOMS” LOSS OF CONSCIOUSNESS

Irritability Headache SEIZURES

Restlessness Blurred vision Management:

Excessive Hunger Slurred speech GLUCAGON

Diaphoresis Dizziness / Drowsiness **If the patient remains

unconscious
Irritability ________ given and ________

MANAGEMENT for MILD and MODERATE: 10-15 grams of fast acting simple carbohydrates

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
2.) DKA 3.)HHNS
-An absence or markedly inadequate amount of -Extreme hyperglycemia without ketosis and acidosis
insulin

ASSESSMENT: ASSESSMENT:
Blurred vision Blurred vision
Polyuria Polyuria
Dehydration Dehydration
Headache Headache
Weakness Weakness
Thirst Thirst

*Sick Day Rule! *Sick Day Rule!

-continue to take medications -continue to take medications
-continue compliance to diet -continue compliance to diet
-increase frequency of glucose monitoring -increase frequency of glucose monitoring
-drink fluids every hour to prevent DKA -drink fluids every hour to prevent HHNS

Chronic Complications Of DM

Macrovascular Microvascular Neuropathy

Myocardial Infarction NEPHROPATHY PERIPHERAL NEUROPATHY

(MI) - Damages the kidneys - Damages the nerves

RETINOPATHY
Cerebrovascular Accident
(CVA) - Damages small blood vessels
in the eyes (retina), which
might lead to blindness
Diabetic Foot

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
FOOT CARE:

AVOID ALLOWED
CROSSING THE LEGS
APPLICATION OF LOTION IN BETWEEN THE TOES CUT TOE NAILS STRAIGHT ACROSS
HEATING PAD FOR SORE FEET CLEAN AND INSPECT DAILY
SHOES HALF SIZE LARGER
Management of DM:
1. Diet

2. Exercise – recommendation 3 times a week

3. Insulin - (Type 1)

4. Oral Hypoglycemic Agents (OHA) - (Type 2)

INSULIN

RAPID ACTING INSULIN

(HUMALOG,NOVOLOG)

SHORT ACTING INSULIN

(HUMULIN R,NOVOLIN R)

INTERMEDIATE ACTING INSULIN

(HUMULIN N,NOVOLIN N,LENTE)

LONG ACTING INSULIN

(ULTRALENTE)

VERY LONG ACTING

GLARGINE(LANTUS) NO PEAK HOURS

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
 ORAL HYPOGLYCEMIC AGENTS

CLASSIFICATION MECHANISM OF ACTION NURSING CONSIDERATION

SULFONYLUREAS
First Generation

Acetohexamide (Dymelor) STIMULATES INSULIN RELEASE TAKE IT WITH MEALS

Chlorpropamide (Diabinase)

Second Generation

NON-SULFONYLUREAS
Alpha Glucosidase Inhibitors
DELAYS THE CONVERSION OF TAKE IT WITH THE FIRST BITE OF A
CARBOHYDRATES INTO SIMPLE MEAL
SUGAR

Biguanide
Metformin (Glucophage) INHIBITS GLUCONEOGENESIS

Meglitinides
TAKE IT WITH MEALS
STIMULATES INSULIN RELEASE

Thiazolidinediones

DECREASE INSULIN RESISTANCE

“Success is a state of mind. If you want success, start thinking of yourself as a success.”
Complications:

DAWN PHENOMENON SOMOGYI’S PHENOMENON INSULIN WANING

-results from a nocturnal release of -rebound phenomenon that occurs -progressive rise in blood glucose
growth hormone which may cause during the initial period of blood from bedtime to morning.
blooD glucose to begin to rise at glucose control; develops at peak
around _______ insulin times and during the night.

Rebound phenomenon due to:

counterregulatory
______@bed time then
______@3am then
______@7am

MANAGEMENT: MANAGEMENT: MANAGEMENT:

Evening dose of intermediate insulin Decreasing evening dose of Increasing evening dose of
at around 10pm intermediate insulin or increasing bed intermediate insulin or long acting
time snack insulin or giving a dose of insulin
before the evening meal.

PROPER ORDER OF MIXING TWO TYPES OF INSULIN

Invert and roll the bottle of intermediate or long-acting insulin between your hands, to mix the insulin. Do not
shake the bottle.

Clean the top of both insulin vials with alcohol prep pads and allow them to dry.

Measure the same volume of air as you need of the intermediate or long-acting insulin and inject into the
insulin vial. Withdraw the needle.

Measure the same volume of air as you need of the regular insulin and inject into the insulin vial. Leave the
needle in the vial, invert the bottle and withdraw the correct dosage, maintaining asepsis. (Rapid and short
acting insulin are clear in color). Expel any air bubbles, recheck the volume of insulin for accuracy, then
remove the needle from vial.

Turn the bottle of intermediate or long-acting insulin upside down and reinsert the needle into this vial,
maintaining asepsis. Slowly pull the plunger to withdraw the correct dosage of insulin. Remove the needle
from the vial.

Replace the needle cap on the sterile needle

“Success is a state of mind. If you want success, start thinking of yourself as a success.”