NURSING CARE OF CLIENTS WITH DISTURBANCES OF THE ENDOCRINE SYSTEM

•PITUITARY GLAND (HYPOPHYSIS)
•Located at the base of the brain
•Directly affects the function of the other endocrine glands
Parts of the Pituitary Gland
(1)Anterior Pituitary Gland (Adenohypophysis)
(2)Posterior Pituitary Gland (Neurohypophysis)

•SECRETIONS OF THE ANTERIOR PITUITARY GLAND
GROWTH HORMONE (SOMATOTROPIN)
•responsible for growth of body tissues and bone
PROLACTIN (MAMMOTROPIC/LACTOTROPIC HORMONE)
•responsible for tissue growth and lactation
ACTH (ADRENOCORTICOTROPIC HORMONE)
•stimulates adrenal cortex to secrete CORTISOL and ALDOSTERONE
TSH (THYROID-STIMULATING HORMONE)
•stimulates the thyroid gland to secrete T3 and T4
GONADOTROPINS (LH AND FSH)
•influence the ovaries to secrete ESTROGENS and PROGESTERONE; testes to secrete TESTOSTERONE
MSH (MELANOCYTE-STIMULATING HORMONE)
•Stimulates melanocytes to produce pigment MELANIN
•SECRETIONS OF THE POSTERIOR PITUITARY GLAND
ADH (ANTI-DIURETIC HORMONE/VASOPRESSIN)
•causes RENAL RETENTION OF WATER (excluding sodium) and VASOCONSTRICTION
OXYTOCIN
•hormone released during childbirth to cause UTERINE CONTRACTION and during breastfeeding to cause “let-down reflex”
•HYPERPITUITARISM
•Chronic, progressive HYPERFUNCTION of the pituitary gland resulting to OVERSECRETION of the anterior pituitary hormones
ETIOLOGY
•Tumor
•Hyperplasia
ASSESSMENT
•ACROMEGALY – gradual, marked enlargement of the bones of the face, jaw, hands and feet. It may be accompanied by diaphoresis, hyperglycemia, oily skin and hirsutism
•GIGANTISM – proportional overgrowth of all body tissues with remarkable height
•Galactorrhea
•Cushing’s Disease
•Hyperthyroidism
•Precocious puberty
•“Eternal tan”
•SIADH
DIAGNOSTIC TESTS
•Skull x-ray, CT Scan and MRI would reveal TUMOUR OR PITUITARY ENLARGEMENT
•Serum Analysis would reveal ELEVATED GROWTH HORMONES
MEDICAL MANAGEMENT
•Administration of BROMOCRIPTINE (PARLODEL) to inhibit synthesis of growth hormone
•Radiation therapy
NURSING INTERVENTIONS
•Provide EMOTIONAL SUPPORT if there is altered body image
•Provide ROM if there is muscle weakness
•Apply OILY LOTION if there is dry skin
SURGICAL MANAGEMENT
•TRANSPHENOIDAL HYPOPHYSECTOMY to remove the pituitary gland
PREPARING THE PATIENT FOR HYPOPHYSECTOMY
•Explain the procedure to the patient
•Insert INDWELLING CATHETER since DIURESIS (SIGN OF DIABETES INSIPIDUS) may be a complication of the surgery
NURSING CARE AFTER HYPOPHYSECTOMY
•Place patient on HIGH-FOWLER’S position to avoid tension on the suture line and avoid increased ICP
•Place patient on BED REST on the first 24 hours and encourage ambulation on DAY 2
•Remind the patient to AVOID SNEEZING, COUGHING, BENDING OVER and BLOWING THE NOSE to avoid injury to the suture line
•Administer analgesics if there is pain
•Monitor for signs and symptoms of DIABETES INSIPIDUS (COMMON COMPLICATION)
MANAGEMENT IF THERE IS DIABETES INSIPIDUS
•Watch out for CARDINAL SIGNS (thirst, urine output of 900ml/2 hours, increased urine specific gravity of 1.004)
•Provide fluid replacement and administer VASOPRESSIN as ordered
•Expect DIABETES INSIPIDUS to resolve within 72 hours
•If there is rhinorrhea, check for glucose since it may be indicative of CSF LEAKAGE
DISCHARGE INSTRUCTIONS AFTER HYPOPHYSECTOMY
•Instruct patient to REPORT PROGRESSIVE VISUAL CHANGES and DIURESIS
•Advise patient NOT TO BRUSH TEETH for 2 weeks to avoid injury to suture line
•Advise patient AVOID USE OF COMMERCIAL MOUTHWASHES to avoid irritation of the suture line
•HYPOPITUITARISM
•HYPOFUNCTION of the pituitary gland resulting to DEFICIENT SECRETION of the pituitary hormones
•Results to MARKED METABOLIC DYSFUNCTION, SEXUAL IMMATURITY AND GROWTH RETARDATION
ETIOLOGY
•Trauma
•Tumor
•Vascular lesion
•Surgery or radiation of the pituitary gland
•congenital
ASSESSMENT
•Dwarfism
•Absence of milk during lactation (women)
•Addisonian symptoms
•Symptoms of hypothyroidism
•Underdeveloped genitals
•No growth of body hair
•Amenorrhea and infertility
•Decreased libido, impotence, and aspermia
•Symptoms of diabetes insipidus
DIAGNOSTIC TESTS
•Skull x-ray, CT scan may reveal PITUITARY TUMOUR
•Serum analysis may reveal LOW LEVELS OF HORMONES
MEDICAL MANAGEMENT
•Hormone replacement therapy
•Radiation therapy
SURGICAL MANAGEMENT
•Surgical removal of the tumor
•SYNDROME OF INAPPROPRIATE ANTI-DIURETIC HORMONE (SIADH)
•EXCESSIVE anti-diuretic hormone (ADH) secretion by the posterior pituitary gland
•Characterized by IMPAIRED WATER EXCRETION with NORMAL SODIUM EXCRETION
ETIOLOGY
•CNS disorders interfering with hypothalamic-pituitary mechanisms such as BRAIN TUMOUR, STROKE, HEAD INJURY AND GUILLAIN-BARRE SYNDROME
•Pulmonary disorders such as PNEUMONIA, TUBERCULOSIS, BRONCHIECTASIS
•DRUGS that increase ADH production such as ANTIDEPRESSANTS, NSAIDs, CHLORPROPRAMIDE (Diabinase), VINCRISTINE (Oncovin), CYCLOPHOSPHAMIDE (Cytoxan), CARBAMAZEPINE (Tegretol), METOCLOPRAMIDE (Reglan), MORPHINE
PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
•Cerebral edema
•Brain herniation
DIAGNOSTIC TESTS
MEDICAL MANAGEMENT
NURSING INTERVENTIONS
•Monitor weight, intake and output, vital signs and serum sodium levels
•Observe for restlessness, irritability, seizures, heart failure, and unresponsiveness (SIGNS OF HYPONATREMIA AND WATER INTOXICATION)
SURGICAL MANAGEMENT
•Removal of tumour causing hypersecretion of ADH
•DIABETES INSIPIDUS
•DEFICIENCY in VASOPRESSIN or anti-diuretic hormone (ADH) secretion by the posterior pituitary gland
•Characterized by EXCESSIVE WATER EXCRETION
ETIOLOGY
•Hereditary
•Tumors or injury to hypothalamus or pituitary gland
•Removal of the pituitary gland (HYPOPHYSECTOMY)
•Drugs that interfere with response of the kidney to ADH such as LITHIUM CARBONATE, DEMECLOCYCLINE
PATHOPHYSIOLOGY
ASSESSMENT
DIAGNOSTIC TESTS
MEDICAL MANAGEMENT
NURSING INTERVENTIONS
•Monitor weight, intake and output, vital signs and electrolyte levels
•Monitor for signs of dehydration
•Increase fluid intake by oral or intravenous route
•Encourage client to drink fluids in equal amount to urine output
•THYROID GLAND
•Located anterior part of the neck Controls rate of body metabolism and growth
HORMONES SECRETED BY THE THYROID GLAND
•DIAGNOSTIC TESTS FOR THYROID FUNCTION
•GOITER
•enlargement of the thyroid gland
•result from increased TSH
•may occur with HYPERTHYROIDISM, HYPOTHYROIDISM OR EUTHYROIDISM
TYPES OF GOITER
(1)TOXIC GOITER – hyperthyroid goiter
(2)NON-TOXIC OR SIMPLE GOITER – euthyroid goiter
•HYPERTHYROIDISM
•Other names include THYROTOXICOSIS, GRAVE’S DISEASE, EXOPHTHALMIC GOITER OR TOXIC DIFFUSE GOITER
•Common to females below 40 years old
ETIOLOGY
•Severe emotional stress
•Autoimmune disorder
•Thyroid inflammation
PATHOPHYSIOLOGY
ASSESSMENT
•Due to increased amounts of thyroid hormone
–Enlarged thyroid
–Nervousness
–Heat intolerance
–Sweating
–Weight loss
–Increased appetite
–Frequent bowel movements
–Tremor
–Palpitations
–Hypertension
•Due to activation of cytokine-mediated activation of orbital tissue fibroblasts
–Exopthalmus (may not be present in other patients)
•Due to increased activity in spinal cord area that controls muscle tone
–Fine tremor
–Shaky handwriting
–Clumsiness
•signs and symptoms of THYROID STORM due to hyperthyroid state
–Tachycardia
–Vomiting
–High fever
–Vomiting
–Shock
–Coma
COMPLICATIONS
•Muscle wasting, atrophy, and paralysis
•Heart failure
•Hypoparathyroidism (after thyroidectomy)
•Hypothyroidism (after radioactive iodine treatment)
DIAGNOSTIC TESTS
•Radioimmunoassay: increased serum T3 and T4 levels
•Blood testing: decreased TSH level
•Thyroid Scan: increased uptake
MEDICAL MANAGEMENT
•Thalidomides
–Propylthiouracil (PTU) and Methimazole (Tapazole)
–Blocks synthesis of thyroid hormones
–Should be takin with meals
–Side Effects: unexplained fever, sore throat, skin rashes
•Radioactive Iodine (I131) treatment
–Treatment of choice for patients not planning to have children
–Produces effects after 6-8 weeks
–May cause hypothyroidism
•Lugol’s Solution (Saturated Solution of Potassium Iodide)
–Inhibits release of thyroid hormone
–Mix with fruit juice or glass of water to improve the taste
–Provide drinking straw to prevent staining
–Side effects: allergic reaction, increased salivation, colds
•Dexamethasone
–Inhibit action of thyroid hormones
–Prevents conversion of T3 and T4
•Beta-Blockers: Propanolol (Inderal)
–Controls hypertension and tachycardia
–Blocks conversion of T4 to active T3
–May cause hypotension
EMERGENCY TREATMENT OF THYROID STORM
•Thalidomide
•Dexamethasone
•Supportive Measures: nutrients, vitamins, oxygen, hypothermia blankets and sedatives
NURSING INTERVENTIONS
•Provide NON-STIMULATING ENVIRONMENT cool environment
•Provide diet that is HIGH-CALORIE, HIGH-PROTEIN, VITAMINS AND MINERALS
•Increase fluid intake (if with diarrhea)
•Avoid stimulants like coffee, tea and nicotine
•Administer artificial tears at regular intervals
•Instruct client to wear artificial tears when going out under the sun
•AVOID EXCESSIVE PALPATION OF THE THYROID to prevent thyroid storm
SURGICAL MANAGEMENT
•Subtotal Thyroidectomy – removal of about 5/6 of the gland
NURSING CARE AFTER THYROIDECTOMY
•Monitor for respiratory distress; keep tracheostomy tray at the bedside
•Monitor for signs of hemorrhage
•Monitor for signs of hypocalcemia (tetany and numbness) indicative of accidental removal of the parathyroid gland
•Monitor for dysphagia or hoarseness (indicative of laryngeal nerve injury)
•Change dressing as ordered
•Place patient on SEMI-FOWLER’S position and support neck with sandbags to ease tension on the incision
•Inform client that HYPOTHYROIDISM may develop 2-4 weeks after the surgery
NURSING CARE AFTER RADIOACTIVE IODINE (I131) TREATMENT
•Instruct patient to AVOID EXPECTORATING since saliva will be radioactive for 24 hours after treatment
•Instruct to avoid taking OTC COUGH medications because it contains iodine
•Instruct that iodine may remain the body for 1 week
•Instruct to avoid breastfeeding

•HYPOTHYROIDISM
•Also called MYXEDEMA in adults or CRETINISM in children
•Results from deficiency of thyroid hormones
ETIOLOGY
•Autoimmune disorder (Hashimoto’s Disease)
•Removal of the thyroid (Thyroidectomy)
•Radiation therapy with radioactive iodine
•Intake of thalidomides
TYPES OF HYPOTHYROIDISM
(1)Primary – if the cause is thyroid hypofunction
(2)Secondary – if the cause is pituitary hyposecretion of TSH
(3)Tertiary – if the cause is hypothalamic hyposecretion of TRH
PATHOPHYSIOLOGY
ASSESSMENT
•Effects of decreased basal metabolic rate (Typical Signs)
–Weakness
–Fatigue
–Forgetfulness
–Sensitivity to cold
–Unexplained weight gain
–Constipation
•Effects of fluid accumulation
–Decreasing mental state (sign of myxedema coma)
–Coarse, dry, flaky, inelastic skin
–Puffy face, hands, and feet
–Hoarseness
–Periorbital edema
–Upper eyelid droop
–Dry, sparse hair
–Thick, brittle nails
•Signs of cardiovascular involvement
–Decreased cardiac output
–Slow pulse rate
–Signs of poor peripheral circulation
–Heart enlargement (cardiomegaly)
•Late signs indicating disease progression
–Progressive stupor
–Hypoventilation
–Hypoglycemia
–Hyponatremia
–Hypotension
–Hypothermia
•Signs of MYXEDEMA COMA (severe stage of hypothyroidism)
–Hypothermia
–Unconscious

COMPLICATIONS
•Heart failure
•Myxedema coma
•Infection
•Megacolon
•Organic psychosis
•Infertility
•Hyperlipidemia
DIAGNOSTIC TESTS
•Radioimmunoassay reveals low T3 and T4 levels
•Increased TSH levels (if cause is thyroid dysfunction)
•Decreased TSH levels (if cause is pituitary and hypothalamic dysfunction)
•Elevated serum cholesterol, alkaline phosphatase and triglyceride level
•Low serum sodium level
•ABG analysis reveal decreased pH and increased carbon dioxide (RESPIRATORY ACIDOSIS)
MEDICAL MANAGEMENT
•Hormone replacement with synthetic thyroid hormones
–Proloid (Thyroglobulin)
–Synthroid (Levothyroxine)
–Dessicated Thyroid Extract
–Cytomel
•Surgery excision, chemotherapy, or radiation if there is tumour
NURSING INTERVENTIONS
•Provide high-bulk, low-calorie diet and encourage activity to manage constipation and weight loss; administer laxatives or cathartics as needed
•After thyroid replacement begins, watch out for signs and symptoms of hyperthyroidism such as restlessness, sweating and excessive weight loss
•Check frequently for signs of decreasing cardiac output
•Provide warm environment during cold climate
•PARATHYROID GLANDS
•Gland located near the thyroid gland
•Produces PARATHORMONE which regulates calcium and phosphorous levels
•HYPERPARATHYROIDISM
•Results from EXCESSIVE PARATHORMONE secretion
CLASSIFICATION
(1)PRIMARY
–Results when secretion of PTH and serum calcium levels increase DUE TO PRESENCE OF TUMOUR
(2)SECONDARY
–Results when secretion of PTH increase DUE TO OVERCOMPENSATION to decreased calcium resulting from decreased intestinal absorption of calcium and vitamin D

ETIOLOGY
•Parathyroid adenoma
•Congenital hyperparathyroidism
•Multiple endocrine neoplasia
•Rickets
•Vitamin D deficiency
•Chronic renal failure
•Phenytoin and laxative use
PATHOPHYSIOLOGY
ASSESSMENT
•Due to hypercalcemia
–Renal insufficiency
–Nephrolithiasis
–Dehydration
–Pseudogout
–Psychomotor and personality disturbances
•Due to bone degeneration
–Chronic low back pain
–Bone tenderness
–Fractures
DIAGNOSTIC TESTS
•Radioimmunoassay: increased serum PTH (CONFIRMATIVE)
•Blood Test: increased calcium and decreased phosphate
•Urine Test: increased calcium
•X-ray: demineralization of bones
MEDICAL MANAGEMENT
•Promote urinary excretion of excess calcium
–Increase fluid intake to p
–Diuretic such as furosemine (Lasix)
–Oral sodium or potassium phosphate
–SQ or IM calcitonin
•Vitamin D to promote bone absorption of calcium
•Aluminum hydroxide to correct hyperphosphatemia
•Dialysis to decrease phosphorus levels
NURSING INTERVENTIONS
•Strain urine to check for calculi
•Provide at least 3L of fluid per day including cranberry or prune juice to increase urine acidity and prevent stones formation
•Limit dietary intake of calcium
•Avoid administration of calcium-containing drugs like some antacids and thiazide diuretics
•Auscultate for signs of pulmonary edema
SURGICAL MANAGEMENT
•Parathyroidectomy – removal of the parathyroid gland
PREPARING PATIENT FOR SURGERY
•Administer IV magnesium and phosphate or sodium phosphate solution by mouth or retention enema to prevent postoperative magnesium and phosphate deficiencies
•Administer calcium, vitamin D to prevent hypocalcemia 4-5 days after the surgery
NURSING CARE AFTER PARATHYROIDECTOMY
•Check frequently for respiratory distress
•Keep tracheostomy set at bedside
•Watch for signs of laryngeal nerve damage and hemorrhage
•Check for swelling at the operative site
•Place patient in SEMI-FOWLER’S position and support head and neck with SANDBAGS to decrease edema
•Watch for TETANY (tingling in the hands and around the mouth) indicative of hypocalcemia
•Administer calcium gluconate or calcium chloride if there is TETANY
•Encourage early ambulation to speed up bone recalcification
•HYPOPARATHYROIDISM
•Disorder characterized by DEFICIENCY OF PTH
ETIOLOGY
•Congenital absence of parathyroid gland
•Autoimmune disease
•Parathyroidectomy
•Massive radiation therapy
PATHOPHYSIOLOGY
ASSESSMENT
•Neuromuscular irritability
•Seizures
•Increased deep tendon reflexes
•POSITIVE CHVOSTEK’S SIGN
•POSITIVE TROSSEAU’S SIGN
•Dysphagia
•Paresthesia
•Psychosis
•Arrhythmias
•Hair loss
•Brittle nails
•Weakened tooth enamel
DIAGNOSTIC TEST
•Radioimmunoassay: decreased serum PTH
•Blood Test: decreased calcium and elevated phosphate
•X-ray: increased bone density
•ECG: prolonged QT intervals and QRS complex and ST segment changes
MEDICAL MANAGEMENT
•Supplementation with vitamin D and calcium
•IV calcium gluconate in emergency conditions
•Sedatives and anti-convulsants to prevent seizures
NURSING INTERVENTIONS
•Maintain patent IV line and keep IV calcium gluconate 10% solution available
•Institute seizure precautions
•Keep tracheostomy and endotracheal set available
•Watch out for cardiac arrhythmias and decreased cardiac output
•Offer HIGH CALCIUM AND LOW PHOSPHATE diet
•ADRENAL GLANDS
•Small structures which cap the kidney
2 PARTS OF THE ADRENAL GLAND
(1)MEDULLA – secretes EPINEPHRINE (adrenalin) and NOREPINEPHRINE
(2)CORTEX – secretes ALDOSTERONE (mineralocorticoid), CORTISOL (glucocorticoid) and ANDROGEN (adrenocorticoid)
FUNCTION OF ADRENAL GLAND HORMONES
•CUSHING’S DISEASE
•Hypersecretion of adrenal cortex leading to INCREASED CORTISOL (MAIN REASON), ALDOSTERONE, ANDROGEN and ESTROGEN
ETIOLOGY
•Tumour of the adrenal gland or the pituitary gland
•Prolonged steroid therapy
PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
•Osteoporosis
•Infections
•Ureteral calculi
•Metastasis of malignant tumors
DIAGNOSTIC TESTS
•Urinalysis: free cortisol levels above 150 μg/24 hours
•Dexamethasone suppression test: failure to suppress plasma cortisol levels
•Blood Test: elevated serum cortisol, decreased potassium and calcium; elevated glucose and sodium levels
MEDICAL MANAGEMENT
•Radiation therapy for tumour
•Ketoconazole (Nizoral) and aminoglutethimide (Cytadren) to inhibit cortisol synthesis
•Mitotane (Lysodren) to destroy adrenocortical cells that secrete cortisol
•Bromocriptine (Parlodel) to inhibit prolactin secretion from pituitary gland
NURSING INTERVENTIONS
•Provide a diet that is HIGH IN PROTEIN AND POTASSIUM, LOW IN CALORIES, CARBOHYDRATES AND SODIUM
•Monitor for side effects of mitotane, aminoglutethimide and metyrapone (slowed mentation and physical weakness)
•Watch for signs of infection
•Perform passive ROM to minimize risk of fractures
•Maintain therapeutic communication for emotional lability
SURGICAL MANAGEMENT
•Bilateral adrenalectomy or Pituitary Surgery to remove tumors
NURSING CARE AFTER SURGERY
•Watch for signs of shock; give vasopressor and increase rate of IV fluids as needed
•Administer analgesics and replacement steroids
•Watch for and report signs of INCREASED ICP (Intracranial Pressure) such as confusion, agitation, change in level of consciousness, nausea and vomiting
NURSING CARE FOR PATIENTS IN STEROID REPLACEMENT THERAPY
•Check for signs of adrenal hypofunction (suggesting inadequate steroid replacement) such as orthostatic hypotension, apathy, weakness and fatigue
•Advise patient to take steroids with antacids or meals to minimize gastric irritation
•Tell patient to report stressful situations that may need increased steroid dosage
•Discourage abrupt discontinuation of steroids to prevent adrenal crisis
•ADDISON’S DISEASE
•Hyposecretion of adrenal cortex leading to DECREASED CORTISOL, ALDOSTERONE AND ANDROGEN
ETIOLOGY
•Autoimmune disorder
•Abrupt withdrawal of steroid therapy
•Hyposecreting tumour of the adrenal gland
•Infections
PATHOPHYSIOLOGY
ASSESSMENT
COMPLICATIONS
•Hyperpyrexia (extreme elevation in temperature)
•Psychotic reactions
•Shock
•Profound hypoglycemia
•Ultimate vascular collapse, renal shutdown, coma and death
DIAGNOSTIC TESTS
•PLASMA CORTISOL LEVEL: DECREASED (LESS THAN 5MCG/DL)
•BLOOD CHEMISTRY: decreased glucose, sodium and increased potassium; increased creatinine and blood urea nitrogen (BUN)
•COMPLETE BLOOD COUNT: elevated hematocrit
•RAPID CORTICOTROPIN STIMULATION TEST: FAILURE OF THE CORTISOL AND ALDOSTERONE LEVELS TO RISE
•CT SCAN: ADRENAL CALCIFICATION AND ENLARGEMENT OR ATROPHY
MEDICAL MANAGEMENT
•Lifelong corticosteroid replacement with cortisone or hydrocortisone to replace deficiency of cortisol
•Oral aldosterone replacement with fludrocortisone (Florinef) to prevent dehydration, hypotension, hyponatremia, and hyperkalemia
NURSING INTERVENTIONS
•Assess for signs of shock, hyperkalemia and cardiac arrhythmia
•Monitor weight, intake and output
•Increase fluid intake with oral fluids and IVF
•If patient has diabetes, check blood glucose regularly
NURSING CARE IF THE PATIENT IS RECEIVING STEROIDS
•Offer diet that is SODIUM AND POTASSIUM BALANCED
•If patient is anorexic, suggest 6 SMALL FREQUENT FEEDINGS
•Watch for FLUID AND ELECTROLYTE IMBALANCE if patient is receiving MINERALOCORTICOID; and ORTHOSTATIC HYPOTENSION OR ELECTROLYTE ABNORMALITY if patient is receiving GLUCOCORTICOID
•Teach patient about signs of STEROID OVERDOSE (SWELLING, WEIGHT GAIN) and UNDERDOSE (LETHARGY AND WEAKNESS)
•OFFER ANTACID while on steroid to prevent GI irritation
ADDISONIAN CRISIS – critical DEFICIENCY OF MINERALOCORTICOIDS AND GLUCOCORTICOIDS
TRIGGERS OF ADDISONIAN CRISIS: acute stress, sepsis, trauma, surgery or omission of steroid therapy
MANAGEMENT FOR ADDISONIAN CRISIS
•Assess for sig
•IV bolus of hydrocortisone
•3-5 L of IV normal saline and glucose solution
•MAINTENANCE DOSE: hydrocortisone
•DIABETES MELLITUS
•Metabolic disorder characterized by HYPERGLYCEMIA (elevated serum glucose) from LACK OF INSULIN (TYPE I) or INCREASED RESISTANCE TO INSULIN (TYPE II) or both
CLASSIFICATIONS
(1)TYPE 1 – Insulin Dependent Diabetes Mellitus (IDDM)
(2)TYPE 2 – Non-Insulin Dependent Diabetes Mellitus (NIDDM)
(3)Gestational Diabetes Mellitus
PREDISPOSING FACTORS
•Stress
•Heredity
•Obesity
•Viral infection
•Autoimmune disorders
•Women
PATHOPHYSIOLOGY
ASSESSMENT
CARDINAL SIGNS OF DIABETES MELLITUS (3PsW)
•P - olyuria
•P - olydipsia
•P - olyphagia
•W - eight loss
COMPLICATIONS
•Microvascular disease (retinopathy, neuropathy, nephropathy)
•Macrovascular disease (coronary artery disease, stroke)
•Diabetic ketoacidosis (if type 1)
•Hyperosmolar hyperglycemic non-ketotic coma (if type 2)
DIAGNOSTIC TESTS
MEDICAL MANAGEMENT
•Insulin administration
•Use of Oral hypoglycemic agents (OHAs)
•Proper diet
•Regular Exercise
INSULIN THERAPY FOR A DIABETIC PATIENT
NURSING INTERVENTIONS DURING INSULIN THERAPY
•Administer insulin using the SUBCUTANEOUS route because it offers slow absorption, less pain and tissue damage
•Administer insulin through INTRAVENOUS only during emergency such as DKA
•Administer insulin at ROOM TEMPERATURE; cold administration may cause LIPODYSTROPHY
•ROTATE INJECTION SITE to prevent lipodystrophy which can inhibit insulin absorption
•GENTLY ROLL VIAL IN BETWEEN THE PALMS to redistribute insulin particles
•DO NOT SHAKE! Bubbles can cause inaccurate measurement
•If mixing insulin, draw up CLEAR INSULIN BEFORE CLOUDY INSULIN
•Observe for side effects of insulin therapy
SIDE EFFECTS OF INSULIN
ORAL HYPOGLYCEMIC AGENTS
PROVIDING DIABETIC FOOT CARE
•INSPECT FEET DAILY, use mirror to inspect bottom of the feet
•Wash feet with WARM WATER AND MILD SOAP
•PAT DRY the feet – do not rub
•Wear COMFORTABLE PROPERLY-FITTED PAIR OF SHOES (leather or canvass)
•Use cotton socks and AVOID SYNTHETIC FIBERS
•Do not go barefooted
•Trim the toenails STRAIGHT ACROSS; use nail file instead
MANAGING COMPLICATIONS OF DIABETES
LIST OF SIMPLE SUGARS
•3-4 oz regular softdrink
•8 0z fruit juice
•5-7 pcs. lifesaver’s candies
•1 tbsp sugar
•5 ml pure honey or karo soup
•10-15 mg carbohydrate