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Medical and Surgical Nursing

Lecture Notes Endocrine System


Prepared By: Mark Fredderick R Abejo R.N, MAN

MEDICAL AND SURGICAL NURSING

Endocrine System

Lecturer: Mark Fredderick R. Abejo RN,MAN

 Second great controlling system of the body.


 Ductless glands
 Produces hormones that they release into the
blood or lymph
 Very rich blood supply
 The major endocrine organs:

 Pituitary gland
 Thyroid gland
 Parathyroid glands
 Adrenal gland
 Pineal gland
 Thymus gland
 Pancreas
 Gonads (Ovaries and Testes)
 Hypothalamus

Pituitary Gland

• The pituitary gland or hypophysis is a round structure about 1.27 cm (1/2 inch) in diameter located on the inferior
aspect of the brain.
• Commonly referred to as the master gland, the pituitary
secretes hormones that control the secretion of
hormones by the endocrine glands.
• It is controlled by the hypothalamus.
• It is approximately the size of a grape.
• It hangs by a stalk from the inferior surface of the
hypothalamus of the brain, where it is snugly
surrounded by the “turk’s saddle” of the sphenoid bone.
• 2 functional lobes:
• Anterior pituitary (glandular tissue)
• Posterior pituitary (nervous tissue)

Anterior Pituitary Gland

MS 1 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

 Growth Hormone (GH) or somatotropin


 Prolactin (PRL)
 Adrenocorticotropic Hormone (ACTH)
 Thyroid-Stimulating Hormone (TSH)
 Gonadotropic Hormones
 Follicle-Stimulating Hormone (FSH)
 Luteinizing Hormone (LH)

Posterior Pituitary Gland

 Oxytocin
 Antidiuretic Hormone (ADH) or vasopressin

Thyroid Gland

• Is a butterfly-shaped organ located in the lower neck, anterior to


the trachea.
• The gland is about 5 cm long and 3 cm wide and weighs about 30
g.
• The blood flow to the thyroid is very high (about 5ml/min per
gram of thyroid tissue.
• Easily palpated during PE
• It is a fairly large gland consisting of two lobes joined by a central
mass, or isthmus.
• Hormones:
 Thyroid Hormone
 Thyroxine (T4)
 Triiodothymine (T3)
 Calcitonin or thyrocalcitonin

Parathyroid Glands

• Are tiny masses of glandular tissue found on the posterior surface of the
thyroid gland.
• There are two (2) glands on each thyroid lobe
• Secretes parathyroid hormone or parathormone

Adrenal Glands

MS 2 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

• Two bean-shaped glands, which curve over the top of the kidneys
• It is structurally and functionally two (2) endocrine organs:
 Adrenal cortex (glandular tissue)
 Corticosteroids
 Mineralocorticoids
 Aldosterone
 Renin
 Glucocorticoids
 Cortisone
 Cortisol
 Sex hormones
 Androgen
 Estrogen
 Adrenal medulla (neural tissue)
 Catecholamines
 Epinephrine (Adrenaline)
 Norepenephrine
(Noradrenaline)

Pancreas

• The pancreas is located close to the stomach in the


abdominal cavity.
• Probably the best-hidden endocrine glands in the
body are the pancreatic islets, formerly known as
the islets of Langerhans
• These little masses of hormone-producing tissue
are scattered among the enzyme-producing tissue
of the pancreas.
• Composed of:
 Alpha cells
 Beta cells
 Delta cells

• Two important hormones:


 Insulin
 Glucagon
 Somatostatin

Thymus Gland

• Located in the upper thorax posterior to the sternum.


• Large in infants and children, but decreases in size
throughout adulthood. By old age, it is composed mostly of
fibrous connective tissue and fat.
• During childhood, the thymus acts as an incubator for the
maturation of T lymphocytes, which is very important in
the immune response.
• Secretes the hormone thymosin.

MS 3 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

Gonads

Male gonads (Testes)


• The paired oval testes of the male are suspended in a sac, the scrotum, outside
the pelvic cavity.
• Produces male sex hormones (sperm) or androgens.
• Hormone:
 Testosterone

Female gonads (Ovaries)

• Paired almond-sized organs located in the pelvic cavity.


• Produces female sex cells or ova
• Do not really begin to function until puberty, when the anterior pituitary
gonadotropic hormones stimulate their activity.
• Hormones:
 Estrogen
o Estrone
o Estradiol
 Progesterone

MS 4 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

MEDICAL AND SURGICAL NURSING

Endocrine System

Lecturer: Mark Fredderick R. Abejo RN,MAN Posterior pituitary (neurohypophysis)


 Oxytocin
o Promotes uterine contractions
o Milk let down reflex with the help of
PROLACTIN (lactogenic hormone)
OVERVIEW OF THE ENDOCRINE SYSTEM o Administered after placental expulsion
 Pituitary gland (Hypophysis Cerebri) – main organ  ADH – prevents urination thereby conserving
o Located at the Sella turcica fluids
o Master clock or master gland of the body o Pitressin (vasopressin)–ADH replacement
o Divisions  Contraction of smooth muscles
Anterior pituitary (adenohypophysis) o Involved in Diabetes insipidus and SIADH

SELECTED DISORDERS OF THE POSTERIOR PITUITARY

DIABETES INSIPIDUS SIADH


Definition DECREASED secretion of ADH; IDIOPATHIC INCREASED secretion of ADH (idiopathic)
Predisposing 1. Pituitary surgery 1. Head injury
Factors 2. Inflammation 2. Bronchogenic cancer (Chest XRAY – non-invasive procedure
3. Trauma that confirms lung CA)
4. Tumor 3. Hyperplasia of Pituitary gland
Signs and 1. Polyuria 1. Fluid retention
Symptoms 2. Dehydration a. Hypertension
a. Thirst – adults b. Edema
b. Tachycardia- pedia c. Weight gain
c. Agitation 2. Water intoxication  cerebral edema  increased ICP 
d. Poor skin turgor seizure activity
e. Dry mucus
3. Weakness and fatigue
4. Hypotension
5. Weight loss
6. Hypovolemic shock  if left untreated
a. Early sign: cool clammy skin
b. Late sign of shock  renal shock  anuria
Diagnostics 1. Urine specific gravity (N= 1.015-1.030) – decreased 1. Urine specific gravity increased
2. Serum Na (N= 135-145) - increased 2. Serum Na – hyponatremia
Nursing 1. Forced fluids 1. Restrict fluids
Management 2. Administer isotonic fluids as ordered 2. Administer meds as ordered (loop and osmotic)
3. Monitor VS and IO strictly 3. Monitor IO strictly
4. Administer medications as ordered – Pitressin (vasopressin) IM 4. Wt pt daily and assess for edema
5. prevent complications : hypovolemic shock 5. Meticulous skin care
6. prevent complications increased ICP and H20 intoxication

MS 5 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

ANTERIOR PITUITARY GLAND PINEAL GLAND – secretes Melatonin which inhibits LH


1. Growth hormones/somatotrophic hormones secretion and regulates circadian rhythm/body clock
 elongation of long bones or growth
 DWARFISM – hyposecretion of GH in children THYROID GLAND
 GIGANTISM – hypersecretion of GH in children  NON-PALPABLE during swallowing!!! Thyroid cartilages
 ACROMEGALY – hypersecretion of GH in adults ang palpable
i. Sandostatine (Oereotide) – drug of choice  Nodular in consistency
for acromegaly  T3 – TRIIODOTHYRONINE  90%  more potent
 T4 – TETRAIODOTHYRONINE or THYROXINE  5%
 Pancreas
 THYROCALCITONIN - its action is opposite to that of
i. Insulin
parathyroid hormone in that calcitonin increases deposition of
ii. Glucagon
calcium and phosphate in bone and lowers the level of calcium
iii. Somatostatin – antagonizes effect of GH
in the blood; its level in the blood is increased by glucagon
2. Adenocorticotrophic Hormone (ACTH) – maturation and and by Ca2+, and thus opposes postprandial Hypercalcemia
development of adrenal cortex  Antagonizes effect of parathormone  restrict Ca
3. Thyroid Stimulating Hormone (TSH) – stimulates the breakdown  restricts Ca absorption
thyroid gland to secrete thyroid hormones o T3 and T4 are metabolic or calorigenic hormones
4. Prolactin/Lactogenic/leuteotrophic Hormone o Increased T3 and T4
 Promotes development of mammary glands  Increased cerebration or thinking
 Initiates milk ejection reflex  Increased vs
5. Melanocyte Stimulating Hormone (MSH) – for skin  Irritability…blah blah  hallucinations
pigmentation
 ALBINISM – hyposecretion of MSH o Decreased T3 and T4
 VITILIGO – hypersecretion of MSH  Lethargy
 The brown race has the most sufficient amount of  Memory impairment
melanin  Loss of appetite but (+) weight gain  (-)
6. Leutenizing Hormone (LH) metabolism  increased lypolysis  CAD
 Secretes estrogen, promotes development of  Menorrhagia
secondary sexual characteristics
7. Follicle Stimulating Hormone (FSH)
 Secretes progesterone

THYROID DISORDERS

SIMPLE GOITER HYPOTHYROIDISM HYPERTHYROIDSM


Definition Enlargement of the thryroid gland due to iodine Decreased T3 and T4 Increased secretion of T3 and T4
deficiency; increased TSH Myxedema – Adults Grave’s disease, Thyrotoxicosis, toxic goiter
Cretinism–Children mental retardation IDIOPATHIC
Predisposing 1. Goiter belt area (d/t increased intake of 1. Iatrogenic causes  diseases caused 1. Autoimmune – release of LATS (long
Factors goitrogenic foods) by medical intervention acting thyroid stimulants) 
a. Places far from the sea 2. Atrophy of the thyroid gland exophthalmos
b. Mountainous regions a. Irradiation 2. Excessive iodine intake
2. Goitrogenic foods b. Tumor 3. hyperplasia of thyroid gland
a. Contains PRO-GOITRIN  c. Trauma
anti-thyroid agent that has no d. Inflammation ENOPHTHALMOS – late sign of severe
IODINE 3. Iodine deficiency dehydration in children
b. Ex: spinach, cabbage, turnips, 4. Autoimmune (Hashimoto’s disease)
radish, strawberries, nuts,
broccoli, potato, camote (root
crops – common in mountain
region  soil erosion iodine
is washed away
3. Goitrogenic drugs
a. Anti-thyroid agent (PTU)
b. Lithium
c. ASA (SE: tinnitus, heartburn,

MS 6 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

dyspepsia)
d. Phenylbutazone
e. Cobalt

#1  endemic goiter
#2-3  causes sporadic goiter

Signs and 1. Enlarged thyroid gland Early Signs 1. Hyperphagia – increased appetite
Symptoms 2. Mild dysphagia 1. Weakness and fatigue 2. (+) weight loss d/t increased
3. Mild restlessness 2. Loss of appetite but (+) weight gain metabolism
d/t increased lipolysis 3. heat intolerance
3. Dry skin 4. moist skin
4. Cold intolerance 5. diarrhea
5. Constipation 6. increased VS – tachycardia, HPN,
6. Menorrhagia tachypnea, hyperventilation,
hyperthermia
7. CNS changes
Late Signs a. Irritability
1. Brittleness of hair b. agitation
2. Non-pitting edema  d/t excessive c. Tremors
accumulation of mucopolysaccharides d. Restlessness
in sq e. Insomnia
3. Hoarseness of voice f. Hallucinations
4. Decreased libido 8. Goiter
5. Decreased VS 9. Exophthalmos
a. Hypotension 10. Amenorrhea
b. Bradycardia
c. Bradypnea
d. Hypothermia
6. CNS changes
a. Lethargy
b. Memory impairment
c. Psychosis

Diagnostics 1. Serum T3 and T4  normal or below 1. Serum T3 and T4 decreased 1. elevated T3 and T4
normal 2. Radioactive Iodine Uptake (RAIU) 2. RAIU elevated
2. Thyroid Scan  enlarged thyroid gland decreased 3. Thyroid Scan  enlarged thyroid
3. Serum TSH increased 3. Serum Cholesterol elevated gland
Nursing 1. Administer medications as ordered 1. Monitor STRICTLY VS, IO to 1. Monitor VS and IO strictly to
Management a. Iodine Solution: Lugol’s Solution – determine presence of MYXEDEMA determine presence of THYROID
saturated solution of potassium COMA a complication of severe STORM/Crisis
iodine; 1 liter of water to 2-3 drops, hypothyroidism characterized by: 2. Administer medications as ordered
use straw to prevent staining of teeth a. Severe hypotension a. Anti-Thyroid Agents: PTU
b. Thyroid agents of hormones b. Bradycardia  toxic effects is
 Levothyroxine (Synthoid) c. Bradypnea AGRANULOCYTOSIS
 Liothyronine (Cytomel) d. Hypoventilation fever and chills, sore throat
 Thyroid extracts e. Hypoglycemia (throat CS pls!),
 NURSING MGMT when f. Hyponatremia LEUKOCYTOSIS (CBC pls!)
giving these: g. Hypothermia b. Methimazole (Tapazole)
 Instruct client to take it  Might lead to progressive stupor 3. High calorie diet to correct weight loss
best at early AM to and coma 4. Provide comfortable and cool
prevent insomnia  Assist in mechanical ventilation, environment
 Monitor VS especially administer thyroid hormones as 5. Institute meticulous skin care
HR (mlt tachycardia and ordered and force fluids, IV 6. Maintain side rails
palpitaitons fluids replacement 7. Bilateral eye patch to prevent drying of
 Monitor SE: insomnia, 2. Administer isotonic fluids as ordered eyes
tachycardia, palpitations, 3. Administer medications as ordered – 8. Assist in surgical procedure: subtotal
HPN, heat intolerance thyroid hormones or agents (may thyroidectomy
2. Encourage increased intake of foods rich in cause insomnia and heat intolerance) a. PRE-OP
iodine 4. Provide dietary intake low in calories i. Administer lugol’s
a. Seaweeds to prevent weight gain solutions/ SSRI to
b. Seafoods: oysters, clams, crabs, 5. institute meticulous skin care promote decreased
lobster, shrimps (have low iodine 6. provide comfortable and warm vasculature and promote
content) environment atrophy of the thyroid
c. Iodized salt (served on the table, (-) 7. forced fluids gland to prevent/minimize
effect with cooking) 8. health teaching and d/c planning bleeding and hemorrhage
3. Institute CBR a. avoidance of precipitating b. POST-OP
4. Assist in surgery – subtotal thyroidectomy factors leading to myxedema i. WOF signs of THYROID
coma STORM  agitation,
 stress hyper-thermia, HPN. If
 infection (+) thyroid storm:

MS 7 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

 exposure to cold administer anti-pyretics


environment and beta-blockers; VS, IO
 Anesthetics, sedatives and and NVS strictly, siderails
narcotics  respi distress up, provide hypothermic
b. prevent complications blanket
(hypovolemic shock and ii. WOF: inadvertent or
myxedema coma) accidental removal of
c. hormonal replacement therapy parathyroid gland 
for lifetime hypocalcemia or tetany
d. importance of ff-up [(+) trousseu’s signs, (+)
e. wearing of medic-alert bracelet chvostek’s Give Ca Gluc
slowly to prevent
arrhythmia and arrest
iii. WOF accidental
laryngeal nerve damage
 hoarness of voice 
instruct client to talk
immediately post-op  if
(+) notify MD
iv. WOF signs of bleeding 
(+) feeling of fullness at
incision site, (+) soiled
dressings at back or nape
area, notify MD
v. WOF signs of laryngeal
spasm  DOB and SOB
 prep trache set
9. Hormonal Replacement therapy for
life
10. importance of FFup care
11. wearing of medic-alert bracelet

PARATHYROID – pair of small nodules located behind the thyroid gland  parathormone  for Ca reabsorption

PARATHYROID DISEASES

HYPOPARATHYROIDISM HYPERPARATHYROIDISM
Definition A condition due to diminution or absence of the secretion of Increased parathormone
the parathyroid hormones, with low serum calcium and tetany, 1. Hypercalcemia (blood)
and sometimes with increased bone density. a. Bone demineralization  bone fracture
 Hypocalcemia b. Kidney stones
 Hyperphosphatemia 2. Hypophosphatemia
 Decreased parathormone
Predisposing 1. Following subtotal thyroidectomy 1. Hyperplasia of parathyroid glands
Factors 2. Atrophy of parathyroid d/t 2. Over compensation of parathyroid gland d/t Vitamin D
a. Inflammation deficiency  Ricketts  Children (Osteomalacia –
b. Trauma Adults)
c. Irradiation
Signs and 1. Acute tetany 1. Bone pain especially at the back  bone fracture
Symptoms a. Tingling sensation 2. Kidney stones
b. Paresthesia a. Renal colic
c. Dysphagia b. Cool moist skin  initial Sx of shock
d. (+) laryngospasm 3. Interaction – elevated Ca and
e. (+) Trousseu’s sign 4. Anorexia and general body malaise
f. (+) Chvostek’s sign 5. Irritability and memory impairment
g. arrhythmia 6. Presence of ulceration
h. seizures
2. Chronic tetany
a. Cataract and photophobia
b. Loss of tooth enamel
c. Anorexia and general body malaise
d. Agitation, Irritability and memory impairment

Diagnostics 1. Serum Ca decreased (N= 8.5-11/100ml) 1. Serum Ca increased

MS 8 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

2. Serum Phosphate increased (N= 2.5 -4.5 mg/100ml) 2. Serum Phosphate decreased
3. X-ray – decreased bone density (long bones) 3. Bone Xray – Bone demyelination
4. CT Scan – degeneration of basal ganglia
Nursing A. Administer medications as ordered 1. Force fluids
Management a. Ca gluconate slowly for acute tetany, slow IV 2. Strain all the urine with gauze pad
b. Oral calcium supplement 3. Provide warm sitz bath for comfort
i. Ca gluconate 4. Provide acid-ash in the diet to acidify the urine
ii. Ca lactate (cranberries)
iii. Ca carbonate 5. Administer medications as ordered
c. Vit D (Cholecalciferol) a. narcotic analagesics
Apricot – high i. Calcidiol – from food i. Morphine sulfate  tremors 
in potassium ii. Calcitrol – from sun naloxone
d. Phosphate binder (aluminum OH gel – ii. Demerol  respiratory depression
Amphogel) – binds Phosphate in intestines  6. Maintain siderails
constipation 7. Ambulate with assistance
i. Maalox given 1 hour before meals 8. Diet: high Phosphate and low Ca (lean meat)
B. Avoid precipitating stimulus such as bright  glaring 9. Assist in surgical procedure – parathyroidectomy
lights and noises  photophobia  seizure 10. Prevent complications – renal failure
C. Diet which is increased in Ca and decreased phosphate 11. Hormonal replacement therapy
a. Salmon, anchovies, green turnips 12. Importance of ffup care
D. Institute seizure and safety precautions
E. Prepare trache set at bedside
F. Encourage the client to breath using paperbag  mild
acidosis  increased ionized Ca levels
G. Prevent complications
a. Arrhythmia
b. Seizures
H. Hormonal replacement for lifetime
I. Importance of ffup care

ANTACIDS ADRENAL GLAND


Aluminum Containing Magnesium Containing -atop of each kidney
Aluminum OHgel (Ampho gel) Milk of Magnesia I. Adrenal Cortex (outer)
Constipation Diarrhea A. Zona faciculata  glucocorticoids (cortisol: glucose
metabolism) SUGAR
B. Zona reticularis  secretes traces of glucocorticoids and
androgenic hormones  testosterone, estrogen (LH) and
progestin (FSH) SEX
PHEOCHROMOCYTOMA – catecholamine producing tumor; C. Zona glomerulosa  mineralocorticoids  aldosterone 
elevated NE  HPN resistant to medications  stroke promotes Na and H2O reabsorption and excretes potassium
 Tx: beta blockers SALT
 Avoid valsalva maneuver II. Adrenal Medulla – secretes catecholamines
A. Epinephrine
B. Norepinephrine

ADRENAL GLAND DISORDERS

MS 9 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

ADDISON’S DISEASE CUSHING’S DISEASE


Definition Hyposecretion of adrenocortical hormones leading to: Hypersecretion of adrenocortical hormone
 Metabolic disturbances (sugar)
 Fluid and electrolyte imbalances (salt)
 Deficiency of neuromuscular function (salt and sex)
Predisposing 1. Atrophy of the Adrenal gland 1. Hyperplasia of Adrenal gland
Factors 2. Fungal infections 2. Tubercular infection (MILIARY – TB to
adjacent organs)
Signs and 1. hypoglycemia (TIRED) 1. Hyperglycemia  can lead to DM
Symptoms a. Tremors and tachycardia a. Polyuria
b. Irritability b. Polydipsia
c. Restlessness c. Polyphagia
d. Extreme fatigue d. Wt. Gain
e. Diaphoresis and depression e. Glucosuria
2. Decreased tolerance to stress (d/t decreased cortisol)  Addisonian Crisis 2. Increased susceptibility to infection (Reverse
3. Hyponatremia isolation!)
a. Hypotension 3. Hypernatremia
b. Signs of dehydration a. HPN
c. Weight loss b. Edema
4. Hyperkalemia c. Wt. gain
a. Irritability and agitation 4. Moonface appearance, buffalo hump, obese
b. Diarrhea trunk, pendulous abdomen, thin extremities
c. Arrhythmias 5. Hypokalemia
5. Decreased Libido a. Weakness and fatigue
6. Loss of pubic and axillary hair b. Constipation
7. Bronze-like skin pigmentation d/t decreased cortisol stimulation of MSH c. U wave on ECG tracing
from pituitary gland 6. Hirsutism
7. Easy brusing
8. Acne and Striae
9. increased masculinity in females

MS 10 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

Diagnostics 1. FBS decreased (N= 80-120 mg/dl) 1. FBS elevated


2. Serum Na decreased (N= 135-145) 2. Elevated Na
3. Serum K elevated (N=3.5-5.5meq/L) 3. Decreased K
4. Plasma cortisol decreased 4. Elevated Cortisol
Nursing 1. Monitor strictly VS, IO to determine presence of Addisonian crisis which 1. Monitor IO, VS
Management results from acute exacerbation of Addison’s disease characterized by: 2. Restrict Na and Fluids
a. Hyponatremia 3. Weigh pt. daily and assess for pitting edema
b. Hypovolemia (ANASARCA – generalized edema nephritic
c. Dehydration syndrome)
d. Severe Hypotension 4. Measure abdominal girth daily, notify MD
e. Weight loss Which may lead to progressive stupor  coma. 5. Diet: low CHO, NA, High CHON and K
 Assist in mech vent, steroids as ordered, forced fluids 6. Administer medications as ordered
2. Administer medications as ordered a. K-sparing diuretics - Spironolactone
a. Corticosteroids (Aldactone); excretes sodium but
 Universal rule: administer 2/3 dose in AM and 1/3 dose retains potassium
in PM to mimic the N diurnal rhythm of the body 7. Prevent Complications – DM
 Taper the dose. Withdraw gradually from the drug 8. Provides meticulous skin care
 Monitor SE: Cushingoid Sx 9. Assist in Surgical Procedure – Bilateral
Adrenalectomy
 HPN, Increased susceptibility to infection, 10. Hormonal replacement for life
Weight gain, Hirsutism, Moon face 11. Importance of ffup care
appearance
 Ex: Hydrocortisone, Dexamethasone, Prednisone
b. Mineralocorticoids – fluorocortisone
3. Forced fluids
4. Maintain patent IV line
5. Diet: high CHO/calories, Na and CHON, low K
6. Meticulous skin care
7. Provide health teaching and d/c planning
a. Avoidance of precipitating factors leading to addisonian crisis:
 Stress, Infection, Sudden withdrawal to steroids
b. Prevent Complications – hypovolemic shock
c. Hormonal replacement therapy for life
d. Importance of ffup care

PANCREAS Acinar Cells


 Behind the stomach 1. secretes pancreatic juices
 Mixed gland: exocrine and endocrine at the same time 2. aids in digestion
 Pancreatitis  inflammation  edema  hemorrhage  B. Islets of Langerhans
autodigestion 1. Alpha cells
 Stomach doesn’t undergo autodigestion despite  Glucagon  hyperglycemia
acidic environment d/t gastric juices that protects it 2. Beta cells
 Chronic hemorrhagic pancreatitis  death during sleep  Insulin  hypoglycemia
3. Delta cells
 Somatostatin  antagonizes effect of gh

DIABETES MELLITUS
 metabolic disorder characterized by non-utilization of CHO, CHON and FAT metabolism

DM I (IDDM) DM II (NIDDM)
Definition Juvenile Onset/ Non-obese; children; BRITTLE DISEASE Adult Onset/Obese (40 yo above) Maturity-onset type
Incidence Rate 10% of general population 90% of the general population

Predisposing 1. Hereditary – total destruction of pancreatic cells Obesity  lack of insulin receptor binding sites
Factors 2. Viruses
3. Toxicities (CCl4)
4. Drugs, steroids and loop diuretics (furosemide)

MS 11 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

Signs and 1. Polyuria, polydipsia, polyphagia Usually asymptomatic (3P’s +1G, weight gain)
Symptoms 2. Glucosuria Absence of lypolysis
3. Weight loss, anorexia, nausea and vomiting
4. Blurring of vision
5. Increased susceptibility to infection
6. Poor/delayed wound healing (lower extremity – distal to
the heart)
Treatment 1. Insulin 1. OHA
2. Exercise 2. Diet
3. Diet 3. Exercise
4. Sodium Bicarbonate for acidosis 4. Insulin used during emergency situation
Complications DKA that may lead to diabetic coma HONK
 Acute complication of type 1 DM due to hyperglycemia
leading to severe CNS depression
 Predisposing Factors:
 Hyperglycemia
 Stress
 Infection
 Signs and symptoms
 3P’s and G
 Weight loss
 Anorexia, nausea and vomiting
 Acetone breath, kussmaul’s, decreased LOC 
coma
 Dx: elevated FBS, BUN, Crea and Hct

1. Monitor for peak action of OHA and insulin


2. Administer insulin/OHA as ordered
a. Brain can tolerate elevated glucose levels but not
decreased glucose
GESTATIONAL DM 3. Monitor strictly VS, CBG, I/O
 d/t maternal hormones 4. Monitor for s/sx of hypogly and hypergly and notify MD
 Infant hypogly signs: high pitch cry and poor sucking reflex 5. Diabetic diet: CHO 50%, CHON 30%, Fats 20%
DM ASSOCIATED WITH ILLNESS a. Offer alternative food substitutes
 Pancreatic Ca b. Give orange juice if patient refuses to eat
 Cushing’s Syndrome 6. Exercise after meals when blood glucose is rising
7. Monitor for Sx complications
Main food Anabolism Catabolism a. Atherosclerosis  HPN  MI or CVA
Stuff b. Microangiopathies
CHO Glucose Glycogen  Eyes
CHON Amino acids Nitrogen  Blindness or Retinopathy
FATS Fatty acids Free fatty acids  ketones and cholesterol  Premature Cataract – hazy
vision, decreased color
 Food  CHO  glucose  insulin aids in absorption of glucose vision; use mydriatics
 Cells  ATP (main fuel of the cells)  Kidneys
 GLUCONEOGENESIS – formation of glucose from non-  Recurrent pyelonephritis
carbohydrate sources (CHON and fats) (inflammation of renal pelvis
 Liver  glycogenesis and glycogenolysis  glucose in  Renal failure ( common
bloodstream causes: HPN, DM)
 Increased fat metabolism release of FFA  Gangrene formation
 Cholesterol  deposition in arteries  HPN  CVA,  Shock
MI  death  Peripheral neuropathy
 Increased CHON catabolism  -N balance  tissue  Diarrhea, constipation
wasting  cachexia  Sexual impotence (HPN,
 Ketones (CNS depressant)  DKA  Kussmaul’s DM)
respiration  acetone breath  diabetic coma
 DM  hyperglycemia  increased osmotic diuresis
 Polyuria  cellular dehydration  stimulates thirst 8. Foot care management
center  polydipsia a. Avoid walking barefooted
 Glucosuria  cellular starvation  stimulate appetite b. Cut toenails straight
center  polyphagia c. Apply lanolin to prevent skin breakdown
 DIAGNOSTICS: d. (-) constricting garments
1. FBS if elevated 3 consecutive times +3Ps and G = DM 9. Encourage annual eye and kidney exam
2. OGTT (oral glucose tolerance test) most sensitive test 10. Monitor for signs of DKA or HONK
3. Alpha Glycosylated Hgb increased 11. Assist in surgical wound debridement
a. Administer analgesics prior to debridement
 DM management 12. Assist in surgical procedures

MS 12 Abejo
Medical and Surgical Nursing
Lecture Notes Endocrine System
Prepared By: Mark Fredderick R Abejo R.N, MAN

a. BKA
b. AKA

INSULIN THERAPY
I. Sources
A. Animal – pork and beef : rarely used because it can cause
severe allergic reactions
B. Human – less antigenicity, less allergic reactions
C. Artificial
II. Types of Insulin
A. Rapid (SAI) – clear, peak: 2-4 hours , Regular insulin
B. Intermediate AI – NPH (Non-Protamine Hagedorn) –
cloudy, peak : 6-12 hours
C. Long AI – Ultra lente – cloudy, peak 12-24 hours
III. Nursing Management
A. Administer insulin at room temp to prevent
lipodystrophy atrophy/hypertrophy of SQ tissue
B. Insulin only refrigerated once opened
C. Avoid shaking insulin, roll between palms only
D. Accuracy of administration is important
E. Rotate insulin sites to prevent lipodystrophy
F. Use short bore needle gauge 25-26
G. No need to aspirate
H. Administer insulin 45/90 degrees angle depending on
amount to pt’s SQ tissue
I. Most accessible route: abdomen
J. Aspirate CLEAR before CLOUDY to prevent
contamination and promote accurate calibration
K. Monitor for local complications:
1. Allergic reactions
2. Lipodystrophy
3. SOMOGYI’S PHENOMENON – rebound effect of insulin
characterized by hypoglycemia, hyperglycemia

ORAL HYPOGLYCEMICS
MOA – stimulates the pancreas to secrete insulin
I. Classification
A. First generation sulfonylureas
1. Chlorpropamide (Diabenase)
2. Talbutamide (Orinase)
3. Tolazamide (Tolinase)
B. Second generation sulfonylureas
1. Glipzide (glucotrol)
2. Diabeta (Micronase)
II. Nursing Management
A. Administer with food to decrease GIT irritation and to
prevent hypoglycemia
B. Instruct pt not to take alcohol
1. Alcohol + OHA  severe hypoglycemic reaction
2. Disulfiram +OHA  toxicity

MS 13 Abejo
DIABETIC KETOACIDOSIS (DKA) HYPEROSMOTIC NON-KETOTIC (HONK)
Definition Acute complication of IDDM d/t hyperglycemia leading to CNS HO  increased osmolality  severe dehydration
depression and coma NK  absence of lypolysis  no ketosis
Precipitating 1. Hyperglycemia
Factors 2. Stress
3. Infection
Signs and 1. 3Ps +1G, weight loss 1. Headache
Symptoms 2. Anorexia, nausea and vomiting 2. Confusion
3. Acetone/fruity breath 3. Seizures
4. Kussmaul’s respirations 4. Decreased LOC  coma
5. CNS depression
6. Coma
Diagnostics Elevated FBS
Elevated BUN, CREA and HcT
Nursing 1. Assist in mechanical ventilation Same but (-) NaHCO3
Management 2. SOP in hospitals: administer 0.9 NaCl, PNSS, isotonic, followed by
0.45 NaCl hypotonic to counteract dehydration
3. Monitor VS, IO, CBG
4. Administer medications as ordered
a. Rapid Acting – regular
b. Sodium Bicarb to counteract acidosis
c. Antimicrobials