Endocrine disorder
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Diabetes Mellitus (DM)
Definition: DM is chronic disorder of carbohydrate
metabolism resulting from deficiency of or resistance
to available insulin and characterized by
hyperglycemia.

Glucose used with oxygen by the cell to produce
energy for body function. When DM occurred the cell
can't use the glucose (it will accumulate in the blood
and excreted in the urine). Body will use proteins and
fat to produce energy. This leads to acidosis.
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
Functions of insulin:
1.
2.
3.
Converting glucose to glycogen.
Promote the conversion of fatty acids into fat (stored in
adipose tissue) and prevent breakdown of adipose tissue
and conversion fat into ketone bodies.
Prevent breakdown of protein.
How Insulin Works?
1.
When we eat, food is broken into chemicals and
glucose enters bloodstream. Insulin in response to
elevated serum glucose, beta cells of pancreas
secrete insulin into bloodstream.
2. Insulin combines with insulin receptors on cell wall
(activating glucose transporters), allowing glucose
to enter cell.
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Causes:
Causes unknown but there are many risk factors that may help in
causing of the disease. From these factors:
1.
2.
3.
Heredity
Environment (autoimmune factors and viruses e.g. chickenpox)
Lifestyle (overweight and sedentary lifestyle)
Types of DM:
1.
2.
3.
Type 1(insulin dependent DM or IDDM): occurs suddenly in
young age <25 years, causes are autoimmune and genetic.
Type 2 (non-insulin dependent DM or NIDDM): occurs in adult
age, causes are obesity and genetic. Little amount of insulin
produced.
Gestational DM: is transitory glucose intolerance during
pregnancy and disappear after delivery. Cause related to resistance
to insulin related to the effect of progesterone and other hormones.
Some of them need insulin while the other can control glucose
with diet.
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Signs and symptoms of DM:
A-3 polies':
1.
2.
3.
1. Polyuria (fluid removed with the glucose by the kidney).
2. Polydipsia (excessive thirst)
3. Polyphagia and wt loss (increase food intake)
B-Hyperglycemia
C-Presence of glucose in urine
Diagnosis:
1.
Presence of signs and symptoms or
2.
Fasting blood sugar > or = 140 mg/dl for 2 times or
3.
Positive glucose tolerance test
4.Glycohemoglobin: give indication for glucose level for 2-3
months.
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Treatment:
to prevent hyperglycemia and prevent complication
1-Medication: decrease sugar level and prevent
complications.
1.
2.
oral hypoglycemic agent: mainly for type 2 DM
Insulin injection: mainly for type 1 DM.
2-Exercise: increase the uptake of glucose by muscle
cells, lower the body weight.
3- Nutrition: to maintain normal level of glucose and
lipids, prevent and treat complication, and improve
overall health.
4- Transplantation of pancreas.
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Complication:
1- -Acute Complication:
A. Hypoglycemia: high dose of insulin or increased exercise or poor
eating

S&S:

Mild Hypoglycemia: diaphoresis, pallor, paraesthesia, excess hunger,
palpitation, and tremor.

Moderate Hypoglycemia: confusion, disorientation, irritability, and slurred
speech.

Sever Hypoglycemia (emergency): seizure, loss of consciousness (LOC),
and shallow respiration
B. Hyperglycemic NonKetotic Syndrome (HNKS): polyuria, polydpsia,
hot skin, decrease turgor, blurred vision, and confusion.
C. Diabetic Ketoacidosis (DKA): Accumulation of ketone bodies in
the blood and tissue (lead to dry skin, fluid and electrolytes loses). Presence
of glucose or ketons bodies in the urine.

S&S: same as in HNKS and fruity (acetone) breathing smell
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Chronic Complication:
1.
Infections: diabetic foot, urinary tract infections.
2.
Diabetic neuropathy:
1.
2.
3.
4.
5.
Peripheral: paraesthesia, ↓pain and temperature
sensation.
Autonomic: affect GI, urinary, and reproductive.
Nephropathy: renal failure
Retinopathy: change of the blood vessels in the
retina→ visual impairment.
Vascular changes: occlusion of peripheral artery,
hypertension, myocardial infarction, angina, and
cerebral vascular accidents.
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Nursing Intervention:
1.
Measure client's intake and output.
2.
Administer intravenous fluid as ordered and
encourage oral fluids.
3.
Administer medication as order.
4.
Monitor vital signs, blood sugar, ketone bodies, and
serum electrolytes.
5.
Teach client about:
1.
2.
3.
Diabetes nature, causes, treatment…
The care to prevent complications and to do regular check
for all systems of the body that may affected by DM
periodically.
Adjusting dietary intake & regular exercise to maintain
weight in normal range.
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Thyroid Dysfunction
Common thyroid problems:
1.
2.
3.
Hyperthyroidism:
Hypothyroidism.
Cancer, tumors, and goiters.
1. Hyperthyroidism:
1.
2.
3.
Hyperthyroidism: increase thyroid hormones (thyroxin T4 and
T3).
Cause: autoimmune (immune system triggers the production of
thyroid stimulating immunoglobulin →stimulate thyroid
function).
Signs and symptoms: enlarge thyroid size and accumulation of
fluid in the orbital (protrude eyeball or exophthalmos). Increase
metabolic rate (→tachycardia, hyperthermia, weight loss, fatigue,
nervousness and mood swing, difficulty in concentration, sleep
disturbance, fine tremor, and smooth, moist & warm skin).
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Treatment:
1.
2.
3.
4.
5.
Antithyriod medication: methimazole
Radiotherapy (external and oral administration of radioactive
materials): increase fluid intake for 2 days, good clean for
toilet for 2 days, use disposable eating utensils, avoid contact
with pregnant and child for a week).
Treat sings and symptoms
Surgery: thyroidectomy (complete removal) and partial
thyroidectomy.
Complication of surgery is respiratory distress, absence of
voice, and hemorrhage.
Diet: increase specially protein, vitamins (A & C), and
minerals
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Nursing intervention:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Put client in comfortable position
Provide oxygen as ordered.
encourage moderate activity
Provide a diet high in calories, protein, and carbohydrates
and obtain nutritional consultation as needed.
Provide small frequent meals spread over waking hours.
Provide a well-ventilated room with temperature controlled
to coolness for comfort.
Suggest wearing cool loose-fitting lightweight clothing.
Provide frequent bathing and changes in linens or clothing.
Provide fluids up to 3 liters per day
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Hypothyroidism
decrease thyroid hormones (primary or related to the
gland and secondary related to stimulators of the
gland).
Signs and symptoms:
Decreased metabolic rate (fatigue, energy loss,
sensitivity to cold, unexplained weight gain, slow
slurred and hoarseness speech, thick dry tongue,
irritability, depression, dry rough skin, dry hair,
bradycardia, decrease heart activity, decreased
libido, and constipation).
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Management:
1.
2.
Medication: Thyroid replacement therapy
Diet :( dietary consultation).
1.
2.
3.
The client should be instructed to avoid foods high
in iodine and foods (shellfish, iodized salt,
saltwater fish, cabbage, and peaches) that interfere
with thyroid hormone replacement.
The diet is designed to increase weight loss and
combat constipation. A high-fiber, high-protein,
low-calorie diet is given.
Sodium should be decreased to prevent fluid
retention.
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Nursing Intervention:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Assist the client to gradually increase activity level but encourage
rest between activities to avoid fatigue & decrease cardiac oxygen
demands.
Reposition client every 2 hours and encourage client to continue
activity when normal activity level is achieved.
Assess for chest pain and advise client to report any episodes of
angina immediately.
Monitor the client's vital signs, cardiac status through ECG and
assessment of heart and lung sounds plus checking for edema.
Provide high-fiber low calories diet and encourage intake of oral
fluids if not contraindicated.
Administer stool softener, bulk laxative, or enema as ordered.
Provide extra warmth
Minimum use of soap. Use cream or lotions to moisten the skin
Teach client about disease, long-term treatment, and symptoms
control.
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Adrenal Dysfunction
Type of adrenal hormones:
1.
Glucocorticooids: regulate metabolism
2.
Mineralocortioids: regulate Na and K level
3.
Androgen: contribute to growth and development and sexual
activity
adrenal gland diseases:
1. Cushing syndrome:
is the hyperfunctioning of the adrenal cortex
Causes:
1.
2.
Endogenous (inside e the body): anterior pituitary (secondary)
and adrenal cortex (primary) tumors
Exogenous (outside of the body): prolong use of
corticosteroids
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Sings and symptoms:
1.
2.
3.
4.
Hypertension, mood swing, irritability, anxiety,
insomnia, menstrual disturbance and diminish libido,
edema, and glucose intolerance.
Increased facial and body hair, Thinning of hair,
Supraclavicular fat pad, Bronze skin, Slow wound
Healing, Thin extremities with muscle atrophy, and
Ecchymosis from easy bruising
Increase Na in the blood
Red checks, weight gain, and moon face.
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Treatment:
1.
Gradual discontinuation of corticosteroids
2.
Medication: decrease hormone production. Side
effect: anorexia, GI bleeding, nausea, vomiting,
dizziness, skin rashes, depression, and double
vision.
3.
Surgery or irradiation: complication of surgery:
hemorrhage (because it is highly vascularised),
increase hormonal release. Post operative care focus
on fluid and electrolyte and BP monitoring
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Nursing diagnosis & Intervention:
1.
2.
3.
4.
5.
Monitor patient's compliance to caloric restrictions.
Encourage high-protein diet and monitor patient's weight.
Plan activity and rest periods with patient daily.
Observe skin, especially areas of thinning and loss
integrity, to identify areas of risk.
Instruct patient concerning good skin hygiene:
1.
2.
3.
Wash and dry thoroughly.
Use lotions and antifungal cream as needed.
Perform aseptic care to minor lacerations and abrasions
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6- Provide adequate pressure to venipuncture sites to prove
subcutaneous hematoma.
7-Keep patient's room clear of obstructions (excess furniture,
etc.)
8-Instruct patient in the use of protective clothing, especial
shoes and socks, to prevent trauma.
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Addison's disease:
hypofunctioning of adrenal cortex ( decrease in
Glucocorticooids and Mineralocortioids)
Causes:
1.
2.
3.
4.
Cortisone therapy →atrophy of gland
Autoimmune: antibody produced against the cortex
→ destruction of the tissue.
Infections: TB, fungal
Hemorrhage, post metastasis and chemotherapy
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Sings and symptoms:
1.
2.
3.
4.
5.
Weakness, fatigue, anorexia, weight loss
Hypoglycemia (nervousness, diaphoresis, headache,
and trembling)
Decrease Na and increase K.
Hyper pigmentation of the skin.
Hypotension
Treatment:
1.
2.
Cortisone replacement (long life) and Hydration
Surgery.
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Nursing Intervention
1.
2.
3.
4.
5.
6.
7.
8.
Provide rest periods for patient between nursing activities.
Allow patient to increase strength and endurance at own
pace; muscle weakness will improve as hormone
replacement is achieved.
Monitor patient for development of pain (headache;
abdominal, leg, back pain); be aware that these signs may
indicate adrenal crisis.
Encourage the patient to report pain or discomfort.
Provide hormonal replacement (hydrocortisone).
Employ comfort measures for the patient as needed
Monitor patient's vital signs and apical pulse to detect
dysrhythmias, and skin turgor for signs of dehydration
Have patient change positions gradually (from lying to
sitting or standing positions) to avoid fainting from
orthostatic hypotension.
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