Endocrine Disorders By: Keith Kainne “D” Garino, RN, LPT, MAEd TOPRANK | Nursing Pituitary Gland Anterior Posterior G O T A P A L F M TOPRANK | Nursing Antidiuretic Hormone/Vasopressin TOPRANK | Nursing Syndrome of Inappropriate Antidiuretic Hormone Secretion Cause: 1. Stroke 2. Tumor 3. Medications TOPRANK | Nursing Interventions: 1. ADH • DOC 4. Oliguria/Polyuria • Monitor 2. Fluid status • Monitor • Monitor V/S • Fluid intake • Position • DOC 3. Hyponatremia/Hypernatremia • Monitor • Neurological • Serum osmolality • IV fluids TOPRANK | Nursing • I • S 5. Cerebral Edema/Shrinkage • Monitor • Priority • Precaution Diabetes Insipidus Types: 1. Neurogenic/Central • • 2. Nephrogenic • • TOPRANK | Nursing Interventions: 1. Neurogenic/central • DOC • Route • WOF 2. Nephrogenic • DOC • T • C • C 3. Medic Alert Bracelet TOPRANK | Nursing 4. Fluid status • Monitor • Monitor vital signs • BP • HR • RR - 5. Hyponatremia/Hypernatremia • Monitor • Neurological • Serum osmolality • IV fluids TOPRANK | Nursing 6. Oliguria/Polyuria • Monitor • I • S • Avoid foods Findings Low ADH Increased body weight Hypertension Tachycardia Increased Serum Osmolality Decreased urine specific gravity Low serum sodium TOPRANK | Nursing Increased urine output DI SIADH Adrenal Glands Parts: 1. Medulla • • 2. Cortex • • • TOPRANK | Nursing Pheochromocytoma Cause: • Diagnostic test: • Vanillylmandelic acid Complications: TOPRANK | Nursing Pheochromocytoma 1. Classic Sign 2. Triad •H •P •D 3. Glucose TOPRANK | Nursing Interventions: 1. Monitor • • 3. Avoid 4. Environment 2. WOF • • • • • • P N O N A B TOPRANK | Nursing 5. Diet 6. DOC 7. Surgery Adrenal Glands 1. Glucocorticoids • Natural release • Sugar • Stress • Suppress • Proteins • Calcium TOPRANK | Nursing Adrenal Glands 2. Mineralocorticoids • Na and H2O •K 3. Androgen TOPRANK | Nursing Cushing’s 1. Syndrome • Steroids • Tumor 2. Disease • ACTH TOPRANK | Nursing Cushing’s 1. Glucocorticoids • Natural release • Sugar • Stress • Suppress • Proteins • Calcium TOPRANK | Nursing Cushing’s 2. Mineralocorticoids • Na and H2O •K 3. Androgen TOPRANK | Nursing Interventions: 1. Cortisol • Avoid • DOC • M • M • K 2. Glucose 3. Immunity 4. Protein 5. Calcium TOPRANK | Nursing 6. Na & H2O 7. Potassium 8. Androgen 9. Surgery • 10. MedicAlert Bracelet Addison’s Disease/Adrenal Insufficiency Types: 1. Primary • Cause 2. Secondary • Cause TOPRANK | Nursing Addison’s Disease/Adrenal Insufficiency 1. Glucocorticoids • Natural release • Sugar • Stress • Suppress • Proteins • Calcium TOPRANK | Nursing Addison’s Disease/Adrenal Insufficiency 2. Mineralocorticoids • Na and H2O •K 3. Androgen TOPRANK | Nursing Interventions: 1. Cortisol • Avoid • DOC • • • • • • • Duration Stress Infection OTC Protein Carbs Calcium 2. Glucose TOPRANK | Nursing 3. Calcium 4. Na & H2O 5. Potassium 6. Androgen 7. Medicalert bracelet Addisonian Crisis Cause: 1. Stress • Infection • Surgery • Trauma 2. Abrupt withdrawal of steroids WOF: 1. Low Aldosterone 2. Severe pain (head, abdomen & legs) TOPRANK | Nursing Addisonian Crisis Intervention: 1. DOC • Hydrocortisone • G&M 2. Monitor • VS • LOC • Labs 3. Activity 4. Environment TOPRANK | Nursing Findings Muscle weakness Weight loss Hirsutism Hypoglycemia Hypernatremia Hypokalemia Hypercalcemia Hypertension Bronze skin TOPRANK | Nursing Addison’s Cushing’s Thyroid Glands TOPRANK | Nursing Hypothyroidism • Cause • Goiter • Types: 1. Primary 2. Secondary TOPRANK | Nursing Clinical Manifestations: 1. T3 • Metabolism • GIT 2. T4 • Heat Production • skin 3. SNS • Muscle • V/S TOPRANK | Nursing Interventions: 1. V/S 2. Body wt. • Monitor • Calorie • Activity 3. GIT • Fiber & fluids 4. Intolerance • Environment 5. Exophthalmos/Myxedema • Assess TOPRANK | Nursing 6. Activity • Sedatives 7. DOC • Time • With food or empty • WOF • Over • Under • MedicAlert Bracelet Myxedema Coma: • V/S • • • • BP HR RR Temp • Hyponatremia • Hypoglycemia • Generalized edema TOPRANK | Nursing Interventions: 1. Follow “ABC” 2. Independent 3. DOC • L Hyperthyroidism: • Cause • Goiter • Laboratory • Clinical Manifestations TOPRANK | Nursing Clinical Manifestations: 1. T3 • Metabolism • GIT 2. T4 • Heat Production • skin 3. SNS • Muscle • V/S TOPRANK | Nursing Interventions: 1. V/S 2. Body wt. • Monitor • Calorie • Activity 3. GIT • Fiber & fluids 4. Intolerance • Environment 5. Exophthalmos/Myxedema • Dry • Sun • Sleep • HOB • DOC 6. Activity • Sedatives • Stimulants • Environment 7. Avoid: TOPRANK | Nursing Medications: 1. ThioAMides (Propylthiouracil & Methimazole) • GI irritants • WOF 2. Iodide Solution (Lugol’s, KI & SSKI) • Palatability • Staining • WOF 3. Radioactive Iodine (iodine 131) • WOF 4. Betablockers “olol” TOPRANK | Nursing Complications of Thyroidectomy: 1. Hypoprara/Hypocalcemia/Tetany • WOF • DOC 2. Thyroid storm • WOF • Priority 3. Bleeding • WOF • Avoid • Position TOPRANK | Nursing Complications of Thyroidectomy: 4. Laryngospasm • WOF • Item 5. Laryngeal nerve damage • WOF • Monitor • Avoid TOPRANK | Nursing 1. 2. 3. 4. 5. Hypoprara/Hypocalcemia/Tetany Thyroid storm Bleeding Laryngospasm Laryngeal nerve damage TOPRANK | Nursing Thyroid Storm Assessment: “VGLant BehaviorS” 1. V/S 2. GIT 3. LOC 4. Behavioral changes 5. Seizure Interventions: 1. “ABC” 2. Independent 3. Antithyroid meds TOPRANK | Nursing Findings Lethargy Tremors Heat intolerance Weight gain Dry skin Tachycardia Diarrhea Myxedema Goiter TOPRANK | Nursing Hypothyroidism Hyperthyroidism Parathyroid Glands 1. PTH • Blood • Bones 2. Calcitonin • Blood • Bones • Calcium • • • • Phosphate Neuromuscular irritability Heart Kidneys TOPRANK | Nursing Hypoparathyroidism 1. Calcium • Phosphate • Neuromuscular irritability (TwiTChing SpaSm) •T •T •C •S •S 2. Heart TOPRANK | Nursing Interventions: 1. Ca 4. Heart • Diet • Vitamin • WOF • DOC • Monitor 5. Precautions 2. Spasm • Item • DOC 3. Phosphate • Diet • DOC TOPRANK | Nursing 6. MedicAlert Bracelet Hyperparathyroidism 1. Ca • Phosphate • Neuromuscular irritability • GIT 2. Bones 3. Heart 4. Kidneys TOPRANK | Nursing Interventions: 1. Ca • Diet • DOC 2. Phosphate • Diet • DOC 3. GIT • Fiber & fluids TOPRANK | Nursing 4. Bones • Priority • Activity • DOC 5. Heart • Monitor 6. Kidneys • Fluid intake Diabetes Mellitus DM is a chronic disorder caused by deficiency of insulin or insulin resistance leading to impaired metabolism of: 1. Fats 2. Proteins 3. Carbohydrates 4. All the above TOPRANK | Nursing DM1 Onset Factor Insulin Appearance Acute Complications DOC TOPRANK | Nursing DM2 Diet 1. Carbs – 50%-60% • Simple or Complex 2. Fats – 20%-30% 3. Protein –10%-20% TOPRANK | Nursing Exercise • Moderate • Strenuous • Effects • Uptake of glucose • Weight • Complications • Time • Meal peaking or Meds Peaking • >250 mg/dL & ketonuria TOPRANK | Nursing DM1 & DKA TOPRANK | Nursing DM2 & HHNS TOPRANK | Nursing Findings Glucose 300 md/dL Hyperosmolarity Negative for ketonuria Low blood pH Low HCO3 High BUN High creatinine Kussmaul’s TOPRANK | Nursing DKA HHNS DKA & HHNS TOPRANK | Nursing Management: 1. Dehydration • IV • 250-300 mg/dL 2. Insulin • Bolus • Continuous 3. Electrolyte 4. Monitor TOPRANK | Nursing Hypoglycemia 1. Mild (<70 mg/dL) • Adrenergic Symptoms 2. Moderate (<40 mg/dL) • Worsening Hypoglycemia (Neuro) 3. Severe (<20 mg/dL) • Seve neuroglycopenic symptoms TOPRANK | Nursing 1. Slurred speech 2. Emotional changes 3. Drowsiness 4. Tremor 5. Loss of consciousness 6. Hunger 7. Headache 8. Numbness 9. Double vision 10. Seizures 11. Confusion TOPRANK | Nursing 12. Combative behavior 13. Sweating 14. Tachycardia 15. Difficulty arousing 16. Nervousness 17. Impaired coordination 18. Inability to concentrate 19. Light-headedness 20. Palpitations 21. Disoriented behavior Interventions: 1. “15-15 3x rule” • • 2. Altered LOC/4th reading • • 3. Recovery • • TOPRANK | Nursing • ½ cup of fruit juice or regular soft drink • 1 Tbsp of honey • 3 graham crackers • 4 tsp or cubes - sugar • 6 saltine crackers • 6 to 10 Life Savers • 8 oz (235 mL) of low-fat milk • 15g glucose tablets or glucose gel TOPRANK | Nursing TOPRANK | Nursing