Kelley Durr, MSN, RN, CPNP-PC
OBJECTIVES
Discuss assessment findings for the endocrine system.
Analyze laboratory and diagnostic tests specific to health problems affecting
the endocrine system.
Identify risk factors associated with health conditions of the endocrine system.
Plan nursing therapies specific to the care of patients with endocrine disease.
Discuss endocrine medications
 Discuss teaching plans for clients regarding endocrine health problems.
DIABETES MELLITUS REVIEW
Types
Causes
Diagnosis
Treatment
ACUTE COMPLICATIONS OF DIABETES
HYPOGLYCEMIA VS HYPERGLYCEMIA
Hypoglycemia
Hyperglycemia
Blood glucose _______
____________ skin
___________ of fingers, toes, mouth
Faintness, ____________
_________ speech
___________, coma
_________ onset
__________ blood glucose
_______, _____ skin
Increased _____________, _____________
Nausea and vomiting
May progress to ___________
Mood swings
__________onset
PATHOPHYSIOLOGY OF HYPOGLYCEMIA
Counter-regulatory _________ released
Activation of ___________ nervous system
Neuroglycopenia
Hypoglycemic ____________
CAUSES OF HYPOGLYCEMIA
Mismatch of food and _______
Oral _________ drugs
_________ exercise
Beta adrenergic blockers
TAKE ACTION: HYPOGLYCEMIA
______________
_____________ selection
IV _________
__________
Future prevention
DIABETIC KETOACIDOSIS (DKA)
Profound deficiency of ________
Most likely to occur with _______ diabetes
Risk factors:
Illness or __________
___________insulin dosage
_____________ type 1 diabetes
Lack of education, understanding, or resources
PATHOPHYSIOLOGY OF DKA
Insufficient insulin  glucose not used properly
for _________
Fat broken down and used as fuel  _________
_________ acidosis
_____________
PATHOPHYSIOLOGY OF DKA
Impaired protein synthesis  _________ degradation  _______
loss from tissues
Production of glucose from amino acids  increased
____________
__________________severe electrolyte depletion
Hypovolemia  shock renal failure  coma  death
Blood glucose >____mg/dL
Blood pH <_____
Bicarbonate <______ mEq/L
Moderate to large ________ in urine
or serum
GOALS FOR DKA TREATMENT
______ resuscitation for volume ________
Reversal of __________ and ___________
___________ of blood glucose
Replenishment of ___________
Identify underlying cause
EMERGENCY MANAGEMENT OF DKA
___________ management
____________ for fluids and electrolytes
Continuous _________ drip
____________ replacement
HYPEROSMOLAR HYPERGLYCEMIA SYNDROME
(HHS)
Life-threatening syndrome
Risk factors
Occurs with _______diabetes
Enough _______ to prevent DKA but still
have severe ____________
CAUSES OF HHS
Acute illness Heart attack or stroke
Sepsis
Medications Newly diagnosed or poorly controlled ________ diabetes
Impaired _______sensation/inability to replace fluids
Poor ________ function
ASSESSMENT CUES OF HHS
_______________ in the early stages
_________________
___________ and _______________
Neurologic manifestations –
DIAGNOSTICS OF HHS
Blood glucose >______ mg/dL
___________ serum osmolality
_________ absent or minimal
Enough ________ to prevent ketoacidosis
Arterial pH ________
Serum bicarbonate _______mEq/L
TAKE ACTION: HHS
Medical emergency with high ________
Management similar to ______
• IV _______ and IV _______
• ____________ monitoring and/or replacement
Correct underlying cause
COMPLICATIONS OF HHS
____________
Myocardial infarction
_________
Coma
_______ failure
DKA vs HHS
REVIEW
____________ gland is considered the master gland of the endocrine system.
Anterior pituitary gland secretes ________ __________, __________, tropic
hormones, ACTH or _____________ hormone, TSH or ________________
hormone, FSH or ________________ hormone, and LH or _____________
hormone.
Parathyroid hormone regulates serum ________ and ___________ levels by
stimulating bone resorption of _________, renal tubular reabsorption of
______, and activation of vitamin ____.
DISORDERS OF ANTERIOR PITUITARY GLAND
Acromegaly
Hypopituitarism
ACROMEGALY
ASSESSMENT CUES: ACROMEGALY
________ tumor
____________ and ______________ of bony and soft tissue
_______ weakness and ______pain
______________of voice
_______ changes
Excessive _____________
ANALYZE CUES: ACROMEGALY
_________ insulin-like growth factor-1 (IGF-1)
Oral ________tolerance test
Imaging
TAKE ACTION: ACROMEGALY
__________
_________
Drugs –
Serial _____________
Support group
HYPOPITUITARISM
Selective hypopituitarism
_____________________
Most commonly involves GH and gonadotropins
Causes –
ASSESSMENT CUES: HYPOPITUITARISM
1.
2.
3.
4.
5.
6.
7.
DIAGNOSTICS
H&P
Imaging
Labs
TAKE ACTION HYPOPITUITARISM
_________
Radiation
____________
REVIEW
Antidiuretic hormone (ADH) or ______________ is produced in the ____________
and is _______ and __________ by the posterior pituitary gland.
Osmolality is the ___________ of particles in a ________ _________.
_______ ____________ is regulated by _______.
SYNDROME OF INAPPROPRIATE ANTIDIURETIC
HORMONE (SIADH)
______________ of ADH
More common in older adults
Causes
• Surgery
• ________
• ______disorders
• ________
ASSESSMENT CUES OF SIADH
______________
Fluid ___________
Concentrated _______
Cramps
__________
Headache
ANALYZE CUES FOR SIADH
Sodium
________ serum, _________ urine osmolality
Urine specific gravity
Imaging
TAKE ACTION SIADH
Fluid __________
___________ fluid – 3% sodium chloride
Positioning
_______ diuretic
Medications to inhibit _____ production
Surgery
DIABETES INSIPIDUS (DI)
___________of ADH
Decreased _______response to ADH
Not related to _____________
Fluid and electrolyte imbalance
Acute or chronic
TYPES OF DIABETES INSIPIDUS
Central – ________ than normal ADH
Nephrogenic – _______ not responding to ADH
Primary (Dipsogenic) – __________ of ADH
ASSESSMENT CUES OF DI
__________
__________
_______ urine
Hypotension
_____________
Intracranial bleeding
Dry ______________
ANALYZE CUES: DIABETES INSIPIDUS
H&P
Fluid __________ test
__________ serum osmolality, _________ urine osmolality
Urine specific gravity ______
Sodium ______
MRI
TAKE ACTION
DIABETES INSIPIDUS
__________ saline, D5W
Hormone therapy
______________
________ I&O
PITUITARY SURGERY
Transsphenoidal hypophysectomy
• Removal of a pituitary tumor through
the nose via endoscope
• Treatment option for acromegaly,
hypopituitarism, SIADH, Cushing’s
disease
NURSING ACTIONS
PITUITARY SURGERY
PRE OP
CONSIDERATIONS
POST OP CARE
POSSIBLE
COMPLICATIONS
HYPERPARATHYROIDISM
________ secretion of parathyroid hormone (PTH)
Increased serum ________
Types
• Primary – increased ______ secretion
• Secondary – compensatory response to __________
• Tertiary – __________ of parathyroid glands
ASSESSMENT CUES
HYPERPARATHYROIDISM
May be _____________
____________
Cardiac ____________
__________bone density
_________ weakness
Loss of _________
Depression
Complications
• Osteoporosis
• Renal _______
• Pancreatitis
• ________changes
• Long bone __________
DIAGNOSTICS
HYPERPARATHYROIDISM
Serum calcium ________
Phosphorus ________
Urinalysis _____ scan
MRI, CT, ultrasound
TAKE ACTION: HYPERPARATHYROIDISM
Complete or partial removal of ____ glands
IV fluids
Medications –
Post-op complication - _________
Monitor intake and output
_________ precautions
HYPOPARATHYROIDISM
_______ PTH
_____________
Pseudohypoparathyroism
Cause - iatrogenic
ASSESSMENT CUES
HYPOPARATHYROIDISM
Positive ___________ and _____________sign
_________
Lethargy
____________
____________
Muscle cramps
TAKE ACTION
HYPOPARATHYROIDISM
Treat ______ complications
IV ________
Rebreathing
___________
Diet
PHEOCHROMOCYTOMA
Very rare tumor in the adrenal medulla
_________
________ epinephrine and norepinephrine
ASSESSMENT CUES
PHEOCHROMOCYTOMA
____________
Palpitations
___________
Sweating
Abdominal ______
ANALYZE CUES: PHEOCHROMOCYTOMA
Physical exam
Imaging Labs –
24 hour _______collection
NURSING ACTIONS
PHEOCHROMOCYTOMA
____________
Diet
Medications -