I.
Reading assignment:
Brunner & Suddarths Textbook of Medical-surgical Nursing
Chapter 40, pages 1376-1383;
Chapter 40, pages 1345-1347 (The pancreas);
Chapter 42, pages 1441-1445 (not “Classification & action of hormones”).
Handbook of Pathophysiology by Elizabeth Corwin Ch. 17
II.
Student learning outcomes
A.
The student will be able to discuss medical terms commonly used in the endocrine system
B.
The student will be able to review and identify anatomy and physiology of the endocrine system
C.
The student will be able to identify components of a complete endocrine physical assessment
D.
The student will be able to identify the clinical significance and related nursing responsibilities of the following test and procedures used for diagnostic assessment of the patient with an endocrine disorder
1.
Fasting blood glucose
2.
Glucose tolerance test
3.
2 hour postprandial
E.
The student will be able to describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following
1.
Diabetes mellitus
2.
Diabetes ketoacidosis
3.
Hyperosmolar nonketonic syndrome
4.
Hypoglycemia
F.
The student will be able to discuss pharmacological interventions in the treatment of a patient with an endocrine disorder
III.
What is the endocrine system?
A.
Similar to the ____________________ system
B.
Function: ________________________ & _____________________________
Speed
Duration
Endocrine System Nervous System
Structure
C.
The link between the endocrine system and the nervous system: _____________
D.
Endocrine glands:
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1.
Secrete __________________________
2.
_________________________ into the bloodstream
3.
Target __________________ organs/receptors
4.
Cause specific _______________________
5.
*No ___________________
E.
Exocrine glands:
1.
Secrete ____________________ via __________________
F.
Which type of gland is more vascular? Endocrine or Exocrine
IV.
Glands of the endocrine system
A.
Pineal
B.
Pituitary
C.
Thyroid
F.
G.
Adrenal Cortex
H.
Adrenal Medulla
Islets of Langerhans
D.
Parathyroid
E.
Thymus
(Pancreas)
I.
Ovaries &Testes
V.
General function of the endocrine system
A.
Secrete __________________________________
B.
Affect the __________________ of an ___________________ process
VI.
What is a hormone?
A.
________________

_____________________

specific _____________ cell/organ

causes _____________ cell to ____________

specific ___________
B.
Hormones are involved in all aspects of metabolism.
1.
Growth
2.
Reproduction
3.
Energy production
4.
Regulation of fluid and electrolyte balance
5.
Regulation of body pH
6.
Resistance to stress
C.
Metabolism: _________________ of molecules to make _______________
D.
Synthesis: __________________ of molecules
VII.
How do hormones work?
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A.
Homeostasis
1.
_______________ in Homeostasis a) Body temperature lowers b) Heart rate slows c) Increased blood sugar levels
B.
Sensors
1.
Sensors

___________________ homeostasis
2.
Identify _______________________ in homeostasis
3.
____________________ to change

4.
Initiates a _________________ ___________________

C.
Hormone secretion
1.
Specific stimuli from sensor 
2.
____________________ gland 
3.
Secretes ____________________

D.
Bloodstream
1.
Hormone secreted _____________________ into the bloodstream 
2.
________________________ by the bloodstream

____________
E.
Target organ
1.
Hormone in the blood stream

_______________ ______________ organs/tissue that have _____________________ for that hormone
F.
Action
1.
The hormone (when it enters the target organ) produces a
______________ ________________
2.
Action is usually _________________________ to the initial homeostasis change a) Body temperature lowers

_______________________ b) Heart rate slows

_______________________________ c) Increased blood sugar levels

_____________________
G.
Homeostasis
1.
Specific action

2.
___________________ homeostasis

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3.
Sensor __________ stimuli

4.
_________ hormone secretion
5.
“Negative Feedback Mechanism” a)
“The _________________ of the hormone often will
________________ the stimulus and ultimately lead to decrease secretion of the hormone.”
VIII.
How do we assess the endocrine system? _________________ & _______________
A.
“In the health physiological state, hormone concentration in the bloodstream is maintained at a relatively __________________ level.”
IX.
Small Group Questions:
A.
Name three characteristics of the endocrine system.
B.
What is the function of a hormone?
C.
How do hormones work?
D.
What is “Negative Feedback Mechanism”?
E.
How do the endocrine system and the nervous system communicate?
F.
Define metabolism and synthesis
G.
What must happen to a gland in order for it to secrete a hormone?
X.
Pancreas Gland
A.
Anatomical description:
1.
______________ long
2.
Position: _______________________________
3.
Behind ___________________
4.
_________________ ______________ abdominal quadrant
5.
Both ___________________ & __________________ functions
B.
Endocrine pancreas: Islets of Langerhans
C.
Three different types of cells:
1.
Alpha

_____________________
2.
Beta

______________________
3.
Delta

_________________________
XI.
Insulin
A.
Insulin is a hormone produced and secreted by: _________________ cells
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B.
Primary function
1.
Stimulates the ___________ ___________ of glucose from the
________________ into muscle, liver and adipose tissue

________ blood glucose levels.
C.
Glucose content of food
1.
________ % of the carbohydrates that we eat break down into glucose
2.
________ % of the proteins that we eat break down into glucose
3.
________ % of the fats we eat are broken down into glucose
D.
Secretion of insulin is stimulated by: (What change in homeostasis does the sensor identify and then stimulates the beta cell to secrete insulin?) _____________
E.
___________________ levels in the bloodstream regulate the rate of insulin secretion
F.
The major action of insulin is:
1.
_________ blood glucose levels
2.
_________ the permeability of target cell membranes to ___________
3.
Main target cells a) _________________, ________________, ________________
4.
The glucose is either _______________________ or stored
5.
In the absence of insulin, glucose is not able to get into the cells and it is excreted in the _____________________
6.
__________________ cells are not dependent on insulin for glucose intake
G.
Other functions of insulin include:
1.
Promoting conversion of ____________ to _________(Glycogenesis)
2.
Inhibits the conversion of ___________ to ________(Glycogenolysis) a) Glycogen = the form in which ____________________ is stored in the ___________________
3.
Promoting the conversion of __________ ________ into ___________
(_________________ tissue)
H.
Preventing the breakdown of ______________ to _________________ bodies
1.
Ketone bodies: The _________________ of _______ metabolism
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I.
Stimulating protein synthesis and inhibiting the breakdown of ___________ into _________ acids.
J.
Summary:
1.
Insulin ______ blood glucose levels
2.
Promotes the _____________ of glucose
3.
____________ energy production from _____________ sources
(glycogen, fat or protein metabolism)
XII.
Glucagon
A.
Glucagon is a hormone produces and secreted by the ____________of the
Islets of Langerhans.
B.
Glucagon stimulates the release of ________________ by the ____________
1.
G_________________
C.
The affect of glucagon: _________ blood glucose levels (_______________)
D.
Glucagon is secreted in response to: _________________ & ______________
E.
Hypoglycemia in a healthy person may occur during:
1.
________________, ________________, ______________________
XIII.
Somatostatin
A.
Somatostatin is a hormone secreted by the _________ of the Islets of
Langerhans
B.
Somatostatin is secreted in response to: ______________________________
C.
Action of Somatostatin:
1.
Interferes with ____________________
2.
Interferes with ____________________ hormone
D.
Somatostatin has a _______________________ effect
XIV.
Diagnostic tests of endocrine pancreas
A.
Blood glucose/ fasting Blood Sugar
1.
Explanation: Measures blood _____________ levels after fasting
2.
Normal levels: _______ - ________ mg/dL
3.
Diabetic levels: > ______________ mg/dL
4.
Critical values: > ______________ mg/dL or < ____________ mg/dL
5.
Nursing responsibility:
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a) ___________ 6-8 hours; Water ___________ b) No _______________ or anti-_______________ meds c) ____________________ will effect results d) Identify all ________________ that interfere
B.
Glucose Tolerance Test
1.
Explanation: Evaluates ___________glucose levels & _______ glucose levels * after a __________________ load. a) * _______ before; ____ after; ____ after; ____ after; ____ after
2.
Normal levels: a) < ________ mg/dL at _____________ AND b) Urine _________ for glucose (at all times)
3.
Diabetic levels: a) > _________ mg/dL at _____________ OR b) _____________ in urine
4.
Nursing responsibility: a) ___________________6-8 hours before test b) _______________ meds that interfere c) Administer glucose ___________ d) Water ___________________________ e) Collect ________________hourly f) Administer _____________and ______________afterwards
C.
Glycosylated Hemoglobin Assay / Hgb A1c
1.
Explanation: __________ of glycosylated hemoglobin a) Lifespan of an RBC ____________ ( ____ months) b) _____________ slowly binds with _________ = glycosylated c) ______ serum glucose levels

_____ glycosylated Hgb levels d) Provides an __________blood glucose levels: Past ______ months e) Can be taken _________________
2.
Normal levels (non diabetic) _________ %
3.
Diabetic levels (goal) _____________%
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XV.
Small Group Questions:
A.
What is the difference between exocrine and endocrine?
B.
Describe anatomically the location of the pancreas.
C.
What are the Islets of Langerhans?
D.
Name the three hormones of the pancreas and identify what cells secrete that hormone*
E.
Describe the action of each hormone secreted by the islets of Langerhans*
F.
What stimulates each hormone of the pancreas to be secreted*?
G.
What effect does insulin have on glucose, on glycogen, on protein metabolism and synthesis and on fat metabolism and synthesis?
H.
What are ketones? How does insulin control ketoacidosis?
Cell Hormone secreted Action Stimulus (change in
Homeostasis)
*These questions can be answered by filling out the above graft
XVI.
Diabetes Mellitus: general information
A.
Diabetes :______________________
B.
Mellitus: ______________________
C.
DM is a group of disorders characterized by _______________ ___________
1.
Due to faulty ___________________ production
2.
(It is not diabetes _____________________)
XVII.
Type 1– Diabetes Mellitus (Juvenile diabetes, Insulin dependent diabetes mellitus
IDDM)
A.
_________________________ of the Beta cells of the pancreas
B.
Resulting in
1.
_______insulin production
2.
Insulin ______________________
C.
Etiology:
1.
#1:_____________ - immune disease
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2.
#2: Idiopathic
3.
____________ susceptibility
D.
Function of insulin: (review)
1.
Need insulin for _____________ to cross cell membrane
2.
No insulin

no ___________ into the ________ (muscles, liver, fat)
3.
Glucose stays in the ________________

____________________
E.
S&S of Type 1 DM
1.
Hyperglycemia: ________ blood glucose levels a) No insulin

glucose stays in the _________________ b) What affect does insulin have on glycogen?
(1) ___________ the conversion of glycogen to glucose
2.
Glycosuria: ___________ in the ___________
3.
Polyuria: ______________ diuresis (due to glycosuria) a) Nocturia: ___________ during the ___________ b) Nursing diagnosis: ___________________________________
4.
Polydipsia: excessive _____________________
5.
Polyphagia: excessive ____________________
6.
Dehydration a) Assessment : _______________________________________ b) Nursing Dx: _______________________________________
7.
Ketonuria a) DM1 = No __________ b) No glucose metabolism (no energy)
 c) Burn ________ (for energy)
 d) By-product of fat metabolism is _______________
 e) ________ ketones in the blood
 f) __________________ cannot excrete all of the ketones
 g) spill into the ________________

ketonuria
8.
Metabolic Acidosis a) Ketones are ____________________ b) ________ ketones in the blood

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c) Metabolic _________________. d) Body pH

_________________
XVIII.
Small Group Discussion:
A.
Why would a person with high glucose levels have polyphagia?
B.
Explain why polyuria is a common symptom of diabetes Mellitus Type 1.
C.
What is hyperglycemia?
D.
Why does hyperglycemia happen in Type 1 diabetes mellitus?
E.
Explain why Ketonuria occurs in uncontrolled diabetics.
F.
What is a normal level for a FBS, and GTT?
G.
Define the following terms:
1.
Glucose
2.
Glycogen
3.
Glucagon
4.
Glycogenolysis
5.
Glycogenesis
6.
Glycosuria
H.
What does an Hgb A1c measure?
1.
What are normal values for a diabetic and non-diabetic?
XIX.
Type 2 – Diabetes Mellitus
A.
Etiology
1.
#1: The pancreas cannot ________________ enough insulin for
______________ needs
2.
Impaired insulin ___________________
3.
Weakened Beta cells Due to ____________________ a) High glucose ________________ b)
“Insulin________________” : The target cells have 
____________ to insulin
B.
Risk Factors for developing DM-2
1.
____________ history
2.
_______
3.
____________
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4.
______________ diabetes or large baby
5.
______________
6.
High _________ diet
7.
Lack of ______________
8.
High ___________ Diet
C.
Insulin and DM-2 diabetics
1.
Don’t _________________ require insulin
2.
1/3 of all type 2 DM will at ____________ time need to take insulin
3.
Seldom get _________________ (because they produce enough insulin to prevent uncontrolled fat metabolism)
XX.
Comparison of type 1 and type 2 DM
Type 1 Type 2
Etiology
Age of onset
Percent of diabetics
Onset
Body weight at onset
Insulin production
Insulin injections
Ketone
Management
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XXI.
Diabetes Mellitus Type 4 - Gestational Diabetes Mellitus
A.
Occurs during __________________: ____________ trimester
B.
Screening: _______________________________
C.
Etiology: Extra ____________________ demands trigger onset
1.
The placenta secrets a hormone which is an ____________________
2.
The adrenal cortex secrets a hormone _______________ which is composed mostly of glucose
D.
#1 Complication for new born: _________________________________
1.
Newborn is also at risk for _______________________________
E.
Controlled/managed with: _______________ & __________________
1.
No ________________ medication
F.
After delivery: generally glucose levels _____________________________
G.
Predisposes patient to … _____________________________
XXII.
Other specific types of Diabetes Mellitus
A.
Beta-cell genetic defects
B.
Endocrinopathies
C.
Pancreatitis
D.
Cystic Fibrosis
E.
Drug or chemical induces diabetes (Steroids)
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XXIII.
Signs and Symptoms of Diabetes mellitus
A.
Definition: A group of disorders characterized by ______________________
B.
3 P’s
1.
P_________________P_________________P_________________
C.
Signs and symptoms of hyperglycemia
Neuro
Cardiovascular
Respiratory
Gastro-intestinal
Genital-urinary
Skeletal/muscular
Integumentary
XXIV.
Small group Questions: Mr. McMillan is a 50-year-old client brought into the emergency department with extreme fatigue and dehydration. After the physician sees him, the nurse asks Mr. McMillan some additional questions. Based on the client’s answers, the nurse requests that the physician add a glucose level to the lab work. The result is 1400 mg/dl.
A.
What question did the nurse most likely ask?
B.
Why was Mr. McMillan fatigued?
C.
Why was he dehydrated?
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XXV.
Questions from the Reading Handbook of Pathophysiology by Elizabeth Corwin
Ch. 17
1.
What type of gland is the pancreas (in terms of function)?
2.
What hormones does the endocrine pancreas synthesize?
3.
Describe the rate of insulin secretion
4.
What is a normal fasting blood sugar?
5.
At what blood sugar level is insulin secretion increased?
6.
How long does it take to restore blood sugar levels to normal?
7.
When are insulin levels at their lowest?
8.
Where does insulin circulate?
9.
What is the action of insulin
10.
When glucose is carried into the cell, what happens to the blood sugar levels?
11.
Describe the relationship of glucose, insulin and the brain.
12.
Glucagon is secreted in response to what?
13.
Insulin is primarily secreted during what stage of digestion?
14.
Glucagon is primarily secreted during what stage of digestion?
15.
What is the normal life span of a red blood cell?
16.
What does the term glycosylated mean?
17.
What is the normal percent of glycosylated red blood cells?
18.
What can cause an increased in glycosylated red blood cells?
19.
Define hypoglycemia?
20.
What are the signs and symptoms of hypoglycemia?
21.
What are the causes of hypoglycemia
22.
Define hyperglycemia
23.
What do the terms diabetes and mellitus mean?
24.
What are the types of DM, characteristics, etiology and treatment?
25.
What is the number one risk factor for type 2 DM?
26.
What % of American children are obese?
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