ENDOCRINE by jen.nyo

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									Endocrine System                                                   1.   Glucocorticoids (Cortisol, Cortisone,
PITUITARY GLAND                                                        Cortecosterone)
  1. Located at the base of the brain.                                  increase blood glucose levels by increasing rate
  2. Directly affects the function of the other endocrine                  of glyconeogenesis
      glands.                                                           increases CHON catabolism
  3. Promotes growth of body tissues.                                   increase mobilization of fatty acids
  4. Influences water absorption by the kidney.                         promote sodium & water retention
  5. Controls sexual development and function.                          anti-inflammatory effect
ADRENAL GLANDS                                                          aid the body in coping stress.
    1. Two small glands, one above each kidney.                     2. Mineralocorticoids (Aldosterone,
    2. Regulates sodium and water retention.                           Deoxycortisone)
    3. Affects CHO, fat and CHON metabolism.                               - regulate F/E balance; stimulate
    4. Influences development of sexual characteristics.                        reabsorption of sodium, chloride & water;
    5. The adrenal cortex synthesizes glucocorticoids and                       stimulate potassium excretion.
    6. mineralocorticoids.                                     ADRENAL MEDULLA
    7. The adrenal medulla produces epinephrine and            1. Epinephrine and Norepinephrine
          norepinephrine.                                            function in acute stress increase heart rate & BP
THYROID GLAND                                                        dilate bronchiole
        1. Located anterior part of the neck.                        convert glycogen to glucose when needed by
        2. Controls rate of body metabolism and growth.                muscles for energy.
        3. Produces T4, T3 and thyrocalcitonin.                THYROID
PARATHYROID GLANDS                                              1. T3 & T4
        1. Located near the thyroid.                                 regulate metabolic rate, CHO, fat and CHON
        2. Controls calcium and phosphorus metabolism.                 metabolism
        3. Produces parathyroid hormone.                             aid in regulating physical and mental growth &
PANCREAS                                                               development.
    1. Located posterior of liver.                             2. Thyrocalcitonin
    2. Influences CHO metabolism.                                    lowers serum calcium by increasing bone
    3. Indirectly influences fat and CHON metabolism.                  deposition.
    4. Produces insulin and glucagon.                          PARATHYROID
                                                               PTH – regulate sodium calcium and phosphate levels.
OVARIES
    1. Located in the pelvic cavity.
    2. Produce estrogen and progesterone.                      Diagnostic Test
                                                               RADIOACTIVE IODINE UPTAKE (RAIU)
TESTES
                                                                   1. A thyroid function test that measures the absorption
    1. Located in the scrotum.
                                                                      of the iodine isotope to determine how the thyroid
    2. Contributes to the development of secondary
                                                                      gland is functioning.
    3. sex characteristics.
                                                                   2. Administration of I123 or I131 orally followed in
    4. Produce testosterone.
                                                                      24 hrs. by a scan of the thyroid for the amount of
                                                                      radioactivity emitted.
Anterior Pituitary gland
    1. FSH – stimulates graafian follicle growth and               3. Normal value is 5-35% in 24 hours
                                                                   4. Elevated values indicate hyperthyroidism,
        estrogen secretion.
                                                                      thyrotoxicosis, decreased iodine intake or increased
    2. LH – induces ovulation & development of corpus
                                                                      iodine excretion.
        luteum and stimulates testosterone secretion in men.
                                                                   5. Decreased values indicate hypothyroidism,
    3. ACTH – stimulates secretion of hormones from
                                                                      thyroiditis, low T4, use of antithyroid meds.
        adrenal cortex.
    4. TSH – regulates secretory activity of thyroid gland.
                                                                             Thyroid medication must be discontinued
    5. GH – stimulates growth of cells, bones, muscles
                                                                              7-10 days prior to test.
        and soft tissue.
                                                                             No radiation precautions necessary.
    6. Prolactin – development of mammary glands &
        lactation
                                                               T3 & T4 RESIN UPTAKE TEST
Posterior Pituitary Gland
    1. ADH (Vasopressin) – regulates water metabolism;            1. Blood test for diagnosis of thyroid disorders
                                                                  2. T3 & T4 regulate thyroid-stimulating hormone
        helps body to retain water.
                                                                  3. Normal Value of T3: 80-230 ng/dL
    2. Oxytocin– stimulates uterine contractions during
                                                                                                 T4: 5-12 ng/dL
        labor and milk secretion in lactating mothers.
                                                                  4. Both values increase in hyperthyroidism &
ADRENAL CORTEX
                                                                      decreased in hypo-thyroidism
                                                                 Preparation:
THYROID-STIMULATING HORMONE (TSH)                                          eat a high-carbohydrate (200 to 300 g) diet for 3
         1. Blood test used to differentiate the                              days before the test
         diagnosis of primary                                              avoid alcohol, coffee & smoking 36 hours
         2. hypothyroidism from secondary                                     before testing
         hypothyroidism.                                                   fast midnight before test
         3. Normal value is 0.2 to 5.4 IU/ml                               fasting blood glucose & urine glucose
         4. Elevated in primary hypothyroidism &                              specimens obtained.
         decreased in hyper-                                               avoid strenuous exercise 8 hours before & after
         5. thyroidism or secondary hypothyroidism                            test
                                                                           client ingests 100g glucose; blood sugar drawn
THYROID SCAN                                                                  at 30 & 60 mins. then hourly for 3-5 hrs.; urine
     1. Performed to identify nodules or growths in the                       specimens may also be collected.
         thyroid glands
     2. A radio isotope of iodine or technetium is               Glycosylated hemoglobin- is blood glucose bound to
         administered prior to the scanning of the               hemoglobin
         thyroid gland.                                              1. Is a reflection of how well blood glucose levels have
     3. Level of radioisotope is not dangerous to self or                been controlled for up to the prior 4 months
         others.                                                     2. Hyperglycemia in clients with DM causes increase
     4. Discontinue medications containing iodine 14                     in glycosylated hemoglobin
         days prior to test and discontinue thyroid meds             3. Fasting is not needed
         4-6 weeks prior to test.                                *Values:
     5. NPO post MN; if iodine is used client will fast                  Diabetics with good control: 7.5% or less
         an additional 45 minutes after ingestion of                     Diabetics with fair control: 7.6% to 8.9%
         radioactive isotope & scan is done after 24                     Diabetics with poor control: 9% or greater
         hours.
                                                                 ANTERIOR PITUITARY
NEEDLE ASPIRATION OF THYROID TISSUE                                  Hypopituitarism
   1. Aspiration of thyroid tissue for cytological exam              Hyperpituitarism
   2. No preparation needed                                      POSTERIOR PITUITARY
   3. Light pressure applied to aspiration site after the            Diabetes Insipidus
      procedure                                                      SIADH (Syndrome of Inappropriate
                                                                      AntidiureticHormone)
Eight-hour intravenous ACTH Test
    1. Administration of 25 units of ACTH in 500 ml of           HYPOPITUITARISM
        saline over an 8-hr period.                                  1. Hyposecretion of growth hormone by the anterior
    2. Used to determine function of adrenal cortex.                      pituitary gland
    3. 24-hr urine specimens are collected, before & after           2. S/Sx: retarded physical growth, premature aging,
        administration, for measurement of 17-ketosteroids                low intellectual
        and 17-hydrocorticosteroids.                                      development, poor development of secondary sex
              In Addison’s disease, urinary output of           characteristics
                 steroids does not increase following                3. Given human growth hormone & offer emotional
                 administration of ACTH; normally steroid                 support to client & family
                 excretion increases threefold to fivefold ff.
                 ACTH administration.                            HYPERPITUITARISM
              In Cushing’s syndrome, hyperactivity of               1. Hypersecretion of GH by anterior pituitary gland
                 the adrenal cortex increases the urine                 which results in gigantism acromegaly
                 output of steroids in the second urine              2. Gigantism occurs in childhood before the closure of
                 specimen tenfold.                                      epiphyses of the long bones vs acromegaly which
                                                                        occurs after the closure of epiphyses of the long
GLUCOSE TOLERANCE TEST (GTT)                                            bones
     1. Aids in the diagnosis of diabetes mellitus               S/Sx:
     2. If the glucose level peaks at higher than normal              large hands & feet
        at 1 to 2 hours after injection or ingestion of               thickening & protrusion of jaw,
        glucose, and are slower than normal to return                 arthritic changes
        to normal levels, DM is diagnosed                             visual disturbances
                                                                      Diaphoresis
                                                                      oily & rough skin
    Organomegaly                                                1.  S/Sx: Signs of fluid overload; changes in LOC &
    Hypertension                                                    mental status; weight gain, hypertension,
    Dysphagia                                                       tachycardia, hyponatremia
    deepening of voice                                          2. Monitor I & O and daily weight; monitor fluid &
Nursing MGT:                                                         electrolyte balance; restrict fluids as prescribed;
          1. Emotional support                                       administer diuretics & monitor IV fluids carefully
          2. frequent skin care                                  3. Meds: demeclocycline (Declomycin) inhibits ADH-
          3. pharmacologic & non- pharmacologic                      induced water reabsorption & produces water
          4. interventions for joint pains                           diuresis
          5. Prepare for radiation of pituitary gland or     ADRENAL CORTEX
             hypophysectomy                                  Addison’s disease
                                                             Cushing’s syndrome
HYPOPHYSECTOMY                                               Aldosteronism (Conn’s Syndrome)
Removal of pituitary gland
*Post-operative care:                                        ADRENAL MEDULLA
    -Monitor V/S, neurological status & LOC                 Pheochromocytoma
    -Elevate head of bed                                          Hyposecretion of the adrenal cortex hormones
    -Monitor for increased intracranial pressure & any           Assessment:
        postnasal drip which might be CSF                         Subjective:
    -Avoid sneezing, coughing & blowing nose                      Muscle weakness,
    -Monitor for temporary diabetes insipidus                     fatigue,
    -Monitor I & O & water intoxication                           lethargy,
    -Administer antibiotics, analgesics,                          dizziness
        antipyretics,hormones & glucocorticoids if entire          fainting,
        gland is removed                                           nausea,
                                                                   anorexia,
DIABETES INSIPIDUS                                                 abdominal pain/cramps.
     Hyposecretion of ADH & deficiency of                        Objective:
       vasopressin                                                          V/S: decreased BP, orthostatic hypotension
S/Sx:                                                                       Pulse: increased, collapsing, irregular
           1. polyuria of 4-24 liters/day                                   Subnormal temp.
           2. polydipsia,                                                   Vomiting, diarrhea, weight loss
           3. dehydration,                                                  Tremors
           4. decreased skin turgor,                                        Skin: poor turgor excessive pigmentation
           5. dry mucus membranes,                                              (bronze tone)
           6. inability to concentrate urine, low urine                     Hyponatremia, hypoglycemia,
                specific gravity of 1.004 or less;                              hyperkalemia
           7. fatigue,                                       NURSING MANAGEMENT:
           8. postural hypotension, headache                 1. Decrease stress:
Management:                                                           a. Provide quiet environment, nondemanding
    1. Provision of safe environment especially with         schedule.
       decreasing LOC,                                       2. Promote adequate nutrition:
    2. monitoring I & O with specific gravity,                        a. Diet: acute phase- high sodium, low potassium;
    3. wear Medic-Alert bracelet                             nonacute phase- increase CHO and CHON
                                                                      b. Fluids: force to balance fluid, monitor I&O,
    Meds:                                                    WOD
    1. vasopressin tannate (Pitressin Tannate)                        c. Administer lifelong exogenous replacement
    2. desmopressin acetate (DDAVP, Stimate)                 therapy as ordered:
    3. lypressin (Diapid) - Enhances reabsorption of water                      1. Glucocorticoids- prednisone,
       in the kidney promoting antidiuretic effect &         hydrocortisone
       regulates fluid                                                          2. Mineralocorticoids- fludrocortisone
       balance                                               (Florinef)
        A/R: hypertension; nasal congest                     3. Health teaching:
                                                                      a. Take meds with food or milk.
SYNDROME OF INAPPROPRITE ANTIDIURETIC                                 b. Avoid stress
HORMONE(SIADH)                                               Monitor for s/sx of addisonian crisis
ADDISONIAN CRISIS                                                6.   Usually will be undergoing adrenalectomy;
1. Life-threatening disorder caused by acute adrenal                  administer
insufficiency precipitated by stress, infection, trauma or            glucocorticoids pre & post-op.
surgery.
2. May cause hyponatremia, hypoglycemia, hyperkalemia        PHEOCHROMOCYTOMA
    & shock.                                                    1. Catecholamine-producing tumor usually found in
3. Given glucocorticoids IV e.g. hydrocortisone Na                 the adrenal gland.
    succinate (Solu-Cortef), mineralocorticoids e.g.            2. Causes hypersecretion of epinephrine &
    fludrocortisone (Florinef).                                    norepinephrine by the adrenal medulla
4. Severe, generalized muscle weakness, severe                  3. Cx: hypertensive retinopathy, CVA & CHF
    hypotension, hypovolemia, shock (vascular collapse)         4. S/Sx: HPN, severe HA, palpitations, pain in chest or
5. Check BP & electrolyte levels.                                  abdomen, hyperglycemia & glucosuria, profuse
6. Strict bed rest in quiet environment & protect from             sweating, n/v, dilated pupils, tachycardia, cold
    infection.                                                     extremities.
                                                                5. Monitor for hypertensive crisis & avoid stimuli
CUSHING’S SYNDROME                                                 which triggers it
*Hypersecretion of corticoids.                                      such as : increased abdominal pressure, vigorous
*ASSESSEMENT:                                                      abdominal palpation & micturation
Subjective:                                                     6. Instruct patient not to smoke, drink cola, coffee or
 headache, backache, weakness, decreased work capacity            tea
Objective:                                                      7. Monitor blood glucose & urine for glucose &
     Hypertension, weight gain, pitting edema                     acetone.
     Characteristic fat deposits, truncal & cervical
         obesity (buffalo hump).                             ADRENALECTOMY
     Pendulous abdomen, purple striae, easy bruising             Surgical removal of one or more of the adrenal
     Moon face, acne, hyperpigmentation, impotence                   gland because of tumors or overactivity;
     Virilization in women: hirsutism, breast atrophy,           For unilateral adrenalectomy, up to 2 years of
         amenorrhea                                                   glucocorticoid therapy needed; for
     Pathologic fractures reduced height                             bilateral…lifelong replacement
     Slow wound healing                                     Preop: reduce risk of postop cx
     Hypernatremia, hyperglycemia, hypokalemia                       a. Prescribed steroid therapy, given 1 wk. before
NURSING MANAGEMENT:                                                   surgery
1. Promote comfort: protect from trauma.                              b. Antihypertensive drugs discontinued
2. Prevent complications: monitor fluid balance, glucose              c. Sedation as ordered
    metabolism, hypertension, infection.                     During surgery: monitor for hypotension & hemorrhage
3. Health teachings:                                         Postop: promote hormonal balance
4. Diet: increased protein, potassium, decreased calories,                 a. Administer hydrocortisone
    sodium                                                                 b. Monitor for signs of Addisonian crisis
•Meds:                                                           1. Observe for hemorrhage and shock.
1. Cytoxic agents: aminoglutethimide (Cytaden), trilostane       2. Prevent infection.
(Modrastane), mitotane (Lysodren)- to decrease cortisol          3. Administer cortisone or hydrocortisone as
production.                                                           prescribed.
2. Replacement hormones as needed.                                    bethamethasone (Celestone), cortisone (Cortone)
3.S/Sx of progression of disease.                                     dexamethasone (Decadron), prednisone (Orasone)
Prepare client for adrenalectomy.                                     Stimulate the adrenal cortex to secrete cortisol
                                                                      Produces an antiinflammatory effect.
CONN’S SYNDROME                                                      *A/R: Increased appetite, mood swings, water & Na
  1. Hypersecretion of aldosterone from the adrenal              retention, hypocalcemia & hypokalemia, cushing-like
      cortex of the                                              symptoms
      adrenal gland commonly caused by adenoma                   4. Check I & O, weight and for edema (decrease Na
  2. S/S: hypertension, hypokalemia, headache,                        intake)
      polydipsia & polyuria, hypernatremia, low urine            5. Monitor for infection
      specific gravity                                           6. Monitor electrolyte & calcium levels
  3. Monitor I & O & administer spironolactone                   7. Monitor for poor wound healing, menstrual
      (Aldactone) & K                                                 irregularities,
       supplements & maintain Na restriction                           decrease in growth & edema
  4. Administer antihypertensives as px                          8. Dose must be tapered & not stopped abruptly
  5. Wear Medic-Alert bracelet                                   9. Advise to wear Medic-Alert bracelet
                                                             NURSING MANAGEMENT
CORTICOSTEROIDS(GLUCOCORTICOIDS)                             •Provide for comfort and safety: monitor for infection or
  1. Produce metabolic effects; alters normal immune         trauma; provide warmth, prevent heat loss & vascular
     response & suppress inflammation; promote Na &          collapse; administer thyroid meds as ordered.
     H2O retention & K excretion
                                                             •Health teaching:
  2. Produce antiinflammatory , antiallergic & anti-stress
                                                                      a. Diet: low calorie, high protein
     effects ; replacement for adrenocortical
                                                                      b. S/Sx of hypothyroidism & hyperthyroidism
     insufficiency
                                                                      c. Lifelong meds, dosage, desired effects, side
  3. A/R: hyperglycemia, hypokalemia, edema & masks
                                                                      effects.
     signs & symptoms of infection
                                                                      d. Stress-management techniques
  4. C/I: DM, increases effect of anticoagulants & oral
                                                                      e. Exercise program
     antidiabetic agents; increases potency of aspirins &
     NSAIDS & K-sparing diuretics
                                                             MYXEDEMA COMA
  5. Check for overdose or signs of Cushing’s syndrome;
                                                               1. Rare but serious d/o which result from persistently
     additional doses during stress or surgery.
                                                                  low thyroid hormone precipitated by acute illness,
                                                                  rapid withdrawal of thyroid meds, use of sedatives
    MINERALOCORTOCOIDS
                                                                  & narcotics
    fludrocortisone (Florinef)
                                                               2. S/Sx: hypotension, bradycardia, hypothermia,
     Steroid hormones that enhance the reabsorption of
                                                                  hyponatremia, hypoglycemia, respiratory failure &
        NaCl &
                                                                  death
     promote K+ excretion & hydrogen at the renal
                                                               3. Patent airway
        tubule promoting fluid & electrolyte balance
                                                               4. Keep patient warm & check V/S frequently
     Used in primary & secondary Addison’s disease
                                                               5. Administer IV fluids & levothyroxine Na
     S/E: Na/H2O retention, hypokalemia, hypocalcemia,
                                                                  (Synthroid)
        delayed wound healing, increased susceptibility to
                                                               6. Give IV glucose & corticosteroids
        infection, mood swings, weight gain
     Take with food or milk; high-K+ diet
                                                             HYPERTHYROIDISM (GRAVE’S DISEASE
     Wear Medic-Alert bracelet
                                                             Hypersecretion of the thyroid gland.
                                                                 Provide adequate rest & administer sedatives as
HYPOTHYROIDISM (MYXEDEMA)
                                                                    prescribed.
HYPERTHYROIDISM (GRAVE’S DISEASE)
                                                                 Provide cool & quiet environment.
   Hyposecretion of the thyroid hormone characterized
                                                                 Obtain daily weight & give high-calorie food.
     by decreased rate of body metabolism.
                                                                 Administer anti-thyroid meds & avoid giving
   Monitor HR including rhythm.
                                                                    stimulants.
   Instruct patient re: thyroid replacement therapy.
                                                                 Prepare the patient for the following:
                                                                         1. -iodine preparations
       Instruct on low-calorie, low-cholesterol, low-
                                                                         2. -antithyroid meds
        saturated fat diet.
                                                                         3. -propanolol (Inderal)
       Assess for constipation & provide roughage.
                                                                         4. -radioactive iodine
       Provide for warm environment.
                                                                         5. -for thyroidectomy as px
       Monitor for overdose of thyroid meds.
                                                             ASSESSMENT:
ASSESSMENT:
                                                             Subjective data:
Subjective data:
                                                                           nervousness, mood swings, palpitations,
 Weakness, fatigue, lethargy, headache, slow memory, loss
                                                                               heat intolerance, dyspnea, weakness.
of interest in sexual activity.
                                                             Objective data:
Objective data:
                                                                           Eyes: exophthalmos, characteristic stare,
 Depressed BMR; intolerance to cold
                                                                               lid lag.
 Cardiomegaly, bradycardia, hypotension, anemia
                                                                           Skin: warm, moist, velvety; increased
 Menorrhagia, amenorrhea, infertility
                                                                               sweating; increased melanin pigmentation;
 Dry skin, brittle nails, coarse hair, hair loss
                                                                               pretibial edema with thickened skin &
 Slow speech, hoarseness, thickened tongue
                                                                               hyperpigmentation
 Weight gain: edema, periorbital puffiness
                                                                           Weight loss despite increased appetite
 Lab data: elevated TRH, TSH; normal-low serum T4 &
                                                             NURSING MANAGEMENT:
T3; decreased RAUI.
                                                             •Protect from stress: private room, restrict visitors, quiet
                                                             environment.
                                                             •Promote physical & emotional equilibrium:
         a. cool, quiet, cool well ventilated environment.                  Assess for laryngeal nerve damage…high-pitched
         b. eye care: sunglasses to protect from photophobia,                voice, stridor,dysphagia, dysphonia & restlessness
         protective drops (methylcellulose) to soothe cornea                Monitor for signs of hypocalcemia & tetany & have
         c. diet: high calorie, protein, vit. B; avoid stimulants            calcium
         Prevent complications: give medications as ordered.
•Monitor for thyroid storm.                                         THYROID HORMONES
•Health teaching: stress reduction techniques; importance of        Levothyroxine (Synthroid, Levothroid, Levoxyl)
medications; methods to protect eyes from environment; s/sx         Thyroglobulin (Proloid)
of thyroid storm.                                                          1. Controls the metabolic rate of tissues &
                                                                               accelerates heat production & oxygen
MEDICAL MANAGEMENT:                                                            consumption
•Propylthiouracil (PTU)                                                    2. For hypothyroidism, myxedema & cretinism
         - blocks thyroid synthesis                                        3. A/R: cramps, diarrhea, nervousness, tremors,
         Methimazole (Tapazole)                                                hypertension, tachycardia, insomnia, seating &
         - to inhibit synthesis of thyroid hormone                             heat intolerance
                                                                           4. Taken same time every day preferably in the
•Iodine preparations (SSKI, Lugol’s Solution)
         - decrease size & vascularity of the thyroid gland                    a.m. with food
         - palatable if diluted with water, milk or juice                  5. Teach client to how to take HR
         - give through straw tp prevent staining of teeth                 6. Avoid foods that will inhibit thyroid secretions
         - takes 2-4 weeks before results are evident                          such as: strawberries, peaches, pears, cabbage,
                                                                               turnips, spinach,Brussels sprouts, cauliflower,
•Beta blockers: Propranolol (Inderal), atenolol
                                                                               peas & radishes
(Tenormin), metoprolol (Lopressor)
                                                                           7. Wear Medic-Alert bracelet
         - given to counteract the increased metabolic effect
of thyroid hormones
                                                                    HYPOPARATHYROIDISM
         - relieve symptoms of tachycardia, tremors &
                                                                    SIGNS OF TETANY
anxiety
                                                                        Positive Chvostek’s Sign
                                                                        Positive Trousseau’s Sign
THYROID STORM
                                                                        Wheezing & dyspnea (bronchospasm,
     1. Acute & life threatening condition in
                                                                          laryngospasm)
         uncontrolled hyperthyroidism
                                                                        Numbness & tingling of face & extremities
     2. Risk factors: Infection, surgery, beginning labor
                                                                        Carpopedal spasm
         to give birth, taking inadequate antithyroid
                                                                        Visual disturbances (photophobia)
         medications before thyroidectomy.
                                                                        Muscle & abdominal cramps
     3. S/Sx: fever, tachycardia, hypotension, marked
                                                                        Cardiac dysrhythmias
         respiratory distress, pulmonary edema,
                                                                        Seizures
         irritability, apprehension, agitation, restlessness,
         confusion, seizures
                                                                    HYPOPARATHYROIDISM
     4. Meds: PTU or Tapazole; Sodium iodide IV or
                                                                    Hyposecretion of parathyroid hormone
         Lugol’s solution orally; Propranolol (Inderal);
                                                                       1. Monitor for hypocalcemia & institute seizure
         Aspirin, Steroids, Diuretics
                                                                           precautions
     5. Removal of thyroid gland & performed for
                                                                       2. Place a tracheostomy set, O2 & suction machine at
         persistent hyper-thyroidism
                                                                           bed side
                                                                       3. Prepare for calcuim gluconate/chloride IV
PRE-OPERATIVE CARE:
                                                                       4. Provide high-calcium/low-phosphorus diet
    Assess V/S, weight, electrolyte & glucose level
                                                                       5. Give vitamin D to enhance calcium absorption at the
    Teach DBE & coughing as well as how to support
                                                                           GIT
      neck in post-op period when coughing & moving
                                                                       6. Given phosphate binders
    Administer antithyroid meds etc. to prevent thyroid
                                                                       7. Wear medic-alert bracelet
      storm
                                                                    PARATHYROIDECTOMY
*POST-OP CARE:
                                                                    Removal of 1 or more parathyroid gland
    Monitor for respiratory distress & have
                                                                    *PRE-OPERATIVE CARE:
      tracheostomy set, O2 &suction machine at bed side
                                                                      -monitor calcium, phosphate & magnesium level
    Maintain semi-Fowler’s position to reduce edema
                                                                      -ensure that calcium is near normal
    Immobilize head with pillows/sandbags; prevent
                                                                      -explain to patient that talking may be painful 2 days post-
      flexion &hyperextension of neck
                                                                    op
    Check surgical site for edema & bleeding
                                                                    *
    Limit client talking & assess for hoarseness
POST-OPERATIVE CARE:                                          ASSESSMENT
     -monitor for respiratory distress & have a                    1. POLYPHAGIA
         tracheostomy set, O2 & suction machine at bed side         2. POLYDIPSIA
     -Semi-Fowler’s position                                       3. POLYURIA
     -Check for bleeding                                           4. HYPERGLYCEMIA
     -Check for hypocalcemic crisis, Trousseau’s or                5. WEIGHT LOSS
         Chvostek’s sign                                            6. BLURRED VISION
     -Assess changes in voice pattern & for laryngeal              7. SLOW WOUND HEALING
         nerve damage                                               8. VAGINAL INFECTIONS
     -Administer calcium & vitamin D supplements as                9. WEAKNESS & PARESTHESIAS
         prescribed.                                                10. SIGNS OF INADEQUATE FEET
CALCIUM SUPPLEMENTS                                                     CIRCULATION
VITAMIN D SUPPLEMENTS                                         APPROACH TO DIABETES MELLITUS:
calcifediol (Calderol)                                        •DIET
CALCIUM REGULATORS
calcitonin human (Cibacalcin)                                 •EXERCISE
ANTIHYPERCALCEMICS                                            •ORAL HYPOGLYCEMIC AGENTS/INSULIN
edetate disodium (Disotate)                                   Sulfonylureas
Parathyroid hormone regulates serum calcium levels            Chlorpropamide (Diabinase)
*Low serum calcium level stimulate parathyroid                Tolbutamide (Orinase)
 hormone release                                              Glimepinide (Solosa)
*Hyperparathyroidism…given antihypercalcemics                 Acetohexamide (Dymelor)
*Hypoparathyroidism…given calcium & Vit. D
                                                              Prandial Glucose Regulator
Diabetes Mellitus                                             Repaglinide (Novonorm)
A chronic disorder of impaired glucose intolerance and        Rosiglitazone (Avandia)
carbohydrate, protein, and lipid metabolism: Caused by a
deficiency in insulin                                         Non-sulfonylureas
                                                              Metphormine (Glucophage)
INSULIN-DEPENDENT DIABETES                                    Precose (Acarbose)
                                                              Rosiglitazone (Avandia)
Deficient insulin production
                                                             INSULIN
Hyperglycemia                                                     Insulin increases glucose transport into cells &
                                                                   promotes conversion of glucose to glycogen,
Inc. concemtration of blood glucose                                 decreasing serum glucose levels
                                                                 Primarily acts in the liver, muscle, adipose tissue by
Glucosuria                                                          attaching to receptors on cellular membranes &
                                                                   facilitating transport of glucose, potassium &
Excess glucose excreted in urine                                    magnesium
         
Excess fluid loss                                             GLUCAGON
                                                                 Hormone secreted by the alpha cells of the islets
Polyuria / Polydipsia                                              of Langerhans in the pancreas
                                                                  Increase blood glucose by stimulating
                                                                   glycogenolysis in the liver
Insulin deficiency                                                given SC, IM or IV routes
                                                                  Used to treat insulin-induced hypoglycemia when
         
Impaired metabolism of CHON and fats                               semiconscious/unconscious
         
                                                              TYPE        ONSET               PEAK         DURATION
Weight loss
                                                             RAPID-ACTING INSULIN
Decreased storage of calories
                                                              Lispro (Humalog) 10-15 mins      1 hour      3hours
         
Polyphagia                                                    SHORT-ACTING INSULIN
                                                              Humulin Regular 0.5-1 hour       2-3 hours    4-6 hours
INTERMEDIATE-ACTING INSULIN                               HYPERGLYCEMIC HYPEROSMOLAR
Humulin NPH 3-4 hours         6-12 hours 16-20 hours      NON^KETOTIC COMA
Humulin Lente                                             Similar to DKA but without Kussmaul Respirations and
LONG-ACTING INSULIN                                       acetone breath.
 Humulin Ultralente 6-8 hours 12-16 hours 20-30 hours
                                                          CHRONIC COMPLICATION
PREMIXED INSULIN 0.5-1 hour 2-12 hours 18-24 hours        *DIABETIC RETINOPATHY
70% NPH-30% Regular                                       *DIABETIC NEUROPATHY

Major Complications of Diabetes mellitus                  Preventive Foot Care
   1. HYPOGLYCEMIA                                                1. Prevent moisture from accumulating between
   2. DIABETIC KETOACIDOSIS (DKA)                                     toes
   3. HYPERGLYCEMIC HYPEROSMOLAR                                  2. Wear loose socks & well-fitting (not tight)
 NONKETOTIC SYNDROME (HHNS)                                           shoes & instruct client not to go barefoot
    sweating                                                     3. Change into clean cotton socks daily
    tremor                                                       4. Wear socks to keep feet warm
    tachycardia                                                  5. Do not wear the same shoes 2 days in a row
    palpitations                                                 6. Do not wear open toed shoes or shoes with
    nervousness                                                      strap that goes between toes
    hunger                                                       7. Check shoes for tears or cracks in lining & for
                                                                      foreign objects before putting them on
Simple Carbohydrates to treat Hypoglycemia                        8. Break in new shoes gradually
*3 or 4 commercially prepared glucose tablets                     9. $Cut toenails straight across & smooth nails
         CHILD: 2-3 GLUCOSE TABS                                      with an emery board
*4-6 ounces of fruit juice or regular soda                        10. Do not smoke
         CHILD: ½ CUP OR 120 ML OF ORANGE JUICE                   11. Meticulous skin care & proper foot care
OR SUGAR-SWEETENED JUICE                                          12. Inspect feet daily & monitor feet for redness,
*6-10 Life Savers or hard candy                                       swelling or break in skin integrity
         CHILD: 3-4 HARD CANDIES OR 1 CANDY BAR                   13. Avoid thermal injuries from hot water, heating
*2-3 teaspoons of sugar or honey                                      pads & baths
         CHILD: 1 SMALL BOX OF RAISINS                            14. Wash feet with warm (not hot) water & dry
DIABETES KETOACIDOSI                                                  thoroughly(avoid foot soaks)
Assessment:                                                       15. Do not soak feet
         1. 3 Ps                                                  16. Do not treat corns, blisters or ingrown nails
         2. Blurred Vision                                        17. Do not cross legs or wear tight garments that
         3. Weakness                                                  may constrict blood flow
         4. Headache                                              18. Apply moisturizing lotion to feet but not
         5. Hypotension                                               between toes
         6. Weak, rapid pulse
         7. Anorexia, nausea, vomiting & abdominal pain   CLIENT EDUCATION DURING ILLNESS
         8. Acetone breath (fruity odor)                         Take insulin or oral hypoglycemic agents as
         9. Kussmaul respirations                                  prescribed.
         10. Mental status changes                               Test blood glucose & test the urine for ketones
 Diabetes ketoacidosis                                             every 3-4 hours
                                                                 If meal plan cannot be followed, substitute with
Progressive insulin deficiency                                     soft food 6-8 x per day
                                                                If vomiting, diarrhea or fever occurs, consume
Glucogenolysis                                                     liquids every ½ to 1 hour to prevent
Gluconeogenesis                                                    dehydration & to provide calories
                                                                Notify doctor if vomiting, diarrhea, or fever
Contribute to further hyperglycemia                                persists, if blood
                                                                glucose levels are greater than 250 to 300
Breakdown of fats                                                  mg/dL, when ketonuria is present for more than
                                                                  24 hours, when unable to take food or fluids for
Increased production of ketones                                    a period of 4 hours, when illness persists for
                                                                   more than 2 days

								
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