nursing: Nursing Lecture about the Endocrine System: Altered Metabolic Function

Altered Metabolic Function

- Lack (<) Endocrine Gland Over (>)
- Pineal –behind lateral ventricles
- Diabetes Insipidus Pituitary - SIADH
- Hypothyroidism Thyroid - Hyperthyroidism
- pedia: Cretinism Basedow’s/Parry’s
- adult: Myxedema Coma Grave’s Disease
- Hypoparathyroidism Parathyroid - Hyperparathyroidism
- Thymus
- DM Pancreas
- Addison’s Disease Adrenals - Cushing’s/Conn’s
- Gonads (testes / ovaries)
- Interaction of endocrine system with aging are inconclusive, however, changes in endocrine glands & target organs occur
- Loss of self-regulation (autoimmune or immunodeficiency disorders)
- Target organs lose ability to respond to hormones
- Hypothalamus & pituitary functions may be altered by changes in neurotransmitter levels
- Wear out of body structures in time are no longer able to adapt to stressors (theory of stress adaptation)
- Inspection:
- Palpation:
- Auscultation
- Vital signs & history taking
- “ diabetes” – going through; “mellitus” – honey/sweet
- Metabolic disorder characterized by glucose intolerance resulting from an imbalance between insulin supply & demand
- Involves β -cells if Islet of Langerhans (pancreas) – source of insulin
- Insulin Functions:
- Types:
- Type I
- Juvenile onset
- Abrupt onset
- Little or no insulin produced
- within ideal body weight / thin
- Tx:
- Type II
- Maturity onset
- Insidious onset
- Below normal or normal insulin production (but high demand for it)
- 80% of clients are obese
- Tx:
Genetic predisposition Environmental agents inciting an immune response Autoimmune destruction of β cells Insulin resistance Inability of pancreas to release insulin ↓ glucose utilization Stimulates insulin secretion initially Increased insulin demand Fat & protein mobilization Blood glucose accumulation Uncontrolled increased in blood sugar Diabetes mellitus ↓ insulin response due to exhaustion
- Hyperglycemia – increased blood sugar levels (normal = 80-120mg/dL)
- Glycosuria – (+) glucose in urine
- Polyuria – excessive urination
- Polydypsia – excessive thirst
- Polyphagia – excessive hunger
- Weight loss despite normal or increased appetite (type I)
- Blurring of vision
- Fatigue / weakness
- Skin infections
- Pruritus (candidal infections common among women)
- Blood Tests
- priority = correct deficiency
- D iet: 50-60%CHO, 10-20%CHON, 20-30%fats (unsaturated)
- I nsulin
- A nti-diabetic agents
- B lood sugar monitoring
- E xercise
- T ransplant of pancreas (if indicated)
- I nsure adequate food intake
- S crupulous foot care – cut toenails straight
- - do not use sandpaper or stones
- - socks = cotton
- - shoes = snugly
- - water = tepid
- - foot powder
- - dry between toes (after bath)
- - do not walk on barefoot
- Oral Hypoglycemic agents – for type II only
- Insulin – must be stored in cold (not freezing) temp
- Preparation Onset Duration Peak Route
- Subcutaneous injections are absorbed fastest at the abdomen
- Watch out for signs of hypoglycemia – cold, clammy skin & diaphoresis
- Lipodystrophy – loss of fatty tissues
- Diabetic Ketoacidosis (DKA) – liver ketone production exceeds cellular use & renal excretion
- Function – synthesis of thyroxin (T4) and triiodothyronine (T3)
- Bound to thyroid hormone-binding globulin (TBG) for transport in blood
- T3 = triiodothyronine (active form)
- T4 = thyroxin (needs to be converted to T3 before manifestation of physiologic action)
- Secretion is regulated by hypothalamic-pituitary-thyroid feedback (release of thyroid stimulating hormones –TSH)
- RDA of iodine is 40-50 mcg (infants), 70-120 mcg (children), and 150 mcg (adolescents and adults)
Sleep, cold temp, stress hypothalamus Thyroid-releasing hormone (TRH) Anterior pituitary (TSH) Thyroid gland (T3 & T4) Target organs Inhibition
- Basal Metabolic Rate – measures O 2 consumption of the body at a given time
- Thyroid Function Test – immunoassays measuring T 3 , T 4 , & TSH levels
- Thyroid scan – used to detect nodules & determine functional activity of thyroid glands
- CT Scan & MRI – used to demonstrate tracheal compression on neighboring structures
- too little thyroid hormone produced, when there is decreased conversion from T4 to T3 , or from Tx of hyperthyroidism
- Primary – intrinsic disorder in the thyroid gland
- Secondary – insufficient stimulation of thyroid hormone by TSH from anterior pituitary gland
- Tertiary – hypothalamus fails to produce TRH
- Dx: detailed Hx & physical assessment;
- Tx/Nursing Management: Replacement T3 or T4 therapy – FOR LIFE (caution use with MI, HPN, DM, pregnant & elderly)
- Myxedema Coma – life-threatening end stage expression of the disease
- Excessive delivery of thyroid hormones
- Common cause: Grave’s disease (autoimmune) & goiter
- Grave’s – abnormal stimulation of thyroid gland by thyroid stimulating antibodies
- Dx: increased serum T4
- Tx/ Nursing Management: Anti-thyroids = 2-3wks before effects are seen
- Thyroid storm/crisis – life-threatening
- Hypothyroidism
- Decreased BMR
- Myxedematous features
- Deep voice
- Impaired growth (child)
- ↑ cholesterol levels
- Behavior: mental & physical fatigability; mental retardation (infant)
- Bradycardia
- Decreased appetite
- Weight gain
- Cold intolerance
- Hyperthyroidism
- Increased BMR
- Exophthalmus
- Lid lag
- Fine hand tremors
- Decreased blinking
- ↓ cholesterol levels
- Behavior: restlessness, wakefulness, irritability, anxiety
- Tachycardia & palpitations
- Increased appetite
- Weight loss
- Heat intolerance
- Pre-op: achieve euthyroid state by Lugol’s solution & antithyroid drugs (2-3wks); rest
- Post-op Care:
- also called Radioiodine I-131 therapy
- for hyperthyroidism
- I-131(small dose) is swallowed, it is absorbed into the bloodstream in the GI tract and concentrated from the blood by the thyroid gland, where it begins destroying the gland’s cells
- client simply swallows a single dose (a prepared dose), in capsule or liquid form, and is quickly absorbed
- effect of this treatment on the thyroid gland usually takes between one and three months to develop, with maximum benefit occurring three to six months after treatment
- Nearly all the radioactive iodine leaves the body during the first two days following the treatment, primarily through the urine (Small amounts will also be excreted in saliva, sweat, tears, vaginal secretions, and feces)
- Client will be able to go home after treatment
- Clients who need to travel immediately after treatment are advised to carry a letter of explanation from physician
- Use private toilet facilities, if possible, and flush twice after each use.
- Bathe daily and wash hands frequently.
- Drink a normal amount of fluids.
- Use disposable eating utensils or wash your utensils separately from others.
- Sleep alone and avoid prolonged intimate contact.
- Avoid prolonged contacts esp. with pregnant women, infants, & children
- Launder your linens, towels, and clothes daily at home, separately.
- Do not prepare food for others that requires prolonged handling with bare hands.
- C/I: pregnancy (can damage the baby's thyroid gland)
- Pregnancy should be delayed until at least 6-12months after treatment (treatment exposes the ovaries to radiation)
- Women who have not yet reached menopause should fully discuss the use of I-131 with their physician.
- Inform client that it is highly likely that the entire thyroid gland will be destroyed with this procedure (most clients will need to take thyroid pills for the rest of their life following the procedure.
- There are essentially no other permanent side effects from the procedure
- Parathyroid hormone (PTH) - major regulator of serum calcium & phosphate
- Parathyroid gland –secretes the hormone
↓ serum Ca PTH Kidney- ↓ Ca Elimination & ↑ phosphate elimination ↑ serum Ca Intestine-↑ Ca absorption Bone-release of Ca Activated Vit.D
- Blood tests:
- Urine calcium & phosphate level determination (PO 4 -3 lost in urine is directly related to PO 4 -3 blood concentrations)
- Parathyroid hormone by radioimmunoassay
- Hypoparathyroidism Hyperparathyroidism
- Main Problem: - deficiency of Ca +2 in blood - excess Ca +2 in blood ↓Ca +2 in bones
- S/Sx: - Early = tingling - Recklin-Hensen’s Disease (↑Ca +2 in blood)
- = Chvostek’s sign - bone pain & destruction
- = Trousseau's sign
- Lab: - Ca +2 <>
- Mgt: - priority = Ca +2 - priority = safety
- replacement
- - diet: Broccoli - diet: ↓Ca +2
- Sardines - ↑oral fluids to prevent stone Spinach formation
- Tuna - strain urine
- Meds: - Fosamax - Paracalcitriol – suppress PTH
- Ca +2 gluconate IV (for acute)
- Adrenal glands – found retroperitoneally at the apex of kidneys
- Dx:
- CUSHING’S SYNDROME
- Overproduction of ACTH
- Cortisol
- Aldosterone
- Androgen (hirsutism)
- Mgt: correct electrolyte imbalance = priority
- ADDISON’S DISEASE
- Inadequate production of ACTH
- Cortisol:
- Aldosterone
- Androgen (lesser pubic hair)
- Mgt: correct electrolyte imbalance
- Addisonian Crisis – severe hypotension (coma & shock)

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Friday, March 6, 2009

Nursing Lecture about the Endocrine System: Altered Metabolic Function

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