endocrine

1. Endocrine Disorders and Therapeutic Management Gladys T. Cruz

2. Diabetes Mellitus

3. Diabetes Mellitus Is a disorder of the endocrine system that causes alterations in glucose metabolism.

4. Diabetes Mellitus: Type Type 1 – an absolute lack of insulin Type 2 – relative lack of insulin

5. Diabetes Mellitus Pancreas is an organ with both endocrine and exocrine functions - Exocrine function is to release a juice full of enzymes and other components that helps with the process of digestion

6. Diabetes Mellitus - Endocrine function (islets of langerhans) Beta cells produce insulin Alpha cells produce glucagon Delta cells produce somatostatin

7. Diabetic Ketoacidosis

8. Diabetic Ketoacidosis Beta cells have the inability to produce insulin Hyperglycemia – hyperosmolar state Electrolyte shifts and total body dehydration Formation of ketones because of breakdown of fats and protein

9. Diabetic Ketoacidosis: Clinical Manifestations Dehydration Ketosis Metabolic acidosis Weakness Anorexia Altered mental status Tachycardia Kussmaul respirations

10. Diabetic Ketoacidosis: Goals of Treatment Correction of acidosis Correction of electrolyte and fluid disturbances Insulin to lower serum glucose levels Prevention of ketosis Prevention of complications

11. Diabetic Ketoacidosis: Treatments Closely monitor blood glucose levels and acidosis Replace fluids and electrolytes Administer insulin Monitor cardiac, pulmonary, neurologic systems

12. Diabetic Ketoacidosis: Treatments Identify and correct precipitating event Educate the patient and the patient’s family

13. Diabetic Ketoacidosis Rapid insulin 0.1 to 0.2 U/kg/hr

14. HyperosmolarNonketotic Coma

15. HyperosmolarNonketotic Coma A serious metabolic complication, usually seen in type 2 diabetes Results in dehydration and electrolyte disturbances without acidosis

16. HyperosmolarNonketotic Coma: Clinical Manifestation Profound dehydration Hypotension Tachycardia Diminished CVP Dry mucous membrane Poor skin turgor Neurologic impairments including confusion, seizures and coma

17. HyperosmolarNonketotic Coma Treatment goals are similar to the interventions of DKA

18. Hypoglycemia

19. Hypoglycemia Occurs when the blood sugar levels drop rapidly

20. Hypoglycemia Sweating, tremors Blurred vvision, hunger, weakness Behavior changes, and confusion Anxiety, paresthesia and poor coordination Slurred speech, headache Palpitation, nausea

21. Hypoglycemia: Treatment Fast acting carbohydrates (if client is conscious) - ½ cup orange juice - 4 oz cola - 4 oz orange juice

22. Syndrome of Inappropriate Secretion of Antidiuretic Hormone

23. Syndrome of Inappropriate Secretion of Antidiuretic Hormone Patient has an excess of antidiuretic hormone secreted into the bloodstream, more than amount needed to maintain normal blood volume and serum osmolality

24. Syndrome of Inappropriate Secretion of Antidiuretic Hormone Excessive water is resorbed at the kidney tubule, leading to dilutionalhyponatremia

25. Assessment Early Clinical Manifestation: - dilutionalhyponatremiainclude lethargy, anorexia, nausea and vomiting

26. Assessment Symptoms of Severe Hyponatremia: - inability to concentrate, mental confusion, apprehension, seizures, decreased level of consciousness, coma and death

27. Nursing Diagnoses Excess Fluid Volume related to comprised regulation mechanism Anxiety related to lack of control over current situation or disease progression Deficient Knowledge: Discharge Regimen related to lack of previous exposure to information

28. Medical Management Fluid restriction Sodium replacement Medications that increase renal water excretion (Demeclocycline)

29. Nursing Management Restriction of Fluids - accurate intake and output - mouth care for fluid restriction - weigh patient to gauge fluid retention or loss of body fluid

30. Diabetes Insipidus

31. Diabetic Insipidus Caused by a deficiency in the production or release of ADH by the posterior pituitary gland

32. Diabetic Insipidus: Neurogenic Nephrogenic Psychogenic

33. Diabetic Insipidus: Clinical Manifestations Polyuria Polydipsia Hypotension Tachycardia Weight loss Dehydration Mental status changes Seizures Constipation

34. Diabetic Insipidus: Medication Vasopressin Desmopressin acetate ( for chronic neurogenic)

35. Diabetic Insipidus: Nursing Management Monitor intake and output

36. Thyroid Storm

37. Thyroid Storm Also called Thyroid Crisis A complication of pre - existing hyperthyroidism

38. Thyroid Storm Increase in cellular oxygen consumption

39. Thyroid Storm: Medical Management Prevent cardiovascular collapse Reduce hyperthermia Reverse dehydration

40. Thyroid Storm: Pharmacologic Management A. Drugs that block thyroid synthesis Propylthiouracil (PTU) = blocks conversion of T4 to T3 B. Drugs that block release of thyroid hormone Iodides = decreases thyroid hormone production

41. Thyroid Storm: Pharmacologic Management C. Drugs that block catecholamine effect Propanolol

42. Thyroid Storm: Nursing Management Medication administration Normalize temperature Rehydration and correction of metabolic derangements

43. Myxedema Coma Progressive worsening or terminal stage of hypothyroidism

44. Myxedema Coma Cell is unable to maintain processes necessary to sustain life - protein synthesis is curtailed - carbohydrates and fat metabolism is incomplete - lipolysis is ineffective, and cholesterol collects in the blood stream

45. Myxedema Coma: Clinical Manifestation Dull and mask-like face Damaged cardiac myocytes due to interstitial edema Pleural effusions ADH levels is increased Decreased gastric motility Heat production decreases

46. Myxedema Coma: Pharmacologic Management Levothyroxine

47. Myxedema Management: Nursing Management Ventilatory support ABG’s measurement ECG monitoring Measures to avoid skin breakdown Manage constipation Monitor I and O

48. Education’s purpose is to replace an empty mind with an open one.