Endocrine System Disorders Lecture

1. JOFRED M. MARTINEZ, MAN, RN

2. Insufficient hormone activity Excess hormone activity
• Gland hypofunction • Gland hyperfunction
• Lack of tropic or stimulating hormone • Excess tropic or stimulating hormone
• Target tissue insensitivity to hormone • Ectopic hormone production
• Self-administration of too much
replacement hormone

3. NTIDIURETIC HORMONE
XYTOCIN

4. RESULTS TO…
Neurogenic DI
Nephrogenic DI
Psychogenic DI

5. RESULTS TO…

6. CAUSES:
Pituitary surgery
Trauma
Presence of tumor
Drugs (glucocorticoids or alcohol)
CAUSES:
Head trauma, surgery
Oat cell carcinoma of the lungs
Hodgkin’s disease
Medications (diuretics, anesthetics, TCAs)
Hyperplasia of pituitary gland
SIGNS AND SYMPTOMS:
1. Polyuria
2. Signs of dehydration
3. Weakness and fatigue
4. Hypotension
5. Weight loss
6. Untreated results to…
HYPOVOLEMIC SHOCK
SIGNS AND SYMPTOMS:
1.Fluid retention
2.Untreated results to
CEREBRAL EDEMA results to…
INCREASE ICP results to…
SEIZURE ACTIVITY
DIAGNOSTIC PROCEDURE:
1. Urine specific gravity DECREASED
2. Serum sodium INCREASED
DIAGNOSTIC PROCEDURE:
1. Urine specific gravity INCREASED
2. Serum sodium DECREASED

7. NURSING MANAGEMENT:
1. Force fluids
2. Monitor strictly vital signs and intake and
output
3. Administer medications…
DESMOPRESSIN (DDAVP)
Administered INTRANASAL
PITRESSIN (VASOPRESIN TANNATE)
administered IM Z-TRACT
CHLORPROPAMIDE (DIABINESE)
4. Prevent complications…
HYPOVOLEMIC SHOCK
NURSING MANAGEMENT:
1. Restrict fluid (500 to 600 mL per 24
hours)
2. Administer medications…
LOOP DIURETICS (LASIX)
OSMOTIC DIURETICS (MANNITOL)
LITHIUM CARBONATE ( ESKALITH)
PHENYTOIN HCL ( DILANTIN)
3. Monitor strictly vital signs, intake and
output and neuro check
4. Weigh patient daily and assess for
pitting edema
5. Provide meticulous skin care
6. Prevent complications

8. MEDICATIONS SIDE-EFFECTS
NURSING
IMPLICATIONS
• Vasopressin (Pitressin):
replaces ADH
• Water retention • Check daily weights and
urine specific gravity.
• Desmopressin (DDAVP):
replaces ADH
• Water loss, dehydration
• Demeclocycline
(Declomycin): reduces
ADH release
• Photosensitivity, allergy,
water loss
• Do not give
demeclocycline with
dairy products or
antacids.

9. • Assess for early signs of dehydration and maintain
adequate hydration
• Assess neurologic status
• Measure fluid I&O
• Check urine specific gravity
• Record daily client weight
• Monitor client for education need and ability to participate
in health care
• Weigh daily using the same scale at the same time of day

10. • Institute seizure precautions for children
• Obtain daily serum and urinary sodium and osmolality
levels
• Measure I&O
• Record daily client weight
• Monitor client for education need and ability to participate
• in health care

11. • Observe changes in client neurologic status
 Assess for muscle twitching
 Check orientation to time, place, and person
 Reduce environmental noise to prevent
overstimulation
• Give ice chips to combat thirst when fluids are restricted
• Provide mouth care often

12. IN CHILDREN…

13. IN CHILDREN…

14. IN CHILDREN…

15. IN ADULTS…

16. IN ADULTS…

17. DWARFISM acromegaly
Etiology • pituitary tumor or failure of the
pituitary to develop
• infection trauma
• neglect or severe emotional
stress
• malnutrition
• pituitary hyperplasia
• benign pituitary tumor
• hypothalamic dysfunction
Signs and
symptoms
• grow to only 3 to 4 feet
• slowed sexual maturation
• children: mental retardation
• adults: weakness, hypoglycemia,
sexual dysfunction, skin
changes, and increased risk for
cardiovascular and
cerebrovascular disease
• nose, jaw, brow, hands, and feet
enlarge
• tongue becomes thick
• kyphosis
• visual disturbances
• headaches
• erectile dysfunction and
amenorrhea

18. DWARFISM acromegaly
Diagnostic
test
• growth hormone stimulation test
• MRI
• radiographic studies
• Serum growth hormone levels
are measured
Treatment • children: administration of growth
hormone
• surgery
• Bromocriptine (Parlodel)
• Octreotide (Sandostatin)
• Hypophysectomy or radiation
• lifelong replacement of thyroid
hormone, corticosteroids, and
sex hormones
Nursing
management
• assessment of mental status,
ability to cope with the effects of
the disorder, and understanding
of the treatment plan.
• assess safety in relation to
impaired eyesight, chewing,
swallowing, and sleep apnea
• monitor serum glucose levels

19. MEDICATIONS SIDE-EFFECTS NURSING IMPLICATIONS
Bromocriptine
(Parlodel): reduces
growth hormone
release
• Dizziness, hypotension,
nausea
• Monitor blood pressure,
serum growth hormone.
Octreotide
(Sandostatin):
supresses growth
hormone
• Uncommon: dizziness,
nausea, constipation
• Teach patient self
administration.
Somatropin
(Humatrope):
replaces growth
hormone
• Insulin resistance,
hypothyroidism
• Monitor growth; teach
patient self-administration.

20. • Promote self-esteem
• Support confidence by capitalizing on idol worship in adolescents
• Encourage participation in a support group
• Promote coping

21. RESULTS TO…

22. RESULTS TO…

25. • Most tumors of the pituitary gland are benign adenomas.
• Benign tumors in the brain can cause visual disturbances,
symptoms of increased pressure in the brain, and symptoms related
to hormone imbalances.
• Treatment for is usually hypophysectomy.
• Radiation is used, either alone or as an adjunct to surgery.

26. PREOPERATIVE CARE
• Ensure that the patient understands the physician’s explanation of surgery.
• Perform and document a baseline neurological assessment.
• Prepare the patient for what to expect following surgery. Instruct the patient to avoid any
actions that increase pressure on the surgical site, such as coughing, sneezing, nose
blowing, straining to move bowels, or bending from the waist.
• Instruct the patient in deep breathing exercises or use of an incentive spirometer.

27. POSTOPERATIVE CARE
• Perform routine neurological assessments
• check urine for specific gravity
• If a patient has had transsphenoidal surgery, nasal packing are left in place and not
removed unless ordered by the physician.
• Monitor the dressing for signs of cerebrospinal fluid (CSF) leakage.
• Avoid any actions that increase pressure on the surgical site.
• Obtain orders for stool softeners and antitussives as needed.
• Tooth brushing is avoided until the incision line is healed.
• The patient may use floss and mouth rinses.
• The patient is placed on hormone replacement therapy following hypophysectomy.
.

28. POSTOPERATIVE CARE
• Pituitary hormones are generally given. These may include thyroid hormone,
glucocorticoids, intranasal desmopressin, and sex hormones.
• Instruct the patient about how to administer the hormones, as well as side effects to report.

32. A. PREDISPOSING FACTORS
1. Goiter belt area
2. Increase intake of goitrogenic foods
• cabbage, turnips, radish, strawberry, carrots, sweet potato, broccoli, all nuts
3. Goitrogenic drugs
a. Anti Thyroid Agent – Prophylthiuracil (PTU)
b. Lithium Carbonate
c. ASA (Aspirin)
d. Cobalt
e. Phenylbutazones (NSAIDs)

34. B. SIGNS AND SYMPTOMS
1. Enlarged thyroid gland
2. Mild dysphagia
3. Mild restlessness
C. DIAGNOSTIC PROCEDURES
1. Decreased serum T3 and T4
2. Thyroid Scan –enlarged thyroid gland
3. Thyroid Stimulating Hormone (TSH) – increased
CONFIRMATORY DIAGNOSTIC TEST

35. D. NURSING MANAGEMENT
1. Enforce complete bed rest
2. Administer medications as ordered
a. LUGOL’S SOLUTION / SSKI
ADMINISTER VIA STRAW TO PREVENT
STAINING OF TEETH
Medications to be taken via straw:
LUGOL’S, IRON, TETRACYCLINE, NITROFURANTOIN

36. b. THYROID HORMONES
• LEVOTHYROXINE (SYNTHROID)
• LIOTHYRONINE (CYTOMEL)
• THYROID EXTRACTS
Nursing management when giving thyroid hormones:
1. Instruct client to take in the morning to prevent insomnia
2. Monitor vital signs especially heart rate because drug causes tachycardia and
palpitations
3. Monitor side effects insomnia, tachycardia, palpitations, hypertension, heat intolerance

37. 4. Increase dietary intake of foods rich in iodine
• seaweeds
• seafood’s like oyster, crabs, clams and lobster but not shrimps because it contains
lesser amount of iodine.
• iodized salt, best taken raw because it is easily destroyed by heat
5. Assist in SUBTOTAL THYROIDECTOMY

38. • All body systems are DECREASED except
WEIGHT & MENTRUATION
• All body systems are INCREASED except
WEIGHT & MENTRUATION
• DECREASED CNS: drowsiness, memory
losses (FORGETFULNESS)
• DECREASED VS: hypotension, bradypnea,
bradycardia, hypothermia
• DECREASED GI motility:
CONSTIPATION
• DECREASED appetite but with WEIGHT
GAIN results to INCREASED SERUM
CHOLESTEROL LEVELS results to
HYPERTENSION, MI, CHF, STROKE
• DECREASED metabolism causes decreased
perspiration w/c results to DRY SKIN &
COLD INTOLERANCE
• INCREASED menorrhagia
• INCREASED CNS: tremors, insomnia
• INCREASED VS: hypertension, tachypnea,
tachycardia, hyperthermia
• INCREASED GI motility: DIARRHEA
• INCREASED appetite but with WEIGHT
LOSS
• INCREASED metabolism causes increased
perspiration w/c results to MOIST SKIN &
HEAT INTOLERANCE
• DECREASED amenorrhea
EXPOTHALMOS
Pathognomonic Sign

40. DIAGNOSTIC TESTS:
1. Serum T3 and T4 is DECREASED
2. Serum Cholesterol is INCREASED
3. RAIU is DECREASED
DIAGNOSTIC TESTS:
1. Serum T3 and T4 is INCREASED
2. RAIU is INCREASED
3. Thyroid Scan - reveals an ENLARGED
THYROID GLAND
NURSING MANAGEMENT:
1. Monitor strictly vital signs and intake and
output to determine presence of:
•MYXEDEMA COMA is a severe form of
hypothyroidism is characterized by severe
hypotension, bradycardia, bradypnea,
hypoventilation, hyponatremia, hypoglycemia
leading to progressive stupor and coma.
NURSING MANAGEMENT:
1. Monitor strictly vital signs and intake and
output to determine presence of:
•THYROID STORM is a severe form of
hyperthyroidism is characterized by severe
hypertension, tachycardia, tachypnea,
hyperventilation, hyperpyrexia, altered
neurologic or mental state, which frequently
appears as delirium psychosis, somnolence, or
coma

41. NURSING MANAGEMENT FOR MYXEDEMA
COMA
Assist in mechanical ventilation
Administer thyroid hormones as ordered
Force fluids
NURSING MANAGEMENT FOR
THYROTOXICOSIS
 Cool quiet environment
 O2 inhalation
 IV fluids (hypertonic)
 Antithyroid agents
2. Force fluids
3. Administer isotonic fluid solution as ordered
4. Administer medications:
Thyroid Hormones
LEVOTHYROXINE
LEOTHYRONINE
THYROID EXTRACTS
5. Provide dietary intake that is LOW IN
CALORIES
6. Provide comfortable and warm environment
7. Provide meticulous skin care
2. Administer medications as ordered
Antithyroid Agents
PROPHYTHIORACIL (PTU)
METHYMAZOLE (TAPAZOLE)
Side effects: AGRANULOCYTOSIS
• increase lymphocytes and monocytes,
fever and chills, sore throat, leukocytosis
(CBC)
BETA-BLOCKERS
PROPANOLOL (INDERAL)
ATENOLOL (TENORMIN)
3. Provide dietary intake that is INCREASED
IN CALORIES.

42. NURSING MANAGEMENT:
8. Provide client health teaching and discharge
planning concerning:
a. Avoid precipitating factors leading to
myxedema coma
• stress
• infection
• cold intolerance
• use of anesthetics, narcotics, and
sedatives
• prevent complications (myxedema
coma, hypovolemic shock
• hormonal replacement therapy for
lifetime
• importance of follow up care
NURSING MANAGEMENT:
4. Provide meticulous skin care
5. Comfortable and cold environment
6. Maintain side rails
7. Provide bilateral eye patch to prevent drying
of the eyes.
8. Assist in surgical procedures:
SUBTOTAL THYROIDECTOMY
• Before thyroidectomy administer LUGOL’S
SOLUTION, SSKI, POTASSIUM IODIDE to
decrease bleeding and hemorrhage.

43. MEDICATIONS SIDE-EFFECTS NURSING IMPLICATIONS
Levothyroxine
(Synthroid):
replaces T3 and T4
• Tachycardia, insomnia,
nervousness, weight loss
• Monitor vital signs and
thyroid laboratory results.
Propylthiouracil
(PTU): inhibits
synthesis of thyroid
hormones
• Nausea, vomiting,
agranulocytosis
• Monitor WBC and
differential, thyroid function.
Methimazole
(Tapazole): inhibits
synthesis of thyroid
hormones
• Rash, agranulocytosis

44. • Alert physician to medications taken that can alter results
of diagnostic tests, especially estrogen, salicylates,
amphetamines, antibiotics, corticosteroids, and mercurial
diuretics
• Modify client activity to accommodate fatigue
• Promote independence in self-care activities
• Provide extra layers of clothing or extra blanket
• Monitor body temperature and report decreases from
baseline
• Provide foods high in fiber

45. • Monitor respiratory rate, depth, pattern, pulse oximetry,
and arterial blood gas
• Orient client to time, place, and events
• Monitor for increasing severity of decreased LOC, VS
changes, and increasing difficulty in arousal
• Position a newborn with a goiter with the neck
hyperextended to aid breathing; provide supplemental
oxygen; and have a tracheostomy set immediately
available in case tracheal compression by the goiter
requires emergency ventilation.

46. • Monitor VS especially heart rate and rhythm
• Monitor serum albumin, hemoglobin, and lymphocyte
• levels
• Encourage a diet high in calories, proteins, and
carbohydrates
• Encourage six meals per day
• Weigh at least weekly
• Assess for visual changes: photophobia, decreased
acuity, or ability to close eyes

47. • If exophthalmos is present, protect eyes with glasses,
wet with artificial tears, elevate head of bed at night;
avoid sleeping in a prone position and wear a patch at
night if eyelids do not fully close
• Assess level of mentation for impending storm

48. • May cause nausea so limit oral intake 2 hours before and
after treatment
• Take acetaminophen for sore throat, which may occur a
few days after the treatment
• I 131 is eliminated in urine over 4–5 days so drink a lot of
fluid, void frequently and flush twice, and thoroughly
clean up any spilled urine
• Wash laundry separately if the treated person has
sweated heavily, such as after exercise

49. • Keep an arm’s length from anyone who will be in contact
with you for more than 2 hours in every 4-hour period;
especially if in contact with children and pregnant
women.
• Small amount found in saliva so avoid kissing and any
sharing of food, fluids, or utensils
• After I 131 treatment, women should not get pregnant or
breast-feed for 6 months
• Report palpitations, chest pain, or dizziness

50. 1. Watch out for signs of thyroid storm/ thyrotoxicosis
HYPERTHERMIA, TACHYCARDIA, AGITATION
a. Administer medications as ordered
ANTI PYRETICS, BETA-BLOCKERS
b. Monitor strictly vital signs, input and output and neuro check.
c. Maintain side rails
d. Provide TSB

51. 2. Watch out for accidental removal of parathyroid gland that may
lead to HYPOCALCEMIA (TETANY)
Signs and Symptoms:
(+) TROUSSEAU’S SIGN (+) CHVOSTEK SIGN
Watch out for arrhythmia, seizure give CALCIUM GLUCONATE IV slowly
as ordered.

52. CHvostek’s sign is assessed near the CHeek.

54. 3. Watch out for accidental laryngeal damage which may lead to
HOARSENESS OF VOICE
Nursing Management:
• encourage client to talk/speak immediately after operation and
notify physician
4. Signs of bleeding
Nursing Management:
• check the soiled dressings at the back or nape area.
5. Hormonal replacement therapy for lifetime
6. Importance of follow up care

58. ETIOLOGY:
1. Subtotal thyroidectomy
2. Atrophy of parathyroid gland
due to:
a. inflammation
b. tumor
c. trauma
ETIOLOGY:
1. Hyperplasia of parathyroid gland
2. Over compensation of
parathyroid gland due to vitamin
D deficiency
a. Children: RICKETTS
b. Adults: OSTEOMALACIA
SIGNS AND SYMPTOMS:
1. ACUTE TETANY
• tingling sensation, paresthesia,
numbness, dysphagia, POSITIVE
TROUSSEAU'S SIGN, POSITIVE
CHVOSTEK’S SIGN,
laryngospasm/broncospasm,
seizure, arrhythmia
2. CHRONIC TETANY
• photophobia and cataract
formation, loss of tooth enamel,
anorexia, nausea and vomiting,
agitation and memory loss
SIGNS AND SYMPTOMS:
1. Bone pain especially at back
2. Kidney stones
a. renal colic
b. cool moist skin
3. Anorexia, nausea and vomiting
4. Agitation and memory
impairment

59. DIAGNOSTIC PROCEDURES
1. Serum Calcium is DECREASED
2. Serum Phosphate is DECREASED
3. X-ray of long bones reveals a
decrease in bone density
4. CT Scan – reveals degeneration
of basal ganglia
RISK FACTORS:
1. Serum Calcium is INCREASED
2. Serum Phosphate is DECREASED
3. X-ray of long bones reveals bone
demineralization
NURSING MANAGEMENT:
1. Administer medications as
ordered such as:
A. ACUTE TETANY
CALCIUM GLUCONATE
IV SLOWLY
B. CHRONIC TETANY
• Oral Calcium supplements
• Calcium Gluconate
• Calcium Lactate
• Calcium Carbonate
C. Vitamin D for absorption of
NURSING MANAGEMENT:
1. Force fluids to prevent kidney
stones
2. Strain all the urine using gauze
pad for stone analysis
3. Provide warm sitz bath
4. Administer medication:
MORPHINE SULFATE (DEMEROL)
5. Encourage increase intake of
foods rich in phosphate but low
in calcium

60. NURSING MANAGEMENT:
2. Avoid precipitating stimulus such
as glaring lights and noise
3. Encourage increase intake of
foods rich in calcium
a. anchovies
b. salmon
c. green turnips
4. Institute seizure and safety
precaution
5. Encourage client to breathe
using paper bag to produce mild
respiratory acidosis result.
6. Prepare TRACHEOSTOMY SET at
bedside for presence of
laryngospasm
7. Prevent complications
8. Hormonal replacement therapy
for lifetime
9. Importance of follow up care.
NURSING MANAGEMENT:
6. Provide acid ash in the diet to
acidify urine and prevent
bacterial growth
7. Assist/supervise in ambulation
8. Maintain side rails
9. Prevent complications (seizure
and arrhythmia)
10. Assist in surgical procedure
known as PARATHYROIDECTOMY
11. Hormonal replacement therapy
for lifetime
12. Importance of follow up care.

61. Milk
Cheeses
Yogurt
Sardines
Oysters
Salmon
Cauliflower
Green leafy vegetables

62. MEDICATIONS SIDE-EFFECTS NURSING IMPLICATIONS
Calcium gluconate:
replaces calcium
• Dysrhythmia, cardiac arrest,
constipation
• Monitor vital signs and ECG
during IV therapy.
• Do not take PO calcium with
other medications.
Alendronate
(Fosamax): inhibits
resorption of bone;
keeps calcium in
bones
• Abdominal pain, constipation,
diarrhea, nausea
• Do not take with calcium
supplements or caffeine.

63. • Monitor serum calcium
• If client complains of paresthesias suggestive of
hypocalcemia check for Chvostek and Trousseau’s signs
• Report signs of impending tetany immediately
• Make certain a tracheostomy set and IV calcium
gluconate or calcium chloride is immediately available

64. • Hypercalcemic crisis:
 Monitor VS, CVP, and output hourly while
administering high-volume IV normal saline (NS)
 Administer medications to lower serum calcium
 Assess for early signs of hypocalcemia, which are
indicative of overtreatment

69. • A pheochromocytoma is an uncommon tumor that arises from
the chromaffin cells of the adrenal medulla.
• The tumor autonomously secretes catecholamines (epinephrine
and norepinephrine) in excessive amounts.
• The cause of pheochromocytoma is unknown.
• About 5% of cases are hereditary.
• Patients with a pheochromocytoma have exaggerated fight or flight
symptoms.

71. The patient should avoid caffeine and medications for 2 days
before and during the test.

73. • During hypertensive crisis, client should be in ICU to
allow for needed cardiac, BP, and neurological
monitoring
• Manage postoperative pain because untreated it can
cause hypertension
• Avoid activities that increase intra-abdominal pressure

75. RISK FACTORS:
1. Atrophy of adrenal glands
2. Fungal infections
RISK FACTORS:
1. Hyperplasia of adrenal gland
SIGNS AND SYMPTOMS:
1. HYPOGLYCEMIA
2. Decrease tolerance to stress
3. HYPONATREMIA
• hypotension
• signs of dehydration
• weight loss
4. HYPERKALEMIA
• agitation
• diarrhea
• arrhythmia
5. Decrease libido
6. Loss of pubic and axillary hair
7. BRONZE LIKE SKIN PIGMENTATION
SIGNS AND SYMPTOMS:
1. Increase susceptibility to infections
2. HYPERNATREMIA
• Hypertension, edema, weight
gain, MOON FACE APPEARANCE
AND BUFFALO HUMP, obese trunk,
pendulous abdomen, thin
extremities
3. HYPOKALEMIA
• Weakness and fatigue,
constipation, U wave upon ECG
(T wave hyperkalemia)
5. Hirsutism
6. Acne and striae
7. Easy bruising
8. INCREASE MASCULINITY AMONG
FEMALES

78. RISK FACTORS:
1. Atrophy of adrenal glands
2. Fungal infections
RISK FACTORS:
1. Hyperplasia of adrenal gland
DIAGNOSTIC PROCEDURES:
1. FBS is DECREASED
2. Plasma cortisol is DECREASED
3. Serum sodium is DECREASED
4. Serum potassium is INCREASED
NURSING MANAGEMENT:
1. Monitor strictly vital signs, input
and output to determine
presence of ADDISONIAN CRISIS
Addisonian crisis characterized by:
a. severe hypotension
b. hypovolemic shock
c. hyponatremia leading to
progressive stupor and coma
DIAGNOSTIC PROCEDURES:
1. FBS is INCREASED
2. Plasma cortisol is INCREASED
3. Serum sodium is INCREASED
4. Serum potassium is DECREASED
NURSING MANAGEMENT:
1. Monitor strictly vital signs and
intake and output
2. Weigh patient daily and assess for
pitting edema
3. Measure abdominal girth daily and
notify physician
4. Restrict sodium intake
5. Provide meticulous skin care
6. Administer medications as ordered
a. Spinarolactone – potassium
sparing diuretic

79. NURSING MANAGEMENT FOR
ADDISONIAN CRISIS:
1. Assist in mechanical ventilation,
2. Administer ISOTONIC FLUID
SOLUTION as ordered
3. Force fluids
4. Administer medications as
ordered:
CORTICOSTEROIDS:
a. DEXAMETHASONE (DECADRONE)
b. PREDNISONE
c. HYDROCORTISONE (CORTISON)
NURSING MANAGEMENT:
7. Prevent complications (DM)
8. Assist in surgical procedure
(BILATERAL ADRENALECTOMY)
9. Hormonal replacement for
lifetime
10. Importance of follow up care

80. MEDICATIONS SIDE-EFFECTS NURSING IMPLICATIONS
Phenoxybenzamine
(Dibenzyline):
blocks action of
epinephrine at alpha
receptors in
pheochromocytoma
• Orthostatic hypotension • Monitor vital signs.
Hydrocortisone:
replaces cortisol in
adrenal insufficiency
• Cushing’s effects • Teach patient to take with
food and not to discontinue
abruptly.
Fludrocortisone
(Florinef): replaces
aldosterone in
adrenal insufficiency
• Fluid retention, heart failure,
hypokalemia
• Monitor daily weights, vital
signs, and serum
potassium.

81. • Interventions to promote fluid balance and monitor for
fluid deficit — Weigh daily, record I&O
• Assess VS every 1–4 hours
• Kayexalate may be needed if severe hyperkalemia is
present
• Monitor blood glucose levels every 4 hours for
hypoglycemia.
• Manage activity intolerance with gradual increases in
self-care activities
• Alert client to strategies to minimize anxiety and stress

82. • Monitor for electrolyte imbalances, hyperglycemia, and
opportunistic infections
• Provide a diet low in sodium, high in potassium, limited in
calories and with increased amounts of calcium and
vitamin D
• Provide measures to prevent skin breakdown
• Assist the client in avoiding pathologic fractures
• Monitor and manage potential for Addisonian crisis,
which can result from withdrawal of exogenous

83. • Monitor for electrolyte imbalances, hyperglycemia, and
opportunistic infections
• Provide a diet low in sodium, high in potassium, limited in
calories and with increased amounts of calcium and
vitamin D
• Provide measures to prevent skin breakdown
• Assist the client in avoiding pathologic fractures

84. 1. Instruct client to take 2/3 dose in the morning and 1/3 dose in the afternoon to mimic the
normal diurnal rhythm
3. Monitor side effects
a. HYPERTENSION
b. EDEMA
c. HIRSUTISM
d. INCREASED SUSCEPTIBILITY TO INFECTION
e. MOON FACE APPEARANCE
Always slowly taper corticosteroid therapy to avoid adrenal crisis.

85. 5. Provide dietary intake, INCREASE CALORIES, CARBOHYDRATES, PROTEIN but
DECREASE IN POTASSIUM
6. Provide meticulous skin care
7. Provide client health teaching and discharge planning
a. avoid precipitating factor leading to Addisonian crisis:
• stress
• infection
• sudden withdrawal to steroids
b. prevent complications
• Addisonian crisis
• hypovolemic shock
c. hormonal replacement for lifetime
d. importance of follow up care

86. PREOPERATIVE CARE
• Monitor the patient for electrolyte imbalance and hyperglycemia.
• To prevent adrenal crisis, glucocorticoids are administered because removal of the
adrenals causes a sudden drop in adrenal hormones.
POSTOPERATIVE CARE
• The patient is closely monitored for changes in fluid and electrolyte balance and adrenal
crisis.
• Patients must take replacement glucocorticoid and
• mineralocorticoid hormones for the remainder of their life.

96. Chronic illness that damages the islet cells:
• pancreatitis
• cystic fibrosis
Prolonged use of some drugs:
• steroid hormones
• phenytoin (Dilantin)
• thiazide diuretics
• thyroid hormone

98. Symptoms of diabetes plus casual plasma glucose
concentration equal to or greater than 200 mg/Dl
or
Fasting plasma glucose greater than or
equal to 126 mg/dL
or
2-hour postload glucose equal to or greater than 200
mg/dL during an oral glucose tolerance test

99. • Normal plasma glucose level is less than 100 mg/dL.
• When the fasting plasma glucose (drawn after at least 8 hours
without eating) is 126 mg/dL, diabetes is diagnosed.
• If the fasting plasma glucose is between 100 and 125 mg/dL, the
patient has impaired fasting glucose (IFG).
• A normal HbA1c is 4% to 6%.

100. • Diabetes is diagnosed if the CPG is 200 mg/dL, with symptoms of
diabetes.
• An OGTT measures blood glucose at intervals after the patient
drinks a concentrated carbohydrate drink.
• Diabetes is diagnosed when the blood glucose level is 200 mg/dL
after 2 hours.
• A result between 140 and 199 mg/dL at 2 hours diagnoses
impaired glucose tolerance (IGT).

101. INCIDENCE RATE:
•10% general population
INCIDENCE RATE:
•90% general population
RISK FACTORS:
1.Age
2.Race
3.Heredity
4.Autoimmune reaction
5. Related to viruses
6. Drugs
a. Lasix
b. Steroids
7. Related to CARBON
TETRACHLORIDE TOXICITY
RISK FACTORS:
1.Age
2.Race
3.Heredity
4. OBESITY – because obese
persons lack insulin receptor
binding sites
5. Sedentary lifestyle (lack of
exercise, increased intake of
carbohydrates)
6. Hypertension
7. Triglyceride level of ≥250 mg/dL

102. SIGNS AND SYMPTOMS:
1. Polyuria
2. Polydypsia
3. Polyphagia
4. Glucosuria
5. WEIGHT LOSS
6. Anorexia, nausea and vomiting
7. Blurring of vision
8. Increase susceptibility to
infection
9. Delayed/poor wound healing
SIGNS AND SYMPTOMS:
1. Usually asymptomatic
2. Polyuria
3. Polydypsia
4. Polyphagia
5. Glucosuria
6. WEIGHT GAIN
TREATMENT:
1. Insulin therapy
2. Diet
3. Exercise
COMPLICATIONS:
1. DIABETIC KETOACIDOSIS (DKA)
TREATMENT:
1. Oral Hypoglycemic agents
2. Diet
3. Exercise
COMPLICATIONS:
1. HYPEROSMOLAR NON-KETOTIC
COMA (HHNKC)

103. RISK FACTORS:
1. Hyperglycemia
2. STRESS
3. Infection
RISK FACTORS:
1.Increased osmolarity
(severe dehydration)
SIGNS AND SYMPTOMS:
1. Polyuria
2. Polydypsia
3. Polyphagia
4. Glucosuria
5. Weight loss
6. Anorexia, nausea and vomiting
7. Blurring of vision
8. Acetone breath odor
9. KUSSMAUL’S RESPIRATION
10. CNS depression leading to coma
SIGNS AND SYMPTOMS:
1. Headache and dizziness
2. Restlessness
3. Seizure activity
4. Decrease LOC – DIABETIC COMA
DIAGNOSTIC PROCEDURES:
1. FBS is INCREASED
2. BUN is INCREASED
3. Creatinine is INCREASED
4. Hct is INCREASED

105. NURSING MANAGEMENT:
1. Assist in mechanical ventilation
2. Administer hypotonic solutions to
counteract dehydration and
shock
3. Monitor strictly vital signs, intake
and output and blood sugar
levels
4. Administer medications as
ordered
a. Insulin therapy (regular acting
insulin/rapid acting insulin
peak action of 2 – 4 hours)
b. Sodium Bicarbonate to
counteract acidosis
c. Antibiotics to prevent infection
NURSING MANAGEMENT:
1. Assist in mechanical ventilation
2. Administer hypotonic solutions to
counteract dehydration and
shock
3. Monitor strictly vital signs, intake
and output and blood sugar
levels
4. Administer medications as
ordered
a. Insulin therapy (regular acting
insulin peak action of 2–4 hrs.)
b. Antibiotics to prevent infection

107. A. SOURCES OF INSULIN
1. Animal sources
• Rarely used because it can cause severe allergic reaction
• Derived from beef and pork
2. Human Sources
• Frequently used type because it has less antigenicity property
thus less allergic reaction
3. Artificial Compound Insulin

108. B. TYPES OF INSULIN
1. RAPID ACTING INSULIN (CLEAR)
• Regular acting insulin (IV only)
• Peak action is 2 – 4 hours
2. INTERMEDIATE ACTING INSULIN (CLOUDY)
• Non Protamine Hagedorn Insulin (NPH)
• Peak action is 8 – 16 hours
3. LONG ACTING INSULIN (CLOUDY)
• Ultra Lente
• Peak action is 16 – 24 hours

110. NURSING MANAGEMENT FOR INSULIN INJECTIONS
1. Administer at room temperature to prevent development of
lipodystrophy (atrophy, hypertrophy of subcutaneous tissues)
2. Place in refrigerator once opened
3. Avoid shaking insulin vial vigorously instead gently roll vial between
palm to prevent formation of bubbles
4. Use gauge 25 – 26 needle
5. Administer insulin either 45◦ – 90◦ depending on amount of clients
tissue deposit
6. No need to aspirate upon injection

111. NURSING MANAGEMENT FOR INSULIN INJECTIONS
7. Rotate insulin injection sites to prevent development of
lipodystrophy
8. Most accessible route is the abdomen
9. When mixing 2 types of insulin aspirate first the clear insulin before
cloudy to prevent contaminating the clear insulin and promote
proper calibration.
10. Monitor for signs of local complications such as allergic reactions,
LIPODYSTROPHY, INSULIN WANING, SOMOGYI PHENOMENON,
DAWN PHENOMENON

128. C. NURSING MANAGEMENT
1. Administer insulin and OHA therapy as ordered
2. Monitor for peak action of insulin and OHA and notify physician
3. Monitor strictly vital signs, intake and output and blood sugar levels
4. Monitor for signs of hypoglycemia and hyperglycemia
• administer simple sugars
• for hypoglycemia (cold and clammy skin) give simple sugars
• for hyperglycemia (dry and warm skin)

129. C. NURSING MANAGEMENT
5. Provide nutritional intake of diabetic diet that includes:
carbohydrates 50%, protein 30% and fats 20% or offer
alternative food substitutes
6. Instruct client to exercise best after meals when blood glucose is
rising
7. Monitor signs for complications
8. Institute foot care management
a. instruct client to avoid walking barefooted
b. instruct client to cut toenails straight

130. C. NURSING MANAGEMENT
c. instruct client to avoid wearing constrictive garments
d. encourage client to apply lanolin lotion to prevent skin
breakdown
e. assist in surgical wound debridement (give analgesics 15 – 30
mins prior to surgery)
9. Instruct client to have an annual eye and kidney exam
10. Monitor for signs of DKA and HONKC

131. D. COMPLICATIONS
1. MACROVASCULAR COMPLICATIONS
• Coronary artery disease
• Cerebrovascular disease
• Peripheral vascular disease
2. MACROVASCULAR COMPLICATIONS
• Diabetic retinopathy
• Diabetic nephropathy
• Diabetic neuropathy

152. Hormone Hypofunction Hyperfunction
Antidiuretic hormone Diabetes insipidus SIADH
Growth hormone Dwarfism Acromegaly, gigantism—bone
and tissue overgrowth
Thyroid hormone Hypothyroidism Hyperthyroidism—increased
metabolism
Epinephrine Rare Pheochromocytoma—
hypertension
Parathyroid hormone Hypoparathyroidism—low
serum calcium, osteoporosis,
tetany
Hyperparathyroidism—high
calcium, weakness
Cortisol Addison’s disease—sodium
and water loss
Cushing’s syndrome—sodium
and water retention,
hyperglycemia