• Save
Endocrine System
Upcoming SlideShare
Loading in...5
×
 

Endocrine System

on

  • 2,654 views

 

Statistics

Views

Total Views
2,654
Views on SlideShare
2,648
Embed Views
6

Actions

Likes
1
Downloads
0
Comments
0

1 Embed 6

http://www.slideshare.net 6

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Endocrine System Endocrine System Presentation Transcript

  • ENDOCRINE SYSTEM Ma. Victoria J. Recinto, BSN, RN, USRN Pediatric Intensive Care Nurse University of the Philippines-Manila Philippine General Hospital
  • PANCREAS
    • Located posterior to the stomach
    • Influences CHO metabolism
    • Indirectly influences CHON & fat metabolism
    • Produces insulin & glucagon
  • PANCREAS
    • Exocrine gland Endocrine gland
    • Acinar cells Islets of Langerhans
    • Pancreatic juices  cells  cells
    • Glucagon Insulin
    • (Hypergly) (Hypogly)
    • (aids in digestion)
    • Pass in pancreatic duct
  • DIAGNOSTIC STUDIES: Glucose tolerance test
    • Aids in dx of DM: if glucose levels peak at higher than N at 1-2hrs after glucose IV or po & slower than N to return to fasting levels
    • Will take 3-5 hrs, pt is given glucose IV or po & multiple blood samples
  • DIAGNOSTIC STUDIES: Glucose tolerance test- pt. prep
    • Before the test:
    • Diet with adequate CHO (3 days)
    • No alcohol, coffee & smoking (36 hrs)
    • Fast (10-16 hrs)
    • Withhold AM insulin or OHA (for DM pt)
    • Avoid strenuous exercise (8 hrs, & after the test)
  • DIAGNOSTIC STUDIES: Glycosylated Hgb A
    • Blood glucose bound to Hgb
    • Reflects how well blood glucose levels have been controlled for the past 3-4 mos.
    •  levels: hyperglycemia in DM pt
    • N (DM pt)= ≤7.5%
    • N (without DM)=4-6%
    • Fasting not needed
  • Diabetes Mellitus
    • Chronic disorder
    • Impaired CHO, CHON & fat metabolism r/t insulin deficiency
    • Cx: CAD, cardiomyopathy, HTN, CVA, PVD, infection, retinopathy, nephropathy, neuropathy
  • Diabetes Mellitus Macronutrient Anabolism Catabolism CHO Glucose Glycogen CHON Amino acid Nitrogen Fats Fatty acids Free fatty acids: Cholesterol & Ketones
  • Diabetes Mellitus
    • Hyperglycemia
    • Osmotic diuresis
    • Polyuria Glycosuria
    • Cellular dehydration Cellular starvation
    • Stimulate thirst center Stimulate satiety center
    • Hypothalamus
    • Polydipsia Polyphagia
  • Type 1 Diabetes Mellitus
    • Insulin-dependent/Juvenile Onset
    • Nearly absolute deficiency of insulin
    • If insulin is not given  fat metabolism  ketonemia (acidosis) DKA
    • Incidence rate: 10% of gen. pop.
    • Predisposing Factors
      • Children, non-obese
      • Cause: Unknown
      • 90%: hereditary, total destruction of  cells
      • Viruses
      • Toxicity to CCl4
      • Drugs: Furosemide (Lasix) & Pentamide HCl (Pentam)
  • Type 1 Diabetes Mellitus
    • S/Sx
      • 3P’s + glycosuria
      • Wt loss, A/N/V
      • Blurred vision
      •  susceptibility to infection
      •  wound healing
  • Type 1 Diabetes Mellitus
    • Tx
      • Diet
      • Exercise
      • Insulin tx
      • WOF Cx: DKA
  • Nursing Interventions: Diet
    • The total no. of calories is individualized based on pt’s wt & other existing health problems
    • Follows the food exchange from the American Diabetic Association (Food Guide Pyramid)
    • Depending on the pt’s needs, lifestyle, cultural & socioeconomic status
  • Nursing Interventions: Exercise
    • Benefits
      •  blood glucose & cholesterol
      •  cardiovascular risks
      •  circulation & muscle tone
      •  wt
    • Monitor CBG before, during & after exercise (deferred if >250 mg/dL & (+) urine ketones)
    • If taking insulin, eat a 15-g CHO snack (a fruit exchange) or complex CHO with CHON before mod. exercise
  • Insulin Therapy
    • Used when diet & wt control have failed to maintain blood glucose levels
    • Sources
      • Animal: Pork/Beef- rarely used r/t anaphylaxis
      • Human: e.g. Humulin R- less allergic reaction
      • Artificial compounds
    • ASA, alcohol, warfarin, OHA,  -blockers, TCA, MAOI, tetracycline  severe hypogly
    • Steroids, thizide diuretics, thyroid agents, OCP & estrogen  severe hypergly
    • Illness, infection & stress  blood glucose &  insulin needs
  • Insulin Therapy Types Consistency Peak Regular acting: Humulin R Clear 2-4 hrs Intermediate-acting: NPH (Humulin H) Cloudy
      • 8-16 hrs
    Long-acting: Ultralente (Humulin U) Cloudy
      • 16-24 hrs
  • Insulin Therapy Type Onset Peak (hrs) Duration (hrs) Rapid-acting: Lispro (Humalog) 15 min ½-1 ½ 4-5 Insulin aspart (Novolog) 5-10 min 1-3 3-5 Short-acting: Regular (Humulin R, Novolin R) ½-1 hr 2-4 5-7 Intermediate-acting: NPH (Humulin N, Novolin N) 1-2 hrs 6-14 24 Lente (Humulin L, Novolin L) 1-3 hrs 6-14 24
  • Insulin Therapy Type Onset Peak (hrs) Duration (hrs) Long-acting: Ultralente (Humulin U) 6 hrs 18-24 36 Insulin glargine (Lantus) - - 24 Premixed: 70% NPH/30% regular (Humulin 70/30) ½-1 hr 2-12 18-24 50% NPH/50% regular (Humulin 50/50) ½ hr 3-5 24 75% Lipro Protamine/25% Lispro 10-15 mins 1-6 24
  • Nursing Interventions: Storing Insulin
    • Avoid exposure to extremes in T, should not be frozen or kept in direct sunlight or hot car
    • Administer at room T (esp. if vial will be used up in a mo., otherwise should be refrigerated) to prevent lipodystrophy
    • Store prefilled syringes (stable for 1 wk), keep the syringes flat or with needle in upright position to avoid clogging of the needle
  • Nursing Interventions: Administering Insulin
    • 1ml TB syringe= 100 units
    • Use G27 or 29 needle, ½ in long
    • Gently roll vial between palms, don’t shake not to create bubbles, mix well
    • Inject air to insulin vial before aspirating
    • Aspirate clear 1 st before cloudy to prevent contamination & to promote proper calibration
    • Administer mixed dose of insulin within 5-15 mins to maximize its tx effect
  • Nursing Interventions: Administering Insulin
    • Administer at either 45-90  angle depending on the pt’s tissue deposit
    • Don’t aspirate syringe after injection
    • Rotate injection sites
      • Main sites: abdomen (even & rapid absorption), posterior arms, anterior thighs, hips
      • Do not use same site more than once in 2-3 wks
      • Injections should be 1.5 in apart within the anatomical area
      • Avoid heat, massage & exercise at the injected area   absorption  hypogly
      • Avoid injection into scar tissue   absorption
  • Nursing Interventions: Administering Insulin
    • WOF Cx and provide tx
      • Local allergic reaction esp. during early stages of tx
        • Avoid using alcohol for skin prep
        • Antihistamine 1 hr before injection
      • Lipodystrophy
        • Use human insulin, rotate injection sites
      • Insulin resistance
        • Use pure insulin
  • Nursing Interventions: Administering Insulin
    • WOF Cx and provide tx
      • Dawn phenomenon: develops bet. 5 & 8 am (prebreakfast hypergly), r/t nocturnal release of growth hormone
        • Give intermediate-acting insulin at 10 pm
      • Somogyi phenomenon: hypogly at 2-3 am with rebound hypergly at 7 am
        •  intermediate-acting insulin or  bedtime snack
      • Insulin waning- progressive hypergly from bedtime to morning
        •  evening dose of intermediate-acting insulin
  • Diabetic Ketoacidosis
    • Gluconeogenesis
    • CHON breakdown Fat breakdown
    • (-) N2 balance FFA ketones
    • Tissue wasting Atherosclerosis Ketoacidosis
    • Cachexia HTN DKA
    • MI CVA
  • Diabetic Ketoacidosis
    • Acute Cx of IDDM r/t severe hypergly  CNS depression with coma
    • Precipitating factors: stress, hypergly, infection, missed or  insulin dose
  • Diabetic Ketoacidosis: S/Sx
      • 3Ps + 1 g
      • CBG: 300-800 mg/dL
      • A/N/V
      • Wt. loss, dehydration
      • Acetone breath (fruity odor)
      • Kussmauls’ respiration: rapid, shallow breathing
      •  LOC  coma
      •  FBS, BUN, crea, Hct, ABG: metabolic acidosis
  • Nursing Interventions: Diabetic Ketoacidosis
    • Assist in mech. vent.
    • Administer as ordered
      • Rapid IVF: 0.9NaCl followed by 0.45NaCl (to counter DHN), then D5 0.45 NaCl when CBG= 250-300 mg/dL (WOF  ICP r/t cerebral edema)
      • Regular Insulin: only given IV, prime the IV tubing then discard the 1 st 50 cc solution or given with albumin to prevent sticking to the IV tubing
      • NaHCO3, K+ supplements (WOF for hypoK esp. within the 1 st hr of tx)
      • Antibiotics
  • Type 2 Diabetes Mellitus
    • Non-insulin dependent/Adult or Maturity Onset
    • Resistant to action of insulin
    • Insulin is enough to stabilize fat & CHON but not CHO
    • Incidence rate: 90% of gen. pop.
    • Predisposing Factors
      • >40 y/o
      • 90%: Obese (lack of insulin receptor binding sites)
  • Type 2 Diabetes Mellitus
    • S/Sx
      • Asymptomatic at first then: 3 P’s + glycosuria
    • Tx
      • Oral Hypoglycemic agents
      • Diet
      • Exercise
      • WOF Cx: Hyper Osmolar Non-Ketotic Coma (HONKC)
  • Oral Hypoglycemic Agents
    • Action: stimulates pancreas to secrete insulin
    • Sulfonylureas
    • 1 st gen.
      • Chlorpropamide (Diabinese)
      • Tolbutamide (Orinase)
      • Tolazamide (Tolinase)
    • 2 nd gen.
      • Glucotrol (Glipizide)
      • Glyburide (Diabeta, Micronase)
    • Biguanide: Metformin (Glucophage)
    • OHA should not be taken with Aluminum hydroxide, alcohol, ASA, OCP, sulfonamide, MAOI  severe hypogly
    • Steroids, thiazide diuretics & estrogen  severe hypergly
  • Hyper Osmolar Non-Ketotic Coma
    • Slow onset of severe hypergly (CBG=600-1,200 mg/dL)
    • Hyperosmotic  severe DHN
    • Non-Ketotic  (-) ketones in urine & blood, no acidosis
    • HA, irritability, agitation, sz,  LOC  Coma
    • Tx: same as in DKA except NaHCO3 & insulin
  • Nursing Interventions: DM
    • Monitor VS, I/O, CBG
    • Monitor for peak action of insulin
    • Monitor for S/Sx of hypo (or hypergly)
      • T-remors, tachycardia
      • I-rritability
      • R-estlessness
      • E-xcessive hunger, weakness
      • D-epression, diaphoresis
  • Nursing Interventions: DM
    • During mild (CBG<60 mg/dl) to moderate hypogly (CBG<40 mg/dl) : give 10-15 g fast-acting simple sugar (check CBG after 15 mins. then give a regular meal or food with CHON & CHO e.g. milk & cheese within 1 hr
      • Commercially prepared glucose tab.
      • 6-10 Life Savers or hard candy
      • 4 tsp of sugar
      • 4 sugar cubes
      • 1 tbs honey or syrup
      • ½ cup fruit juice or regular softdrink
      • 8 oz low-fat milk
      • 6 saltin crackers
      • 3 graham crackers
  • Nursing Interventions: DM
    • During severe hypogly (CBG<20 mg/dl): give glucagon SQ or IM up to a 2 nd dose after 10 mins. if pt is still unconscious, or 25-50 cc D50W IV
  • Nursing Interventions: DM
    • Provide diabetic diet: alternative food products & not to skip meals
    • Encourage exercise after meals
    • Encourage annual eye & kidney exam
  • Nursing Interventions: DM
    • Meticulous Skin & Foot care (r/t peripheral neuropathy)
      • Inspect feet & between toes OD, keep it dry (no foot soaks)
      • Wear well-fitting socks to keep feet warm, Change socks OD
      • Don’t wear same pair of shoes 2 days in a row
      • Don’t wear open-toed shoes or with a strap across toes
  • Nursing Interventions: DM
    • Meticulous Skin & Foot care (r/t peripheral neuropathy)
      • Check shoes for cracks/tears/foreign objects before wearing
      • Don’t walk barefooted
      • Cut toenails straight, smooth nails with an emery board
      • Apply lanolin lotion but not in between toes
      • Avoid restrictive garments, leg crossing, heating pads, hot water & baths
  • Nursing Interventions: DM
    • Monitor for U/A: ketones/glucose (since Tape-test method & Clinistix may cause inaccurate results), 2 nd voided urine is most accurate
    • Assist in surgical wound debridement, BKA, AKA
  • Nursing Interventions: DM
    • WOF Cx
      • Atheroslerosis, HTN, MI, CVA
      • Microangiopathy
      • Eyes: Retinopathy, premature cataract, retinal detachment, blindness
      • Kidneys: Nephropathy, Recurrent pyelonephritis, ARF
      • Peripheral neuropathy  PVD, sexual impotence
      • Shock r/t DKA & HONKC
      • Gangrene formation