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Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
Endocrine week 5 pt
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Endocrine week 5 pt

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  • 1. DIABETES MELLITUS-TREATMENT(INSULIN)
  • 2. DIABETES MELLITUS-TREATMENT(INSULIN) <ul><li>Medications </li></ul><ul><ul><li>Insulin: Main goal is to normalize insulin activity and blood glucose level </li></ul></ul><ul><ul><ul><li>Classified by action: Regular; Lente and NPH; Ultralente </li></ul></ul></ul><ul><ul><ul><li>Classified by type: beef/pork: Humulin/Novolin </li></ul></ul></ul><ul><ul><ul><li>Injection sites should be rotated to prevent scar tissue formation </li></ul></ul></ul><ul><ul><ul><li>Sliding scale </li></ul></ul></ul><ul><li>Insulin- extracts from beef, pork or human. Illness and stress increase the need for it. Given subQ because GI secretions deactivate it . Regular insulin can be given IV. </li></ul><ul><li>Don’t shake to prevent bubbles. Refrigerate but don’t freeze. Once opened, maybe kept at room temp. for a month or refrigerated for 3 months. Don’t expose to sunlight. </li></ul><ul><li> Lets Watch This </li></ul>
  • 3. DIABETES MELLITUS-TREATMENT(INSULIN) A, Rotation of sites for insulin injections. B, Injection diagram to track rotation of injection sites.
  • 4. DIABETES MELLITUS <ul><li>Peak action is important to monitor for hypoglycemia. </li></ul><ul><li>Insulin type / peak: </li></ul><ul><ul><li>Rapid acting (Humalog, Novolog)- 1-2 hrs </li></ul></ul><ul><ul><li>Regular (Humulin R, Novolin R)- 2-4 hrs </li></ul></ul><ul><ul><li>Intermediate (NPH, Lente)- 6-8 hrs </li></ul></ul><ul><ul><li>Long- acting (Lantus, Ultralente)- 16-20 hrs </li></ul></ul>
  • 5.
  • 6. DIABETES MELLITUS <ul><li>Medical management/nursing interventions </li></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><ul><li>Oral hypoglycemic agents </li></ul></ul></ul><ul><ul><ul><ul><li>Stimulate islet cells to secrete more insulin </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Only for type II diabetes mellitus </li></ul></ul></ul></ul><ul><li>Oral hypoglycemic: </li></ul><ul><li>Sulfonylureas (Amaryl, Diabreta, Diabenase, Glucotrol, Micronase, Orinase, Tolinase)- stimulate the pancreas to produce more insulin. Contraindicated in people with renal or hepatic disease. </li></ul>
  • 7. DIABETES MELLITUS-ORAL MEDICATION <ul><li>Biguanides (Glucophage)- decrease releasse of glucose by liver and make cells more susceptible to insulin. Can be used alone or combination with sulfonylureas. Adverse effects include diarrhea, n/v, abdominal bloating, flatulence, anorexia. </li></ul>
  • 8. DIABETES MELLITUS <ul><li>Thi-zol-idine-diones (TZD’s) (Actos, Avandia, Avelox)- reduce the amount of insulin needed while improving blood sugar control. Used in those over 18 without liver or heart disease. Side effects: decrease in bone density , weight gain, edema, anemia, could lead to congestive heart failure or worsen existing heart conditions </li></ul>
  • 9. DIABETES MELLITUS <ul><li>Alpha glucosidase inhibitor (Precose)- slows down body’s absorption of CHO and allows insulin to work better. Must be taken with first bite of food at each meal. Mabey combined with sulfonylureas. Contraindications - inflammatory bowel syndrome, ulcers of colon, intestinal obstruction. Side effects- GI symptoms, rash, hives, fever. </li></ul>
  • 10.
  • 11. DIABETES MELLITUS <ul><li>Patients must have some functioning insulin production for oral hypoglycemics to be effective. They’re used in addition to diet and exercise. Used for those over 40 at onset of DM,. </li></ul><ul><li>Medical management/nursing interventions (continued) </li></ul><ul><ul><li>Patient teaching </li></ul></ul><ul><ul><ul><li>Good skin care </li></ul></ul></ul><ul><ul><ul><li>Report any skin abnormalities to physician </li></ul></ul></ul><ul><ul><ul><li>Special foot care is crucial </li></ul></ul></ul><ul><ul><ul><ul><li>Do not trim toenails—go to podiatrist </li></ul></ul></ul></ul><ul><ul><ul><ul><li>No hot water bottles or heating pads </li></ul></ul></ul></ul><ul><ul><ul><li>Assess for symptoms of hypoglycemia </li></ul></ul></ul>
  • 12. DIABETES MELLITUS <ul><li>Patients with type 2 diabetes maybe require insulin temporarily during illness, infection, pregnancy, surgery or other stressful event. Don’t drink alcohol, it may result to hypoglycemia. </li></ul><ul><li>Fasting blood sugar- single specimen of blood in a.m. after fasting for 8 hrs. </li></ul><ul><li>Urine test- testing urine for presence of glucose and ketones. </li></ul><ul><li>Accucheck - test for blood glucose level at any given time. Done at home by the patient. Used by patients on sliding scale. </li></ul>
  • 13. SLIDING SCALE EXAMPLE
  • 14. DIABETES MELLITUS- COMPLICATIONS: <ul><li>Acute complications </li></ul><ul><ul><li>Coma </li></ul></ul><ul><ul><ul><li>Diabetic ketoacidosis </li></ul></ul></ul><ul><ul><ul><li>Hyperglycemic hyperosmolar nonketotic </li></ul></ul></ul><ul><ul><ul><li>Hypoglycemic reaction </li></ul></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><li>Long-term complications </li></ul><ul><ul><li>Diabetic retinopathy </li></ul></ul><ul><ul><li>Cardiovascular problems </li></ul></ul><ul><ul><li>Renal failure </li></ul></ul>
  • 15.
  • 16. DM-DKA A LIFE-THREATENING EMERGENCY <ul><li>Diabetic Ketoacidosis (DKA) – a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes. </li></ul><ul><li>What causes DKA? </li></ul><ul><ul><li>A lack of insulin usually due to: </li></ul></ul><ul><ul><ul><li>Unknown or newly diagnosed cases of type 1 diabetes </li></ul></ul></ul><ul><ul><ul><li>Missed or inadequate doses of insulin, or spoiled insulin </li></ul></ul></ul><ul><ul><ul><li>Infection </li></ul></ul></ul><ul><ul><ul><li>Steroid medications </li></ul></ul></ul><ul><ul><ul><li>An extremely stressful medical condition </li></ul></ul></ul><ul><li>Symptoms of DKA include: </li></ul><ul><li>Nausea, vomiting, Stomach pain, Fruity breath – the smell of ketoacids , Frequent urination, Excessive thirst </li></ul><ul><li>Weakness, fatigue, confusion or unconsciousness </li></ul>
  • 17. DIABETES MELLITUS <ul><li>DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia. Cells starve resulting to breakdown of fats into glycerol and free fatty acids, which are converted by the liver to ketones resulting to acidosis. The condition is known as diabetic ketoacidosis. </li></ul><ul><li>Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver. </li></ul><ul><li>3 main causes-DKA decreased/missed insulin dose, illness or infection, initial manifestation of undiagnosed/untreated diabetes. </li></ul>
  • 18.
  • 19. DIABETES MELLITUS <ul><li>Symptoms of DKA- Kussmaul respiration (fast, deep, labored breathing), acetone breath (fruity odor), rapid, weak pulse, low BP, weakness, vomiting, flushed cheeks, dry skin and mouth. </li></ul><ul><li>Rx - rehydration (6-10 L of IV fluid, K replacement, IV insulin, hourly blood glucose test. If untreated, outcome is circulatory collapse, renal shutdown and death. </li></ul>
  • 20. DM A LIFE-THREATENING EMERGENCY <ul><li>Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS , is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes, but it occurs more often in people with type 2. HHNS is usually brought on by something else, such as an illness or infection. </li></ul><ul><li>In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine. You make lots of urine at first, and you have to go to the bathroom more often. Later you may not have to go to the bathroom as often, and your urine becomes very dark. Also, you may be very thirsty. </li></ul>
  • 21. DM A LIFE-THREATENING EMERGENCY <ul><li>S/S: high blood glucose, low Na and K, thirst, dehydration, tachycardia, fever, seizures, lethargy, coma. </li></ul><ul><li>What are the warning signs? </li></ul><ul><li>Blood sugar level over 600 mg/dl </li></ul><ul><li>Dry, parched mouth </li></ul><ul><li>Extreme thirst (although this may gradually disappear) </li></ul><ul><li>Warm, dry skin that does not sweat </li></ul><ul><li>High fever (over 101 degrees Fahrenheit, for example) </li></ul><ul><li>Sleepiness or confusion </li></ul><ul><li>Loss of vision </li></ul><ul><li>Hallucinations (seeing or hearing things that are not there) </li></ul><ul><li>Weakness on one side of the body </li></ul>
  • 22. HHNS TREATMENT <ul><li>Hospitalization - HHNS can be severe enough to require hospitalization, especially if occurring in a newly diagnosed diabetic. </li></ul><ul><li>Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting. Milder HHNS can be treated mainly by reducing blood sugars using insulin. </li></ul><ul><li>Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration. </li></ul><ul><li>Treat metabolic imbalances - </li></ul><ul><li>Treat the underlying cause - Once the main symptoms are alleviated, it is important to identify what caused the HHNS. </li></ul>
  • 23. DIABETES MELLITUS
  • 24. HYPERGLYCEMIA-EMERGENCY CASES Hyperglycemia
  • 25. DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK) <ul><li>Hypoglycemia means low blood sugar. It occurs when there is not enough sugar or glucose in the blood. It is also called insulin shock or insulin reaction. Hypoglycemia is most common in type 1 diabetics, especially diabetics who have tight control of their blood sugar level. People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions. </li></ul><ul><li>Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic, decreased food intake, ingestion of certain drugs or too much exercise. Blood glucose below 50-60. Usually occurs before meals. </li></ul>
  • 26. DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK) <ul><li>The causes of low blood sugar include: </li></ul><ul><ul><li>missing a meal </li></ul></ul><ul><ul><li>taking too much insulin, or medication </li></ul></ul><ul><ul><li>unexpected or excessive exercise </li></ul></ul><ul><ul><li>drinking alcohol </li></ul></ul><ul><ul><li>certain other medications </li></ul></ul><ul><ul><li>older age </li></ul></ul><ul><ul><li>vomiting and diarrhea </li></ul></ul><ul><ul><li>other medical problems or </li></ul></ul><ul><ul><li>an unknown cause </li></ul></ul><ul><li>S/S- weakness, headache, drowsiness, hunger, confusion, slurred speech, tremors. High BP and PR </li></ul>
  • 27. DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK) <ul><li>The common symptoms of hypoglycemia include : </li></ul><ul><ul><li>shakiness </li></ul></ul><ul><ul><li>dizziness </li></ul></ul><ul><ul><li>weak feeling </li></ul></ul><ul><ul><li>sweating </li></ul></ul><ul><ul><li>nervousness </li></ul></ul><ul><ul><li>fast heart rate </li></ul></ul><ul><ul><li>pale skin color </li></ul></ul><ul><ul><li>hunger </li></ul></ul><ul><ul><li>difficulty paying attention or confusion </li></ul></ul><ul><ul><li>headache </li></ul></ul><ul><ul><li>sudden moodiness or behavior changes and </li></ul></ul><ul><ul><li>tingling sensations around the mouth </li></ul></ul>
  • 28. DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK) <ul><li>Hypoglycemia (cont.)- if untreated, unconsciousness and seizures, permanent brain damage and death. </li></ul><ul><li>Rx- administer quick acting CHO, glucagon (insulin antagonist, works in 5-20 min.), simple sugar such as orange juice. Proglycem- stimulates release of epinephrine, used to treat chronic hypoglycemia (onset- 1 hr, duration 8 hrs). </li></ul>
  • 29. DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK) <ul><li>To prevent hypoglycemia, do the following: </li></ul><ul><ul><li>keep blood sugar in normal range </li></ul></ul><ul><ul><li>check blood sugar regularly and whenever symptoms of hypoglycemia occur </li></ul></ul><ul><ul><li>know what causes hypoglycemia </li></ul></ul><ul><ul><li>know the symptoms of hypoglycemia </li></ul></ul><ul><ul><li>carry glucose tablets or hard candy at all times </li></ul></ul><ul><ul><li>wear a medical ID bracelet or carry a diabetic ID card </li></ul></ul><ul><ul><li>let friends, co-workers, or family members know how to give an injection of glucagon </li></ul></ul><ul><ul><li>eat a full meal at regular times; do not skip meals or eat partial meals </li></ul></ul><ul><ul><li>eat more than usual when exercising and </li></ul></ul><ul><ul><li>check blood sugar more often when you are ill, eating less, or exercising more than usual </li></ul></ul>
  • 30. DIABETES MELLITUS- NEUROPATHY <ul><li>Neuropathy - is damage to a single nerve or nerve group, which results in loss of movement, sensation, or other function of that nerve. </li></ul><ul><li>Poor circulation results to nerve damage. Commonly affects the lower extremities, retina and kidneys. May resolve spontaneously in 6 months, or persist for many years. </li></ul><ul><li>Symptoms depend on the specific nerve affected, and may include: </li></ul><ul><ul><li>Loss of sensation </li></ul></ul><ul><ul><li>Paralysis </li></ul></ul><ul><ul><li>Tingling, burning, pain, abnormal sensations </li></ul></ul><ul><ul><li>Weakness </li></ul></ul>
  • 31.
  • 32. NEUROPATHY TREATMENT <ul><li>Treatment </li></ul><ul><ul><li>The goal of treatment is to allow you to use the affected body part as much as possible. </li></ul></ul><ul><ul><li>The cause of the neuropathy should be identified and treated as appropriate. </li></ul></ul><ul><ul><li>High blood pressure and diabetes can injure an artery, which can often affect a single nerve. The underlying condition should be treated. </li></ul></ul><ul><ul><li>Corticosteroids i njected into the area may reduce swelling and pressure on the </li></ul></ul><ul><ul><li>Medications: </li></ul></ul><ul><ul><ul><li>Over-the-counter or prescription pain medicine may be needed to control pain (neuralgia). </li></ul></ul></ul>
  • 33. DIABETES MELLITUS <ul><li>Sexual dysfunction- impotence is common. </li></ul><ul><li>Prone to infection. </li></ul><ul><li>Treatment - diet, meds, foot care. </li></ul><ul><li>Nutritional management- crucial part of DM management. Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar. Menu is individualized based on age, sex, weight, height, activity, occupation and cultural background. Diet is rigid and uncompromising. </li></ul>
  • 34. LIFE ADJUSTMENT WITH DM
  • 35. DIABETES MELLITUS <ul><li>Diabetic exchange list- milk, vegetables, fruits, breads, meats and fats. Each list shows equivalents that can be exchanged to allow some freedom of choice. Exchanges cannot be from one list to another. Patients cannot have more than daily food allowance, and must eat all of it. Patient must participate in meal planning. </li></ul>
  • 36.
  • 37. DIABETES MELLITUS <ul><li>Exercise- How exercise can help? Aerobic exercise increases insulin sensitivity and, along with proper nutrition, helps restore normal glucose metabolism by decreasing body fat. Strength training (a.k.a. resistance or weight training) also decreases body fat by raising the metabolism. It&apos;s main benefit, however, is increasing glucose uptake by the muscles and enhancing the ability to store glucose. Exercise can mean the difference between &amp;quot;medical management&amp;quot; and &amp;quot;lifestyle management&amp;quot; of Type 2 diabetes. </li></ul><ul><li>Very important, because it lowers blood sugar. Should be regular, not sporadic. ADA recommends 30 min. of moderate exercise most days of the week. Counsel patient to carry 15 gm. </li></ul>
  • 38. DIABETES MELLITUS <ul><li>Sick day rules: </li></ul><ul><li>Take insulin or oral hypoglycemics as usual. </li></ul><ul><li>Check blood glucose Q 3-4 hrs. If &gt; 300, call MD. </li></ul><ul><li>Small frequent meals, 6-8 times/day. </li></ul><ul><li>If vomiting/diarrhea persist, take liquids Q 1/2-1 hr to prevent dehydration. </li></ul><ul><li>For patients with type 1 diabetes, inability to retain fluids may require hospitalization. </li></ul>
  • 39.
  • 40. DIABETES MELLITUS <ul><li>Teaching: </li></ul><ul><li>Start with the basics, assume the pt. knows nothing about diabetes </li></ul><ul><li>It is chronic condition and requires a lifetime of self-management behaviors </li></ul><ul><li>Evaluate literacy level, finances, family support, and typical daily schedule </li></ul><ul><li>Diabetic foot care is very important. </li></ul><ul><li>Discuss safety measures to prevent cuts, wounds and infection </li></ul><ul><li>Stop smoking </li></ul><ul><li>Teach patient about diet, blood testing, sliding scale and insulin administration </li></ul><ul><li>Medic-Alert tag </li></ul>
  • 41. DIABETES MELLITUS <ul><li>NANDA: </li></ul><ul><li>High risk for fluid volume deficit R/t polyuria and dehydration </li></ul><ul><li>Altered nutrition R/t imbalance of insulin/food. </li></ul><ul><li>Knowledge deficit </li></ul><ul><li>Anxiety </li></ul><ul><li>Self-esteem, risk for situational low </li></ul><ul><li>Sensory and perceptual alterations: visual </li></ul><ul><li>Infection, risk for </li></ul><ul><li>Sexual dysfunction </li></ul><ul><li>Body image, disturbed </li></ul><ul><li>Coping, ineffective </li></ul><ul><li>Activity intolerance </li></ul>
  • 42. THE END
  • 43. Common Drugs use in the Endocrine System
  • 44. Common Drugs use in the Endocrine System <ul><li>Posterior Pituitary Hormones </li></ul><ul><li>􀂄 Animal posterior pituitary hormone extract </li></ul><ul><li>􀂄 Examples: Pitressin (vasopressin) IM, SC </li></ul><ul><li>(desmopressin) synthetic. IV, SC, intranasal </li></ul><ul><li>􀂄 MOA: Natural antidiuretics . Produces concentrated urine by increasing tubular reabsorption of water. </li></ul><ul><li>􀂄 Uses: Diabetes insipidus, SIADH caused by trauma, </li></ul><ul><li>surgery, etc. Bedwetting (DDAVP) </li></ul><ul><li>􀂄 Monitor BP, I&amp;O, weight, and urine specific gravity </li></ul>
  • 45. Posterior pituitary hormone <ul><li>Pitocin (oxytocin) </li></ul><ul><li>Action: Enhances contractile activity of the </li></ul><ul><li>uterine smooth muscle. </li></ul><ul><li>􀂄 Uses: Induce or stimulate labor, control post </li></ul><ul><li>partum hemorrhage. </li></ul><ul><li>􀂄 Adverse Effects: Uterine rupture, fetal </li></ul><ul><li>hypoxia or trauma. </li></ul><ul><li>􀂄 Nursing Measures: Accurate dose, Close </li></ul><ul><li>monitoring of contractions and FHT in labor. </li></ul><ul><li>Add drug to IV bag after IV is started . </li></ul>
  • 46. Anterior Pituitary Hormones <ul><li>Example: Genotropin (somatropin) </li></ul><ul><li>􀂄 Action: Promotes growth in children whose </li></ul><ul><li>growth has been impaired by a deficiency of </li></ul><ul><li>growth hormone. </li></ul><ul><li>􀂄 Uses: Children with deficiency of growth </li></ul><ul><li>hormone, adults with deficiency of growth </li></ul><ul><li>hormone from disease, surgery or radiation of </li></ul><ul><li>pituitary </li></ul>
  • 47. Thyroid Hormones <ul><li>Examples: Synthroid, Levothroid </li></ul><ul><li>(levothyroxine) synthetic thyroxine (T4 ) </li></ul><ul><li>􀂄 Action: Increase metabolic activity of body </li></ul><ul><li>􀂄 Uses: Drug of choice for long-term </li></ul><ul><li>hypothyroidism, simple goiter. </li></ul><ul><li>􀂄 Adverse Effects: S/S of hyperthyroidism – </li></ul><ul><li>tachycardia, sweating, intolerance to heat, </li></ul><ul><li>diarrhea, abd. cramping, weight loss, </li></ul><ul><li>decreased bone density in the hip &amp; spine. </li></ul>
  • 48. Antithyroid Drugs <ul><li>Examples: PTU (propylthiouracil) prototype, </li></ul><ul><li>Tapazole (methimazole), Lugol’s solution </li></ul><ul><li>(strong iodine solution). </li></ul><ul><li>􀂄 MOA: PTU and Tapazole interfere with </li></ul><ul><li>synthesis of thyroid hormone and inhibits </li></ul><ul><li>conversion of T4 to the more active T3. </li></ul><ul><li>􀂄 Lugol’s Inhibits the release of thyroid </li></ul><ul><li>hormone, causing them to accumulate in the </li></ul><ul><li>thyroid gland. </li></ul>
  • 49. Antithyroid Drugs <ul><li>Lugol’s solution </li></ul><ul><li>Uses: Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op, decrease the size and vascularity of thyroid pre-op. </li></ul><ul><li>􀂄 Adverse Effects: Hypothyroidism, hair loss, allergic reaction. </li></ul>
  • 50. Corticosteroids <ul><li>Mineralocorticoids </li></ul><ul><li>􀂄 Example: Florinef (fludrocortisone) </li></ul><ul><li>􀂄 MOA: Promote Na and water retention. Help </li></ul><ul><li>maintain fluid and electrolyte balance. </li></ul><ul><li>Aldosterone is the main mineralocorticoid. </li></ul><ul><li>􀂄 Uses: Chronic adrenocortical insufficiency. </li></ul><ul><li>􀂄 Adverse Effects: Hypokalemia, fluid </li></ul><ul><li>retention, hypertension, HA </li></ul>
  • 51. Glucocorticoids <ul><li>Examples: Decadron (dexamethasone), Solu-Medrol </li></ul><ul><li>(methylpredinisolone), Prednisone, Celestone </li></ul><ul><li>(betamethasone), Aristocort (triancinolone), Nasonex, </li></ul><ul><li>Azmacort </li></ul><ul><li>􀂄 MOA: Affect CHO, protein and lipid metabolism by: </li></ul><ul><li>Increasing the catabolism of protein in bone, skin and </li></ul><ul><li>connective tissue. Increasing output of glucose by </li></ul><ul><li>the liver and decreasing cellular use of glucose. </li></ul><ul><li>Mobilizing amino acids to increase energy in times of </li></ul><ul><li>stress. Antiinflammatory response protects cells from </li></ul><ul><li>damage related to immune response. &gt;&gt;&gt;continue. </li></ul>
  • 52. Glucocorticoids <ul><li>Uses: Replacement therapy in deficiency </li></ul><ul><li>states. Antiinflammatory for hpersensitivity </li></ul><ul><li>and inflammatory diseases like arthritis, </li></ul><ul><li>lupus, psoriasis. Bronchospasm and edema </li></ul><ul><li>related to emphysema, asthma and other </li></ul><ul><li>respiratory diseases or injuries. Mature lungs </li></ul><ul><li>in preterm fetus prior to delivery. </li></ul><ul><li>􀂄 Adverse Effects: Edema, hyperglycemia, </li></ul><ul><li>hypokalemia, muscle wasting, peptic ulcer, </li></ul><ul><li>hypertension, immunosuppression, increased </li></ul><ul><li>WBC, masks signs of infection, thin skin.&gt;&gt;&gt; </li></ul>
  • 53. Glucocorticoids <ul><li>􀂄 Nursing Measures: Give PO with food. Give </li></ul><ul><li>at 9am to mimic normal corticosteroid levels </li></ul><ul><li>and minimize adrenal suppression. Weigh </li></ul><ul><li>daily. Monitor BP, blood sugars, and </li></ul><ul><li>electrolytes. Monitor for s/s of adverse </li></ul><ul><li>effects. </li></ul><ul><li>􀂄 Teach to moderate salt intake, eat K rich </li></ul><ul><li>foods, diet high in protein. Avoid licorice </li></ul><ul><li>(may intensify hypokalemia), alcohol and </li></ul><ul><li>caffeine. Medic Alert. Tapering drugs. </li></ul>
  • 54. Adrenal Sex Hormones <ul><li>􀂄 Androgens – male hormones secreted by the adrenal </li></ul><ul><li>cortex in both sexes and are responsible for the </li></ul><ul><li>physiological effects exerted by adrenal sex </li></ul><ul><li>hormones. </li></ul><ul><li>􀂄 They increase protein synthesis (anabolism), which </li></ul><ul><li>increases muscle and bone mass and strength, effect </li></ul><ul><li>development of male secondary sex characteristics. </li></ul><ul><li>They increase hair growth and libido in women. </li></ul><ul><li>Excessive secretion: masculine effects in women. </li></ul><ul><li>􀂄 Female sex hormones exert few effects. Excessive </li></ul><ul><li>secretion: feminine characteristics in men </li></ul>
  • 55. Drugs Affecting the Reproductive System <ul><li>Female Hormones: </li></ul><ul><li>􀂄 Estrogen and Progesterone </li></ul><ul><li>􀂄 Example: Oral contraceptives (OCPs) </li></ul><ul><li>􀂄 MOA: Estrogen prevents ovulation. </li></ul><ul><li>Progesterone prevents implantation of ovum, </li></ul><ul><li>decreases amount and increases viscosity of </li></ul><ul><li>cervical mucous to impair sperm motility, and </li></ul><ul><li>impedes motility of the ova by affecting </li></ul><ul><li>peristalsis of the fallopian tubes.&gt;&gt;&gt;&gt; </li></ul>
  • 56. OCPs <ul><li>􀂄 Uses: Contraception, menstrual irregularities. </li></ul><ul><li>􀂄 Adverse Effects: N,V, HA, weight gain, fluid </li></ul><ul><li>retention, breast tenderness, breakthrough </li></ul><ul><li>bleeding. </li></ul><ul><li>􀂄 Contraindications: ABSOULUTE: </li></ul><ul><li>Thromboplebitis, CVA, breast cancer, </li></ul><ul><li>pregnancy, liver disease or impairment, CAD, </li></ul><ul><li>over 35 and smokes </li></ul>
  • 57. OCPs <ul><li>Nursing Measures: Teach how to take pill and how to use BUM to use with missed pills and antibiotic use. Encourage not to d/c pills without consulting HCP (30-50% stop before one year). Teach to report ACHES immediately and d/c pills. </li></ul><ul><li>􀂄 A=Abdominal pain </li></ul><ul><li>􀂄 C=Chest pain, cough, dyspnea H=HA severe, </li></ul><ul><li>dizziness, numbness </li></ul><ul><li>􀂄 E=eye problems, vision loss, blurred vision </li></ul><ul><li>􀂄 S=severe leg pain, calf or thigh </li></ul>
  • 58. Infertility Drugs <ul><li>Example: Clomid </li></ul><ul><li>􀂄 MOA: Stimulates secretion of FSH and LH </li></ul><ul><li>which stimulates maturation of follicles, </li></ul><ul><li>ovulation &amp; development of the corpus </li></ul><ul><li>luteum. </li></ul><ul><li>􀂄 Uses: Inadequate ovulation, low sperm count </li></ul><ul><li>in males </li></ul><ul><li>􀂄 Adverse Effects: Similar to OCPs. Increased </li></ul><ul><li>incidence of early abortion &amp; multiple births. </li></ul><ul><li>􀂄 Teach to report pelvic pain immediately. </li></ul>
  • 59. Male Hormones <ul><li>􀂄 Example: Testosterone </li></ul><ul><li>􀂄 Secreted by the testes </li></ul><ul><li>􀂄 Uses: Treatment of low sperm count and impotence </li></ul><ul><li>caused by deficiency. Undescended testicles. </li></ul><ul><li>Anabolic action in conditions such as osteoporisis, </li></ul><ul><li>anemia, and debilitated states. Inoperable breast </li></ul><ul><li>cancer in post menopausal women. </li></ul><ul><li>􀂄 Adverse Effects : Edema, acne, hirsutism, voice </li></ul><ul><li>deepening, N&amp;V, polycythemia, increased </li></ul><ul><li>cholesterol, depression. </li></ul><ul><li>􀂄 Contraindications: Pregnancy, prostate cancer,breast cancer in males </li></ul>
  • 60. Drugs used to treat Diabetes <ul><li>Insulin </li></ul><ul><li>Oral Hypoglycemic Agents </li></ul><ul><li>Hyperglycemic Agents: </li></ul><ul><ul><li>􀂄 Glucagon </li></ul></ul><ul><ul><li>􀂄 MOA: Appears to increase synthesis of </li></ul></ul><ul><ul><li>CAMP and phosporylase activity which </li></ul></ul><ul><li>increases hepatic gluconeogenesis. </li></ul><ul><ul><li>􀂄 Uses: Emergency treatment of severe </li></ul></ul><ul><li>hypoglycemia reactions when patient is </li></ul><ul><li>unconscious or unable to swallow. </li></ul>
  • 61. Dietary Consideration in the Endocrine System

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