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Endocrine Disorders and Therapeutic Management<br />Gladys T. Cruz<br />
Diabetes Mellitus<br />
Diabetes Mellitus<br />Is a disorder of the endocrine system that causes alterations in glucose metabolism.<br />
Diabetes Mellitus: Type<br />Type 1 – an absolute lack of insulin<br />Type 2 – relative lack of insulin<br />
Diabetes Mellitus<br />Pancreas is an organ with both endocrine and exocrine functions<br /> - Exocrine function is to rel...
Diabetes Mellitus<br /> -  Endocrine function (islets of langerhans)<br />Beta cells produce insulin<br />Alpha cells prod...
Diabetic Ketoacidosis<br />
Diabetic Ketoacidosis<br />Beta cells have the inability to produce insulin<br />Hyperglycemia – hyperosmolar state<br />E...
Diabetic Ketoacidosis: Clinical Manifestations<br />Dehydration <br />Ketosis<br />Metabolic acidosis<br />Weakness<br />A...
Diabetic Ketoacidosis: Goals of Treatment<br />Correction of acidosis<br />Correction of electrolyte and fluid disturbance...
Diabetic Ketoacidosis: Treatments<br />Closely monitor blood glucose levels and acidosis<br />Replace fluids and electroly...
Diabetic Ketoacidosis: Treatments<br />Identify and correct precipitating event<br />Educate the patient and the patient’s...
Diabetic Ketoacidosis<br />Rapid insulin<br />0.1 to 0.2 U/kg/hr<br />
HyperosmolarNonketotic Coma<br />
HyperosmolarNonketotic Coma<br />A serious metabolic complication, usually seen in type 2 diabetes<br />Results in dehydra...
HyperosmolarNonketotic Coma: Clinical Manifestation<br />Profound dehydration<br />Hypotension<br />Tachycardia<br />Dimin...
HyperosmolarNonketotic Coma<br />Treatment goals are similar to the interventions of DKA<br />
Hypoglycemia<br />
Hypoglycemia<br />Occurs when the blood sugar levels drop rapidly<br />
Hypoglycemia<br />Sweating, tremors<br />Blurred vvision, hunger, weakness<br />Behavior changes, and confusion<br />Anxie...
Hypoglycemia: Treatment<br />Fast acting carbohydrates (if client is conscious)<br /> - ½ cup orange juice<br /> - 4 oz co...
Syndrome of Inappropriate Secretion of Antidiuretic Hormone<br />
Syndrome of Inappropriate Secretion of Antidiuretic Hormone<br />Patient has an excess of antidiuretic hormone secreted in...
Syndrome of Inappropriate Secretion of Antidiuretic Hormone<br />Excessive water is resorbed at the kidney tubule, leading...
Assessment<br />Early Clinical Manifestation:<br /> - dilutionalhyponatremiainclude lethargy, anorexia, nausea and vomitin...
Assessment<br />Symptoms of Severe Hyponatremia:<br /> - inability to concentrate, mental confusion, apprehension, seizure...
Nursing Diagnoses<br />Excess Fluid Volume related to comprised regulation mechanism<br />Anxiety related to lack of contr...
Medical Management<br />Fluid restriction<br />Sodium replacement<br />Medications that increase renal water excretion (De...
Nursing Management<br />Restriction of Fluids<br /> - accurate intake and output<br /> - mouth care for fluid restriction<...
Diabetes Insipidus<br />
Diabetic Insipidus<br />Caused by a deficiency in the production or release of ADH by the posterior pituitary gland<br />
Diabetic Insipidus:<br />Neurogenic<br />Nephrogenic<br />Psychogenic<br />
Diabetic Insipidus: Clinical Manifestations<br />Polyuria<br />Polydipsia<br />Hypotension<br />Tachycardia<br />Weight lo...
Diabetic Insipidus: Medication<br />Vasopressin<br />Desmopressin acetate ( for chronic neurogenic)<br />
Diabetic Insipidus: Nursing Management<br />Monitor intake and output<br />
Thyroid Storm<br />
Thyroid Storm<br />Also called Thyroid Crisis<br />A complication of pre - existing hyperthyroidism<br />
Thyroid Storm<br />Increase in cellular oxygen consumption<br />
Thyroid Storm: Medical Management<br />Prevent cardiovascular collapse<br />Reduce hyperthermia<br />Reverse dehydration<b...
Thyroid Storm: Pharmacologic Management<br />A. Drugs that block thyroid synthesis<br />Propylthiouracil (PTU) = blocks co...
Thyroid Storm: Pharmacologic Management<br />C. Drugs that block catecholamine effect<br />Propanolol<br />
Thyroid Storm: Nursing Management<br />Medication administration<br />Normalize temperature<br />Rehydration and correctio...
Myxedema Coma<br />Progressive worsening or terminal stage of hypothyroidism<br />
Myxedema Coma<br />Cell is unable to maintain processes necessary to sustain life<br />- protein synthesis is curtailed<br...
Myxedema Coma: Clinical Manifestation<br />Dull and mask-like face<br />Damaged cardiac myocytes due to interstitial edema...
Myxedema Coma: Pharmacologic Management<br />Levothyroxine<br />
Myxedema Management: Nursing Management<br />Ventilatory support<br />ABG’s measurement<br />ECG monitoring<br />Measures ...
Education’s purpose is to replace an empty mind with an open one.<br />
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Transcript of "Endocrine disorders and therapeutic management"

  1. 1. Endocrine Disorders and Therapeutic Management<br />Gladys T. Cruz<br />
  2. 2. Diabetes Mellitus<br />
  3. 3. Diabetes Mellitus<br />Is a disorder of the endocrine system that causes alterations in glucose metabolism.<br />
  4. 4. Diabetes Mellitus: Type<br />Type 1 – an absolute lack of insulin<br />Type 2 – relative lack of insulin<br />
  5. 5. Diabetes Mellitus<br />Pancreas is an organ with both endocrine and exocrine functions<br /> - Exocrine function is to release a juice full of enzymes and other components that helps with the process of digestion<br />
  6. 6. Diabetes Mellitus<br /> - Endocrine function (islets of langerhans)<br />Beta cells produce insulin<br />Alpha cells produce glucagon<br />Delta cells produce somatostatin<br />
  7. 7. Diabetic Ketoacidosis<br />
  8. 8. Diabetic Ketoacidosis<br />Beta cells have the inability to produce insulin<br />Hyperglycemia – hyperosmolar state<br />Electrolyte shifts and total body dehydration<br />Formation of ketones because of breakdown of fats and protein<br />
  9. 9. Diabetic Ketoacidosis: Clinical Manifestations<br />Dehydration <br />Ketosis<br />Metabolic acidosis<br />Weakness<br />Anorexia<br />Altered mental status<br />Tachycardia<br />Kussmaul respirations<br />
  10. 10. Diabetic Ketoacidosis: Goals of Treatment<br />Correction of acidosis<br />Correction of electrolyte and fluid disturbances<br />Insulin to lower serum glucose levels<br />Prevention of ketosis<br />Prevention of complications<br />
  11. 11. Diabetic Ketoacidosis: Treatments<br />Closely monitor blood glucose levels and acidosis<br />Replace fluids and electrolytes<br />Administer insulin<br />Monitor cardiac, pulmonary, neurologic systems<br />
  12. 12. Diabetic Ketoacidosis: Treatments<br />Identify and correct precipitating event<br />Educate the patient and the patient’s family<br />
  13. 13. Diabetic Ketoacidosis<br />Rapid insulin<br />0.1 to 0.2 U/kg/hr<br />
  14. 14. HyperosmolarNonketotic Coma<br />
  15. 15. HyperosmolarNonketotic Coma<br />A serious metabolic complication, usually seen in type 2 diabetes<br />Results in dehydration and electrolyte disturbances without acidosis<br />
  16. 16. HyperosmolarNonketotic Coma: Clinical Manifestation<br />Profound dehydration<br />Hypotension<br />Tachycardia<br />Diminished CVP<br />Dry mucous membrane<br />Poor skin turgor<br />Neurologic impairments including confusion, seizures and coma<br />
  17. 17. HyperosmolarNonketotic Coma<br />Treatment goals are similar to the interventions of DKA<br />
  18. 18. Hypoglycemia<br />
  19. 19. Hypoglycemia<br />Occurs when the blood sugar levels drop rapidly<br />
  20. 20. Hypoglycemia<br />Sweating, tremors<br />Blurred vvision, hunger, weakness<br />Behavior changes, and confusion<br />Anxiety, paresthesia and poor coordination<br />Slurred speech, headache<br />Palpitation, nausea<br />
  21. 21. Hypoglycemia: Treatment<br />Fast acting carbohydrates (if client is conscious)<br /> - ½ cup orange juice<br /> - 4 oz cola<br /> - 4 oz orange juice<br />
  22. 22. Syndrome of Inappropriate Secretion of Antidiuretic Hormone<br />
  23. 23. Syndrome of Inappropriate Secretion of Antidiuretic Hormone<br />Patient has an excess of antidiuretic hormone secreted into the bloodstream, more than amount needed to maintain normal blood volume and serum osmolality<br />
  24. 24. Syndrome of Inappropriate Secretion of Antidiuretic Hormone<br />Excessive water is resorbed at the kidney tubule, leading to dilutionalhyponatremia<br />
  25. 25. Assessment<br />Early Clinical Manifestation:<br /> - dilutionalhyponatremiainclude lethargy, anorexia, nausea and vomiting<br />
  26. 26. Assessment<br />Symptoms of Severe Hyponatremia:<br /> - inability to concentrate, mental confusion, apprehension, seizures, decreased level of consciousness, coma and death<br />
  27. 27. Nursing Diagnoses<br />Excess Fluid Volume related to comprised regulation mechanism<br />Anxiety related to lack of control over current situation or disease progression<br />Deficient Knowledge: Discharge Regimen related to lack of previous exposure to information<br />
  28. 28. Medical Management<br />Fluid restriction<br />Sodium replacement<br />Medications that increase renal water excretion (Demeclocycline)<br />
  29. 29. Nursing Management<br />Restriction of Fluids<br /> - accurate intake and output<br /> - mouth care for fluid restriction<br /> - weigh patient to gauge fluid retention or loss of body fluid<br />
  30. 30. Diabetes Insipidus<br />
  31. 31. Diabetic Insipidus<br />Caused by a deficiency in the production or release of ADH by the posterior pituitary gland<br />
  32. 32. Diabetic Insipidus:<br />Neurogenic<br />Nephrogenic<br />Psychogenic<br />
  33. 33. Diabetic Insipidus: Clinical Manifestations<br />Polyuria<br />Polydipsia<br />Hypotension<br />Tachycardia<br />Weight loss<br />Dehydration<br />Mental status changes<br />Seizures<br />Constipation <br />
  34. 34. Diabetic Insipidus: Medication<br />Vasopressin<br />Desmopressin acetate ( for chronic neurogenic)<br />
  35. 35. Diabetic Insipidus: Nursing Management<br />Monitor intake and output<br />
  36. 36. Thyroid Storm<br />
  37. 37. Thyroid Storm<br />Also called Thyroid Crisis<br />A complication of pre - existing hyperthyroidism<br />
  38. 38. Thyroid Storm<br />Increase in cellular oxygen consumption<br />
  39. 39. Thyroid Storm: Medical Management<br />Prevent cardiovascular collapse<br />Reduce hyperthermia<br />Reverse dehydration<br />
  40. 40. Thyroid Storm: Pharmacologic Management<br />A. Drugs that block thyroid synthesis<br />Propylthiouracil (PTU) = blocks conversion of T4 to T3<br />B. Drugs that block release of thyroid hormone<br />Iodides = decreases thyroid hormone production<br />
  41. 41. Thyroid Storm: Pharmacologic Management<br />C. Drugs that block catecholamine effect<br />Propanolol<br />
  42. 42. Thyroid Storm: Nursing Management<br />Medication administration<br />Normalize temperature<br />Rehydration and correction of metabolic derangements<br />
  43. 43. Myxedema Coma<br />Progressive worsening or terminal stage of hypothyroidism<br />
  44. 44. Myxedema Coma<br />Cell is unable to maintain processes necessary to sustain life<br />- protein synthesis is curtailed<br />- carbohydrates and fat metabolism is incomplete<br />- lipolysis is ineffective, and cholesterol collects in the blood stream<br />
  45. 45. Myxedema Coma: Clinical Manifestation<br />Dull and mask-like face<br />Damaged cardiac myocytes due to interstitial edema<br />Pleural effusions<br />ADH levels is increased<br />Decreased gastric motility<br />Heat production decreases<br />
  46. 46. Myxedema Coma: Pharmacologic Management<br />Levothyroxine<br />
  47. 47. Myxedema Management: Nursing Management<br />Ventilatory support<br />ABG’s measurement<br />ECG monitoring<br />Measures to avoid skin breakdown<br />Manage constipation<br />Monitor I and O<br />
  48. 48. Education’s purpose is to replace an empty mind with an open one.<br />
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