Endocrine Ppt

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Endocrine Ppt

Endocrine Ppt

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  • 1. METABOLISM ENDOCRINE SYSTEM
  • 2. ENDOCRINE GLANDS
    • Development of mammary glands & lactation
    PROLACTIN/ LTH
    • Growth of body tissues & bones
    GH/ SOMATOTROPIN
    • Growth, maturation & function of sex organs
    FSH,LH
    • Adrenal cortex to release hormones
    ACTH LOBE
    • Thyroid to release hormones
    TSH
    • PITUITARY
    • ANTERIOR
    FUNCTIONS HORMONES ENDOCRINE GLAND
  • 3. ENDOCRINE GLANDS
    • Affects skin pigmentation
    MSH
    • INTERME-
    • DIATE LOBE
    • Stimulate uterine contractions
    • release of milk
    OXYTOCIN
    • Regulates water metabolism
    ADH
    • PITUITARY
    • POSTERIOR
    • LOBE
    FUNCTION HORMONE ENDOCRINE GLAND
  • 4. ENDOCRINE GLANDS
    • Slightly significant
    SEX HORMONES
    • Glycogenolysis;
    • Gluconeogenesis
    • Na & water reabsorption
    • Antiinflammatory
    • Stress hormone
    CORTISOL
    • Fluid & electrolyte balance;
    • Na reabsorption;
    • K excretion
    ALDOSTERONE ADRENAL CORTEX FUNCTION HORMONES ENDOCRINE GLAND
  • 5. ENDOCRINE GLANDS
    • Increase heart rate & BP
    • Bronchodilation,
    • Glycogenolysis
    • Stress hormone
    EPINEPHRINE NOR- EPINEPHRINE ADRENAL MEDULLA FUNCTION HORMONE ENDOCRINE GLAND
  • 6.  
  • 7. ENDOCRINE GLANDS
    • Increase serum calcium by promoting bone decalcification
    PTH PARA- THYROID
    • Decrease serum Ca by increasing bone deposition
    THYRO- CALCITONIN
    • Regulate metabolic rate
    • P,C,F metabolism
    • Regulate physical & mental growth & development
    T3 & T4’ THYROID FUNCTION HORMONE ENDOCRINE GLAND
  • 8. ENDOCRINE GLANDS
    • Increase blood glucose by:
    • Gluconeogenesis
    • Glycogenolysis
    GLUCAGON
    • ALPHA
    • CELLS
    • Decrease blood glucose by:
    • Glucose diffusion across cell membrane;
    • Converts glucose to glycogen
    INSULIN
    • PANCREAS
    • BETA
    • CELLS
    FUNCTION HORMONE ENDOCRINE GLAND
  • 9. ENDOCRINE GLANDS
    • Development of secondary sex charac in male
    • Maturation of sex organs
    • Sexual functioning
    TESTOS- TERONE TESTES
    • Development of secondary sex charac in female
    • Maturation of sex organs
    • Sexual functioning
    • Maintenance of pregnancy
    ESTROGEN & PROGES- TERONE OVARIES FUNCTION HORMONES ENDOCRINE GLAND
  • 10. HORMONE REGULATION
    • NEGATIVE FEEDBACK MECHANISM
    • CHANGING OF BLOOD LEVELS OF CERTAIN SUBSTANCES (e..g CALCIUM & GLUCOSE)
    • RHYTHMIC PATTERNS OF SECRETION
    • (e.g. CORTISOL, FEMALE REPRODUCTIVE HORMONES)
    • AUTONOMIC & C.N.S. CONTROL
    • (PITUITARY-HYPOTHALAMIC AXIS,
    • ADRENAL MEDULLA HORMONES)
  • 11. NEGATIVE FEEDBACK MECHANISM
    • DECREASED HORMONE CONCENTRATION IN THE BLOOD (e.g. Thyroxine )
    • PITUITARY GLAND
    • RELEASE OF STIMULATING HORMONE (e.g. TSH)
    • STIMULATION OF TARGET ORGANS TO PRODUCE & RELEASE HORMONE
    • (e.g. Thyroid gland release of Thyroxine)
    • RETURN OF THE NORMAL CONCENTRATION OF HORMONE
  • 12. NEGATIVE FEEDBACK MECHANISM
    • INCREASED HORMONE CONCENTRATION IN THE BLOOD (e.g. Thyroxine )
    • PITUITARY GLAND IS INHIBITED TO
    • RELEASE STIMULATING HORMONE (e.g. TSH)
    • DECREASED PRODUCTION & SECRETION
    • OF TARGET ORGAN OF THE HORMONE
    • (e.g. Thyroid gland release of Thyroxine)
    • RETURN OF THE NORMAL CONCENTRATION OF HORMONE
  • 13. CASE STUDY
    • Katie, an elderly, came in because of palpitations.
    • VS revealed: 37.9 o , 120, 25, 140/ 90
    • She expressed hyperactivty, sweating, increased appetite & weight loss
  • 14. CASE STUDY
    • She claimed history of goiter since her 30’s but no follow-up was done.
    • What are your nursing plans?
  • 15. PLANNING
    • HEALTH PROMOTION
      • IODIZED SALT
      • CONTROLLING WEIGHT
    • HEALTH MAINTENANCE & RESTORATION
      • STEROID THERAPY
  • 16. STEROID THERAPY
    • STEROID LEVELS
    • PITUITARY GLAND IS INHIBITED TO REALEASE ACTH
    ENDOGENOUS CORTISOL PRODUCTION & RELEASE BY ADRENAL MEDULLA ADRENAL ATROPHY
  • 17. STEROID THERAPY
    • PHARMACOLOGIC CONSIDERATIONS:
    • PEPTIC ULCER IN SHORT TERM, HIGH DOSE STEROID TX
    • ADMINISTER DRUG: HIGHER DOSE IN THE MORNING, TAPERING TO LOWER ONES IN THE AFTERNOON
    • LAST DOSE @ MEAL TIME TO AVOID INSOMNIA
    • PALLIATIVE EFFECT
  • 18. STEROID THERAPY
    • ASSESSMENT:
    • BASELINE STEROID LEVEL IS ASSESSED BEFORE PROLONGED THERAPY IS STARTED TO DETERMINE THE DOSE REQUIRED
    • STEROID WITHDRAWAL (LOW STRESS TOLERANCE)
      • EXHAUSTION
      • WEAKNESS
      • LETHARGY
  • 19. STEROID THERAPY
    • ASSESSMENT:
    • ACUTE ADRENAL CRISIS
      • RESTLESSNESS
      • WEAKNESS
      • HEADACHE
      • DHN
      • N/V
      • FALLING BP TO SHOCK
    • PSYCHOLOGICAL CXS
      • MOOD ELEVATION,
      • FRANK EUPHORIA
      • THEN, DEPRESSION
  • 20. STEROID THERAPY
    • IMPORTANT FACTS:
    • MAJOR UNTOWARD EFFECTS:
      • MASKS INFECTION
      • DEFENSE AGAINST INFECTION FROM LYMPHOPENIA
      • SLOW WOUND HEALING FROM ITS ANTIINFLAMMATORY EFFECT
      • P.U.D . ACTIVATION/ REACTIVATION
      • SERUM SODIUM
      • SERUM POTASSIUM
  • 21. STEROID THERAPY
    • IMPORTANT FACTS:
    • MINOR UNTOWARD EFFECTS:
      • PIGMENTATION
      • ACNE
      • FACIAL HAIR
      • MOON-FACIE
  • 22. STEROID THERAPY
    • IMPORTANT FACTS:
    • PROBLEMS OF LONG TERM THERAPY:
      • GROWTH RETARDATION
      • OBESITY
      • GASTRITIS TO P.U.D.
      • OSTEOPOROSIS
      • HPN
      • RENAL CALCULI
      • ADRENAL ATROPHY
  • 23. STEROID THERAPY
    • STEROID LEVELS
    • PITUITARY GLAND IS INHIBITED TO REALEASE ACTH
    ENDOGENOUS CORTISOL PRODUCTION & RELEASE BY ADRENAL MEDULLA ADRENAL ATROPHY
  • 24. STEROID THERAPY
    • IMPLEMENTATION
    • DECREASE Na IN THE DIET
    • CALORIC RESTRICTION
    • FOODS HIGH IN POTASSIUM
    • GIVE MEDS WITH ANTACIDS OR WITH FOOD
    • TEST STOOLS OR EMESIS FOR BLOOD
    • REPORT ANY EVIDENCE OF GI BLEEDING
    • LYMPHOPENIC PRECAUTION
  • 25. ANTERIOR PITUITARY DISTURBANCES
    • HYPOPITUITARISM
    • HYPERPITUITARISM
  • 26. HYPOPITUITARISM ANTERIOR LOBE
    • PANHYPOPITUITARISM
    • (SIMMOND’S DSE)
      • DECREASED SECRETION OF ALL ANTERIOR LOBE HORMONES
  • 27. HYPERPITUITARISM ANTERIOR LOBE
    • EOSINOPHILIC TUMOR
      • INCREASED GROWTH HORMONE AND PROLACTIN
    • BASOPHILIC TUMOR
      • INCREASED TSH, FSH, LH, MSH,
      • INCREASED ACTH (CUSHING’S DSE)
    • CHROMOPHOBE TUMOR
      • INCREASED ACTH & GROWTH HORMONE
  • 28. PITUITARY ANTERIOR LOBE
    • Decreased milk production
    • Underdevelopment of mammary glands
    PROLACTIN
    • Exaggerated fxn of sex organs
    • Atrophy & infertility
    FSH
    • Grave’s dse
    • Atrophy & depressed thyroid fxn
    TSH
    • Cushing’s dse
    • Atrophy of adrenal cortex
    ACTH
    • Gigantism – young
    • Acromegaly - adult
    • Dwarfism – young
    • Cachexia - adult
    GH HYPER FXN HYPO FXN HORMONE
  • 29. MANAGEMENT
    • HYPOPITUITARISM
      • SURGICAL REMOVAL / IRRADIATION
      • REPLACEMENT THERAPY
        • THYROID HORMONES
        • STEROIDS
        • SEX HORMONES
        • GONADOTROPINS (restore fertility)
    • HYPERPITUITARISM
      • SURGICAL REMOVAL / IRRADIATION
      • MONITOR FOR HYPERGLYCEMIA & CARDIOVASCULAR PROBLEMS
  • 30. POSTERIOR PITUITARY DISTURBANCES
    • DIABETES INSIPIDUS
    • SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE
  • 31. DIABETES INSIPIDUS ABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSIN
    • CAUSE:
    • TUMOR
    • TRAUMA
    • VASCULAR DSE
    • INFLAMMATION
    • PITUITARY SURGERY
    • S/SX:
    • POLYURIA
    • 15-29L/ DAY
    • POLYDIPSIA
    • SG OF URINE IS
    • <1.010
    • S/SX OF DHN
    • SHOCK
  • 32. DIABETES INSIPIDUS ABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSIN
    • MANAGEMENT
    • HORMONAL REPLACEMENT – FOR LIFE
      • VASOPRESSIN (PITRESSIN TANNATE IN OIL ) – IM OR NASAL SPRAY
    • NON-HORMONAL THERAPY
      • CHLORPROPRAMID E – INCREASE RESPONSE OF THE BODY TO DECREASED VASOPRESSIN
    • SALT & P RESTRICTED DIET, INCREASE FLUIDS
    • MONITOR I&O
    • MAINTAIN FLUID & ELECTROLYTE BALANCE
  • 33. SYNDROME OF INAPPROPRIATE ADH
    • ELEVATED ADH
    • CAUSES:
    • BRONCHOGENIC CA
    • NONENDOCRINE TUMORS
    • S/SX:
    • DECREASED SERUM SODIUM
      • CX IN LOC TO UNCONSCIOUSNESS
      • SEIZURES
    • WATER INTOXICATION
      • N/V
      • MENTAL CONFUSION
  • 34. SYNDROME OF INAPPROPRIATE ADH
    • MANAGEMENT:
    • WATER INTAKE RESTRICTION
    • ADMINISTER AS ORDERED :
      • NaCl
      • Diuretics
      • Demeclocycline (declamycin) – a tetracycline analogue that interferes with the action of ADH on the collecting tubules
  • 35. Mission possible
  • 36. THYROID GLAND
    • STIMULATED BY THYROID STIMULATING HORMONE (TSH)
    • NEEDS IODINE TO SYNTHESIZE HORMONE
    • SECRETES:
      • THYROXINE (T4)
      • TRIIODOTHYRONINE (T3)
  • 37. THYROID DISTURBANCES
    • DIAGNOSTIC TESTS :
    • B.M.R.- AMT OF O2 USED BY A PERSON @ A GIVEN TIME
    • PBI – MEASURE IODINE LIBERATED IN THE BLOOD WITH THYROID DAMAGE
    • SERUM THYROXINE (T4), SERUM TRIIODOTHYRONINE (T3), SERUM TSH
    • BLOOD SERUM CHOLESTEROL
    • RADIOACTIVE IODINE TESTS:
      • T3 RED CELL UPTAKE
      • RADIOACTIVE IODINE UPTAKE (I131
      • THYROID SCAN
  • 38. THYROID DISTURBANCES GRAVE’S DSE or Exophthalmic goiter
    • CRETINISM- infants, young children
    • HYPOTHYROIDISM WITHOUT MYXEDEMA - atrophy/ destruction of thyroid gland
    • MYXEDEMA –adults
    HYPERTHYROIDISM HYPOTHYROIDISM
  • 39. EFFECTS
    • Increase heat
    • Deranged C metabolism, glycosuria
    • Increase use of F & P as fuel
    • Reduction in HEAT PRODUCTION
    • Failure of MENTAL & PHYSICAL GROWTH
    • increased storage of C, P & F
    • Abnormal collection of WATER
    HYPERTHYROIDISM HYPOTHYROIDISM
  • 40.
    • DECREASED
    • INCREASED
    • WARM, MOIST, FLUSHED
    • SOFT, SILKY
    • SERUM
    • CHOLESTEROL:
    • INCREASED
    • BMR:
    • DECREASED
    • SKIN:
    • THICK, PUFFY, DRY
    • HAIR:
    • DRY, BRITTLE
    HYPERTHYROIDISM HYPOTHYROIDISM
  • 41.
    • HYPERACTIVE
    • LABILE MOOD
    • HYPERSENSITIVE
    • TENSED
    • DECREASED
    • INCREASED
    • NERVOUS SYSTEM:
    • APATHETIC
    • LETHARGIC
    • MAYBE HYPERIRRITABLE
    • SLOW CEREBRATION
    • WEIGHT:
    • INCREASED
    • APPETITE:
    • DECREASED
    HYPERTHYROIDISM HYPOTHYROIDISM
  • 42. MANAGEMENT
    • MEDICAL:
    • REST
    • ANTITHYROID DRUGS:
    • LUGOL’S SOLUTION
    • THIOUREA DERIVATIVES
    • RADIOACTIVE IODINE
    • BETA-BLOCKERS
    • SURGICAL:
    • SUBTOTAL THYROIDECTOMY
    • MEDICAL:
    • HORMONE REPLACEMENT
    • DESSICATED THYROID
    • THYROGLOBULIN
    • Na LEVOTHYROXINE
    • Na LYOTHYRONINE
    HYPERTHYROIDISM HYPOTHYROIDISM
  • 43. ANTITHYROID MEDICATIONS
    • LUGOL’S SOLUTION
    • (POTASSIUM IODIDE)
      • DECREASE THYROID VASCULARITY
      • INHIBIT IODINE RELEASE
      • DILUTED IN MILK / JUICE
      • STAINS THE TEETH- USE STRAW
    • THIOUREA & DERIVATIVES
      • (PTU,METHIMAZOLE)
      • BLOCK THYROID HORMONE RELEASE
      • TOXIC SIGNS: FEVER, SORETHROAT, LEUKOPENIA
    • RADIOACTIVE IODINE
      • PATIENT IS ISOLATED FOR 3 DAYS
    • BETA BLOCKERS
      • PROPANOLOL
  • 44. SUBTOTAL THYROIDECTOMY
    • REMAINING TISSUE PROVIDES ENOUGH HORMONES FOR NORMAL FXN
    • PRE OP NURSING CARE:
    • PATIENT EDUCATION ON POST OP:
      • LITTLE HOARSENESS
      • DIFFICULTY OF SWALLOWING
    • POST OP NURSING CARE:
    • SEMIFOWLER’S
    • AVOID HYPEREXTENSION OF THE NECK
    • BE ASKED TO SPEAK @ 40 MIN INTERVAL – ASSESS RECURRENT NERVE INJURY
    • WATCH OUT FOR COMPLICATIONS.
  • 45. SUBTOTAL THYROIDECTOMY
    • COMPLICATIONS:
    • RECURRENT LARYNGEAL NERVE INJURY
      • HOARSENESS
    • HEMORRHAGE
      • 12-24 HRS POST OP
      • OBSERVE FOR IRREGULAR BREATHING, CHOKING SIGNS
      • TRACHEOSTOMY SET @ BEDSIDE
    • TETANY
    • RESPIRATORY OBSTRUCTION
    • THYROID STORM
  • 46. TETANY
    • DEPENDS UPON THE NUMBER OF PARATHYROID GLANDS REMOVED
    • S/SX:
    • 1 ST – TINGLING TOES & FINGERS
    • 2 ND – CHEVOSTEK’S SIGN (TAPPING THE FACIAL MUSCLES)
    • 3 RD – TROUSSEAU’S SIGN (CARPO-PEDAL SPASM WITH OCCLUSION OF CIRCULATION WITH A BP CUFF)
    • MANAGEMENT:
    • CALCIUM REPLACEMENT: CaGluconate IV
  • 47. THYROID STORM / CRISIS
    • S/SX:
    • HYPERTHERMIA
    • > 41C
    • TACHYCARDIA
    • APPREHENSION
    • RESTLESSNESS
    • IRRITABILITY
    • DELIRIUM
    • COMA
    • MANAGEMENT:
    • DECREASE TEMP
    • ANTITHYROID DRUGS
    • GLUCOSE
    • DIGITALIS
    • STEROIDS TO DECREASE ACTH
  • 48. THYROID STORM / CRISIS
    • INCREASED AMOUNT OF THYROID HORMONES
    • POST OP
    • AFTER RADIOACTIVE IODINE ADMINISTRATION
    • TOO SHORT PERIOD OF PRE OP TX
    • CAUSES:
    • EMOTIONAL STRESS
    • PHYSICAL STRESS
  • 49. VARIANTS OF HYPERTHYROIDISM
    • GRAVE’S DSE
    • THYROIDITIS
    • GOITER
  • 50. GRAVE’S DISEASE
    • CAUSE:
    • UNKNOWN
    • AUTOIMMUNE WITH LONG-ACTING THYROID STIMULATOR
    • S/SX: TRIAD OF SYMPTOMS:
    • HYPERTHYROIDISM
    • OPHTHALMOPATHY
    • DERMOPATHY
  • 51. OPHTHALMOPATHY
    • EXOPHTHALMOS – ACCUMULATION OF FLUID IN THE FAT PADS BEHIND HE EYEBAL
    • LID LAG – PROMINENT PALPEBRAL FISSURE WHEN THE PATIENT LOOKS DOWN
    • THYROID STARE
    • (DARYMPLE’S SIGN) – INFREQUENT EYE BLINKING
  • 52. DERMOPATHY
    • PRETIBIAL MYXEDEMA
    • @ THE DORSUM OF THE LEG
    • RAISED, THICKENED, PRURITIC, HYPERPIGMENTED SKIN
    • CLUBBING OF FINGERS & TOES
    • OSTEOARTHROPATHY
  • 53. THYROIDITIS
    • CLASSIFICATION:
    • SUBACUTE, NONSUPPURATIVE
      • UNKNOWN CAUSE
      • ASSOC. WITH VIRAL URT INFECTIONS
    • CHRONIC, HASHIMOTO’S
      • IMMUNOLOGICAL FACTORS
      • PRESENCE OF IMMUNOGLOBULINS & ANTIBODIES DIRECTED AGAINST THE THYROID
  • 54. GOITER
    • ENLARGEMENT OF THE THYROID GLAND.
    • TYPES:
    • TOXIC NODULAR
    • NONTOXIC
  • 55. TOXIC NODULAR GOITER
    • COMMON IN ELDERLY
    • FROM LONG STANDING SIMPLE GOITER
    • NODULES
      • FUNCTIONING TISSUE
      • SECRETES THYROXINE AUTONOMOUSLY FROM TSH
  • 56. NON-TOXIC GOITER
    • (SIMPLE/ COLLOID/ EUTHYROID)
    • CAUSE :
    • IODINE DEFICIENCY
    • INTAKE OF GOITROGENIC SUBSTANCES/ DRUGS:
      • CASSAVA,
      • CABBAGE,
      • CAULIFLOWER,
      • CARROTS
      • RADDISH
      • TURNIPS
      • RED SKIN OF PEANUTS
      • IODINE
      • COBALT
      • LITHIUM
  • 57. NON-TOXIC GOITER
    • IMPAIRED THYROID HORMONE SYNTHESIS
    • SERUM THYROXINE
    • PITUITARY SECRETE TSH
    • THYROID GLAND ENLARGES
    • TO COMPENSATE FOR THE REDUCED LEVEL OF THYROXINE
    IODINE DEFICIENCY OR INTAKE OF GOITROGENIC SUBSTANCES
  • 58. NON-TOXIC GOITER
    • COMMON IN WOMEN:
    • ADOLESCENT
    • PREGNANT
    • LACTATING
    • MENOPAUSE
    • TREATMENT:
    • IODIZED OIL IM
    • IODINE TABLETS
    • SALT FORTIFICATION WITH IODINE
    • EDUCATE ABOUT INTAKE OF :
      • SEAWEEDS
      • SHELLFISH
      • FISH- TAMBAN, HITO, DALAG
  • 59. MYXEDEMA COMA
    • MEDICAL EMERGENCY
    • OCCURS IN SEVERE & UNTREATED MYXEDEMA
    • HIGH MORTALTY RATE
    • S/SX:
    • INTENSIFIED HYPOTHYROIDISM
    • NEUROLOGIC IMPAIRMENT COMA
  • 60. MYXEDEMA COMA
    • PRECIPITATING FACTORS:
    • FAILURE TO TAKE MEDS
    • INFECTION
    • TRAUMA
    • EXPOSURE TO COLD
    • USE OF SEDATIVES, NARCOTICS, ANESTHETICS
  • 61. MYXEDEMA COMA
    • MANAGEMENT:
    • IV THYROID HORMONES
    • CORRECTION OF HYPOTHERMIA
    • MAINTAIN VITAL FXNS
    • TREAT PRECIPITATING CAUSES
  • 62.  
  • 63. PARATHYROID GLAND
    • 4 GLANDS
    • SECRETES PARATHORMONE (PTH) IN RESPONSE TO SERUM Ca & Ph LEVELS
    • REGULATE CALCIUM & PHOSPHORUS METABOLISM
    • ORGANS AFFECTED:
    • BONES - RESORPTION
    • KIDNEYS
      • Ca REABSORPTION
      • Ph EXCRETION
    • GIT – ENHANCES Ca ABSORPTION
  • 64. PARATHYROID DISORDERS
    • DIAGNOSTIC TESTS:
    • HEMATOLOGICAL
      • SERUM CALCIUM
      • SERUM PHOSPHORUS
      • SERUM ALKALINE PHOSPHATASE
    • URINARY STUDIES
      • URINARY CALCIUM
      • URINARY PHOSPHATE - TUBULAR REABSORPTION OF PHOSPHATE
  • 65. HYPOPARATHYROIDISM
    • DECREASED PTH PRODUCTION
    • HYPOCALCEMIA
    • CALCIUM IS:
      • DEPOSITED IN THE BONE
      • EXCRETED
    • CAUSE:
    • HEREDITARY
    • IDIOPATHIC
    • SURGICAL
  • 66. HYPOPARATHYROIDISM
    • S/SX:
    • ACUTE HYPOCALCEMIA
      • TINGLING OF THE FINGERS
      • CHEVOSTEK’S, TROUSSEAU’S
    • CHRONIC HYPOCALCEMIA
      • FATIGUE, WEAKNESS
      • PERSONALITY CHANGES
      • LOSS OF TOOTH ENAMEL, DRY SCALY SKIN
      • CARDIAC ARRHYTHMIA
      • CATARACT
  • 67. HYPOPARATHYROIDISM
    • XRAY: INCREASED BONE DENSITY
    • MANAGEMENT:
    • Ca SUPPLEMENT
    • VIT D SUPPLEMENT – LIQ FORM: WITH WATER, JUICE OR MILK, pc
    • SEIZURE prec
    • LISTEN FOR STRIDOR OR HOARSENESS
    • TRACHEOSTOMY SET @ BEDSIDE
    • CaGLUCONATE @ BEDSIDE
  • 68. HYPERPARATHYROIDISM
    • INCREASED PTH PRODUCTION
    • HYPERCALCEMIA
    • HYPOPHOSPHATEMIA
    • PRIMARY – TUMOR OR HYPERPLASIA OF THE PARATHYROID GLAND
    • SECONDARY – COMPENSATORY OVERSECRETION OF PTH IN RESPONSE TO HYPOCALCEMIA FROM:
      • CHRONIC RENAL DSE
      • RICKETS
      • MALABSORPTION SYNDROME
      • OSTEOMALACIA
  • 69. HYPERPARATHYROIDISM
    • S/SX:
    • BONE PAIN : ESP @ THE BACK, PATHOLOGIC FRUCTURES
    • TUBULAR CALCIUM DEPOSITS - KIDNEY STONES, RENAL COLIC, POLYURIA, POLYDIPSIA
    • MUSCLE WEAKNESS
    • PERSONALITY CX, DEPRESSION
    • CARDIAC ARRHYTHMIAS, HPN
    • XRAY: BONE DEMINERALIZATION
  • 70. HYPERPARATHYROIDISM
    • MANAGEMENT:
    • TX OF CHOICE : SURGICAL REMOVAL OF HYERPLASTIC TISSUE
    • IV PNSS 5L/ DAY WITH DIURETICS
    • CRANBERRY JUICE (ACID-ASH)
    • LOW Ca, HIGH Ph DIET
    • NO MILK, CAULIFLOWER & MOLASSES
    • STRAIN URINE FOR STONES
    • CARE FOR PARATHYROIDECTOMY
  • 71. ADRENAL GLAND
    • STIMULATED BY ACTH
    • HORMONE PRECURSOR:
      • CHOLESTEROL
    • SECRETES:
      • CORTISOL
      • ALDOSTERONE
      • SEX HORMONES : ANDROGEN, ESTROGEN
  • 72. ADRENAL GLAND
    • Physiologically insignificant
    • Becomes useful during menopause in women
    SEX HORMONE
    • increase serum glucose by gluconeogenesis & glycogenolysis esp during STRESS
    • Blocks inflammation
    • Counteracts effect of histamine
    GLUCO- CORTICOIDS
    • Renal : Na & Cl reabsorption; K excretion
    • GI : Na absorption
    ALDOSTERONE FUNCTION HORMONE
  • 73. SYMPTOMATOLOGY
    • ALDOSTERONE DEFICIENCY
    • DECREASE IN PLASMA VOLUME LEADING TO DEHYDRATON
    • HYPOTENSION TO SHOCK
    • INCREASED K
    • METABOLIC ACIDOSIS
  • 74. SYMPTOMATOLOGY
    • CORTISOL DEFICIENCY
    • ANOREXIA, N/V, ABDOMINAL PAIN, WT LOSS, LETHARGY
    • HYPOGLYCEMIA
    • HYPOTENSION
    • INCREASED K, WEAK PULSE
    • PIGMENTATION
    • IMPAIRED STRESS TOLERANCE
  • 75. SYMPTOMATOLOGY
    • SEX HORMONE DEFICIENCY
    • LOSS OF BODY HAIR
    • LOSS OF LIBIDO OR IMPOTENCE
    • MENSTRUAL & FERTILITY DISORDER
  • 76. ADRENAL CORTEX DISORERS
    • ADRENAL INSUFFICIENCY
    • ADRENAL CRISIS
    • CUSHING’S SYNDROME
    • ALDOSTERONISM
  • 77. ADRENAL INSUFFICIENCY ADDISON’S DISEASE
    • INCAPABILITY OF THE ADRENAL CORTEX TO PRODUCE GLUCOCORTICOIDS IN RESPONSE TO STRESS
  • 78. ADRENAL CRISIS
    • ACUTE EPISODES FROM STRESS THAT TAXES THE ADRENAL CORTICAL FUNCTION BEYOND ITS CAPABILITIES
    • POSSIBLE COMPLICATION OF ADDISON’S DISEASE
  • 79. ADRENAL CRISIS
    • PRECIPITATING CAUSES:
    • ABDOMINAL DISCOMFORT
    • INFECTION
    • TRAUMA
    • HIGH TEMP
    • EMOTIONAL UPSET
    • ANTICOAGULANT DRUGS
  • 80. ADRENAL CRISIS
    • S/SX:
    • HYPOTENSION
    • FLUID LOSS
    • HYPONATREMIA
  • 81. ADRENAL CRISIS
    • LAB:
    • SERUM ELEC: DECREASED Na
    • INCREASED K
    • S. BUN :
    • S. GLUCOSE:
    • ADRENAL HORMONE ASSAY : HYDROXYCORTICOID & 17 KETOSTEROID IN 24-HR URINE DET .
  • 82. ADRENAL CRISIS
    • GOALS OF CARE:
    • TO REVERSE SHOCK
    • RESTORE BLOOD CIRCULATION
    • REPLENISH NEEDED STEROID
  • 83. ADRENAL CRISIS
    • TREATMENT:
    • D5NSS
    • ADRENAL CORTICAL HORMONE REPLACEMENT: INJECTABLE
    • NEOSYNEPHRINE - SHOCK
    • HIGH SALT DIET
    • ANTIBIOTICS
  • 84. CUSHING’S SYNDROME
    • CAUSE:
    • SUSTAINED OVER-PRODUCTION OF GLUCOCORTICOIDS BY ADRENAL GLAND FROM
    • ACTH BY PITUITARY TUMOR
    • EXCESSIVE GLUCORTICOID ADMINISTRATION
  • 85. CUSHING’S SYNDROME
    • S/SX:
    • TRUNCAL OBESITY
    • BUFFALO HUMP
    • MOON-FACIE
    • WT GAIN
    • SODIUM RETENTION
    • THINNING OF EXTREMITIES – FROM LOSS OF MUSCLE TISSUE DUE TO PROTEIN CATABOLISM
  • 86. CUSHING’S SYNDROME
    • PURPLE STRIAE – FROM THINNING OF SKIN
    • ECHYMOSIS FROM SLIGHT TRAUMA
    • ANDROGENIC EFFECTS:
    • OLIGOMENORRHEA
    • HIRSUTISM
    • GYNECOMASTIA
    • HYPERTENSION FROM S. Na
  • 87. CUSHING’S SYNDROME
    • TREATMENT & NURSING CARE:
    • PSYCHOLOGICAL SUPPORT
    • PREVENT INFECTION – INFLAM & IMMUNE RESPONSE ARE SUPPRESSED
    • PROMOTE SAFETY
    • SURGERY – SUB/TOTAL ADRENALECTOMY
  • 88. ALDOSTERONISM
    • HYPERSECRETION OF ALDOSTERONE
    • PRIMARY – CONN’S SYNDROME
    • SECONDARY
  • 89. CONN’S SYNDROME
    • PRIMARY ALDOSTERONISM
    • CAUSE:
    • ADRENAL ADENOMA
    • S/SX:
    • HYPOKALEMIA
    • FATIGUE
    • HYPERNATREMIA, HPN, TETANY
    • MANAGEMENT :
    • SURGERY
    • ALDACTONE – ALDOSTERONE ANTAGONIST
  • 90. SECONDARY ALDOSTERONISM
    • THE PROBLEM IS OUTSIDE THE ADRENAL GLAND:
    • e.g. RENIN – ANGIOTENSIN SYSTEM
  • 91. ADRENAL MEDULLA
    • HORMONES : EPINEPHRINE
    • NOREPINEPHRINE
    • EFFECTS
  • 92. PHEOCHROMOCYTOMA
    • TUMOR OF ADRENAL MEDULLA
    • SECRETES INCREASED AMOUNT OF CATECHOLAMINES
    • S/SX:
    • HPN
    • HYPERGLYCEMIA
    • CARDIAC ARRHYTHMIA & CHF
    • DIAGNOSTIC TEST :
    • VMA IN 24H URINE
  • 93. VMA IN 24H URINE
    • END PRODUCT OF CATECHOLAMINE METABOLISM
    • DRUGS & FOOD TO BE WITHHELD 24H B4 THE TEST:
      • COFFEE & TEA
      • BANANA
      • VANILLA
      • CHOCOLATES
  • 94. PHEOCHROMOCYTOMA
    • MANAGEMENT:
    • SURGERY
    • MEDICAL : ADRENERGIC BLOCKING AGENTS: PHENTOLAMINE
    • NURSING CARE:
    • MONITOR BP IN SUPINE & STANDING
    • MONITOR URINE FOR GLUC & ACETONE
  • 95. PANCREAS
    • HORMONES:
    • INSULIN BY BETA CELLS
    • GLUCAGON BY ALPHA CELLS
  • 96. DIABETES MILLETUS
    • CAUSE:
    • INSUFFICIENCY OF INSULIN
    • LACK OF INSULIN
    • EFFECT:
    • HYPERGLYCEMIA
  • 97. DIABETES MILLETUS PATHOPHYSIOLOGY REDUCED /NO INSULIN HYPERGLYCEMIA GLUCOSURIA WEIGHT LOSS OSMOTIC DIURESIS POLYURIA CELLULAR HUNGER POLYPHAGIA POLYDIPSIA LIPOLYSIS OSMOTIC DEHYDRATION
  • 98. DIABETES MILLETUS
    • S/SX:
    • 3 – P’s
    • WEIGHT LOSS
    • STAGES:
    • PREDIABETES
    • SUSPECTED
    • CHEMICAL
    • CLINICAL / OVERT
  • 99. DIABETES MILLETUS
    • PREDIABETES / POTENTIAL:
    CONCEPTION EVIDENCE OF GLUCOSE METABOLISM ALTERATION
  • 100. DIABETES MILLETUS
    • SUSPECTED/ SUBCLINICAL/ LATENT:
    PREDIABETES NO STRESS STRESS NORMAL GLUCOSE METABOLISM OVERT DIABETES
  • 101. DIABETES MILLETUS
    • CHEMEICAL:
    SUBCLINICAL GTT IS ABNORMAL NO STRESS STRESS ASYMPTOMATIC SYMPTOMATIC
  • 102. DIABETES MILLETUS
    • CLINICAL / OVERT:
    CHEMICAL PERSISTENT INCREASED FBS WITH OR WITHOUT STRESS SYMPTOMATIC
  • 103. DIABETES MILLETUS
    • TYPES:
    • TYPE I
      • JUVENILE ONSET
      • BEFORE 15 YO
      • LEAN/ NORMAL WEIGHT
      • ABSOLUTE INSULIN DEFICIENCY
      • INSULIN -DEPENDENT
      • PRONE TO DKA
    • TYPE II –
      • MATURITY ONSET
      • AFTER AGE 40
      • OBESE
      • REDUCED INSULIN RECEPTOR
      • NONINSULIN DEPENDENT
      • PRONE TO HHONK
  • 104. DIABETES MILLETUS
    • DIAGNOSTIC EXAMS:
    • FBS
    • 2 HR- POSTPRANDIAL
    • OGTT
    • GLYCOSYLATED HGB
    • DEXTROSTRIP
    • URINE TESTS:
      • BENEDICT’S
      • CLINITEST TAB
      • ACETONE TEST
  • 105. 2 HR POSTPRANDIAL BLOOD SUGAR
    • INTAKE OF 100GM GLUCOSE, 2 HRS BEFORE THE TEST
    • TEST FOR ABILITY TO DISPOSE GLUCOSE LOAD
  • 106. OGTT
    • CONFIRMATORY, WHEN OTHER BLOOD TESTS ARE BORDERLINE
    • 3 DAYS OF NORMAL ACITIVITY & 150MG OF CARB DIET
    • NPO 10-12HRS BEFORE THE TEST
    • BASELINE BLOOD SUGAR TAKEN
    • GLUCOSE LOAD IS GIVEN, P.O. OR IV
    • BLOOD & URINE SPECS TAKEN 30 MIN, 1HR, 2HRS, 3 HRS, AFTER GLUCOSE LOADING
  • 107. GLYCOSYLATED HEMOGLOBIN
    • MEASURES GLUCOSE METABOLISM FOR THE PAST 3 MONTHS
    • USEFUL TO CHECK:
      • COMPLIANCE WITH THERAPY
      • HISTORY OF SUBCLINICAL OR CHEMICAL DIABETES
  • 108. DIABETES MILLETUS
    • PLANNING & IMPLEMENTATION:
    • CLIENT’S ACTIVITY
    • DIET : C,F,P – 50, 30, 20 LOW SATURATED FATS, HIGH FIBER
    • DRUGS:
      • ORAL HYPOGLYCEMICS
        • BIGUANIDE
        • SULFONYLUREAS
        • CONTRAINDICATED - PREGNANCY
      • INSULIN
  • 109. DIABETES MILLETUS
    • INSULIN THERAPY
    • DISPENSED IN “U”/ml : eg 100, 80
    • REFRIGERATE
    • GIVEN @ ROOM TEMP
    • GENTLY ROTATED, NOT SHAKEN
    • ROUTE : SQ (MTC); IM OR IV
    • SYRINGE: 5/8 INCH ; SAME BRAND
  • 110. DIABETES MILLETUS
    • INSULIN THERAPY:
    • SITE OF INJECTION:
      • ABDOMEN
      • ANTERIOR THIGH
      • ARM
      • UPPER BACK
      • BUTTOCKS
  • 111. DIABETES MILLETUS
    • INSULIN THERAPY REACTIONS:
    • LOCAL:
      • STNGING
      • INDURATION
      • ITCHING
    • LIPODYSTROPHY
    • GENERALIZED:
      • HIVES
      • URTICARIA
      • ANTIHISTAMINES 30 MIN B4
      • DESENSITIZATION
  • 112. LIPODYSTROPHY
    • CAUSE:
    • FAULTY TECHNIQUE
    • TRAUMA
    • INJECTION OF REFRIGERATED INSULIN
    • MANAGEMENT:
    • ROTATING SITES: 1 AREA IS NOT USED MORE THAN ONCE EVERY 3 WKS
  • 113. INSULIN THERAPY & HORMONAL ACTIVITY
    • GLUCORTICOIDS & EPINEPHRINE CAUSES HYPERGLYCEMIA DURING:
      • PHYSICAL TRAUMA
      • STRESS
      • INFECTION
      • ANXIETY
      • ANGER
      • FEAR
      • CHANGE IN LIFESTYLE
    • INCREASE IN INSULIN DOSE IS NEEDED
  • 114. SURPRISE!!!
  • 115. ACUTE COMPLICATIONS OF DIABETES MILLETUS
    • DIABETIC KETO-ACIDOSIS (DKA)
    • INSULIN SHOCK
    • HYPERGLYCEMIC, HYPEROSMOLAR,
    • NONKETOTIC (HHONK) COMA
    • SOMOGYI EFFECT
  • 116. D.K.A. PATHOPHYSIOLOGY NO INSULIN MARKED HYPERGLYCEMIA GLUCOSURIA WEIGHT LOSS OSMOTIC DIURESIS POLYURIA CELLULAR HUNGER POLYPHAGIA POLYDIPSIA LIPOLYSIS OSMOTIC DEHYDRATION KETOACIDOSIS
  • 117. D.K.A.
    • S/SX:
    • S/SX OF DM +
    • KETONURIA
    • METABOLIC ACIDOSIS
    • KUSSMAUL’S RESPIRATION
    • ACETONE BREATH
    • DHN
    • FLUSHED FACE
    • TACHYCARDIA
    • CIRCULATORY COLLAPSE COMA DEATH
  • 118. D.K.A.
    • MANAGEMENT:
    • ADEQUATE VENTILATION
    • FLUID REPLACEMENT
    • INSULIN – RAPID ACTING
    • ECG – ELEC IMB
  • 119. INSULIN SHOCK
    • LOW BLOOD SUGAR
    • CAUSE:
    • OVERDOSE OF EXOGENOUS INSULIN
    • EATING LESS
    • OVEREXERTION WITHOUT ADDITIONAL CALORIE INTAKE
  • 120. INSULIN SHOCK
    • S/SX:
    • PARASYMPATHETIC
      • HUNGER
      • NAUSEA
      • HYPORTENSION
      • BRADYCARDIA
    • CEREBRAL
      • LETHARGY,
      • YAWNING
      • SENSORIUM CX
    • SYMPATHETIC
      • IRRITABILITY
      • SWEATING
      • TREMBLING
      • TACHYCARDIA
      • PALLOR
  • 121. INSULIN SHOCK
    • CLINICAL FINDING :
    • BLOOD GLUCOSE BELOW 55-60 mg%
    • TREATMENT:
    • GLUCOSE PO ( SUGAR, ORANGE JUICE OR CANDY) or IV
    • ADMINISTRATION OF GLUCAGON IM, IV OR SQ
  • 122. HHONK PATHOPHYSIOLOGY Very insufficient INSULIN MARKED HYPERGLYCEMIA GLUCOSURIA WEIGHT LOSS OSMOTIC DIURESIS POLYURIA CELLULAR HUNGER POLYPHAGIA POLYDIPSIA LIPOLYSIS Without KETOSIS SEVERE OSMOTIC DEHYDRATION
  • 123. HHONK
    • S/SX:
    • S/SX OF DKA WITHOUT:
      • KAUSMAUL’S BREATHING
      • ACETONE BREATH
      • METABOLIC ACIDOSIS
      • KETONURIA
  • 124. LACTIC ACIDOSIS SEVERE TISSUE ANOXIA LACTIC ACID PRODUCTION AGGRAVATION OF EXISTING METABOLIC ACIDOSIS
  • 125. SOMOGYI EFFECT TOO MUCH INSULIN HYPOGLYCEMIA GLUCAGON IS RELEASED LIPOLYSIS GLUCONEOGENESIS GLYCOGENOLYSIS REBOUND HYPERGLYCEMIA + KETOSIS
  • 126. CHRONIC COMPLICATIONS OF DIABETES MILLETUS
    • DEGENERATIVE CHANGES IN THE VASCULAR SYSTEM
      • UNDERNOURISHMENT
      • ATHEROSCLEROSIS
    • NEUROPATHY FROM:
      • VASCULAR INSUFFICIENCY
      • VIT B DEFICIENCY
      • HYPERGLYCEMIA
    • EYE COMPLICATIONS FROM ANOXIA
      • CATARACT
      • DIABETIC RETINOPATHY
      • RETINAL DETACHMENT
  • 127. CHRONIC COMPLICATIONS OF DIABETES MILLETUS
    • NEPHROPATHY
      • DAMAGE & OBLITERATION OF CAPILLARIES SUPPLYING THE KIDNEY
    • HEART DISEASE
      • MI FROM ATHEROSCLEROSIS
    • SKIN CHANGES
      • DIABETIC DERMOPATHY – HYPERPIGMENTED & SCALY PRETIBIAL AREAS
    • LIVER CHANGES
      • ENLARGEMENT & FATTY INFILTRATION
  • 128.
    • Ms A, 45 y.o., has a simple goiter. She’s being seen by the community health nurse for teaching & follow-up regarding nutritional deficiencies related to her goiter. Ms A’s problem is almost associated with what nutritional deficiency?
    • Calcium
    • Iodine
    • Iron
    • Sodium
  • 129. GOD BLESS