ENDOCRINE<br />SYSTEM AND MAJOR DISORDERS<br />By: MISS SHENELL  A. DELFIN, RN<br />
FUNCTION:<br />Endocrine system consist of a series of glands “ductless” that function individually or conjointly to integ...
FUNCTION:<br />Control and coordination of the processes which are wide spread in the body such as:<br /><ul><li>Response ...
Growth and development
Reproduction
Fluids and electrolytes
Acid base-balance
Energy metabolism</li></li></ul><li>
ENDOCRINE GLANDS<br />
ENDOCRINE GLANDS<br />
ENDOCRINE GLANDS<br />
ENDOCRINE GLANDS<br />
ENDOCRINE GLANDS<br />
ENDOCRINE GLANDS<br />
HORMONE REGULATION<br />NEGATIVE FEEDBACK MECHANISM<br />CHANGING OF BLOOD LEVELS OF CERTAIN SUBSTANCES (e..g CALCIUM & GL...
NEGATIVE FEEDBACK MECHANISM<br />DECREASED HORMONE CONCENTRATION IN THE BLOOD (e.g.      Thyroxine)<br />PITUITARY GLAND R...
NEGATIVE FEEDBACK MECHANISM<br />INCREASED HORMONE CONCENTRATION IN THE BLOOD(e.g.        Thyroxine)<br />PITUITARY GLAND ...
Endocrine Disorders<br />If you can remember what each hormone does in the body, it will be easier to remember what result...
ANTERIOR PITUITARY  DISTURBANCES<br />HYPOPITUITARISM<br />HYPERPITUITARISM<br />
PITUITARY ANTERIOR LOBE<br />
Hyperpituitarism<br />May be due to overactivity of gland<br />or the result of an adenoma<br />Characterized by:<br />Exc...
Growth Hormone Hypersecretion<br />GIGANTISM<br />
Manifestations of acromegaly. Progressive alterations in facial appearance include enlargement of the cheekbones and jaw a...
Hyperpituitarism:Clinical Manifestations<br />Arthritis<br />Chest: barrel-shaped<br />Rough facial features<br />Odd sens...
Hyperpituitarism:Clinical Manifestations<br />
Hypopituitarism<br />Deficiency of one or more<br />anterior pituitary hormones<br />Causes<br />Infections / Inflammatory...
Hypopituitarism:Clinical Manifestations<br />Hypo-thermia, -glycemia, -tension<br />Loss of vision, strength, libido, & se...
DWARFISM<br />
MANAGEMENT<br />HYPOPITUITARISM<br />SURGICAL REMOVAL / IRRADIATION<br />REPLACEMENT THERAPY<br />THYROID HORMONES<br />ST...
Trans-sphenoidal hypophysectomy<br />
POSTERIOR PITUITARY DISTURBANCES<br />DIABETES INSIPIDUS<br />SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE<br />
FUNCTION:<br />WHEN  THERE IS A       OF SERUM OSMOLALITY, THE NORMAL BODY RESPONSE IS TO    THE SECRETION OF ADH.<br />WH...
DIABETES INSIPIDUS<br />CHARACTERIZED BY A DEFICIENCY OF ADH. <br />WHEN IT OCCURS, IT IS MOST OFTEN ASSOCIATED WITH :<br ...
DIABETES INSIPIDUS ABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSIN<br />S/SX:<br />POLYURIA <br />	15-29L/ DAY<br />POLYDIPSI...
DIABETES INSIPIDUS ABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSIN<br />MANAGEMENT<br />HORMONAL REPLACEMENT – FOR LIFE<br />...
SYNDROME OF INAPPROPRIATE ADH(SIADH)<br />ELEVATED ADH<br />S/SX:<br />DECREASED SERUM SODIUM<br />CX IN LOC TO UNCONSCIOU...
SYNDROME OF INAPPROPRIATE ADH<br />MANAGEMENT:<br />WATER INTAKE RESTRICTION<br />ADMINISTER AS ORDERED:<br />NaCl<br />Di...
THYROID DISORDERS<br />
Hypothyroidism<br /> underactive state of the thyroid gland hyposecretion 		of thyroid hormone<br /> most common in women...
Hypothyroidism<br />A state of low serum TH levels<br />or cellular resistance to TH<br />Iodine deficiency<br />Oncologic...
Pathophysiology<br /><ul><li> inadequate secretion of thyroid hormone  general slowing of all physical and mental process
  metabolic rate
  oxidation of nutrients for energy
  heat production</li></li></ul><li>
Complications :<br /><ul><li>Cretinism– severe physical and mental retardation resulting from severe deficiency of thyroid...
MYXEDEMA COMA-  a condition resulting from persistent low thyroid production.<br />
Med. Mgt. – thyroid replacement therapy<br />Levothyroxine(Synthyroid) ,liothyronine<br /> Expected effects: diuresis, pu...
Nsg. Interventions<br /><ul><li>  provide a warm environment, conducive to rest
  avoid use of all sedatives
  assist client in choosing calorie,  cholesterol 	diet
   fluid and fiber to relieve constipation
   physical activity and sensory stimulation 	gradually as condition improves
  monitor cardiovascular response to increased 	hormone levels carefully
  provide info. about prescribed medications (name, 	dosage, side effects) and importance of lifelong 	medical supervision...
Hyperthyroidism<br /> over-secretion of the thyroid gland<br /> also called thyrotoxicosis  or graves disease, tissues 	ar...
Hyperthyroidism (cont.)<br />DX: > elevated T3, T4 values<br />T4= 5-12mcg/dl , T3= 70-220 ng/dl , TSH= 0.2-5.4 mU/L<br />...
may be hereditary</li></li></ul><li>Grave’s Disease<br /><ul><li> disorder char. by one or more of the ff:</li></ul> diffu...
 result from stimulation of the thyroid gland by</li></ul>    thyroid-stimulating immunoglobulins (TSI)<br /><ul><li> caus...
Complications :<br /> cardiovascular disease (HPN, Angina, CHF)<br /> Exophthalmos – abnormal protrusion of the eyeballs<b...
Thyroid Storm or Crisis<br /> a medical emergency pts. develop severe<br />    manifestation of hyperthyroidism <br />  ...
Do you take this woman as your wife…. In sickness and in health…<br />TAKE ME! TAKE ME!!<br />
Assessment Findings: Thyroid storm<br /><ul><li>Anxiety
Flushed, smooth skin
Heat intolerance
Mood swings
Diaphoresis
Tachycardia
Palpitations
Dyspnea
Delirium, coma
Heart failure</li></li></ul><li>Med. Mgt.<br /><ul><li>Medications </li></ul>Propylthiouracil (PTU) – antithyroid drug <br...
Med. Mgt.<br /><ul><li>Medications </li></ul>Propanolal (Inderal) and other adrenergic blockers<br /><ul><li> relieve the ...
 total thyroidectomy (if carcinoma is present)</li></li></ul><li>Nsg. Interventions:<br />Provide calm, restful envt. <br ...
Nsg. Interventions:<br />Provide emotional support<br />Provide eye care<br />eye drops, dark glasses, patch eyes if neces...
Post-op care after Thyroidectomy<br /><ul><li> O2 therapy, suction secretions
 Monitor for signs of bleeding and excessive edema
 elevate head of bed 30o, support head and neck – to</li></ul>    avoid tension on sutures<br /><ul><li>check dressing fre...
Post-op Complications: be alert for the possibility of:<br />1. Tetany(due to hypocalcemia caused by accidental removal of...
 Chvostek’s sign and Trousseau’s sign
 Ca+ gluconate IV</li></ul>2. Hemorrhage<br /><ul><li>WOF: hypotension, tachycardia, other signs of hypovolemia
WOF: irregular breathing, swelling, choking---possible hemorrhage and tracheal compression
WOF: early signs of hemorrhage: repeated clearing of the throat, difficulty swallowing</li></li></ul><li>Post-op Complicat...
PARATHYROID GLAND DISORDERS<br />
Promotes resorption of calcium from bone to maintain normal serum calcium levels<br />CALCIUM DEPOSITED IN THE BONE<br />M...
CHVOSTEKS/ TROUSSEAU’S
FATIGUE, WEAKNESS
CARDIAC ARRHYTHMIAS
SEIZURE
BRONCHOSPASM</li></ul>Function of calcium:<br /><ul><li> maintains N muscle and neuromuscular responses.
Necessary component for blood coagulation mechanisms</li></ul>Promotes absorption of calcium in the GI tract ( by stimulat...
TESTS USED TO ELICIT SIGNS OF CALCIUM DEFICIENCY<br />TROUSSEAU'SSIGN<br />CHVOSTEK'SSIGN<br />
PARATHYROID DISORDERS<br />DIAGNOSTIC TESTS:<br />HEMATOLOGICAL<br />SERUM CALCIUM<br />SERUM PHOSPHORUS<br />SERUM ALKALI...
HYPOPARATHYROIDISM<br />XRAY: INCREASED BONE DENSITY<br />MANAGEMENT:<br />Ca SUPPLEMENT<br />VIT D SUPPLEMENT – LIQ FORM:...
T <br />ETANY<br />AKE<br />RACHEOSTOMY<br />C <br />ALCIUM GLUCONATE<br />ARE<br />ALCIUM 8.6 – 10.6 mg / dL<br />
HYPERCALCEMIA, LACK OF RESORPTION OF CALCIUM INTO THE BONE( BONE CYST AND PATHOLOGIC FRACTURE)<br />Promotes resorption of...
Necessary component for blood coagulation mechanisms</li></ul>MUSCLE WEAKNESS<br />PERSONALITY CHANGES<br />CARDIAC ARRHYT...
HYPERPARATHYROIDISM<br />INCREASED  PTH  PRODUCTION<br />HYPERCALCEMIA<br />HYPOPHOSPHATEMIA<br />PRIMARY – TUMOR OR HYPER...
HYPERPARATHYROIDISM<br />MANAGEMENT:<br />TX OF CHOICE : SURGICAL REMOVAL OF HYPERPLASTIC TISSUE<br />IV PNSS 5L/ DAY WITH...
DISORDERS OF THE PANCREAS<br />
DIABETES MELLITUS<br />(TYPE I, TYPE II)<br />
TWO TYPES OF DIABETES<br />
Diabetes Mellitus<br /> is a chronic disorder of carbohydrate, protein, and<br />   fat metabolism resulting from insulin ...
 genetic / hereditary predisposition
 viruses
 pancreatitis
 pancreatic tumor
 autoimmune disorder
 obesity (overweight people require more insulin   </li></ul>     to metabolize the food they eat or the number of     ins...
Types<br />Insulin – Dependent Diabetes Mellitus (IDDM) or Type I<br /><ul><li> destruction of beta cells of the pancreas ...
 may occur at any age, usually appears below age 15</li></ul>Non Insulin–Dependent Diabetes Mellitus (NIDDM) or Type II<br...
 disturbance in insulin reception in the cells
 number of insulin receptors
 loss of beta cell responsiveness to glucose leading to</li></ul>   slow or  insulin release by the pancreas<br /><ul><li...
 common in overweight or obese
 w/ some circulating insulin present, often do not require</li></ul>    insulin <br />
P <br />olyuria<br />olydipsia<br />olyphagia<br />ruritus<br />aresthesia<br />oor healing<br />oor eyesight<br />
DIAGNOSTIC TEST FOR DM<br />Fasting Blood Sugar (FBS)<br /><ul><li>NPO for 12 hours
Normal value= 80-120 mg/dl
 140 mg/dl or more – diagnostic of DM</li></ul>Postprandial blood sugar<br /><ul><li>Blood is withdrawn 2 hrs. after a meal
N value = < 120mg/dl
200 mg/dl or more is diagnostic of DM</li></li></ul><li>3.    Oral Glucose Tolerance Test (OGTT)<br /><ul><li>NPO 12 hrs, ...
obtain FBS, administer 100 gm. Glucose by mouth diluted in juice; obtain blood and urine specimen after 1, 2 and 3 hrs.
N value = blood glucose rise to 140 mg/dl in the 1st hour and returns to normal by 2nd and 3rd hrs.
Abnormal = blood glucose does not return to normal by 2nd and 3rd hrs.; all urine specimen positive for glucose</li></li><...
bec. glucose in the bloodstream attaches to some of the hemoglobin and stay attached during the 120-day lifespan of the RB...
Management of Hypoglycemia<br />Give simple sugar orally if pt. is conscious and can swallow – orange juice, candy, glucos...
Oral Antidiabetic Agents<br />
Oral Antidiabetic Agents<br />
DIABETES MILLETUS<br />INSULIN THERAPY<br />DISPENSED IN “U”/ml : eg 100, 80<br />REFRIGERATE<br />GIVEN @ ROOM TEMP<br />...
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Endocrine New Edition

  1. 1. ENDOCRINE<br />SYSTEM AND MAJOR DISORDERS<br />By: MISS SHENELL A. DELFIN, RN<br />
  2. 2. FUNCTION:<br />Endocrine system consist of a series of glands “ductless” that function individually or conjointly to integrate and control innumerable metabolic activities in the body.<br />These glands automatically regulate various body processes by releasing chemical messengers called hormones.<br />OVERACTIVITY OR UNDERACTIVITY of any one of them affects the whole system.<br />
  3. 3. FUNCTION:<br />Control and coordination of the processes which are wide spread in the body such as:<br /><ul><li>Response to stress or injury
  4. 4. Growth and development
  5. 5. Reproduction
  6. 6. Fluids and electrolytes
  7. 7. Acid base-balance
  8. 8. Energy metabolism</li></li></ul><li>
  9. 9. ENDOCRINE GLANDS<br />
  10. 10.
  11. 11. ENDOCRINE GLANDS<br />
  12. 12. ENDOCRINE GLANDS<br />
  13. 13.
  14. 14.
  15. 15. ENDOCRINE GLANDS<br />
  16. 16.
  17. 17. ENDOCRINE GLANDS<br />
  18. 18.
  19. 19. ENDOCRINE GLANDS<br />
  20. 20. HORMONE REGULATION<br />NEGATIVE FEEDBACK MECHANISM<br />CHANGING OF BLOOD LEVELS OF CERTAIN SUBSTANCES (e..g CALCIUM & GLUCOSE)<br />RHYTHMIC PATTERNS OF SECRETION <br /> (e.g. CORTISOL, FEMALE REPRODUCTIVE HORMONES)<br />AUTONOMIC & C.N.S. CONTROL<br />(PITUITARY-HYPOTHALAMIC AXIS, <br /> ADRENAL MEDULLA HORMONES)<br />
  21. 21. NEGATIVE FEEDBACK MECHANISM<br />DECREASED HORMONE CONCENTRATION IN THE BLOOD (e.g. Thyroxine)<br />PITUITARY GLAND RELEASE OF STIMULATING HORMONE (e.g. TSH)<br />STIMULATION OF TARGET ORGANS TO PRODUCE & RELEASE HORMONE <br />(e.g. Thyroid gland release of Thyroxine)<br />RETURN OF THE NORMAL CONCENTRATION OF HORMONE<br />
  22. 22. NEGATIVE FEEDBACK MECHANISM<br />INCREASED HORMONE CONCENTRATION IN THE BLOOD(e.g. Thyroxine)<br />PITUITARY GLAND IS INHIBITED TO<br />RELEASE STIMULATING HORMONE (e.g. TSH)<br />DECREASED PRODUCTION & SECRETION <br />OF TARGET ORGANOF THEHORMONE <br />(e.g. Thyroid gland release of Thyroxine)<br />RETURN OF THE NORMAL CONCENTRATION OF HORMONE<br />
  23. 23. Endocrine Disorders<br />If you can remember what each hormone does in the body, it will be easier to remember what results from imbalances of that hormone. Most symptoms of hormone HYPERACTIVITY are the opposite of symptoms of that hormones HYPOACTIVITY. <br />
  24. 24. ANTERIOR PITUITARY DISTURBANCES<br />HYPOPITUITARISM<br />HYPERPITUITARISM<br />
  25. 25. PITUITARY ANTERIOR LOBE<br />
  26. 26. Hyperpituitarism<br />May be due to overactivity of gland<br />or the result of an adenoma<br />Characterized by:<br />Excessive serum concentration<br />of pituitary hormones (GH, ACTH, PRL)<br />Morphologic and functional changes<br />in the anterior pituitary<br />
  27. 27. Growth Hormone Hypersecretion<br />GIGANTISM<br />
  28. 28. Manifestations of acromegaly. Progressive alterations in facial appearance include enlargement of the cheekbones and jaw along with thickening of soft-tissue structures such as the nose, lips, cheeks, and the flesh above the brows. (Courtesy of Clinical Pathological Conference, American Journal of Medicine.)<br />
  29. 29. Hyperpituitarism:Clinical Manifestations<br />Arthritis<br />Chest: barrel-shaped<br />Rough facial features<br />Odd sensations: hands and feet<br />Muscle weakness & fatigue<br />Enlargement of organs<br />Growth of coarse hair<br />Amenorrhea; breast milk production<br />Loss of vision; headaches<br />Impotence; increased perspiration <br />Snoring<br />
  30. 30. Hyperpituitarism:Clinical Manifestations<br />
  31. 31. Hypopituitarism<br />Deficiency of one or more<br />anterior pituitary hormones<br />Causes<br />Infections / Inflammatory disorders<br />Autoimmune diseases<br />Congenital absence<br />Tumor<br />Surgery / Radiation therapy<br />
  32. 32. Hypopituitarism:Clinical Manifestations<br />Hypo-thermia, -glycemia, -tension<br />Loss of vision, strength, libido, & secondary sexual characteristics<br />
  33. 33. DWARFISM<br />
  34. 34. MANAGEMENT<br />HYPOPITUITARISM<br />SURGICAL REMOVAL / IRRADIATION<br />REPLACEMENT THERAPY<br />THYROID HORMONES<br />STEROIDS<br />SEX & GROWTH HORMONES<br />GONADOTROPINS (restore fertility)<br />HYPERPITUITARISM<br />SURGICAL REMOVAL / IRRADIATION<br />MONITOR FOR HYPERGLYCEMIA & CARDIOVASCULAR PROBLEMS<br />
  35. 35. Trans-sphenoidal hypophysectomy<br />
  36. 36. POSTERIOR PITUITARY DISTURBANCES<br />DIABETES INSIPIDUS<br />SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE<br />
  37. 37. FUNCTION:<br />WHEN THERE IS A OF SERUM OSMOLALITY, THE NORMAL BODY RESPONSE IS TO THE SECRETION OF ADH.<br />WHEN THE NORMAL FEEDBACK MECHANISM FOR ADH IS SUSTAINED, THERE IS EXCESSIVE WATER RETENTION IN THE BODY<br />WHEN THERE IS OR INADEQUATE AMOUNT OF ADH, THE BODY IS UNABLE TO CONCENTRATE URINE, & EXCESSIVE H2O LOSS OCCURS<br />
  38. 38.
  39. 39.
  40. 40. DIABETES INSIPIDUS<br />CHARACTERIZED BY A DEFICIENCY OF ADH. <br />WHEN IT OCCURS, IT IS MOST OFTEN ASSOCIATED WITH :<br />NEUROLOGICAL CONDITIONS, <br />SURGERY, <br />TUMORS, <br />HEAD INJURY, <br />OR INFLAMMATORY PROBLEMS<br />
  41. 41. DIABETES INSIPIDUS ABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSIN<br />S/SX:<br />POLYURIA <br /> 15-29L/ DAY<br />POLYDIPSIA<br />SG OF URINE IS <br /> <1.010<br />S/SX OF DHN<br />SHOCK<br />
  42. 42. DIABETES INSIPIDUS ABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSIN<br />MANAGEMENT<br />HORMONAL REPLACEMENT – FOR LIFE<br />VASOPRESSIN (PITRESSIN TANNATE IN OIL) – IM OR NASAL SPRAY<br />NON-HORMONAL THERAPY<br />CHLORPROPRAMIDE – INCREASE RESPONSE OF THE BODY TO DECREASEDVASOPRESSIN<br />INCREASE FLUIDS<br />MONITOR I&O + WEIGHT (MIOW)<br />MAINTAIN FLUID & ELECTROLYTE BALANCE <br />
  43. 43. SYNDROME OF INAPPROPRIATE ADH(SIADH)<br />ELEVATED ADH<br />S/SX:<br />DECREASED SERUM SODIUM<br />CX IN LOC TO UNCONSCIOUSNESS<br />SEIZURES<br />WATER INTOXICATION<br />N/V<br />MENTAL CONFUSION<br />Persistent excretion of concentrated urine<br />Signs of fluid overload<br />Hyponatremia<br />
  44. 44. SYNDROME OF INAPPROPRIATE ADH<br />MANAGEMENT:<br />WATER INTAKE RESTRICTION<br />ADMINISTER AS ORDERED:<br />NaCl<br />Diuretics<br />Demeclocycline (declamycin) – a tetracycline analogue that interferes with the action of ADH on the collecting tubules<br />
  45. 45. THYROID DISORDERS<br />
  46. 46.
  47. 47. Hypothyroidism<br /> underactive state of the thyroid gland hyposecretion of thyroid hormone<br /> most common in women, middle-age<br /> primary function is to control the level of cellular metabolism by secreting thyroxin (T4) and triiodothyronine (T3)<br />DX: decreased T3, T4<br /> Elevated TSH, cholesterol<br />
  48. 48. Hypothyroidism<br />A state of low serum TH levels<br />or cellular resistance to TH<br />Iodine deficiency<br />Oncologic<br />Autoimmune<br />Drugs<br />Developmental<br />Iatrogenic<br />Dietary<br />Non-thyroidal<br />Endocrine<br />
  49. 49. Pathophysiology<br /><ul><li> inadequate secretion of thyroid hormone  general slowing of all physical and mental process
  50. 50.  metabolic rate
  51. 51.  oxidation of nutrients for energy
  52. 52.  heat production</li></li></ul><li>
  53. 53. Complications :<br /><ul><li>Cretinism– severe physical and mental retardation resulting from severe deficiency of thyroid function in infancy or childhood (congenital hypothyroidism)</li></ul> requires lifetime hormone replacement<br /><ul><li>Myxedema– occur from prolonged severe disease</li></ul> accelerated devt. of coronary artery disease<br /> coma – rapid dev’t. of impaired consciousness and<br /> suppression of vital functions<br />
  54. 54. MYXEDEMA COMA- a condition resulting from persistent low thyroid production.<br />
  55. 55. Med. Mgt. – thyroid replacement therapy<br />Levothyroxine(Synthyroid) ,liothyronine<br /> Expected effects: diuresis, puffiness, improved reflexes and muscle tone, PR<br />
  56. 56. Nsg. Interventions<br /><ul><li> provide a warm environment, conducive to rest
  57. 57. avoid use of all sedatives
  58. 58. assist client in choosing calorie,  cholesterol diet
  59. 59.  fluid and fiber to relieve constipation
  60. 60.  physical activity and sensory stimulation gradually as condition improves
  61. 61. monitor cardiovascular response to increased hormone levels carefully
  62. 62. provide info. about prescribed medications (name, dosage, side effects) and importance of lifelong medical supervision</li></li></ul><li>
  63. 63. Hyperthyroidism<br /> over-secretion of the thyroid gland<br /> also called thyrotoxicosis or graves disease, tissues are stimulated by excessive thyroid hormone <br /> a recurrent syndrome, may appear after emotional<br /> stress or infection<br /> occurs mostly in women 20-50 yrs old<br />Causes : adenoma, goiter, viral inflammation, auto-immune glandular stimulation, grave’s disease - most common cause<br />
  64. 64. Hyperthyroidism (cont.)<br />DX: > elevated T3, T4 values<br />T4= 5-12mcg/dl , T3= 70-220 ng/dl , TSH= 0.2-5.4 mU/L<br /><ul><li>abnormal findings in the thyroid scan</li></ul>Goiter – enlargement of the thyroid gland <br /><ul><li>due to  stimulation of the thyroid gland by TSH</li></ul>Simple goiter – enlarged thyroid gland<br /><ul><li>due to iodine deficiency, intake of goitrogenic foods  cabbage, turnips, soybeans
  65. 65. may be hereditary</li></li></ul><li>Grave’s Disease<br /><ul><li> disorder char. by one or more of the ff:</li></ul> diffuse goiter<br /> hyperthyroidism<br /> infiltrative opthalmopathy  exophthalmos<br /><ul><li> seen in females under age 40
  66. 66. result from stimulation of the thyroid gland by</li></ul> thyroid-stimulating immunoglobulins (TSI)<br /><ul><li> cause is unknown, may be hereditary, gender-related,</li></ul> often occurs after severe emotional stress or<br /> infection<br />
  67. 67.
  68. 68. Complications :<br /> cardiovascular disease (HPN, Angina, CHF)<br /> Exophthalmos – abnormal protrusion of the eyeballs<br /><ul><li> caused by abnormal deposits of fat and fluid in </li></ul> the retroocular tissue<br /> Corneal abrasion <br />Thyroid storm or crisis  life-threatening <br /> hypermetabolism and excessive adrenergic<br /> response (HR, RR, BP)<br />
  69. 69. Thyroid Storm or Crisis<br /> a medical emergency pts. develop severe<br /> manifestation of hyperthyroidism <br />  temp., tachycardia, dysrhythmias<br /> worsening tremors, restlessness<br /> delirious or psychotic state or coma<br /> abdominal pain<br />  BP and RR<br />Precipitated by a major stressor: <br /> infection<br /> trauma or surgery (thyroidectomy)<br /> inadequate treatment<br />
  70. 70. Do you take this woman as your wife…. In sickness and in health…<br />TAKE ME! TAKE ME!!<br />
  71. 71.
  72. 72. Assessment Findings: Thyroid storm<br /><ul><li>Anxiety
  73. 73. Flushed, smooth skin
  74. 74. Heat intolerance
  75. 75. Mood swings
  76. 76. Diaphoresis
  77. 77. Tachycardia
  78. 78. Palpitations
  79. 79. Dyspnea
  80. 80. Delirium, coma
  81. 81. Heart failure</li></li></ul><li>Med. Mgt.<br /><ul><li>Medications </li></ul>Propylthiouracil (PTU) – antithyroid drug <br /> - blocks thyroid hormone production<br /> - can cause agranulocytosis<br /> - monitor pt. CBC<br />Methimazole (Tapazole) – blocks TH prod.<br /> Iodine preparations –  the size and <br />vascularity of the thyroid gland; inhibit release of<br /> thyroid hormones<br /> 1.) Lugol’s solution<br /> can be given with milk or fruit juice<br /> should be taken with a straw – may stain the teeth<br /> complications : brassy taste in the mouth, sore teeth and gums<br />2.) Saturated solution of potassium iodide (SSKI)<br />
  82. 82. Med. Mgt.<br /><ul><li>Medications </li></ul>Propanolal (Inderal) and other adrenergic blockers<br /><ul><li> relieve the adrenergic effects of excess thyroid</li></ul> hormone (sweating, palpitations, tremors)<br /><ul><li>Radioactive iodine – limits the secretion of the</li></ul> hormone by damaging or destroying thyroid tissue<br /><ul><li>Surgical intervention (performed only when pt. is in a</li></ul>euthyroid state)<br /><ul><li> subtotal thyroidectomy (large goiter)
  83. 83. total thyroidectomy (if carcinoma is present)</li></li></ul><li>Nsg. Interventions:<br />Provide calm, restful envt. <br />physical comfort, cool envt. temp., bathe frequently w/ cool water<br />provide adequate rest, avoid muscle fatigue<br /> stressors in the envt.— noise and lights<br />relaxation techniques<br />Provide adequate nutrients<br /> calorie,  protein, balanced diet (4,000-5,000 cal/day)<br /> fluid intake<br />Restrict stimulants (tea, coffee, alcohol)<br />small, frequent feedings if hypermotility is present<br />Daily wt.<br />
  84. 84. Nsg. Interventions:<br />Provide emotional support<br />Provide eye care<br />eye drops, dark glasses, patch eyes if necessary<br />elevate head of bed for sleep<br />restrict dietary sodium<br />assess adequacy of lid closure<br />Be alert for complications<br />
  85. 85. Post-op care after Thyroidectomy<br /><ul><li> O2 therapy, suction secretions
  86. 86. Monitor for signs of bleeding and excessive edema
  87. 87. elevate head of bed 30o, support head and neck – to</li></ul> avoid tension on sutures<br /><ul><li>check dressing frequently, check behind the neck for</li></ul> bleeding<br /><ul><li> assess for signs of resp. distress, hoarseness</li></ul> (laryngeal edema or damage)<br /><ul><li> keep tracheostomy set in patient’s room for emergency</li></ul> use<br />
  88. 88. Post-op Complications: be alert for the possibility of:<br />1. Tetany(due to hypocalcemia caused by accidental removal of parathyroid glands)<br /><ul><li>assess for numbness, tingling or muscle twitching
  89. 89. Chvostek’s sign and Trousseau’s sign
  90. 90. Ca+ gluconate IV</li></ul>2. Hemorrhage<br /><ul><li>WOF: hypotension, tachycardia, other signs of hypovolemia
  91. 91. WOF: irregular breathing, swelling, choking---possible hemorrhage and tracheal compression
  92. 92. WOF: early signs of hemorrhage: repeated clearing of the throat, difficulty swallowing</li></li></ul><li>Post-op Complications: be alert for the possibility of:<br />3. Thyroid storm <br /> - life-threatening<br /> - sudden  release of thyroid hormone<br /> - fever, tachycardia, increasing restlessness and<br /> agitation, delirium<br />
  93. 93.
  94. 94.
  95. 95. PARATHYROID GLAND DISORDERS<br />
  96. 96.
  97. 97.
  98. 98. Promotes resorption of calcium from bone to maintain normal serum calcium levels<br />CALCIUM DEPOSITED IN THE BONE<br />Mobilization of calcium and phosphorous from bone<br />Renal: increases calcium reabsorption and phosphate excretion<br />CALCIUM STAYS IN THE BONE<br />EXCRETION OF CALCIUM <br />Hypoparathyroidism is characterized by decrease in the PTH level<br />PARATHYROID HORMONE<br /><ul><li>TINGLING OF FINGERS
  99. 99. CHVOSTEKS/ TROUSSEAU’S
  100. 100. FATIGUE, WEAKNESS
  101. 101. CARDIAC ARRHYTHMIAS
  102. 102. SEIZURE
  103. 103. BRONCHOSPASM</li></ul>Function of calcium:<br /><ul><li> maintains N muscle and neuromuscular responses.
  104. 104. Necessary component for blood coagulation mechanisms</li></ul>Promotes absorption of calcium in the GI tract ( by stimulating kidneys to convert vit.D to its active form).<br />HYPOCALCEMIA<br />
  105. 105. TESTS USED TO ELICIT SIGNS OF CALCIUM DEFICIENCY<br />TROUSSEAU'SSIGN<br />CHVOSTEK'SSIGN<br />
  106. 106. PARATHYROID DISORDERS<br />DIAGNOSTIC TESTS:<br />HEMATOLOGICAL<br />SERUM CALCIUM<br />SERUM PHOSPHORUS<br />SERUM ALKALINE PHOSPHATASE<br />URINARY STUDIES<br />URINARY CALCIUM<br />URINARY PHOSPHATE - TUBULAR REABSORPTION OF PHOSPHATE<br />
  107. 107. HYPOPARATHYROIDISM<br />XRAY: INCREASED BONE DENSITY<br />MANAGEMENT:<br />Ca SUPPLEMENT<br />VIT D SUPPLEMENT – LIQ FORM: WITH WATER, JUICE OR MILK, pc<br />SEIZURE prec<br />LISTEN FOR STRIDOR OR HOARSENESS<br />TRACHEOSTOMY SET @ BEDSIDE<br />CaGLUCONATE @ BEDSIDE<br />
  108. 108. T <br />ETANY<br />AKE<br />RACHEOSTOMY<br />C <br />ALCIUM GLUCONATE<br />ARE<br />ALCIUM 8.6 – 10.6 mg / dL<br />
  109. 109. HYPERCALCEMIA, LACK OF RESORPTION OF CALCIUM INTO THE BONE( BONE CYST AND PATHOLOGIC FRACTURE)<br />Promotes resorption of calcium from bone to maintain normal serum calcium levels<br />TUBULAR CALCIUM DEPOSIT- KIDNEY STONES, AZOTEMIA, HPN BY RF, RENAL FAILURE<br />CALCIUM RELEASED INTO THE BLOOD LEADS TO BONE DAMAGE<br />Mobilization of calcium and phosphorous from bone<br />Renal: increases calcium reabsorption and phosphate excretion<br />Hyperparathyroidism is characterized by excesssive secretion of PTH<br />PARATHYROID HORMONE<br />Function of calcium:<br /><ul><li> maintains N muscle and neuromuscular responses.
  110. 110. Necessary component for blood coagulation mechanisms</li></ul>MUSCLE WEAKNESS<br />PERSONALITY CHANGES<br />CARDIAC ARRHYTHMIAS<br />Promotes absorption of calcium in the GI tract ( by stimulating kidneys to convert vit.D to its active form).<br />ANOREXIA<br />N/V<br />CONSTIPATION<br />PEPTIC ULCER DSE<br />
  111. 111. HYPERPARATHYROIDISM<br />INCREASED PTH PRODUCTION<br />HYPERCALCEMIA<br />HYPOPHOSPHATEMIA<br />PRIMARY – TUMOR OR HYPERPLASIA OF THE PARATHYROID GLAND<br />SECONDARY – COMPENSATORY OVERSECRETION OF PTH IN RESPONSE TO HYPOCALCEMIA FROM:<br />CHRONIC RENAL DSE<br />MALABSORPTION SYNDROME<br />OSTEOMALACIA <br />
  112. 112. HYPERPARATHYROIDISM<br />MANAGEMENT:<br />TX OF CHOICE : SURGICAL REMOVAL OF HYPERPLASTIC TISSUE<br />IV PNSS 5L/ DAY WITH DIURETICS<br />CRANBERRY JUICE (ACID-ASH)<br />LOW Ca<br />STRAIN URINE FOR STONES<br />CARE FOR PARATHYROIDECTOMY<br />
  113. 113. DISORDERS OF THE PANCREAS<br />
  114. 114. DIABETES MELLITUS<br />(TYPE I, TYPE II)<br />
  115. 115.
  116. 116. TWO TYPES OF DIABETES<br />
  117. 117. Diabetes Mellitus<br /> is a chronic disorder of carbohydrate, protein, and<br /> fat metabolism resulting from insulin deficiency or<br /> abnormality in the use of insulin<br />Predisposing factors:<br /><ul><li> exact cause of diabetes mellitus remain unknown
  118. 118. genetic / hereditary predisposition
  119. 119. viruses
  120. 120. pancreatitis
  121. 121. pancreatic tumor
  122. 122. autoimmune disorder
  123. 123. obesity (overweight people require more insulin </li></ul> to metabolize the food they eat or the number of insulin receptor sites in cells is decreased)<br />
  124. 124. Types<br />Insulin – Dependent Diabetes Mellitus (IDDM) or Type I<br /><ul><li> destruction of beta cells of the pancreas  little or no</li></ul> insulin production<br /><ul><li> requires daily insulin admin.
  125. 125. may occur at any age, usually appears below age 15</li></ul>Non Insulin–Dependent Diabetes Mellitus (NIDDM) or Type II<br /><ul><li> probably caused by:
  126. 126. disturbance in insulin reception in the cells
  127. 127.  number of insulin receptors
  128. 128. loss of beta cell responsiveness to glucose leading to</li></ul> slow or  insulin release by the pancreas<br /><ul><li> occurs over age 40 but can occur in children
  129. 129. common in overweight or obese
  130. 130. w/ some circulating insulin present, often do not require</li></ul> insulin <br />
  131. 131.
  132. 132.
  133. 133. P <br />olyuria<br />olydipsia<br />olyphagia<br />ruritus<br />aresthesia<br />oor healing<br />oor eyesight<br />
  134. 134.
  135. 135. DIAGNOSTIC TEST FOR DM<br />Fasting Blood Sugar (FBS)<br /><ul><li>NPO for 12 hours
  136. 136. Normal value= 80-120 mg/dl
  137. 137. 140 mg/dl or more – diagnostic of DM</li></ul>Postprandial blood sugar<br /><ul><li>Blood is withdrawn 2 hrs. after a meal
  138. 138. N value = < 120mg/dl
  139. 139. 200 mg/dl or more is diagnostic of DM</li></li></ul><li>3. Oral Glucose Tolerance Test (OGTT)<br /><ul><li>NPO 12 hrs, no smoking, coffee or tea, minimize activity, minimize stress
  140. 140. obtain FBS, administer 100 gm. Glucose by mouth diluted in juice; obtain blood and urine specimen after 1, 2 and 3 hrs.
  141. 141. N value = blood glucose rise to 140 mg/dl in the 1st hour and returns to normal by 2nd and 3rd hrs.
  142. 142. Abnormal = blood glucose does not return to normal by 2nd and 3rd hrs.; all urine specimen positive for glucose</li></li></ul><li>Diagnostic Tests for DM<br />4. Glycosylated hemoglobin<br /><ul><li>Provides information about blood glucose level during the previous 3 months
  143. 143. bec. glucose in the bloodstream attaches to some of the hemoglobin and stay attached during the 120-day lifespan of the RBC</li></li></ul><li>D-I-A-B-E-T-E-S<br />D- DIET: 50-60% CHO, 20-30% FATS, 10-20% CHON<br />I- INSULIN– TYPE 1<br />A- ANTIDIABETIC AGENTS– TYPE 2<br />B- BLOOD SUGAR MONITORING<br />E- EXERCISE<br />T- TRANSPLANT OF PANCREAS<br />E- ENSURE ADEQUATE FOOD INTAKE<br />S- SCRUPULOUS FOOT CARE<br />
  144. 144.
  145. 145. Management of Hypoglycemia<br />Give simple sugar orally if pt. is conscious and can swallow – orange juice, candy, glucose tablets, lump of sugar<br />Give Glucagon (SQ or IM) if pt. is unconscious or cannot take sugar by mouth<br />As soon as pt. regains consciousness, he should be given carbohydrate by mouth<br />If pt. does not respond to the above measures, he is given 50 ml of 50% glucose I.V. or 1000 ml of 5%-10% glucose in water I.V.<br />
  146. 146.
  147. 147. Oral Antidiabetic Agents<br />
  148. 148. Oral Antidiabetic Agents<br />
  149. 149. DIABETES MILLETUS<br />INSULIN THERAPY<br />DISPENSED IN “U”/ml : eg 100, 80<br />REFRIGERATE<br />GIVEN @ ROOM TEMP<br />GENTLY ROTATED, NOT SHAKEN<br />ROUTE : SQ ; IM OR IV <br />SYRINGE: 5/8 INCH ; SAME BRAND<br />
  150. 150.
  151. 151. DIABETES MILLETUS<br />INSULIN THERAPY:<br />SITE OF INJECTION:<br />ABDOMEN<br />ANTERIOR THIGH<br />ARM <br />UPPER BACK <br />BUTTOCKS<br />
  152. 152.
  153. 153.
  154. 154. B. Teach pt. on correct administration of insulin and other hypoglycemic agents.<br />insulin in current use may be stored at room temp., all others in ref. or cool area<br />avoid injecting cold insulin  lead to tissue reaction<br />roll insulin vial to mix, do not shake, remove air bubbles from syringe<br />press (do not rub) the site after injection (rubbing may alter the rate of absorption of insulin)<br />avoid smoking for 30 mins. after injection (cigarette smoking absorption)<br />Rotate sites<br /><ul><li>Failure to rotate sites may lead to Lipodystrophy
  155. 155. Lipodystrophy – localized disturbance of fat metabolism
  156. 156. Ex. Lipohypertrophy – thickening of subcutaneous tissue at injection site, feel lumpy or hard, spongy</li></ul> result to  absorption of insulin making it difficult to control the pt.’s blood glucose<br />
  157. 157. Teach pt. to estabilish and maintain a pattern of regular exercise<br />Benefits of exercise : <br />promotes use of CHO & enhances action of insulin<br /> blood glucose levels<br /> need for insulin<br /> the no. of functioning receptor sites for insulin<br /><ul><li>perform exercise after meals to ensure an adequate level of blood glucose
  158. 158. carry a rapid-acting source of glucose during exercise
  159. 159. excessive or unplanned exercise may trigger hypoglycemia
  160. 160. take insulin and food before active exercise</li></li></ul><li>
  161. 161. ACUTE COMPLICATIONS OF DIABETES MILLETUS<br />DIABETIC KETO-ACIDOSIS (DKA)<br />INSULIN SHOCK<br />HYPERGLYCEMIC, HYPEROSMOLAR, <br /> NONKETOTIC (HHONK) COMA <br />
  162. 162.
  163. 163. Diabetic Ketoacidosis (DKA) Coma<br />S/Sx:<br />polyuria, thirst<br />nausea, vomiting, abdominal pain –-- due to acidosis<br />weakness, headache, fatigue --- due to acidosis and F/E imbalance<br />dim vision<br />dehydration, hypovolemic shock (PR, BP, dry skin, wt. loss)<br />hyperpnea (Kussmaul’s breathing)<br />acetone breath (fruity odor)<br />lethargy  COMA<br />Blood glucose level > 250-350 mg/100 ml.<br />
  164. 164.
  165. 165.
  166. 166.
  167. 167. Hyperglycemic, Hyperosmolar, Non-Ketotic Coma (HHNC)<br />can occur when the action of insulin is severely inhibited<br />seen in pts. w/ NIDDM, elderly persons w/ NIDDM<br />Precipitating factors:<br />infection, renal failure, MI, CVA, GI hemorrhage, pancreatitis, CHF, TPN, surgery, dialysis, steroids<br />S/Sx:<br /><ul><li>polyuriaoliguria (renal insufficiency)
  168. 168. lethargy
  169. 169. temp, PR, BP, signs of severe fluid deficit
  170. 170. Confusion, seizure, coma
  171. 171. Blood glucose level > 600 mg/100 ml.</li></li></ul><li>HHONK<br />S/SX:<br />S/SX OF DKA WITHOUT:<br />KAUSMAUL’S BREATHING<br />ACETONE BREATH<br />METABOLIC ACIDOSIS<br />KETONURIA<br />
  172. 172. Interventions for DKA and Hyperosmolar Coma<br />Regular insulin IV push or IV drip<br /> 0.9% NaCl IV – 1 L during the 1st hr, 2-8 L over 24 hrs.<br /> administer sodium bicarbonate IV to correct acidosis<br /> Monitor electrolyte levels, esp. serum K+ levels<br /> administer K+, monitor UO hourly (30ml/hr)<br />
  173. 173. Long-term Complications of DM<br />Vascular Changes<br />) Macroangiopathy – hardening and damage of the walls of large arteries<br />Coronary Artery Disease<br />CVA (Stroke)<br />Peripheral vascular disease – foot ulcers and gangrene<br />b. ) Microangiopathy – destruction of small blood vessels<br />Retinopathy – damage to retinal capillaries; hemorrhage, blindness<br />Nephropathy – damage microcirculation of kidneys; CRF<br />2. Neuropathy <br />Damage to the neurons caused by vascular insufficiency and  blood glucose<br />Sensory and motor impairment<br />Numbness, tingling, pain in extremities <br />Painless neuropathy<br />Impotence!!<br />
  174. 174.
  175. 175.
  176. 176.
  177. 177. DISORDERS OF THE ADRENAL GLANDS<br />
  178. 178. ADRENAL GLAND<br />STIMULATED BY ACTH<br />ADRENAL MEDULLA- SECRETES CATECOLAMINE, (EPINEPHRINE, & NOREPINEPHRINE).<br />ADRENAL CORTEX- MAIN BODY; RESP FOR SECRETION OF GLUCO,MINERALO, SEX HORMONES (ANDRO & ESTRO)<br />FUNCTION IS TO CONTROL THE (-) FEEDBACK MECHANISMS REGULATING HORMONE RELEASE<br />
  179. 179.
  180. 180. ADRENAL CORTEX DISORERS<br />ADRENAL INSUFFICIENCY ( ADDISON’S DSE)<br />CUSHING’S SYNDROME<br />
  181. 181. ADRENAL INSUFFICIENCYADDISON’S DISEASE<br />INCAPABILITY OF THE ADRENAL CORTEX TO PRODUCE GLUCOCORTICOIDS IN RESPONSE TO STRESS <br />
  182. 182.
  183. 183. Addison's Disease<br />Replacement of hormones <br />Hydrocortisone; Fludrocortisone<br />PNSS (0.9 NaCl)<br />Dextrose <br />Diet:<br />High-CHO & CHON<br />Low potassium, high sodium<br />
  184. 184. Addison’s disease<br />
  185. 185. Addison's Disease<br />MVS [4x / day]<br />Infection, Addisonian crisis, dehydration<br />MIOW / MBP / MBG<br />Give steroids with milk or an antacid<br />Avoid: Contacts & Stress <br />
  186. 186. CUSHING’S SYNDROME<br />CAUSE:<br />SUSTAINED OVER-PRODUCTION OF GLUCOCORTICOIDS BY ADRENAL GLAND FROM<br /> ACTH BY PITUITARY TUMOR<br />EXCESSIVE GLUCORTICOID ADMINISTRATION<br />
  187. 187. CUSHING’S SYNDROME<br />S/SX:<br />TRUNCAL OBESITY<br />BUFFALO HUMP<br />MOON-FACE<br />WT GAIN<br />SODIUM RETENTION<br />THINNING OF EXTREMITIES – FROM LOSS OF MUSCLE TISSUE DUE TO PROTEIN CATABOLISM<br />
  188. 188. CUSHING’S SYNDROME<br />PURPLE STRIAE – FROM THINNING OF SKIN<br />ECHYMOSIS FROM SLIGHT TRAUMA<br />ANDROGENIC EFFECTS:<br />OLIGOMENORRHEA<br /> HIRSUTISM<br /> GYNECOMASTIA<br />HYPERTENSION FROM S. Na<br />
  189. 189.
  190. 190. CUSHING’S SYNDROME<br />TREATMENT & NURSING CARE:<br />PSYCHOLOGICAL SUPPORT<br />PREVENT INFECTION – INFLAM & IMMUNE RESPONSE ARE SUPPRESSED<br />PROMOTE SAFETY <br />SURGERY – SUB/TOTAL ADRENALECTOMY<br />Treat HPN<br />
  191. 191. ALDOSTERONISM<br />HYPERSECRETION OF ALDOSTERONE<br />CONN’S SYNDROME<br />
  192. 192. CONN’S SYNDROME<br />PRIMARY ALDOSTERONISM<br />CAUSE:<br />ADRENAL ADENOMA<br />S/SX:<br />HYPOKALEMIA<br />FATIGUE<br />HYPERNATREMIA, HPN<br />MANAGEMENT:<br />SURGERY<br />ALDACTONE – ALDOSTERONE ANTAGONIST<br />
  193. 193.
  194. 194. ADRENAL MEDULLA<br />HORMONES : EPINEPHRINE<br /> NOREPINEPHRINE EFFECTS<br />
  195. 195. PHEOCHROMOCYTOMA<br />TUMOR OF ADRENAL MEDULLA SECRETES INCREASED AMOUNT OF CATECHOLAMINES<br />A small tumor in the adrenal gland that secretes large amounts of epinephrine and norepinephrine.<br />S/SX:<br />HPN<br />HYPERGLYCEMIA<br />CARDIAC ARRHYTHMIA & CHF <br />DIAGNOSTIC TEST : <br />VMA IN 24H URINE- VANILLYMANDALIC ACID<br />
  196. 196. VMA IN 24H URINE<br />END PRODUCT OF CATECHOLAMINE METABOLISM<br />DRUGS & FOOD TO BE WITHHELD 24H B4 THE TEST:<br />COFFEE & TEA<br />BANANA<br />VANILLA<br />CHOCOLATES<br />
  197. 197. PHEOCHROMOCYTOMA<br />MANAGEMENT:<br />SURGERY<br />MEDICAL : ADRENERGIC BLOCKING AGENTS: PHENTOLAMINE<br />NURSING CARE:<br />MONITOR BP IN SUPINE & STANDING<br />MONITOR URINE FOR GLUCOSE & ACETONE<br />
  198. 198.
  199. 199. RECAP:<br />ANTERIOR PITUITARY:<br /><ul><li>GIGANTISM,
  200. 200. ACROMEGALLY,
  201. 201. DWARFISM</li></ul>POSTERIOR PITUITARY:<br /><ul><li>DIABETES INSIPIDUS,
  202. 202. SIADH</li></ul>LOCATION: BASE OF THE BRAIN<br />
  203. 203. RECAP<br />ADRENAL GLAND:<br /><ul><li>ADDISON’S DSE
  204. 204. CUSHING SYNDROME
  205. 205. ALADOSTERONISM</li></ul>ADRENAL MEDULLA:<br /><ul><li>PHEOCHROMOCYTOMA</li></ul>LOCATION: ON TOP OF THE KIDNEY<br />
  206. 206. RECAP<br />PANCREAS:<br /><ul><li>DM</li></ul>LOCATION: POSTERIOR TO LIVER<br />PARATHYROID:<br /><ul><li>HYPORATHYROIDISM
  207. 207. HYPERPARATHYROIDISM</li></ul>LOCATION: NEAR THYROID<br />
  208. 208. RECAP<br />THYROID:<br /><ul><li>HYPOTHYROIDISM
  209. 209. CRETINISM
  210. 210. MYXEDEMA
  211. 211. HYPERTHYROIDISM (GRAVE’S DSE)</li></ul>LOCATION: ANTERIOR PART OF NECK<br />
  212. 212. QUESTION NO. 1<br />A CLIENT IS FOUND TO BE COMATOSE & HYPOGLYCEMIC W/ A BLOOD SUGAR OF 50 MG/DL. WHAT NURSING ACTION IS IMPLEMENTED FIRST?<br />INFUSE 1L OF D5W OVER A 12 HR PERIOD.<br />ADMIN. 50% GLUCOSE IV<br />CHECK THE CLIENT’S URINE FOR THE PRESENCE OF SUGAR AND ACETONE<br />ENCOURAGE THE CLIENT TO DRINK ORANGE JUICE W/ ADDED SUGAR<br />
  213. 213. QUESTION NO.2<br />WHAT IS THE PRIMARY ACTION OF INSULIN IN THE BODY?<br />ENHANCES THE TRANSPORT OF GLUCOSE ACROSS THE CELL WALLS<br />AIDS IN THE PROCESS OF GLUCONEOGENESIS<br />STIMULATES THE PANCREATIC BETA CELLS<br />DECREASE THE INTESTINAL ABSORPTION OF GLUCOSE<br />
  214. 214. QUESTION NO.3<br />POSTOPERATIVE THYROIDECTOMY NURSING CARE INCLUDES WHICH MEASURES?<br />HAVE CLIENT SPEAK EVERY 5-10 MINUTES IF HOARSENESS IS PRESENT<br />PROVIDE LOW-CALCIUM DIET TO PREVENT HYPERCALCEMIA<br />CHECK THE DRESSING AT THE BACK OF THE NECK FOR BLEEDING<br />APPLY SOFT CERVICAL COLLAR TO RESTRICT MOVEMENT<br />
  215. 215. Any Questions???<br />
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