PSYCHOENDOCRINOLOGY Dr. James M. Alo, RN,MAN,MAP.PHD
ENDOCRINE GLANDSENDOCRINE   HORMONES         FUNCTIONSGLANDPITUITARY TSH                 Thyroid to release               ...
ENDOCRINE GLANDSENDOCRINE    HORMONE    FUNCTIONGLANDPITUITARY    ADH        Regulates water metabolism POSTERIOR  LOBE   ...
ENDOCRINE GLANDSENDOCRINE   HORMONES      FUNCTIONGLANDADRENAL     ALDOSTERONE   Fluid & electrolyte balance;             ...
ENDOCRINE GLANDSENDOCRINE   HORMONE       FUNCTIONGLANDADRENAL     EPINEPHRINE   Increase heart rate & BP                 ...
ENDOCRINE GLANDSENDOCRINE   HORMONE       FUNCTIONGLANDTHYROID     T3 & T4’       Regulate metabolic rate                 ...
ENDOCRINE GLANDSENDOCRINE   HORMONE    FUNCTIONGLANDPANCREAS INSULIN       Decrease blood glucose by:                     ...
ENDOCRINE GLANDSENDOCRINE HORMONES      FUNCTIONGLANDOVARIES   ESTROGEN & Development of secondary sex                    ...
HORMONE REGULATIONNEGATIVE FEEDBACK MECHANISMCHANGING OF BLOOD LEVELS OFCERTAIN SUBSTANCES (e..g CALCIUM & GLUCOSE)RHYTHMI...
NEGATIVE FEEDBACK    MECHANISMDECREASED HORMONE CONCENTRATION      IN THE BLOOD (e.g. Thyroxine)            PITUITARY GLAN...
NEGATIVE FEEDBACK    MECHANISMINCREASED HORMONE CONCENTRATION      IN THE BLOOD (e.g. Thyroxine)  PITUITARY GLAND IS INHIB...
CASE STUDYKatie, an elderly, came in because ofpalpitations.VS revealed: 37.9o , 120, 25, 140/ 90She expressed hyperactivt...
CASE STUDYShe claimed history of goiter since her30’s but no follow-up was done.What are your nursing plans?
PLANNINGHEALTH PROMOTIONl IODIZED SALTl CONTROLLING WEIGHTHEALTH MAINTENANCE &RESTORATIONl   STEROID THERAPY
STEROID THERAPY                  STEROID LEVELS      PITUITARY GLAND IS INHIBITED TO              REALEASE ACTH   ENDOGENO...
STEROID THERAPYPHARMACOLOGIC CONSIDERATIONS: PEPTIC ULCER IN SHORT TERM, HIGH DOSE STEROID TX ADMINISTER DRUG: HIGHER DOSE...
STEROID THERAPYASSESSMENT: BASELINE STEROID LEVEL IS ASSESSED BEFORE PROLONGED THERAPY IS STARTED TO DETERMINE THE DOSE RE...
STEROID THERAPYASSESSMENT: ACUTE ADRENAL CRISIS l   RESTLESSNESS l   WEAKNESS l   HEADACHE l   DHN l   N/V l   FALLING BP ...
STEROID THERAPYIMPORTANT FACTS: MAJOR UNTOWARD EFFECTS: l MASKS INFECTION l   DEFENSE AGAINST INFECTION FROM      LYMPHOPE...
STEROID THERAPYIMPORTANT FACTS: MINOR UNTOWARD EFFECTS: l PIGMENTATION l ACNE l FACIAL HAIR l MOON-FACIE
STEROID THERAPYIMPORTANT FACTS: PROBLEMS OF LONG TERM THERAPY: l GROWTH RETARDATION l OBESITY l GASTRITIS TO P.U.D. l OSTE...
STEROID THERAPY                  STEROID LEVELS      PITUITARY GLAND IS INHIBITED TO              REALEASE ACTH   ENDOGENO...
STEROID THERAPYIMPLEMENTATION DECREASE Na IN THE DIET CALORIC RESTRICTION FOODS HIGH IN POTASSIUM GIVE MEDS WITH ANTACIDS ...
ANTERIOR PITUITARY  DISTURBANCESHYPOPITUITARISMHYPERPITUITARISM
HYPOPITUITARISM       ANTERIOR LOBEPANHYPOPITUITARISM  (SIMMOND’S DSE)l   DECREASED SECRETION OF ALL    ANTERIOR LOBE HORM...
HYPERPITUITARISM       ANTERIOR LOBEEOSINOPHILIC TUMORl   INCREASED GROWTH HORMONE AND    PROLACTINBASOPHILIC TUMORl INCRE...
PITUITARY ANTERIOR LOBEHORMONE     HYPO FXN                 HYPER FXNGH           Dwarfism – young         Gigantism – you...
MANAGEMENTHYPOPITUITARISMl   SURGICAL REMOVAL / IRRADIATIONl   REPLACEMENT THERAPY    l   THYROID HORMONES    l   STEROIDS...
POSTERIOR PITUITARY   DISTURBANCESDIABETES INSIPIDUSSYNDROME OF INAPPROPRIATEANTIDIURETIC HORMONE
DIABETES INSIPIDUSABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSINCAUSE:                S/SX: TUMOR                  POLYURIA ...
DIABETES INSIPIDUSABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSINMANAGEMENT HORMONAL REPLACEMENT – FOR LIFE  l   VASOPRESSIN ...
SYNDROME OF  INAPPROPRIATE ADH ELEVATED ADHCAUSES:  BRONCHOGENIC CA  NONENDOCRINE TUMORSS/SX:  DECREASED SERUM SODIUM  l  ...
SYNDROME OF INAPPROPRIATE ADHMANAGEMENT: WATER INTAKE RESTRICTION ADMINISTER AS ORDERED: l NaCl l Diuretics l Demeclocycli...
Mission possible
THYROID GLANDSTIMULATED BY THYROID STIMULATINGHORMONE (TSH)NEEDS IODINE TO SYNTHESIZE HORMONESECRETES:l THYROXINE (T4)l TR...
THYROID DISTURBANCESDIAGNOSTIC TESTS: B.M.R.- AMT OF O2 USED BY A PERSON @ A GIVEN TIME PBI – MEASURE IODINE LIBERATED IN ...
THYROID DISTURBANCESHYPOTHYROIDISM         HYPERTHYROIDISM  CRETINISM- infants, GRAVE’S DSE oryoung children          Exop...
EFFECTSHYPOTHYROIDISM        HYPERTHYROIDISM Reduction in HEAT     Increase heatPRODUCTION Failure of MENTAL &PHYSICAL GRO...
HYPOTHYROIDISM HYPERTHYROIDISMSERUMCHOLESTEROL:INCREASED           DECREASEDBMR:DECREASED           INCREASEDSKIN:THICK, P...
HYPOTHYROIDISM      HYPERTHYROIDISMNERVOUS SYSTEM: APATHETIC          HYPERACTIVE LETHARGIC          LABILE MOOD MAYBE    ...
MANAGEMENTHYPOTHYROIDISM       HYPERTHYROIDISMMEDICAL:             MEDICAL:HORMONE               RESTREPLACEMENT          ...
ANTITHYROID MEDICATIONS LUGOL’S SOLUTION (POTASSIUM IODIDE)  l   DECREASE THYROID VASCULARITY  l   INHIBIT IODINE RELEASE ...
SUBTOTAL THYROIDECTOMYREMAINING TISSUE PROVIDES ENOUGH HORMONES FOR  NORMAL FXNPRE OP NURSING CARE: PATIENT EDUCATION ON P...
SUBTOTAL THYROIDECTOMYCOMPLICATIONS: RECURRENT LARYNGEAL NERVE INJURY  l   HOARSENESS HEMORRHAGE  l   12-24 HRS POST OP  l...
TETANYDEPENDS UPON THE NUMBER OF PARATHYROID GLANDS  REMOVEDS/SX:  1ST – TINGLING TOES & FINGERS  2ND – CHEVOSTEK’S SIGN (...
THYROID STORM / CRISISS/SX:              MANAGEMENT: HYPERTHERMIA       DECREASE TEMP           > 41C    ANTITHYROID TACHY...
THYROID STORM / CRISISINCREASED AMOUNT OF THYROID HORMONES POST OP AFTER RADIOACTIVE IODINE ADMINISTRATION TOO SHORT PERIO...
VARIANTS OF HYPERTHYROIDISMGRAVE’S DSETHYROIDITISGOITER
GRAVE’S DISEASECAUSE: UNKNOWN AUTOIMMUNE WITH LONG-ACTING THYROID STIMULATORS/SX: TRIAD OF SYMPTOMS: HYPERTHYROIDISM OPHTH...
OPHTHALMOPATHYEXOPHTHALMOS – ACCUMULATION OFFLUID IN THE FAT PADS BEHIND HE EYEBALLID LAG – PROMINENT PALPEBRAL FISSUREWHE...
DERMOPATHYPRETIBIAL MYXEDEMA@ THE DORSUM OF THE LEGRAISED, THICKENED, PRURITIC,HYPERPIGMENTED SKINCLUBBING OF FINGERS & TO...
THYROIDITISCLASSIFICATION: SUBACUTE, NONSUPPURATIVE l   UNKNOWN CAUSE l   ASSOC. WITH VIRAL URT INFECTIONS CHRONIC, HASHIM...
GOITER ENLARGEMENT OF THE THYROID GLAND.TYPES: TOXIC NODULAR NONTOXIC
TOXIC NODULAR        GOITERCOMMON IN ELDERLYFROM LONG STANDING SIMPLEGOITERNODULESl FUNCTIONING TISSUEl SECRETES THYROXINE...
NON-TOXIC GOITER(SIMPLE/ COLLOID/ EUTHYROID)CAUSE :  IODINE DEFICIENCY  INTAKE OF GOITROGENIC SUBSTANCES/  DRUGS:  l   CAS...
NON-TOXIC GOITER           IODINE DEFICIENCY OR     INTAKE OF GOITROGENIC SUBSTANCESIMPAIRED THYROID HORMONE SYNTHESIS    ...
NON-TOXIC GOITER              TREATMENT:               IODIZED OIL IMCOMMON IN               IODINE TABLETS WOMEN:        ...
MYXEDEMA COMA MEDICAL EMERGENCY OCCURS IN SEVERE & UNTREATED MYXEDEMA HIGH MORTALTY RATES/SX: INTENSIFIED HYPOTHYROIDISM N...
MYXEDEMA COMAPRECIPITATING FACTORS: FAILURE TO TAKE MEDS INFECTION TRAUMA EXPOSURE TO COLD USE OF SEDATIVES, NARCOTICS, AN...
MYXEDEMA COMAMANAGEMENT: IV THYROID HORMONES CORRECTION OF HYPOTHERMIA MAINTAIN VITAL FXNS TREAT PRECIPITATING CAUSES
PARATHYROID GLAND 4 GLANDS SECRETES PARATHORMONE (PTH) IN RESPONSE TO SERUM Ca & Ph LEVELS REGULATE CALCIUM & PHOSPHORUS M...
PARATHYROID DISORDERSDIAGNOSTIC TESTS: HEMATOLOGICAL l SERUM CALCIUM l SERUM PHOSPHORUS l SERUM ALKALINE PHOSPHATASE URINA...
HYPOPARATHYROIDISM DECREASED PTH PRODUCTION HYPOCALCEMIA CALCIUM IS: l   DEPOSITED IN THE BONE l   EXCRETEDCAUSE: HEREDITA...
HYPOPARATHYROIDISMS/SX:  ACUTE HYPOCALCEMIA  l   TINGLING OF THE FINGERS  l   CHEVOSTEK’S, TROUSSEAU’S CHRONIC HYPOCALCEMI...
HYPOPARATHYROIDISMXRAY: INCREASED BONE DENSITYMANAGEMENT: Ca SUPPLEMENT VIT D SUPPLEMENT – LIQ FORM: WITH WATER, JUICE OR ...
HYPERPARATHYROIDISM INCREASED PTH PRODUCTION HYPERCALCEMIA HYPOPHOSPHATEMIA PRIMARY – TUMOR OR HYPERPLASIA OF THE PARATHYR...
HYPERPARATHYROIDISMS/SX: BONE PAIN : ESP @ THE BACK, PATHOLOGIC FRUCTURES TUBULAR CALCIUM DEPOSITS - KIDNEY STONES, RENAL ...
HYPERPARATHYROIDISMMANAGEMENT: TX OF CHOICE : SURGICAL REMOVAL OF HYERPLASTIC TISSUE IV PNSS 5L/ DAY WITH DIURETICS CRANBE...
ADRENAL GLANDSTIMULATED BY ACTHHORMONE PRECURSOR:l   CHOLESTEROLSECRETES:l   CORTISOLl   ALDOSTERONEl   SEX HORMONES : AND...
ADRENAL GLANDHORMONE        FUNCTIONALDOSTERONE   Renal : Na & Cl reabsorption; K             excretion              GI : ...
SYMPTOMATOLOGYALDOSTERONE DEFICIENCY DECREASE IN PLASMA VOLUME LEADING TO DEHYDRATON HYPOTENSION TO SHOCK INCREASED K META...
SYMPTOMATOLOGYCORTISOL DEFICIENCY ANOREXIA, N/V, ABDOMINAL PAIN, WT LOSS, LETHARGY HYPOGLYCEMIA HYPOTENSION INCREASED K, W...
SYMPTOMATOLOGYSEX HORMONE DEFICIENCY LOSS OF BODY HAIR LOSS OF LIBIDO OR IMPOTENCE MENSTRUAL & FERTILITY DISORDER
ADRENAL CORTEX     DISORERSADRENAL INSUFFICIENCYADRENAL CRISISCUSHING’S SYNDROMEALDOSTERONISM
ADRENAL INSUFFICIENCY  ADDISON’S DISEASEINCAPABILITY OF THE ADRENAL  CORTEX TO PRODUCE  GLUCOCORTICOIDS IN RESPONSE  TO ST...
ADRENAL CRISISACUTE EPISODES FROM STRESS THAT TAXES THE ADRENAL CORTICAL FUNCTION BEYOND ITS CAPABILITIESPOSSIBLE COMPLICA...
ADRENAL CRISISPRECIPITATING CAUSES: ABDOMINAL DISCOMFORT INFECTION TRAUMA HIGH TEMP EMOTIONAL UPSET ANTICOAGULANT DRUGS
ADRENAL CRISISS/SX: HYPOTENSION FLUID LOSS HYPONATREMIA
ADRENAL CRISISLAB: SERUM ELEC: DECREASED Na                 INCREASED K S. BUN : S. GLUCOSE: ADRENAL HORMONE ASSAY : HYDRO...
ADRENAL CRISISGOALS OF CARE: TO REVERSE SHOCK RESTORE BLOOD CIRCULATION REPLENISH NEEDED STEROID
ADRENAL CRISISTREATMENT: D5NSS ADRENAL CORTICAL HORMONE REPLACEMENT: INJECTABLE NEOSYNEPHRINE - SHOCK HIGH SALT DIET ANTIB...
CUSHING’S SYNDROMECAUSE: SUSTAINED OVER-PRODUCTION OF GLUCOCORTICOIDS BY ADRENAL GLAND FROM   ACTH BY PITUITARY TUMOR EXCE...
CUSHING’S SYNDROMES/SX: TRUNCAL OBESITY BUFFALO HUMP MOON-FACIE WT GAIN SODIUM RETENTION THINNING OF EXTREMITIES – FROM LO...
CUSHING’S SYNDROMEPURPLE STRIAE – FROM THINNINGOF SKINECHYMOSIS FROM SLIGHT TRAUMAANDROGENIC EFFECTS:  OLIGOMENORRHEA  HIR...
CUSHING’S SYNDROMETREATMENT & NURSING CARE: PSYCHOLOGICAL SUPPORT PREVENT INFECTION – INFLAM & IMMUNE RESPONSE ARE SUPPRES...
ALDOSTERONISMHYPERSECRETION OF ALDOSTERONE PRIMARY – CONN’S SYNDROME SECONDARY
CONN’S SYNDROME PRIMARY ALDOSTERONISMCAUSE: ADRENAL ADENOMAS/SX: HYPOKALEMIA FATIGUE HYPERNATREMIA, HPN, TETANYMANAGEMENT:...
SECONDARY    ALDOSTERONISM THE PROBLEM IS OUTSIDE THE ADRENAL GLAND:e.g. RENIN – ANGIOTENSIN SYSTEM
ADRENAL MEDULLAHORMONES : EPINEPHRINE           NOREPINEPHRINEEFFECTS
PHEOCHROMOCYTOMA TUMOR OF ADRENAL MEDULLA SECRETES INCREASED AMOUNT OF CATECHOLAMINESS/SX: HPN HYPERGLYCEMIA CARDIAC ARRHY...
VMA IN 24H URINEEND PRODUCT OF CATECHOLAMINEMETABOLISMDRUGS & FOOD TO BE WITHHELD24H B4 THE TEST:l COFFEE & TEAl BANANAl V...
PHEOCHROMOCYTOMAMANAGEMENT: SURGERY MEDICAL : ADRENERGIC BLOCKING AGENTS: PHENTOLAMINENURSING CARE: MONITOR BP IN SUPINE &...
PANCREASHORMONES: INSULIN BY BETA CELLS GLUCAGON BY ALPHA CELLS
DIABETES MILLETUSCAUSE: INSUFFICIENCY OF INSULIN LACK OF INSULINEFFECT: HYPERGLYCEMIA
DIABETES MILLETUS     PATHOPHYSIOLOGY               REDUCED /NO INSULIN  OSMOTICDEHYDRATION      HYPERGLYCEMIA  GLUCOSURIA...
DIABETES MILLETUSS/SX:  3 – P’s  WEIGHT LOSSSTAGES:  PREDIABETES  SUSPECTED  CHEMICAL  CLINICAL / OVERT
DIABETES MILLETUSPREDIABETES / POTENTIAL:             CONCEPTION    EVIDENCE OF GLUCOSE METABOLISM              ALTERATION
DIABETES MILLETUSSUSPECTED/ SUBCLINICAL/ LATENT:                PREDIABETES    NO STRESS                 STRESS  NORMAL GL...
DIABETES MILLETUSCHEMEICAL:              SUBCLINICAL         GTT IS ABNORMAL  NO STRESS                   STRESSASYMPTOMAT...
DIABETES MILLETUSCLINICAL / OVERT:            CHEMICAL     PERSISTENT INCREASED FBS      WITH OR WITHOUT STRESS          S...
DIABETES MILLETUSTYPES:  TYPE I                   TYPE II –  l   JUVENILE ONSET       l   MATURITY ONSET  l   BEFORE 15 YO...
DIABETES MILLETUSDIAGNOSTIC       DEXTROSTRIP  EXAMS:         URINE TESTS:  FBS            l   BENEDICT’S  2 HR-          ...
2 HR POSTPRANDIAL   BLOOD SUGARINTAKE OF 100GM GLUCOSE, 2 HRSBEFORE THE TESTTEST FOR ABILITY TO DISPOSEGLUCOSE LOAD
OGTTCONFIRMATORY, WHEN OTHER BLOOD TESTSARE BORDERLINE3 DAYS OF NORMAL ACITIVITY & 150MGOF CARB DIETNPO 10-12HRS BEFORE TH...
GLYCOSYLATED     HEMOGLOBINMEASURES GLUCOSE METABOLISMFOR THE PAST 3 MONTHSUSEFUL TO CHECK:l COMPLIANCE WITH THERAPYl HIST...
DIABETES MILLETUSPLANNING & IMPLEMENTATION:  CLIENT’S ACTIVITY  DIET : C,F,P – 50, 30, 20 LOW SATURATED FATS,  HIGH FIBER ...
DIABETES MILLETUSINSULIN THERAPY  DISPENSED IN “U”/ml : eg 100, 80  REFRIGERATE  GIVEN @ ROOM TEMP  GENTLY ROTATED, NOT SH...
DIABETES MILLETUSINSULIN THERAPY:  SITE OF INJECTION:  l ABDOMEN  l ANTERIOR THIGH  l ARM  l UPPER BACK  l BUTTOCKS
DIABETES MILLETUSINSULIN THERAPY  REACTIONS:  LOCAL:           GENERALIZED:  l   STNGING      l   HIVES  l   INDURATION   ...
LIPODYSTROPHYCAUSE: FAULTY TECHNIQUE TRAUMA INJECTION OF REFRIGERATED INSULINMANAGEMENT: ROTATING SITES: 1 AREA IS NOT USE...
INSULIN THERAPY &HORMONAL ACTIVITYGLUCORTICOIDS & EPINEPHRINECAUSES HYPERGLYCEMIA DURING:l   PHYSICAL TRAUMAl   STRESSl   ...
SURPRISE!!!
ACUTE COMPLICATIONS OF DIABETES MILLETUSDIABETIC KETO-ACIDOSIS (DKA)INSULIN SHOCKHYPERGLYCEMIC, HYPEROSMOLAR,NONKETOTIC (H...
D.K.A.     PATHOPHYSIOLOGY                         NO INSULIN  OSMOTICDEHYDRATION         MARKED HYPERGLYCEMIA   GLUCOSURI...
D.K.A.S/SX: S/SX OF DM + KETONURIA METABOLIC ACIDOSIS KUSSMAUL’S RESPIRATION ACETONE BREATH DHN FLUSHED FACE TACHYCARDIA C...
D.K.A.MANAGEMENT: ADEQUATE VENTILATION FLUID REPLACEMENT INSULIN – RAPID ACTING ECG – ELEC IMB
INSULIN SHOCKLOW BLOOD SUGARCAUSE: OVERDOSE OF EXOGENOUS INSULIN EATING LESS OVEREXERTION WITHOUT ADDITIONAL CALORIE INTAKE
INSULIN SHOCKS/SX:  PARASYMPATHETIC    SYMPATHETIC  l   HUNGER         l   IRRITABILITY  l   NAUSEA         l   SWEATING  ...
INSULIN SHOCKCLINICAL FINDING : BLOOD GLUCOSE BELOW 55-60 mg%TREATMENT: GLUCOSE PO ( SUGAR, ORANGE JUICE OR CANDY) or IV A...
HHONK     PATHOPHYSIOLOGY                Very insufficient INSULIN   SEVERE  OSMOTICDEHYDRATION       MARKED HYPERGLYCEMIA...
HHONKS/SX:  S/SX OF DKA WITHOUT:  l KAUSMAUL’S BREATHING  l ACETONE BREATH  l METABOLIC ACIDOSIS  l KETONURIA
LACTIC ACIDOSIS   SEVERE TISSUE ANOXIA  LACTIC ACID PRODUCTION    AGGRAVATION OF EXISTING    METABOLIC ACIDOSIS
SOMOGYI EFFECT         TOO MUCH INSULIN          HYPOGLYCEMIAGLUCAGON IS RELEASED                            REBOUND      ...
CHRONIC COMPLICATIONS OF DIABETES MILLETUS DEGENERATIVE CHANGES IN THE VASCULAR SYSTEM  l   UNDERNOURISHMENT  l   ATHEROSC...
CHRONIC COMPLICATIONS OF DIABETES MILLETUS NEPHROPATHY l   DAMAGE & OBLITERATION OF CAPILLARIES     SUPPLYING THE KIDNEY H...
Ms A, 45 y.o., has a simple goiter. She’s     being seen by the community health nurse     for teaching & follow-up regard...
Psycho endocrinology.drjma
Psycho endocrinology.drjma
Psycho endocrinology.drjma
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Psycho endocrinology.drjma

  1. 1. PSYCHOENDOCRINOLOGY Dr. James M. Alo, RN,MAN,MAP.PHD
  2. 2. ENDOCRINE GLANDSENDOCRINE HORMONES FUNCTIONSGLANDPITUITARY TSH Thyroid to release hormones ANTERIOR LOBE ACTH Adrenal cortex to release hormones FSH,LH Growth, maturation & function of sex organs GH/ Growth of body tissues & bones SOMATOTROPIN PROLACTIN/ Development of mammary glands & LTH lactation
  3. 3. ENDOCRINE GLANDSENDOCRINE HORMONE FUNCTIONGLANDPITUITARY ADH Regulates water metabolism POSTERIOR LOBE OXYTOCIN Stimulate uterine contractions release of milk INTERME- MSH Affects skin pigmentation DIATE LOBE
  4. 4. ENDOCRINE GLANDSENDOCRINE HORMONES FUNCTIONGLANDADRENAL ALDOSTERONE Fluid & electrolyte balance; Na reabsorption;CORTEX K excretion CORTISOL Glycogenolysis; Gluconeogenesis Na & water reabsorption Antiinflammatory Stress hormone SEX Slightly significant HORMONES
  5. 5. ENDOCRINE GLANDSENDOCRINE HORMONE FUNCTIONGLANDADRENAL EPINEPHRINE Increase heart rate & BP Bronchodilation,MEDULLA NOR- Glycogenolysis EPINEPHRINE Stress hormone
  6. 6. ENDOCRINE GLANDSENDOCRINE HORMONE FUNCTIONGLANDTHYROID T3 & T4’ Regulate metabolic rate P,C,F metabolism Regulate physical & mental growth & development THYRO- Decrease serum Ca by increasing bone deposition CALCITONINPARA- PTH Increase serum calcium by promoting bone decalcification THYROID
  7. 7. ENDOCRINE GLANDSENDOCRINE HORMONE FUNCTIONGLANDPANCREAS INSULIN Decrease blood glucose by: Glucose diffusion across cell BETA membrane; CELLS Converts glucose to glycogen ALPHA GLUCAGON Increase blood glucose by: Gluconeogenesis CELLS Glycogenolysis
  8. 8. ENDOCRINE GLANDSENDOCRINE HORMONES FUNCTIONGLANDOVARIES ESTROGEN & Development of secondary sex charac in female PROGES- Maturation of sex organs TERONE Sexual functioning Maintenance of pregnancyTESTES TESTOS- Development of secondary sex charac in male TERONE Maturation of sex organs Sexual functioning
  9. 9. HORMONE REGULATIONNEGATIVE FEEDBACK MECHANISMCHANGING OF BLOOD LEVELS OFCERTAIN 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)
  10. 10. NEGATIVE FEEDBACK MECHANISMDECREASED HORMONE CONCENTRATION IN THE BLOOD (e.g. Thyroxine) PITUITARY GLANDRELEASE 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
  11. 11. NEGATIVE FEEDBACK MECHANISMINCREASED HORMONE CONCENTRATION IN THE BLOOD (e.g. Thyroxine) PITUITARY GLAND IS INHIBITED TORELEASE 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
  12. 12. CASE STUDYKatie, an elderly, came in because ofpalpitations.VS revealed: 37.9o , 120, 25, 140/ 90She expressed hyperactivty, sweating,increased appetite & weight loss
  13. 13. CASE STUDYShe claimed history of goiter since her30’s but no follow-up was done.What are your nursing plans?
  14. 14. PLANNINGHEALTH PROMOTIONl IODIZED SALTl CONTROLLING WEIGHTHEALTH MAINTENANCE &RESTORATIONl STEROID THERAPY
  15. 15. STEROID THERAPY STEROID LEVELS PITUITARY GLAND IS INHIBITED TO REALEASE ACTH ENDOGENOUS CORTISOL PRODUCTION & ADRENAL ATROPHYRELEASE BY ADRENAL MEDULLA
  16. 16. STEROID THERAPYPHARMACOLOGIC 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
  17. 17. STEROID THERAPYASSESSMENT: BASELINE STEROID LEVEL IS ASSESSED BEFORE PROLONGED THERAPY IS STARTED TO DETERMINE THE DOSE REQUIRED STEROID WITHDRAWAL (LOW STRESS TOLERANCE) l EXHAUSTION l WEAKNESS l LETHARGY
  18. 18. STEROID THERAPYASSESSMENT: ACUTE ADRENAL CRISIS l RESTLESSNESS l WEAKNESS l HEADACHE l DHN l N/V l FALLING BP TO SHOCK PSYCHOLOGICAL CXS l MOOD ELEVATION, l FRANK EUPHORIA l THEN, DEPRESSION
  19. 19. STEROID THERAPYIMPORTANT FACTS: MAJOR UNTOWARD EFFECTS: l MASKS INFECTION l DEFENSE AGAINST INFECTION FROM LYMPHOPENIA l SLOW WOUND HEALING FROM ITS ANTIINFLAMMATORY EFFECT l P.U.D. ACTIVATION/ REACTIVATION l SERUM SODIUM l SERUM POTASSIUM
  20. 20. STEROID THERAPYIMPORTANT FACTS: MINOR UNTOWARD EFFECTS: l PIGMENTATION l ACNE l FACIAL HAIR l MOON-FACIE
  21. 21. STEROID THERAPYIMPORTANT FACTS: PROBLEMS OF LONG TERM THERAPY: l GROWTH RETARDATION l OBESITY l GASTRITIS TO P.U.D. l OSTEOPOROSIS l HPN l RENAL CALCULI l ADRENAL ATROPHY
  22. 22. STEROID THERAPY STEROID LEVELS PITUITARY GLAND IS INHIBITED TO REALEASE ACTH ENDOGENOUS CORTISOL PRODUCTION & ADRENAL ATROPHYRELEASE BY ADRENAL MEDULLA
  23. 23. STEROID THERAPYIMPLEMENTATION 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
  24. 24. ANTERIOR PITUITARY DISTURBANCESHYPOPITUITARISMHYPERPITUITARISM
  25. 25. HYPOPITUITARISM ANTERIOR LOBEPANHYPOPITUITARISM (SIMMOND’S DSE)l DECREASED SECRETION OF ALL ANTERIOR LOBE HORMONES
  26. 26. HYPERPITUITARISM ANTERIOR LOBEEOSINOPHILIC TUMORl INCREASED GROWTH HORMONE AND PROLACTINBASOPHILIC TUMORl INCREASED TSH, FSH, LH, MSH,l INCREASED ACTH (CUSHING’S DSE)CHROMOPHOBE TUMORl INCREASED ACTH & GROWTH HORMONE
  27. 27. PITUITARY ANTERIOR LOBEHORMONE HYPO FXN HYPER FXNGH Dwarfism – young Gigantism – young Cachexia - adult Acromegaly - adultACTH Atrophy of adrenal Cushing’s dse cortexTSH Atrophy & Grave’s dse depressed thyroid fxnFSH Atrophy & infertility Exaggerated fxn of sex organsPROLACTIN Underdevelopment Decreased milk of mammary glands production
  28. 28. MANAGEMENTHYPOPITUITARISMl SURGICAL REMOVAL / IRRADIATIONl REPLACEMENT THERAPY l THYROID HORMONES l STEROIDS l SEX HORMONES l GONADOTROPINS (restore fertility)HYPERPITUITARISMl SURGICAL REMOVAL / IRRADIATIONl MONITOR FOR HYPERGLYCEMIA & CARDIOVASCULAR PROBLEMS
  29. 29. POSTERIOR PITUITARY DISTURBANCESDIABETES INSIPIDUSSYNDROME OF INAPPROPRIATEANTIDIURETIC HORMONE
  30. 30. DIABETES INSIPIDUSABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSINCAUSE: S/SX: TUMOR POLYURIA TRAUMA 15-29L/ DAY VASCULAR DSE POLYDIPSIA INFLAMMATION SG OF URINE IS PITUITARY <1.010 SURGERY S/SX OF DHN SHOCK
  31. 31. DIABETES INSIPIDUSABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSINMANAGEMENT HORMONAL REPLACEMENT – FOR LIFE l VASOPRESSIN (PITRESSIN TANNATE IN OIL) – IM OR NASAL SPRAY NON-HORMONAL THERAPY l CHLORPROPRAMIDE – INCREASE RESPONSE OF THE BODY TO DECREASED VASOPRESSIN SALT & P RESTRICTED DIET, INCREASE FLUIDS MONITOR I&O MAINTAIN FLUID & ELECTROLYTE BALANCE
  32. 32. SYNDROME OF INAPPROPRIATE ADH ELEVATED ADHCAUSES: BRONCHOGENIC CA NONENDOCRINE TUMORSS/SX: DECREASED SERUM SODIUM l CX IN LOC TO UNCONSCIOUSNESS l SEIZURES WATER INTOXICATION l N/V l MENTAL CONFUSION
  33. 33. SYNDROME OF INAPPROPRIATE ADHMANAGEMENT: WATER INTAKE RESTRICTION ADMINISTER AS ORDERED: l NaCl l Diuretics l Demeclocycline (declamycin) – a tetracycline analogue that interferes with the action of ADH on the collecting tubules
  34. 34. Mission possible
  35. 35. THYROID GLANDSTIMULATED BY THYROID STIMULATINGHORMONE (TSH)NEEDS IODINE TO SYNTHESIZE HORMONESECRETES:l THYROXINE (T4)l TRIIODOTHYRONINE (T3)
  36. 36. THYROID DISTURBANCESDIAGNOSTIC 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: l T3 RED CELL UPTAKE l RADIOACTIVE IODINE UPTAKE (I131 l THYROID SCAN
  37. 37. THYROID DISTURBANCESHYPOTHYROIDISM HYPERTHYROIDISM CRETINISM- infants, GRAVE’S DSE oryoung children Exophthalmic goiter HYPOTHYROIDISMWITHOUT MYXEDEMA-atrophy/ destruction ofthyroid gland MYXEDEMA –adults
  38. 38. EFFECTSHYPOTHYROIDISM HYPERTHYROIDISM Reduction in HEAT Increase heatPRODUCTION Failure of MENTAL &PHYSICAL GROWTH increased storage of Deranged CC, P & F metabolism, glycosuria Abnormal collection Increase use of F &of WATER P as fuel
  39. 39. HYPOTHYROIDISM HYPERTHYROIDISMSERUMCHOLESTEROL:INCREASED DECREASEDBMR:DECREASED INCREASEDSKIN:THICK, PUFFY, DRY WARM, MOIST, FLUSHEDHAIR: SOFT, SILKYDRY, BRITTLE
  40. 40. HYPOTHYROIDISM HYPERTHYROIDISMNERVOUS SYSTEM: APATHETIC HYPERACTIVE LETHARGIC LABILE MOOD MAYBE HYPERSENSITIVEHYPERIRRITABLE TENSED SLOW CEREBRATIONWEIGHT:INCREASED DECREASEDAPPETITE:DECREASED INCREASED
  41. 41. MANAGEMENTHYPOTHYROIDISM HYPERTHYROIDISMMEDICAL: MEDICAL:HORMONE RESTREPLACEMENT ANTITHYROIDDESSICATED THYROID DRUGS:THYROGLOBULIN LUGOL’S SOLUTIONNa LEVOTHYROXINE THIOUREA DERIVATIVESNa LYOTHYRONINE RADIOACTIVE IODINE BETA-BLOCKERS SURGICAL: SUBTOTAL THYROIDECTOMY
  42. 42. ANTITHYROID MEDICATIONS LUGOL’S SOLUTION (POTASSIUM IODIDE) l DECREASE THYROID VASCULARITY l INHIBIT IODINE RELEASE l DILUTED IN MILK / JUICE l STAINS THE TEETH- USE STRAW THIOUREA & DERIVATIVES (PTU,METHIMAZOLE) l BLOCK THYROID HORMONE RELEASE l TOXIC SIGNS: FEVER, SORETHROAT, LEUKOPENIA RADIOACTIVE IODINE l PATIENT IS ISOLATED FOR 3 DAYS BETA BLOCKERS l PROPANOLOL
  43. 43. SUBTOTAL THYROIDECTOMYREMAINING TISSUE PROVIDES ENOUGH HORMONES FOR NORMAL FXNPRE OP NURSING CARE: PATIENT EDUCATION ON POST OP: l LITTLE HOARSENESS l DIFFICULTY OF SWALLOWINGPOST 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.
  44. 44. SUBTOTAL THYROIDECTOMYCOMPLICATIONS: RECURRENT LARYNGEAL NERVE INJURY l HOARSENESS HEMORRHAGE l 12-24 HRS POST OP l OBSERVE FOR IRREGULAR BREATHING, CHOKING SIGNS l TRACHEOSTOMY SET @ BEDSIDE TETANY RESPIRATORY OBSTRUCTION THYROID STORM
  45. 45. TETANYDEPENDS UPON THE NUMBER OF PARATHYROID GLANDS REMOVEDS/SX: 1ST – TINGLING TOES & FINGERS 2ND – CHEVOSTEK’S SIGN (TAPPING THE FACIAL MUSCLES) 3RD – TROUSSEAU’S SIGN (CARPO-PEDAL SPASM WITH OCCLUSION OF CIRCULATION WITH A BP CUFF)MANAGEMENT: CALCIUM REPLACEMENT: CaGluconate IV
  46. 46. THYROID STORM / CRISISS/SX: MANAGEMENT: HYPERTHERMIA DECREASE TEMP > 41C ANTITHYROID TACHYCARDIA DRUGS APPREHENSION GLUCOSE RESTLESSNESS DIGITALIS IRRITABILITY STEROIDS TO DELIRIUM DECREASE ACTH COMA
  47. 47. THYROID STORM / CRISISINCREASED AMOUNT OF THYROID HORMONES POST OP AFTER RADIOACTIVE IODINE ADMINISTRATION TOO SHORT PERIOD OF PRE OP TXCAUSES: EMOTIONAL STRESS PHYSICAL STRESS
  48. 48. VARIANTS OF HYPERTHYROIDISMGRAVE’S DSETHYROIDITISGOITER
  49. 49. GRAVE’S DISEASECAUSE: UNKNOWN AUTOIMMUNE WITH LONG-ACTING THYROID STIMULATORS/SX: TRIAD OF SYMPTOMS: HYPERTHYROIDISM OPHTHALMOPATHY DERMOPATHY
  50. 50. OPHTHALMOPATHYEXOPHTHALMOS – ACCUMULATION OFFLUID IN THE FAT PADS BEHIND HE EYEBALLID LAG – PROMINENT PALPEBRAL FISSUREWHEN THE PATIENT LOOKS DOWNTHYROID STARE(DARYMPLE’S SIGN) – INFREQUENT EYEBLINKING
  51. 51. DERMOPATHYPRETIBIAL MYXEDEMA@ THE DORSUM OF THE LEGRAISED, THICKENED, PRURITIC,HYPERPIGMENTED SKINCLUBBING OF FINGERS & TOESOSTEOARTHROPATHY
  52. 52. THYROIDITISCLASSIFICATION: SUBACUTE, NONSUPPURATIVE l UNKNOWN CAUSE l ASSOC. WITH VIRAL URT INFECTIONS CHRONIC, HASHIMOTO’S l IMMUNOLOGICAL FACTORS l PRESENCE OF IMMUNOGLOBULINS & ANTIBODIES DIRECTED AGAINST THE THYROID
  53. 53. GOITER ENLARGEMENT OF THE THYROID GLAND.TYPES: TOXIC NODULAR NONTOXIC
  54. 54. TOXIC NODULAR GOITERCOMMON IN ELDERLYFROM LONG STANDING SIMPLEGOITERNODULESl FUNCTIONING TISSUEl SECRETES THYROXINE AUTONOMOUSLY FROM TSH
  55. 55. NON-TOXIC GOITER(SIMPLE/ COLLOID/ EUTHYROID)CAUSE : IODINE DEFICIENCY INTAKE OF GOITROGENIC SUBSTANCES/ DRUGS: l CASSAVA, l CABBAGE, l CAULIFLOWER, l CARROTS l RADDISH l TURNIPS l RED SKIN OF PEANUTS l IODINE l COBALT l LITHIUM
  56. 56. NON-TOXIC GOITER IODINE DEFICIENCY OR INTAKE OF GOITROGENIC SUBSTANCESIMPAIRED THYROID HORMONE SYNTHESIS SERUM THYROXINE PITUITARY SECRETE TSH THYROID GLAND ENLARGES TO COMPENSATE FOR THE REDUCED LEVEL OF THYROXINE
  57. 57. NON-TOXIC GOITER TREATMENT: IODIZED OIL IMCOMMON IN IODINE TABLETS WOMEN: SALT ADOLESCENT FORTIFICATION PREGNANT WITH IODINE LACTATING EDUCATE ABOUT MENOPAUSE INTAKE OF: l SEAWEEDS l SHELLFISH l FISH- TAMBAN, HITO, DALAG
  58. 58. MYXEDEMA COMA MEDICAL EMERGENCY OCCURS IN SEVERE & UNTREATED MYXEDEMA HIGH MORTALTY RATES/SX: INTENSIFIED HYPOTHYROIDISM NEUROLOGIC IMPAIRMENT COMA
  59. 59. MYXEDEMA COMAPRECIPITATING FACTORS: FAILURE TO TAKE MEDS INFECTION TRAUMA EXPOSURE TO COLD USE OF SEDATIVES, NARCOTICS, ANESTHETICS
  60. 60. MYXEDEMA COMAMANAGEMENT: IV THYROID HORMONES CORRECTION OF HYPOTHERMIA MAINTAIN VITAL FXNS TREAT PRECIPITATING CAUSES
  61. 61. PARATHYROID GLAND 4 GLANDS SECRETES PARATHORMONE (PTH) IN RESPONSE TO SERUM Ca & Ph LEVELS REGULATE CALCIUM & PHOSPHORUS METABOLISMORGANS AFFECTED: BONES - RESORPTION KIDNEYS l Ca REABSORPTION l Ph EXCRETION GIT – ENHANCES Ca ABSORPTION
  62. 62. PARATHYROID DISORDERSDIAGNOSTIC TESTS: HEMATOLOGICAL l SERUM CALCIUM l SERUM PHOSPHORUS l SERUM ALKALINE PHOSPHATASE URINARY STUDIES l URINARY CALCIUM l URINARY PHOSPHATE - TUBULAR REABSORPTION OF PHOSPHATE
  63. 63. HYPOPARATHYROIDISM DECREASED PTH PRODUCTION HYPOCALCEMIA CALCIUM IS: l DEPOSITED IN THE BONE l EXCRETEDCAUSE: HEREDITARY IDIOPATHIC SURGICAL
  64. 64. HYPOPARATHYROIDISMS/SX: ACUTE HYPOCALCEMIA l TINGLING OF THE FINGERS l CHEVOSTEK’S, TROUSSEAU’S CHRONIC HYPOCALCEMIA l FATIGUE, WEAKNESS l PERSONALITY CHANGES l LOSS OF TOOTH ENAMEL, DRY SCALY SKIN l CARDIAC ARRHYTHMIA l CATARACT
  65. 65. HYPOPARATHYROIDISMXRAY: INCREASED BONE DENSITYMANAGEMENT: 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
  66. 66. HYPERPARATHYROIDISM INCREASED PTH PRODUCTION HYPERCALCEMIA HYPOPHOSPHATEMIA PRIMARY – TUMOR OR HYPERPLASIA OF THE PARATHYROID GLAND SECONDARY – COMPENSATORY OVERSECRETION OF PTH IN RESPONSE TO HYPOCALCEMIA FROM: l CHRONIC RENAL DSE l RICKETS l MALABSORPTION SYNDROME l OSTEOMALACIA
  67. 67. HYPERPARATHYROIDISMS/SX: BONE PAIN : ESP @ THE BACK, PATHOLOGIC FRUCTURES TUBULAR CALCIUM DEPOSITS - KIDNEY STONES, RENAL COLIC, POLYURIA, POLYDIPSIA MUSCLE WEAKNESS PERSONALITY CX, DEPRESSION CARDIAC ARRHYTHMIAS, HPNXRAY: BONE DEMINERALIZATION
  68. 68. HYPERPARATHYROIDISMMANAGEMENT: 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
  69. 69. ADRENAL GLANDSTIMULATED BY ACTHHORMONE PRECURSOR:l CHOLESTEROLSECRETES:l CORTISOLl ALDOSTERONEl SEX HORMONES : ANDROGEN, ESTROGEN
  70. 70. ADRENAL GLANDHORMONE FUNCTIONALDOSTERONE Renal : Na & Cl reabsorption; K excretion GI : Na absorptionGLUCO- increase serum glucose by CORTICOIDS gluconeogenesis & glycogenolysis esp during STRESS Blocks inflammation Counteracts effect of histamineSEX HORMONE Physiologically insignificant Becomes useful during menopause in women
  71. 71. SYMPTOMATOLOGYALDOSTERONE DEFICIENCY DECREASE IN PLASMA VOLUME LEADING TO DEHYDRATON HYPOTENSION TO SHOCK INCREASED K METABOLIC ACIDOSIS
  72. 72. SYMPTOMATOLOGYCORTISOL DEFICIENCY ANOREXIA, N/V, ABDOMINAL PAIN, WT LOSS, LETHARGY HYPOGLYCEMIA HYPOTENSION INCREASED K, WEAK PULSE PIGMENTATION IMPAIRED STRESS TOLERANCE
  73. 73. SYMPTOMATOLOGYSEX HORMONE DEFICIENCY LOSS OF BODY HAIR LOSS OF LIBIDO OR IMPOTENCE MENSTRUAL & FERTILITY DISORDER
  74. 74. ADRENAL CORTEX DISORERSADRENAL INSUFFICIENCYADRENAL CRISISCUSHING’S SYNDROMEALDOSTERONISM
  75. 75. ADRENAL INSUFFICIENCY ADDISON’S DISEASEINCAPABILITY OF THE ADRENAL CORTEX TO PRODUCE GLUCOCORTICOIDS IN RESPONSE TO STRESS
  76. 76. ADRENAL CRISISACUTE EPISODES FROM STRESS THAT TAXES THE ADRENAL CORTICAL FUNCTION BEYOND ITS CAPABILITIESPOSSIBLE COMPLICATION OF ADDISON’S DISEASE
  77. 77. ADRENAL CRISISPRECIPITATING CAUSES: ABDOMINAL DISCOMFORT INFECTION TRAUMA HIGH TEMP EMOTIONAL UPSET ANTICOAGULANT DRUGS
  78. 78. ADRENAL CRISISS/SX: HYPOTENSION FLUID LOSS HYPONATREMIA
  79. 79. ADRENAL CRISISLAB: SERUM ELEC: DECREASED Na INCREASED K S. BUN : S. GLUCOSE: ADRENAL HORMONE ASSAY : HYDROXYCORTICOID & 17 KETOSTEROID IN 24- HR URINE DET.
  80. 80. ADRENAL CRISISGOALS OF CARE: TO REVERSE SHOCK RESTORE BLOOD CIRCULATION REPLENISH NEEDED STEROID
  81. 81. ADRENAL CRISISTREATMENT: D5NSS ADRENAL CORTICAL HORMONE REPLACEMENT: INJECTABLE NEOSYNEPHRINE - SHOCK HIGH SALT DIET ANTIBIOTICS
  82. 82. CUSHING’S SYNDROMECAUSE: SUSTAINED OVER-PRODUCTION OF GLUCOCORTICOIDS BY ADRENAL GLAND FROM ACTH BY PITUITARY TUMOR EXCESSIVE GLUCORTICOID ADMINISTRATION
  83. 83. CUSHING’S SYNDROMES/SX: TRUNCAL OBESITY BUFFALO HUMP MOON-FACIE WT GAIN SODIUM RETENTION THINNING OF EXTREMITIES – FROM LOSS OF MUSCLE TISSUE DUE TO PROTEIN CATABOLISM
  84. 84. CUSHING’S SYNDROMEPURPLE STRIAE – FROM THINNINGOF SKINECHYMOSIS FROM SLIGHT TRAUMAANDROGENIC EFFECTS: OLIGOMENORRHEA HIRSUTISM GYNECOMASTIAHYPERTENSION FROM S. Na
  85. 85. CUSHING’S SYNDROMETREATMENT & NURSING CARE: PSYCHOLOGICAL SUPPORT PREVENT INFECTION – INFLAM & IMMUNE RESPONSE ARE SUPPRESSED PROMOTE SAFETY SURGERY – SUB/TOTAL ADRENALECTOMY
  86. 86. ALDOSTERONISMHYPERSECRETION OF ALDOSTERONE PRIMARY – CONN’S SYNDROME SECONDARY
  87. 87. CONN’S SYNDROME PRIMARY ALDOSTERONISMCAUSE: ADRENAL ADENOMAS/SX: HYPOKALEMIA FATIGUE HYPERNATREMIA, HPN, TETANYMANAGEMENT: SURGERY ALDACTONE – ALDOSTERONE ANTAGONIST
  88. 88. SECONDARY ALDOSTERONISM THE PROBLEM IS OUTSIDE THE ADRENAL GLAND:e.g. RENIN – ANGIOTENSIN SYSTEM
  89. 89. ADRENAL MEDULLAHORMONES : EPINEPHRINE NOREPINEPHRINEEFFECTS
  90. 90. PHEOCHROMOCYTOMA TUMOR OF ADRENAL MEDULLA SECRETES INCREASED AMOUNT OF CATECHOLAMINESS/SX: HPN HYPERGLYCEMIA CARDIAC ARRHYTHMIA & CHFDIAGNOSTIC TEST : VMA IN 24H URINE
  91. 91. VMA IN 24H URINEEND PRODUCT OF CATECHOLAMINEMETABOLISMDRUGS & FOOD TO BE WITHHELD24H B4 THE TEST:l COFFEE & TEAl BANANAl VANILLAl CHOCOLATES
  92. 92. PHEOCHROMOCYTOMAMANAGEMENT: SURGERY MEDICAL : ADRENERGIC BLOCKING AGENTS: PHENTOLAMINENURSING CARE: MONITOR BP IN SUPINE & STANDING MONITOR URINE FOR GLUC & ACETONE
  93. 93. PANCREASHORMONES: INSULIN BY BETA CELLS GLUCAGON BY ALPHA CELLS
  94. 94. DIABETES MILLETUSCAUSE: INSUFFICIENCY OF INSULIN LACK OF INSULINEFFECT: HYPERGLYCEMIA
  95. 95. DIABETES MILLETUS PATHOPHYSIOLOGY REDUCED /NO INSULIN OSMOTICDEHYDRATION HYPERGLYCEMIA GLUCOSURIA LIPOLYSIS CELLULAR HUNGER OSMOTIC DIURESIS WEIGHT LOSS POLYPHAGIA POLYURIA POLYDIPSIA
  96. 96. DIABETES MILLETUSS/SX: 3 – P’s WEIGHT LOSSSTAGES: PREDIABETES SUSPECTED CHEMICAL CLINICAL / OVERT
  97. 97. DIABETES MILLETUSPREDIABETES / POTENTIAL: CONCEPTION EVIDENCE OF GLUCOSE METABOLISM ALTERATION
  98. 98. DIABETES MILLETUSSUSPECTED/ SUBCLINICAL/ LATENT: PREDIABETES NO STRESS STRESS NORMAL GLUCOSE OVERT DIABETES METABOLISM
  99. 99. DIABETES MILLETUSCHEMEICAL: SUBCLINICAL GTT IS ABNORMAL NO STRESS STRESSASYMPTOMATIC SYMPTOMATIC
  100. 100. DIABETES MILLETUSCLINICAL / OVERT: CHEMICAL PERSISTENT INCREASED FBS WITH OR WITHOUT STRESS SYMPTOMATIC
  101. 101. DIABETES MILLETUSTYPES: TYPE I TYPE II – l JUVENILE ONSET l MATURITY ONSET l BEFORE 15 YO l AFTER AGE 40 l LEAN/ NORMAL l OBESE WEIGHT l REDUCED INSULIN l ABSOLUTE INSULIN RECEPTOR DEFICIENCY l NONINSULIN l INSULIN -DEPENDENT DEPENDENT l PRONE TO DKA l PRONE TO HHONK
  102. 102. DIABETES MILLETUSDIAGNOSTIC DEXTROSTRIP EXAMS: URINE TESTS: FBS l BENEDICT’S 2 HR- l CLINITEST TAB POSTPRANDIAL l ACETONE TEST OGTT GLYCOSYLATED HGB
  103. 103. 2 HR POSTPRANDIAL BLOOD SUGARINTAKE OF 100GM GLUCOSE, 2 HRSBEFORE THE TESTTEST FOR ABILITY TO DISPOSEGLUCOSE LOAD
  104. 104. OGTTCONFIRMATORY, WHEN OTHER BLOOD TESTSARE BORDERLINE3 DAYS OF NORMAL ACITIVITY & 150MGOF CARB DIETNPO 10-12HRS BEFORE THE TESTBASELINE BLOOD SUGAR TAKENGLUCOSE LOAD IS GIVEN, P.O. OR IVBLOOD & URINE SPECS TAKEN 30 MIN, 1HR,2HRS, 3 HRS, AFTER GLUCOSE LOADING
  105. 105. GLYCOSYLATED HEMOGLOBINMEASURES GLUCOSE METABOLISMFOR THE PAST 3 MONTHSUSEFUL TO CHECK:l COMPLIANCE WITH THERAPYl HISTORY OF SUBCLINICAL OR CHEMICAL DIABETES
  106. 106. DIABETES MILLETUSPLANNING & IMPLEMENTATION: CLIENT’S ACTIVITY DIET : C,F,P – 50, 30, 20 LOW SATURATED FATS, HIGH FIBER DRUGS: l ORAL HYPOGLYCEMICS l BIGUANIDE l SULFONYLUREAS l CONTRAINDICATED - PREGNANCY l INSULIN
  107. 107. DIABETES MILLETUSINSULIN 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
  108. 108. DIABETES MILLETUSINSULIN THERAPY: SITE OF INJECTION: l ABDOMEN l ANTERIOR THIGH l ARM l UPPER BACK l BUTTOCKS
  109. 109. DIABETES MILLETUSINSULIN THERAPY REACTIONS: LOCAL: GENERALIZED: l STNGING l HIVES l INDURATION l URTICARIA l ITCHING l ANTIHISTAMINES LIPODYSTROPHY 30 MIN B4 l DESENSITIZATION
  110. 110. LIPODYSTROPHYCAUSE: FAULTY TECHNIQUE TRAUMA INJECTION OF REFRIGERATED INSULINMANAGEMENT: ROTATING SITES: 1 AREA IS NOT USED MORE THAN ONCE EVERY 3 WKS
  111. 111. INSULIN THERAPY &HORMONAL ACTIVITYGLUCORTICOIDS & EPINEPHRINECAUSES HYPERGLYCEMIA DURING:l PHYSICAL TRAUMAl STRESSl INFECTIONl ANXIETYl ANGERl FEARl CHANGE IN LIFESTYLEINCREASE IN INSULIN DOSE IS NEEDED
  112. 112. SURPRISE!!!
  113. 113. ACUTE COMPLICATIONS OF DIABETES MILLETUSDIABETIC KETO-ACIDOSIS (DKA)INSULIN SHOCKHYPERGLYCEMIC, HYPEROSMOLAR,NONKETOTIC (HHONK) COMASOMOGYI EFFECT
  114. 114. D.K.A. PATHOPHYSIOLOGY NO INSULIN OSMOTICDEHYDRATION MARKED HYPERGLYCEMIA GLUCOSURIA LIPOLYSIS CELLULAR HUNGER OSMOTIC DIURESIS WEIGHT LOSS KETOACIDOSIS POLYPHAGIA POLYURIA POLYDIPSIA
  115. 115. 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
  116. 116. D.K.A.MANAGEMENT: ADEQUATE VENTILATION FLUID REPLACEMENT INSULIN – RAPID ACTING ECG – ELEC IMB
  117. 117. INSULIN SHOCKLOW BLOOD SUGARCAUSE: OVERDOSE OF EXOGENOUS INSULIN EATING LESS OVEREXERTION WITHOUT ADDITIONAL CALORIE INTAKE
  118. 118. INSULIN SHOCKS/SX: PARASYMPATHETIC SYMPATHETIC l HUNGER l IRRITABILITY l NAUSEA l SWEATING l HYPORTENSION l TREMBLING l BRADYCARDIA l TACHYCARDIA CEREBRAL l PALLOR l LETHARGY, l YAWNING l SENSORIUM CX
  119. 119. INSULIN SHOCKCLINICAL FINDING : BLOOD GLUCOSE BELOW 55-60 mg%TREATMENT: GLUCOSE PO ( SUGAR, ORANGE JUICE OR CANDY) or IV ADMINISTRATION OF GLUCAGON IM, IV OR SQ
  120. 120. HHONK PATHOPHYSIOLOGY Very insufficient INSULIN SEVERE OSMOTICDEHYDRATION MARKED HYPERGLYCEMIA LIPOLYSIS GLUCOSURIA Without CELLULAR KETOSIS HUNGER OSMOTIC DIURESIS WEIGHT LOSS POLYPHAGIA POLYURIA POLYDIPSIA
  121. 121. HHONKS/SX: S/SX OF DKA WITHOUT: l KAUSMAUL’S BREATHING l ACETONE BREATH l METABOLIC ACIDOSIS l KETONURIA
  122. 122. LACTIC ACIDOSIS SEVERE TISSUE ANOXIA LACTIC ACID PRODUCTION AGGRAVATION OF EXISTING METABOLIC ACIDOSIS
  123. 123. SOMOGYI EFFECT TOO MUCH INSULIN HYPOGLYCEMIAGLUCAGON IS RELEASED REBOUND HYPERGLYCEMIA + LIPOLYSIS KETOSIS GLUCONEOGENESIS GLYCOGENOLYSIS
  124. 124. CHRONIC COMPLICATIONS OF DIABETES MILLETUS DEGENERATIVE CHANGES IN THE VASCULAR SYSTEM l UNDERNOURISHMENT l ATHEROSCLEROSIS NEUROPATHY FROM: l VASCULAR INSUFFICIENCY l VIT B DEFICIENCY l HYPERGLYCEMIA EYE COMPLICATIONS FROM ANOXIA l CATARACT l DIABETIC RETINOPATHY l RETINAL DETACHMENT
  125. 125. CHRONIC COMPLICATIONS OF DIABETES MILLETUS NEPHROPATHY l DAMAGE & OBLITERATION OF CAPILLARIES SUPPLYING THE KIDNEY HEART DISEASE l MI FROM ATHEROSCLEROSIS SKIN CHANGES l DIABETIC DERMOPATHY – HYPERPIGMENTED & SCALY PRETIBIAL AREAS LIVER CHANGES l ENLARGEMENT & FATTY INFILTRATION
  126. 126. 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?a. Calciumb. Iodinec. Irond. Sodium

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