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