158 Endocrine System 2. Assess for changes in mental or emotional status. 3. Evaluate reflexes and neuromuscular response to stimuli. 4. Evaluate serum calcium levels. D. Pancreas problems. 1. Evaluate changes in weight, particularly increase in weight in the adult and decrease in weight in the child. 2. Evaluate alterations in fluid balance. 3. Evaluate changes in mental status. 4. Evaluate serum glucose levels. 5. Evaluate pancreatic enzyme studies. 6. Evaluate the abdomen for epigastric pain and abdominal discomfort. E. Adrenal glands. 1. Adrenal medulla. a. Evaluate changes in blood pressure. b. Assess for changes in metabolic rate. 2. Adrenal cortex. a. Evaluate changes in weight. b. Evaluate changes in skin color and texture, and in the presence and distribution of body hair. c. Assess cardiovascular system for instability as evidenced by labile blood pressure and cardiac output. d. Evaluate GI discomfort. e. Assess status of potassium and sodium levels. f. Assess for changes in glucose metabolism. g. Assess for changes in reproductive system and in sexual activity. h. Evaluate changes in muscle mass. Hyperpituitary: Acromegaly Acromegaly is most often the result of a benign slow ✽ growing tumor (pituitary adenoma) that secretes growth hormones. It occurs after the closure of epiphyses of the long bones. Data Collection A. Enlargement of the hands and feet and hypertrophy of the skin. B. Changes in facial features: protruding jaw, slanting forehead, and an increase in the size of the nose. PHYSIOLOGY OF THE ENDOCRINE SYSTEM A. Pituitary gland - Often referred to as the “master gland” because it secretes hormones that control hormone se- cretion of other endocrine glands. B. Thyroid gland - Primary function of thyroid hormone is to control the level of cellular metabolism by secreting thyroxin (T 4 ) and triiodothyronine (T 3 ). C. Parathyroid gland - Four small parathyroid glands are located near or embedded in the thyroid gland, which secrete parathyroid hormone (PTH) that is primarily involved in the control of serum calcium levels. D. Pancreas - Produces the enzymes trypsin, amylase, and lipase, which are necessary for the digestion and absorption of nutrients; contains the islets of Lang- erhans, which contain beta cells that are responsible for the production of insulin. Insulin is necessary for maintaining normal carbohydrate metabolism and glucose utilization. E. Adrenal glands – Main body is the adrenal cortex that is responsible for the secretion of glucocorticoids, mineralocorticoids, and adrenal sex hormones (andro- gens and estrogen); adrenal cortical function is essential for life. The adrenal medulla secretes catecholamines, epinephrine, and norepinephrine; under the influence of the sympathetic nervous system. System Data Collection A. Pituitary problems. 1. Assess for growth imbalance. 2. Assess for secondary characteristics appropriate for age. 3. Assess for hormonal imbalances throughout the en- docrine system organs. B. Thyroid problems. 1. Assess for changes in weight and appetite: increased or decreased. 2. Assess for intellectual development and mental changes: increased irritability, excitability, nervous- ness, altered mood and affect, confusion, and coma. 3. Assess for changes in hair and skin, altered general appearance, and sexual dysfunction. C. Parathyroid problems. 1. History of problems of calcium metabolism and thyroid surgery.
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158 CHAPTER 8 Endocrine System
158
Endocrine System
2. Assess for changes in mental or emotional status. 3. Evaluatereflexesandneuromuscularresponseto stimuli. 4. Evaluate serum calcium levels.D. Pancreasproblems. 1. Evaluatechangesinweight,particularlyincreasein weightintheadultanddecreaseinweightinthe child. 2. Evaluatealterationsinfluidbalance. 3. Evaluate changes in mental status. 4. Evaluate serum glucose levels. 5. Evaluatepancreaticenzymestudies. 6. Evaluatetheabdomenforepigastricpainand abdominaldiscomfort.E. Adrenalglands. 1. Adrenalmedulla. a. Evaluatechangesinbloodpressure. b. Assessforchangesinmetabolicrate. 2. Adrenalcortex. a. Evaluate changes in weight. b. Evaluatechangesinskincolorandtexture,and inthepresenceanddistributionofbodyhair. c. Assesscardiovascularsystemforinstabilityas evidencedbylabilebloodpressureandcardiac output. d. EvaluateGIdiscomfort. e. Assessstatusofpotassiumandsodiumlevels. f. Assessforchangesinglucosemetabolism. g. Assessforchangesinreproductivesystemandin sexualactivity. h. Evaluate changes in muscle mass.
Hyperpituitary: AcromegalyAcromegaly is most often the result of a benign slow ✽
growing tumor (pituitary adenoma) that secretes growth hormones. It occurs after the closure of epiphyses of the long bones.
Data CollectionA. Enlargementofthehandsandfeetandhypertrophyof theskin.B. Changesinfacialfeatures:protrudingjaw,slanting forehead,andanincreaseinthesizeofthenose.
PHYSIOLOGY OF THE ENDOCRINE SYSTEM
A. Pituitarygland-Oftenreferredtoasthe“mastergland” becauseitsecreteshormonesthatcontrolhormonese- cretionofotherendocrineglands.B. Thyroidgland-Primaryfunctionofthyroidhormoneis tocontrolthelevelofcellularmetabolismbysecreting thyroxin(T
Diabetes InsipidusDiabetes insipidus (DI) is a problem of the posterior ✽
pituitary characterized by a deficiency of ADH (or kidney’s inability to respond to ADH). When it occurs, it is most often associated with neurological conditions, surgery, tumors, head injury, or inflammatory problems.
Data CollectionA. Excretionofexcessiveamountsurine(greaterthan 200mL/hr)(Polyuria).B. Polydipsia,weakness.C. Lowurinespecificgravity(1.001to1.005).D. Severedehydration(tachycardia,poorskintugor,dry mucousmembranes).E. Increaseinserumsodiumlevel(greaterthan147mEq/L).
TEST ALERT: Observe client for side effects of chemotherapy or radiation.
Home CareA. Thyroidlevelscheckedannually.B. Lifelongthyroidreplacement.C. Ifexcessivefatigueortachycardiaandtremorsbecome aconsistentproblem,notifyhealthcareprovider.
Hypothyroidism Hypothyroidism is characterized by a slow deteriora- ✽
tion of thyroid function. It occurs primarily in older adults and five times more frequently in women (ages 30 – 60) than in men. Myxedema coma is a life-threatening form of hypothyroidism
morefrequently;thyroidpreparationsmayaltereffects ofhypoglycemicagents.C. Continue to reinforce teaching information as client beginstomakeprogress;earlyinthedisease,theclient maynotcomprehendimportanceofinformation.
Hyperparathyroidism
✽ Hyperparathyroidism is characterized by excessive secretion of parathyroid hormone (PTH), resulting in hy-percalcemia. Excessive PTH leads to decalcification of the bones, as the calcium moves from the bones into the serum, hypercalcemia results and possible kidney damage.
NURSING PRIORITY: ✔ Administer sedatives and hypnotics with caution because of increased susceptibility. These medications tend to precipitate respiratory de-pression in the client with hypothyroidism.
Diabetes MellitusDiabetes mellitus is a complex, multisystem disease ✽
characterized by the absence of or a severe decrease in the secretion or utilization of insulin.A. Pathophysiology. 1. Theprimaryfunctionofinsulinistodecreasethe bloodglucoselevel.
2. Insulinissecretedbythebetacellsintheisletsof Langerhansinthepancreas. 3. Insulinallowsthebodytousecarbohydratesmore effectivelyforconversionofglucoseforenergy. 4. Ifcarbohydratesarenotavailabletobeusedfor energy,cellswillbegintobreakdownthefatsand proteinstores. a. Breakdownoffatresultsintheproductionof ketonebodies. b. Proteiniswastedduringinsulindeficiencyand isbrokendown. c. Whenfatsareusedastheprimaryenergy source,theserumlipidlevelrisesandcontri- butestotheaccelerateddevelopmentofathero- sclerosis. 5. Whencirculatingglucosecannotbeutilizedfor energy,thelevelofserumglucosewillincrease (hyperglycemia).B. Classification. 1. Type1:absolutedeficiencyofinsulinsecretion (Figure8-2). a. Onsetisfrequentlyinchildhood;mostoften diagnosedbeforetheageof18years.Most commonagerangeis10to15years. b. Previouslycalledjuvenilediabetesorinsulin- dependentdiabetesmellitus. c. ClientwillhaveType1diabetesfortherestof his or her life.
FIGURE 8-2 Diabetes, type 1. (From Zerwekh J, Claborn J, Miller CJ: Memory notebook of nursing, vol 1, ed 4, Ingram, 2008, Nursing Education Consultants.)
CHAPTER 8 Endocrine System 163
2. Type2:combinationofinsulinresistanceandinad- equateinsulinsecretiontocompensate(Figure8-3). a. Insulindeficiencycausedbydefectsininsulin productionorbyexcessivedemandsforinsulin; clientisnotdependentoninsulin. b. Onsetispredominatelyinadulthood,generally aftertheageof40years,butitmayoccuratany age. c. Previouslycalledadultonsetdiabetes(AODM) ornoninsulin-dependentdiabetesmellitus (NIDDM). d. Associatedwithobesity;overweightpeople requiremoreinsulin. e. Mayrequireinsulinforcontrol. 3. Gestationaldiabetes. a. Developsduringpregnancy;usuallydetectedat 24-28weeksgestationbyoralglucosetolerance test. b. Glucosetoleranceusuallyreturnstonormal soonafterdelivery. c. Commonlyoccursagaininfuturepregnancies; clientisatincreasedriskfordevelopmentofglu- coseintoleranceandType2diabeteslaterinlife. d. Infantmaybelargeforgestationalageandmay experiencehypoglycemiashortlyafterbirth.
Data CollectionA. Clinical manifestations. 1. Types1and2. a. ThreeP’s:polyphagia,polydipsia,polyuria. b. Fatigue. c. Increasedfrequencyofinfections. 2. Type1. a. Weightloss,excessivethirst. b. Bed-wetting,blurredvision c. Complaintsofabdominalpain. d. Onsetisrapid,generallyoverdaystoweeks. 3. Type2.(mostclientsasymptomaticfirst5to10 years).
a. Weightgain(obese),visualdisturbances. b. Onsetisslow;mayoccurovermonths. c. Onsetusuallyaftertheageof40years;peaks around45to50years. d. Fatigueandmalaise. e. Recurrentvaginalyeastormoniliainfections -frequentlyinitialsymptominwomen. f. Olderadultassessmentconsiderations(Box8-1).B. Diagnostics(thecriteriafordiagnosisaretwoormore abnormaltestresultswithtwoormorevaluesoutside thenormalrange)(seeAppendix8-1). 1. Fastingbloodglucoselevelisabove126mg/dl (normalglucoserange70-100mg/dl). 2. Glucosetolerancetest:2-hourglucosevaluesare greaterthan200mg/dl. 3. Randomglucosegreaterthan200mg/dlwithsymp- toms(threeP’s,weightloss). 4. Prediabetes–intermediatestagebetweennormal anddiabetes. a. Impairedglucosetolerance(IGT):greaterthan 140mg/dlandlessthanorequalto200mg/dl. b. Impairedfastingglucose(IFG):fastingblood glucosegreaterthan100mg/dl,butlessthan 126mg/dl. 5. Glycosylatedhemoglobin(HbA
NURSING PRIORITY: ✔ Metabolic effects of exercise: 1. Reduces insulin needs by reducing the blood glucose. 2. Contributes to weight loss or maintenance of normal weight. 3. Assists the body to metabolize cholesterol more efficiently. 4. Promotes less extreme fluctuations in blood glucose level.5. Decreases blood pressure.
Complications of Insulin TherapyA. Hypoglycemia(Table8-1).B. Lipoatrophy(tissueatrophy)andlipohypertrophy(accu- mulationofextrafatatthesiteofmanysubcutaneous injectionsofinsulin).C. Somogyieffect. 1. Reboundhyperglycemiafromanunrecognizedhy poglycemicstate. 2. Mostoftenoccursatnightandtreatedbydecreasing theeveninginsulindoseorbyincreasingthecalo- riesinthebedtimesnack.D. Dawnphenomenon 1. Results from nighttime release of growth hormone andcortisol. 2. Bloodglucoseelevatesat5:00to6:00AM(predawn hours).
FIGURE 8-4 Insulin Profiles (Adapted from Lewis S, Heitkemper M, Dirksen S: Medical-surgical nursing: assessment and management of clinical problems, “Commercially available insulin preparations showing onset, peak, and duration of action,” St Louis, 2007, Mosby).
HIGH
ALERT
Nursing Implications (intermediate acting) 1. Hypoglycemia tends to occur in mid to late afternoon. 2. Never give IV. 3. May be mixed with regular insulin.
Nursing Implications (long acting) 1. Glargine has low pH (4); CANNOT be mixed with other insulins. 2. Usually given once a day at bedtime, but can be administered during the day.
Nursing Implications (rapid acting) 1. Should be used in combination with longer acting insulin.
NURSING PRIORITY: Because of quick onset of action, client must eat immediately.
Nursing Implications (short acting) 1. Usually given 20 - 30 minutes before meals. 2. May be given alone or in combination with longer-acting insulins. 3. Given for sliding scale coverage.
NURSING PRIORITY: When administering injections: 1. May mix regular insulin with other insulins. 2. Only regular insulin may be given IV.
FIGURE 8-4 Profile of Insulins
TEST ALERT: Intervene to control hypoglycemia/ hyperglycemia. Know various insulins and nursing implications. Specifically, know when to anticipate reaction and what to teach the client about his or her insulin.
NURSING PRIORITY: ✔ Intensive control of blood glucose levels in clients with type 1 diabetes can prevent or ameliorate the complications. Intervene to control symptoms of hypoglycemia or hyperglycemia.
Complications Associated with Poorly Controlled DiabetesA. Diabeticketoacidosis. 1. Asevereincreaseinthehyperglycemicstate. 2. Occurspredominatelyintype1diabetes.B. Clinicalmanifestationsofdiabeticketoacidosis(see Table8-1). 1. Onset-maybeacuteoroccuroverseveraldays. a. Mayresultfromstress,infection,surgery,or lackofeffectiveinsulincontrol. b. Resultsfrompoorlycontrolleddiabetes. 2. Severehyperglycemia(bloodglucoselevelsof300- 800mg/dL). 3. Presenceofmetabolicacidosis(lowpH[6.8-7.3]and serumbicarbonatelevellessthan15mEq/L).
Lab Values: Urine Sugar High NegativeKetones High NegativeOnset Rapid(lessthan24hr) RapidClassificationofdiabetes PrimarilyType1;Type2inseveredistress Type1andtype2
DKA,Diabeticketoacidosis;GI, gastrointestinal
166 CHAPTER 8 Endocrine System
C. Thereisanincreasedtendencytowardthedevelopment ofmetabolicacidosis.D. Thereisatendencytointensifytheexistingcomplica- tionsofdiabetes.E. Oralhypoglycemicagentsarenotusedtocontroldiabe- tesinthepregnantclient–insulinisused.
Nursing Intervention (All Types)v Goal: To return serum glucose to normal level.A. Initiallyadministerregularinsulinonaproportional basisaccordingtoneed(Box8-2).B. Administerinsulin30minutesbeforeamealorsnack.C. Maintainadequatefluidintake.D. Evaluateserumelectrolytelevels,especiallypotassium.E. Evaluatehydrationstatus.F. Evaluate and report clinical manifestations of hypogly- cemia and hyperglycemia.
TEST ALERT: Monitor hydration status and electrolyte balance.
v Goal: Toplanandimplementateachingregimen.A. Assesscurrentlevelofknowledgeregardingdiabetes.B. Evaluateculturalandsocioeconomicparameters.C. Evaluateclient’ssupportsystem(family,significant others).D. Instructregardingsick-dayguidelines(Box8-3).
TEST ALERT: Determine ability of family/support systems to provide care for client. Identify client’s and family’s strengths.
B. Nervedamageresultinginneuropathy. 1. Peripheralneuropathy:painandtinglinginlegsand feet;mayprogresstopainlessneuropathy. 2. Verycommoncomplication.C. Infections:Immunesystemisaltered;persistent glycosuriapotentiatesurinarytractinfections.
NURSING PRIORITY: ✔ Painless peripheral neurop-athy is a very dangerous situation for the diabetic. Severe injury to the lower extremities may occur, and the client will not be aware of it. Clients should be taught to visually inspect their feet and legs.
Clinical Implications of Diabetes in PregnancyA. Duringthesecondandthirdtrimester,thenormalre- sponseisfortheinsulinneedstoincreaseasmuch as70%to100%.B. Failureofinsulinneedstoincreasemaybeindicativeof placentalinsufficiency.
NURSING PRIORITY: ✔ Evaluate intake; do not give client on NPO status insulin unless IV is in place.
v Goal: Tomaintaincontrolofdiabeticconditioninthepostoperativeclient.A. IVfluidsandregularinsulinuntilclientisabletotake fluidsorally.B. Frequentbloodsugarlevelassessment.C. Observeforhypoglycemiaimmediatelyaftersurgery.v Goal: Toidentifydiabeticketoacidosisandassistcli-ent to return to homeostasis.A. Frequentmonitoringofvitalsignsandserumglucose checks(normallyhourly).B. Hourlyurinemeasurements:Donotadministerpotas- siumifurineoutputislowordropping.
FIGURE 8-5 Sites Used for Insulin Injection. The injection site can affect the onset, peak, and duration of action of the insulin. Insulin injected into the abdomen (area I) is absorbed fastest, followed by insulin injected into the arm (area II) and the leg (area III). (From Black J, Hawks, J: Medical surgical nursing: clinical management for positive outcomes, ed 8, St Louis, 2009, Mosby.)
Nursing Interventionv Goal: To increase serum glucose level.A. Administerglucose/carbohydratepreparationsasindi- cated.
NURSING PRIORITY: ✔ When in doubt of diagnosis of hypoglycemia versus hyperglycemia, administer car-bohydrates; severe hypoglycemia can rapidly result in permanent brain damage.
If you do not feel well (not eating regularly, fever, lethargy, nausea and vomiting, etc.):1. Checkyourbloodglucoseevery3to4hoursandurine ketoneswhenvoiding.2. Increaseyourintakeoffluidsthatarehighincarbohy- drates;everyhour,drinkfluidsthatreplaceelectro- lytes:fruitdrinks,sportsdrinks,regularsoftdrinks (notdietbeverages).3. Ifyoucannoteatandyouhavereplacedfourtofive mealswithliquids,notifyyourhealthcareprovider.4. Getplentyofrest;ifpossible,havesomeonestaywith you.5. Donotomitorskipyourinsulininjectionsororal medicationsunlessspecificallydirectedtodosobyyour healthcareprovider.6. Followyourhealthcareprovider’sinstructionsregarding bloodglucoselevelsandinsulinororalhypoglycemic agents.7. Staywarm,stayinbed,anddonotoverexertyourself.8. Callyourhealthcareproviderwhen: a. Youhavebeenillfor1to2dayswithoutgettingany better. b. Youhavebeenvomitingorhaddiarrheaformorethan 6 hours. c. Yoururineself-testingshowsmoderatetolarge amountsofketones. d. Youaretakinginsulinandyourbloodglucoselevel continuestobegreaterthan240mg/dlafteryouhave takentwotothreesupplementaldosesofregular insulin(pre-arrangedwithyourprovider). e. Youaretakinginsulinandyourbloodglucoselevelis lessthan60mg/dl. f. YouhaveType2diabetes,youaretakingoraldiabetic medications,andyourpremealbloodglucoselevels are240mg/dlorgreaterformorethan24hours. g. Youhavesignsofseverehyperglycemia(verydry mouthorfruityodortobreath),dehydration,or confusion. h. Youaresleepierormoretiredthannormal. i. Youhavestomachorchestpainoranydifficulty breathing. j. Youhaveanyquestionsorconcernsaboutwhatyou needtodowhileill.
Nursing InterventionNursing intervention is the same for the client with acute pancreatitisandfortheclientwithchronicpancreatitisexpe-riencinganacuteepisode.v Goal: Torelievepainanddecreasepancreaticstimula-tion.A. Administeranalgesics;paincontrolisessential(rest- lessnessmaycausepancreaticstimulationandfurther secretionofenzymes).B. Placeclientonsideinknee-chestorinsemi-Fowler’s position.C. Evaluateprecipitatingcause.
Home CareA. Avoidallalcoholintake.B. Knowsignsofdevelopmentofdiabetesandwhento returnforevaluationofbloodsugarlevel.C. Blanddiet,lowinfat,highincarbohydrates(protein recommendationsvary).D. Replacementofpancreaticenzymes.
Cancer of the PancreasThe majority of tumors occur in the head of the ✽
pancreas. As tumors grow, the bile ducts are obstructed, causing jaundice. Tumors in the body of the pancreas frequently do not cause symptoms until growth is advanced. Cancer of the pancreas has a poor prognosis; the 5 year survival rate is low.
Data CollectionA. Dull,achingabdominalpain.B. Ascites, nausea, vomiting.C. Anorexiaandprogressiveweightloss.D. Jaundice,clay-coloredstools,E. Dark,frothyurine.
Home CareA. Evaluateforboutsofanxietyanddepressioncausedby severityofillnessandprognosis(seeChapter6).B. Assist client in setting realistic goals.C. Encourage ventilation of feelings.
PheochromocytomaPheochromocytoma is a rare disorder of the adrenal ✽
medulla characterized by a tumor that secretes an excess of epinephrine and norepinephrine.
Data Collection
NURSING PRIORITY: ✔ Clients experiencing prob-lemsof theadrenalmedullahaveseverefluctuations inblood pressure related to the levels of catecholamines.
A. Persistentorparoxysmalhypertension.B. Palpitations,tachycardia.C. Hyperglycemia,headache.
Nursing Interventionv Goal: To return to homeostasis.A. InitiateandmaintainIVinfusionofnormalsaline solution.B. AdministerlargedosesofcorticosteroidsthroughIV bolusinitially,thentitrateinadilutedsolution.C. Frequentevaluationofvitalsigns.D. Assesssodiumandwaterretention.E. Evaluateserumpotassiumlevels.F. Keepclientimmobilizedandquiet.
NURSING PRIORITY: ✔ If any client is experiencing difficultywithmaintainingadequatebloodpressure,donot move him or her unless absolutely necessary. Avoid all unnecessary nursing procedures until the client’s condition is stabilized.
v Goal: Tosafelytakesteroidreplacements(seeAppen-dix5-7).A. Administersteroidpreparationswithfoodoranantacid.B. Evaluateforedemaandfluidretention.C. Assessserumsodiumandpotassiumlevels.D. Checkdailyweight.E. Increaseintakeofproteinandcarbohydrates.F. Evaluateforhypoglycemia.G. Observeforcushingoidsymptoms.
CHAPTER 8 Endocrine System 171
Home CareA. Lifelongsteroidtherapyisnecessary.B. Dosageofsteroidsmayneedtobeincreasedintimesof additionalstress.C. Infection,diaphoresis,andinjurywillnecessitatean increaseintheneedforsteroidsandmayprecipitate a crisis state.D. Reportgastricdistressbecauseitmaybecausedby steroids.E. Carryamedicalidentificationcard.
Cushing’s syndrome occurs as a result of excess levels ✽of adrenal cortex hormones.
NURSING PRIORITY: ✔ The most common cause of Cushing’s syndrome is long-term steroid therapy for chronic conditions. Many chronic conditions necessitate the use of long-term steroid therapy. The symptoms of the syndrome are the same regardless of the origin of the problem.
TEST ALERT: Frequently, the level of the FBS is given in a question, and it is necessary to evaluate the level and determine the appropriate nursing intervention.
174 CHAPTER 8 Endocrine System
HIGH
ALERT
Appendix 8-2 MEDICATIONS USED IN ENDOCRINE DISORDERS
ANTITHYROID AGENT: Inhibits production of thyroid hormone; does not inactivate thyroid hormone in circulating blood. Medi-cations are not reliable for long-term inhibition of thyroid hormone production.
ORAL HYPOGLYCEMIC AGENTS: Stimulate beta cells to secrete more insulin; enhance body utilization of available insulin (see Figure 8-4 for insulin). HIGH ALERT MEDICATIONS
GENERAL NURSING IMPLICATIONS• Doseshouldbedecreasedforelderly.• Usewithcautioninclientswithrenalandhepaticimpairment.• Alloralhypoglycemicagentsarecontraindicatedinpregnantclients.• Allclientsshouldbecarefullyobservedforsymptomsofhypoglycemiaandhyperglycemia.• Medicationsshouldbetakeninthemorning.• Long-termtherapymayresultindecreasedeffectiveness.
CHAPTER 8 Endocrine System 175
Appendix 8-2 MEDICATIONS USED IN ENDOCRINE DISORDERS—cont’d
Medications Side Effects Nursing Implications SULFONYLUREAS: Stimulate the pancreas to make more insulin.
THIAZOLIDINEDIONES: Enhance insulin utilization at receptor sites (they do NOT increase insulin production); also referred to as “insulin sensitizers.”
DIPEPTIDYL PEPTIDASE-4 (DDP-4) INHIBITORS: Enhances the incretin system, stimulates release of insulin for beta cells, and decreases hepatic glucose production.