Chapter 11 Chapter 11 Care of the Patient with an Endocrine Disorder Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Dec 25, 2015
Chapter 11Chapter 11
Care of the Patient with
an Endocrine Disorder
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Endocrine glands and hormones The endocrine system is composed of a series of
ductless glands It communicates through the use of hormones
• Hormones are chemical messengers that travel though the bloodstream to their target organ
*Exocrine=glands that secrete through ducts (sebaceous, sudoriferous)
*Endocrine= ductless glands; release secretions directly into bloodstream
Slide 3Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Works closely with nervous system
• Both control homeostasis
• Small amount of hormone is very powerful
• Too much or too little of one hormone can affect other hormones (interrelated)
• Controlled by negative feedback system
• Information continually exchanged between target organ and pituitary gland
Slide 4Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Pituitary gland—“master gland”; works closely with hypothalamus Anterior pituitary gland (6 hormones)
• TSH (growth and secretion of thyroid)
• FSH (growth of ovarian follicle, production of estrogen in females, and production of sperm in males)
• GH (also called somatropic hormone; accelerates the growth of the body)
• ACTH (growth and secretion of adrenal cortex)
• LH (stimulates ovulation and formation of corpus luteum in menstruation cycle)
• PROLACTIN (secretion of milk and influences maternal behavior)
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
Slide 5Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Posterior PituitaryPosterior Pituitary
Posterior pituitary gland (2 hormones)• Oxytocin (maintains water balance by increasing the reabsorption
of water by the kidneys)
• ADH (vasopressin) maintains water balance by increasing the reabsorption of water by the kidneys.
Categorized Based on Function:
• TROPIC- target other endocrine structures to increase their growth and secretions
• SEX- influence reproductive changes
• ANABOLIC- stimulate the process of building tissues.
Slide 6Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Thyroid gland Butterfly shaped Thyroxine (T3), Triiodothronine (T4), Calcitonin Requires iodine for function Control metabolism, growth and development,
nervous system activity Controlled by TSH released by pituitary gland
• Parathyroid gland 4 glands in posterior surface of thyroid PTH; regulates Ca and PhosphorusCalcium: > levels=impaired heart fx, cardiac arrest
<levels=excitability of nerve cells; increased muscle stimulation; tetany
Slide 7Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Adrenal gland Adrenal cortex; outer section
• 3 layers; each secrete hormone (steroid) Mineralocorticoids, glucocorticoids, sex hormones
Adrenal medulla; middle section• Epinephrine (adrenaline), norepinephrine
• Pancreas Exocrine and endocrine functions Insulin and glucagon
Slide 8Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 11-2Figure 11-2
Pituitary hormones.
(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)
Slide 9Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Female sex glands Ovaries; estrogen & progesterone Placenta; releases estrogen & progesterone during
pregnancy
• Male sex glands Testes; testosterone
• Thymus gland Thymosin; assists with immunity during infancy
• Pineal gland Melatonin; biological clock & inhibits gonadotropic
activity
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
Slide 10Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 11-1Figure 11-1
Location of the endocrine glands in the female and male bodies.
(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)
Slide 11Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
• Acromegaly Etiology/pathophysiology
• Overproduction of growth hormone in the adult
• Causes Idiopathic hyperplasia of the anterior pituitary gland Tumor growth in the anterior pituitary gland
• Changes are irreversible
Slide 12Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
• Acromegaly (continued) Clinical manifestations/assessment
• Enlargement of the cranium and lower jaw
• Separation and malocclusion of the teeth
• Bulging forehead
• Bulbous nose
• Thick lips; enlarged tongue; hypertrophy of vocal cords
• Generalized coarsening of the facial features
• Enlarged hands and feet
• Enlarged heart, liver, and spleen
Slide 13Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
• Acromegaly (continued) Clinical manifestations/assessment (continued)
• Muscle weakness
• Hypertrophy of the joints with pain and stiffness
• Males—impotence
• Females—deepened voice, increased facial hair, amenorrhea
• Partial or complete blindness with pressure on the optic nerve due to tumor
• Severe headaches common
Slide 14Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 11-6Figure 11-6
Right: Coarse facial features typical of acromegaly. Left: Patient’s
face several years before she developed the pituitary tumor.
(Courtesy of the Group for Research in Pathology Education.)
Slide 15Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
AcromegalyAcromegaly
• Assessment Subjective; pain, visual disturbances, emotional
reactions Objective data; monitor bone enlargement, joint
involvement, vital signs, s/s heart failure
• Diagnosis CT, MRI, cranial radiographic evaluation Complete ophthalmic exam to determine damage to
optic nerve, Lab tests: serum GH level, oral GTT (GH usually falls
during challenge but not in acromegaly)
Slide 16Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
• Acromegaly (continued) Medical management/nursing interventions
• Pharmacological management
• Given to suppress GH release Parlodel Sandostatin Analgesics
• Cryosurgery (application of extreme cold)
• Transsphenoidal removal of tissue
• Proton beam therapy (radiation)
• Soft, easy-to-chew diet
• Prognosis: changes irreversible; prone to complications
Slide 17Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
• Gigantism Etiology/pathophysiology
• Overproduction of growth hormone
• Caused by hyperplasia of the anterior pituitary gland
• Occurs in a child before closure of the epiphyses
• Results in overgrowth of long bones
Slide 18Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
• Gigantism (continued) Clinical manifestations/assessment
• Great height
• Increased muscle and visceral development
• Increased weight
• Normal body proportions
• Weakness
Slide 19Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
GigantismGigantism
Assessment• Subjective; patient’s understanding of disease
process/ability to verbalize emotional responses
• Objective; frequent height measurement, use of adaptive coping mechanisms/family interactions
Diagnosis• GH suppression test (glucose loading test); baseline
GH levels high Medical management/nursing interventions
• Surgical removal of tumor
• Irradiation of the anterior pituitary gland
Prognosis: shorter than average life span
Slide 20Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
• Dwarfism Etiology/pathophysiology
• Deficiency in growth hormone; usually idiopathic
• Some cases attributed to autosomal recessive trait Clinical manifestations/assessment
• Abnormally short height
• Normal body proportion
• Appear younger than age
• Dental problems due to underdeveloped jaws
• Delayed sexual development`
Slide 21Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
• Assessment Subjective; pt’s understanding of disease process; emotional
response Objective; regular ht/wt measurement
• Diagnostic tests Radiographic evaluation of wrist for bone age & MRI/CT scan to
r/o pituitary tumor Plasma GH levels (will be decreased)
• Medical management/nursing interventions• Growth hormone injections• Removal of tumor, if present• Major issues with self-esteem• Prognosis: normal life span; prone to
musculoskeletal/cardiovascular problems
Slide 22Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
• Diabetes insipidus Etiology/pathophysiology
• Transient or permanent metabolic disorder of the posterior pituitary
• Deficiency of antidiuretic hormone (ADH)
• Primary or secondary
• Significant electrolyte and fluid imbalances
Slide 23Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
• Diabetes insipidus Clinical manifestations/assessment
• Polyuria; polydipsia• May become severely dehydrated• Lethargic• Dry skin; poor skin turgor• Constipation
Assessment• Subjective; embarrassment, not restricting fluids• Objective; skin turgor, I&O, urine color, daily weight
Diagnosis• Urine ADH measurement, urine specific gravity, urine
output, serum Na levels
Slide 24Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Diabetes InsipidusDiabetes Insipidus
Medical management/nursing interventions• ADH preparations
• Limit caffeine due to diuretic properties
• Prognosis: dependant on etiology, usually dependant on medication for life, constant medical monitoring since condition may worsen with time
Slide 25Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
• Hyperthyroidism Etiology/pathophysiology
• Also called Graves’ disease, exophthalmic goiter, and thyrotoxicosis
• Overproduction of the thyroid hormones
• Exaggeration of metabolic processes
• Exact cause unknown
Slide 26Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hyperthyroidism (continued) Clinical manifestations/assessment
• Edema of the anterior portion of the neck
• Exophthalmos
• Inability to concentrate; memory loss
• Dysphagia
• Hoarseness
• Increased appetite
• Weight loss
• Nervousness
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 27Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hyperthyroidism (continued) Clinical manifestations/assessment (continued)
• Insomnia
• Tachycardia; hypertension
• Warm, flushed skin
• Fine hair
• Amenorrhea
• Elevated temperature
• Diaphoresis
• Hand tremors
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 28Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
HyperthyroidismHyperthyroidism
• Assessment Subjective: inability to concentrate, memory loss,
feelings of nervousness, jittery, insomnia Objective: rapid pulse, high BP, skin warm/flushed,
amenorrhea, hyperactivity, clumsiness, weight loss
• Diagnosis Decrease in TSH levels & elevated T3, T4 Elevated iodine uptake test
Slide 29Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hyperthyroidism (continued) Medical management/nursing interventions
• Pharmacological management Propylthiouracil (PTU) Methimazole (Tapazole) Block production of thyroid hormones
• Radioactive iodine (ablation therapy)
• Subtotal thyroidectomy
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 30Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hyperthyroidism (continued) Medical management/nursing interventions
(continued)• Postoperative
Voice rest; voice checks Avoid hyperextension of the neck Tracheotomy tray at bedside Assess for signs and symptoms of internal and external
bleeding Assess for tetany
o Chvostek’s and Trousseau’s signs Assess for thyroid crisis Prognosis: normal life expectancy; may develop
hypothyroidism due to treatment
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 31Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hypothyroidism Etiology/pathophysiology
• Insufficient secretion of thyroid hormones
• Slowing of all metabolic processes
• Failure of thyroid or insufficient secretion of thyroid-stimulating hormone from pituitary gland
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 32Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hypothyroidism (continued) Clinical manifestations/assessment
• Hypothermia; intolerance to cold
• Weight gain
• Depression
• Impaired memory; slow thought process
• Lethargic
• Anorexia
• Constipation
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 33Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hypothyroidism (continued) Clinical manifestations/assessment
• Decreased libido
• Menstrual irregularities
• Thin hair
• Skin thick and dry
• Enlarged facial appearance
• Low, hoarse voice
• Bradycardia
• Hypotension
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 34Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
HypothyroidismHypothyroidism
• Assessment Subjective: depression, paranoia, impaired memory,
irritability, coping mechanisms Objective: skin, hair, facial features, voice,
bradycardia, decreased BP, weakness, menorrhagia
• Diagnosis Physical exam Lab tests: TSH, T3, T4,
Slide 35Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hypothyroidism (continued) Medical management/nursing interventions
• Pharmacological management Synthroid Levothyroid Proloid Cytomel
• Symptomatic treatment
• Prognosis: require medication for life
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 36Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Simple goiter Etiology/pathophysiology
• Enlarged thyroid due to low iodine levels
• Enlargement is caused by the accumulation of colloid in the thyroid follicles
• Usually caused by insufficient dietary intake of iodine
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 37Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Simple goiter (continued) Clinical manifestations/assessment
• Enlargement of the thyroid gland• Dysphagia• Hoarseness• Dyspnea
Assessment Medical management/nursing interventions
• Pharmacological management Potassium iodide
• Diet high in iodine• Surgery—thyroidectomy• Prognosis: normal life expectancy
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 38Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 11-10Figure 11-10
Simple goiter.
(Courtesy of L. V. Bergman & Associates, Inc., Cold Springs, New York.)
Slide 39Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Cancer of the thyroid Etiology/pathophysiology
• Malignancy of thyroid tissue; very rare Clinical manifestations/assessment
• Firm, fixed, small, rounded mass or nodule on thyroid Assessment Diagnosis; thyroid needle biopsy Medical management/nursing interventions
• Total thyroidectomy• Thyroid hormone replacement• If metastasis is present: radical neck dissection;
radiation, chemotherapy, and radioactive iodine• Prognosis: dependant on tumor type
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 40Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hyperparathyroidism Etiology/pathophysiology
• Overactivity of the parathyroid, with increased production of parathyroid hormone
• Hypertrophy of one or more of the parathyroid glands
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 41Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hyperparathyroidism (continued) Clinical manifestations/assessment
• Hypercalcemia
• Skeletal pain; pain on weight-bearing
• Pathological fractures
• Kidney stones
• Fatigue
• Drowsiness
• Nausea
• Anorexia
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 42Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hyperparathyroidism (continued) Assessment Diagnosis
• X-ray-skeletal decalcification; PTH increased, serum phosphorus low, calcium high
Medical management/nursing interventions• Removal of tumor
• Removal of one or more parathyroid glands
• Prognosis: good with proper treatment unless due to carcinoma
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 43Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hypoparathyroidism Etiology/pathophysiology
• Decreased parathyroid hormone
• Decreased serum calcium levels
• Inadvertent removal or destruction of one or more parathyroid glands during thyroidectomy
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 44Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hypoparathyroidism (continued) Clinical manifestations/assessment
• Neuromuscular hyperexcitability
• Involuntary and uncontrollable muscle spasms
• Tetany
• Laryngeal spasms
• Stridor
• Cyanosis
• Parkinson-like syndrome
• Chvostek’s and Trousseau’s signs
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 45Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Hypoparathyroidism (continued) Assessment Diagnosis
• Decreased serum calcium and PTH, increased serum phosphorus
Medical management/nursing interventions• Pharmacological management
Calcium gluconate or intravenous calcium chloride
• Vitamin D
• Prognosis: fairly normal lifestyle and expectancy
Disorders of the Thyroid and Parathyroid GlandsDisorders of the Thyroid and Parathyroid Glands
Slide 46Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Adrenal GlandsDisorders of the Adrenal Glands
• Adrenal hyperfunction (Cushing’s syndrome) Etiology/pathophysiology
• Plasma levels of adrenocortical hormones are increased
• Hyperplasia of adrenal tissue due to overstimulation by the pituitary gland
• Tumor of the adrenal cortex
• Adrenocorticotropic hormone (ACTH) secreting tumor outside the pituitary
• Overuse of corticosteroid drugs
Slide 47Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Adrenal GlandsDisorders of the Adrenal Glands
• Adrenal hyperfunction (Cushing’s syndrome) (continued) Clinical manifestations/assessment
• Moonface
• Buffalo hump
• Thin arms and legs
• Hypokalemia; proteinuria
• Increased urinary calcium excretion
• Susceptible to infections
• Depression
• Loss of libido
Slide 48Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Adrenal GlandsDisorders of the Adrenal Glands
• Adrenal hyperfunction (Cushing’s syndrome) (continued) Clinical manifestations/assessment
• Ecchymoses and petechiae
• Weight gain
• Abdominal enlargement
• Hirsutism in women
• Menstrual irregularities
• Deepening of the voice
Slide 49Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Adrenal GlandsDisorders of the Adrenal Glands
• Adrenal hyperfunction (Cushing’s syndrome) (continued) Assessment Diagnosis
• Clinical appearance and lab tests; high cortisol levels, CT/ultrasound to r/o adrenal/pituitary tumor
Medical management/nursing interventions• Treat causative factor
Adrenalectomy for adrenal tumor Radiation or surgical removal for pituitary tumors
• Lysodren• Dietary recommendations:
Low-sodium High-potassium
Slide 50Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Adrenal GlandsDisorders of the Adrenal Glands
• Adrenal hypofunction (Addison’s disease) Etiology/pathophysiology
• Adrenal glands do not secrete adequate amounts of glucocorticoids and mineralocorticoids
• May result from Adrenalectomy Pituitary hypofunction Long-standing steroid therapy
Slide 51Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Adrenal GlandsDisorders of the Adrenal Glands
• Adrenal hypofunction (Addison’s disease) (continued) Clinical manifestations/assessment
• Usually not detected until 90% cortex destroyed
• Related to imbalances of hormones, nutrients, and electrolytes
• Nausea; anorexia
• Postural hypotension
• Headache
• Disorientation
• Abdominal pain; lower back pain
• Anxiety
Slide 52Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Adrenal GlandsDisorders of the Adrenal Glands
• Adrenal hypofunction (Addison’s disease) (continued) Clinical manifestations/assessment
• Darkly pigmented skin and mucous membranes
• Weight loss
• Vomiting
• Diarrhea
• Hypoglycemia
• Hyponatremia
• Hyperkalemia
• Assess for adrenal crisis
Slide 53Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Adrenal GlandsDisorders of the Adrenal Glands
• Adrenal hypofunction (Addison’s disease) (continued) Assessment Diagnosis
• Decreased serum Na, increased K+, decreased glucose, cortisol/aldosterone levels low
Treatment• Restore fluid and electrolyte balance• Replacement of adrenal hormones• Diet high in sodium and low in potassium• Adrenal crisis
IV corticosteroids in a solution of saline and glucose Prognosis: fair with proper treatment
Slide 54Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Adrenal GlandsDisorders of the Adrenal Glands
• Pheochromocytoma Etiology/pathophysiology
• Chromaffin cell tumor; usually found in the adrenal medulla
• Causes excessive secretion of epinephrine and norepinephrine
Clinical manifestations/assessment• Hypertension
Diagnosis: urinary metanephrines (catecholamine metabolites) elevated
Medical management/nursing interventions• Surgical removal of tumor
Slide 55Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus Etiology/pathophysiology
• A systemic metabolic disorder that involves improper metabolism of carbohydrates, fats, and proteins
• Insulin deficiency
• Risk factors Heredity Environment and lifestyle Viruses Malignancy or surgery of pancreas
Slide 56Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Types of diabetes mellitus
• Type I—insulin dependent (IDDM)
• Type II—non-insulin dependent (NIDDM) Clinical manifestations/assessment
• Type I and type II “3 Ps”
o Polyuriao Polydipsiao Polyphagia
Slide 57Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Clinical manifestations/assessment (continued)
• Type I Sudden onset Weight loss Hyperglycemia Under 40 years old
Slide 58Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Clinical manifestations/assessment (continued)
• Type II Slow onset May go undetected for years “3 Ps” are usually mild If untreated, may have skin infections and arteriosclerotic
conditions
Slide 59Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Diagnostic tests
• Fasting blood glucose (FBG)
• Oral glucose tolerance test (OGTT)
• 2-hour postprandial blood sugar
• Patient self-monitoring of blood glucose (SMBG)
• Glycosylated hemoglobin (HbA1c)
• C-peptide test
Slide 60Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Medical management/nursing interventions
• Diet A goal of nutritional therapy is to achieve a blood glucose
level of <126 mg/dL Balanced diet should include proteins, carbohydrates,
and fats Type II—may be controlled by diet alone Type I—diet is calculated and then the amount of insulin
required to metabolize it is established
Slide 61Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Medical management/nursing interventions
(continued)• Diet (continued)
American Diabetes Association (ADA) dieto Seven exchangeso Quantitative diet
Need three regular meals with snacks between meals and at bedtime to maintain constant glucose levels
Slide 62Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Medical management/nursing interventions
(continued)• Exercise
Promotes movement of glucose into the cell Lowers blood glucose Lowers insulin needs
• Stress of acute illness and surgery Extra insulin may be required Increased risk of ketoacidosis (hyperglycemia) Glucose must be monitored closely
Slide 63Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Medical management/nursing interventions
(continued)• Medications
Insulino Classified by action: Regular; Lente and NPH;
Ultralenteo Classified by type: beef/pork: Humulin/Novolino Injection sites should be rotated to prevent scar
tissue formationo Sliding scale
Slide 64Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
A, Rotation of sites for insulin injections.
B, Injection diagram to track rotation of injection sites.
Figure 11-16Figure 11-16
(From Potter, P.A., Perry, A.G. [2003]. Basic nursing: essentials for practice. [5th ed.]. St. Louis: Mosby.)
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Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Medical management/nursing interventions
(continued)• Medications
Oral hypoglycemic agentso Stimulate islet cells to secrete more insulino Only for type II diabetes mellitus
Slide 66Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Medical management/nursing interventions
(continued)• Patient teaching
Good skin care Report any skin abnormalities to physician Special foot care is crucial
o Do not trim toenails—go to podiatristo No hot water bottles or heating pads
Assess for symptoms of hypoglycemia
Slide 67Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Medical management/nursing interventions
(continued)• Acute complications
Comao Diabetic ketoacidosiso Hyperglycemic hyperosmolar nonketotico Hypoglycemic reaction
Infection
Slide 68Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the PancreasDisorders of the Pancreas
• Diabetes mellitus (continued) Medical management/nursing interventions
(continued)• Long-term complications
Diabetic retinopathy Cardiovascular problems Renal failure
Slide 69Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Nursing ProcessNursing Process
• Nursing diagnoses Knowledge, deficient Self-esteem, risk for situational low Sensory and perceptual alterations: visual Fluid volume, deficient, risk for Infection, risk for Sexual dysfunction Body image, disturbed Coping, ineffective Nutrition, imbalanced Activity intolerance
Chapter 21
Hormones and Steroids
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Chapter 21
Lesson 21.1
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Learning Objectives
Describe the use of antidiabetic medications Identify preparations that act on the uterus
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Overview
Hormones and steroids Natural and synthetic preparations Used to replace and/or increase natural
chemicals in the body
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Endocrine System
Regulation and coordination of body systems Endocrine glands Pituitary, thyroid, parathyroid, adrenal glands,
pancreas, testes, ovaries, and placenta
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Endocrine System
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Male Reproductive System
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Female Reproductive System
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Antidiabetic Drugs
Diabetes mellitus: chronic disorder of metabolism
Insulin: necessary for the metabolism and use of glucose in the body
Pancreas Type 1 and type 2 diabetes
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Insulin
Action Lowers blood glucose levels by helping
glucose move into target tissuesUses Treatment of type 1 diabetesTable 21-1
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Insulin (cont.)
Adverse Reactions Lipodystrophy, local itching, swelling, erythema Hypoglycemia: serum glucose less than 60
mg/dLDrug Interactions Insulin antagonists Anabolic steroids and alcohol may increase the
hypoglycemic effects of insulin
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Insulin (cont.)
Nursing Implications Assessment: polyuria, polyphagia, polydipsia,
weight loss, blurred vision, and fatigue Hyperglycemia: systemic acidosis Conditions that alter requirements for insulin
Patient Teaching
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Oral Hypoglycemics
Action Stimulate insulin release from pancreatic beta cells;
decrease insulin resistanceUses Monotherapy versus combination therapy Six classes
Sulfonylureas, 1st and 2nd generation Biguanides Alpha-glucosidase inhibitors Meglitinides Thiazolidinediones Incretins
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Oral Hypoglycemics (cont.)
Adverse Reactions Hypoglycemia; allergic reactions
Drug Interactions Displacement; potentiation Thiazides oppose the secretion of insulin
from beta cells and decrease the effectiveness of sulfonylureas
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Oral Hypoglycemics (cont.)
Nursing Implications Assessment: health history; renal and liver
function; sulfa allergies
Patient Teaching
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Selected Drugs Used with Pregnancy and Delivery
Overview Antepartum, intrapartum, and postpartum
Tocolytics Oxytocics Uterine relaxants Abortifacients
Drug Table 21-4
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Selected Drugs Used with Pregnancy and Delivery (cont.)
Action and Uses Abortifacients stimulate uterine contractions and
cause the uterus to empty Oxytocic agents and ergot preparations cause
the uterus to contract Uterine relaxants act on beta-adrenergic
receptors to stop smooth-muscle contraction in the uterus
Tocolytics are used to stop preterm labor
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Selected Drugs Used with Pregnancy and Delivery (cont.)
Adverse Reactions Abortifacients: cramping and pain Tocolytics: visual disturbance, malaise, nausea, and
confusion Oxytocics: dysrhythmias, edema, fetal bradycardia,
anxiety, redness of skin during administration, nausea, vomiting, anaphylaxis, postpartum hemorrhage, cyanosis, and dyspnea
Ergots: nausea and vomiting, allergic reactions, bradycardia, hypotension, hypertension, cerebrospinal symptoms, and spasms
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Selected Drugs Used with Pregnancy and Delivery (cont.)
Drug Interactions Vasoconstrictors and local anesthetics
increase the effectiveness of oxytocics
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Selected Drugs Used with Pregnancy and Delivery (cont.)
Nursing Implications and Patient Teaching Assessment Diagnosis Planning Implementation: nursing care and monitoring
during drug administration Evaluation Patient and family teaching: adverse effects of
ergonovine
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Question 1
____________________ are chemicals that are made in an organ or gland and carried through the bloodstream to another part of the body.
1. Steroids2. Hormones3. Androgens4. Estrogens
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Question 2
Which of the following are NOT part of the endocrine system?
1. Pituitary gland2. Adrenal glands3. Placenta4. Sweat glands
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Question 3
A lack of insulin can increase the production of free fatty acids. There may be an increase in glucagon and other hormones and a decrease in pH. This is called:
1. Lipodystrophy.2. Ketoacidosis.3. Hyperglycemia.4. Hypoglycemia.
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Chapter 21
Lesson 21.2
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Learning Objectives
Compare and contrast the action of adrenal and pituitary hormones
Describe at least five adverse reactions that may result from the use of glucocorticoid and mineralocorticoid steroids
Compare the actions of various male and female hormones
List the indications for the use of thyroid preparations
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Pituitary and Adrenocortical Hormones
Pituitary gland: “master gland” Adenohypophysis Neurohypophysis Hormone production, control growth,
electrolyte balance, water retention or loss, and reproductive cycle
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Pituitary Hormones
Anterior Pituitary Hormones HCG LH and FSH STH ACTH
Drug Table 21-5
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Anterior Pituitary Hormones (cont.)
Adverse Reactions (systemic or local reaction) Menotropins: enlarged ovaries; multiple births when
used for fertilization Clomiphene: abdominal discomfort, ovarian
enlargement, blurred vision, nervousness, nausea and vomiting, vasomotor flushes
Chorionic gonadotropins: headache, irritability, restlessness, fatigue, and edema
Somatotropin: antibody stimulation ACTH: adrenal gland
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Posterior Pituitary Hormones
ADH Vasopressin may cause abdominal cramps,
anaphylaxis, bronchial constriction, circumoral pallor, diarrhea, flatus, intestinal hyperactivity, headache, sweating, tremors, urticaria, uterine cramps, vertigo, vomiting; large doses may produce death
Oxytocin ACTH Drug Table 21-6
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Adrenocortical Hormones
Actions Manufactures glucocorticoids,
mineralocorticoids, and small amounts of sex hormones
Uses Adrenal insufficiency (Addison disease) Reduce inflammation in allergic or
immunologic responses; treat hematologic and malignant diseases
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Adrenocortical Hormones (cont.)
Adverse Reactions Table 21-7Drug Interactions Increase effects of barbiturates, sedatives,
narcotics, and certain anticoagulants Decrease effects of insulin, oral
hypoglycemics, Coumadin, isoniazid, aspirin, and broad-spectrum antibiotics
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Adrenocortical Hormones (cont.)
Nursing Implications and Patient Teaching Frequent medical monitoring Avoid smoking Alcohol use: ulcer development Risk for infection Increase dose during times of stress Signs and symptoms of adrenal insufficiency Do not stop drug abruptly MedicAlert bracelet Immunization considerations Diet Storage of drug Drug interactions Dosage schedule, missed dosage
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Sex Hormones
Production influenced by the anterior pituitary Male: testosterone; androgens Female: estrogen; progesterone
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Androgens
Actions Development of secondary sex characteristics; tissue
building
Uses Hypogonadism, hypopituitarism, dwarfism, eunuchism,
cryptorchidism, oligospermia, and male androgen deficiency
Adverse Reactions Edema due to sodium retention, acne, hirsutism, male
pattern baldness, cholestatic hepatitis with jaundice, buccal irritation, nausea and vomiting, diarrhea
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Androgens (cont.)
Drug Interactions Increased effects – anticoagulants, antidiabetic agents,
and other drugs Decreased effects – barbiturates Concurrent use with corticosteroids increase edemaNursing Implications Assessment, diagnosis, planning, implementation, and
evaluationDrug Table 21-9
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Androgens (cont.)
Patient and Family Teaching Administration Response time Diet Symptoms to report Administration considerations
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Female Sex Hormones
Estrogens Progestins Table 21-10
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Estrogens
Action and Uses Used for hormone replacement therapy in menopause
and other conditions (ovarian failure); infertility work-ups; palliative breast cancer treatment
Adverse Reactions
Drug Interactions
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Progestins
ActionUses Contraception, control excessive uterine bleeding,
treatment of secondary amenorrhea, dysmenorrhea, premenstrual tension, and control of pain in endometriosis
Drug InteractionsNursing Implications and Patient Teaching
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Oral Contraceptives
Combination Drugs: Estrogen and Progestin Table 21-11Action Prevent ovulationUse ContraceptionAdverse Reactions Estrogen excess, progestin excess, androgen excess,
estrogen deficiency, progestin deficiencyContraindications for Oral Contraceptives
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Thyroid Hormones
Thyroid Supplements or ReplacementsAction Increase metabolic rate: increase tissue oxygen
consumption, body temperature, heart and respiratory rate, cardiac output, and carbohydrate, lipid, and protein metabolism; influence the development of the skeletal system
Uses Replacement therapy for several conditionsTable 21-12
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Thyroid Hormones (cont.)
Adverse Reactions Dysrhythmias, hypertension, tachycardia,
hand tremors, headache, insomnia, nervousness, diarrhea, vomiting, weight loss, menstrual irregularities, rash, glycosuria, hyperglycemia, increase prothrombin time, and increase serum cholesterol levels
Drug Interactions
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Thyroid Hormones (cont.)
Nursing Implications and Patient Teaching Assessment, diagnosis, planning,
implementation, evaluation Administration Drug action/expected outcomes Drug interactions: diabetes; anticoagulants;
checking with health care provider Signs/symptoms of hyperthyroidism and
hypothyroidism
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Antithyroid Products
Action Stop the production of thyroid hormones Uses Treatment of hyperthyroidism; to improve
hyperthyroidism in preparation for surgery or radioactive iodine therapy
Adverse ReactionsDrug InteractionsNursing Implications and Patient Teaching
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Williams' Basic Nutrition & Diet Therapy
Chapter 20
Diabetes Mellitus
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14th Edition
Lesson 20.1: Diabetes Mellitus as a Metabolic Disorder
Diabetes mellitus is a metabolic disorder of glucose metabolism with many causes and forms.
A consistent, sound diet is a major keystone of diabetes care and control.
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Introduction (p. 400)
11% of U.S. adults have diabetes Seventh leading cause of death in the United States Historically, victims died at young age With proper care, people with diabetes can live long,
fulfilling lives
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Nature of Diabetes (p. 400)
Defining factor Glucose is primary source of energy for the body Insulin is needed to be taken out of blood and
transferred into cells People with diabetes either do not produce insulin
or cannot effectively use insulin produced Diabetes: group of metabolic diseases
characterized by hyperglycemia
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Classification of Diabetes Mellitus and Glucose Intolerance (p. 400)
Type 1 diabetes mellitus Accounts for 5% to 10% of cases Previously called insulin-dependent or juvenile-
onset diabetes Severe, unstable form
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Classification of Diabetes Mellitus and Glucose Intolerance (cont’d) (p. 401)
Type 1 diabetes mellitus (cont’d) Caused by autoimmune destruction of pancreatic
cells Can occur at any age Requires exogenous insulin
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Type 2 Diabetes Mellitus (p. 401)
Accounts for 90% to 95% of cases Previously called adult-onset or non–insulin-
dependent diabetes Initial onset usually after age 40 years Now being diagnosed in children
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Type 2 Diabetes Mellitus (cont’d) (p. 402)
Strong genetic link Prevalent in older, obese people Caused by insulin resistance or defect Usually treated with diet, exercise
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Gestational Diabetes (p. 402)
Temporary form of disease occurring in pregnancy Presents complications for mother and fetus/infant Must be carefully monitored and controlled
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Other Types of Diabetes (p. 404)
Causes Genetic defect Pancreatic conditions or disease Endocrinopathies: imbalance with other hormones
in the body Drug/toxin induced or chemical induced
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Impaired Glucose Tolerance(p. 404)
Above normal fasting blood glucose but not high enough to be diabetes
A risk factor for type 2 diabetes Underlying conditions often present
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Symptoms of Diabetes (p. 404)
Initial signs Increased thirst Increased urination Increased hunger Unusual weight loss (type 1) Unusual weight gain (type 2)
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Symptoms of Diabetes (cont’d) (p. 405)
Laboratory test results Glycosuria (sugar in urine) Hyperglycemia (elevated blood sugar) Abnormal glucose tolerance tests
Progressive results Water, electrolyte imbalance Ketoacidosis Coma
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The Metabolic Pattern of Diabetes (p. 405)
Energy supply and control of blood glucose Diabetes is especially related to metabolism of
carbohydrate and fat It is important to control blood glucose within
normal levels of 70 to 110 mg/dl
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Case Study
Mr. Jones is a 45-year-old black male. He is 25 lbs overweight. He also has a family history of diabetes. His most recent lab work reveals an elevated fasting blood sugar, elevated total cholesterol, and low HDL level.
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Case Study (cont’d)
List Mr. Jones’ risk factors for type 2 diabetes.
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Case Study (cont’d)
What other screening tools could be used for diabetes?
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Case Study (cont’d)
What are some signs and symptoms that Mr. Jones may be experiencing?
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The Metabolic Pattern of Diabetes (cont’d) (p. 405)
Sources of blood glucose Dietary intake Glycogen from liver and muscles
Uses of blood glucose For immediate energy needs: glycolysis Change to glycogen for storage: glycogenesis Convert to fat for longer-term storage: lipogenesis
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Pancreatic Hormone Control(p. 405)
Islets of Langerhans produce: Insulin Glucagon Somatostatin
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Islets of Langerhans (p. 407)
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Insulin (p. 405)
Controls blood sugar Helps transport glucose into cells Helps change glucose to glycogen and store it in
liver, muscles Stimulates changes of glucose to fat for storage
as body fat Inhibits breakdown of tissue fat and protein Promotes uptake of amino acids by skeletal
muscles Influences burning of glucose for energy
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Glucagon (p. 407)
Acts in a manner opposite to insulin Breaks down stored glycogen and fat Raises blood glucose as needed to protect brain
during sleep or fasting
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Somatostatin (p. 407)
A “referee” for several other hormones Inhibits secretion of insulin, glucagon, and other GI
hormones Also produced in other parts of the body (e.g.,
hypothalamus)
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Abnormal Metabolism in Uncontrolled Diabetes (p. 407)
When insulin activity insufficient, imbalances occur in: Glucose Fat Protein
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Glucose (p. 407)
Glucose normally absorbed into pancreatic cells, triggering secretion of insulin
Glucose taken up into cells Without insulin, cells starved for glucose
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Fat (p. 407)
Without insulin, fat tissue formation decreases Fat tissue breakdown increases Intermediate products of fat breakdown, ketones,
accumulate in body
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Protein (p. 408)
Without insulin, protein also broken down to secure energy
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Long-Term Complications(p. 408)
Retinopathy: leading cause of new cases of blindness age 20 to 74
Nephropathy: leading cause of end-stage renal disease
Neuropathy: nervous system damage in legs and feet
Heart disease Dyslipidemia: Elevated triglyceride, decreased
high-density lipoprotein cholesterol Hypertension: A major comorbid condition
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General Management of Diabetes (p. 409)
Early detection Prevention of complications Glucose tolerance test Goals of care
Maintaining optimal nutrition Avoiding symptoms Preventing complications
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General Management of Diabetes (cont’d) (p. 411)
Self-care skills People with diabetes must treat themselves
Basic elements of diabetes management Healthy diet Physical activity Ensure adequate insulin
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Special Objectives During Pregnancy (p. 411)
Usually involves team of specialists Careful monitoring of mother with diabetes Preventing fetal damage
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Lesson 20.2: Care for the Person with Diabetes Mellitus
Daily self-care skills enable a person with diabetes to remain healthy and reduce risks for complications.
Blood glucose monitoring is a critical practice for blood glucose control.
A personalized care plan balancing food intake, exercise, and insulin regulation is essential to successful diabetes management.
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Medical Nutrition Therapy for Individuals with Diabetes (p. 411) Individuals with prediabetes
Promote healthy food choices Increase physical activity Achieve and maintain moderate weight loss
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Medical Nutrition Therapy for Individuals with Diabetes (cont’d) (p. 411)
Individuals with diabetes Blood glucose levels as safely as possible Lipid and lipoprotein profile Blood pressure levels Prevent, or at least slow, the rate of chronic
complications Address individual nutrition needs Maintain the pleasure of eating
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Additional Considerations(p. 411)
Additional considerations For youth with type 1 diabetes, youth with type 2
diabetes, pregnant and lactating women, and older adults with diabetes, to meet the nutrition needs of these unique times in the life cycle
Provide self-management training for safe conduct of exercise, including the prevention and treatment of hypoglycemia and diabetes treatment during acute illness
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Total Energy Balance (p. 411)
Normal growth and weight management Type 1 in childhood: use normal height/weight
charts Type 2 in adulthood: major goal is often weight
reduction/control Energy intake
Balances with needs for growth/development, physical activity, desirable lean weight
Negative balance if weight loss is goal
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Nutrient Balance (p. 412)
Carbohydrate Starch and sugar: Complex and simple
carbohydrates Glycemic index Fiber Sugar substitutes: Nutritive and nonnutritive
Glycemic index Measure of a food’s ability to raise blood glucose
level Carbohydrates differ
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Nutrient Balance (cont’d) (p. 412)
Fiber Normal consumption encouraged
Sugar substitute sweeteners Nutritive and nonnutritive allowed in moderation
Protein About 10% to 35% of total energy
Fat No more than 7% of kilocalories from saturated fat
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Food Distribution (p. 414)
Eat even amounts of food at regular intervals Maintain even blood glucose supply Snacks may be needed Adjust eating according to activity level and stress Regulate glycemic response according to physical
activity and exercise Drug therapy
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Daily Activity Schedule (p. 414)
Food distribution must be adjusted to activities Especially important for children and adolescents Stressful event can counteract insulin activity
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Exercise (p. 414)
Recommendation: 150 min/week of moderate-intensity aerobic activity
Helps those with type 2 DM control blood glucose and prevent cardiovascular disease, other risks
For those using insulin, energy needs of exercise must be covered in food distribution plan
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Drug Therapy (p. 415)
Affects food distribution Patient must adjust diet, medications, exercise as
needed
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Diet Management (p. 415)
General planning according to type of diabetes Develop plan to meet individual needs: living
situation, background, food habits
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Diet Management (cont’d)(p. 415)
Carbohydrate counting Count carbohydrates for a meal Inject appropriate amount of insulin to process
glucose Food exchange system
Organizes food into groups
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Special Concerns (p. 416)
Special diet food items: usually not needed Alcohol: occasional cautious use allowed Hypoglycemia: prepare for possibility Illness: adjust food and insulin accordingly Travel: consult with dietitian first Eating out: plan ahead and choose restaurants wisely Stress: antagonistic to insulin
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Diabetes Education Program(p. 419)
Goal: person-centered self-care Patients taking more active role in their care Diabetes requires daily survival skills
Diabetes Self-Management Education (DSME) Support informed decision-making Self-care behaviors Problem-solving Active collaboration with health care team
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Necessary Skills (p. 419)
Healthy eating Being active Monitoring Medications
Insulin Oral hypoglycemic agents
Problem-solving Health coping Reducing risk
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Case Study (cont’d)
The physician sends Mr. Jones for nutritional counseling.
What are your recommendations for him?
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Resources (p. 422)
American Diabetes Association American Dietetic Association American Association of Diabetes Educators
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Staff Education (p. 422)
Success of diabetes education programs depends on sensitivity and training of staff
Continuing education essential
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