ENDOCRINE DISORDERS AND THERAPEUTIC MANAGEMENT Gladys T. Cruz
Dec 17, 2014
ENDOCRINE DISORDERS AND
THERAPEUTIC MANAGEMENT
Gladys T. Cruz
Diabetes Mellitus
Diabetes Mellitus
Is a disorder of the endocrine system that causes alterations in glucose metabolism.
Diabetes Mellitus: Type
Type 1 – an absolute lack of insulin
Type 2 – relative lack of insulin
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
Diabetes Mellitus
- Endocrine function (islets of langerhans)
Beta cells produce insulin
Alpha cells produce glucagon
Delta cells produce somatostatin
Diabetic Ketoacidosis
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
Diabetic Ketoacidosis: Clinical Manifestations Dehydration Ketosis Metabolic
acidosis
Weakness Anorexia Altered mental
status Tachycardia Kussmaul
respirations
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
Diabetic Ketoacidosis: Treatments Closely monitor blood glucose levels
and acidosis Replace fluids and electrolytes Administer insulin Monitor cardiac, pulmonary,
neurologic systems
Diabetic Ketoacidosis: Treatments Identify and correct precipitating event Educate the patient and the patient’s
family
Diabetic Ketoacidosis
Rapid insulin
0.1 to 0.2 U/kg/hr
Hyperosmolar Nonketotic Coma
Hyperosmolar Nonketotic Coma
A serious metabolic complication, usually seen in type 2 diabetes
Results in dehydration and electrolyte disturbances without acidosis
Hyperosmolar Nonketotic Coma: Clinical Manifestation
Profound dehydration
Hypotension Tachycardia Diminished CVP
Dry mucous membrane
Poor skin turgor Neurologic
impairments including confusion, seizures and coma
Hyperosmolar Nonketotic Coma
Treatment goals are similar to the interventions of DKA
Hypoglycemia
Hypoglycemia
Occurs when the blood sugar levels drop rapidly
Hypoglycemia
Sweating, tremors
Blurred vvision, hunger, weakness
Behavior changes, and confusion
Anxiety, paresthesia and poor coordination
Slurred speech, headache
Palpitation, nausea
Hypoglycemia: Treatment Fast acting carbohydrates (if client is
conscious)
- ½ cup orange juice
- 4 oz cola
- 4 oz orange juice
Syndrome of Inappropriate Secretion of Antidiuretic Hormone
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
Syndrome of Inappropriate Secretion of Antidiuretic Hormone
Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia
Assessment
Early Clinical Manifestation:
- dilutional hyponatremia include lethargy, anorexia, nausea and vomiting
Assessment
Symptoms of Severe Hyponatremia:
- inability to concentrate, mental confusion, apprehension, seizures, decreased level of consciousness, coma and death
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
Medical Management
Fluid restriction Sodium replacement Medications that increase renal water
excretion (Demeclocycline)
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
Diabetes Insipidus
Diabetic Insipidus
Caused by a deficiency in the production or release of ADH by the posterior pituitary gland
Diabetic Insipidus:
Neurogenic Nephrogenic Psychogenic
Diabetic Insipidus: Clinical Manifestations Polyuria Polydipsia Hypotension Tachycardia Weight loss Dehydration Mental status
changes
Seizures Constipation
Diabetic Insipidus: Medication
Vasopressin
Desmopressin acetate ( for chronic neurogenic)
Diabetic Insipidus: Nursing Management Monitor intake and output
Thyroid Storm
Thyroid Storm
Also called Thyroid Crisis A complication of pre - existing
hyperthyroidism
Thyroid Storm
Increase in cellular oxygen consumption
Thyroid Storm: Medical Management Prevent cardiovascular collapse Reduce hyperthermia Reverse dehydration
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
Thyroid Storm: Pharmacologic Management
C. Drugs that block catecholamine effect
Propanolol
Thyroid Storm: Nursing Management Medication administration Normalize temperature Rehydration and correction of
metabolic derangements
Myxedema Coma
Progressive worsening or terminal stage of hypothyroidism
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
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
Myxedema Coma: Pharmacologic Management
Levothyroxine
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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