Care of the Client with Care of the Client with Problems Related to the Problems Related to the Endocrine System Endocrine System Earl Francis R. Earl Francis R. Sumile, RN Sumile, RN Instructor, College of Instructor, College of Nursing Nursing University of Santo Tomas University of Santo Tomas
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Care of the Client with Problems Care of the Client with Problems Related to the Endocrine Related to the Endocrine
SystemSystem
Earl Francis R. Sumile, RNEarl Francis R. Sumile, RNInstructor, College of NursingInstructor, College of Nursing
University of Santo TomasUniversity of Santo Tomas
Endocrine SystemEndocrine System
1.1. PituitaryPituitary
2.2. ThyroidThyroid
3.3. ParathyroidParathyroid
4.4. ThymusThymus
5.5. AdrenalAdrenal
6.6. PancreasPancreas
7.7. GonadsGonads
1.1. Pituitary GlandPituitary Gland
A.A. Anterior lobe Anterior lobe – AdenohypophysisAdenohypophysis– Releases and synthesizes hormonesReleases and synthesizes hormones
B.B. Posterior lobePosterior lobe– NeurohyphosisNeurohyphosis– Does not produce but stores and releasesDoes not produce but stores and releases
A.A. Anterior PituitaryAnterior Pituitary
a.a. Gonadotropic Gonadotropic oror Somatropic Hormone Somatropic Hormone– Stimulates growth of body tissues or bonesStimulates growth of body tissues or bones
– Stimulates thyroid gland and secretionsStimulates thyroid gland and secretions
c.c. Adreno-Cortico Tropic Hormone (ACTH)Adreno-Cortico Tropic Hormone (ACTH)– Stimulates steroid production by adrenal cortexStimulates steroid production by adrenal cortex
e. Luteinizing Hormone (LH)e. Luteinizing Hormone (LH)- In females, ovulation and luteinization of ovarian In females, ovulation and luteinization of ovarian
folliclesfollicles
f. Follicle Stimulating Hormone (FSH)f. Follicle Stimulating Hormone (FSH)- Growth of ovarian follicle in femalesGrowth of ovarian follicle in females- Spermatogenesis in malesSpermatogenesis in males
g. Interstitial Cell Stimulating Hormone (ICSHg. Interstitial Cell Stimulating Hormone (ICSH))- In males, production of testosteroneIn males, production of testosterone
h. Prolactinh. Prolactin- Stimulates mammary tissues and lactationStimulates mammary tissues and lactation
B. Posterior PituitaryB. Posterior Pituitary
a.a. Anti-Diuretic Hormone (ADH) or Anti-Diuretic Hormone (ADH) or VasopressinVasopressin
- Reabsorption of waterReabsorption of water- Decreases urinary outputDecreases urinary output
b.b. OxytocinOxytocin- Ejection of milkEjection of milk- Uterine contractionUterine contraction- Sperm transportSperm transport
a.a. ParathormoneParathormone– Regulates calcium and phosphate levelsRegulates calcium and phosphate levels
4. Thymus4. Thymus
a.a. ThymosinThymosin– Incubator of T-lymphocytesIncubator of T-lymphocytes– Cornered mainly with:Cornered mainly with:
GrowthGrowth
MaturationMaturation
Metabolic processesMetabolic processes
Reproduction of target cell or tissueReproduction of target cell or tissue
5. Adrenal 5. Adrenal A. CortexA. Cortex
a.a. GlucocorticoidsGlucocorticoids– GluconeogenesisGluconeogenesis– Regulates blood sugar by conserving glucose and Regulates blood sugar by conserving glucose and
cortisonecortisone
b.b. MineralocorticoidsMineralocorticoids– Aldosterone, corticosteroneAldosterone, corticosterone– Regulates electrolyte balance by Na retention and Regulates electrolyte balance by Na retention and
K excretionK excretion
c.c. Androgens and EstrogensAndrogens and Estrogens– Secondary sex characteristicsSecondary sex characteristics
5. Adrenal 5. Adrenal B. MedullaB. Medulla
a.a. Epinephrine or AdrenalineEpinephrine or Adrenaline– Increases blood pressureIncreases blood pressure– Increases cardiac rateIncreases cardiac rate– Dilates bronchiolesDilates bronchioles
6. Pancreas6. Pancreas
A.A. Islets of LangerhansIslets of Langerhansa.a. InsulinInsulin
Hypoglycemic agentHypoglycemic agent
Metabolism of carbohydrates, proteins and fatsMetabolism of carbohydrates, proteins and fats
A.A. OvariesOvariesa.a. Estrogen and ProgesteroneEstrogen and Progesterone
Stimulates development of secondary sex Stimulates development of secondary sex characteristicscharacteristics
B.B. TestesTestesa.a. TestosteroneTestosterone
For normal functioning of male reproductive For normal functioning of male reproductive organsorgans
Development male secondary sex characteristicsDevelopment male secondary sex characteristics
Nursing AssessmentNursing Assessment
a.a. Nursing historyNursing historyb.b. Growth and DevelopmentGrowth and Development
– Developmental historyDevelopmental history
c.c. Sexual functioningSexual functioning– Loss of libidoLoss of libido– ImpotenceImpotence– Menstrual cycle or irregularitiesMenstrual cycle or irregularities
d.d. Hair growth; VoiceHair growth; Voicee.e. Changes in the skinChanges in the skinf.f. Emotional stateEmotional stateg.g. Nutritional stateNutritional state
Physical AssessmentPhysical Assessment
1.1. InspectionInspection• HeightHeight• WeightWeight• Body statureBody stature• Muscle wastingMuscle wasting• Hair growth and Hair growth and
3.3. Water Deprivation Test-Water Deprivation Test- no water 4-18 hrs no water 4-18 hrs(+) diabetes insipidus- (+) diabetes insipidus- ↑in volume, no ↑ in urine ↑in volume, no ↑ in urine osmolality; ↓specific gravityosmolality; ↓specific gravity
Disorders of the Pituitary GlandDisorders of the Pituitary Gland
oversecretion because of pituitary tumoroversecretion because of pituitary tumor
A.A.GigantismGigantism• sustained hypersecretion of growth hormone sustained hypersecretion of growth hormone
in childrenin children• General overgrowth of long bones, skeleton General overgrowth of long bones, skeleton
and tissueand tissue• Marked increase in height and weightMarked increase in height and weight
1.1. HyperpituitarismHyperpituitarism
B . AcromegalyB . Acromegaly sustained hypersecretion of growth hormone in sustained hypersecretion of growth hormone in
adults after epiphyseal closureadults after epiphyseal closure• Bone grows wider and thickerBone grows wider and thicker• Extremities are enlargedExtremities are enlarged
Soft tissues on hands or feet enlarged and coarseSoft tissues on hands or feet enlarged and coarse• PrognathismPrognathism
Lengthened lower jawLengthened lower jaw• Bridge of nose broaderBridge of nose broader
Nursing AssessmentNursing Assessment
a.a. Oily skin and excessive sweatingOily skin and excessive sweating• Hypertrophy of sebacious glandHypertrophy of sebacious gland
b.b. Thickening of vocal chordsThickening of vocal chords• Voice changeVoice change
c.c. Visual impairmentVisual impairment• Pressure on visual pathwayPressure on visual pathway
• Sexual promiscuity in childrenSexual promiscuity in children
f.f. Increased prolactinIncreased prolactin• Amenorrhea and galactorrheaAmenorrhea and galactorrhea
Management of Management of HyperpituitarismHyperpituitarism
Management of choiceManagement of choice• Surgery (removal of tumor) Surgery (removal of tumor) transpheinoidal transpheinoidal
hypophysectomyhypophysectomy
Nursing interventions post op:Nursing interventions post op:– Proper oral hygiene; no brushing; encourage use of Proper oral hygiene; no brushing; encourage use of
HH22OO22 1;1 gargle 1;1 gargle– No chewing on affected siteNo chewing on affected site– No rough/coarse foodNo rough/coarse food– No sneezing and blowing of nose for 2 weeksNo sneezing and blowing of nose for 2 weeks– No dentures for 10 daysNo dentures for 10 days
2. Hypopituitarism2. Hypopituitarism
• deficiency of pituitary hormonesdeficiency of pituitary hormones• PanhypopituitarismPanhypopituitarism
When both both anterior and posterior lobes fail to secrete When both both anterior and posterior lobes fail to secrete hormoneshormones
Starvation, anorexia nervosa, severe anemia, GI disordersStarvation, anorexia nervosa, severe anemia, GI disorders
A.A. DwarfismDwarfism
Secondary to congenital lack of growth Secondary to congenital lack of growth hormone or space occupying tumorshormone or space occupying tumors• Retardation of growth on 1Retardation of growth on 1stst year, chubby year, chubby• Lack muscular development, delayed pubertyLack muscular development, delayed puberty
• Nursing managementNursing management• Injection of growth hormoneInjection of growth hormone
B. Diabetes InsipidusB. Diabetes Insipidus
Passage of excessive amounts of highly diluted Passage of excessive amounts of highly diluted urineurine
• Diagnostic AssessmentDiagnostic Assessment• (+) water deprivation test(+) water deprivation test
• Nursing ManagementNursing Management• Surgery (removal of tumor)- Surgery (removal of tumor)- transphenoidal transphenoidal
hypophysectomyhypophysectomy• Pitressine tannatePitressine tannate- vasopressin tannate in oil- vasopressin tannate in oil• Salt and protein restricted dietSalt and protein restricted diet
a.a. Hematologic level of steroids Hematologic level of steroids • cortisol, aldosterone, and testosterone levelcortisol, aldosterone, and testosterone level
4.4. Increased melanin stimulating hormone, Increased melanin stimulating hormone, increased adenocorticotropic hormone-increased adenocorticotropic hormone-cortisol deficiency-cortisol deficiency-external tan or bronzed external tan or bronzed appearanceappearance
Addison’s CrisisAddison’s Crisis
CausesCauses• surgery, pregnancy, injury, infection, salt loss, surgery, pregnancy, injury, infection, salt loss,
second degree profuse diaphoresissecond degree profuse diaphoresis• Sudden profound astheniaSudden profound asthenia• Severe abdominal, back and leg painSevere abdominal, back and leg pain• Hyperpyrexia followed by hypothermiaHyperpyrexia followed by hypothermia• Peripheral vascular collapse, comaPeripheral vascular collapse, coma• Renal shutdownRenal shutdown
Nursing management:Nursing management:
• Hydrocortisone (solu-cortef) IVHydrocortisone (solu-cortef) IV• Monitor vital signsMonitor vital signs• Prevent infectionPrevent infection• Daily weightDaily weight• Electrolyte balanceElectrolyte balance• High carbohydrate and protein dietHigh carbohydrate and protein diet
Disorders of Adrenal CortexDisorders of Adrenal Cortex
f.f. Sodium and water retention- edema and Sodium and water retention- edema and hypertensionhypertension
g.g. Abnormal fat distribution- moon faceAbnormal fat distribution- moon face• Buffalo humpBuffalo hump- cervico-dorsal fat pad on - cervico-dorsal fat pad on
neck neck truncal obesitytruncal obesity with slender limbs with slender limbsh.h. Increased susceptibility to infectionIncreased susceptibility to infectioni.i. Increased production of androgens- mild Increased production of androgens- mild
virilism, virilism, acne, thinning of scalp and hair andacne, thinning of scalp and hair and hirsutismhirsutism
Nursing managementNursing management
a.a. Surgery Surgery • hypophysectomy, hypophysectomy, adrenalectomyadrenalectomy, total or , total or
aminoglutethimide (aminoglutethimide (eliptenelipten); metyrapone ); metyrapone ((metapironemetapirone)-long term)-long term
Disorders of the Adrenal Disorders of the Adrenal MedullaMedulla
• PheochromocytomaPheochromocytoma• Tumor which results in ypersecretion of Tumor which results in ypersecretion of
adrenal medullaadrenal medulla• Typically benign; curable if detected earlyTypically benign; curable if detected early• Precipitating factors: pregnancy and stressPrecipitating factors: pregnancy and stress
Nursing Assessment and Nursing Assessment and ManagementManagement
• Nursing AssessmentNursing Assessment• Hypertension- main symptomHypertension- main symptom• Persistent, fluctuating, pounding headachePersistent, fluctuating, pounding headache• Sweating palpitations, nausea or vomitingSweating palpitations, nausea or vomiting• Hyperglycemia and glycosuriaHyperglycemia and glycosuria• Shock-like stateShock-like state
• Management or choiceManagement or choice• Surgical excisionSurgical excision
Thyroid GlandThyroid Gland
• Iodine regulates body metabolism (oxygen Iodine regulates body metabolism (oxygen consumption and heat production)consumption and heat production)
• Regulate growth and developmentRegulate growth and developmentTSHTSH- from anterior pituitary stimulates thyroid - from anterior pituitary stimulates thyroid
gland to release thyroxine, triiodothyromine, gland to release thyroxine, triiodothyromine, thyrocalcitoninthyrocalcitonin
EuthyroidEuthyroid- normal thyroid function and - normal thyroid function and secretionsecretion
c.c. Triiodothyronin (TTriiodothyronin (T33) resin uptake test) resin uptake test
d.d. Radioactive iodine (Radioactive iodine (131131I) uptake and excretion testI) uptake and excretion teste.e. Serum TSHSerum TSHf.f. Thyrotropin- releasing hormoneThyrotropin- releasing hormoneg.g. Serum cholesterol- increase in patients with Serum cholesterol- increase in patients with
myxedemia or hypothyrodismmyxedemia or hypothyrodism
Diagnostic AssessmentDiagnostic Assessment
h. PBI (h. PBI (Protein Bound IodineProtein Bound Iodine)- measures the )- measures the amount of iodine binded in blood protein.amount of iodine binded in blood protein.
• Preparation: Preparation: no food or drug containing iodine 24 no food or drug containing iodine 24 hours before the testhours before the test
i. BMR (i. BMR (Basal Metabolic RateBasal Metabolic Rate)- indirect measure )- indirect measure of amount of oxygen consumed in the body of amount of oxygen consumed in the body under basal conditions during given time.under basal conditions during given time.
• Preparation:Preparation: proper sleep or rest night before the proper sleep or rest night before the preocedurepreocedure
• Fasting for 6-8 hoursFasting for 6-8 hours• Done before getting out of bedDone before getting out of bed
Disorders of the Thyroid GlandDisorders of the Thyroid Gland
• GoiterGoiter- enlargement of the Thyroid Gland- enlargement of the Thyroid Gland• EtiologyEtiology
a.a. lack of iodinelack of iodine• (simple goiter), pregnancy, lactation, iodine deficient areas(simple goiter), pregnancy, lactation, iodine deficient areas
b.b. Intake of too much Intake of too much goitrogenic foodsgoitrogenic foods• Nutritional goitrogens that inhibit thyroxine productionNutritional goitrogens that inhibit thyroxine production• Such as cabbage, soybeans, peanuts, spinach, peaches, Such as cabbage, soybeans, peanuts, spinach, peaches,
b.b. Lugol’s solutionLugol’s solution or or Potassium Iodide Potassium Iodide Saturated SolutionSaturated Solution (KISS) (KISS)
• Dose comes in drops; mixed with cold water and Dose comes in drops; mixed with cold water and given with a strawgiven with a straw
c.c. Thryroid hormone replacementThryroid hormone replacement• Watch for thyrotoxicosisWatch for thyrotoxicosis
• Tachycardia, increase appetite, diarrhea, Tachycardia, increase appetite, diarrhea, sweating, tremor, palpitations, shortness of breathsweating, tremor, palpitations, shortness of breath
Disorders of the Thyroid GlandDisorders of the Thyroid Gland
• Hyperthyroidism; Grave’s DiseaseHyperthyroidism; Grave’s Disease (Basedow’s disease)(Basedow’s disease)• Excessive production of TExcessive production of T33 or T or T44 or both or both
• Toxic diffuse goiter or exophthalmic goiterToxic diffuse goiter or exophthalmic goiter
b.b. Iodine- lugol’s solution or KISSIodine- lugol’s solution or KISS• To decrease the vascularity and size of the thyroidTo decrease the vascularity and size of the thyroid
c.c. Radioactive Iodine Therapy Radioactive Iodine Therapy • to middle aged and elderly clientsto middle aged and elderly clients
Nursing ManagementNursing Management
d. Surgeryd. Surgery
• When patient is euthyroidWhen patient is euthyroid• Post-operativePost-operative
• Semifowler’s position when consciousSemifowler’s position when conscious
• tracheostomy set at bedsidetracheostomy set at bedside
• Ambulate 2Ambulate 2ndnd post-operative day post-operative day
• Accidental injury to the laryngeal nerveAccidental injury to the laryngeal nerve• Watch for decreasing voiceWatch for decreasing voice
• Hypocalcemia or tetanyHypocalcemia or tetany• Accidental removal of parathyroid glandAccidental removal of parathyroid gland• (+) (+) Chovstek’s signChovstek’s sign
• Spasms of the facial muscles when tappedSpasms of the facial muscles when tapped• (+) (+) Troussaeu’s signTroussaeu’s sign
• Carpopedal spasms upon constriction of Carpopedal spasms upon constriction of the extremitiesthe extremities
• Management on HypocalcemiaManagement on Hypocalcemia• Increase Ca – 100% sol of calcium carbonate Increase Ca – 100% sol of calcium carbonate
or gluconate or calcium lactateor gluconate or calcium lactate• Calcium supplement and Vit DCalcium supplement and Vit D
*Thyroid storm*Thyroid storm
• Overactivity of thryroid characterized by Overactivity of thryroid characterized by increased temperature, severe tachycardia, increased temperature, severe tachycardia, delirium, dehydration and irritability, hypotensiondelirium, dehydration and irritability, hypotension
• Nursing management:Nursing management:• Cool darkened quiet roomCool darkened quiet room• Antipyretic oral or parenteral antithyroid drug followed Antipyretic oral or parenteral antithyroid drug followed
by K iodine; corticosteroids, propanolol- to relieve by K iodine; corticosteroids, propanolol- to relieve heart arrythmiasheart arrythmias
HypothyroidismHypothyroidism
• CretinismCretinism• Usually silent babyUsually silent baby• Severe hypothyroid condition of infancy due Severe hypothyroid condition of infancy due
to deficiency of thyroid hormone synthesis to deficiency of thyroid hormone synthesis during fetal life or soon after birthduring fetal life or soon after birth
HypothyroidismHypothyroidism
• Nursing assessment:Nursing assessment:a.a.Physical and mental retardationPhysical and mental retardationb.b.Shunted statureShunted staturec.c.Wide open mouth and lolling tongueWide open mouth and lolling tongued.d.Small eyes and half closed with swollen lidsSmall eyes and half closed with swollen lidse.e.Stolid expressionless faceStolid expressionless facef.f. Squat figureSquat figureg.g.Muddy dry skinMuddy dry skin
HypothyroidismHypothyroidism
• MyxedemaMyxedema- deficiency in thyroid synthesis in adult- deficiency in thyroid synthesis in adult• Asymptomatic to full blownAsymptomatic to full blown
• Nursing management:Nursing management:• Fatigue and apatheticFatigue and apathetic• Obesity: puffy and edematous with course featuresObesity: puffy and edematous with course features• Dry and sparse hair, dry flaky skinDry and sparse hair, dry flaky skin• Severe intolerance to cold decreased metabolic rateSevere intolerance to cold decreased metabolic rate• Fecal impaction, hypersensitive to narcotics, Fecal impaction, hypersensitive to narcotics,
barbiturates, and anestheticsbarbiturates, and anesthetics• MANAGEMENT:MANAGEMENT:
• Hormone therapy for life (synthroid, cytomel)Hormone therapy for life (synthroid, cytomel)
Pancreas- Islets of LangerhansPancreas- Islets of Langerhans
• Insulin- from beta cells- fat or protein Insulin- from beta cells- fat or protein metabolism- hypoglycemic agentmetabolism- hypoglycemic agent
• Glucagon- from alpha-cells- hyperglycemic Glucagon- from alpha-cells- hyperglycemic agentagent
Diabetes MellitusDiabetes Mellitus
• Chronic disorder of carbohydrate metabolism Chronic disorder of carbohydrate metabolism (imbalance between the supply and demand)(imbalance between the supply and demand)
• Types:Types:• Type I- insulin dependent (!DDM or juvenile diabetes)Type I- insulin dependent (!DDM or juvenile diabetes)• Type II- non-insulin dependent (NIDDM or maturity Type II- non-insulin dependent (NIDDM or maturity
onset)onset)
Nursing AssessmentNursing Assessment
1.1. PolyuriaPolyuria• Water not reabsorbed by renal tunules because Water not reabsorbed by renal tunules because
osmotic activity of glucoseosmotic activity of glucose
2.2. PolydipsiaPolydipsia• Severe dehydration, causes thirstSevere dehydration, causes thirst
3.3. PolyphagiaPolyphagia• Tissue breakdown and wasting causes starvationTissue breakdown and wasting causes starvation
4.4. Weight lossWeight loss (IDDM)- no glucose available to (IDDM)- no glucose available to cells, therefore body breaks down fat and cells, therefore body breaks down fat and protein stores for energyprotein stores for energy
Ability to dispose of glucose load in 2 hrsAbility to dispose of glucose load in 2 hrsN= 150%N= 150%
Oral Glucose Tolerance Test Oral Glucose Tolerance Test (OGTT)(OGTT)Prep: NPO 10-12 hrs; baseline sugar in blood and urine; Prep: NPO 10-12 hrs; baseline sugar in blood and urine;
100gms glucose diet is given; blood or urine is taken after 30 100gms glucose diet is given; blood or urine is taken after 30 mins; 1 hr; 1 ½ hrs and 2 hrs after- N=150mgs/dlmins; 1 hr; 1 ½ hrs and 2 hrs after- N=150mgs/dl
Glucosylated HGBGlucosylated HGBGlucose bonds to hemoglobin – measures blood glucose Glucose bonds to hemoglobin – measures blood glucose
Ketotic ComaKetotic Coma• Non-insulin dependent diabetics who have enough Non-insulin dependent diabetics who have enough
insulin but unable to use insulin to combat insulin but unable to use insulin to combat hyperglycemiahyperglycemia
• Nursing AssessmentNursing Assessment• Same as DKA but no kussmaul breathing and Same as DKA but no kussmaul breathing and
acetone breathacetone breath
Nursing ManagementNursing Management
B. Insulin- B. Insulin- Lower blood sugar by transport of Lower blood sugar by transport of glucose to cells and inhibits conversion of glucose to cells and inhibits conversion of glucogen to glucoseglucogen to glucose
TypeType InsulinInsulin ColorColor PeakPeak
Rapid actingRapid acting RegularRegular
SemilenteSemilente
ClearClear
CloudyCloudy
2-4 hrs2-4 hrs
2-4 hrs2-4 hrs
Intermediate Intermediate actingacting
NPHNPH
LenteLente
CloudyCloudy
CloudyCloudy
6-8 hrs6-8 hrs
6-8 hrs6-8 hrs
Long actingLong acting Protamine/ZincProtamine/Zinc
UltralenteUltralente
CloudyCloudy
CloudyCloudy
18+ hrs18+ hrs
8-12 hrs8-12 hrs
PremixedPremixed
(NPH/Req)(NPH/Req)
Humulin 50/50Humulin 50/50
Humulin 70/30Humulin 70/30
CloudyCloudy
CloudyCloudy
2-8 hrs2-8 hrs
2-12 hrs2-12 hrs
Nursing ManagementNursing Management
Complications (insulin)Complications (insulin)• Tissue hyperthrophy or atrophy or Tissue hyperthrophy or atrophy or lipodystrophylipodystrophy• Diabetic KetoacidosisDiabetic Ketoacidosis
• Fatty acids are broken down to ketone bodies because of Fatty acids are broken down to ketone bodies because of absolute or relative deficiency in insulinabsolute or relative deficiency in insulin
EtiologyEtiology• too little insulin dosetoo little insulin dose• Omitting insulin doseOmitting insulin dose• Increase need for insulin due to surgery, trauma, pregnancy, Increase need for insulin due to surgery, trauma, pregnancy,
puberty, or febrile illnesspuberty, or febrile illness• Insulin resistance secondary to development of insulin Insulin resistance secondary to development of insulin
antibodies or severe emotional stressantibodies or severe emotional stress
Nursing ManagementNursing Management
Nursing AssessmentNursing Assessmenta.a. Polyuria, thirst, nausea or vomiting, dry mucus Polyuria, thirst, nausea or vomiting, dry mucus
membrane, cracked lipsmembrane, cracked lipsb.b. Hot flushed skin, weight lossHot flushed skin, weight lossc.c. Abdominal pain, and rigidity (Na deficiency)Abdominal pain, and rigidity (Na deficiency)d.d. Kussmaul respirationsKussmaul respirationse.e. Acetone breathAcetone breathf.f. Weakness, paralysis, paresthesiaWeakness, paralysis, paresthesiag.g. Hypotension, oliguria, coma, stuporHypotension, oliguria, coma, stuporh.h. ABG’s, metabolic acidosis, with compensated ABG’s, metabolic acidosis, with compensated
Etiology:Etiology:a.a. Overdose of insulin or sulfonylureaOverdose of insulin or sulfonylurea
b.b. Omission of meals or eating less than prescribed Omission of meals or eating less than prescribed foodfood
c.c. Overexertion without compensating with increase in Overexertion without compensating with increase in carbohydratescarbohydrates
d.d. Nutritional and fluid imbalance secondary to nausea Nutritional and fluid imbalance secondary to nausea and vomitingand vomiting
HypoglycemiaHypoglycemia
Nursing assessmentNursing assessment::a.a. Headache, weakness, irritability, apprehensionHeadache, weakness, irritability, apprehensionb.b. Lack of muscular coordinationLack of muscular coordinationc.c. DiaphoreticDiaphoreticd.d. Behaves in bizarre, psychotic fashionBehaves in bizarre, psychotic fashione.e. Palor, bradycardia, visual disturbancesPalor, bradycardia, visual disturbancesf.f. Alterations in mental or level of consciousnessAlterations in mental or level of consciousnessg.g. Confusion or hallucinationsConfusion or hallucinations
juice if awakejuice if awakeb.b. DD5050W IVP or glucagonW IVP or glucagon
c.c. Epinephrine, steroids, diaoxide if with insulinemiaEpinephrine, steroids, diaoxide if with insulinemia
Long term complicationsLong term complications
1.1. Degenerative vascular changesDegenerative vascular changes1.1.AtherosclerosisAtherosclerosis2.2.MicroangiopathyMicroangiopathy- major hallmark of DM - major hallmark of DM
destruction of small blood vessels (eyes and destruction of small blood vessels (eyes and kidneys)kidneys)