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

Education’s purpose is to replace an empty mind with an open one.