ENDOCRINE DISORDERS c.

Peripheral Arteries: Peripheral Vascular

Diseases (PVD)
DIABETES MELLITUS 2. Microangiopathy
- A group of metabolic diseases characterized by a. Kidneys: Renal Failure
hyperglycemia resulting from a defect in insulin b. Eyes: retinopathy and blindness
secretion, insulin action, or both. 3. Neuropathy
a. Peripheral Neuropathy
Diagnostic Evaluation ▪ Paresthesia/Paralysis
1. Fasting Blood Sugar (FBS) b. Neurogenic bladder
a. NPO for 8 hours before the test. c.  libido, impotence
b. Findings: Normal: 80-120mg/dl
Abnormal: 140mg/dl or Nursing Management
more for two readings 1. Diet
2. Glycosylated Hemoglobin Test: measures the a. High complex carbohydrates (50-60%),
percentage of the person’s circulating High fiber diet but Low in fat (20-30%),
hemoglobin that is glycosylated. Reflects and Protein (10-20%).
carbohydrate levels for the past 3-4 months. b. Eat 3 or more measured meals each
a. Specimen: blood sample. day.
b. Excessive glucose in the blood→ c. Avoid foods high in simple or refined
molecules of glucose attaches to sugars
hemoglobin. 2. Daily Exercise: promotes the utilization of
c. Findings: Normal: less than 6 % carbohydrates and enhances the action of
Abnormal: 6 – 22 % insulin.
Etiology: Unknown a. Benefits
Predisposing Factors •  CHO (glucose) uptake by the
1. Stress. cells
2. Heredity •  Insulin requirement
3. Obesity/ overweight • Maintain IBW and serum lipids
4. Autoimmune • Decrease blood pressure and
Types decrease stress and tension
Type I: Autoimmune/abnormal function of the b. Done 1-2 hours p.c. to prevent
pancreas hypoglycemia
1. Juvenile onset c. Exercise for 30 to 45 minutes, a
2. Absolute deficiency minimum of 3-5 x a week.
3. Thin
4. Prone to DKA 3. Drugs/Medications
Type II: Insulin resistance of cells a. Oral Hypoglycemic Agents- stimulate
1. Adult-onset islets of Langerhans to secrete insulin.
2. Relative deficiency or increased insulin Indicated only in type II DM
resistance • “Sulphonyloreas”
3. Obese • tolbutamide (Orinase)
4. Prone to HHNS • chlorpropamide
Pathophysiology: (Diabinese)
Insulin Deficiency • acetohexamide (Dymelor)
 • tolazamide (Tolinase)
Glucose is not conveyed from ECF to the cells. • glyburide (Micronase/
Glucose, “locked” outside the cells, accumulates and Diabeta)
raises the blood sugar level • glipizide (Glucotrol)
 • glimepiride (Amaryl)
Hyperglycemia • “Biguanide”
 • metformin (Glucophage)
Clinical Manifestations • “Alpha-Glucosidase Inhibitors”
1. Polyuria. Glucose exerts a high osmotic • acarbose (Precose)
force within the renal tubules. → Osmotic • miglitol (Glyset)
diuresis occurs→ Hypovolemia → ECF • Thiazolidinediones
dehydration • Rosiglitazone (Avandia)
2. Polydipsia. • Pioglitazone (Actos)
3. Polyphagia. b. Insulin
4.  Blood osmolarity (exerting a strong • (Very) Rapid-acting insulin:
osmotic force)→ ICF deficit or dehydration. Clear insulin
5.  Blood viscosity → sluggish/ impaired blood • Lispro (Humalog)
circulation→ Proliferation of microorganism • Insulin Aspartate
(high sugar content) → Infections: (Novolog)
periodontal, UTI, vasculitis, Vaginitis, • Glulisine (Apidra)
furuncle, carbuncle, retard wound healing. Peak of onset: 1-2 hours
6. Glucosuria. • Short-Acting insulin
7. Weight loss. • Regular (Humulin-R,
Novoline-R)
Chronic lipolysis of adipose tissue Peak: 2- 4 hours
 • Intermediate: cloudy/ turbid
Hyperlipidemia • NPH (Humulin-N, Novolin-
 N)
Atherosclerosis (coronary, peripheral arteries, and • Lente (Humulin-L,
arterioles). Novolin-L)
Capillary walls thicken, and the exchange of gases Peak: 6-8 hours
and nutrients diminishes. • Long-Acting insulin: cloudy/
 turbid
Clinical Manifestations • Ultralente (Humulin-U)
1. Macroangiopathy • Insulin Glargine (Lantus)
a. Brain: CVA Peak: Continuous
b. Heart: Myocardial Infarction (MI)
Nursing Responsibility in Insulin Therapy Clinical Manifestations
1. Hyperglycemia
1. Route: Subcutaneous- slow absorption and less 2. Hyperosmolarity → severe DHN →
painful hypovolemia, hypotension, fever,
a. Administer thru IV in DKA tachycardia, poor skin turgor →decreased
LOC (stupor) → Coma
b. SC @ 90 angle
3. No ketonemia/acidosis
c. Gauge: 27 or 28, ½ inch
d.
Do not massage the site of injection Management
2. Administer insulin at room temperature 1. Maintain a patent airway
a. Cold insulin → LIPODYSTROPHY 2. IVF
(lipoatrophy or lipohypertrophy) 3. Low dose of insulin
3. Rotate the site of injection systematically to
prevent lipodystrophy. Lipodystrophy inhibits HYPERPARATHYROIDISM
insulin absorption. - Hypersecretion of the parathyroid gland
4. Store vial of insulin in current use @ room causing overproduction of PTH
temperature.
5. Gently roll the bottle/vial in between the palms Pathophysiology:
of your hands to thoroughly mix the insulin. Do ↑ PTH
not shake the bottle/vial ↓
6. Observe for hypoglycemia Excessive osteoclast growth and activity within bones
a. Clinical manifestations: ↓
Tachycardia/tremor Destruction of bone matrix
Irritability/Restlessness ↓
Muscle weakness Withdrawal of calcium from bones
Extreme hunger ↓
Diaphoresis/decreased LOC Demineralization
b. Management: 1 tbsp. of sugar, 2-3 tsp.
of honey, 4-6 ounces of orange juice, Clinical Manifestations
6-10 hard candy 1. Pathologic fracture
2. Hypercalcemia → hypercalciuria → renal
Preventive foot care stone
1. Avoid foot injuries and inspect the feet daily
for redness, swelling, or break in the skin Nursing Management
integrity. 1. Increase fluid intake (3L/day)
2. Cut toenails straight across 2. Diet: low calcium; acid ash diet
3. Do not treat corn, blister, or ingrown nails 3. Strain all urine
4. Promote safety
Acute Complication of Diabetes a. Turn patient cautiously & handle
1. Diabetic Ketoacidosis (DKA): an acute extremities gently
complication of Type I DM b. Lower bed position & use of side
rails
Precipitating Factor c. Demonstrate proper body
1. Missed dose of insulin mechanics
2. Infection Surgical Management: Parathyroidectomy
3. Surgery Medical Management: Calcitonin and Biphosphonate

Pathophysiology: HYPOPARATHYROIDISM
Absence of effective insulin - Hyposecretion of the parathyroid gland
↓ causing deficiency of the PTH
Lipolysis
↓ Pathophysiology:
The liver converts fat to ketones (acid) ↓PTH
↓ ↓
Ketonemia Hypocalcemia
↓ ↓
Ketonuria Neuromuscular hyperexcitability/hyperirritability to
↓ stimuli due to ↑ membrane permeability of neurons
Dehydration & worsen acidosis → Acetone breath & to sodium (Na+)
Kussmaul’s respiration
↓ Clinicalmanifestations
Altered level of consciousness (ALOC) 1. Numbness and tingling sensation
2. CNS: convulsions/seizures
Clinical Manifestations 3. MS: muscle spasm, tetany, Trousseau’s &
1. Hyperglycemia Chvostek’s sign;
2. Acidosis (ketoacidosis) laryngospasm/bronchospasm →airway
3. Dehydration obstruction
4. CVS: cardiac arrhythmias
Management
1. Maintain a patent airway Nursing Management
2. IVF & electrolytes 1. Provide a quiet environment
3. Regular insulin 2. Diet: high calcium & low phosphorous
4. Sodium bicarbonate (pH <7.0) 3. Assess for an increased sign of
neuromuscular irritability
Syndrome (HHNS): an acute complication of Type
II DM Medical Management
1. Calcium gluconate IV→ Oral calcium & Vit. D
Precipitating Factor 2. Tracheotomy set (B/S)
1. Infection 3. Aluminum hydroxide (Amphojel)
2. Surgery
HYPERTHYROIDISM Nursing management
- Excessive activity of the thyroid gland → 1. Diet: low calorie, low cholesterol, high fiber
Hypersecretion of thyroid hormone (T3 & T4) & diet, low calcium
thyrocalcitonin 2. Rest after activity
• ↑ cellular metabolism; ↑ body heat 3. Warm environment during cold climate
production; hypocalcemia
Myxedema Coma
Clinical Manifestations - A rare life-threatening condition due to
1. MS: hyperactivity/restlessness → muscle severe hypothyroidism
fatigability, fine hand tremors Precipitated by: Infection, use of sedative/opioids,
2. CVS: tachycardia, palpitations, HPN cold exposure & withdrawal of thyroid drugs
3. GIT: increased appetite & weight loss;
diarrhea Clinical Manifestations
4. Insomnia 1. Profound ↓ in V/S
5. Heat intolerance & diaphoresis 2. Progressive ↓ LOC
6. Exophthalmos 3. Depression of respiratory drive → alveolar
hypoventilation → CO2 retention → narcosis
Medical Management (respiratory acidosis) → coma
1. Anti-thyroid drugs
a. Methimazole (Tapazole) Management
b. Propylthiouracil (PTU) 1. Maintain a patent airway
2. Iodine therapy: Lugol’s solution 2. Administer thyroid hormone/IV
3. Keep client warm
Surgical Management: Subtotal thyroidectomy 4. Manage hypotension
5. Treat precipitating factors
Nursing Management
1. Diet: CUSHING’S DISEASE
a. High calorie, high protein, high - Hypersecretion of adrenal cortex hormones
calcium, low fiber
b. Increase fluid intake 1. Glucocorticoids (cortisol)- regulates blood
c. Avoid stimulants glucose (sugar) level
2. Adequate rest • Gluconeogenesis → Hyperglycemia
a. Limit visitors 2. Mineralocorticoids (aldosterone)- regulates
b. Calm environment sodium (salt) level
c. Backrub • Sodium retention via kidneys →
d. Warm milk water retention and potassium excretion
e. Clustering intervention 3. Sex hormones (testosterone/progesterone)
3. Provide cool environment
a. Use of fans and air conditioning Clinical Manifestations
1. Excessive glucocorticoids
Thyroid storm or crisis a. Hyperglycemia → DM
- An extreme form of hyperthyroidism b. Protein tissue wasting
i. Muscle atrophy →
Precipitated by: Stress, Severe infection, Surgery weakness & thin extremities
ii. Ecchymosis
Clinical Manifestations iii. Osteoporosis→ fracture
1. Hyperpyrexia c. Abnormal fat distribution
2. Diarrhea → dehydration i. Truncal obesity
3. Tachycardia → dysrhythmias ii. Moon face
4. Tremors & restlessness iii. Buffalo hump
5. Delirium, coma → death d. Decrease immunity (eosinophils &
lymphocytes) → infection and poor
Nursing Management wound healing
1. Report to a physician immediately 2. Excessive mineralocorticoids
2. Maintain a patent airway; O2 therapy Hypernatremia & Hypokalemia→ muscle
3. IVF & increase fluid intake; cooling weakness & cardiac arrhythmia
techniques
4. Administer medication: anti-thyroid Fluid (H2O) retention → oliguria
↓
HYPOTHYROIDISM Hypervolemia → HPN
- Under activity of the thyroid gland → ↓
Hyposecretion of thyroid hormone (T3 & T4) Edema → weight gain
& thyrocalcitonin
3. Excessive sex hormones
• ↓ Cellular metabolism; ↓body heat a. Female: virilism/masculinization
production; Hypercalcemia b. Male: loss of libido, gynecomastia

Clinical Manifestations Nursing Diagnosis: Fluid Volume Excess

1. MS: Tiredness or extreme muscle Medical Management
fatigability→ Activity intolerance 1. Amino glutethimide (Cytadren)
2. CVS: bradycardia, hyperlipidemia & 2. Mitotane (Lysodren)
cholesterolemia→ atherosclerosis → MI 3. Metyrapone (Metopirone)
3. GIT: anorexia & weight gain; constipation Surgical Management
4. Increase sensitivity to sedatives, narcotics, 1. Adrenalectomy
and anesthesia → respiratory depression 2. Hypophysectomy
5. Cold intolerance
6. Edema Nursing Management
1. Fluid restriction
Medical Management 2. Diet:
1. Levothyroxine (Synthroid) a. Low sodium & high potassium
2. Liothyronine (Cytomel) b. Low carbohydrate & high protein
 3. Bed rest Medical Management
4. Reverse isolation 1. Desmopressin acetate (DDAVP): IN
5. Safety 2. Vasopresin (Pitressin): IM
3. Chlorpropamide (Diabinese)
ADDISON’S DISEASE
- Hypo secretion of adrenal cortex hormones Nursing Management
1. Increase fluid intake
Clinical Manifestations 2. Patient teaching
1. Deficiency of glucocorticoids a. Eliminate coffee & tea
a. Hypoglycemia→ Weakness and b. Lifelong hormone replacement
fatigability
b. Bronze skin appearance (Eternal SYNDROME OF INAPPROPRIATE ANTI-
Tan) DIURETIC HORMONE (SIADH)
2. Deficiency of Aldosterone - Over /excessive secretion of ADH caused by
hypersecretion of the posterior pituitary
Hyponatremia & hyperkalemia → cardiac arrhythmia gland
↓ Causes
Fluid loss (H2O) → polyuria 1. Trauma
↓ 2. Stroke
Hypovolemia → hypotension 3. Medication
↓ 4. Stress
Dehydration → weight loss
Pathophysiology:
3. Deficiency of sex hormones
a. Female: less axillary & pubic hair Over /excessive secretion of ADH
b. Male: impotence ↓
Excessive water retention
Nursing Diagnosis: Fluid volume deficit ↓
Fluid overload
Medical Management
1. Hydrocortisone (Solu-Cortef) ClinicalManifestations
2. Prednisone (Deltasone) 1. Oliguria
3. Fludrocortisone (Florinef) 2. Edema, weight gain
3. Hypervolemia → Hypertension
Nursing Management 4. Dilutional hyponatremia
1. Increase fluid intake/ IVF 5. Altered level of consciousness (ALOC) →
2. Diet coma
a. High sodium & low potassium 6. Congestive Heart Failure (CHF)
b. High carbohydrate, high protein
3. Bed rest Medical Management
4. Avoid stress, infection, surgery 1. Diuretics
Addisonian Crisis 2. Declomycin (Demeclocycline)
- A life-threatening condition caused by acute 3. Anti-HPN
adrenal insufficiency
Nursing Management
Clinical Manifestations 1. Fluid and sodium restriction
1. Hypoglycemia → sudden profound weakness 2. Monitor I & O and daily weight, electrolyte
2. Hyperpyrexia level
3. Circulatory shock
4. Coma/↓ LOC PHEOCHROMOCYTOMA
5. Renal shutdown and & death - Tumor of the adrenal medulla
Pathophysiology:
Management
1. Steroids: hydrocortisone/IV Increase Epinephrine and norepinephrine
2. IVF (NSS) ↓
3. IV glucose Sympathetic nervous system overactivity
↓
DIABETES INSIPIDUS 5 H’s (hypertension, headache, hyperhidrosis,
- Deficiency of ADH caused by hyposecretion hypermetabolism, hyperglycemia)
of the posterior pituitary gland
Pathophysiology: Diagnostic Evaluation
ADH Deficiency 1. Vanillyl Mandelic Acid Test (VMA test)
↓ ➢ 24-hour urine specimen
Inability of the kidney to retain water ➢ (+) elevated level of VMA
↓
Severe dehydration Medical Management
1. Anti-hypertensive drugs
Clinical Manifestations a. Alpha-blockers
1. Marked polyuria (20 L/day of very diluted b. Beta-blockers
urine with a specific gravity of 1.000-1.005) c. Vasodilators
→ dehydration
2. Polydipsia Surgical management: Adrenalectomy
3. Dehydration → weight loss
4. Hypovolemia → hypotension Nursing Management
5. Hypernatremia 1. Monitor
a. V/S
Diagnostic Evaluation: Fluid (water) deprivation test b. Hypertensive crisis → CVA, MI
➢ No fluid intake within 12 hours c. Blood glucose
➢ (+) urine remains diluted 2. Bed rest
3. Avoid smoking, drinking caffeine-containing
beverages