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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.

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Presentation on theme: "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."— Presentation transcript:

1 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.

2 Slide 2 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Overview 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

3 Slide 3 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Pituitary gland—“master gland”  Anterior pituitary gland  Posterior pituitary gland Thyroid gland Parathyroid gland Adrenal gland  Adrenal cortex  Adrenal medulla Pancreas Overview of Anatomy and Physiology

4 Slide 4 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 11-2 Pituitary hormones. (From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13 th ed.]. St. Louis: Mosby.)

5 Slide 5 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Female sex glands  Ovaries  Placenta Male sex glands  Testes Thymus gland Pineal gland Overview of Anatomy and Physiology

6 Slide 6 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 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. [13 th ed.]. St. Louis: Mosby.)

7 Slide 7 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pituitary Gland Acromegaly  Etiology/pathophysiology Overproduction of growth hormone in the adult Idiopathic hyperplasia of the anterior pituitary gland Tumor growth in the anterior pituitary gland Changes are irreversible

8 Slide 8 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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 Generalized coarsening of the facial features Enlarged hands and feet Enlarged heart, liver, and spleen

9 Slide 9 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

10 Slide 10 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 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.)

11 Slide 11 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pituitary Gland Acromegaly (continued)  Medical management/nursing interventions Pharmacological management  Parlodel  Sandostatin  Analgesics Cryosurgery Transsphenoidal removal of tissue Proton beam therapy Soft, easy-to-chew diet

12 Slide 12 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

13 Slide 13 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pituitary Gland Gigantism (continued)  Clinical manifestations/assessment Great height Increased muscle and visceral development Increased weight Normal body proportions Weakness  Medical management/nursing interventions Surgical removal of tumor Irradiation of the anterior pituitary gland

14 Slide 14 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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`

15 Slide 15 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pituitary Gland Dwarfism (continued)  Diagnostic tests  Medical management/nursing interventions Growth hormone injections Removal of tumor, if present

16 Slide 16 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

17 Slide 17 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pituitary Gland Diabetes insipidus  Clinical manifestations/assessment Polyuria; polydipsia May become severely dehydrated Lethargic Dry skin; poor skin turgor Constipation  Medical management/nursing interventions ADH preparations Limit caffeine due to diuretic properties

18 Slide 18 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

19 Slide 19 Mosby 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 Glands

20 Slide 20 Mosby 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 Glands

21 Slide 21 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Hyperthyroidism (continued)  Medical management/nursing interventions Pharmacological management  Propylthiouracil  Methimazole Radioactive iodine Subtotal thyroidectomy Disorders of the Thyroid and Parathyroid Glands

22 Slide 22 Mosby 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 Disorders of the Thyroid and Parathyroid Glands

23 Slide 23 Mosby 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 Glands

24 Slide 24 Mosby 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 Glands

25 Slide 25 Mosby 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 Glands

26 Slide 26 Mosby 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 Disorders of the Thyroid and Parathyroid Glands

27 Slide 27 Mosby 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 Glands

28 Slide 28 Mosby 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  Medical management/nursing interventions Pharmacological management  Potassium iodide Diet high in iodine Surgery—thyroidectomy Disorders of the Thyroid and Parathyroid Glands

29 Slide 29 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Simple goiter. (Courtesy of L. V. Bergman & Associates, Inc., Cold Springs, New York.)

30 Slide 30 Mosby 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  Medical management/nursing interventions Total thyroidectomy Thyroid hormone replacement If metastasis is present: radical neck dissection; radiation, chemotherapy, and radioactive iodine Disorders of the Thyroid and Parathyroid Glands

31 Slide 31 Mosby 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 Glands

32 Slide 32 Mosby 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 Glands

33 Slide 33 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Hyperparathyroidism (continued)  Medical management/nursing interventions Removal of tumor Removal of one or more parathyroid glands Disorders of the Thyroid and Parathyroid Glands

34 Slide 34 Mosby 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 Glands

35 Slide 35 Mosby 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 Glands

36 Slide 36 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Hypoparathyroidism (continued)  Medical management/nursing interventions Pharmacological management  Calcium gluconate or intravenous calcium chloride Vitamin D Disorders of the Thyroid and Parathyroid Glands

37 Slide 37 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

38 Slide 38 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

39 Slide 39 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

40 Slide 40 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Adrenal Glands Adrenal hyperfunction (Cushing’s syndrome) (continued)  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

41 Slide 41 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

42 Slide 42 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Adrenal Glands Adrenal hypofunction (Addison’s disease) (continued)  Clinical manifestations/assessment Related to imbalances of hormones, nutrients, and electrolytes Nausea; anorexia Postural hypotension Headache Disorientation Abdominal pain; lower back pain Anxiety

43 Slide 43 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

44 Slide 44 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Adrenal Glands Adrenal hypofunction (Addison’s disease) (continued)  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

45 Slide 45 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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  Medical management/nursing interventions Surgical removal of tumor

46 Slide 46 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

47 Slide 47 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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 Polyuria o Polydipsia o Polyphagia

48 Slide 48 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pancreas Diabetes mellitus (continued)  Clinical manifestations/assessment (continued) Type I  Sudden onset  Weight loss  Hyperglycemia  Under 40 years old

49 Slide 49 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

50 Slide 50 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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 (HbA 1c ) C-peptide test

51 Slide 51 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

52 Slide 52 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pancreas Diabetes mellitus (continued)  Medical management/nursing interventions (continued) Diet (continued)  American Diabetes Association (ADA) diet o Seven exchanges o Quantitative diet  Need three regular meals with snacks between meals and at bedtime to maintain constant glucose levels

53 Slide 53 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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

54 Slide 54 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pancreas Diabetes mellitus (continued)  Medical management/nursing interventions (continued) Medications  Insulin o Classified by action: Regular; Lente and NPH; Ultralente o Classified by type: beef/pork: Humulin/Novolin o Injection sites should be rotated to prevent scar tissue formation o Sliding scale

55 Slide 55 Mosby 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 (From Potter, P.A., Perry, A.G. [2003]. Basic nursing: essentials for practice. [5 th ed.]. St. Louis: Mosby.)

56 Slide 56 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pancreas Diabetes mellitus (continued)  Medical management/nursing interventions (continued) Medications  Oral hypoglycemic agents o Stimulate islet cells to secrete more insulin o Only for type II diabetes mellitus

57 Slide 57 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders 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 podiatrist o No hot water bottles or heating pads  Assess for symptoms of hypoglycemia

58 Slide 58 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pancreas Diabetes mellitus (continued)  Medical management/nursing interventions (continued) Acute complications  Coma o Diabetic ketoacidosis o Hyperglycemic hyperosmolar nonketotic o Hypoglycemic reaction  Infection

59 Slide 59 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Pancreas Diabetes mellitus (continued)  Medical management/nursing interventions (continued) Long-term complications  Diabetic retinopathy  Cardiovascular problems  Renal failure

60 Slide 60 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing 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


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