1. Chapter 11 Care of the Patient with an Endocrine Disorder Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.

2. Care of the Patient with an Endocrine Disorder Endocrine glands are ductless glands that release chemicals (hormones) into the blood stream to regulate body activities The endocrine glands regulate themselves by a series of negative feedback messages The hormones secreted by the endocrine glands affect tissues of the entire body, and the imbalance in their levels may contribute to pathological changes in many different systems

3. Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Hormone Effects Generalized effect on metabolism, growth and development, and reproduction The slightest changes in hormonal levels can upset the metabolic balance of the body Hormones increases and decreases normal body processes by exerting their effects on target organs Abnormal levels of these hormones cause diseases and disorders of the endocrine system

4. Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Pituitary Gland Acromegaly and gigantism – growth changes that my lead to negative effects on the patient’s self-image and self-esteem Diabetes insipidus – antidiuretic hormone deficiency – results in marked polyuria and intense polydipsia SIADH – syndrome of inappropriate secretion of antidiuretic hormone – too much ADH hormone

5. Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Thyroid and Parathyroid Hyperthyroidism – too much thyroid hormone – patient’s metabolic processes exaggerated Hypothyroidism – not enough thyroid hormone – slows the body’s metabolic processes Goiter – enlarged thyroid Cancer – relatively rare malignancy Hyperparathyroidism – too much parathyroidism – elevated calcium Hypoparathyroidism – insufficient parathyroidism – decrease calcium

6. Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Person with Myxedema (Figure 11-8)

7. Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Adrenal Glands Cushing’s syndrome – elevated adrenocortical hormones – body’s protective mechanism fails Addison's disease – insufficient adrenocortical hormone – electrolytes and fluid balance is unstable Pheochromocytoma – tumor in the adrenal medulla – causes severe hypertension that may result in CVA

8. Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Pancreas Diabetes mellitus – improper metabolism of carbohydrates, fats and proteins due to lack of insulin – Type 1 (IDDM) – autoimmune beta-cell destruction – usually in patient under 30 years of age – Type 2 (NIDDM) – decrease response to insulin – more commonly found after age 30 and incidence increases with the aging process

9. Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Treatment of Diabetes Mellitus Individualized treatment that depends on: – Age – Lifestyle – Food preferences – Ability to cook – Activity levels

10. Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Nursing Responsibilities Diabetes Mellitus Monitor medications effects during peak action of the medication, and treatment must be initiated promptly if hypoglycemia develops Be familiar with the clinical manifestations of DKA/HH and hypoglycemic reaction Frequent assessments necessary because DKA can result in seizures, brain damage, or death

11. Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Sites for Insulin Injections (Figure 11-13)

12. Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Nursing Diagnoses Knowledge, deficient Self-esteem, risk for situational low Sensory perceptions, disturbed Fluid volume, risk for deficient Infection, risk for Injury, risk for Sexual dysfunction Body image, disturbed Coping, ineffective Home maintenance, impaired Nutrition: less than body requirements, imbalanced Nutrition: more than body requirement, imbalanced Activity intolerance