Endocrine System
Glucocorticoids (Cortisol, Cortisone,
PITUITARY GLAND
1. Located at the base of the brain.
2. Directly affects the function of the other endocrine
glands.
3. Promotes growth of body tissues.
4. Influences water absorption by the kidney.
5. Controls sexual development and function.
ADRENAL GLANDS
1. Two small glands, one above each kidney.
2. Regulates sodium and water retention.
3. Affects CHO, fat and CHON metabolism.
4. Influences development of sexual characteristics.
5. The adrenal cortex synthesizes glucocorticoids and
6. mineralocorticoids.
7. The adrenal medulla produces epinephrine and
norepinephrine.
THYROID GLAND
1. Located anterior part of the neck.
2. Controls rate of body metabolism and growth.
3. Produces T4, T3 and thyrocalcitonin.
PARATHYROID GLANDS
1. Located near the thyroid.
2. Controls calcium and phosphorus metabolism.
3. Produces parathyroid hormone.
PANCREAS
1. Located posterior of liver.
2. Influences CHO metabolism.
3. Indirectly influences fat and CHON metabolism.
4. Produces insulin and glucagon.
OVARIES
1. Located in the pelvic cavity.
2. Produce estrogen and progesterone.
TESTES
1. Located in the scrotum.
2. Contributes to the development of secondary
3. sex characteristics.
4. Produce testosterone.
Anterior Pituitary gland
1. FSH – stimulates graafian follicle growth and
estrogen secretion.
2. LH – induces ovulation & development of corpus
luteum and stimulates testosterone secretion in men.
3. ACTH – stimulates secretion of hormones from
adrenal cortex.
4. TSH – regulates secretory activity of thyroid gland.
5. GH – stimulates growth of cells, bones, muscles
and soft tissue.
6. Prolactin – development of mammary glands &
lactation
Posterior Pituitary Gland
1. ADH (Vasopressin) – regulates water metabolism;
helps body to retain water.
2. Oxytocin– stimulates uterine contractions during
labor and milk secretion in lactating mothers.
ADRENAL CORTEX
1.
Cortecosterone)
 increase blood glucose levels by increasing rate
of glyconeogenesis
 increases CHON catabolism
 increase mobilization of fatty acids
 promote sodium & water retention
 anti-inflammatory effect
 aid the body in coping stress.
2. Mineralocorticoids (Aldosterone,
Deoxycortisone)
- regulate F/E balance; stimulate
reabsorption of sodium, chloride & water;
stimulate potassium excretion.
ADRENAL MEDULLA
1. Epinephrine and Norepinephrine
 function in acute stress increase heart rate & BP
 dilate bronchiole
 convert glycogen to glucose when needed by
muscles for energy.
THYROID
1. T3 & T4
 regulate metabolic rate, CHO, fat and CHON
metabolism
 aid in regulating physical and mental growth &
development.
2. Thyrocalcitonin
 lowers serum calcium by increasing bone
deposition.
PARATHYROID
PTH – regulate sodium calcium and phosphate levels.
Diagnostic Test
RADIOACTIVE IODINE UPTAKE (RAIU)
1. A thyroid function test that measures the absorption
of the iodine isotope to determine how the thyroid
gland is functioning.
2. Administration of I123 or I131 orally followed in
24 hrs. by a scan of the thyroid for the amount of
radioactivity emitted.
3. Normal value is 5-35% in 24 hours
4. Elevated values indicate hyperthyroidism,
thyrotoxicosis, decreased iodine intake or increased
iodine excretion.
5. Decreased values indicate hypothyroidism,
thyroiditis, low T4, use of antithyroid meds.
 Thyroid medication must be discontinued
7-10 days prior to test.
 No radiation precautions necessary.
T3 & T4 RESIN UPTAKE TEST
1. Blood test for diagnosis of thyroid disorders
2. T3 & T4 regulate thyroid-stimulating hormone
3. Normal Value of T3: 80-230 ng/dL
T4: 5-12 ng/dL
4. Both values increase in hyperthyroidism &
decreased in hypo-thyroidism
THYROID-STIMULATING HORMONE (TSH) Preparation:
1. Blood test used to differentiate the  eat a high-carbohydrate (200 to 300 g) diet for 3
diagnosis of primary days before the test
2. hypothyroidism from secondary  avoid alcohol, coffee & smoking 36 hours
hypothyroidism. before testing
3. Normal value is 0.2 to 5.4 IU/ml  fast midnight before test
4. Elevated in primary hypothyroidism &  fasting blood glucose & urine glucose
decreased in hyper- specimens obtained.
 avoid strenuous exercise 8 hours before & after
5. thyroidism or secondary hypothyroidism
test
 client ingests 100g glucose; blood sugar drawn
THYROID SCAN
at 30 & 60 mins. then hourly for 3-5 hrs.; urine
1. Performed to identify nodules or growths in the
specimens may also be collected.
thyroid glands
2. A radio isotope of iodine or technetium is
Glycosylated hemoglobin- is blood glucose bound to
administered prior to the scanning of the
hemoglobin
thyroid gland.
1. Is a reflection of how well blood glucose levels have
3. Level of radioisotope is not dangerous to self or
been controlled for up to the prior 4 months
others.
2. Hyperglycemia in clients with DM causes increase
4. Discontinue medications containing iodine 14
in glycosylated hemoglobin
days prior to test and discontinue thyroid meds
3. Fasting is not needed
4-6 weeks prior to test.
*Values:
5. NPO post MN; if iodine is used client will fast
Diabetics with good control: 7.5% or less
an additional 45 minutes after ingestion of
Diabetics with fair control: 7.6% to 8.9%
radioactive isotope & scan is done after 24
Diabetics with poor control: 9% or greater
hours.
ANTERIOR PITUITARY
NEEDLE ASPIRATION OF THYROID TISSUE
 Hypopituitarism
1. Aspiration of thyroid tissue for cytological exam
 Hyperpituitarism
2. No preparation needed
POSTERIOR PITUITARY
3. Light pressure applied to aspiration site after the
 Diabetes Insipidus
procedure
 SIADH (Syndrome of Inappropriate
AntidiureticHormone)
Eight-hour intravenous ACTH Test
1. Administration of 25 units of ACTH in 500 ml of
HYPOPITUITARISM
saline over an 8-hr period.
1. Hyposecretion of growth hormone by the anterior
2. Used to determine function of adrenal cortex.
pituitary gland
3. 24-hr urine specimens are collected, before & after
2. S/Sx: retarded physical growth, premature aging,
administration, for measurement of 17-ketosteroids
low intellectual
and 17-hydrocorticosteroids.
development, poor development of secondary sex
 In Addison’s disease, urinary output of
characteristics
steroids does not increase following
3. Given human growth hormone & offer emotional
administration of ACTH; normally steroid
support to client & family
excretion increases threefold to fivefold ff.
ACTH administration.
HYPERPITUITARISM
 In Cushing’s syndrome, hyperactivity of
1. Hypersecretion of GH by anterior pituitary gland
the adrenal cortex increases the urine
which results in gigantism acromegaly
output of steroids in the second urine
2. Gigantism occurs in childhood before the closure of
specimen tenfold.
epiphyses of the long bones vs acromegaly which
occurs after the closure of epiphyses of the long
GLUCOSE TOLERANCE TEST (GTT)
bones
1. Aids in the diagnosis of diabetes mellitus
S/Sx:
2. If the glucose level peaks at higher than normal
 large hands & feet
at 1 to 2 hours after injection or ingestion of
 thickening & protrusion of jaw,
glucose, and are slower than normal to return
 arthritic changes
to normal levels, DM is diagnosed
 visual disturbances
 Diaphoresis
  oily & rough skin 1. S/Sx: Signs of fluid overload; changes in LOC &
 Organomegaly mental status; weight gain, hypertension,
 Hypertension tachycardia, hyponatremia
 Dysphagia 2. Monitor I & O and daily weight; monitor fluid &
 deepening of voice electrolyte balance; restrict fluids as prescribed;
Nursing MGT: administer diuretics & monitor IV fluids carefully
1. Emotional support 3. Meds: demeclocycline (Declomycin) inhibits ADH-
2. frequent skin care induced water reabsorption & produces water
3. pharmacologic & non- pharmacologic diuresis
4. interventions for joint pains ADRENAL CORTEX
5. Prepare for radiation of pituitary gland or Addison’s disease
hypophysectomy Cushing’s syndrome
Aldosteronism (Conn’s Syndrome)
HYPOPHYSECTOMY
Removal of pituitary gland ADRENAL MEDULLA
*Post-operative care: Pheochromocytoma
 -Monitor V/S, neurological status & LOC  Hyposecretion of the adrenal cortex hormones
 -Elevate head of bed Assessment:
 -Monitor for increased intracranial pressure & any Subjective:
postnasal drip which might be CSF  Muscle weakness,
 -Avoid sneezing, coughing & blowing nose  fatigue,
 -Monitor for temporary diabetes insipidus  lethargy,
 -Monitor I & O & water intoxication  dizziness
 -Administer antibiotics, analgesics,  fainting,
antipyretics,hormones & glucocorticoids if entire  nausea,
gland is removed  anorexia,
 abdominal pain/cramps.
DIABETES INSIPIDUS Objective:
 Hyposecretion of ADH & deficiency of  V/S: decreased BP, orthostatic hypotension
vasopressin  Pulse: increased, collapsing, irregular
S/Sx:  Subnormal temp.
1. polyuria of 4-24 liters/day  Vomiting, diarrhea, weight loss
2. polydipsia,  Tremors
3. dehydration,  Skin: poor turgor excessive pigmentation
4. decreased skin turgor, (bronze tone)
5. dry mucus membranes,  Hyponatremia, hypoglycemia,
6. inability to concentrate urine, low urine hyperkalemia
specific gravity of 1.004 or less; NURSING MANAGEMENT:
7. fatigue, 1. Decrease stress:
8. postural hypotension, headache a. Provide quiet environment, nondemanding
Management: schedule.
1. Provision of safe environment especially with 2. Promote adequate nutrition:
decreasing LOC, a. Diet: acute phase- high sodium, low potassium;
2. monitoring I & O with specific gravity, nonacute phase- increase CHO and CHON
3. wear Medic-Alert bracelet b. Fluids: force to balance fluid, monitor I&O,
WOD
Meds: c. Administer lifelong exogenous replacement
1. vasopressin tannate (Pitressin Tannate) therapy as ordered:
2. desmopressin acetate (DDAVP, Stimate) 1. Glucocorticoids- prednisone,
3. lypressin (Diapid) - Enhances reabsorption of water hydrocortisone
in the kidney promoting antidiuretic effect & 2. Mineralocorticoids- fludrocortisone
regulates fluid (Florinef)
balance 3. Health teaching:
A/R: hypertension; nasal congest a. Take meds with food or milk.
 b. Avoid stress
SYNDROME OF INAPPROPRITE ANTIDIURETIC Monitor for s/sx of addisonian crisis
HORMONE(SIADH)
Hypersecretion of ADH
ADDISONIAN CRISIS
1. Life-threatening disorder caused by acute adrenal
insufficiency precipitated by stress, infection, trauma or
surgery.
2. May cause hyponatremia, hypoglycemia, hyperkalemia
& shock.
3. Given glucocorticoids IV e.g. hydrocortisone Na
succinate (Solu-Cortef), mineralocorticoids e.g.
fludrocortisone (Florinef).
4. Severe, generalized muscle weakness, severe
hypotension, hypovolemia, shock (vascular collapse)
5. Check BP & electrolyte levels.
6. Strict bed rest in quiet environment & protect from
infection.
CUSHING’S SYNDROME
*Hypersecretion of corticoids.
*ASSESSEMENT:
Subjective:
 headache, backache, weakness, decreased work
capacity
Objective:
 Hypertension, weight gain, pitting edema
 Characteristic fat deposits, truncal & cervical
obesity (buffalo hump).
 Pendulous abdomen, purple striae, easy bruising
 Moon face, acne, hyperpigmentation, impotence
 Virilization in women: hirsutism, breast atrophy,
amenorrhea
 Pathologic fractures reduced height
 Slow wound healing
 Hypernatremia, hyperglycemia, hypokalemia
NURSING MANAGEMENT:
1. Promote comfort: protect from trauma.
2. Prevent complications: monitor fluid balance, glucose
metabolism, hypertension, infection.
3. Health teachings:
4. Diet: increased protein, potassium, decreased calories,
sodium
• Meds:
1. Cytoxic agents: aminoglutethimide (Cytaden), trilostane
(Modrastane), mitotane (Lysodren)- to decrease cortisol
production.
2. Replacement hormones as needed.
3.S/Sx of progression of disease.
Prepare client for adrenalectomy.
CONN’S SYNDROME
1. Hypersecretion of aldosterone from the adrenal
cortex of the
adrenal gland commonly caused by adenoma
2. S/S: hypertension, hypokalemia, headache,
polydipsia & polyuria, hypernatremia, low urine
specific gravity
3. Monitor I & O & administer spironolactone
(Aldactone) & K
supplements & maintain Na restriction
4. Administer antihypertensives as px
5. Wear Medic-Alert bracelet
6. Usually will be undergoing adrenalectomy;
administer
glucocorticoids pre & post-op.
PHEOCHROMOCYTOMA
1. Catecholamine-producing tumor usually found in
the adrenal gland.
2. Causes hypersecretion of epinephrine &
norepinephrine by the adrenal medulla
3. Cx: hypertensive retinopathy, CVA & CHF
4. S/Sx: HPN, severe HA, palpitations, pain in chest or
abdomen, hyperglycemia & glucosuria, profuse
sweating, n/v, dilated pupils, tachycardia, cold
extremities.
5. Monitor for hypertensive crisis & avoid stimuli
which triggers it
such as : increased abdominal pressure, vigorous
abdominal palpation & micturation
6. Instruct patient not to smoke, drink cola, coffee or
tea
7. Monitor blood glucose & urine for glucose &
acetone.
ADRENALECTOMY
 Surgical removal of one or more of the adrenal
gland because of tumors or overactivity;
 For unilateral adrenalectomy, up to 2 years of
glucocorticoid therapy needed; for bilateral…
lifelong replacement
Preop: reduce risk of postop cx
a. Prescribed steroid therapy, given 1 wk. before
surgery
b. Antihypertensive drugs discontinued
c. Sedation as ordered
During surgery: monitor for hypotension & hemorrhage
Postop: promote hormonal balance
a. Administer hydrocortisone
b. Monitor for signs of Addisonian crisis
1. Observe for hemorrhage and shock.
2. Prevent infection.
3. Administer cortisone or hydrocortisone as
prescribed.
bethamethasone (Celestone), cortisone (Cortone)
dexamethasone (Decadron), prednisone (Orasone)
Stimulate the adrenal cortex to secrete cortisol
Produces an antiinflammatory effect.
*A/R: Increased appetite, mood swings, water & Na
retention, hypocalcemia & hypokalemia, cushing-like
symptoms
4. Check I & O, weight and for edema (decrease Na
intake)
5. Monitor for infection
6. Monitor electrolyte & calcium levels
7. Monitor for poor wound healing, menstrual
irregularities,
decrease in growth & edema
8. Dose must be tapered & not stopped abruptly
 9. Advise to wear Medic-Alert bracelet
NURSING MANAGEMENT
CORTICOSTEROIDS(GLUCOCORTICOIDS) • Provide for comfort and safety: monitor for
1. Produce metabolic effects; alters normal immune infection or trauma; provide warmth, prevent heat loss &
response & suppress inflammation; promote Na & vascular collapse; administer thyroid meds as ordered.
H2O retention & K excretion
• Health teaching:
2. Produce antiinflammatory , antiallergic & anti-stress
a. Diet: low calorie, high protein
effects ; replacement for adrenocortical
b. S/Sx of hypothyroidism & hyperthyroidism
insufficiency
c. Lifelong meds, dosage, desired effects, side
3. A/R: hyperglycemia, hypokalemia, edema & masks
effects.
signs & symptoms of infection
d. Stress-management techniques
4. C/I: DM, increases effect of anticoagulants & oral
e. Exercise program
antidiabetic agents; increases potency of aspirins &
NSAIDS & K-sparing diuretics
MYXEDEMA COMA
5. Check for overdose or signs of Cushing’s syndrome;
1. Rare but serious d/o which result from persistently
additional doses during stress or surgery.
low thyroid hormone precipitated by acute illness,
rapid withdrawal of thyroid meds, use of sedatives
MINERALOCORTOCOIDS
& narcotics
fludrocortisone (Florinef)
2. S/Sx: hypotension, bradycardia, hypothermia,
 Steroid hormones that enhance the reabsorption of
hyponatremia, hypoglycemia, respiratory failure &
NaCl &
death
 promote K+ excretion & hydrogen at the renal
3. Patent airway
tubule promoting fluid & electrolyte balance
4. Keep patient warm & check V/S frequently
 Used in primary & secondary Addison’s disease
5. Administer IV fluids & levothyroxine Na
 S/E: Na/H2O retention, hypokalemia, hypocalcemia,
(Synthroid)
delayed wound healing, increased susceptibility to
6. Give IV glucose & corticosteroids
infection, mood swings, weight gain
 Take with food or milk; high-K+ diet
HYPERTHYROIDISM (GRAVE’S DISEASE
 Wear Medic-Alert bracelet
Hypersecretion of the thyroid gland.
 Provide adequate rest & administer sedatives as
HYPOTHYROIDISM (MYXEDEMA)
prescribed.
HYPERTHYROIDISM (GRAVE’S DISEASE)
 Provide cool & quiet environment.
 Hyposecretion of the thyroid hormone characterized
 Obtain daily weight & give high-calorie food.
by decreased rate of body metabolism.
 Administer anti-thyroid meds & avoid giving
 Monitor HR including rhythm.
stimulants.
 Instruct patient re: thyroid replacement therapy.
 Prepare the patient for the following:
1. -iodine preparations
 Instruct on low-calorie, low-cholesterol, low-
2. -antithyroid meds
saturated fat diet.
3. -propanolol (Inderal)
 Assess for constipation & provide roughage.
4. -radioactive iodine
 Provide for warm environment.
5. -for thyroidectomy as px
 Monitor for overdose of thyroid meds.
ASSESSMENT:
ASSESSMENT:
Subjective data:
Subjective data:
 nervousness, mood swings, palpitations,
 Weakness, fatigue, lethargy, headache, slow
heat intolerance, dyspnea, weakness.
memory, loss of interest in sexual activity.
Objective data:
Objective data:
 Eyes: exophthalmos, characteristic stare,
 Depressed BMR; intolerance to cold
lid lag.
 Cardiomegaly, bradycardia, hypotension, anemia
 Skin: warm, moist, velvety; increased
 Menorrhagia, amenorrhea, infertility
sweating; increased melanin pigmentation;
 Dry skin, brittle nails, coarse hair, hair loss
pretibial edema with thickened skin &
 Slow speech, hoarseness, thickened tongue
hyperpigmentation
 Weight gain: edema, periorbital puffiness
 Weight loss despite increased appetite
 Lab data: elevated TRH, TSH; normal-low serum
NURSING MANAGEMENT:
T4 & T3; decreased RAUI.
• Protect from stress: private room, restrict visitors,
quiet environment.
• Promote physical & emotional equilibrium:
a. cool, quiet, cool well ventilated environment.
b. eye care: sunglasses to protect from photophobia,
protective drops (methylcellulose) to soothe cornea
c. diet: high calorie, protein, vit. B; avoid stimulants
Prevent complications: give medications as ordered.
• Monitor for thyroid storm.
• Health teaching: stress reduction techniques;
importance of medications; methods to protect eyes from
environment; s/sx of thyroid storm.
MEDICAL MANAGEMENT:
• Propylthiouracil (PTU)
- blocks thyroid synthesis
Methimazole (Tapazole)
- to inhibit synthesis of thyroid hormone
• Iodine preparations (SSKI, Lugol’s Solution)
- decrease size & vascularity of the thyroid gland
- palatable if diluted with water, milk or juice
- give through straw tp prevent staining of teeth
- takes 2-4 weeks before results are evident
• Beta blockers: Propranolol (Inderal), atenolol
(Tenormin), metoprolol (Lopressor)
- given to counteract the increased metabolic effect
of thyroid hormones
- relieve symptoms of tachycardia, tremors &
anxiety
THYROID STORM
1. Acute & life threatening condition in
uncontrolled hyperthyroidism
2. Risk factors: Infection, surgery, beginning labor
to give birth, taking inadequate antithyroid
medications before thyroidectomy.
3. S/Sx: fever, tachycardia, hypotension, marked
respiratory distress, pulmonary edema,
irritability, apprehension, agitation, restlessness,
confusion, seizures
4. Meds: PTU or Tapazole; Sodium iodide IV or
Lugol’s solution orally; Propranolol (Inderal);
Aspirin, Steroids, Diuretics
5. Removal of thyroid gland & performed for
persistent hyper-thyroidism
PRE-OPERATIVE CARE:
 Assess V/S, weight, electrolyte & glucose level
 Teach DBE & coughing as well as how to support
neck in post-op period when coughing & moving
 Administer antithyroid meds etc. to prevent thyroid
storm
*POST-OP CARE:
 Monitor for respiratory distress & have
tracheostomy set, O2 &suction machine at bed side
 Maintain semi-Fowler’s position to reduce edema
 Immobilize head with pillows/sandbags; prevent
flexion &hyperextension of neck
 Check surgical site for edema & bleeding
 Limit client talking & assess for hoarseness
 Assess for laryngeal nerve damage…high-pitched
voice, stridor,dysphagia, dysphonia & restlessness
 Monitor for signs of hypocalcemia & tetany & have
calcium
THYROID HORMONES
Levothyroxine (Synthroid, Levothroid, Levoxyl)
Thyroglobulin (Proloid)
1. Controls the metabolic rate of tissues &
accelerates heat production & oxygen
consumption
2. For hypothyroidism, myxedema & cretinism
3. A/R: cramps, diarrhea, nervousness, tremors,
hypertension, tachycardia, insomnia, seating &
heat intolerance
4. Taken same time every day preferably in the
a.m. with food
5. Teach client to how to take HR
6. Avoid foods that will inhibit thyroid secretions
such as: strawberries, peaches, pears, cabbage,
turnips, spinach,Brussels sprouts, cauliflower,
peas & radishes
7. Wear Medic-Alert bracelet
HYPOPARATHYROIDISM
SIGNS OF TETANY
 Positive Chvostek’s Sign
 Positive Trousseau’s Sign
 Wheezing & dyspnea (bronchospasm,
laryngospasm)
 Numbness & tingling of face & extremities
 Carpopedal spasm
 Visual disturbances (photophobia)
 Muscle & abdominal cramps
 Cardiac dysrhythmias
 Seizures
HYPOPARATHYROIDISM
Hyposecretion of parathyroid hormone
1. Monitor for hypocalcemia & institute seizure
precautions
2. Place a tracheostomy set, O2 & suction machine at
bed side
3. Prepare for calcuim gluconate/chloride IV
4. Provide high-calcium/low-phosphorus diet
5. Give vitamin D to enhance calcium absorption at the
GIT
6. Given phosphate binders
7. Wear medic-alert bracelet
PARATHYROIDECTOMY
Removal of 1 or more parathyroid gland
*PRE-OPERATIVE CARE:
-monitor calcium, phosphate & magnesium level
-ensure that calcium is near normal
 -explain to patient that talking may be painful 2 days post- Polyphagia
op
*
POST-OPERATIVE CARE: ASSESSMENT
 -monitor for respiratory distress & have a 1. POLYPHAGIA
tracheostomy set, O2 & suction machine at bed side 2. POLYDIPSIA
 -Semi-Fowler’s position 3. POLYURIA
 -Check for bleeding 4. HYPERGLYCEMIA
 -Check for hypocalcemic crisis, Trousseau’s or 5. WEIGHT LOSS
Chvostek’s sign 6. BLURRED VISION
 -Assess changes in voice pattern & for laryngeal 7. SLOW WOUND HEALING
nerve damage 8. VAGINAL INFECTIONS
 -Administer calcium & vitamin D supplements as 9. WEAKNESS & PARESTHESIAS
prescribed. 10. SIGNS OF INADEQUATE FEET
CALCIUM SUPPLEMENTS CIRCULATION
VITAMIN D SUPPLEMENTS APPROACH TO DIABETES MELLITUS:
calcifediol (Calderol)
CALCIUM REGULATORS
• DIET
calcitonin human (Cibacalcin) • EXERCISE
ANTIHYPERCALCEMICS • ORAL HYPOGLYCEMIC AGENTS/INSULIN
edetate disodium (Disotate) Sulfonylureas
Parathyroid hormone regulates serum calcium levels Chlorpropamide (Diabinase)
*Low serum calcium level stimulate parathyroid Tolbutamide (Orinase)
hormone release Glimepinide (Solosa)
*Hyperparathyroidism…given antihypercalcemics Acetohexamide (Dymelor)
*Hypoparathyroidism…given calcium & Vit. D
Prandial Glucose Regulator
Diabetes Mellitus Repaglinide (Novonorm)
A chronic disorder of impaired glucose intolerance and Rosiglitazone (Avandia)
carbohydrate, protein, and lipid metabolism: Caused by a
deficiency in insulin Non-sulfonylureas
Metphormine (Glucophage)
INSULIN-DEPENDENT DIABETES Precose (Acarbose)
Rosiglitazone (Avandia)
Deficient insulin production
 INSULIN
Hyperglycemia  Insulin increases glucose transport into cells &
 promotes conversion of glucose to glycogen,
Inc. concemtration of blood glucose decreasing serum glucose levels
  Primarily acts in the liver, muscle, adipose tissue by
Glucosuria attaching to receptors on cellular membranes &
 facilitating transport of glucose, potassium &
Excess glucose excreted in urine magnesium

Excess fluid loss GLUCAGON
  Hormone secreted by the alpha cells of the islets
Polyuria / Polydipsia of Langerhans in the pancreas
 Increase blood glucose by stimulating
glycogenolysis in the liver
Insulin deficiency  given SC, IM or IV routes
  Used to treat insulin-induced hypoglycemia when
Impaired metabolism of CHON and fats semiconscious/unconscious

Weight loss TYPE ONSET PEAK DURATION

Decreased storage of calories RAPID-ACTING INSULIN
 Lispro (Humalog) 10-15 mins 1 hour 3hours
SHORT-ACTING INSULIN
Humulin Regular 0.5-1 hour 2-3 hours 4-6 hours
HYPERGLYCEMIC HYPEROSMOLAR
INTERMEDIATE-ACTING INSULIN NON^KETOTIC COMA
Humulin NPH 3-4 hours 6-12 hours 16-20 hours  Similar to DKA but without Kussmaul Respirations
Humulin Lente and acetone breath.
LONG-ACTING INSULIN
Humulin Ultralente 6-8 hours 12-16 hours 20-30 hours CHRONIC COMPLICATION
*DIABETIC RETINOPATHY
PREMIXED INSULIN 0.5-1 hour 2-12 hours 18-24 hours *DIABETIC NEUROPATHY
70% NPH-30% Regular
Preventive Foot Care
Major Complications of Diabetes mellitus 1. Prevent moisture from accumulating between
1. HYPOGLYCEMIA toes
2. DIABETIC KETOACIDOSIS (DKA) 2. Wear loose socks & well-fitting (not tight)
3. HYPERGLYCEMIC HYPEROSMOLAR shoes & instruct client not to go barefoot
NONKETOTIC SYNDROME (HHNS) 3. Change into clean cotton socks daily
 sweating 4. Wear socks to keep feet warm
 tremor 5. Do not wear the same shoes 2 days in a row
 tachycardia 6. Do not wear open toed shoes or shoes with
 palpitations strap that goes between toes
 nervousness 7. Check shoes for tears or cracks in lining & for
 hunger foreign objects before putting them on
8. Break in new shoes gradually
Simple Carbohydrates to treat Hypoglycemia 9. $Cut toenails straight across & smooth nails
*3 or 4 commercially prepared glucose tablets with an emery board
CHILD: 2-3 GLUCOSE TABS 10. Do not smoke
*4-6 ounces of fruit juice or regular soda 11. Meticulous skin care & proper foot care
CHILD: ½ CUP OR 120 ML OF ORANGE JUICE 12. Inspect feet daily & monitor feet for redness,
OR SUGAR-SWEETENED JUICE swelling or break in skin integrity
*6-10 Life Savers or hard candy 13. Avoid thermal injuries from hot water, heating
CHILD: 3-4 HARD CANDIES OR 1 CANDY BAR pads & baths
*2-3 teaspoons of sugar or honey 14. Wash feet with warm (not hot) water & dry
CHILD: 1 SMALL BOX OF RAISINS thoroughly(avoid foot soaks)
DIABETES KETOACIDOSI 15. Do not soak feet
Assessment: 16. Do not treat corns, blisters or ingrown nails
1. 3 Ps 17. Do not cross legs or wear tight garments that
2. Blurred Vision may constrict blood flow
3. Weakness 18. Apply moisturizing lotion to feet but not
4. Headache between toes
5. Hypotension
6. Weak, rapid pulse CLIENT EDUCATION DURING ILLNESS
7. Anorexia, nausea, vomiting & abdominal pain  Take insulin or oral hypoglycemic agents as
8. Acetone breath (fruity odor) prescribed.
9. Kussmaul respirations  Test blood glucose & test the urine for ketones
10. Mental status changes every 3-4 hours
Diabetes ketoacidosis  If meal plan cannot be followed, substitute with
soft food 6-8 x per day
Progressive insulin deficiency  If vomiting, diarrhea or fever occurs, consume
 liquids every ½ to 1 hour to prevent
Glucogenolysis dehydration & to provide calories
Gluconeogenesis  Notify doctor if vomiting, diarrhea, or fever
 persists, if blood
Contribute to further hyperglycemia  glucose levels are greater than 250 to 300
 mg/dL, when ketonuria is present for more than
Breakdown of fats 24 hours, when unable to take food or fluids for
 a period of 4 hours, when illness persists for
Increased production of ketones more than 2 days