OVERVIEW OF THE ENDOCRINE SYSTEM

Pituitary gland (Hypophysis Cerebri) main organ o Located at the Sella turcica

o Administered expulsion

after

placental

o
o

Master clock or master gland of the body Divisions Anterior pituitary (adenohypophysis) Posterior pituitary (neurohypophysis) Oxytocin o Promotes uterine contractions o Milk let down reflex with the help of PROLACTIN (lactogenic hormone)

ADH prevents urination thereby conserving fluids o Pitressin (vasopressin)ADH replacement Contraction of smooth muscles o Involved in Diabetes insipidus and SIADH

SELECTED DISORDERS OF THE POSTERIOR PITUITARY

Definition Predisposing Factors Signs and Symptoms DIABETES INSIPIDUS DECREASED secretion of ADH; IDIOPATHIC 1. Pituitary surgery 2. Inflammation 3. Trauma 4. Tumor 1. Polyuria 2. Dehydration a. Thirst adults b. Tachycardia- pedia c. Agitation d. Poor skin turgor e. Dry mucus 3. Weakness and fatigue 4. Hypotension 5. Weight loss 6. Hypovolemic shock if left untreated a. Early sign: cool clammy skin b. Late sign of shock renal shock anuria 1. Urine specific gravity (N= 1.015-1.030) decreased 2. Serum Na (N= 135-145) - increased 1. Forced fluids 2. Administer isotonic fluids as ordered 3. Monitor VS and IO strictly 4. Administer medications as ordered Pitressin (vasopressin) IM 5. prevent complications : hypovolemic shock SIADH INCREASED secretion of ADH (idiopathic) 1. Head injury 2. Bronchogenic cancer (Chest XRAY non-invasive procedure that confirms lung CA) 3. Hyperplasia of Pituitary gland 1. Fluid retention a. Hypertension b. Edema c. Weight gain 2. Water intoxication cerebral edema increased ICP seizure activity

Diagnostics Nursing Management

1. 2. 1. 2. 3. 4. 5. 6.

Urine specific gravity increased Serum Na hyponatremia Restrict fluids Administer meds as ordered (loop and osmotic) Monitor IO strictly Wt pt daily and assess for edema Meticulous skin care prevent complications increased ICP and H20 intoxication

ANTERIOR PITUITARY GLAND 1. Growth hormones/somatotrophic hormones elongation of long bones or growth DWARFISM hyposecretion of GH in children GIGANTISM hypersecretion of GH in children ACROMEGALY hypersecretion of GH in adults i. Sandostatine (Oereotide) drug of choice for acromegaly Pancreas i. Insulin ii. Glucagon

3. 4.

5.

2.
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iii. Somatostatin antagonizes effect of GH Adenocorticotrophic Hormone (ACTH) maturation and development of adrenal cortex
1

6.

Thyroid Stimulating Hormone (TSH) stimulates the thyroid gland to secrete thyroid hormones Prolactin/Lactogenic/leuteotrophic Hormone Promotes development of mammary glands Initiates milk ejection reflex Melanocyte Stimulating Hormone (MSH) for skin pigmentation ALBINISM hyposecretion of MSH VITILIGO hypersecretion of MSH The brown race has the most sufficient amount of melanin Leutenizing Hormone (LH) Secretes estrogen, promotes development of secondary sexual characteristics Abejo

7.

Follicle Stimulating Hormone (FSH) Secretes progesterone

THELARCHE breast enlargement ADRENARCHE - Axillary and pubic hair growth during puberty induced by hyperactivity of the adrenal cortex. MENARCHE first menstruation Males enlargement of repro organs deepening of voice LEYDIG cells production of sperms CRYPTORCHIDISM undescended testes SPERMATOGENESIS requires at least a temperature which is a degree lower from the body temp. PINEAL GLAND secretes Melatonin which inhibits LH secretion and regulates circadian rhythm/body clock

T3 TRIIODOTHYRONINE 90% more potent T4 TETRAIODOTHYRONINE or THYROXINE 5% THYROCALCITONIN - its action is opposite to that of parathyroid hormone in that calcitonin increases deposition of calcium and phosphate in bone and lowers the level of calcium in the blood; its level in the blood is increased by glucagon and by Ca2+, and thus opposes postprandial Hypercalcemia Antagonizes effect of parathormone restrict Ca breakdown restricts Ca absorption T3 and T4 are metabolic or calorigenic hormones Increased T3 and T4 Increased cerebration or thinking Increased vs

o
o

o THYROID GLAND

Irritabilityblah blah hallucinations Decreased T3 and T4 Lethargy Memory impairment

Loss of appetite but (+) weight gain (-) metabolism increased lypolysis CAD Menorrhagia

NON-PALPABLE during swallowing!!! Thyroid cartilages ang palpable Nodular in consistency THYROID DISORDERS
SIMPLE GOITER Enlargement of the thryroid gland due to iodine deficiency; increased TSH 1. Goiter belt area (d/t increased intake of goitrogenic foods) a. Places far from the sea b. Mountainous regions Goitrogenic foods a. Contains PRO-GOITRIN anti-thyroid agent that has no IODINE b. Ex: spinach, cabbage, turnips, radish, strawberries, nuts, broccoli, potato, camote (root crops common in mountain region soil erosion iodine is washed away Goitrogenic drugs a. Anti-thyroid agent (PTU) b. Lithium c. ASA (SE: tinnitus, heartburn, dyspepsia) d. Phenylbutazone e. Cobalt

Definition

Predisposing Factors

2.

HYPOTHYROIDISM Decreased T3 and T4 Myxedema Adults CretinismChildren mental retardation 1. Iatrogenic causes diseases caused by medical intervention 2. Atrophy of the thyroid gland a. Irradiation b. Tumor c. Trauma d. Inflammation 3. Iodine deficiency 4. Autoimmune (Hashimotos disease)

HYPERTHYROIDSM Increased secretion of T3 and T4 Graves disease, Thyrotoxicosis, toxic goiter IDIOPATHIC 1. Autoimmune release of LATS (long acting thyroid stimulants) exophthalmos 2. Excessive iodine intake 3. hyperplasia of thyroid gland ENOPHTHALMOS late sign of severe dehydration in children

3.

Signs and Symptoms

#1 endemic goiter #2-3 causes sporadic goiter 1. Enlarged thyroid gland 2. Mild dysphagia 3. Mild restlessness

Early Signs 1. Weakness and fatigue 2. Loss of appetite but (+) weight gain d/t increased lipolysis 3. Dry skin 4. Cold intolerance 5. Constipation 6. Menorrhagia Late Signs 1. Brittleness of hair 2. Non-pitting edema d/t excessive accumulation of mucopolysaccharides in sq 3. Hoarseness of voice

1. 2. 3. 4. 5. 6. 7.

Hyperphagia increased appetite (+) weight loss d/t increased metabolism heat intolerance moist skin diarrhea increased VS tachycardia, HPN, tachypnea, hyperventilation, hyperthermia CNS changes a. Irritability b. agitation c. Tremors d. Restlessness e. Insomnia f. Hallucinations

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6.

Diagnostics

1. 2. 3. 1.

Nursing Management

2.

3. 4.

Serum T3 and T4 normal or below normal Thyroid Scan enlarged thyroid gland Serum TSH increased Administer medications as ordered a. Iodine Solution: Lugols Solution saturated solution of potassium iodine; 1 liter of water to 2-3 drops, use straw to prevent staining of teeth b. Thyroid agents of hormones Levothyroxine (Synthoid) Liothyronine (Cytomel) Thyroid extracts NURSING MGMT when giving these: Instruct client to take it best at early AM to prevent insomnia Monitor VS especially HR (mlt tachycardia and palpitaitons Monitor SE: insomnia, tachycardia, palpitations, HPN, heat intolerance Encourage increased intake of foods rich in iodine a. Seaweeds b. Seafoods: oysters, clams, crabs, lobster, shrimps (have low iodine content) c. Iodized salt (served on the table, (-) effect with cooking) Institute CBR Assist in surgery subtotal thyroidectomy

1. 2. 3. 1.

Decreased libido Decreased VS a. Hypotension b. Bradycardia c. Bradypnea d. Hypothermia CNS changes a. Lethargy b. Memory impairment c. Psychosis Serum T3 and T4 decreased Radioactive Iodine Uptake (RAIU) decreased Serum Cholesterol elevated Monitor STRICTLY VS, IO to determine presence of MYXEDEMA COMA a complication of severe hypothyroidism characterized by: a. Severe hypotension b. Bradycardia c. Bradypnea d. Hypoventilation e. Hypoglycemia f. Hyponatremia g. Hypothermia Might lead to progressive stupor and coma Assist in mechanical ventilation, administer thyroid hormones as ordered and force fluids, IV fluids replacement Administer isotonic fluids as ordered Administer medications as ordered thyroid hormones or agents (may cause insomnia and heat intolerance) Provide dietary intake low in calories to prevent weight gain institute meticulous skin care provide comfortable and warm environment forced fluids health teaching and d/c planning a. avoidance of precipitating factors leading to myxedema coma stress infection exposure to cold environment Anesthetics, sedatives and narcotics respi distress b. prevent complications (hypovolemic shock and myxedema coma) c. hormonal replacement therapy for lifetime d. importance of ff-up e. wearing of medic-alert bracelet

8. 9. 10.

Goiter Exophthalmos Amenorrhea

1. 2. 3. 1. 2.

elevated T3 and T4 RAIU elevated Thyroid Scan enlarged thyroid gland Monitor VS and IO strictly to determine presence of THYROID STORM/Crisis Administer medications as ordered Anti-Thyroid Agents: PTU toxic effects is AGRANULOCYTOSIS fever and chills, sore throat (throat CS pls!), LEUKOCYTOSIS (CBC pls!) b. Methimazole (Tapazole) High calorie diet to correct weight loss Provide comfortable and cool environment Institute meticulous skin care Maintain side rails Bilateral eye patch to prevent drying of eyes Assist in surgical procedure: subtotal thyroidectomy a. PRE-OP Administer lugols solutions/ SSRI to promote decreased vasculature and promote atrophy of the thyroid gland to prevent/minimize bleeding and hemorrhage b. POST-OP

a.

3. 4. 5. 6. 7. 8.

2. 3. 4. 5. 6. 7. 8.

i.

i.

WOF signs of THYROID STORM agitation, hyper-thermia, HPN. If (+) thyroid storm: administer anti-pyretics and beta-blockers; VS, IO and NVS strictly, siderails up, provide hypothermic blanket WOF: inadvertent or accidental removal of parathyroid gland hypocalcemia or tetany [(+) trousseus signs, (+) chvosteks Give Ca Gluc slowly to prevent arrhythmia and arrest WOF accidental laryngeal nerve damage hoarness of voice instruct client to talk immediately post-op if (+) notify MD WOF signs of bleeding (+) feeling of fullness at incision site,

ii.

iii.

iv.
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(+) soiled dressings at back or nape area, notify MD WOF signs of laryngeal spasm DOB and SOB prep trache set Hormonal Replacement therapy for life importance of FFup care wearing of medic-alert bracelet HYPERTHYROIDISM

v.

9. 10. 11. SIMPLE GOITER HYPOTHYROIDISM

PARATHYROID pair of small nodules located behind the thyroid gland parathormone for Ca reabsorption PARATHYROID DISEASES
Definition HYPOPARATHYROIDISM A condition due to diminution or absence of the secretion of the parathyroid hormones, with low serum calcium and tetany, and sometimes with increased bone density. Hypocalcemia Hyperphosphatemia Decreased parathormone Following subtotal thyroidectomy Atrophy of parathyroid d/t a. Inflammation b. Trauma c. Irradiation Acute tetany a. Tingling sensation b. Paresthesia c. Dysphagia d. (+) laryngospasm e. (+) Trousseus sign f. (+) Chvosteks sign g. arrhythmia h. seizures Chronic tetany a. Cataract and photophobia b. Loss of tooth enamel c. Anorexia and general body malaise HYPERPARATHYROIDISM Increased parathormone 1. Hypercalcemia (blood) Bone demineralization bone fracture b. Kidney stones Hypophosphatemia Hyperplasia of parathyroid glands Over compensation of parathyroid gland d/t Vitamin D deficiency Ricketts Children (Osteomalacia Adults) Bone pain especially at the back bone fracture Kidney stones a. Renal colic

a.

2. 1. 2.

Predisposing Factors

1. 2.

Signs and Symptoms

1.

1. 2.

3. 4. 5. 6.

b. Cool moist skin initial Sx of shock Interaction elevated Ca and Anorexia and general body malaise Irritability and memory impairment Presence of ulceration

2.

d.
Diagnostics 1. 2. 3. 4. A.

Agitation, Irritability and memory impairment 1. 2. 3. 1. 2. 3. 4. 5. Serum Ca increased Serum Phosphate decreased Bone Xray Bone demyelination Force fluids Strain all the urine with gauze pad Provide warm sitz bath for comfort Provide acid-ash in the diet to acidify the urine (cranberries) Administer medications as ordered a. narcotic analagesics

Nursing Management

Serum Ca decreased (N= 8.5-11/100ml) Serum Phosphate increased (N= 2.5 -4.5 mg/100ml) X-ray decreased bone density (long bones) CT Scan degeneration of basal ganglia Administer medications as ordered

a.
b.

Apricot high in potassium

c.

Ca gluconate slowly for acute tetany, slow IV Oral calcium supplement i. Ca gluconate ii. Ca lactate iii. Ca carbonate Vit D (Cholecalciferol) i. Calcidiol from food ii. Calcitrol from sun

i.
6. 7. 8. 9. 10. 11. 12.

Morphine sulfate tremors naloxone

B. C. D.

Phosphate binder (aluminum OH gel Amphogel) binds Phosphate in intestines constipation i. Maalox given 1 hour before meals Avoid precipitating stimulus such as bright glaring lights and noises photophobia seizure Diet which is increased in Ca and decreased phosphate a. Salmon, anchovies, green turnips Institute seizure and safety precautions

d.

ii. Demerol respiratory depression Maintain siderails Ambulate with assistance Diet: high Phosphate and low Ca (lean meat) Assist in surgical procedure parathyroidectomy Prevent complications renal failure Hormonal replacement therapy Importance of ffup care
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E. F. G. H. I.

Prepare trache set at bedside Encourage the client to breath using paperbag mild acidosis increased ionized Ca levels Prevent complications a. Arrhythmia b. Seizures Hormonal replacement for lifetime Importance of ffup care

ANTACIDS Aluminum Containing Aluminum OHgel (Ampho gel) Constipation

Magnesium Containing Milk of Magnesia Diarrhea

ADRENAL GLAND -atop of each kidney

I. Adrenal Cortex (outer)

A. B.

Zona faciculata glucocorticoids (cortisol: glucose metabolism) SUGAR Zona reticularis secretes traces of glucocorticoids and androgenic hormones testosterone, estrogen (LH) and progestin (FSH) SEX Zona glomerulosa mineralocorticoids aldosterone promotes Na and H2O reabsorption and excretes potassium SALT

PHEOCHROMOCYTOMA catecholamine producing tumor; elevated NE HPN resistant to medications stroke Tx: beta blockers Avoid valsalva maneuver

C. II.

Adrenal Medulla secretes catecholamines A. Epinephrine B. Norepinephrine

ADRENAL GLAND DISORDERS

Definition ADDISONS DISEASE Hyposecretion of adrenocortical hormones leading to: CUSHINGS DISEASE Hypersecretion of adrenocortical hormone

Predisposing Factors Signs and Symptoms

1. 2. 1.

Deficiency of neuromuscular function (salt and sex) Atrophy of the Adrenal gland Fungal infections hypoglycemia (TIRED)

Metabolic disturbances (sugar) Fluid and electrolyte imbalances (salt) 1. 2. 1. Hyperplasia of Adrenal gland Tubercular infection (MILIARY TB to adjacent organs) Hyperglycemia can lead to DM a. Polyuria b. Polydipsia c. Polyphagia d. Wt. Gain e. Glucosuria Increased susceptibility to infection (Reverse isolation!) Hypernatremia a. HPN b. Edema c. Wt. gain Moonface appearance, buffalo hump, obese trunk, pendulous abdomen, thin extremities Hypokalemia a. Weakness and fatigue b. Constipation c. U wave on ECG tracing Hirsutism Easy brusing Acne and Striae increased masculinity in females FBS elevated Elevated Na Decreased K Elevated Cortisol Monitor IO, VS Restrict Na and Fluids Weigh pt. daily and assess for pitting edema (ANASARCA generalized edema nephritic syndrome) Measure abdominal girth daily, notify MD Diet: low CHO, NA, High CHON and K Administer medications as ordered a. K-sparing diuretics - Spironolactone

2. 3.

4.

5. 6. 7. Diagnostics 1. 2. 3. 4. 2.

Diaphoresis and depression Decreased tolerance to stress (d/t decreased cortisol) Addisonian Crisis Hyponatremia a. Hypotension b. Signs of dehydration c. Weight loss Hyperkalemia a. Irritability and agitation b. Diarrhea c. Arrhythmias Decreased Libido Loss of pubic and axillary hair Bronze-like skin pigmentation d/t decreased cortisol stimulation of MSH from pituitary gland FBS decreased (N= 80-120 mg/dl) Serum Na decreased (N= 135-145) Serum K elevated (N=3.5-5.5meq/L) Plasma cortisol decreased Administer medications as ordered a. Corticosteroids Universal rule: administer 2/3 dose in AM and 1/3 dose in PM to mimic the N diurnal rhythm of the body Taper the dose. Withdraw gradually from the drug

a. b. c. d. e.

Tremors and tachycardia Irritability Restlessness Extreme fatigue 2. 3.

4. 5.

Nursing Management

6. 7. 8. 9. 1. 2. 3. 4. 1. 2. 3. 4. 5. 6.

Monitor SE: Cushingoid Sx

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HPN, Increased susceptibility to infection, Weight gain, Hirsutism, Moon face

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appearance Ex: Hydrocortisone, Dexamethasone, Prednisone b. Mineralocorticoids fluorocortisone Forced fluids Maintain patent IV line Diet: high CHO/calories, Na and CHON, low K Meticulous skin care Provide health teaching and d/c planning a. Avoidance of precipitating factors leading to addisonian crisis: Stress, Infection, Sudden withdrawal to steroids b. Prevent Complications hypovolemic shock c. Hormonal replacement therapy for life d. Importance of ffup care

7. 8. 9. 10. 11.

(Aldactone); excretes sodium but retains potassium Prevent Complications DM Provides meticulous skin care Assist in Surgical Procedure Bilateral Adrenalectomy Hormonal replacement for life Importance of ffup care

PANCREAS Behind the stomach Mixed gland: exocrine and endocrine at the same time

A. B.

Pancreatitis inflammation edema hemorrhage autodigestion

Acinar Cells 1. secretes pancreatic juices 2. aids in digestion Islets of Langerhans 1. Alpha cells

Stomach doesnt undergo autodigestion despite acidic environment d/t gastric juices that protects it

2. 3.

Glucagon hyperglycemia Beta cells

Chronic hemorrhagic pancreatitis death during sleep

Insulin hypoglycemia Delta cells Somatostatin antagonizes effect of gh

DIABETES MELLITUS metabolic disorder characterized by non-utilization of CHO, CHON and FAT metabolism
Definition Incidence Rate Predisposing Factors Signs and Symptoms DM I (IDDM) Juvenile Onset/ Non-obese; children; BRITTLE DISEASE 10% of general population Hereditary total destruction of pancreatic cells Viruses Toxicities (CCl4) Drugs, steroids and loop diuretics (furosemide) Polyuria, polydipsia, polyphagia Glucosuria Weight loss, anorexia, nausea and vomiting Blurring of vision Increased susceptibility to infection Poor/delayed wound healing (lower extremity distal to the heart) 1. Insulin 2. Exercise 3. Diet 4. Sodium Bicarbonate for acidosis DKA that may lead to diabetic coma Acute complication of type 1 DM due to hyperglycemia leading to severe CNS depression Predisposing Factors: Hyperglycemia Stress Infection Signs and symptoms 3Ps and G Weight loss Anorexia, nausea and vomiting
1. 2. 3. 4. 1. 2. 3. 4. 5. 6.

DM II (NIDDM) Adult Onset/Obese (40 yo above) Maturity-onset type 90% of the general population Obesity lack of insulin receptor binding sites

Usually asymptomatic (3Ps +1G, weight gain) Absence of lypolysis

Treatment

Complications

OHA Diet Exercise Insulin used during emergency situation HONK

1. 2. 3. 4.

Acetone breath, kussmauls, decreased LOC coma Dx: elevated FBS, BUN, Crea and Hct Pancreatic Ca Cushings Syndrome
Anabolism Catabolism

GESTATIONAL DM d/t maternal hormones Infant hypogly signs: high pitch cry and poor sucking reflex DM ASSOCIATED WITH ILLNESS

Main food

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Stuff CHO CHON FATS

Glucose Amino acids Fatty acids

Glycogen Nitrogen Free fatty acids ketones and cholesterol

Food CHO glucose insulin aids in absorption of glucose Cells ATP (main fuel of the cells) GLUCONEOGENESIS formation of glucose from noncarbohydrate sources (CHON and fats)

1. 2. 3.

Liver glycogenesis and glycogenolysis glucose in bloodstream Cholesterol deposition in arteries HPN CVA, MI death Increased CHON catabolism -N balance tissue wasting cachexia Ketones (CNS depressant) DKA Kussmauls respiration acetone breath diabetic coma Polyuria cellular dehydration stimulates thirst center polydipsia Glucosuria cellular starvation stimulate appetite center polyphagia FBS if elevated 3 consecutive times +3Ps and G = DM OGTT (oral glucose tolerance test) most sensitive test Alpha Glycosylated Hgb increased

Increased fat metabolism release of FFA

DM hyperglycemia increased osmotic diuresis

DIAGNOSTICS:

DM management 1. Monitor for peak action of OHA and insulin 2. Administer insulin/OHA as ordered

Brain can tolerate elevated glucose levels but not decreased glucose 3. Monitor strictly VS, CBG, I/O 4. Monitor for s/sx of hypogly and hypergly and notify MD 5. Diabetic diet: CHO 50%, CHON 30%, Fats 20% a. Offer alternative food substitutes b. Give orange juice if patient refuses to eat 6. Exercise after meals when blood glucose is rising 7. Monitor for Sx complications a. Atherosclerosis HPN MI or CVA b. Microangiopathies Eyes Blindness or Retinopathy Premature Cataract hazy vision, decreased color vision; use mydriatics Kidneys Recurrent pyelonephritis (inflammation of renal pelvis Renal failure ( common causes: HPN, DM) Gangrene formation Shock Peripheral neuropathy Diarrhea, constipation Sexual impotence (HPN, DM) 8. Foot care management a. Avoid walking barefooted b. Cut toenails straight c. Apply lanolin to prevent skin breakdown d. (-) constricting garments 9. Encourage annual eye and kidney exam 10. Monitor for signs of DKA or HONK 11. Assist in surgical wound debridement a. Administer analgesics prior to debridement 12. Assist in surgical procedures a. BKA b. AKA
HYPEROSMOTIC NON-KETOTIC (HONK) HO increased osmolality severe dehydration NK absence of lypolysis no ketosis

a.

Definition Precipitating Factors Signs and Symptoms

Diagnostics Nursing Management

DIABETIC KETOACIDOSIS (DKA) Acute complication of IDDM d/t hyperglycemia leading to CNS depression and coma 1. Hyperglycemia 2. Stress 3. Infection 1. 3Ps +1G, weight loss 2. Anorexia, nausea and vomiting 3. Acetone/fruity breath 4. Kussmauls respirations 5. CNS depression 6. Coma Elevated FBS Elevated BUN, CREA and HcT 1. Assist in mechanical ventilation 2. SOP in hospitals: administer 0.9 NaCl, PNSS, isotonic, followed by 0.45 NaCl hypotonic to counteract dehydration 3. Monitor VS, IO, CBG 4. Administer medications as ordered a. Rapid Acting regular b. Sodium Bicarb to counteract acidosis c. Antimicrobials

1. 2. 3. 4.

Headache Confusion Seizures Decreased LOC coma

Same but (-) NaHCO3

INSULIN THERAPY I. Sources

II.

Types of Insulin

A. B.
C.

Animal pork and beef : rarely used because it can cause severe allergic reactions Human less antigenicity, less allergic reactions Artificial

A. B.

Rapid (SAI) clear, peak: 2-4 hours , Regular insulin Intermediate AI NPH (Non-Protamine Hagedorn) cloudy, peak : 6-12 hours

C. Long AI Ultra lente cloudy, peak 12-24 hours III. Nursing Management
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A. B. C.
D.

Administer insulin at room temp to lipodystrophy atrophy/hypertrophy of SQ tissue Insulin only refrigerated once opened Avoid shaking insulin, roll between palms only Accuracy of administration is important Rotate insulin sites to prevent lipodystrophy

prevent

E. F.
G. H. I.

Use short bore needle gauge 25-26 No need to aspirate Administer insulin 45/90 degrees angle depending on amount to pts SQ tissue Most accessible route: abdomen Aspirate CLEAR before CLOUDY to contamination and promote accurate calibration Monitor for local complications: 1. Allergic reactions 2. Lipodystrophy prevent

J.
K.

3.

SOMOGYIS PHENOMENON rebound effect of insulin characterized by hypoglycemia, hyperglycemia

ORAL HYPOGLYCEMICS MOA stimulates the pancreas to secrete insulin I. Classification A. First generation sulfonylureas 1. Chlorpropamide (Diabenase) 2. Talbutamide (Orinase) 3. Tolazamide (Tolinase) B. Second generation sulfonylureas 1. Glipzide (glucotrol) 2. Diabeta (Micronase) II. Nursing Management

A.
B.

Administer with food to decrease GIT irritation and to prevent hypoglycemia Instruct pt not to take alcohol

1. 2.

Alcohol + OHA severe hypoglycemic reaction Disulfiram +OHA toxicity

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