*PITUITARY *ADRENAL *THYROID *PARATHYROID *PANCREAS *OVARIES *TESTES

ENDOCRINE GLANDS
PITUITARY GLAND * Located at the base of the brain. * Directly affects the function of the other endocrine glands. * Promotes growth of body tissues. * Influences water absorption by the kidney. * Controls sexual development and function.

ADRENAL GLANDS * Two small glands, one above each kidney. * Regulates sodium and water retention. * Affects CHO, fat and CHON metabolism.

* Influences development of sexual characteristics.

* The adrenal cortex synthesizes glucocorticoids and mineralocorticoids.

* The adrenal medulla produces epinephrine and

norepinephrine. THYROID GLAND

* Located anterior part of the neck.

* Controls rate of body metabolism and growth. * Produces T4, T3 and thyrocalcitonin.

PARATHYROID GLANDS * Located near the thyroid. * Controls calcium and phosphorus metabolism.

* Produces parathyroid hormone.

PANCREAS * Located posterior of liver.

* Influences CHO metabolism.

* Indirectly influences fat and CHON metabolism. * Produces insulin and glucagon. OVARIES * Located in the pelvic cavity. * Produce estrogen and progesterone.

TESTES * Located in the scrotum. * Contributes to the development of secondary

sex characteristics.
* Produce testosterone.

APG:
FSH stimulates graafian follicle growth and estrogen secretion. LH induces ovulation & development of corpus luteum and stimulates testosterone secretion in men. ACTH stimulates secretion of hormones from adrenal cortex.

TSH
regulates secretory activity of thyroid gland. GH

stimulates growth of cells, bones, muscles and soft tissue.

Prolactin development of mammary glands & lactation

PPG:
ADH (Vasopressin) regulates water metabolism; helps body to retain water. Oxytocin stimulates uterine contractions during labor and milk secretion in lactating mothers.

ADRENAL CORTEX
Glucocorticoids (Cortisol, Cortisone, 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. Mineralocorticoids (Aldosterone, Deoxycortisone) - regulate F/E balance; stimulate reabsorption of sodium, chloride & water; stimulate potassium excretion.

ADRENAL MEDULLA
Epinephrine and Norepinephrine - function in acute stress; increase heart rate & BP; dilate bronchiole; convert glycogen to glucose when needed by muscles for energy.

THYROID
T3 & T4 regulate metabolic rate, CHO, fat and CHON metabolism; aid in regulating physical and mental growth & development. Thyrocalcitonin lowers serum calcium by increasing bone deposition.

PARATHYROID
PTH regulate sodium calcium and phosphate levels.

PANCREAS
Insulin allows glucose to diffuse across cell membrane; converts glucose to glycogen. Glucagon

increases blood glucose by causing gluconeogenesis in the liver; secreted in response to blood sugar.

OVARIES
Estrogen & Progesterone
- development of secondary sex characteristics in female, maturation of sex organs, sexual functioning , maintainance of preganancy.

TESTES
Testosterone development of secondary sex characteristics in males , maturation of sex organs, sexual functioning.

RADIOACTIVE IODINE UPTAKE (RAIU)

*A thyroid function test that measures the absorption of the iodine isotope to determine how the thyroid gland is functioning. *Administration of I123 or I131 orally followed in 24 hrs. by a scan of the thyroid for the amount of radioactivity emitted. *Normal value is 5-35% in 24 hours

*Elevated values indicate hyperthyroidism, thyrotoxicosis, decreased iodine intake or increased iodine excretion.
*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

*Blood test for diagnosis of thyroid disorders *T3 & T4 regulate thyroid-stimulating hormone *Normal Value of T3: 80-230 ng/dL T4: 5-12 ng/dL *Both values increase in hyperthyroidism & decreased in hypothyroidism

THYROID-STIMULATING HORMONE (TSH)

*Blood test used to differentiate the diagnosis of primary hypothyroidism from secondary hypothyroidism. *Normal value is 0.2 to 5.4 uU/ml *Elevated in primary hypothyroidism & decreased in hyperthyroidism or secondary hypothyroidism

THYROID SCAN
*Performed to identify nodules or growths in the thyroid glands *A radio isotope of iodine or technetium is administered prior to the scanning of the thyroid gland. *Level of radioisotope is not dangerous to self or others. *Discontinue medications containing iodine 14 days prior to test and discontinue thyroid meds 4-6 weeks prior to test. *NPO post MN; if iodine is used client will fast an additional 45 minutes after ingestion of radioactive isotope & scan is done after 24 hours.

NEEDLE ASPIRATION OF THYROID TISSUE

*Aspiration of thyroid tissue for cytological exam
*No preparation needed *Light pressure applied to aspiration site after the procedure

Eight-hour intravenous ACTH Test

*Administration of 25 units of ACTH in 500 ml of saline over an 8-hr period. *Used to determine function of adrenal cortex. *24-hr urine specimens are collected, before & after administration, for measurement of 17-ketosteroids and 17hydrocorticosteroids. *In Addisons disease, urinary output of steroids does not increase following administration of ACTH; normally steroid

excretion increases threefold to fivefold ff. ACTH administration.

*In Cushings syndrome, hyperactivity of the adrenal cortex increases the urine output of steroids in the second urine specimen tenfold.

GLUCOSE TOLERANCE TEST (GTT)

*Aids in the diagnosis of diabetes mellitus *If the glucose level peaks at higher than normal at 1 to 2 hours after injection or ingestion of glucose, and are slower than normal to return to normal levels, DM is diagnosed *Preparation: -eat a high-carbohydrate (200 to 300 g) diet for 3 days before the test -avoid alcohol, coffee & smoking 36 hours before testing -fast midnight before test -fasting blood glucose & urine glucose specimens obtained.

-avoid strenuous exercise 8 hours before & after test

-client ingests 100g glucose; blood sugar drawn at 30 & 60 mins. then hourly for 3-5 hrs.; urine specimens may also be collected.

GLYCOSYLATED HEMOGLOBIN
Glycosylated hemoglobin is blood glucose bound to hemoglobin
*Is a reflection of how well blood glucose levels have been controlled for up to the prior 4 months

*Hyperglycemia in clients with DM causes increase in glycosylated hemoglobin

*Fasting is not needed

*Values: Diabetics with good control: 7.5% or less Diabetics with fair control: 7.6% to 8.9% Diabetics with poor control: 9% or greater

ANTERIOR PITUITARY
Hypopituitarism Hyperpituitarism

POSTERIOR PITUITARY
Diabetes Insipidus SIADH (Syndrome of Inappropriate Antidiuretic Hormone)

*Hyposecretion of growth hormone by the anterior pituitary

gland *S/Sx: retarded physical growth, premature aging, low intellectual development, poor development of secondary sex characteristics *Given human growth hormone & offer emotional support to client & family

*Hypersecretion of GH by anterior pituitary gland which results in gigantism or acromegaly *Gigantism occurs in childhood before the closure of epiphyses of the long bones vs acromegaly which occurs after the closure of epiphyses of the long bones *S/Sx: large hands & feet, thickening & protrusion of jaw, arthritic changes, visual disturbances, diaphoresis, oily & rough skin, organomegaly, hypertension, dysphagia, deepening of voice *Emotional support; frequent skin care; pharmacologic & nonpharmacologic interventions for joint pains *Prepare for radiation of pituitary gland or hypophysectomy

*Removal of pituitary gland *Post-operative care: -Monitor V/S, neurological status & LOC -Elevate head of bed -Monitor for increased intracranial pressure & any postnasal drip which might be CSF -Avoid sneezing, coughing & blowing nose -Monitor for temporary diabetes insipidus -Monitor I & O & water intoxication -Administer antibiotics, analgesics, antipyretics, hormones & glucocorticoids if entire gland is removed

*Hyposecretion of ADH & deficiency of vasopressin *S/Sx: polyuria of 4-24 liters/day; polydipsia, dehydration, decreased skin turgor, dry mucus membranes, inability to concentrate urine, low urine specific gravity of 1.004 or less; fatigue, postural hypotension, headache

*Provision of safe environment especially with decreasing LOC, monitoring I & O with specific gravity, wear Medic-Alert bracelet
*Meds: vasopressin tannate (Pitressin Tannate) desmopressin acetate (DDAVP, Stimate) lypressin (Diapid) *Enhances reabsorption of water in the kidneys promoting antidiuretic effect & regulates fluid balance A/R: hypertension; nasal congestion

*Hypersecretion of ADH *S/Sx: Signs of fluid overload; changes in LOC & mental status; weight gain, hypertension, tachycardia, hyponatremia

*Monitor I & O and daily weight; monitor fluid & electrolyte balance; restrict fluids as prescribed; administer diuretics & monitor IV fluids carefully
*Meds: demeclocycline (Declomycin) inhibits ADH-induced water reabsorption & produces water diuresis

ADRENAL CORTEX
Addisons disease Cushings syndrome Aldosteronism (Conns Syndrome)

ADRENAL MEDULLA
Pheochromocytoma

*Hyposecretion

of the adrenal cortex hormones

Assessment: Subjective: Muscle weakness, fatigue, lethargy, dizziness, fainting, nausea, anorexia, abdominal pain/cramps. Objective: V/S: decreased BP, orthostatic hypotension Pulse: increased, collapsing, irregular Subnormal temp. Vomiting, diarrhea, weight loss Tremors Skin: poor turgor excessive pigmentation (bronze tone) Hyponatremia, hypoglycemia, hyperkalemia

NURSING MANAGEMENT:

1. Decrease stress:
a. Provide quiet environment, nondemanding schedule. 2. Promote adequate nutrition: a. Diet: acute phase- high sodium, low potassium; nonacute phase- increase CHO and CHON b. Fluids: force to balance fluid, monitor I&O, WOD c. Administer lifelong exogenous replacement therapy as ordered: 1. Glucocorticoids- prednisone, hydrocortisone 2. Mineralocorticoids- fludrocortisone (Florinef) 3. Health teaching: a. Take meds with food or milk. b. Avoid stress Monitor for s/sx of addisonian crisis

*Life-threatening disorder caused by acute adrenal insufficiency precipitated by stress, infection, trauma or surgery.

*May cause hyponatremia, hypoglycemia, hyperkalemia & shock. *Given glucocorticoids IV e.g. hydrocortisone Na succinate (SoluCortef), mineralocorticoids e.g. fludrocortisone (Florinef). *Severe, generalized muscle weakness, severe hypotension, hypovolemia, shock (vascular collapse)

*Check BP & electrolyte levels.

*Strict bed rest in quiet environment & protect from infection.

*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: a. Diet: increased protein, potassium, decreased calories, sodium b. Meds: 1. Cytoxic agents: aminoglutethimide (Cytaden), trilostane (Modrastane), mitotane (Lysodren)- to decrease cortisol production. 2. Replacement hormones as needed. c. S/Sx of progression of disease. d. Prepare client for adrenalectomy.

*Hypersecretion of aldosterone from the adrenal cortex of the adrenal gland commonly caused by adenoma *S/S: hypertension, hypokalemia, headache, polydipsia & polyuria, hypernatremia, low urine specific gravity *Monitor I & O & administer spironolactone (Aldactone) & K supplements & maintain Na restriction

*Administer antihypertensives as px
*Wear Medic-Alert bracelet *Usually will be undergoing adrenalectomy; administer glucocorticoids pre & post-op.

*Catecholamine-producing tumor usually found in the adrenal gland.

*Causes hypersecretion of epinephrine & norepinephrine by the adrenal medulla

*Cx: hypertensive retinopathy, CVA & CHF *S/Sx: HPN, severe HA, palpitations, pain in chest or abdomen, hyperglycemia & glucosuria, profuse sweating, n/v, dilated pupils, tachycardia, cold extremities. *Monitor for hypertensive crisis & avoid stimuli which triggers it such as : increased abdominal pressure, vigorous abdominal palpation & micturation *Instruct patient not to smoke, drink cola, coffee or tea *Monitor blood glucose & urine for glucose & acetone.

*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 bilaterallifelong 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 *Observe for hemorrhage and shock. *Prevent infection. *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

*Check I & O, weight and for edema (decrease Na intake) *Monitor for infection *Monitor electrolyte & calcium levels *Monitor for poor wound healing, menstrual irregularities, decrease in growth & edema *Dose must be tapered & not stopped abruptly *Advise to wear Medic-Alert bracelet

*Produce metabolic effects; alters normal immune response & suppress inflammation; promote Na & H2O retention & K+ excretion *Produce antiinflammatory , antiallergic & anti-stress effects; replacement for adrenocortical insufficiency *A/R: hyperglycemia, hypokalemia, edema & masks signs & symptoms of infection *C/I: DM, increases effect of anticoagulants & oral antidiabetic agents; increases potency of aspirins & NSAIDS & K-sparing diuretics *Check for overdose or signs of Cushings syndrome; additional doses during stress or surgery.

fludrocortisone (Florinef)
*Steroid hormones that enhance the reabsorption of NaCl & promote K+ excretion & hydrogen at the renal tubule promoting fluid & electrolyte balance *Used in primary & secondary Addisons disease *S/E: Na/H2O retention, hypokalemia, hypocalcemia, delayed wound healing, increased susceptibility to infection, mood swings, weight gain *Take with food or milk; high-K+ diet *Wear Medic-Alert bracelet

HYPOTHYROIDISM (MYXEDEMA) HYPERTHYROIDISM (GRAVES DISEASE)

*Hyposecretion of the thyroid hormone characterized by decreased rate of body metabolism. *Monitor HR including rhythm. *Instruct patient re: thyroid replacement therapy. *Instruct on low-calorie, low-cholesterol, low-saturated fat diet. *Assess for constipation & provide roughage. *Provide for warm environment. *Monitor for overdose of thyroid meds.

ASSESSMENT:
Subjective data: Weakness, fatigue, lethargy, headache, slow memory, loss of interest in sexual activity.

Objective data:
Depressed BMR; intolerance to cold Cardiomegaly, bradycardia, hypotension, anemia Menorrhagia, amenorrhea, infertility Dry skin, brittle nails, coarse hair, hair loss Slow speech, hoarseness, thickened tongue Weight gain: edema, periorbital puffiness

Lab data: elevated TRH, TSH; normal-low serum T4 & T3; decreased
RAUI.

NURSING MANAGEMENT
1. Provide for comfort and safety: monitor for infection or trauma; provide warmth, prevent heat loss & vascular collapse; administer thyroid meds as ordered. 2. Health teaching:

a. Diet: low calorie, high protein

b. S/Sx of hypothyroidism & hyperthyroidism c. Lifelong meds, dosage, desired effects, side effects. d. Stress-management techniques

e. Exercise program

*Rare but serious d/o which result from persistently low thyroid hormone precipitated by acute illness, rapid withdrawal of thyroid meds, use of sedatives & narcotics *S/Sx: hypotension, bradycardia, hypothermia, hyponatremia,

hypoglycemia, respiratory failure & death

*Patent airway *Keep patient warm & check V/S frequently

*Administer IV fluids & levothyroxine Na (Synthroid)

*Give IV glucose & corticosteroids

*Hypersecretion of the thyroid gland. *Provide adequate rest & administer sedatives as prescribed. *Provide cool & quiet environment. *Obtain daily weight & give high-calorie food. **Administer anti-thyroid meds & avoid giving stimulants. *Prepare the patient for the following: -iodine preparations -antithyroid meds -propanolol (Inderal) -radioactive iodine -for thyroidectomy as px

ASSESSMENT:
Subjective data:
o nervousness, mood swings, palpitations, heat intolerance, dyspnea, weakness.

Objective data:
o
o

Eyes: exophthalmos, characteristic stare, lid lag.

Skin: warm, moist, velvety; increased sweating; increased melanin pigmentation; pretibial edema with thickened skin & hyperpigmentation Weight loss despite increased appetite V/S: increased systolic BP, widened pulse pressure, tachycardia Goiter: thyroid gland noticeable & palpable Gyne: abnormal menstruation GI: frequent bowel movements Activity pattern: fatigue which leads to depression Lab data: elevated T3 & T4 level; elevated RAIU; elevated metabolic rate (BMR); decreased WBC caused by decreased granulocytosis (<4500).

o o o o o o o

NURSING MANAGEMENT:
1. Protect from stress: private room, restrict visitors, quiet environment.

2. 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 3. Prevent complications: give medications as ordered. 4. Monitor for thyroid storm. 5. Health teaching: stress reduction techniques; importance of medications; methods to protect eyes from environment; s/sx of thyroid storm.

MEDICAL MANAGEMENT:
1. Propylthiouracil (PTU) - blocks thyroid synthesis
2.

Methimazole (Tapazole) - to inhibit synthesis of thyroid hormone

3. Iodine preparations (SSKI, Lugols 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

4. Beta blockers: Propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor) - given to counteract the increased metabolic effect of thyroid hormones - relieve symptoms of tachycardia, tremors & anxiety

Acute & life threatening condition in uncontrolled hyperthyroidism *Risk factors: Infection, surgery, beginning labor to give birth, taking inadequate antithyroid medications before thyroidectomy. *S/Sx: fever, tachycardia, hypotension, marked respiratory distress, pulmonary edema, irritability, apprehension, agitation, restlessness, confusion, seizures *Meds: PTU or Tapazole; Sodium iodide IV or Lugols solution orally; Propranolol (Inderal); Aspirin, Steroids, Diuretics

*Removal of thyroid gland & performed for persistent hyperthyroidism *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-Fowlers 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 damagehigh-pitched voice, stridor, dysphagia, dysphonia & restlessness -Monitor for signs of hypocalcemia & tetany & have calcium

Levothyroxine (Synthroid, Levothroid, Levoxyl) Thyroglobulin (Proloid)

*Controls the metabolic rate of tissues & accelerates heat production & oxygen consumption *For hypothyroidism, myxedema & cretinism *A/R: cramps, diarrhea, nervousness, tremors, hypertension, tachycardia, insomnia, seating & heat intolerance *Taken same time every day preferably in the a.m. with food *Teach client to how to take HR *Avoid foods that will inhibit thyroid secretions such as: strawberries, peaches, pears, cabbage, turnips, spinach, Brussels sprouts, cauliflower, peas & radishes *Wear Medic-Alert bracelet

HYPOPARATHYROIDISM HYPERPARATHYROIDISM

*Positive Chvosteks Sign *Positive Trousseaus Sign *Wheezing & dyspnea (bronchospasm, laryngospasm) *Numbness & tingling of face & extremities *Carpopedal spasm *Visual disturbances (photophobia) *Muscle & abdominal cramps *Cardiac dysrhythmias *Seizures

*Hyposecretion of parathyroid hormone *Monitor for hypocalcemia & institute seizure precautions *Place a tracheostomy set, O2 & suction machine at bed side *Prepare for calcuim gluconate/chloride IV *Provide high-calcium/low-phosphorus diet

*Give vitamin D to enhance calcium absorption at the GIT

*Given phosphate binders *Wear medic-alert bracelet

*Hypersecretion of parathyroid hormones

*S/Sx: hypercalcemia & hypophosphophatemia, fatigue & muscle weakness, skeletal pain & tenderness, bone deformities resulting from pathologic fractures, weight loss, constipation, hypertension, cardiac dysrhythmias & renal stones *Encourage fluids & administer furosemide (Lasix) & IV salineas px *Move patient slowly & carefully *Administer phosphates as px *Administer calcitonin (Calcimar) as px to decrease skeletal calcium release & increase renal calcium clearance & monitor for hypocalcemia & report to MD *Prepare for 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-op *POST-OPERATIVE CARE: -monitor for respiratory distress & have a tracheostomy set, O2 & suction machine at bed side -Semi-Fowlers position -Check for bleeding -Check for hypocalcemic crisis, Trousseaus or Chvosteks sign -Assess changes in voice pattern & for laryngeal nerve damage -Administer calcium & vitamin D supplements as prescribed.

CALCIUM SUPPLEMENTS calcium carbonate (Tums) calcium gluconate calcium lactate

VITAMIN D SUPPLEMENTS calcifediol (Calderol)

CALCIUM REGULATORS calcitonin human (Cibacalcin) ANTIHYPERCALCEMICS edetate disodium (Disotate)

*Parathyroid hormone regulates serum calcium levels *Low serum calcium level stimulate parathyroid hormone release *Hyperparathyroidismgiven antihypercalcemics

*Hypoparathyroidismgiven calcium & Vit. D

DIABETES MELLITUS
A CHRONIC DISORDER OF IMPAIRED GLUCOSE INTOLERANCE AND CARBOHYDRATE, PROTEIN &

LIPID METABOLISM; CAUSED BY A DEFIECIENCY

OF INSULIN

1. INSULIN-DEPENDENT DIABETES 2. NON-INSULIN DEPENDENT DIABETES

Deficient insulin production Hyperglycemia Inc. concentration of blood glucose

Glucosuria
Excess glucose excreted in urine

Excess fluid loss Polyuria / Polydipsia

Insulin deficiency Impaired metabolism of CHON and fats Weight loss Decreased storage of calories Polyphagia

ASSESSMENT
POLYPHAGIA POLYDIPSIA POLYURIA HYPERGLYCEMIA WEIGHT LOSS BLURRED VISION

SLOW WOUND HEALING

VAGINAL INFECTIONS WEAKNESS & PARESTHESIAS

SIGNS OF INADEQUATE FEET CIRCULATION

APPROACH TO DIABETES MELLITUS:

DIET

EXERCISE
ORAL HYPOGLYCEMIC AGENTS/INSULIN

Sulfonylureas Chlorpropamide (Diabinase) Tolbutamide (Orinase) Glimepinide (Solosa) Acetohexamide (Dymelor) Prandial Glucose Regulator Repaglinide (Novonorm) Rosiglitazone (Avandia) Non-sulfonylureas Metphormine (Glucophage) Precose (Acarbose) Rosiglitazone (Avandia)

*Insulin increases glucose transport into cells & promotes conversion of glucose to glycogen, decreasing serum glucose levels *Primarily acts in the liver, muscle, adipose tissue by attaching to receptors on cellular membranes & facilitating transport of glucose, potassium & magnesium

*Hormone secreted by the alpha cells of the islets of Langerhans in the pancreas *Increase blood glucose by stimulating glycogenolysis in the liver *given SC, IM or IV routes

*Used to treat insulin-induced hypoglycemia when semiconscious/ unconscious

TYPE

ONSET

PEAK
1 hour

DURATION
3 hours 4-6 hours 16-20 hours 16-20 hours 20-30 hours

RAPID-ACTING INSULIN Lispro (Humalog) 10-15 mins

SHORT-ACTING INSULIN Humulin Regular 0.5-1 hour 2-3 hours

INTERMEDIATE-ACTING INSULIN Humulin NPH 3-4 hours 4-12 hours Humulin Lente 3-4 hours 4-12 hours LONG-ACTING INSULIN Humulin Ultralente 6-8 hours 12-16 hours

PREMIXED INSULIN 0.5-1 hour 70% NPH-30% Regular

2-12 hours

18-24 hours

*HYPOGLYCEMIA

*DIABETIC KETOACIDOSIS (DKA)

*HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME (HHNS)

*sweating *tremor *tachycardia *palpitations *nervousness *hunger

*3 or 4 commercially prepared glucose tablets *4-6 ounces of fruit juice or regular soda
CHILD: 2-3 GLUCOSE TABS

*6-10 Life Savers or hard candy

CHILD: 3-4 HARD CANDIES OR 1 CANDY BAR CHILD: 1 SMALL BOX OF RAISINS

CHILD: CUP OR 120 ML OF ORANGE JUICE OR SUGAR-SWEETENED JUICE

*2-3 teaspoons of sugar or honey

Assessment: *3 Ps *Blurred Vision *Weakness *Headache *Hypotension *Weak, rapid pulse *Anorexia, nausea, vomiting & abdominal pain *Acetone breath (fruity odor) *Kussmaul respirations *Mental status changes

Progressive insulin deficiency

Glucogenolysis Gluconeogenesis Contribute to further hyperglycemia Breakdown of fats Increased production of ketones

Hyperglycemic Hyperosmolar Nonketotik Coma

Similar to DKA but without Kussmaul Respirations and acetone breath.

*DIABETIC RETINOPATHY *DIABETIC NEUROPATHY

*Prevent moisture from accumulating between toes

*Wear loose socks & well-fitting (not tight) shoes & instruct client not to go barefoot
*Change into clean cotton socks daily *Wear socks to keep feet warm

*Do not wear the same shoes 2 days in a row

*Do not wear open toed shoes or shoes with strap that goes between toes *Check shoes for tears or cracks in lining & for foreign objects before putting them on *Break in new shoes gradually *Cut toenails straight across & smooth nails with an emery board *Do not smoke

*Meticulous skin care & proper foot care *Inspect feet daily & monitor feet for redness, swelling or break in skin integrity *Avoid thermal injuries from hot water, heating pads & baths *Wash feet with warm (not hot) water & dry thoroughly (avoid foot soaks) *Do not soak feet *Do not treat corns, blisters or ingrown nails

*Do not cross legs or wear tight garments that may constrict blood flow
*Apply moisturizing lotion to feet but not between toes

*Take insulin or oral hypoglycemic agents as prescribed. *Test blood glucose & test the urine for ketones every 3-4 hours *If meal plan cannot be followed, substitute with soft food 6-8 x per day *If vomiting, diarrhea or fever occurs, consume liquids every to 1 hour to prevent dehydration & to provide calories

*Notify doctor if vomiting, diarrhea, or fever persists, if blood

glucose levels are greater than 250 to 300 mg/dL, when ketonuria is present for more than 24 hours, when unable to take food or fluids for a period of 4 hours, when illness persists for more than 2 days

IF OTHERS MADE IT, WHY CANT I!