ENDOCRINE DISORDER
. Diabetes mellitus Assistant Lecturer Hussam Abbas
. Definition
1. Chronic disorder of carbohydrate metabolism with subsequent alteration of protein and fat metabolism
Results from a disturbance in the production, action, and rate of utilization of insulin
Five types of diabetes mellitus
1. Type I (insulin-dependent diabetes mellitus [IDDM], or ketosis
prone): usually develops in childhood
2. Type II (non-insulin-dependent diabetes mellitus [NIDDM], or
ketosis-resistant): usually develops after age 30
3. Gestational diabetes mellitus (GDM): occurs with pregnancy
4. Secondary diabetes: induced by trauma, surgery, or medications;
can be treated as Type I or type II
5. Maturity-onset diabetes (MODY): Type II that develops in teens and
young adults under age 30
. Possible etiology
1.Failure of body to produce insulin
/2.
Blockage of insulin supply
,3.
Autoimmune disease _
4.
Receptor defect in normally insulin-responsive cells
e,5.
Genetics
,,6.
Exposure to chemicals
7.
Hyperpituitarism
8.
Cushing s syndrome
9.
Hyperthyroidism
10.
Infection
11.
Surgery
x,.12.
Stress
13.
Medications
14.
Pregnancy
15.
Trauma
. Possible clinical manifestations
1. Weight loss
-2. Anorexia
3. polyphagia
4. Acetone breath
5.Weakness
6. Fatigue
7. Dehydration
8. Pain
9. Paresthesia
10. Polyuria
11. Polydipsia
12. Kussmaul respirations
13.Multiple infections and boils
14. Flushed, warm, smooth, shiny skin
15. Atrophic muscles
6. Poor wound healing
17. Mottled extremities
18. Peripheral and visceral neuropathies
19. Retinopathy
20. Sexual dysfunction
21.Blurred vision,
. Possible diagnostic test findings
1. Blood chen;istry.increased gulcose, potassium, chloride, ketones,
cholesterol, and trig lycerides; decreased COQ; pH less than 7.4
2. Urine chemistry: increased glucose, ketones
3. FBS: increased
4. GTT: hyperglycemia
5. Postprandial blood sugar: hyperglycemia
Nursing interventions and responsibilities
1. Maintain the patient s diet
2. Force fluids
3. Assess acid-base and fluid balance
4. Monitor and record VS, U0, I/O, finger sticks for blood glucose, and
laboratory studies
5. Administer medications, as prescribed
`6. Encourage the patient to express feelings about diet, medication
regimen, and body image changes
7. Encourage activity, as tolerated
8. Weigh the patient weekly
9.Provide meticulous skin and foot care
10. Monitor the patient for infection
11. Maintain a warm and quiet environment
12. Monitor wound healing
13. foster independence
14. Determine the patient s compliance to diet, exercise, and medication
regimens
Teaching goals (instructions to the patient and family)
1. Keep follow-up appointments
2. Exercise regularly
3: Stop smoking
4. Maintain a normal weight
5.Know the action, side effects, and scheduling of medications
6. Identify ways to reduce stress
7.- Recognize the signs and symptoms of hyperglycemia and
hypoglycemia
8. Alternate rest periods with ctivity
-9. Monitor self for infection skin breakdown, changes in peripheral
circulation, poor wound healing, and numbness in extremities
10. Follow dietary recommendations and restrictions
11. Maintain a quiet environment
12. Seek help from community agencies and resources
13. Know and use proper dietary substitutions if unable to take prescribed
diet because of illness
14. Adjust diet and insulin for changes in work, exercise, trauma, infection, fever, and stress
15. Demonstrate administration of hypoglycemics
16.Demonstrate home blood glucose monitoring technique (HBGM)
17.Complete daily skin and foot care
18.Wear a medical identification bracelet
19. Carry an emergency supply of glucose
20. Seek counseling for sexual dysfunction and feelings about body image
changes
21. Avoid use of over-the-counter medication
22. Avoid alcohol
23. Demonstrate use of the subcutaneous insulin infusion therapy (Insulin Pump)
24. Adhere to the treatment regimen to prevent complications
Possible medical complications
1.Ketoacidosis (diabetic coma): abdominal pain; acetone breath; altered
consciousness; hot, flushed skin; nausea;
vomiting; hypotension; oliguria; tachycardia
2.Insulin reaction (hypoglycemia): hunger, weakness, hand tremors,
pallor, tachycardia, diaphoresis, irritability, confusion, diplopia, slurred
speech, headaches
3. Infections
4.Periphral neuropathies
5.Glaucoma
6.Impotence
7.Coronary artery disease
8. Gangrene
9.Cercbrovascular accident (CVA)
10 Chronic renal failure
11. Hypovolemia
12. Diabetic retinopathy
13. Peripheral vascular disease
Hyperthyroidism
. Definition-increased synthesis of thyroid hormone from overactivity
(Graves disease) or change in thyroid gland (toxic nodular goiter)
. Possible etiology
1. Autoimmunc disease
2. Genetic
3. Psychological or physiologic stress
4. Thyroid adenomas
5. Pituitary tumors
6. Infection
Possible clinical manifestations
1. Anxiety
,2. Flushed, smoooth skin
3. Heat intolerance
4. Mood swings
5. Diaphoresis
6. Tachycardia
7. Palpitations
.8. Dyspnca
9. Weakness
10. Increased hunger
11. Increased systolic blood pressure
12. Tachypnea
13. Fine hand tremors
14. Fxophthahnos
` 15. Weight loss
16. Diarrhea
17. Hyperhydrosis
18. Bruit or thrill over thyroid
E. Possible diagnostic test findings
1. Thyroid scan: nodules
2. Blood chemistry: increased T3, T4, decreased
cholesterol
3. ECG: atrial fibrillation 4. BMR: increased .
. Nursing interventions and responsibilities
1. Maintain the patient s diet
2. Avoid stimulants, such as drugs and foods that contain caffeine
3. Administer I V fluids
4. Assess fluid balance
5. Monitor and record VS, UO, 1/0, and laboratory studies
6. Administer medications, as prescribed
7. Weigh the patient daily
8. Provide rest periods
9. Provide a quiet, cool environment
10. Provide eye and skin care
11. Allay the patient s anxiety
12. Encourage the patient to express feelings about changes in body image
13. Provide postchemotheraputic and postradiation nursing care
a. Provide skin, mouth, and perineal care
b. Encourage dietary intake
c. Administer antiernetics and antidiarrheals, as prescribed
d. Monitor for bleeding, infection, and electrolyte imbalance
e. Provide rest periods
. Teaching goals (instructions to the patient and family)
I . Keep follow-up appointments
2. Stop smoking
3. Maintain a normal weight
4. Know the action, side effects, and scheduling of medications
5. Identify ways to reduce stress
6. Recognize the signs and symptoms of thyroid storm
7. Adhere to activity limitations
8. Avoid exposure to people with infections
9. Alternate rest periods with activity
10. Monitor self for infection
11. Follow dietary recommendations and restrictions
12. Maintain a quiet environment
13. State reasons for emotional changes
. Possible medical complications
l. Thyroid storm (thyroid crisis): tachycardia, delirium, agitation, coma,
death, hyperpyrexia, dehydration, arrhythmias, diarrhea
2: Cardiac arrhythmias
3. Diabetes mellitus
Possible surgical interventions: subtotal thyroidectomy
. Hypothyroidism (rnyxedema)
A. Definition -underactive state of thyroid gland, resulting in absence or decreased secretion of thyroid hormone
B. Possible etiology
1. Autoimmune disease:
2. Thyroidectomy
3. Overuse of anti thyroid drugs
4. Malfunction of pituitary gland
5. Use of radioactive iodine
. Possible clinical manifestations
1.
Fatigue
/2.
Weight gain
3.
Dry, flaky skin
4.
/,5.
Edema
Cold intolerance
6.
Coarse hair
-7.
Alopecia
8.
Thick tongue, swollen lips
9.
Mental sluggishness
10.
Menstrual disorders
11.
Constipation
~~
12.
Hypersensitivity to narcotics, barbiturates, and;iesthctics
13.
Anorexia
14.
Decreased diaphoresis
15.
Hypothermia
Possible diagnostic test findings
/l.
Blood chemistry: decreased T3 T,4, PBI,
sodium; increased TSH,
Cholesterol
2.
BMK: decreased
.
3.
ECG: sinus bradvcardia
Nursing interventions and responsibilities
l . Maintain the patient s diet
2. Force fluids
3. Assess fluid balance
4. Monitor and record VS, UO, I/O, and laboratory studies
5. Administer medications, as prescribed
6. Encourage the patient to express feelings of depression
7. Encourage physical activity and mental stimulation
8. Provide a warm environment
9. , Avoid sedation: administer one-half to one-third the normal dose of
sedatives or narcotics
10. Check for constipation, infection, and edema
11. Prevent skin breakdown
12. Provide frequent rest periods
Teaching goals (instructions to the patient and family)
1. Keep follow-up appointments
2. Exercise regularly
3. Maintain a normal weight
4. Know the action, side effects, and scheduling of medications
5. Recognize the signs and symptoms of myxedema coma
6. Alternate rest periods with activity
7. Monitor self for constipation
8. Follow dietary recommendations and restrictions
9. Use additional protection in cold weather
10. Limit activity in cold weather
11. Avoid using sedatives
12. Complete skin care daily
Possible medical complications
1. Coronary artery disease
2. Congestive heart failure (CHF)
3. Acute organic psychosis
4. Angina
-5. Myocardial infarction (MI)
6. Myxedema coma: hypoventilation, hypothermia, respiratory acidosis, syncope, bradycardia, hypotension, seizures, and cerebral hypoxia
1