Embed Size (px)
Citation preview
1
DIABETES MELLITUS-DIABETES MELLITUS-TREATMENT(INSULIN)TREATMENT(INSULIN)
2
DIABETES MELLITUS-DIABETES MELLITUS-TREATMENT(INSULIN)TREATMENT(INSULIN)
MedicationsInsulin Main goal is to normalize insulin activity and blood
glucose levelClassified by action Regular Lente and NPH UltralenteClassified by type beefpork HumulinNovolinInjection sites should be rotated to prevent scar tissue formation
Sliding scaleInsulin- extracts from beef pork or human Illness and stress increase the need for it Given subQ because GI secretions deactivate it Regular insulin can be given IV
Donrsquot shake to prevent bubbles Refrigerate but donrsquot freeze Once opened maybe kept at room temp for a month or refrigerated for 3 months Donrsquot expose to sunlight
Lets Watch This
3
DIABETES MELLITUS-DIABETES MELLITUS-TREATMENT(INSULIN)TREATMENT(INSULIN)
A Rotation of sites for insulin injections B Injection diagram to track rotation of injection sites
4
DIABETES MELLITUSDIABETES MELLITUS
Peak action is important to monitor for hypoglycemia
Insulin type peakRapid acting (Humalog Novolog)- 1-2 hrsRegular (Humulin R Novolin R)- 2-4 hrsIntermediate (NPH Lente)- 6-8 hrsLong- acting (Lantus Ultralente)- 16-20 hrs
5
6
DIABETES MELLITUSDIABETES MELLITUS
Medical managementnursing interventions Medications
Oral hypoglycemic agentsStimulate islet cells to secrete more insulinOnly for type II diabetes mellitus
Oral hypoglycemicSulfonylureas (Amaryl Diabreta Diabenase Glucotrol Micronase Orinase Tolinase)- stimulate the pancreas to produce more insulin Contraindicated in people with renal or hepatic disease
7
DIABETES MELLITUS-ORAL DIABETES MELLITUS-ORAL MEDICATIONMEDICATION
Biguanides (Glucophage)- decrease releasse of glucose by liver and make cells more susceptible to insulin Can be used alone or combination with sulfonylureas Adverse effects include diarrhea nv abdominal bloating flatulence anorexia
8
DIABETES MELLITUSDIABETES MELLITUS
Thi-zol-idine-diones (TZDrsquos) (Actos Avandia Avelox)- reduce the amount of insulin needed while improving blood sugar control Used in those over 18 without liver or heart disease Side effects decrease in bone density weight gain edema anemia could lead to congestive heart failure or worsen existing heart conditions
9
DIABETES MELLITUSDIABETES MELLITUSAlpha glucosidase inhibitor (Precose)- slows down bodyrsquos absorption of CHO and allows insulin to work better Must be taken with first bite of food at each meal Mabey combined with sulfonylureas Contraindications- inflammatory bowel syndrome ulcers of colon intestinal obstruction Side effects- GI symptoms rash hives fever
10
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
2
DIABETES MELLITUS-DIABETES MELLITUS-TREATMENT(INSULIN)TREATMENT(INSULIN)
MedicationsInsulin Main goal is to normalize insulin activity and blood
glucose levelClassified by action Regular Lente and NPH UltralenteClassified by type beefpork HumulinNovolinInjection sites should be rotated to prevent scar tissue formation
Sliding scaleInsulin- extracts from beef pork or human Illness and stress increase the need for it Given subQ because GI secretions deactivate it Regular insulin can be given IV
Donrsquot shake to prevent bubbles Refrigerate but donrsquot freeze Once opened maybe kept at room temp for a month or refrigerated for 3 months Donrsquot expose to sunlight
Lets Watch This
3
DIABETES MELLITUS-DIABETES MELLITUS-TREATMENT(INSULIN)TREATMENT(INSULIN)
A Rotation of sites for insulin injections B Injection diagram to track rotation of injection sites
4
DIABETES MELLITUSDIABETES MELLITUS
Peak action is important to monitor for hypoglycemia
Insulin type peakRapid acting (Humalog Novolog)- 1-2 hrsRegular (Humulin R Novolin R)- 2-4 hrsIntermediate (NPH Lente)- 6-8 hrsLong- acting (Lantus Ultralente)- 16-20 hrs
5
6
DIABETES MELLITUSDIABETES MELLITUS
Medical managementnursing interventions Medications
Oral hypoglycemic agentsStimulate islet cells to secrete more insulinOnly for type II diabetes mellitus
Oral hypoglycemicSulfonylureas (Amaryl Diabreta Diabenase Glucotrol Micronase Orinase Tolinase)- stimulate the pancreas to produce more insulin Contraindicated in people with renal or hepatic disease
7
DIABETES MELLITUS-ORAL DIABETES MELLITUS-ORAL MEDICATIONMEDICATION
Biguanides (Glucophage)- decrease releasse of glucose by liver and make cells more susceptible to insulin Can be used alone or combination with sulfonylureas Adverse effects include diarrhea nv abdominal bloating flatulence anorexia
8
DIABETES MELLITUSDIABETES MELLITUS
Thi-zol-idine-diones (TZDrsquos) (Actos Avandia Avelox)- reduce the amount of insulin needed while improving blood sugar control Used in those over 18 without liver or heart disease Side effects decrease in bone density weight gain edema anemia could lead to congestive heart failure or worsen existing heart conditions
9
DIABETES MELLITUSDIABETES MELLITUSAlpha glucosidase inhibitor (Precose)- slows down bodyrsquos absorption of CHO and allows insulin to work better Must be taken with first bite of food at each meal Mabey combined with sulfonylureas Contraindications- inflammatory bowel syndrome ulcers of colon intestinal obstruction Side effects- GI symptoms rash hives fever
10
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
3
DIABETES MELLITUS-DIABETES MELLITUS-TREATMENT(INSULIN)TREATMENT(INSULIN)
A Rotation of sites for insulin injections B Injection diagram to track rotation of injection sites
4
DIABETES MELLITUSDIABETES MELLITUS
Peak action is important to monitor for hypoglycemia
Insulin type peakRapid acting (Humalog Novolog)- 1-2 hrsRegular (Humulin R Novolin R)- 2-4 hrsIntermediate (NPH Lente)- 6-8 hrsLong- acting (Lantus Ultralente)- 16-20 hrs
5
6
DIABETES MELLITUSDIABETES MELLITUS
Medical managementnursing interventions Medications
Oral hypoglycemic agentsStimulate islet cells to secrete more insulinOnly for type II diabetes mellitus
Oral hypoglycemicSulfonylureas (Amaryl Diabreta Diabenase Glucotrol Micronase Orinase Tolinase)- stimulate the pancreas to produce more insulin Contraindicated in people with renal or hepatic disease
7
DIABETES MELLITUS-ORAL DIABETES MELLITUS-ORAL MEDICATIONMEDICATION
Biguanides (Glucophage)- decrease releasse of glucose by liver and make cells more susceptible to insulin Can be used alone or combination with sulfonylureas Adverse effects include diarrhea nv abdominal bloating flatulence anorexia
8
DIABETES MELLITUSDIABETES MELLITUS
Thi-zol-idine-diones (TZDrsquos) (Actos Avandia Avelox)- reduce the amount of insulin needed while improving blood sugar control Used in those over 18 without liver or heart disease Side effects decrease in bone density weight gain edema anemia could lead to congestive heart failure or worsen existing heart conditions
9
DIABETES MELLITUSDIABETES MELLITUSAlpha glucosidase inhibitor (Precose)- slows down bodyrsquos absorption of CHO and allows insulin to work better Must be taken with first bite of food at each meal Mabey combined with sulfonylureas Contraindications- inflammatory bowel syndrome ulcers of colon intestinal obstruction Side effects- GI symptoms rash hives fever
10
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
4
DIABETES MELLITUSDIABETES MELLITUS
Peak action is important to monitor for hypoglycemia
Insulin type peakRapid acting (Humalog Novolog)- 1-2 hrsRegular (Humulin R Novolin R)- 2-4 hrsIntermediate (NPH Lente)- 6-8 hrsLong- acting (Lantus Ultralente)- 16-20 hrs
5
6
DIABETES MELLITUSDIABETES MELLITUS
Medical managementnursing interventions Medications
Oral hypoglycemic agentsStimulate islet cells to secrete more insulinOnly for type II diabetes mellitus
Oral hypoglycemicSulfonylureas (Amaryl Diabreta Diabenase Glucotrol Micronase Orinase Tolinase)- stimulate the pancreas to produce more insulin Contraindicated in people with renal or hepatic disease
7
DIABETES MELLITUS-ORAL DIABETES MELLITUS-ORAL MEDICATIONMEDICATION
Biguanides (Glucophage)- decrease releasse of glucose by liver and make cells more susceptible to insulin Can be used alone or combination with sulfonylureas Adverse effects include diarrhea nv abdominal bloating flatulence anorexia
8
DIABETES MELLITUSDIABETES MELLITUS
Thi-zol-idine-diones (TZDrsquos) (Actos Avandia Avelox)- reduce the amount of insulin needed while improving blood sugar control Used in those over 18 without liver or heart disease Side effects decrease in bone density weight gain edema anemia could lead to congestive heart failure or worsen existing heart conditions
9
DIABETES MELLITUSDIABETES MELLITUSAlpha glucosidase inhibitor (Precose)- slows down bodyrsquos absorption of CHO and allows insulin to work better Must be taken with first bite of food at each meal Mabey combined with sulfonylureas Contraindications- inflammatory bowel syndrome ulcers of colon intestinal obstruction Side effects- GI symptoms rash hives fever
10
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
5
6
DIABETES MELLITUSDIABETES MELLITUS
Medical managementnursing interventions Medications
Oral hypoglycemic agentsStimulate islet cells to secrete more insulinOnly for type II diabetes mellitus
Oral hypoglycemicSulfonylureas (Amaryl Diabreta Diabenase Glucotrol Micronase Orinase Tolinase)- stimulate the pancreas to produce more insulin Contraindicated in people with renal or hepatic disease
7
DIABETES MELLITUS-ORAL DIABETES MELLITUS-ORAL MEDICATIONMEDICATION
Biguanides (Glucophage)- decrease releasse of glucose by liver and make cells more susceptible to insulin Can be used alone or combination with sulfonylureas Adverse effects include diarrhea nv abdominal bloating flatulence anorexia
8
DIABETES MELLITUSDIABETES MELLITUS
Thi-zol-idine-diones (TZDrsquos) (Actos Avandia Avelox)- reduce the amount of insulin needed while improving blood sugar control Used in those over 18 without liver or heart disease Side effects decrease in bone density weight gain edema anemia could lead to congestive heart failure or worsen existing heart conditions
9
DIABETES MELLITUSDIABETES MELLITUSAlpha glucosidase inhibitor (Precose)- slows down bodyrsquos absorption of CHO and allows insulin to work better Must be taken with first bite of food at each meal Mabey combined with sulfonylureas Contraindications- inflammatory bowel syndrome ulcers of colon intestinal obstruction Side effects- GI symptoms rash hives fever
10
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
6
DIABETES MELLITUSDIABETES MELLITUS
Medical managementnursing interventions Medications
Oral hypoglycemic agentsStimulate islet cells to secrete more insulinOnly for type II diabetes mellitus
Oral hypoglycemicSulfonylureas (Amaryl Diabreta Diabenase Glucotrol Micronase Orinase Tolinase)- stimulate the pancreas to produce more insulin Contraindicated in people with renal or hepatic disease
7
DIABETES MELLITUS-ORAL DIABETES MELLITUS-ORAL MEDICATIONMEDICATION
Biguanides (Glucophage)- decrease releasse of glucose by liver and make cells more susceptible to insulin Can be used alone or combination with sulfonylureas Adverse effects include diarrhea nv abdominal bloating flatulence anorexia
8
DIABETES MELLITUSDIABETES MELLITUS
Thi-zol-idine-diones (TZDrsquos) (Actos Avandia Avelox)- reduce the amount of insulin needed while improving blood sugar control Used in those over 18 without liver or heart disease Side effects decrease in bone density weight gain edema anemia could lead to congestive heart failure or worsen existing heart conditions
9
DIABETES MELLITUSDIABETES MELLITUSAlpha glucosidase inhibitor (Precose)- slows down bodyrsquos absorption of CHO and allows insulin to work better Must be taken with first bite of food at each meal Mabey combined with sulfonylureas Contraindications- inflammatory bowel syndrome ulcers of colon intestinal obstruction Side effects- GI symptoms rash hives fever
10
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
7
DIABETES MELLITUS-ORAL DIABETES MELLITUS-ORAL MEDICATIONMEDICATION
Biguanides (Glucophage)- decrease releasse of glucose by liver and make cells more susceptible to insulin Can be used alone or combination with sulfonylureas Adverse effects include diarrhea nv abdominal bloating flatulence anorexia
8
DIABETES MELLITUSDIABETES MELLITUS
Thi-zol-idine-diones (TZDrsquos) (Actos Avandia Avelox)- reduce the amount of insulin needed while improving blood sugar control Used in those over 18 without liver or heart disease Side effects decrease in bone density weight gain edema anemia could lead to congestive heart failure or worsen existing heart conditions
9
DIABETES MELLITUSDIABETES MELLITUSAlpha glucosidase inhibitor (Precose)- slows down bodyrsquos absorption of CHO and allows insulin to work better Must be taken with first bite of food at each meal Mabey combined with sulfonylureas Contraindications- inflammatory bowel syndrome ulcers of colon intestinal obstruction Side effects- GI symptoms rash hives fever
10
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
8
DIABETES MELLITUSDIABETES MELLITUS
Thi-zol-idine-diones (TZDrsquos) (Actos Avandia Avelox)- reduce the amount of insulin needed while improving blood sugar control Used in those over 18 without liver or heart disease Side effects decrease in bone density weight gain edema anemia could lead to congestive heart failure or worsen existing heart conditions
9
DIABETES MELLITUSDIABETES MELLITUSAlpha glucosidase inhibitor (Precose)- slows down bodyrsquos absorption of CHO and allows insulin to work better Must be taken with first bite of food at each meal Mabey combined with sulfonylureas Contraindications- inflammatory bowel syndrome ulcers of colon intestinal obstruction Side effects- GI symptoms rash hives fever
10
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
9
DIABETES MELLITUSDIABETES MELLITUSAlpha glucosidase inhibitor (Precose)- slows down bodyrsquos absorption of CHO and allows insulin to work better Must be taken with first bite of food at each meal Mabey combined with sulfonylureas Contraindications- inflammatory bowel syndrome ulcers of colon intestinal obstruction Side effects- GI symptoms rash hives fever
10
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
10
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
11
DIABETES MELLITUSDIABETES MELLITUS
Patients must have some functioning insulin production for oral hypoglycemics to be effective Theyrsquore used in addition to diet and exercise Used for those over 40 at onset of DM
Medical managementnursing interventions (continued)Patient teaching
Good skin careReport any skin abnormalities to physician Special foot care is crucial
Do not trim toenailsmdashgo to podiatristNo hot water bottles or heating pads
Assess for symptoms of hypoglycemia
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
12
DIABETES MELLITUSDIABETES MELLITUSPatients with type 2 diabetes maybe require insulin temporarily during illness infection pregnancy surgery or other stressful event Donrsquot drink alcohol it may result to hypoglycemia
Fasting blood sugar- single specimen of blood in am after fasting for 8 hrs
Urine test- testing urine for presence of glucose and ketones
Accucheck- test for blood glucose level at any given time Done at home by the patient Used by patients on sliding scale
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
13
SLIDING SCALE EXAMPLE
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
14
DIABETES MELLITUS-DIABETES MELLITUS-COMPLICATIONS
Acute complicationsComa
Diabetic ketoacidosisHyperglycemic hyperosmolar nonketoticHypoglycemic reaction
InfectionLong-term complications
Diabetic retinopathyCardiovascular problemsRenal failure
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
15
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
16
DM-DKA A LIFE-THREATENING
EMERGENCY Diabetic Ketoacidosis (DKA) ndash a condition brought on by inadequate insulin - is a life-threatening emergency affecting people with type 1 diabetes
What causes DKA A lack of insulin usually due to
Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin or spoiled insulin Infection Steroid medications An extremely stressful medical condition
Symptoms of DKA includeNausea vomiting Stomach pain Fruity breath ndash the smell of ketoacids Frequent urination Excessive thirst
Weakness fatigue confusion or unconsciousness
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
17
DIABETES MELLITUSDIABETES MELLITUS
DKA Increased production of glucose and inability of cells to use glucose resulting to hyperglycemia Cells starve resulting to breakdown of fats into glycerol and free fatty acids which are converted by the liver to ketones resulting to acidosis The condition is known as diabetic ketoacidosis
Ketoacidosis (DKA)- acute insulin deficiency followed by decrease in glucose in body cells and increased production of glucose by the liver
3 main causes-DKA decreasedmissed insulin dose illness or infection initial manifestation of undiagnoseduntreated diabetes
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
18
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
19
DIABETES MELLITUSDIABETES MELLITUS
Symptoms of DKA- Kussmaul respiration (fast deep labored breathing) acetone breath (fruity odor) rapid weak pulse low BP weakness vomiting flushed cheeks dry skin and mouth
Rx- rehydration (6-10 L of IV fluid K replacement IV insulin hourly blood glucose test If untreated outcome is circulatory collapse renal shutdown and death
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
20
DMA LIFE-THREATENING EMERGENCY
Hyperosmolar Hyperglycemic Nonketotic Syndrome or HHNS is a serious condition most frequently seen in older persons HHNS can happen to people with either type 1 or type 2 diabetes but it occurs more often in people with type 2 HHNS is usually brought on by something else such as an illness or infection
In HHNS blood sugar levels rise and your body tries to get rid of the excess sugar by passing it into your urine You make lots of urine at first and you have to go to the bathroom more often Later you may not have to go to the bathroom as often and your urine becomes very dark Also you may be very thirsty
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
21
DMA LIFE-THREATENING EMERGENCY SS high blood glucose low Na and K thirst
dehydration tachycardia fever seizures lethargy coma
What are the warning signs Blood sugar level over 600 mgdl Dry parched mouth Extreme thirst (although this may gradually disappear) Warm dry skin that does not sweat High fever (over 101 degrees Fahrenheit for example) Sleepiness or confusion Loss of vision Hallucinations (seeing or hearing things that are not
there) Weakness on one side of the body
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
22
HHNS TREATMENTHospitalization - HHNS can be severe enough to require hospitalization especially if occurring in a newly diagnosed diabetic
Lowering blood sugars - Extreme HHNS requires gradual blood sugar lowering in a hospital setting Milder HHNS can be treated mainly by reducing blood sugars using insulin
Fluid replacement - Fluids such as water are required to replace the lost fluid and fix the dehydration
Treat metabolic imbalances -Treat the underlying cause - Once the main symptoms are alleviated it is important to identify what caused the HHNS
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
23
DIABETES MELLITUS
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
24
HYPERGLYCEMIA-EMERGENCY CASES
Hyperglycemia
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
25
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia means low blood sugar It occurs when there is not enough sugar or glucose in the blood It is also called insulin shock or insulin reaction Hypoglycemia is most common in type 1 diabetics especially diabetics who have tight control of their blood sugar level People with Type 2 diabetes who take insulin or certain diabetic medications may also have hypoglycemia reactions
Hypoglycemia (insulin shock)- excessive insulin resulting to hypoglycemia due to overdose of hypoglycemic decreased food intake ingestion of certain drugs or too much exercise Blood glucose below 50-60 Usually occurs before meals
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
26
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The causes of low blood sugar include missing a meal taking too much insulin or medication unexpected or excessive exercise drinking alcohol certain other medications older age vomiting and diarrhea other medical problems or an unknown cause
SS- weakness headache drowsiness hunger confusion slurred speech tremors High BP and PR
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
27
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
The common symptoms of hypoglycemia include shakiness dizziness weak feeling sweating nervousness fast heart rate pale skin color hunger difficulty paying attention or confusion headache sudden moodiness or behavior changes and tingling sensations around the mouth
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
28
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)
Hypoglycemia (cont)- if untreated unconsciousness and seizures permanent brain damage and death
Rx- administer quick acting CHO glucagon (insulin antagonist works in 5-20 min) simple sugar such as orange juice Proglycem- stimulates release of epinephrine used to treat chronic hypoglycemia (onset- 1 hr duration 8 hrs)
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
29
DIABETES MELLITUS- HYPOGLYCEMIA HYPOGLYCEMIA (INSULIN SHOCK)To prevent hypoglycemia do the following
keep blood sugar in normal range check blood sugar regularly and whenever symptoms
of hypoglycemia occur know what causes hypoglycemia know the symptoms of hypoglycemia carry glucose tablets or hard candy at all times wear a medical ID bracelet or carry a diabetic ID card let friends co-workers or family members know how
to give an injection of glucagon eat a full meal at regular times do not skip meals or
eat partial meals eat more than usual when exercising and check blood sugar more often when you are ill eating
less or exercising more than usual
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
30
DIABETES MELLITUS-DIABETES MELLITUS-NEUROPATHY
Neuropathy- is damage to a single nerve or nerve group which results in loss of movement sensation or other function of that nerve
Poor circulation results to nerve damage Commonly affects the lower extremities retina and kidneys May resolve spontaneously in 6 months or persist for many years
Symptoms depend on the specific nerve affected and may includeLoss of sensationParalysisTingling burning pain abnormal sensationsWeakness
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
31
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
32
NEUROPATHY TREATMENTTreatment
The goal of treatment is to allow you to use the affected body part as much as possible
The cause of the neuropathy should be identified and treated as appropriate
High blood pressure and diabetes can injure an artery which can often affect a single nerve The underlying condition should be treated
Corticosteroids injected into the area may reduce swelling and pressure on the
MedicationsOver-the-counter or prescription pain medicine may be needed to control pain (neuralgia)
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
33
DIABETES MELLITUSDIABETES MELLITUSSexual dysfunction- impotence is common
Prone to infection Treatment- diet meds foot careNutritional management- crucial part of DM management Aims to maintain consistency in amount of calories and CHO eaten at different times to maintain blood sugar Menu is individualized based on age sex weight height activity occupation and cultural background Diet is rigid and uncompromising
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
34
LIFE ADJUSTMENT WITH DM
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
35
DIABETES MELLITUSDIABETES MELLITUSDiabetic exchange list- milk vegetables fruits breads meats and fats Each list shows equivalents that can be exchanged to allow some freedom of choice Exchanges cannot be from one list to another Patients cannot have more than daily food allowance and must eat all of it Patient must participate in meal planning
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
36
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
37
DIABETES MELLITUSDIABETES MELLITUS
Exercise- How exercise can helpAerobic exercise increases insulin sensitivity and along with proper nutrition helps restore normal glucose metabolism by decreasing body fat Strength training (aka resistance or weight training) also decreases body fat by raising the metabolism Its main benefit however is increasing glucose uptake by the muscles and enhancing the ability to store glucose Exercise can mean the difference between medical management and lifestyle management of Type 2 diabetes
Very important because it lowers blood sugar Should be regular not sporadic ADA recommends 30 min of moderate exercise most days of the week Counsel patient to carry 15 gm
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
38
DIABETES MELLITUSDIABETES MELLITUSSick day rulesTake insulin or oral hypoglycemics as usual Check blood glucose Q 3-4 hrs If gt 300 call MDSmall frequent meals 6-8 timesdayIf vomitingdiarrhea persist take liquids Q 12-1 hr to prevent dehydration
For patients with type 1 diabetes inability to retain fluids may require hospitalization
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
39
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
40
DIABETES MELLITUSTeachingTeachingStart with the basics assume the pt knows nothing about diabetes
It is chronic condition and requires a lifetime of self-management behaviors
Evaluate literacy level finances family support and typical daily schedule
Diabetic foot care is very importantDiscuss safety measures to prevent cuts wounds and infection
Stop smokingTeach patient about diet blood testing sliding scale and insulin administration
Medic-Alert tag
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
41
DIABETES MELLITUSDIABETES MELLITUSNANDAHigh risk for fluid volume deficit Rt polyuria and dehydration
Altered nutrition Rt imbalance of insulinfood Knowledge deficitAnxietySelf-esteem risk for situational lowSensory and perceptual alterations visualInfection risk forSexual dysfunctionBody image disturbedCoping ineffectiveActivity intolerance
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
42
THE END
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
43
Common Drugs use in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
44
Common Drugs use in the Endocrine System
Posterior Pituitary Hormones
1048708 Animal posterior pituitary hormone extract
1048708 Examples Pitressin (vasopressin) IM SC
(desmopressin) synthetic IV SC intranasal
1048708 MOA Natural antidiuretics Produces concentrated urine by increasing tubular reabsorption of water
1048708 Uses Diabetes insipidus SIADH caused by trauma
surgery etc Bedwetting (DDAVP)
1048708 Monitor BP IampO weight and urine specific gravity
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
45
Posterior pituitary hormone
Pitocin (oxytocin)
Action Enhances contractile activity of the
uterine smooth muscle
1048708 Uses Induce or stimulate labor control post
partum hemorrhage
1048708 Adverse Effects Uterine rupture fetal
hypoxia or trauma
1048708 Nursing Measures Accurate dose Close
monitoring of contractions and FHT in labor
Add drug to IV bag after IV is started
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
46
Anterior Pituitary Hormones
Example Genotropin (somatropin)1048708 Action Promotes growth in children whose
growth has been impaired by a deficiency of
growth hormone
1048708 Uses Children with deficiency of growth
hormone adults with deficiency of growth
hormone from disease surgery or radiation of
pituitary
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
47
Thyroid HormonesExamples Synthroid Levothroid
(levothyroxine) synthetic thyroxine (T4)
1048708 Action Increase metabolic activity of body
1048708 Uses Drug of choice for long-term
hypothyroidism simple goiter
1048708 Adverse Effects SS of hyperthyroidism ndash
tachycardia sweating intolerance to heat
diarrhea abd cramping weight loss
decreased bone density in the hip amp spine
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
48
Antithyroid DrugsExamples PTU (propylthiouracil) prototype
Tapazole (methimazole) Lugolrsquos solution
(strong iodine solution)
1048708 MOA PTU and Tapazole interfere with
synthesis of thyroid hormone and inhibits
conversion of T4 to the more active T3
1048708 Lugolrsquos Inhibits the release of thyroid
hormone causing them to accumulate in the
thyroid gland
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
49
Antithyroid Drugs
Lugolrsquos solutionUses Short-term treatment of hyperthyroid to bring patient to euthyroid pre-op decrease the size and vascularity of thyroid pre-op
1048708 Adverse Effects Hypothyroidism hair loss allergic reaction
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
50
Corticosteroids
Mineralocorticoids
1048708 Example Florinef (fludrocortisone)
1048708 MOA Promote Na and water retention Help
maintain fluid and electrolyte balance
Aldosterone is the main mineralocorticoid
1048708 Uses Chronic adrenocortical insufficiency
1048708 Adverse Effects Hypokalemia fluid
retention hypertension HA
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
51
Glucocorticoids Examples Decadron (dexamethasone) Solu-Medrol
(methylpredinisolone) Prednisone Celestone
(betamethasone) Aristocort (triancinolone) Nasonex
Azmacort1048708 MOA Affect CHO protein and lipid metabolism by
Increasing the catabolism of protein in bone skin and
connective tissue Increasing output of glucose by
the liver and decreasing cellular use of glucose
Mobilizing amino acids to increase energy in times of
stress Antiinflammatory response protects cells from
damage related to immune response gtgtgtcontinue
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
52
GlucocorticoidsUses Replacement therapy in deficiency
states Antiinflammatory for hpersensitivity
and inflammatory diseases like arthritis
lupus psoriasis Bronchospasm and edema
related to emphysema asthma and other
respiratory diseases or injuries Mature lungs
in preterm fetus prior to delivery1048708 Adverse Effects Edema hyperglycemia
hypokalemia muscle wasting peptic ulcer
hypertension immunosuppression increased
WBC masks signs of infection thin skingtgtgt
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
53
Glucocorticoids1048708 Nursing Measures Give PO with food Give
at 9am to mimic normal corticosteroid levels
and minimize adrenal suppression Weigh
daily Monitor BP blood sugars and
electrolytes Monitor for ss of adverse
effects1048708 Teach to moderate salt intake eat K rich
foods diet high in protein Avoid licorice
(may intensify hypokalemia) alcohol and
caffeine Medic Alert Tapering drugs
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
54
Adrenal Sex Hormones 1048708 Androgens ndash male hormones secreted by the
adrenal
cortex in both sexes and are responsible for the
physiological effects exerted by adrenal sex
hormones 1048708 They increase protein synthesis (anabolism)
which
increases muscle and bone mass and strength effect
development of male secondary sex characteristics
They increase hair growth and libido in women
Excessive secretion masculine effects in women 1048708 Female sex hormones exert few effects Excessive
secretion feminine characteristics in men
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
55
Drugs Affecting the ReproductiveSystem
Female Hormones
1048708 Estrogen and Progesterone
1048708 Example Oral contraceptives (OCPs)
1048708 MOA Estrogen prevents ovulation
Progesterone prevents implantation of ovum
decreases amount and increases viscosity of
cervical mucous to impair sperm motility and
impedes motility of the ova by affecting
peristalsis of the fallopian tubesgtgtgtgt
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
56
OCPs1048708 Uses Contraception menstrual irregularities
1048708 Adverse Effects NV HA weight gain fluid
retention breast tenderness breakthrough
bleeding1048708 Contraindications ABSOULUTE
Thromboplebitis CVA breast cancer
pregnancy liver disease or impairment CAD
over 35 and smokes
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
57
OCPsNursing Measures Teach how to take pill and how to use BUM to use with missed pills and antibiotic use Encourage not to dc pills without consulting HCP (30-50 stop before one year) Teach to report ACHES immediately and dc pills
1048708 A=Abdominal pain1048708 C=Chest pain cough dyspnea H=HA
severedizziness numbness
1048708 E=eye problems vision loss blurred vision
1048708 S=severe leg pain calf or thigh
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
58
Infertility DrugsExample Clomid1048708 MOA Stimulates secretion of FSH and LH
which stimulates maturation of folliclesovulation amp development of the corpusluteum1048708 Uses Inadequate ovulation low sperm count
in males1048708 Adverse Effects Similar to OCPs Increased
incidence of early abortion amp multiple births
1048708 Teach to report pelvic pain immediately
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
59
Male Hormones1048708 Example Testosterone1048708 Secreted by the testes1048708 Uses Treatment of low sperm count and impotence
caused by deficiency Undescended testiclesAnabolic action in conditions such as osteoporisis
anemia and debilitated states Inoperable breast
cancer in post menopausal women1048708 Adverse Effects Edema acne hirsutism voice
deepening NampV polycythemia increasedcholesterol depression1048708 Contraindications Pregnancy prostate cancerbreast cancer in males
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
60
Drugs used to treat Diabetes InsulinOral Hypoglycemic AgentsHyperglycemic Agents
1048708 Glucagon1048708 MOA Appears to increase synthesis ofCAMP and phosporylase activity which
increases hepatic gluconeogenesis1048708 Uses Emergency treatment of severe
hypoglycemia reactions when patient is
unconscious or unable to swallow
61
Dietary Consideration in the Endocrine System
61
Dietary Consideration in the Endocrine System
