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Endocrine System

The document provides an overview of the endocrine system, detailing the functions and disorders associated with various glands, including the pituitary, adrenal, thyroid, pancreas, ovaries, and testes. It specifically focuses on diabetes mellitus, its types, pathophysiology, complications, diagnostic tests, and management strategies, including insulin therapy and oral hypoglycemic medications. Additionally, it covers disorders related to the pituitary and thyroid glands, including their symptoms, diagnostic tests, and medical management.

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0% found this document useful (0 votes)
14 views91 pages

Endocrine System

The document provides an overview of the endocrine system, detailing the functions and disorders associated with various glands, including the pituitary, adrenal, thyroid, pancreas, ovaries, and testes. It specifically focuses on diabetes mellitus, its types, pathophysiology, complications, diagnostic tests, and management strategies, including insulin therapy and oral hypoglycemic medications. Additionally, it covers disorders related to the pituitary and thyroid glands, including their symptoms, diagnostic tests, and medical management.

Uploaded by

asca.regis.swu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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THE ADULT CLIENT WITH

ENDOCRINE DISORDERS
Functions of the Endocrine System
• Maintenance and regulation of vital functions
• Response to stress and Injury
• Growth and Development
• Energy metabolism
• Reproduction
• Fluid, electrolyte, acid-base balance
Pituitary Gland
• The Master Gland
• Directly affects the function of the
other endocrine glands
• Promotes growth of body tissue
• Influences water absorption and
function
• Controls sexual development and
function
Adrenal Glands
• Rests upon each kidney
• Regulates sodium and electrolyte balance
• Affects carbohydrate, fat and protein metabolism
• Influences the development of sexual
characteristics
• Flight or Fight response
• Synthesizes glucocorticoids and mineralocorticoids
and secretes small amounts of sex hormones (cortex)
• Produces norepinephrine and epinephrine (medulla)
Thyroid Gland
• Located in the anterior part of the
neck
• Controls the rate of body metabolism
and growth
• Produces thyroxine (T4) and
triiodothyronine (T3) and
thyrocalcitonin
Pancreas
• Located posterior to the liver
• Influences carbohydrate metabolism
• Indirectly influences fat and protein
metabolism
• Produces insulin and glucagon
Ovaries and Testes
• Ovaries:
•Located in the pelvic cavity
•Produce estrogen and progesterone

• Testes:
•Located in the scrotum
•Controls the development of
secondary sex characteristics
•Produces Testosterone
ENDOCRINE DISORDERS:
PANCREAS
DIABETES MELLITUS
• a chronic condition where the body either doesn’t produce
enough insulin or cannot use insulin effectively, leading to
high blood sugar levels. It can cause complications in various
organs if not properly managed.
• There are two main types: Type 1, where the body doesn’t
produce insulin, and Type 2, where the body becomes
resistant to insulin.
Pathophysiology (Type 1)
Cause: Autoimmune destruction of pancreatic beta cells in the islets of
Langerhans.

Process:
1. Immune system attacks beta cells, leading to insulin deficiency.
2. Without insulin, glucose cannot enter cells, resulting in:

Hyperglycemia (high blood sugar).
Cellular starvation despite high blood glucose levels.
1. The liver compensates by producing more glucose

(gluconeogenesis), worsening hyperglycemia


2. Lipolysis occurs, leading to the formation of ketone bodies and the
risk of diabetic ketoacidosis (DKA).
Pathophysiology (Type 2)
Cause: Insulin resistance in peripheral tissues and a relative
insulin deficiency.

Process:
1. Cells in the muscles, liver, and fat tissues become resistant to
insulin.
2. The pancreas compensates by producing more insulin
(hyperinsulinemia).
3. Over time, beta cells become overworked, leading to reduced
insulin production.
4. Persistent hyperglycemia damages tissues and organs over
time.
Microvascular Complications
(Small Blood Vessels):
• Mechanism: Chronic hyperglycemia damages
endothelial cells in capillaries.
• Diabetic Retinopathy: Damage to retinal blood vessels,
leading to vision problems or blindness.
• Diabetic Nephropathy: Damage to kidney capillaries,
leading to proteinuria and kidney failure.
• Diabetic Neuropathy: Nerve damage due to poor blood
supply, causing pain, numbness, or loss of sensation.
Macrovascular Complications
(Large Blood Vessels):
• Mechanism: Persistent hyperglycemia leads to
atherosclerosis due to endothelial damage and
increased inflammation.
• Cardiovascular Disease (CVD): Increased risk of heart
attacks and heart failure.
• Peripheral Artery Disease (PAD): Reduced blood flow to
limbs, increasing the risk of ulcers and amputations.
• Cerebrovascular Disease: Higher risk of stroke due to
atherosclerosis in brain arteries.
SIGNS AND SYMPTOMS
• 3 Ps- polyuria, polydipsia, polyphagia
• Hyperglycemia- (above 180 to 200 mg/dl)
• Weight loss
• Blurred vision
• Slow wound healing
• Vaginal infections
• Weakness and paresthesia
• Signs of inadequate circulation to the feet
DIAGNOSTIC TESTS
Fasting Plasma glucose (FPG): fasting for at least 8 hours
• Normal: less than 100 mg/dL (< 5.6 mmol/L)
• Prediabetes: 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
• Diabetes: 126 mg/dL or higher (7 mmol/L or higher) on two
separate tests
DIAGNOSTIC TESTS
Random Plasma glucose: a blood sample for a random plasma
glucose test can be taken at any time.
• Normal: less than 200 mg/dL (<11.1 mmol/L)
• Diabetes: 200 mg/dL or higher (11.1 mmol/L or higher)
DIAGNOSTIC TESTS
2-hour Post load Glucose
• Normal: less than 140 mg/dL (< 7.8 mmol/L)
• Prediabetes: 140 to 199 mg/dL (7.8 to 11.0 mmol/L)
• Diabetes: 200 mg/dL or higher (11.1 mmol/L or higher)
MEDICAL MANAGEMENT
• Nutrition and Diet Therapy
• Exercise
• Monitoring Glucose Levels and Ketones
• Pharmacologic Therapy: Insulin and Oral Hypoglycemic
Agent
ORAL HYPOGLYCEMIC MEDICATIONS
• Prescribed for clients with dm type 2
• Aspirin, alcohol, sulfonamides, oral contraceptives, MAOIs
increase hypoglycemic effect
• Glucocorticoids, thiazide diuretics, estrogen increase blood
glucose levels
• Alcohol should be avoided with sulfonylureas
COMMON ORAL HYPOGLYCEMIC
MEDICATIONS
• SULFONYLUREAS
• METFORMIN
• THIAZOLINEDIONES (Alogliptin)
• DIPEPTYDIL PEPTIDASE 4 INHIBITOR
INSULIN
• Used in the treatment of type 1 dm and type 2 Dm when
diet and weight control therapy have failed to maintain
satisfactory blood glucose levels
• Aspirin, alcohol, oral anticoagulants, oral hypoglycemics,
beta blockers, tricyclic antidepressants, tetracycline, and
MAOIs increase hypoglycemic effect.
• Glucocorticoids, thiazide diuretics, thyroid agent, oral
contraceptives, and estrogen increase blood glucose levels
INSULIN
• Insulin should not be withheld during illness or infection-
could result to ketoacidosis

• The peak action time of insulin is very important because of


the possibility of hypoglycemic reactions
COMPLICATIONS OF
INSULIN THERAPY
COMPLICATIONS OF INSULIN THERAPY
• Local allergic reactions
•Instruct patient to avoid using alcohol to cleanse the skin prior to
injection
•The physician may prescribe an antihistamine to be taken 1 hour
prior to injection

• Insulin lipodystrophy- loss of subcutaneous and appears as


slight dimpling
•The use of human insulin helps to prevent this complication
•Instruct the client about the importance of rotating injection sites
COMPLICATIONS OF INSULIN THERAPY
• Insulin Resistance- develops immune antibodies that bind
with insulin
•Administering a purer insulin preparation; occasionally prednisone is
prescribed to block the production of antibodies

• Dawn Phenomenon- nocturnal release of growth hormone,


blood glucose increases at about 3am
•administer an evening dose of intermediate acting insulin at 10Pm
COMPLICATIONS OF INSULIN THERAPY
• Somogyl’s phenomenon- a rebound phenomenon that
occurs during the initial period of blood glucose control;
develops at peak insulin times and during the night
• Normal or elevated blood glucose levels are present at
bedtime, decrease occurs at about 2am to 3am to
hypoglycemic levels, and a subsequent increase occurs as a
result of the production of counter regulatory hormones
•Treatment includes decreasing the evening dose of intermediate
acting insulin or increasing the bedtime snack
THING TO REMEMBER IN INSULIN
ADMINISTRATION
• Ensure that there is a match of the insulin concentration
noted on the vial with the calibration units on the insulin
syringe.
• Most insulin syringes have a 27 to 29 gauge needle that is
0.5 inch long
•Administer insulin at 45 to 90 degree angle and at 45 to 60
degree angle in thin persons
• Roll, do not shake the insulin bottle to ensure that it is
mixed well
THING TO REMEMBER IN INSULIN
ADMINISTRATION
• A 3 week supply of insulin may be prepared and stored in
the refrigerator
• Prefilled syringes should be kept flat or with the needle in
an upright position to avoid clogging of the needle
• Regular insulin is the only type of insulin that can be
administered by IV
COMPLICATION OF
DIABETES MELLITUS
ACUTE AND LONG TERM COMPLICATIONS
A. HYPOGLYCEMIA
MANAGEMENT:
• Treat with Carbohydrates - 15 g of a fast acting
concentrated source of carbohydrate, given orally
• Injection of glucagon 1 mg subcutaneously or
intramuscularly (unconscious patients)
• Provide patient education about routine blood glucose
testing, consistent pattern of eating and recognizing
symptoms of hypoglycemia
B. DIABETIC KETOACIDOSIS
• The three main clinical features of DKA are: Hyperglycemia;
Dehydration and electrolyte loss; and Acidosis

MANAGEMENT:
• Regular insulin infused via IV
• Rehydration: 6 to 10 L of IV fluid to replace
• Restoring Electrolytes: Potassium
C. HYPERGLYCEMIC HYPEROSMOLAR
NONKETOTIC SYNDROME (HHNS)
• characterized by extremely high blood sugar levels, high
blood osmolality (concentration of particles in the blood), and
dehydration

MANAGEMENT: Fluid replacement, correction of electrolyte


imbalances, and insulin administration
DISORDERS OF PITUITARY
GLAND
PITUITARY TUMORS
CLASSIFICATIONS:
• Eosinophilic tumors- gigantism
• Basophilic tumors- makes too much ACTH
• Chromophobic tumors- hypopituitarism
MEDICAL MANAGEMENT:
• Stereotactic Radiation Therapy
• Conventional Radiation Therapy
• Medications that inhibit the production release of GH
•Bromocriptine and Octreotide
• Surgery: Hypophysectomy
Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)
• A disorder in which a continued release of ADH
occurs
• Results in water intoxication
• MANIFESTATIONS: Signs of fluid volume overload;
Changes in LOC and mental status changes, weight
gain, hypertension, tachycardia, hyponatremia
MEDICAL MANAGEMENT:

• PHARMACOLOGIC: Diuretics (Lasix)


• Electrolyte Replacement
• Fluid and Sodium Restriction
• Hypertonic IVF
NURSING MANAGEMENT:
• Monitor vital signs and cardiac and neurologic status
• Provide a safe environment, particularly for patient with
mental status changes and changes in LOC
• Monitor I&O and obtain daily weights
• Monitor fluid and electrolyte balance
• Restrict fluid intake as prescribed
• Administer IV fluids and monitor as prescribed
• Administer demeclocycline as prescribed
DIABETES INSIPIDUS (DI)

• a deficiency of antidiuretic hormone (vasopressin), leading


to polydipsia and large volumes of dilute urine.
• Causes: Tumors, Head Injury and Medications
• CLINICAL MANIFESTATIONS: very diluted or water-like urine;
polyuria; polydipsia (2- 20L/day); weight loss; hypotension;
dehydration; poor skin turgor; dry mucous membranes,
muscle pain and weakness
NURSING MANAGEMENT:
• Instruct client to avoid foods or liquids with a diuretic effect
• Administer chlorpropamide (Diabenese), Clofibrate (Atromid
-S) if prescribed
• Administer vasopressin tannate, desmopressin acetate
(DDVAP, stimate) or lypressin (Diapid) as prescribed
• Instruct patient to wear a medic-alert bracelet
DISORDERS OF THYROID
GLAND
ENDEMIC (IODINE-DEFICIENT) GOITER
• encountered chiefly in geographic regions where the
natural supply of iodine is deficient
• Intake of large quantities of goitrogenic substances
• recede after the iodine imbalance is corrected.

MANAGEMENT : Supplementary Iodine, antithyroid


medications and iodide to reduce the size and vascularity of
the goiter before surgery
NODULAR GOITER

• Caused by hyperplasia, these nodules slowly increase in size,


with some descending into the thorax, where they cause local
pressure symptoms.
• become malignant, and some are associated with a
hyperthyroid state.

SURGICAL MANAGEMENT: Total or Near-total Thyroidectomy


THYROID CANCER
• Lesions that are single, hard, and fixed on palpation or
associated with cervical lymphadenopathy
• Radiation of the head, neck, or chest in infancy and
childhood increases the risk of thyroid carcinoma

SURGICAL MANAGEMENT: Total or Near-total Thyroidectomy


DIAGNOSITC TESTS
• Thyroid-stimulating hormone (TSH): Normal 0.4 to 4.0 mU/L
• Serum Free T4: Normal: 0.9 to 1.7 ng/dL
• Serum T3: Normal: 70 to 220 ng/dL
• Serum T4: Normal range: 4.5 to 11.5 ug/dL
• T3 Resin Uptake Test
• Thyroid Antibodies
• Fine Needle Aspiration Biopsy
• Thyroid scan, Radioscan or Scintiscan
HYPERTHYROIDISM (Grave’s Disease)

• Excessive secretion of thyroid hormones.


• Characterized by an increased rate of body metabolism
• Thyrotoxicosis- refers to the signs and symptoms that
appear when body tissues are stimulated by increased
thyroid hormones
SIGNS AND SYMPTOMS
• Enlarged thyroid gland
• Cardiac Dysrhythmias (tachycardia and
palpitations)
• Exophthalmos
• Hypertension and Heat Intolerance
• Diaphoresis
• Weight loss
• Smooth, soft skin and hair
• Nervousness and fine tremors of hands
DIAGNOSTIC TESTS
• TSH decreased
• Free T4: increased
• T3: increased
• T4: increased
• T3 Resin Uptake Test: increased
• Thyroid Antibodies: Are positive in chronic autoimmune
thyroid disease
• Radioactive Iodine Uptake: high uptake
MEDICAL MANAGEMENT
• Radioactive iodine therapy (131I)
• Propylthiouracil (PTU) or Methimazole (Tapazole)
• Adjunctive Therapy: Iodine or iodide compounds, Beta-
adrenergic blocking agents

SURGICAL MANAGEMENT: Thyroidectomy


NURSING MANAGEMENT:
• Provide adequate rest
• Provide a cool and quiet environment
• Provide a high calorie diet
• Administer anti-thyroid medications and iodine preparations
as prescribed
• Prepare client for radioactive therapy and surgery
(thyroidectomy) as prescribed
THYORID STORM
• An acute and life threatening condition that occurs in a
client with uncontrollable hyperthyroidism
• Can occur from manipulation of the thyroid gland during
surgery and the release of thyroid hormone into the blood
stream
• Can also occur from severe infection and stress
SIGNS AND SYMPTOMS
• Fever
• Tachycardia
• Systolic Hypertension
• Nausea, vomiting and diarrhea
• Agitation, tremors, anxiety
• Irritability, restlessness, confusion
• Seizures
• Delirium and coma
NURSING MANAGEMENT
• Maintain a patent airway and adequate ventilation
• Administer anti-thyroid medications, sodium iodide solution,
propranolol and glucocorticoids as prescribed
• Monitor vital signs and for cardiac dysrhythmias
• Administer non-salicylate antipyretics
• Use cooling blankets
HYPOTHRYOIDISM (MYXEDEMA)
• A hypothyroid state resulting from hyposecretion of thyroid
hormone
• Characterized by a decreased rate of body metabolism
• Risk Factors: Autoimmune, surgery, therapy for
hyperthyroidism, antithyroid medications, radiation therapy
SIGNS AND SYMPTOMS
• Lethargy and Fatigue
• Weakness, muscle aches and paresthesia
• Intolerance to cold
• Weight gain
• Dry skin and hair, loss of body hair
• Bradycardia
• Constipation
• Generalized puffiness and edema around the eyes and face
DIAGNOSTIC TESTS
• TSH: increased
• Free T4: decreased
• T3: decreased
• T4: decreased
• T3 Resin Uptake Test: decreased
• Thyroid Antibodies: Are positive in chronic autoimmune
thyroid disease
• Radioactive Iodine Uptake: low uptake
NURSING MANAGEMENT
• Synthetic levothyroxine (Synthroid or Levothyroid)
• Monitor vital signs including heart rate and rhythm
• Administer low calorie, low cholesterol, low saturated fat
diet
• Assess for constipation, provide high fiber and fluids
• Provide warm environment
• Monitor for overdose of thyroid medications
• Instruct client to report episode of chest pain immediately
MYXEDEMA COMA

• A rare but serious disorder that results from persistently low


thyroid production
• Can be precipitated by acute illness, rapid withdrawal of
thyroid medications, anesthesia and surgery, or the use of
sedatives and narcotics
SIGNS AND SYMPTOMS
• Hypotension
• Bradycardia
• Hypothermia
• Hyponatremia
• Hypoglycemia
• Respiratory Failure
• Coma
NURSING MANAGEMENT
• Maintain a patent airway
• Administer IV fluids, levothyroxine sodium (IV) as prescribed
• Administer IV glucose as prescribed
• Administer corticosteroids
• Assess temperature to address hypothermia
• Monitor blood pressure
• Keep client warm
• Monitor mental status changes
• Monitor electrolytes and glucose level
THYROIDECTOMY
• Removal of the thyroid gland
• Performed when persistent hyperthyroidism exists
• Can be:
•Partial Thyroidectomy- only part thyroid is removed, the
remaining portion typically takes over the function of the
entire thyroid gland.
•Complete or Total Thyroidectomy- entire thyroid is
removed
PREOPERATIVE IMPLEMENTATION

• Assess for hyperglycemia and glucosuria


• Instruct client in how to perform coughing and deep
breathing exercises, how to support the neck in the
postoperative period when coughing and moving
• Administer antithyroid medications, sodium iodide
solution, propranolol and glucocorticoids
preoperatively.
POSTOPERATIVE IMPLEMENTATION
• Have a tracheostomy set, oxygen and suction at the
bedside
• Maintain in Semi-fowler’s position
• Monitor surgical site for signs of edema and bleeding
• Check dressing anteriorly and at the back of the neck
• Limit talking, assess level of voice hoarseness
POSTOPERATIVE IMPLEMENTATION
• Monitor for laryngeal nerve damage
• Signs of laryngeal nerve damage: respiratory obstruction,
dysphonia, high pitched voice, stridor, dysphagia and
restlessness
• Monitor for signs of hypocalcemia and tetany
• Prepare to administer calcium gluconate or calcium chloride
• Monitor for thyroid storm
DISORDERS OF THE
PARATHYROID GLAND
HYPOPARATHYROIDISM

• A condition caused by hyposecretion of parathyroid


hormone by the parathyroid gland
• Can occur following thyroidectomy because of removal of
parathyroid tissue
SIGNS AND SYMPTOMS
• Hypocalcemia and hyperphosphatemia
• Numbness and tingling in the face
• Muscle cramps and cramps in the abdomen or in the
extremities
• Positive Trousseau’s sign or Chvostek’s sign
• Signs of latent and overt tetany
• Hypotension
• Anxiety, irritability and depression, seizures
MEDICAL MANAGEMENT
• High calcium- low phosphorus diet
• Avoid spinach- contains oxalate
• Aluminum hydroxide gel or aluminum carbonate
• IV Calcium gluconate
• Pentobarbital for seizure
• IV parathormone:
• Reduce stimuli
• Tracheostomy or mechanical ventilation if the patient
develops respiratory distress.
NURSING MANAGEMENT
• Monitor for signs of hypocalcemia and tetany
• Initiate seizure precaution
• Have a tracheostomy set, oxygen and suction at the bedside
• Instruct the client in the administration of vitamin D
supplements as prescribed
• Instruct client in the administration of phosphate binders
• Instruct client to wear a medic- alert bracelet
HYPERPARATHYROIDISM

• A condition caused by hypersecretion of parathyroid


hormone by the parathyroid gland
• characterized by bone decalcification and the development
of renal calculi (kidney stones) containing calcium.
SIGNS AND SYMPTOMS
• Hypercalcemia and hypophosphatemia
• Fatigue and muscle weakness
• Skeletal pain and tenderness
• Bone deformities that result in pathological fractures
• Weight loss
• Hypertension and Cardiac dysrhythmias
• Renal Stones
MEDICAL MANAGEMENT
• Hydration Therapy with Diuretics
• Avoid Thiazide Diuretics (Hydrochlorothiazide, Indapamide,
Metolazone)
• Avoid dehydration
• Calcium Chelators and Calcitonin
• Promote mobility
• Diet and medications
NURSING MANAGEMENT
• Monitor BP and cardiac rhythm
• Monitor for signs of renal stones
• Monitor calcium and phosphorus levels
• Administer IV normal saline- to lower calcium levels
• Administer calcitonin, phosphate and calcium chelators as
prescribed
• Notify physician immediately if there is a significant drop in
calcium levels- assess for signs of tetany and hypocalcemia
PARATHYROIDECTOMY
• Removal of one or more of the parathyroid glands

PREOPERATIVE IMPLEMENTATION:
•Monitor calcium, phosphate and magnesium levels
•Ensure that calcium levels are decreased to near normal
•Inform the client that talking may be painful for the first
day or two after surgery
POSTOPERATIVE IMPLEMENTATION
• Position the client in semi-fowler’s position
• Assess neck drainage for bleeding: 1 to 5 ml of
serosanguineous drainage is expected
• Monitor for hypocalcemic crisis (tingling and twitching in
the extremities and face)
• Assess for positive Trousseau's or Chvostek’s sign
• Monitor for changes in voice pattern and hoarseness
• Instruct client the administration of calcium and Vit D
supplements as prescribed
DISORDERS OF THE
ADRENAL GLANDS
FUNCTIONS OF CORTICOSTEROIDS
GLUCOCORTICOIDS: MINERALOCORTICOIDS:
• Metabolism Regulation • Electrolyte Balance
• Immune Response Modulation • Acid Base Balance
• Stress Response • Blood Pressure Regulation
• Maintenance of Homeostasis
• Regulation of Mood and
Cognitive Function
ADDISON’S DISEASE

• Hyposecretion of adrenal cortex hormones


(glucocorticoids and mineralocorticoids)
• Fatal if left untreated
SIGNS AND SYMPTOMS
• L- low sodium • A- Altered Mental Status
(hyponatremia) • D- Depression
• A- Acidosis • R- Refractory
Hypotension
• C- Calcium elevation • E- Eosinophilia
(hypercalcemia) • N- Nausea/ abdominal
• K- K (potassium) elevation pain/ anorexia
• S- Skin Hyperpigmentation • A- Asthenia
• L- Loss of weight
DIAGNOSTIC TESTS
• Hypoglycemia
• Hyponatremia
• Hyperkalemia
• Leukocytosis
• Confirmed by low levels of adrenocortical hormones in the
blood or urine and decreased serum cortisol levels.
MEDICAL MANAGEMENT
• IV Hydrocortisone
• Vasopressor amines
• Antibiotics
• IV fluids
• Lifelong replacement of corticosteroids and
mineralocorticoids
• Glucocorticoids during stressful procedures or significant
illnesses
NURSING MANAGEMENT
• Monitor for signs and symptoms of Addisonian crisis
• Avoid stressors
• Avoid people with infection
• Prevent very hot weather, illness, stressful situations.
• Administer hormone replacement as prescribed and to
modify the dosage during illness and other stressful
situations
NURSING MANAGEMENT
• Development of edema or weight gain may signify too high
a dose of hormone
• Postural hypotension and weight loss frequently signify too
low a dose
• Diet should be high in protein, carbohydrates, and sodium.
• Wear a medic-alert bracelet
ADDISONIAN CRISIS

• A life-threatening disorder caused by acute adrenal


insufficiency
• Precipitated by stress, infection, trauma or surgery
• Can cause hyponatremia, hyperkalemia, hypoglycemia and
shock
SIGNS AND SYMPTOMS
• Severe headache
• Severe abdominal, leg and lower back pain
• Generalized weakness
• Irritability and confusion
• Severe hypotension
• Shock
MEDICAL/NURSING MANAGEMENT
• Administer IV glucocorticoids; hydrocortisone sodium
succinate is usually prescribed initially
• Following the resolution of the crisis, administer oral
glucocorticoids and mineralocorticoids
• Monitor vital signs, especially BP
• Monitor neurological status, I & O, blood glucose and
electrolyte values
• Protect the client from infection
• Maintain bed rest and provide a quiet environment
CUSHING’S SYNDROME

• A condition resulting form the hypersecretion of


glucocorticoids from the adrenal cortex
• Can be caused by an increased pituitary secretion of
adrenocorticotropic hormone (ACTH), a pituitary adenoma, or
an adrenal adenoma.
SIGNS AND SYMPTOMS

• M- Moon Face • H- Hirsutism, Hypertension


• O- Obesity • A- Acne
• O- Osteoporosis • P- Plethora (facial swelling)
• N- Neurologic Problems • P- Peptic Ulcer
• S- Striae • E- Edema
• N- No Sexual Desire
• D- Diabetes Mellitus
MEDICAL MANAGEMENT
• Adrenal enzyme inhibitors
• Reduce or taper the medication to the minimum dosage.
• High in protein, calcium, and vitamin D are recommended
• Low in sodium and carbohydrates
• Adequate calcium
• SURGICAL MANAGEMENT: Transsphenoidal
hypophysectomy; Adrenalectomy
NURSING MANAGEMENT
• Decrease risk of injury
• Decrease risk of infection
• Blood glucose monitoring before, during, and after surgery
• Monitor WBC, sodium, potassium and calcium levels
• Encourage moderate activity and rest periods
• Meticulous skin care: avoid use of adhesive tape; assesses
the skin and bony prominence; assist in changing positions
frequently to prevent skin breakdown
NURSING MANAGEMENT
• Administer aminoglutethimide (Elipten, Cytadren) an
adrenal enzyme inhibitor as prescribed
• Prepare the client for hypophysectomy and adrenalectomy
• Monitor fluid and electrolyte status
• Daily weights
• Inform patient not to stop corticosteroid therapy abruptly
without medical supervision

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