Lecture 11 Endocrine
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What is diabetes
A chronic, progressive disease characterized by the body's inability to metabolize carbs, fats and proteins.
What is Type 1 Diabetes
- Also known as Insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes mellitus
- destruction of the beta cells of the pancreas
- absolute insulin deficiency
- produces no insulin
What is a normal blood glucose range?
How do you want to maintain health with type 1 diabetes
- diet and exercise
- daily foot care
- stress and illness control
- remove and treat coexisting risk factors such as smoking, HTN, etc
What is caused by destruction of beta cells in the pancreas, requires complete external insulin dependence.
Type 1 diabetes
What is it when an Antidiuretic Hormone (ADH) deficiency results in the body's inability to conserve water.
Caused when body becomes resistant/desensitized to insulin resulting in increased blood glucose levels.
Type 2 diabetes
Glucose intolerance that occurs or develops during pregnancy.
Occurs when blood glucose levels drop below 70 mg/dl. May lead to coma or death if not treated promptly.
The most appropriate diet for a person with Type 1 diabetes would be:
3 medium sized meals per day with several snacks throughout the day
Your diabetic patient has orders for 3 units of regular insulin to be taken before meals as well as 1 additional unit of regular insulin to be given for every 15 gms of carbohydrate. You calculate that the patient's dinner will have 45 gms of carbohydrate. How much TOTAL insulin would you administer?
Long-term complications of diabetes include the following
- Cardiovascular disease
- Retinopathy (leading to blindness)
- Chronic kidney problems
- Poor wound healing
A diabetic patient calls the doctor's office complaining of an acute illness (nausea/vomiting). You would advise the patient to do what?
- Take sips of fluid every 15-30 minutes as tolerated in order to prevent dehydration.
- Try to eat 10-15 g of carbs every 1-2 hours as tolerated.
Sick day management of diabetes includes
- checking blood sugar levels more frequently
- don't stop taking insulin, even if unable to eat
- eat 10-15g of carbs every 1-2 hours as tolerated
- take sips of fluid every 15-30 minutes as tolerated
What are we going to see with Type 1 Diabetes
- Polydipsia (excess thirst)
- polyphagia (excess appetite)
- polyuria (excess urine)
- weakness and fatiuge
- blurred vision
- weight loss
how is type 1 diabetes dx?
- presence of sytmpoms
- fasting blood glucose level above 125
- hemoglobin A1C levels
what does the hemoglobin A1C level measure
represents an average blood glucose level for the past 1-3 months (better indicator of control)
what should hemoglobin A1C levels be?
- 2-5% in adults
- 1.5-4% in kids
What is the leading cause of new blindness and renal failure in adults
type 2 diabetes
What does an exocrine gland do?
Secretes substances onto a surface, usually through a duct
What does an endocrine gland do?
Secretes substances into the bloodstream
What organs make up the endocrine system
- pituitary gland
- adrenal glands
What does the hypothalamus do?
secretes hormones that trigger other endocrine glands
what does the pituitary gland do?
- the master galnd
- most of the hypothalamic hormones trigger the pituitary gland
- makes hormones that affect growth and function of other glands in the body (GH, ACTH, TSH, ADH, LH, FSH)
What do the adrenal glands do
secrete cortisol, corticosterone, androgen sex hormones, epinephrine and norepinephrine
What does an increase in GH cause
What does an increase in vasopressin cause
What does a decrease in vasopressin cause
What are some s/s of acromegaly
- decreased muscle strength
- excessive height
- joint pain
- large feet
- large hands
- large jaw
- widely spaced teeth
What are some s/s of hyperproactinemia
- abnormal lactation in non-lactating breast
- decreased libido in men
- headache/visual loss
What is cushing's syndrome
- adrenal cortex hyperfunction
- too much cortisol
what are some s/s of cushing's syndrome
- "moon face"
- thinning scalp hair
- striae and truncal obesity
- thin limbs
- insulin resistance
True or False: After a sphenoidectomy to remove a
pituitary tumor you should advise your patient to NOT brush his or her teeth for up to 2 weeks following the surgery.
What is cushing's syndrome usually caused by?
70% caused by pituitary secretion and tumors
what is the treatment for cushing's syndrome
surgery to remove pituitary tumor (transphenoidal - through nose)
what is the nursing care for a post-op transphenoidal
- monitor for cerebral edema/increased ICP (inc BP, widened pulse pressure, low pulse, pupil changes)
- strict I/O
- oral care - no teeth brushing for 2 weeks
What are the causes of hypopituitarism
- invasion (tumors)
- infarction (postpartum necrosis)
- iatrogenic (surgery, radiation)
what are the s/s of hypopituitarism
- short stature
- sexual and reproductive disorders
- prolactin deficiency
what is the treatment for hypopituitarism
remove tumor, permanent hormone replacement
What are the causes of diabetes insipidus
- head injury
- cranial surgery
What are the S/S of diabetes Insipidus
- cool, dry skin
- dry mucous membranes
- weight loss
- electrolyte imbalances
what is the treatment for DI
- remove pituitary tumor
- ADH replacement
- IV fluids
- vasopressin meds
what is caused by excessive ADH secretion (inability to excrete water)
syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
what are the S/S of SIADH
- water retention
- dec GI motility/N/V
- weight gain w/o edema
what is the tx for SIADH
- hypertonic IV fluids
- sodium restriction
A nursing student is preparing to administer insulin to a client with a blood sugar level of 124 mg/dL. The student compares the result to the medication record and physician's order and notes that the client is ordered NovoLog insulin. The student draws the appropriate amount of insulin and then goes to the client's room to administer the injection. The meal tray is due in 30 minutes. What should the nursing student do next?
Hold the medication until the tray is in front of the client, because onset is 5 minutes.
What are the rapid-acting insulins
- Humalog (inlusin lispro)
- Novolog (insulin aspart)
- Apidra (insulin glulisine)
What is the onset time for rapid-acting insulins?
What is a short acting-insulin
regular (also known as Humulin R, Novolin R)
what is the onset time for short-acting insulin
what are some intermediate acting insulins?
- NPH (also known as humulin N, Novolin N)
- Lente (also known as humulin L, Novolin L)
What is the onset time for intermediate-acting insulin?
What are some long-acting insulins?
- Lantus (insulin glargine)
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