EEGMLOGO
eegmed.com
 
   
line decor
   ::  
line decor
   
 

Generally responsible for regulating mood, growth and development, tissue function, and metabolism, and the sexual function and reproductive processes. Consists mainly of the following glands: hypothalamus, pituitary, thyroid, parathyroids, adrenals, pineal body, and the reproductive glands, (ovaries and testes), along with the pancreas, though it is mainly associated with the digestive system. These glands are the responsible for the production of the body’s hormones.

 

Regulation of the hormones is important for the body and any excess or too little production of a particular hormone is harmful to the body. For example, too much growth hormone will make a child grow too tall and too little growth hormone can make a person abnormally short. 

 

 

Hypothalamus and Pituitary Glands.

·         Located in the brain, the hypothalamus regulates the pituitary gland, which is also called the “master gland” since it regulates the production of several hormones. Below are some of the common hormones:

  1. Growth Hormone also called Somatotropin - stimulates bone growth and body tissues and plays a role in the body's handling of nutrients and minerals.
  2. Prolactin- activates milk production in women who are breastfeeding.
  3. Thyrotropin - stimulates the thyroid gland to produce thyroid hormones.
  4. Corticotropin - stimulates the adrenal gland to produce certain hormones, previously mentioned above.
  5. Antidiuretic hormone – helps balance water in the body by allowing the tubules and collecting ducts of the kidneys to become impermeable to water in order to reenter the interstitail fluid, thus, conserving the fluid content of the body.

 

·         The pituitary also secretes endorphins that act on the nervous system to reduce sensitivity to pain.

 

 

Thyroid Gland

·         Located dorsal to the lower neck, the thyroid gland produces the thyroxine and triiodothyronine hormones that play a role in the way body cells burn fuel for energy. In effdect, the hormones increase all metabolic activities of the body.

·         Cold temperature is the strongest cause for the thyroxine and triiodothyronine to be released. Thhough possibly not asked in NCLEX, Triiodothyronin is four times tronger in causing a metabolic change but the Thyroxine last four times as long as Triiodothyronine. In essence, they balance out. .

·         Also produces the calcitonin which helps in the regulation of the calcium level in the blood.  NOTE: calcium is inversely related to calcitonin.

 

 

Parathyroid Gland

·         Located behind the thyroid glands

·         Produces the parathyroid hormone that regulates the calcium level in the blood. NOTE: calcitonin is inversely related to calcium. It releases the parathormone (PTH) that increases reabosroption of calcium, magnesium, and hydrogen ions in the renal tubules. 

·         It decreased the reabosorption of the phosphorus, sodium, potassiu, and amino acids from the renal tubules.

 

 

Adrenal Gland

·         Produces corticosteroids that are responsible for:

          (a)        Regulating the body’s salt and water balance.

          (b)        The body’s response to stress.

          (C)       The body’s metabolism and immune system

          (d)        The body’s sexual function and development.

 

·         Produces catecholamines – produces epinephrine (also called adrenaline) that help the body respond to stress by affecting the BP, heart rate and sweating

 

Pineal Gland

·         Produces melatonin, which regulates the wake-sleep cycle.

 

 

Gonads (testes for males and ovaries for females)

·         The testes, produces the sex hormones, particularly the testosterone, which is responsible for male secondary characteristics such as facial & pubic hair and muscle strength. Testosterone also support sperm production in males.

·         The ovaries, secrete estrogen and progesterone hormones. Estrogen is involved in female sexual features such as breast development, along with fat accumulation in hips and thighs. Both hormones are involved in pregnancy and menstrual cycle regulation.

 

 

Pancreas (see the Gastrointestinal system for more discussion)

·         As an exocrine organ, it mainly produces the Insulin and Glucagon, both help in the regulation of sugar level in the blood.

 

NOTE: All endocrine glands are vascular where they function by removing substances from the blood to synthesize comples hormones and these hormones are released in the veins that drain the glands themselves.


TOPICS


Adrenal Crisis

·         Hyponatremia, hypoglycemia and hyperkalemia are all expected.

·         May have hypovolemia and shock symptoms, thus, check on low blood pressure 

·         Heart rate will be fast to compensate.

 

Addisons Disease

·         Too much secretion of adrenal hormones.

·         Patient may exhibit “eternal tan” decrease in weight,  low BP, low resistance to stress.

·         Patient is given glucocorticoid but the side effect of glucocorticoid is difficulty in sleeping. Also, an increase in weight may suggest a need to change the dosage.

 

Adrenal Insufficiency

·         Can lead to fluid volume deficit and acidosis.

·         A condition due to underproduction of the adrenal corticosteroid hormone. Symptoms include weakness, fatigue, nausea, dehydration and skin changes. 

·         Usually treated with replacement corticosteroid hormone.

 

 

Cushing Syndrome

·         There is an increase secretion of cortisone, which causes an individual to be immunosuppressed or have low immunity. The increase in cortisone secretion is usually due to a tumor in the pituitary gland that regulates the ACTH (Adrenocorticotropic Hormone) that govern adrenal activity.

·         Patient may develop a “buffalo hump” around the neck area, moon face, obesity around the trunk, low resistance to infection, acne, high blood pressure.

 

 

Diabetes Insipidus    

·         Most common cause of Diabetis Insipidus is tumor in the hypothalamus or pituitary or any type of closed head injury or damage.

·         Deficient in ADH by pituitary gland, thus, there is an increase in urine output and very diluted urine.

·         Patients have excessive urine output.

·         Can develop in patients who has had tumors removed from the pituitary gland.

·         Specific gravity is less than 1.005.

·         Patient would require a Desmopressin Acetate, a synthetic ADH, intra-nasally or SQ for the rest of life to reduce urine production.

·         It is best to weigh the patient daily to assess fluid loss.  Other than monitorin weight loss, monitor electrolytes, urine specific gravity, BUN,

·         Nurse should carefully record patient's Input and Output. Be alert for signs of dehydration.


 

Diabetic Ketoacidosis (DKA)

·         Bascially occurs because of the lack of insulin that leads to an increase in glucose which the body is unable to use as a source of energy, thus, the body begins to breakdown fat as a secondary source of fuel. The breakdown of fat leads to over production of acetyl-COA that are eventually degraded into keto, acetoacetic & hydroxybutyric acids. The keto acids are excreted into the urine and the other acids are oxidized into acetone which is ehxhaled and provides the sweet, fruity smell of patients' breath.

·         Charactericed by hyperglycemia, acidosis, ketosis (ketonuria or ketonemia) and dehydration.

·         DKA commonly occurs with people with Type I diabetes.

·         Person will exhibit fruity breath (similar to acetone or polish remover) and person is restless, having difficulty waking up.

·         Severe DKA leads to cerebral edema or coma and treatment involves giving insulin and fluids.

·         Associated with dehydration so fluids are encouraged.

·         Hypovolemia is corrected wtih infusion of 0.9% or 0.45% NS.

·         Hyperglycemia is corrected with Insulin infusion, normally a bolus infusion followed by slow infusion coupled with SQ injection.

 

Diabetes Mellitus

    Types:

            a.    Type 1 Diabetes (also called Juvenile Diabetes) – failure of the pancreas to produce insulin or not enough insulin.

            b.    Type 2 Diabetes – pancreas produces insulin but the body is not able to respond to the insulin normally. Common to overweight individuals.

                        Symptoms for both types include excessive thirst, hunger and urination and weight loss.

                       

          c.     Gestational Diabetes - Occurs during pregnancy where extra glucose produced can cross the placenta and cause the baby pancreas to produce additional insulin but can lead to a large baby (macrosomia). After birth, the baby may be hypoglycemic because it continues to creates its own insulin without the mother’s additional glucose.

 

·         Very low glucose puts the patient at high risk for seizures.

·         Garlic can potentiate the action of diabetic drugs.

·         If hypoglycemia, especially if around 40 - 60 mg/dL, occurs give milk and crackers. If orange juice is given it’s good to follow it up with a meal or protein shake.  Note: orange juice should be avoided for those with

      renal failure since kidneys will not be able to excrete the added potassium.

·         For children, polyuria, polyphagia, polydyspia (3Ps), along with weight loss (even if the person is eating well) suggest Type 1 diabetes. One may see fatigue and bed wetting in children.

·         In adolescents, recurring UTI is an indication of Type 2 diabetes.

·         Watch for SOMOGYI effect - Normal or elevated blood glucose at bedtime but hypoglycemic at 2 - 3 a.m. and a spike in the morning upon waking.

·         Glycosylated Hemoglobin (HBAIC) – level of glucose within a period of at least 3 months.  Normal range is 3 – 6%

·         The best way to diagnose diabetes is the fasting plasma glucose (FPG) test since it is easy to administer, convenient for patients, and less expensive than other tests. FPG measures your blood glucose level after youhave fasted or not eaten for 10 to 12 hours. Normal fasting blood glucose is between 70 and 100 mg/dl for people who do not have diabetes. The standard diagnosis of diabetes is made when two blood tests show that your fasting blood glucose level is greater than or equal to 126 mg/dl.

 

GLUCOCORTICOID

·          Can raise glucose level so monitor glucose level.

 

Growth Hormone Problem

·         Too much growth hormone which leads to Gigantism. Usually due to a tumor in the pituitary gland.

·         Too little growth hormone can lead to abnormal height for a child.

 

Hyperglycemic Hyperosmolar Rate (formerly referred to as HHNK - Hyperosmolar, hyperglucemic, Nonketonic coma)

·         Classified with hyperglycemia and great dehydrationg without ketosis. See DKA topic above to compare.

·         The difference in HHS coma and DKA is that there is suffiicient insulin produced to prevent ketosis.

·         Three outstanding signs are elevated blood sugar,plasm hyperosmolarity and extremely elevated hematocrit. BUN and leukocytes may be elevated also.

·         Similar to DKA, fluids are administered to correct hypovolemia and hyperosmolality.

·         Hourly check of glucose may is necessary.

·       

 

Hypothyroidism (also referred to as Myxedema)

·         Abnormally low thyroid hormone production which leads to slow heart rate, dry skin, weight gain, slow growth.

·         Look for common symptoms such as edema of the face, puffy eyelids. Patient may complain of feeling cold, paresthesia of the fingers. and loss of hearing and concentration.

·         Skin and hair changes are oftern the early signs.

·         Arteriosclerosis is the a major long term problem. Can lead to seizures also.Futher complications can possibly be prevented with careful early recognition of the early symptoms.

·         Hashimoto thyroiditis, an autoimmune disease that damages the thyroid and blocks thyroid production is a common cause of hypothyroidism. 

·         Synthroid is usually given to increase metabolic rate. It increase heart rate too and therefore patient must check pulse before taking medication.

·      

 

Hyperthyroidsm (also called Graves Disease)

·         Abnormally high thyroid hormone production which leads to weight loss, nervousness, irritability,restlessness, increased heart rate and blood pressure, tacchycardia, excessive sweating.

·         Graves disease, an autoimmune disease, that stimulates the thyroid gland is a common cause of hyperthyroidism. 

·         Can lead to renal calculi, so watch for HEMATURIA.

·         Will exhibit exophthalmus (eyeballs are protruding).

·         Will exhibit tachycardia, increase in appetite and weigh loss.

·         Nurses should provide a quite environment and limit the number of visitors to decrease external stress.

·         Nurses should provide cooling blankets

 

 INSULIN

·         Insulin is used by the body to allow glucose to enter the cells of the body and be used as energy. Without insulin, glucose level can increase in the blood.

·         Insulin is the ONLY medication compatible with TPN.

·         Doesn’t have to be refrigerated.

·         Insulin is used by the body to allow glucose to enter the cells of the body and be used as energy. Without insulin, glucose level can increase in the blood.

·         Human Regular insulin is clear and be drawn with NPH, a cloudy, insulin to avoid giving two injections. Be sure to draw the clear insulin first to avoid contaminating the cloudy insulin.

·         Shaking the bottle causes it to form bubbles and foam. Simply rotate the bottle between palms for at least a minute.

·         When doing a needlestick DON’T milk the finger, it can force to mix the interstitial fluid with cap blood.

·         Rotate injection sites. Failure to do so can result in poor absorption, thus, increasing blood glucose level. Use of the same site can result in lipodystrophy a saucer like depression at the site due to the changes in the

      subcutaneous fat.

 

 

Mineralocorticoid

·         Monitor sodium and potassium levels

 

Myexedema

·         Synonymous to hypothyroidism. So, patient can experience weight gain, lethargy, slowed speech, decreased respiratory rate.

·         Patient is possibly taking Synthroid (Levothyroxine) and should be taught to check their pulse before taking the medication since it causes tachycardia and dysrhythmias.

·         Seizure is the most common complication.

·         Offer blanket to patients to provide warmth.

   


Pancreatitis

·         Pancreatic enzymes are given with meals to help in the digestion of meals.

·         Whipple is the head of the pancreas. A whipple procedure would entail the removal of the head of the pancreas including portions of the stomach and jejunum and are all re-anastomosed.

·         After the whipple procedure, nurse should watch out for any clear or bile tinged output which may indicate some kind of leakage in the anastamosed area.

·         An NG tube to bypass the pancreas therefore reducing the secretion of the pancreatic juices and to assist in relieving pain.

·         Viokase, a pancreatic enzyme or a pancrelipase that can facilitate digestion, can be given to a patient BUT is best given during meals.

·         DO NOT give Morphine, can cause spasms  of the sphincter of Oddi; Meperidine is drug of choice; DO nasogastric suctioning to remove gastric secretions and distention since Patient is NPO to decrease secretion of secretin.

·         Diet for a pancreatic patient is high in calorie and low in fat.

·         Patient is usually placed NPO to reduce pancreatic enzyme secretion.

·         ERCP (endoscopic retrograde cholangiopancreatography) is done to help in the diagnosis;  an endoscopy is done down the throat through the stomach up until the opening of the bile and pancreatic ducts in duodenum. A dye passed through a thin, flexible tube (catheter) inside the endoscope allows for X-ray images of the ducts

 


Symptom of Inappropriate Secretion of Antiduretic Hormone (SIADH)
 

·         Leads to increase in total body water and cause Hyponatremia (low sodium) - usually less than 130mmol / L and Hypoosmolality (concentration of extracellular flud and serum are severely decreased) - about 275 mOsm/kg. Hyponatremia and hypoosmolality usually occur simultaneously. .  

·         Watch for symptoms such as decreased in mental status, lethargy, nausea and vomiting, diarrhea.  

·         Urine will have a high sodium excretion. 

·         Main objective is to restric fluid intake to prevent water intoxication. So, Daily Weighs is importnat to measure fluid gain.

·         Monitor electrolytes imbalances that can lead to confusion, lethargy or vomiting.  

·         To help patient cope with fluid restriction, mouth rinsinc without swallowing and smacking on candy can help.  

 

Thyroidectomy

·         Leads to hypocalcemiahypoparathyroidism. So, assess tingling around mouth, toes, finger, muscular twitching

·         Patient may experience tracheal edema which restricts breathing. A tracheotomy set should be made ready just in case.

·         THYROID Storm - MEANS an uncontrolled hyperthyroidism, which is often precipitated by stress (trauma infection) High levels of thyroid hormone leads to increase in metabolism which is manifested in fever, tachycardia and hypertension.

 

 

Thyroid Storm (also referred to as Thyrotoxic Crisis)

·         Basically occures due to unrecognized or poorly treated hyperthyroidism.

·         Thyroidectomy, abruptly stopping antythyroid drugs, or overdoins on thyroid medications may all cause Thyroid Storm.

 

About EEGM | Blog | Links | In The Press| Scrubs | Home