LLANERA, Daniel Kevin P. Mrs.

Rowena Escolar-Chua, RN, MAN

BSN III – 6 RLE 2 September 15, 2010
SUMMARY: Care of Patients with Endocrine Disorders
Disease Condition and Main Problem Signs and Symptoms Management
Pituitary Tumors Eosinophilic Diagnostics:
 an abnormal growth in the pituitary gland thus the  early gigantism (maybe 7 ft)  Physical examination
inability of the body to regulate its balance of  lethargic and weak  CT and MRI
hormones  acromegaly (in adult onset)  Serum levels of pituitary hormones and endocrine
 severe headaches and visual disturbances organ hormones
 decalcification of bones Medical:
 muscular weakness  Hypophysectomy
 hyperthyroidism-like symptoms  Radiation therapy – stereotactic or conventional
Basophilic  Bromocriptine – dopamine antagonist
 Cushing’s syndrome  Octreotide – synthetic analog of GH
 Masculinization  Replacement therapy – corticosteroids and thyroid
 Amenorrhea hormone
 Truncal obesity Nursing:
 Hypertension  Postoperative care
 Osteoporosis  Teaching patients for long term management and
 Polycythemia medication therapy
Chromophobic (causes hypopituitarism)
 Obesity
 Somnolent
 Fine scanty hair
 Dry soft skin
 Pasty complexion
 Small bones
 Headaches, loss of libido, visual defects (may lead to
blindness)
 Others: polyuria, polyphagia, low BMR, subnormal body
temperature
Diabetes Insipidus  Polyuria Diagnostics:
 Posterior pituitary gland disorder characterized by a  Water-like urine (spg = 1.001-1.005)  Fluid deprivation test (8-12 hours of no FI or until
deficiency of ADH (vasopressin)  (-) abnormal substance in urine like glucose and albumin 3%-5% of BW is lost)
 Intense thirst for cold water o Frequent weighing
 Polydipsia (2-20 L/day) o Serum/urine osmolality evaluation at
 Onset: birth (if hereditary) or abrupt (if adult) beginning and end
 Fluid restriction may result to hyponatremia and severe o Frequent monitoring
dehydration o (+) – tachycardia, excessive weight loss,
hypotension
 ADH level monitoring
 Medical:
 GOALS:
o To replace ADH – long term
o To ensure adequate fluid replacement
o To identify and correct the underlying
intracranial pathology
 Desmopressin (DDAVP) – synthetic vasopressin
o Intranasal, 1-2/day
o Caution in CAD patients
 IM ADH/vasopressin tanate
o Every 24-96 hours
o Warmed and shaken before administration
o HS
o Rotate site to prevent lipodystrophy
 Clofibrate (Atromid-S; hypolipidemic agent) – has
antidiuretic effect
 Chlorpropamide (Diabinese) and thiazide diuretics –
potentiate ADH action
Nursing:
 Follow up care and emergency measures and verbal
and written instructions on pharmacologic information
 Return demonstrations for relatives regarding correct
drug administrations
 Provide information regarding signs and symptoms of
hyponatremia
 Advise wearing a medical ID and carrying medication
and information about DI at all times
Syndrome of Inappropriate ADH  Hyponatremia Medical:
 Excessive ADH secretion from PPG even in the face  Confusion  Treatment of underlying cause
of subnormal serum osmolality  Nausea  Restrict fluid intake
 Altered mood  Furosemide
 Seizures Nursing:
 Loss of consciousness  Strick I/O monitoring
 Daily weight, urine, blood chemistries, and neurologic
status monitoring
 Supportive measures and explanations of procedures
and treatments
Hypothyroidism  Fatigue  Inadequate ventilation and Medical:
 Suboptimal levels of thyroid hormones  Weakness sleep apnea  Synthetic levothyroxime (Synthroid or Levothroid)
 Weight gain or  Pleural and pericardial  Prevention of cardiac dysfunction
increased difficulty effusion  Prevention of medication interactions – insulin, oral
losing weight  Respiratory muscular hypoglycemic agents, digoxin, anticoagulants,
 Coarse, dry hair depression indomethacin, phenytoin, tricyclic antidepressants,
 Dry, rough pale skin  Hypercholesterolemia calcium
 Brittle nails  Atherosclerosis  ABG monitoring
 paraesthesia  CAD  MechVen
 Hair loss  Left CHF  Pulse oximetry
 Cold intolerance  Myxedema coma –  Corticosteroid therapy
 Muscle cramps and hyperthermic and Nursing:
frequent muscle unconscious  Activity intolerance
aches  Sensitivity to analgesics, o Proper spacing of activities
 Constipation sedatives and anesthetic o Assist when fatigued
 Depression agents o Provide stimulation through nonstressful
 Irritability  Decreased libido activities
 Memory loss  Personality and cognitive o Monitor response to increasing activities
 Abnormal menstrual characteristics of dementia  Risk for imbalanced body temperature
cycles o Provide extra layer of clothing/blanket
o Avoid use of external heat source
o Monitor body temperature
o Protect from exposure to cold
 Constipation
o High fiber; increase fluid intake within fluid
restriction
o Encourage exercise
 Knowledge deficit
 Ineffective breathing pattern related to depressed
ventilation
o Monitor respiration
o Encourage DBCE
o Suction as needed
 Myxedema and coma
o Monitor GCS/VS frequently
o Turn and reposition at intervals
o Avoid CNS depressants
Hyperthyroidism  Palpitations Medical:
 Excessive output of thyroid hormones  Heat intolerance  Irradiation with radioisotope iodine 131 (at risk for
 Nervousness AR: thyroid storms – cardiac dysrhythmias, fever,
 Insomnia neurologic impairment; treat with propranolol)
 Breathlessness  Antithyroid medications – propylthiouracil (PTU) or
 Increased bowel movements methimazole (Tapazole)
  Light or absent menstrual periods  Thyroidectomy
 Fatigue Nursing:
 Fast heart rate  Maintain a calm, cool environment
 Trembling hands  Nurse should be calm & unrushed
 Weight loss  Procedures should be done slowly
 Muscle weakness  Avoid: upsetting visitors & topics
 Warm moist skin  Quiet roommate
 Hair loss  Promote safety - prone to accidents
 Staring gaze  Eye care - artificial tears, HOB elevated, dark glasses,
if unable to close protect mask
 Diet- increased calories, protein, CHO, vitamins &
minerals
 Avoid stimulants - caffeine, spice, nicotine
Acute Thyroiditis  Anterior neck pain and swelling  ATB
 Infection of the thyroid gland; most common: S.  Fever  Fluid replacement
aureus  Dysphagia  Surgical incision and drainage - abscess
 Dysphonia
 Pharyngitis or pharyngeal pain
Subacute granulomatous thyroiditis (de Quervain’s  Myalgias  NSAIDS
thyroiditis)  Pharyngitis  No ASA
 Inflammation of the thyroid gland; women of 40-50  Low-grade fever  Beta-blockers to control hyperthyroidism symptoms
years old – high risk; viral – coxsackievirus group A  Fatigue  Steroids
and B and echovirus  Painful swelling of anterior neck – lasts 1-2 months
 Dysphagia
 Irritability, nervousness and insomnia
 Weight loss
 chills
Subacute lymphocytic thyroiditis (painless or silent  Hypo/hyperthyroidism symptoms  Symptomatic treatment
thyroiditis)
 Inflammation of thyroid gland; often in postpartum
period; autoimmune
Chronic thyroiditis (Hashimoto’s Disease)  Normal to low thyroid activity  Thyroid hormone therapy
 Inflammation of the thyroid gland; common in 30-50  Symptoms of hypothyroidism if left untreated  Surgery if pressure symptoms persists
year old women
Endemic goiter (iron-deficient)  Hyperthyroidism symptoms  Supplementary iodine – SSKI
 Caused by iodine deficiency or consumption of large  thyroidectomy
quantities of goitrogenic substances
 Hypertrophy of the thyroid gland caused by
stimulation of the pituitary gland
 Increased secretion of TSH
Nodular Goiter  no specific symptoms but pressure symptoms may occur  surgery
 hyperplasia of areas of the thyroid gland
Thyroid Cancer  Problems with swallowing Medical:
  malignancy of thyroid tumors/nodules  Hoarseness  Total or near total thyroidectomy
 Enlarged lymph nodes in the neck  Radioactive iodine therapy
 Breathing difficulty  Hormone therapy (postop)
 Pain in the throat and/or neck  External radiation therapy
 Lesions that are single, hard and fixed on palpation  Chemotherapy
Nursing:
 Diet- increased calories, protein, CHO, vitamins &
minerals
 Avoid stimulants - caffeine, spice, nicotine
 Perioperative care and teachings
 Monitor for signs of bleeding, respiratory distress,
pain
 Semi -fowler’s
 No flexion or hyperextension – use small pillow
 Position hands behind neck to stabilize neck when
moving
 Inspect dressing under neck for hidden haemorrhage
 Talk as little as possible post op
 Ambulate asap
 Monitor for hypocalcemia (Chvostek’s or
Trousseau’s)– ready IV calcium gluconate
Hyperparathyroidism  May be asymptomatic Medical:
 Overproduction of parathormone by the parathyroid  weakness and fatigue, depression, or aches and pains  Parathyroidectomy
glands  loss of appetite, nausea, vomiting, constipation, confusion  2000ml or more daily fluid intake
 Primary – 2-4x more in women; 60-70 y/o; 50% are or impaired thinking and memory, and increased thirst and  Acidify urine
asymptomatic urination  Encourage exercise
 Secondary – CRF or renal rickets; increased  phosphaturia and hypercalciuria  Avoid restrictive or excess calcium diet
stimulation of PT glands and increased  apathy, hypertension, cardiac dysrhythmias Nursing:
parathormone secretion  joint and back pain, pain on weight-bearing  Postoperative considerations
 pathologic fractures  Monitor for signs of hypercalcemia
 deformities
 shortening of body stature
 high incidence of peptic ulcer and pancreatitis
Hypoparathyroidism  Muscle spasm or cramping, typically in hands or feet Medical:
 Inadequate secretion of parathormone resulting (tetany)  Parenteral parathormone
from decreased blood supply, removal of parathyroid  Hair loss  IV calcium gluconate for hypocalcemia or tetany
gland during thyroidectomy, parathyroidectomy, or  Dry skin or malformed nails episodes
radial neck dissection or atrophy of the said gland  Numbness, tingling, or burning, especially around the  Tracheostomy or mechven
mouth and fingers  High calcium, low phosphorus diet
 Candidiasis (yeast infection)  Vitamin D administration
 Seizures Nursing:
 Chvostek’s sign and Trousseau’s sign  Early detection of signs of hypocalcemia and tetany,
seizures and respiratory distress
 FOR CHILDREN:  Calcium gluconate at bedside
o Poor tooth development  Continuous cardiac monitoring
o Vomiting  Teach about medication and diet therapy
o Headaches
o Mental deficiency
Pheochromocytoma  High blood pressure Medical:
 A tumor that is usually benign and originates from  Rapid heart rate  Alpha-adrenergic blocking agents and smooth muscle
the chromaffin cells of the adrenal medulla  Forceful heartbeat relaxants for hypertensive crisis
 Profound sweating  Calcium channel blockers
 Abdominal pain  Beta-blockers
 Sudden-onset headaches — usually severe — of varying  Catecholamine synthesis inhibitors
duration  Adrenalectomy
 Feeling of anxiety  Corticosteroid therapy
 Feeling of extreme fright Nursing:
 Pale skin  Teach about medication and compliance to regimen
 Weight loss  Follow up
Addison’s Disease (adrenocortical insufficiency)  chronic, worsening fatigue Medical:
 Adrenal cortex function is inadequate to meet the  muscle weakness  restoring blood circulation
patient’s need for cortical hormones  loss of appetite  administer fluids and corticosteroids
 weight loss  monitor VS
 Addisonian crisis – cyanosis, pallor, apprehension, rapid  place patient in recumbent position with legs elevated
and weak pulse, rapid respirations, and low blood pressure  ATB if with infection
 nausea Nursing:
 vomiting  Monitor for signs and symptoms of addisonian crisis
 diarrhea  Encourage to consume foods and fluids that assist in
 low blood pressure that falls further when standing, restoring and maintaining fluid and electrolyte
causing dizziness or fainting balance
 irritability and depression  Avoid unnecessary activity and stress
 a craving for salty foods due to salt loss
 hypoglycemia, or low blood glucose
 headache
 sweating
 in women, irregular or absent menstrual periods
Cushing’s Syndrome  upper body obesity  disturbed sleep pattern Medical:
 Excessive adrenocortical activity  a rounded face  muscle wasting  transsphenoidal hypophysectomy
 increased fat around  osteoporosis  radiation of pituitary gland
the neck  kyphosis  adrenalectomy
 relatively slender arms  back ache  adrenal enzyme inhibitors – metyrapone,
and legs  compression fractures aminoglutethimide, mitotane, ketoconazole
 glucose intolerance  moon-faced appearance  corticosteroids
 buffalo hump in neck  weight gain Nursing:
and supraclavicular  slow healing  establish protective environment
areas  virilisation in women  prevent exposure to infection
 heavy trunk  psychosis  postoperative care and teaching
 thin extremities  ecchymoses and striae  encourage rest and activity
 thin, fragile and easily  promote skin integrity
traumatized skin  monitor for signs of addisonian crisis and
 weakness and lassitude hyperglycemia
Primary Aldosteronism  Hypokalemia – muscle weakness, fatigue, cramping Medical:
 excessive production of aldosterone  Alkalosis  adrenalectomy
 Hypertension  spironolactone for hypertension
 Polyuria  insulin
 Diluted urine  diet modifications
 High serum osmolality  IV fluids
 Polydipsia Nursing:
 Hypocalemia and hyperglycemia risk  Monitor for signs of adrenocortical insufficiency and
crisis and haemorrhage
Diabetes Mellitus  Polyuria Medical:
 A group of metabolic diseases characterized by  Polydipsia  Insulin therapy
hyperglycemia resulting from defects in inuslin  Polyphagia  Oral hypoglycemic agents
secretion, insulin action or both  Weakness  Medical nutrition therapy
 Type 1 (IDDM), Type 2 (NIDDM), Gestational  Sudden vision changes  Pramlintide
 Paresthesia of hands and feet  Exenatide
 Dry skin Nursing:
 Slow healing  Providing education to patient
 Recurrent infection  Monitor for signs of hypo/hyperglycemia and
 Sudden weight loss ketoacidosis and hyperglycemic hyperosmolar
 n/v nonketotic syndrome (HHNS)
 abdominal pain  Prevention of long term complications of diabetes