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I. Anatomy and Physiology 2
left to select the page and click "GO". You can print II. General Concepts 4
this page for easy reference. III. Disorders of the Anterior
6
Pituitary
IV. Disorders of the Posterior
10
Pituitary
V. Disorders of the Thyroid
12
Gland
VI. Disorders of the Parathyroid
18
Gland
VII. Disorders of the Adrenal
22
Gland
VIII. Disorders of the Pancreas 30
Interactive Exercise 37
Points to Remember 38
Terms to Know 40

Illustrations 41

Page 1 of 41

I. Anatomy and Physiology (illustration )

A. The endocrine system, together with the neurological system, functions as
the communication system for the body
B. Endocrine glands secrete hormones
1. Secreted in very small amounts
2. Alters the rate of many physiologic activities
a. reproduction
b. metabolism
c. growth and development
d. neurological and mental functions
3. Secreted into the blood
4. Regulated by several methods
a. autonomic nervous system
b. changes in concentrations of specific substances in plasma
c. feedback system
 Page 2 of 41
C. Glands
D. Pituitary (illustration 1 illustration 2 )
1. Lies in sella turcica above the sphenoid bone
2. Consists of two lobes connected by the hypothalamus
3. Regulates the other endocrine glands by stimulating target organs
4. Controlled by releasing and inhibiting hormones from the
hypothalamus
E. Thyroid gland (illustration )
1. Located at the level of the cricoid cartilage in front of the trachea
2. Two highly vascular lobes
3. Controls the rate of the body metabolism
F. Parathyroid glands - parathormone (PTH)
1. Four small glands located near the thyroid gland
2. Controls calcium and phosphorus metabolism
G. Adrenal glands (illustration )
1. Two small glands lying in the retroperitoneal region
2. Functions
a. cortex - promotes organic metabolism, regulates sodium
and potassium, response to stress, preadolescent growth
spurt
b. medulla - stimulation of sympathetic nervous system,
responds to stress
H. Pancreas - insulin, glucagon secretion into the blood, an endocrine
function (illustration )
1. Lies retroperitoneally, with the head of the gland in the duodenal
cavity and the tail lying against the spleen
2. Excretion of enzymes and bicarbonate that aid digestion and
controls carbohydrate metabolism as an exocrine function
I. Gonads - ovaries, estrogen, progesterone, inhibin - decreases secretion of
follicle-stimulating hormone (FSH); testes, testosterone
1. Located: two ovaries are situated in the lower abdomen on each
side of the uterus. The testes are the pair of male sex organs that
form within the abdomen but descend into the scrotum
2. Responsible for secondary sex characteristics and reproductive
function

Page 3 of 41
II. General Concepts
A. Endocrine glands must maintain homeostasis of about 50 billion cells.
B. Endocrine glands are ductless, and secrete many hormones directly into
the blood or lymph.
C. These hormones regulate growth; maturation; reproduction; metabolism;
the balances of electrolytes, water, and nutrients; and the balances of
behavior and energy
D. Concentration in the bloodstream of most hormones is maintained at a
constant level. If the hormone concentration rises, further production of
that hormone is inhibited (also known as "feedback control")

Page 4 of 41

Endocrine Glands and their Secretions

E. Unlike the endocrine, exocrine glands secrete their products

through duct(s) into the body's cavities or onto its surface. Exocrine
glands produce sweat (sweat glands), skin oils (sebaceous glands),
 mucus (mucous membranes), and digestive juices (for example,
the pancreas in its exocrine function).

Endocrine Glands and their Disorders

Memory Aid Gland Disorders

Head

Herman Hypothalamus Since hypothalamus

regulates pituitary, its
disorders appear in the
pituitary.

Probably Pituitary Anterior Pituitary:

Hypopituitarism (includes
lowered libido),
Hyperpituitarism (bone
deformities); Posterior
Pituitary: Diabetes Insipidus
(water loss)

Pasted Pineal

Throat

The Thyroid Hypothyroidism (lowered

basal metabolic rate BMR),
Hyperthyroidism (increased
BMR)

Paper Parathyroid Hypoparathyroidism

(lowered serum calcium),
Hyperparathyroidism
(increased serum calcium)
 Thorax

To Thymus Present only in infants and

children
Abdomen

A Adrenal Addison's (too little ACTH);

Cushing's (too much
cortisone);
Pheochromocytoma (too
much epinephrine &
norepinephrine)

Pot Pancreas Diabetes Mellitus: Type 1

(IDDM), Type 2 (NIDDM)

Of Ovaries For disorders, see

Genitourinary System

Tea Testes For disorders, see

Genitourinary System

Page 5 of 41
III. Disorders of the Anterior Pituitary
A. Hypopituitarism
1. Definition - underactivity of the front (anterior) pituitary gland
a. classifications of pituitary tumors
i. functioning: hormone present in insufficient
quantities
ii. non-functioning: hormone absent
2. Etiology - most common cause: neoplasms, usually benign
3. Findings - result from hormone deficiency (hypogonadism)
a. hypogonadism, female:
i. amenorrhea
ii. infertility
iii. decreased libido
iv. breast and uterine atrophy
v. loss of axillary and pubic hair
vi. vaginal dryness
b. hypogonadism, male
i. decreased libido
ii. impotence
iii. small, soft testicles
 iv. loss of axillary and pubic hair
c. hypothyroidism (because pituitary regulates thyroid glands
by thyroid stimulating hormone (TSH))
d. hypoadrenalism (because pituitary regulates adrenal glands
by ACTH production)
e. may see signs of increased intracranial pressure (ICP)

Page 6 of 41
4. Diagnostics
a. history and physical exam
b. neuro-ophthalmological exam
c. x-rays of pituitary fossa
d. radioimmunoassays of anterior pituitary hormones
e. computerized tomogram (CT) scan
5. Management
a. expected outcome: hormone deficiency corrected
b. hormone replacement therapy
i. corticosteroid therapy
ii. thyroid hormone replacement
iii. sex hormone replacement
c. surgical removal of tumor
6. Nursing interventions
a. provide for
i. care of the client with increased ICP
ii. care of the client undergoing surgery
b. monitor for desired effects of administered medications as
ordered
c. provide emotional support with referral to support groups
d. teach client
i. medications desired effects and side effects
ii. need for lifelong hormone replacement therapy and
regular checks of sirum levels

Page 7 of 41
CARE OF THE CLIENT WITH INCREASED INTRACRANIAL PRESSURE

1. Monitor neuro vital signs as ordered

2. Maintain fluid restriction as ordered
3. Raise head of bed at 30-45 degrees
4. Prevent any activities that increase ICP such as straining at stool,
coughing, vomiting, any restrictive clothing around neck, neck rotation,
flexion, extension, anxiety
5. Observe for herniation syndrome
6. Monitor intracranial pressure
7. Administer oxygen as ordered
8. Seizure precautions
1. Hyperpituitarism
1. Definition - anterior pituitary secretes too much growth hormone
and/or ACTH
2. Etiology
1. usually caused by benign neoplasm
2. growth hormone overproduction: acromegaly
3. ACTH overproduction leads adrenal gland to overproduce
cortisone: Cushing's syndrome
3. Findings
1. may see signs of increased ICP
2. acromegaly: excess longitudinal bone growth
3. prognathism
4. coarse facial features
5. prominent forehead and orbital ridge
6. large, broad, spade-like hands
7. arthritis, kyphosis

Page 8 of 41
4. Diagnostics
a. history and physical exam
b. computerized tomogram (CT) scan
c. plasma hormone levels: increased growth hormone, ACTH
5. Management
a. expected outcome: remove tumor and restore hormonal
balance
b. surgical removal of tumor
c. irradiation of gland
d. pharmacologic: growth hormone suppressant:
bromocriptine (parlodel)
6. Nursing interventions
a. provide
i. care of the client with increased ICP
ii. care of the client undergoing surgery
iii. care of the client undergoing radiation therapy
iv. emotional support
b. assess for signs of diabetes insipidus, since removal of a
pituitary tumor may injure the posterior pituitary glands
and decrease antidiuretic hormone (ADH) secretions
c. teach client that treatment usually produces hypopituitarism
so lifelong hormone replacement therapy with regular
check-ups are required
 Page 9 of 41
IV. Disorders of the Posterior Pituitary
A. Diabetes insipidus
1. Posterior pituitary gland makes too little antidiuretic hormone
(ADH). Body loses too much water in the urine; plasma osmolality
and sodium levels increase.
2. Etiology can include tumor, trauma, inflammation, or psychogenic
causes.
3. Findings
a. excessive thirst (polydipsia)
b. polyuria: as much as 20 liters per day with specific gravity
below 1.006
c. nocturia
d. signs of dehydration
e. constipation
4. Diagnostics
a. water deprivation tests: inability to concentrate urine
b. osmotic stimulation
c. administration of vasopressin (pitressin) or desmopressin
acetate (stimate)
d. computerized tomogram (CT) scan

Page 10 of 41
5. Management
a. expected outcomes: to correct underlying cause and restore
hormonal balance
b. pharmacotherapy
i. desmopressin acetate (stimate)
ii. vasopressin (pitressin) - antidiuretic hormone
iii. lypressin (diapid)
iv. chloropropamide (chloronase)
v. clofibrate (claripex)
vi. carbamazapine (mazepine)
c. IV fluid replacement therapy
d. surgical removal of tumor
6. Nursing interventions
a. monitor for findings of dehydration; measure urine;
specific gravity
b. administer medications as ordered
c. monitor fluids and give IV fluids as ordered
d. measure intake and output
e. weigh client daily
f. care of the client with increased ICP
g. care of the client undergoing surgery
h. teach client
 i. to record intake and output
ii. about medications and side effects
iii. to check urine specific gravity
iv. the need to wear disease identification jewelry

The Nephrogenic Diabetes Insipidus Foundation NDI supports education,

research, treatment, and care for the disease.

Page 11 of 41

V. Disorders of the Thyroid Gland

A. Hypothyroidism
1. Definition - an underactive thyroid resulting in a lessened secretion
of thyroid hormone
a. deficiency of thyroid hormones causing decreased
metabolic rate
i. affects more women
ii. age group: 30 to 50 years of age
b. classifications
i. cretinism: hypothyroidism in children
ii. hypothyroidism without myxedema: mild thyroid
failure
iii. hypothyroidism with myxedema: severe thyroid
failure; usually seen in older adults
iv. myxedema coma
 most severe type of hypothyroidism
 precipitated by stress
 findings include:
o hypothermia
o bradycardia
o hypoventilation
o altered LOC leading to coma
 potentially life threatening condition

Page 12 of 41
2. Etiology
a. thyroid surgery
b. treatment for hyperthyroid condition
c. overdosage of thyroid medications
d. deficiency in dietary iodine
3. Findings
 a. cognitive impairment
b. constipation, fatigue, depression
c. intolerance to cold
d. coarse, dry skin; periorbital edema; thick, brittle nails
e. bradycardia; increased diastolic pressure
f. menstrual changes - increased menstrual flow
g. loss of the outer one-third of eyebrows
h. weight gain
i. fluid retention

Page 13 of 41
4. Diagnostics
a. history and physical exam
b. increased TSH
c. decreased serum T3 and T4
d. anemia
e. decreased basal metabolic rate (BMR)
f. elevated cholesterol and triglycerides
g. hypoglycemia
5. Management
a. expected outcomes: to restore hormonal balance and
prevent complications
b. administer synthetic thyroid hormone: levothyroxine
sodium (levothroid)
c. myxedema coma:
i. IV fluids as ordered
ii. correct hypothermia
iii. give synthetic thyroid hormone
6. Nursing interventions
a. give medications as ordered
b. watch client for signs of myxedema
c. provide restful environment
d. teach client
i. how to conserve energy
ii. how to avoid stress
iii. about the medications and side effects - synthyroid
is to be taken in the morning on an empty stomach
at least one hour before any other medications or
vitamins or ingestion of milk
iv. the importance of lifelong therapy
e. protect client from cold

Page 14 of 41
 TESTS OF THYROID FUNCTION

A. Blood tests
1. Serum Thyroxine (T4)
2. Thyroid-Binding Globulin (TBG)
3. Serum Triiodothyronine (T3)
4. T3 Resin Uptake
5. Free Thyroid Index (FTI)
6. Thyrotropin, Thyroid-Stimulating Hormone (TSH)
7. Thyrotropin-Releasing Hormone (TRH) stimulation test
8. Thyroid autoantibodies
B. Radiologic and imaging tests
1. Radioactive Iodine Uptake (RAIU) I 131 uptake
2. Thyroid scan
3. Thyroid ultrasound
4. Hyperthyroidism (Graves' disease, thyrotoxicosois)
A. Definition - overactive thyroid over secretes hormones, and causes
increased basal metabolic rate or hyperactivity of thyroid as a
primary disease state
B. Etiology - considered autoimmune response
A. women affected more than men
B. age group: 30 to 50 years
C. Findings
A. hyperphagia, weight loss, diarrhea
B. heat intolerance
C. exophthalmos
D. tachycardia
E. palpitations
F. increased systolic BP
G. difficulty concentrating
H. irritability
I. hyperactivity
J. thin, brittle hair, pliable nails: plummer's nails
K. diaphoresis
L. insomnia
M. reduced tolerance for stress

Page 15 of 41
4. Diagnostics
a. history and physical exam: palpable thyroid enlargement:
(goiter)
b. elevated serum T3 and T4 levels
c. elevated radioactive iodine uptake
 d. presence of thyroid autoantibodies
e. decreased TSH (thyroid-stimulating hormone; comes from
pituitary) levels
5. Complication: thyrotoxic crisis (thyroid storm)
a. rare but potentially fatal
b. breakdown of body's tolerance to chronic hormone excess
c. state of extreme hypermetabolism
d. precipitating factors: stress, infection, pregnancy
e. findings include:
i. systolic hypertension
ii. hyperthermia
iii. angina
iv. infarction or heart failure
v. extreme anxiety
vi. even psychosis

Page 16 of 41
6. Management
a. expected outcomes: to reduce the excess hormone secretion
and to prevent complications
b. pharmacologic
i. sodium131I
ii. antithyroid agents: propylthiouracil (PTU)
iii. beta-adrenergic blocking agents: propranolol
(inderol)
iv. iodides: useful adjunct
c. surgical: thyroidectomy: partial or total removal of thyroid
gland
d. diet high in calories, protein, carbohydrates
7. Nursing interventions
a. monitor vital signs, especially blood pressure and heart rate
b. provide quiet, restful, cool environment
c. monitor diet therapy
d. provide extra fluids
e. provide emotional support
f. administer medications as ordered
g. teach client
i. about medications and side effects
ii. stress avoidance measures
iii. energy conservation measures
h. care of the client undergoing surgery

Page 17 of 41
VI. Disorders of the Parathyroid Gland
A. Hypoparathyroidism
1. Definition - parathyroid produces too little parathormone; results in
hypocalcemia
2. Etiology unknown
a. possibly an autoimmune disorder
b. most often results from surgical removal of parathyroid
glands
3. Findings (mild to severe order)
a. neuromuscular
i. irritability
ii. personality changes
iii. muscular weakness or cramping
iv. numbness of fingers
v. tetany
vi. carpopedal spasms
vii. laryngospasms
viii. seizures
b. dry, scaly skin
c. hair loss
d. abdominal cramping

Page 18 of 41
4. Diagnostics
a. history and physical exam
b. positive Chvostek's sign
c. positive Trousseau's sign (carpopedal spasm as inflated BP
cuff is released)
d. decreased serum calcium
e. increased serum phosphate
5. Management
a. expected outcomes: to restore hormonal balance and
prevent complications
b. calcium replacement therapy: ideal serum calcium level
8.6mg/dl
c. vitamin D preparations facilitate uptake of calcium
d. calcium-rich diet
6. Nursing interventions
a. monitor carefully for signs of tetany
b. place airway, suction and tracheotomy tray at bedside
c. institute seizure precautions
d. administer medications as ordered
e. teach client
i. about medications and side effects
ii. signs of vitamin D toxicity
 iii. to consume more calcium and get vitamin D from
sun exposure to skin
iv. to reduce phosphorus intake: minimize intake of
fish, eggs, cheese and cereals

Page 19 of 41

TESTS OF PARATHYROID FUNCTION

1. Parathyroid hormone (PTH)
2. Serum calcium, total
3. Serum calcium, ionized
4. Serum phosphate
1. Hyperparathyroidism
1. Definition - parathyroid secretes too much parathormone; results in
increased serum calcium (hypercalcemia)
2. Etiology
1. benign growth in parathyroid
2. secondarily as result of kidney disease or osteomalacia
3. incidence increases dramatically in both sexes after age 50
3. Findings
1. many clients are asymptomatic
2. gastrointestinal: constipation, nausea, vomiting, anorexia
3. skeletal: bone pain and demineralization
4. irritability
5. muscle weakness and fatigue

Page 20 of 41
4. Diagnostics
a. history and physical exam
b. elevated serum calcium
c. decreased serum phosphate level
d. x-rays reveal bone demineralization
5. Management
a. expected outcomes: to restore hormonal balance and
prevent complications
b. surgery: removal of parathyroid glands - parathyroidectomy
6. Nursing interventions
a. care of the client undergoing surgery
b. after surgery observe for signs of hypocalcemia
c. after surgery, teach client to consume diet rich in calcium

Page 21 of 41
PHARMACOLOGIC INTERVENTIONS FOR HYPERPARATHYROIDISM

1. Hydration with 0.9% normal saline solution

2. Diuretics
3. Plicamycin
4. Didronel
5. Glucocorticoids
6. Phosphate as antihypercalcemic agent
7. Calcitonin
8. Estrogen
9. Etidronate disodium
10. Phosphate-binding antacid
11. Calcium supplement
12. Vitamin D
13. Disorders of the Adrenal Gland
1. Addison's disease
1. Definition
1. adrenal cortex secretes too little adrenocorticotropic
hormone (ACTH)
2. decreases secretion of other adrenal products:
mineralocorticoid, glucocorticoids, and sex hormones
3. relatively rare
2. Etiology - autoimmune adrenalitis
3. Findings
1. acute adrenal insufficiency (Addisonian crisis)
1. severe headache or back pain
2. severe generalized muscle weakness
3. diarrhea or constipation
4. confusion
5. lethargy
6. severe hypotension
7. circulatory collapse
2. adrenal insufficiency
1. vague complaints or findings
2. fatigue
3. muscle weakness
4. vague abdominal complaints: anorexia, nausea,
vomiting
5. personality changes
6. skin pigmentation

Page 22 of 41
4. Diagnostics
 a. history and physical exam
b. ACTH stimulation test: low cortisol level
c. low blood levels of sodium and glucose and high levels of
potassium
d. 24-hour urine collection: decreased levels of free cortisol
5. Management
a. expected outcome: to return to hormonal balance
b. Addisonian crisis
i. emergency management of circulatory collapse
ii. intravenous hydrocortisone
c. chronic insufficiency
i. glucocorticoid replacement therapy: hydrocortisone
(cortef)
ii. mineralocorticoid replacement therapy:
fludrocortisone acetate (florinef acetate)
iii. diet high in protein, carbohydrates, and sodium

Page 23 of 41

Test of Adrenal Function

A. Blood and Urine Tests

1. Dexamethasone suppression test for cortisol levels
2. Fasting prephlebotomy for cortisol plasma level
3. 17-hydroxycorticosterone (Porter-Silber test) 17-OCHS
4. 17-ketosteroids
5. Aldosterone
6. Urinary cortisol level
7. Renin level ACTH
8. Captopril test
B. Radiologic and Imaging: Angiography of Adrenals

Pharmacologic Interventions for Adrenal Insufficiency

1. Glucocorticoids
2. Betamethasone (CELESTONE)
3. Cortisone (CORTONE)
4. Dexamethasone (DECADRON)
5. Hydrocortisone
6. Methylprednisone (MEDROL)
7. Prednisolone (DELTA-CORTEF)
8. Prednisone (DELTASONE tablets, liquid)
9. Mineralocorticoids
10. Desoxycorticosterone (DOCA PERCORTEN)
11. Fludrocortisone (FLORINEF)

6. Nursing interventions during hospitalization

a. administer medications as ordered
b. manipulate the environment to reduce stressors
c. preserve the client's energy by assisting with ADL as
indicated
d. monitor diet therapy
e. measure intake and output and observe for signs of
hyponatremia, hyperkalemia, and hypoglycemia.

f. teach client
i. about medications and side effects
ii. the need for lifelong hormone-replacement therapy
iii. the need for medical-alert jewelry
iv. how to conserve energy
v. how to avoid or minimize stress
vi. guidelines for diet: high sodium

Page 24 of 41
B. Cushing's syndrome
1. Definition: adrenal gland secretes too much cortisol
2. Etiology
a. average age of onset 20 to 40 years of age
b. affects women more often than men
c. primary syndrome caused by tumor of adrenal cortex
d. secondary syndrome caused by an ACTH-producing tumor
of pituitary
e. long term steroid therapy
3. Findings
a. personality changes
b. hypertension
c. metabolic alkalosis
d. weight gain, buffalo hump, truncal obesity
e. change in libido
f. moon face
g. muscle weakness
h. virilization in women, amenorrhea, or menstrual
irregularities
i. osteoporosis
j. acne or hyperpigmentation

Page 25 of 41
4. Diagnostics
 a. history and physical exam
b. blood tests show
i. increased levels of cortisol,
ii. increased sodium and glucose,
iii. decreased potassium
c. 24-hour urine collection:
i. elevated free cortisol
ii. elevated 17-ketosteroids
iii. elevated 17-hydroxycorticosterone
5. Management
a. expected outcome: to restore hormonal balance
b. surgery for adrenal or pituitary tumor
c. irradiation therapy
d. pharmacologic
e. adrenal enzyme inhibitors that block enzymes needed for
cortisol synthesis
i. aminogluthemide
ii. metyrapone
iii. mitotane
f. potassium supplements
g. high protein diet with sodium restriction

Page 26 of 41
6. Nursing interventions
a. administer medications as ordered
b. monitor diet therapy
c. monitor for signs of hypokalemia, hypernatremia
d. teach client
i. the need for lifelong treatment
ii. about medications and side effects
iii. the need for medical alert jewelry
e. surgical treatment may cause adrenal or pituitary
insufficiency

Page 27 of 41
CARE OF CLIENT ON STEROID THERAPY

Teach client to:

1. Never discontinue medications abruptly- could precipitate acute crisis.

2. Take medication with breakfast - corresponds to biorhythms and reduces
gastric irritation.
3. Take higher dose in AM and lower doses in PM.
4. Always take medication with a meal or a snack.
5. Carry extra medication on self during travel.
6. Adjust medications during periods of acute or chronic stress such as
pregnancy or infections; contact health care provider.
7. Wear medical identification jewelry or carry medical card .
8. Avoid other people with infections or shopping malls, grocery stores, etc in
times when the flu or colds are most evident.
1. Pheochromocytoma
1. Definition
Adrenal medulla secretes too much epinephrine and
norepinephrine (called the catecholamines). Causes excessive
stimulation of the sympathetic nervous system
2. Etiology
1. generally benign tumor of the adrenal medulla
2. curable, but fatal if untreated
3. Findings
1. severe stress response
2. panic metabolic state
3. hypertensive crisis
4. headache, usually severe
5. orthostatic hypotension
6. tachycardia
7. pallor or flushing
8. diaphoresis
9. palpitations
10. anxiety, high and sustained
11. hyperglycemia
12. dysrhythmias

Page 28 of 41
4. Diagnostics
a. increased BMR
b. computerized tomogram (CT) scan
c. 24-hour urine collection: increased urinary catecholamines
5. Management
a. expected outcomes: to remove the tumor and correct the
imbalance
b. surgical removal of the tumor: scheduled only after client
has been normotensive for at least one week
c. antihypertensive agents as needed preop
d. alpha-adrenergic blocking agent and beta adrenergic
blocking agent (beta blockers): phentolamine (regitine),
nitroprusside (nitropress), propranolol (inderal)
e. tyrosine inhibitors: alphamethylparatyrosine decreases
circulating catecholamines
 f. antidysrhythmic agents as needed preop
6. Nursing interventions
a. monitor vital signs, especially blood pressure
b. administer medications as ordered
c. provide care of the client undergoing surgery
d. if bilateral adrenalectomy performed, lifelong steroid
therapy required
e. teach client
i. about medications and side effects
ii. need for lifelong followup

Page 29 of 41

TESTS OF ADRENAL MEDULLA FUNCTION

A. Blood tests
1. Epinephrine, norepinephrine levels
2. Vanillylmandelic acid (VMA)
B. Radiologic and imaging: angiography of adrenals
C. Disorders of the Pancreas
1. Diabetes mellitus
A. Definition - a condition in which the pancreas produces too little
insulin, or cells stop responding to insulin; results in
hyperglycemia
A. type 1 diabetes mellitus: genetic, auto-immune respones;
severe insulin deficiency from beta cells stop production of
insulin
B. type 2 diabetes mellitus: obesity; cells stop responding to
insulin

Page 30 of 41
2. Diagnostics
a. history and physical exam
b. fasting blood sugar: elevated serum glucose levels
c. oral glucose tolerance test (GTT)
d. after meal, serum glucose is elevated - post-prandial
glucose
e. glycosylated hemoglobin test (A1c test)
3. Data collection
a. hyperglycemia
 b. the 3 "polys" of diabetes mellitus: polydipsia, polyuria,
polyphagia
c. additional findings: fatigue, hunger, weight loss
d. blurred vision
e. slow wound healing

Page 31 of 41

TESTS FOR DIABETES MELLITUS (FUNCTION OF PANCREAS)

1. Glucose Tolerance Test (GTT)

2. Glycated Hemoglobin (Glycohemoglobin, Glycosylated Hemoglobin, HbA)
- gives average glucose level for prior two to three months
3. Blood glucose - fasting
4. C-Peptide Assay (Connecting Peptide Assay)
5. Fructosamine Assay
6. Blood glucose monitoring - finger sticks
7. Serum glucose and osmolarity
8. Serum sodium and potassium
9. BUN and creatinine
10. Urine glucose and ketone monitoring
11. Urine specific gravity
1. Management
1. diet therapy and weight loss
1. the total number of calories is individualized
according to the client's weight
2. as prescribed by the care provider, the client may be
advised to follow dietary guidelines for Americans
(food guide pyramid) or individualized food
exchanges from the American Diabetic Association
2. exercise
1. lowers glucose level and improves circulation
2. decreases total cholesterol and triglycerides
3. instruct client to monitor glucose before exercising
4. before exercise, clients who require insulin should
eat a carbohydrate snack with protein to prevent
hypoglycemia
3. insulin
1. used in type 1 diabetes mellitus (DM) and type 2
DM, if needed for better control of blood glucose
levels
2. regular insulin, the only insulin that is given IV, is
used for ketoacidosis
3. check other medications the client is taking
 4. illness, infections, and stress increase the need for
insulin
5. instruct client about the importance of rotating
injection within one region (the abdomen absorbs
insulin the most rapidly)
6. insulin administration: see Pharmacology section of
this course
7. insulin pens, jet injectors, and insulin pumps are
used to administer insulin
4. oral antidiabetic medications
1. prescribed for clients with type 2 DM
2. monitor blood glucose levels
3. check other medications the client is taking
4. instruct the client to recognize manifestations for
hypoglycemia and hyperglycemia
5. pancreas transplant
6. islet cell transplant
7. blood glucose monitoring - with different self-check
systems
2. Medications
1. type 1 DM: insulin therapy
2. type 2 DM: oral hypoglycemic agents

Page 32 of 41
6. Complications
a. hypoglycemia (insulin shock)
i. blood sugar falls below 50 mg / dl
ii. caused by too much insulin, too little food, or
excessive physical activity
iii. may result from delayed meals, exercise, or
vomiting
iv. rapid onset
v. findings of insulin shock
 diaphoresis; cold, clammy skin
 anxiety, tremor, slurred speech
 weakness
 nausea
 mental confusion, personality changes,
altered LOC
 headache
vi. management of hypoglycemia
 if client is conscious, give oral sugar: hard
candy, honey, Karo syrup, jelly, cola
 if unconscious: give one mg glucagon IM,
IV or subcutaneous (SC); or 20 to 50 ml
50% dextrose IV push
 Page 33 of 41
b. diabetic ketoacidosis (DKA) - an acute complication
i. results from severe insulin deficiency
ii. findings
 blood sugar levels > 350 mg/dl
 elevated ketone levels: sweet odor to breath
may also have odor of someone drinking
alcohol
 metabolic acidosis: Kussmaul's respirations,
flushed appearance, dry skin
 thirst
 polyuria
 drowsiness
 anorexia, vomiting
 may lead to shock and coma
 usual causes:
o undiagnosed diabetes mellitus
o inadequacy of prescribed therapy for
diabetes mellitus
o physical stress such as surgery,
illness, or trauma in person with
diabetes mellitus
o caused by increased gluconeogenesis
from amino acids and glycogenolysis
in the liver
 management:
o correct fluid depletion - IV fluids
o correct electrolyte depletion -
replacement particularly of
potassium
o correct metabolic acidosis - insulin
IV

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c. hyperglycemic, hyperosmolar nonketotic coma (HHNKC)
i. potentially fatal
ii. findings
 severe hyperglycemia; usually > 600 mg/dl
 plasma hyperosmolarity
 dehydration
 altered LOC - decreased
 absence of ketoacidosis
iii. usually precipitated by physical stress such as an
infection;
 iv. in non-diabetics can be due to tube feedings without
supplemental water, or too rapid rate of infusion for
parenteral nutrition
v. occurs more often in the elderly, typically
vi. expected: to correct fluid depletion, insulin
deficiency, and electrolyte imbalance
d. other chronic complications
i. diabetic triopathy
 retinopathy
 nephropathy
 neuropathy
ii. macrovascular disease in the
 coronary artery
 peripheral vascular

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6. Nursing interventions
a. give medications as ordered
b. monitor for findings of hyperglycemia or hypoglycemia
c. help client monitor blood glucose
d. refer client to dietician for planing of meals
e. support client emotionally
f. teach client
i. the importance of balanced, consistent daily focus
of diet, medication and exercise
ii. self blood-glucose monitoring
iii. dietary exchange system or refer to appropriate
resources
iv. about medications and side effects
v. foot care
vi. early reporting of complications of
 ketoacidosis
 insulin shock
 long term issues
vii. about insulin administration
viii. about the need to:
 eat more before strenuous exercise
 carry extra rapid-absorbing carbohydrate on
person at all times
 wear medical-alert jewelry
 have regular eye exams
 consider emergency care for insulin shock
 Learn more about diabetes mellitus, from the American Diabetes
Association, and the National Institute of Diabetes and Digestive and
Kidney Diseases.

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FOOT CARE

1. Wash feet daily with mild soap with tepid water.

2. Do not soak feet.
3. Pat dry thoroughly especially in between toes; do not rub.
4. Observe feet every day, in bright light, for dryness, redness, swelling,
sores.
5. Check for ingrown toenails, calluses, and corns. If one appears, consult a
foot health care provider.
6. Never cut corns or calluses.
7. Use lotion to prevent dryness but do not use lotion in between toes.
8. Wear cotton socks and change them several times each day if feet
perspire.
9. Trim toenails only after bathing, when they are soft and pliable.
10. Cut toenails straight across.
11. Never go barefoot.
12. Do not wear circular garters or anything that constricts blood flow to feet.
13. Avoid shoes that fit poorly.
14. Treat cuts and scratches right away with antiseptic and topical antibiotic.
15. Call health care provider for any sign of infection, blisters, or sores on feet

About Insulin
 In the pancreas's islets of Langerhans, beta cells secrete insulin-the islet-cell
hormone of major physiological importance;
 Without sufficient insulin, the body develops diabetes mellitus.
 Exploration of a number of new delivery systems for insulin is ongoing.
 Implanted insulin delivery systems, in combination with a glucose sensor may
create an "artificial pancreas."
 Exercise increases the body's metabolic rate to result in a decrease in blood sugar
and an increase in insulin sensitivity. Signs of hypoglycemia often occur.
  Illness can disrupt metabolic control and raise blood sugar, which results in an
increased need for insulin.
 Insulin-dependent clients should be well controlled for at least one week prior to
any surgery.
 Special care for any client with either type of diabetes mellitus should be taken to
monitor blood glucose during and after surgery and adjust insulin accordingly.

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About the Thyroid

 Following neck surgery, potentially life-threatening complications such as
laryngeal edema and tracheal obstruction can occur. Monitor for respiratory
distress.
 Following thyroid surgery, many clients suffer transient hypocalcemia from
hyporfunction or removal of the parathyroids. Monitor for signs of tetany for up
to three days after surgery.

About the Parathyroid

 Positive Chvostek's sign: contraction of facial muscle near mouth occurs when
light tap is given over facial nerve in front of ear.
 Positive Trousseau's sign: carpopedal spasm results during the deflation of a blood
pressure cuff that has been inflated for at least one minute.

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