NURSING INTEGRATED COURSE 2

RADIOACTIVE IODINE UPTAKE (RAIU): 2. Drugs that may decrease result:

q Ingest a radioactive isotope; “iodine isotope” o Phenytoin (Dilantin)
q Route of administration of radioactive iodine: PO/ IV o Inderal (Propranolol)
q Amount of radioactivity is measured in 2-4 hours and o Lithium
again at 24 hours.
q Normal values: 3-10 % THYROXINE (T4)
q Elevated values indicate: Hyperthyroidism (>10%) q this serum test aid in the diagnosis of
hyperthyroidism
At 24 hours: q Normal free T4: 1-2.3 ng/dl
q Normal value: 5-30 % 1. Drugs that may elevate result:
q Elevated values indicate: Hyperthyroidism (>30%) o Estrogen
o Oral contraceptives
2. Drugs that may decrease result:
o Lithium
o Inderal (Propanolol)
o Phenytoin (Dilantin)

THYROID SCAN
q to identify nodules or growths in the thyroid
PATIENT TEACHING gland
1. Radioactive dose is small and harmless q Chemical that administered before scanning the
2. Contraindication: Pregnancy thyroid gland: technetium
3. Foods that may elevate result: q Route: PO/IV
o Seafoods, shellfish, crab, fish BEFORE:
4. Drugs that may elevate result: o Given technetium: 30 minutes before the test
o Barbiturates AFTER 30 minutes= thyroid scan
o Estrogen
o Lithium
o Phenothiazines
5. Drugs that may decrease result:
o Lugol’s Solution PATIENT TEACHING
o Antithyroid 1. Discontinuing medications containing iodine for 14
o SSKI days before the test
o Aspirin R: inaccurate result
o Antihistamine 2. NPO status before the test; if iodine is consumed, the
o Cortisone client will fast for an additional 45 minutes
6. NPO before the test but can have food 1 hour after R: to ensure accurate results
the oral dose is given. 3. Reassure the client that the level of radioactive
medication is safe
TRIIODOTHYRONINE (T3) 4. Determine whether the client has received
q this serum test is used to diagnose radiographic contrast agents within the past 3
hyperthyroidism months
q Normal: 80-200 ng/dl R: inaccurate result
1. Drugs that may elevate result: 5. Contraindication: Pregnancy
o Estrogen 6. Cold nodules: Cancer
o Oral contraceptives 7. Hot nodules: Benign

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 NURSING INTEGRATED COURSE 2

GLUCOSE TOLERANCE TEST q Decreased skin turgor

q aids in the diagnosis of DM
q Confirmation: 2 hours after ingestion of glucose LAB FINDINGS
higher than 200 mg/dL q SPECIFIC GRAVITY: Decreased (<1.010)
q CONFIRMATORY DIAGNOSTIC TEST: WATER
PREPARATION DEPRIVATION TEST
o Eat a diet with at least 200-300 g of carbohydrates for o withhold fluid intake for 4-18 hours if no increase
3 days before the test. in urine concentration or specific gravity
o Avoid alcohol, coffee, and smoking for 36 hours q SERUM ELECTROLYTES: Hypernatremia
before testing.
o NPO for 10-16 hours before the test. NURSING INTERVENTIONS
q Monitor I and O
PATIENT TEACHING q Avoid alcohol- suppresses ADH production
1. Avoid strenuous exercise for 8 hours before and after q Increase fluids- orally or IV
the test. q Daily weight- Same time, clothing, scale, patient.
2. Withhold morning insulin or oral hypoglycemic q Skin turgor - decreased
medication
3. Blood samples will be drawn at 30 minute intervals PHARMACOLOGIC MANAGEMENT
for a minimum of 3 hours. DOC: DESMOPRESSION ACETATE
q ADH replacement
ENDOCRINE DISORDERS
SYNDROME OF INAPPROPRIATE ADH SECRETION
DIABETES INSIPIDUS q Increased ADH
q Decreased ADH
q Inability of the renal tubules to retain water (water CAUSES:
loss) q malignant tumors (pituitary gland)
q head injury
CAUSES: q use of medications – TCA, Diuretics
o Head trauma with increased ICP
§ Cushing’s triad (hypotension, bradycardia, ASSESSMENT
bradypnea) a. Fluid Volume Excess- Weight Gain/Edema
§ Anisocoria R: d/t excessive retention of water
§ Diplopia b. Disorientation and Confusion
§ doll’s eyes sign c. Headache
§ high temperature and chills R: HPN, vasopressin causes vasoconstriction
§ Nausea and vomiting d. TITE
§ Photophobia e. Electrolyte imbalance- Hyponatremia (dilutional
§ seizures hyponatremia)
o If caused by cerebral injury, symptoms commonly R: d/t excessive retention of water, without
appear 3-5 days after initial injury and last 7-10 days proportionate retention of sodium
o Brain tumors or infections
NURSING INTERVENTIONS
CLINICAL MANIFESTATIONS 1. Monitor vital signs and cardiac and neurological
q Polyuria: 20 L / day status
q Diluted urine R: HPN, CHF, Increased ICP
q Polydipsia: crave for very cold water 2. Provide a safe environment

2 ENDOCRINE DISORDERS
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 NURSING INTEGRATED COURSE 2

R: due to D/C; aneurism, seizure. Raise the side rails CHRONIC ADRENOCORTICAL INSUFFICIENCY OR
3. Monitor intake and output ADDISON’S DISEASE -

small , weak and tanned

4. Obtain weight daily. q Decrease ACTH (Decreased 3S- Sugar, Salt,
5. Monitor fluid and electrolyte balance Sex) -

adrenocorticotrophic hormone
6. Restrict fluid intake as prescribed q Gender incidence: Female
f. Administer IV fluids -- (usually normal saline or
hypertonic) POSSIBLE CAUSES
R: to shrink the cells o Autoimmune
APAT
h. Monitor IV fluids carefully o PGT- Pituitary Gland Tumor
o TB, AIDS – it invades and attacks the adrenal
PHARMACOLOGIC MANAGEMENT gland.
Demeclocyline (Demlomycin)
q used as a treatment for SIADH S/SX:
q inhibits water reabsorption and produces water
diuresis.
Everything is LOW except K+, Ca+ and PR
Dark skin
#4
NOTE!!! § INITIAL MANIFESTATION: Fatigue (Low and
25
m2AWPEIBD
vo
o No calcium containing foods Slow)
o No milk/antacids – affects absorption § Muscle weakness
§ Weak and diminished Pulse
Diuretics: Furosemide § Postural Hypotension and Syncope
NOTE!!! § Weight Loss
o WOF: Decreased K+ § Anorexia
o Administer slowly to prevent transient hearing § Nausea and Vomiting
loss § Hypotension, rapid weak pulse
§ Hypoglycemia
COMPARISON BETWEEN SIADH AND DI § Menstrual changes in women; impotence in men
SIADH DI § Hyperkalemia
o Hypersecretion of o Hyposecretion of ADH § Bronze pigmentation of skin
ADH o Water loss/ water § Emotional changes
o Water retention/ water outside the body (in § Decreased ability to cope with stress
inside the body (in the the urine)
blood) o High serum sodium NURSING INTERVENTIONS
MAMCTWETR
o Low serum sodium o Increased UO 1. Monitor I and O
(dilutional (polyuria) 2. Assess for signs of DHN (decreased BP, Poor skin
hyponatremia) o Decreased USG/ turgor)
o Decreased urine SG/ osmolarity (dilute 3. Monitor cardiovascular status.
osmolality urine) R: Cardiac Arrest (increased K+; Peak T wave,
(concentrated urine) o Increased blood Prolonged PR interval, Wide QRS complex)
o Decreased blood osmolarity 4. Take and record VS, assess character of pulses,
osmolality (hemoconcentration) monitor potassium levels and ECGs.
(hemodilution) o Constipation R: Weak diminished pulse (+1)
o Growth retardation 5. Weigh daily
Treatment: Diuretics, Treatment: 6. Encourage oral fluid intake of 3-4 L/day and increased
Declomycin Desmopressin, Pitressin salt intake.
7. Teach to sit and stand slowly and provide assistance
as necessary.

3 ENDOCRINE DISORDERS
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 NURSING INTEGRATED COURSE 2

8. Recommended Diet: Low K+, Low Ca+, High Salt, q easy bruising
High Carbs q hirsutism
q acne
NURSING RESPONSIBILITIES –for STEROID q altered fat metabolism (truncal obesity with thin
THERAPHY arms and legs, buffalo hump)
a. VS four times a day and weight. -FBEQ
b. Promote Na+ and water retention- May cause HPN, CONTRAINDICATIONS OF CORTICOSTEROIDS
FVE, Edema o psychosis and fungal infection
c. administer oral forms after meals or milk; steroids o Used with caution in clients with DM
after meals. (hyperglycemia may occur)
d. Dose: 2/3 in AM, 1/3 in PM o When used with ASA and NSAIDs (increased
e. monitor electrolyte levels ---FBEQ (Hypokalemia, risk for GI bleeding and ulcerations)
Hypocalcemia, Hypernatremia) o Use of diuretics – K+ wasting (prone in
f. Monitor urine and blood glucose levels and urine hypokalemia)
ketones. -FBEQ o Phenytoin, Rifampin, barbiturates (decreased
R: Prone to HPN, Heart Disease absorption)
g. Most people need to take this for the rest of their lives. o Masks the s/s of infection, so they should be
S/E: used with caution in clients with infection- FBEQ
§ Immunosuppressant- risk for infection and o ADVISE CLEINT TO WEAR MEDIC- ALERT
contraindicated to fungal infection. BRACELET
§ Poor wound healing.
§ Easy bruising, thinning of skin ADDISONIAN CRISIS- FBEQ
§ Increased protein metabolism q A life- threatening response to acute adrenal
q Weigh each day at the same time and report insufficiency
consistent weight gain q Can cause hyponatremia, hyperkalemia,
q Use safety measures hypoglycemia and shock
q Take medications regularly and continuously
q Dose should be tapered and not stopped TRIGGERS/STRESSORS:
abruptly-FBEQ o Stress
q Monitor for increased stressors o Infection
q Report the ff. to the physician: Dizziness on o Surgery
sitting and standing, N/V, Malaise o Abrupt withdrawal of steroid use

SIDE EFFECTS OF STEROIDS: FBEQ MANIFESTATIONS

q hyperglycemia § Severe HA
q hypokalemia § Generalized weakness
q hypocalcemia § SV/D
q osteoporosis § Hypotension
q edema § Irritability and Confusion
q hypertension
q increased susceptibility to infection- limit visitors TREATMENT
(reverse isolation), no fresh fruits in the room q Glucocorticoids per IV then orally
unless it is nutrient dense. (solu-cortef, hydrocortisone sodium
succinate)
SIDE EFFECTS OF STEROIDS: FBEQ q Monitor VS especially BP
q mood swings

4 ENDOCRINE DISORDERS
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 NURSING INTEGRATED COURSE 2

q Monitor neurologic status, noting irritability and c. Monitor laboratory values, particularly the white
confusion blood cell count, and serum glucose, sodium,
q Monitor I and O potassium, and calcium levels.
q Monitor serum sodium and potassium and blood d. Provide meticulous skin care.
glucose e. Allow the client to discuss feelings related to body
q Protect client from infection appearance.
q STRICT BED REST, provide quiet environment q Place in private room and limit visitors Risk for infection- fungal infection
q Rapid replacement of IV fluids and q Use principles of medical and surgical asepsis
glucocorticoids, antibiotics q Increase nutrient dense foods ---such as fruits
q Fluid balance restored usually in _________ and vegetables, whole grains and legumes
hours q DIET: Low sodium, High K+, High Ca+ Low sugar low fat, high protein

HYPERCORTISOLISM/CUSHING’S SYNDROME HYPERPITUITARISM

q hyperfunction/hypersecretion of the adrenal q Hyperfunction of the anterior pituitary hormones
cortex CAUSES:
CAUSES o Benign pituitary adenoma; may result from
o pituitary adenoma or adrenal adenoma hyperplasia of pituitary tissues
o prolonged steroid therapy
GENDER INCIDENCE: women ASSESSMENT
q LH and F Large hands and feet
MANIFESTATIONS q T and P of the J Thickening and protrusion of the jaw
q Central Obesity Redistriburion of fat q VD Visual disturbances
q Obesed trunk, thin arms and legs q D Diaphoresis/ increase sweeting
q Moonface q ORS Oily and rough skin
q Buffalo hump q D of the V Deepening of the voice
q Reddish purple striae on trunk
q Muscle wasting and weakness INTERVENTIONS
q Thinning of skin a. Provide emotional support to the client and family--
q Easy Bruising related to disturbed body image. Allow pt. To verbalize their feelings
q Poor Wound Healing, inc. susceptibility to b. Provide frequent skin care.
infection c. Prepare the client for radiation of the pituitary gland if
q Edema Edema prescribed.
Hypernatremia
q Hypertension d. Prepare the client for hypophysectomy if planned.
q Hyperglycemia
q Hypokalemia TRANSSPHENOIDAL HYPOPHYSECTOMY Removal of the pituitary gland
q Hypocalcemia Complications:
Hypopituitarism
q DL Decrease libido o DI
q Hirsutism, acne (masculinization of women) o CSF leak
Infection
q Osteoporosis Site of INCISION: between the upper lip and upper gum Csf leakage
q Low resistance to infection
POSTOPERATIVE INTERVENTIONS
INTERVENTIONS a. Monitor vital signs, neurological status, and level of
a. Monitor vital signs, particularly blood pressure for consciousness.
HPN b. Elevate the head of the bed at least 2 weeks (to
Observe for nasal discharge
b. Monitor intake and output and weight for edema promote venous drainage and drainage from the
surgical site)

Provide oral care and use soft

5 ENDOCRINE DISORDERS
DYCHITAN, CEM brissle toothbrush
 NURSING INTEGRATED COURSE 2

c. Monitor for increased intracranial pressure

d. Monitor for bleeding
e. Maintain nasal packing and reinforce
f. Avoid sneezing, coughing, and blowing the nose and
activities that increase ICP Post op complication: diabetes insipidus
g. Monitor intake and output and avoid water
intoxication. Water intoxication leading to increased ICP
h. Administer oral mouth rinse as prescribed.
i. As prescribed, instruct the client to brush teeth gently
2
with an ultrasoft toothbrush/toothettes for at least ____
weeks following surgery (to prevent trauma to the
incision)
j. Monitor for postnasal drip or nasal drainage. Check
nasal drainage for glucose.
k. Report output above 900 mls/ 2 hours or urine specific
gravity below 1.004 (indicates DI)
l. Administer glucocorticoids and other hormone
replacement as prescribed

HYPOPITUITARISM
q Hypofunction of anterior pituitary gland causing
deficiencies in both the pituitary hormones and
the hormones of the target glands
CAUSES:
q Tumors
q Trauma
q Autoimmunity
q Stroke, surgery/ radiation of pituitary gland

ASSESSMENT Dwarfism
a. Obesity
b. Decreased CO
c. Infertility
d. Decreased Libido
e. Fatigue Fever
f. Hypotension
g. HA Headache
h. Blurring of Vision

INTERVENTIONS
a. Provide emotional support to the client and family.
b. Encourage the client and family to express feelings
c. Client may need hormone replacement for the
specific deficient hormones.

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Pathophysiology