Professional Documents
Culture Documents
MetabolicAlterations 1
MEtaBol iC
aLteRaTiONs
Glands
Hormones
Receptors
Amines
Polypeptides
Steroids
FJRC.MS.MetabolicAlterations 3
GLAN DS OF
TH E
EN DOC RINE
SY STEM
FJRC.MS.MetabolicAlterations 4
HYP OTH AL AM US
Cone-shaped
Back of the third ventricle of
the brain
Mystery-mystery!
Melatonin
FJRC.MS.MetabolicAlterations 8
PITUITAR Y GLAND
Pede na rin
Hamak na imbakan
OXYTOCIN
ANTIDIURETIC HORMONE
(Vasopressin)
FJRC.MS.MetabolicAlterations 11
T H YROI D GL AND
H urray! Hurray!
Le – H – eg
H – either side
H – istHmus connected
TriiodotHyronine (T3)
– more potent
THyroxine – less
Calcito-H-nin
FJRC.MS.MetabolicAlterations 12
FJRC.MS.MetabolicAlterations 13
PARA THY ROID GLA NDS
Tagong kabit
Kaya hanggang 8,
4 ang legal (daw)
PARATHORMONE:
most popular regulator of
calcium ions
FJRC.MS.MetabolicAlterations 14
FJRC.MS.MetabolicAlterations 15
TH YMUS GLAND
Upper thorax
Immuno-endo
Thymosin : T-lymphocytes
maturation
FJRC.MS.MetabolicAlterations 16
ENDOC RI NE PANC REAS
Pancreatic
islets : New-NSO
reg
GA-BIDSFJRC.MS.MetabolicAlterations 17
FJRC.MS.MetabolicAlterations 18
FJRC.MS.MetabolicAlterations 19
ADRE NAL GL AND S
ADRENALINE:
R – esembles bean (each)
U – ri’y pituitary (glandular
; neural)
S – ituated top of the kidney
H – ati: Cortex(co), Medulla(mines)
FJRC.MS.MetabolicAlterations 20
FJRC.MS.MetabolicAlterations 21
FJRC.MS.MetabolicAlterations 22
GO NA DS
OVARIES:
mainly estradiol
TESTES:
testosterone
FJRC.MS.MetabolicAlterations 23
FJRC.MS.MetabolicAlterations 24
These are blood
examinations for the levels
of individual hormones
Measurements can also be
done after stimulation and
suppression of the
secretions- Stimulation and
Suppression tests
FJRC.MS.MetabolicAlterations 25
Usually done to diagnose
hypo/hyperthyroidism
If T3 is elevated, T4 is
elevated and TSH is
depressed Primary
HYPERthyroidism
If T3 is depressed,T4 is
depressed and TSH is
elevated Primary
HYPOthyoidism
FJRC.MS.MetabolicAlterations 26
This is a thyroid function
test to measure the
absorption of the injected
iodine isotope by the thyroid
tissue
Increased uptake may
indicate HYPER functioning
gland
Decreased uptake my
FJRC.MS.MetabolicAlterations 27
Performed to identify
nodules or growth in the
thyroid gland
RAI is used
Pretest- Check for
pregnancy, Thyroid
medication may be withheld
temporarily, advise NPO
Post-test- Ensure proper
FJRC.MS.MetabolicAlterations 28
Aids in the diagnosis of
Diabetes
Pre-test: NPO for 8 hours
Normal FBS- 80-109 mg/dL
DM- 126 mg/dL and above
FJRC.MS.MetabolicAlterations 29
Aids in the diagnosis of DM
Pre-test: Provide high-
carbohydrate foods x 3 days,
instruct to avoid caffeine, alcohol
and smoking, NPO 10 hours prior
to test
Post-test: avoid strenuous
activity for 8 hours
Normal OGTT- 1 and 2 hours
FJRC.MS.MetabolicAlterations 30
post-prandial- glucose is less
Blood glucose bound to
RBC hemoglobin
Reflects how well blood
glucose is controlled for the
past 3 months
FASTING is NOT required!
FJRC.MS.MetabolicAlterations 31
Normal level-
expressed as
percentage of total
hemoglobin
N- 4-7%
Good control- 7.5%or
less
Fair control- 7.5 % to
8.9%
Poor control- 9% and
above
FJRC.MS.MetabolicAlterations 32
DISORDERS OF THE
ENDOCRINE GLAND
Disorders are generally
grouped into:
HYPER- when the gland
secretes excessive
hormones
HYPO- when the gland does
not secrete enough
hormones
FJRC.MS.MetabolicAlterations 33
Hyper and Hypo can be
classified as PRIMARY when
the Gland itself is the
problem or SECONDARY
when the pituitary or the
hypothalamus is causing the
problem
FJRC.MS.MetabolicAlterations 34
THY RO ID
DIS OR DE RS
FJRC.MS.MetabolicAlterations 35
HYP ERTI RE DDYTI ES
FJRC.MS.MetabolicAlterations 36
A hypothyroid state
characterized by decreased
secretions of T3 and T4
CAUSES:
Hypofunctioning tumor, IDG,
Pituitary tumor, Ablation
therapy, Surgical removal of
thyroid FJRC.MS.MetabolicAlterations 37
Decreased T3 and T4
decreased basal
metabolism
FJRC.MS.MetabolicAlterations 38
1. Lethargy and fatigue
2. Weakness and
paresthesia
3. COLD intolerance
4. Weight gain
5. Bradycardia,
constipation
FJRC.MS.MetabolicAlterations 39
6. Dry hair and skin, loss of
body hair
7. Generalized puffiness
and edema around the eyes
and face8. Forgetfulness
and memory loss
9. Slowness of movement
10. Menstrual irregularities
and cardiac irregularities
FJRC.MS.MetabolicAlterations 40
1. Monitor VS especially HR
2. Administer hormone
replacement: usually
Levothyroxine( Synthroid)-
should be taken on an
empty stomach
3. Instruct patient to eat
LOW calorie, LOW
FJRC.MS.MetabolicAlterations 41
4. Manage constipation
appropriately
5. Provide a WARM
environment
6. Avoid sedatives and
narcotics because of
increased sensitivity to
these medications
7. Instruct patient to
FJRC.MS.MetabolicAlterations 42
report chest pain promptly
Called GRAVE’S
DISEASE
A hyperthyroid
state
characterized by
increased
circulating T3
and T4
CAUSES:
Auto-immune
disorder, toxicFJRC.MS.MetabolicAlterations 43
FJRC.MS.MetabolicAlterations 44
1. Weight loss
2. HEAT intolerance
3. Hypertension
4. Tachycardia and
palpitations
5. Exopthalmos
6. Diarrhea
FJRC.MS.MetabolicAlterations 45
7. Warm skin
8. Diaphoresis
9. Smooth and soft skin
Oligomenorrhea to
amenorrhea
10. Fine tremors and
nervousness
11. Irritability, mood swings,
personality changes and
agitation
FJRC.MS.MetabolicAlterations 46
FJRC.MS.MetabolicAlterations 47
FJRC.MS.MetabolicAlterations 48
1. Provide adequate rest
periods in a quiet room
2. Administer anti-thyroid
medications that block
hormone synthesis-
Methimazole and PTU
3. Provide a HIGH-calorie
diet, HIGH protein
FJRC.MS.MetabolicAlterations 49
4. Manage diarrhea
5. Provide a cool and quiet
environment
6. Avoid giving stimulants
7. Provide eye care
Hypoallergenic tape for eyelid
closure
8. Administer PROPRANOLOL
for tachycardia
9. Administer IODIONE
preparation- Lugol’s solution
and SSKI to inhibit the release
of T3 and T4
FJRC.MS.MetabolicAlterations 50
FJRC.MS.MetabolicAlterations 50
10. Prepare clients for
Radioactive iodine
therapy
11. Prepare patient for
thyroidectomy
12. Manage thyroid storm
appropriately
FJRC.MS.MetabolicAlterations 51
An acute LIFE-
threatening condition
characterized by
excessive thyroid
hormone
CAUSE:
Manipulation of the
thyroid during surgery
causing the release of
FJRC.MS.MetabolicAlterations 52
1. Maintain PATENT airway
and adequate ventilation
2. Administer anti-thyroid
medications such as Lugol’s
solution, Propranolol, and
Glucocorticoids
3. Monitor VS
FJRC.MS.MetabolicAlterations 54
4. Monitor Cardiac
rhythms
5. Administer
PARACETAMOL ( not
Aspirin) for FEVER
6. Manage Seizures as
required.
FJRC.MS.MetabolicAlterations 55
Removal of the thyroid
gland
FJRC.MS.MetabolicAlterations 56
1. Obtain VS and weight
2. Assess for Electrolyte levels,
glucose levels and T3/T4 levels
3. Provide pre-operative
teaching like coughing and
deep breathing, early
ambulation and support of the
neck when moving
4. Administer prescribed
medicationsFJRC.MS.MetabolicAlterations 57
1. Position patient: Semi-
Fowler’s, neck on neutral
position
2. Monitor for respiratory
distress- apparatus at bedside-
tracheostomy set, O2 tank and
suction machine!
3. Check for edema and
bleeding by noting the
FJRC.MS.MetabolicAlterations 58
4. LIMIT client talking
5. Assess for HOARSENESS
Expected to be present only
initially, limit excess
vocalization
If persistent, may indicate
damage to laryngeal nerve!
6. Monitor for Laryngeal Nerve
damage – Respiratory distress,
Dysphonia, voice changes,
Dysphagia and restlessness
FJRC.MS.MetabolicAlterations 59
7. Monitor for signs of
HYPOCALCEMIA and tetany
due to trauma of the
parathyroid
8. Prepare Calcium
gluconate
9. Monitor for thyroid storm
FJRC.MS.MetabolicAlterations 60
PAR ATHY ROI D
DI SOR DERS
FJRC.MS.MetabolicAlterations 61
Hypo-secretion of
parathyroid hormone
CAUSES:
Tumor, removal of the
gland during thyroid
surgery
FJRC.MS.MetabolicAlterations 62
Decreased PTH deranged
calcium metabolism
FJRC.MS.MetabolicAlterations 63
1. Signs of HYPOCALCEMIA
2. Numbness and tingling
sensation on the face
3. Muscle cramps
4. (+) Trosseau’s and (+)
Chvostek’s signs
5. Bronchospasms,
laryngospasms, and
dysphagia
FJRC.MS.MetabolicAlterations 64
6. Cardiac dysrhythmias
7. Hypotension
8. Anxiety, irritability ands
depression
FJRC.MS.MetabolicAlterations 65
FJRC.MS.MetabolicAlterations 66
Monitor VS and signs of
HYPOcalcemia
Initiate seizure precautions
and management
Place a tracheostomy set.
O2 tank and suction at the
bedside
Prepare CALCIUM gluconate
Provide a HIGH-calcium and
LOW phosphate diet
FJRC.MS.MetabolicAlterations 67
Advise client to eat Vitamin
D rich foods
Administer Phosphate
binding drugs
FJRC.MS.MetabolicAlterations 68
Hyper-
secretion of
the gland
CAUSE:
Tumor
FJRC.MS.MetabolicAlterations 69
Increase PTH increased
CALCIUM levels in the
body
FJRC.MS.MetabolicAlterations 70
Fatigue and muscle
weakness/pain
Skeletal pain and tenderness
Fractures
Anorexia/N/V epigastric pain
Constipation
FJRC.MS.MetabolicAlterations 71
Hypertension
Cardiac Dysrhythmias
Renal Stones
FJRC.MS.MetabolicAlterations 72
Monitor VS, Cardiac rhythm, I
and O
Monitor for signs of renal
stones, skeletal fractures.
Strain all urine.
Provide adequate fluids- force
fluids
AdministerFJRC.MS.MetabolicAlterations
prescribed 73
Administer calcium
chelators
Administer CALCITONIN
Prepare the patient for
surgery
FJRC.MS.MetabolicAlterations 74
ADR EN OCO RT ICAL
DI SO RDE RS
FJRC.MS.MetabolicAlterations 75
Decreased secretion of
adrenal cortex hormones,
especially glucocorticoids
and mineralocorticoids
CAUSE:
Tumor, idopathic
FJRC.MS.MetabolicAlterations 76
Decreased Glucocorticoids
decreased resistance to stress
Decreased
mineralocorticoids
decreased retention of
sodium and water
Hypovolemia
FJRC.MS.MetabolicAlterations 77
Weight loss
GI disturbances
Hyponatremia
FJRC.MS.MetabolicAlterations 78
Hyperkalemia
Hypoglycemia
dehydration and
hypovolemia
CAUSES:
Severe stress, infection,
trauma or surgery
FJRC.MS.MetabolicAlterations 82
Overwhelming stimuli
mobilize body defense
decreased stress
hormones inadequate
coping
FJRC.MS.MetabolicAlterations 83
Severe headache
Severe pain
Severe weakness
Severe hypotension
Signs of Shock
FJRC.MS.MetabolicAlterations 84
Administer IV
glucocorticoids, usually
hydrocortisone
Monitor VS frequently
Monitor I and O,
neurological status,
electrolyte imbalances and
FJRC.MS.MetabolicAlterations 85
Administer IVF
Maintain bed rest
Administer prescribed
antibiotics
FJRC.MS.MetabolicAlterations 86
A condition resulting from
the hyper-secretion of
glucocorticoids from the
adrenal cortex
CAUSES:
Pituitary tumor, adrenal
tumor, abuse of steroids
FJRC.MS.MetabolicAlterations 87
Increased Glucocorticoids
exaggerated effects of the
hormone
FJRC.MS.MetabolicAlterations 88
Normal functions of Exaggerated
Cortisol functions
1. Gluconeogenesis HYPERGLYCEMIA
2. Protein OSTEOPOROSISS,
breakdown delayed wound
healing
Purplish striae ,
Bleeding
Muscle wasting
3. Fat breakdown THIN extremity,
Truncal deposition
4. Decreased WBC IMMUNOSUPPRESSIO
N
FJRC.MS.MetabolicAlterations 89
Functions of Exaggerated functions
Mineralocorticoids
FJRC.MS.MetabolicAlterations 90
Generalized muscle
weakness and wasting
Truncal obesity
Moon-face
Buffalo hump
Easy bruisability
FJRC.MS.MetabolicAlterations 91
Reddish-purplish striae on
the abdomen and thighs
Hirsutism and acne
Hypertension
Hyperglycemia
Osteoporosis
Amenorrhea
FJRC.MS.MetabolicAlterations 92
FJRC.MS.MetabolicAlterations 93
FJRC.MS.MetabolicAlterations 94
Serum cortisol level
FJRC.MS.MetabolicAlterations 95
Monitor I and O , weight and
VS
Monitor laboratory values-
glucose, Na, K and Ca
Provide meticulous skin care
Administer prescribed
medications like
aminogluthetimide to inhibit
adrenal hyperfunctioning
FJRC.MS.MetabolicAlterations 96
Prepare client for surgical
management- pituitary
surgery and adrenalectomy
Protect patient from
infection
Improve body image
Provide a LOW
carbohydrate, LOW sodium
and HIGH protein
FJRC.MS.MetabolicAlterations 97
ADR EN OMED ULLAR Y
DI SO RDE R
FJRC.MS.MetabolicAlterations 98
Increased secretion of
epinephrine and nor-
epinephrine by the adrenal
medulla
CAUSE: Tumor
FJRC.MS.MetabolicAlterations 99
Increased Adrenergic
hormones
exaggerated
sympathetic effects
FJRC.MS.MetabolicAlterations 100
Hypertension
Severe headache
Palpitations
Tachycardia
Profuse sweating and
Flushing
Weight loss, tremors
FJRC.MS.MetabolicAlterations 101
Hyperglycemia and
Monitor VS especially BP
Monitor for HYPERTENSIVE
crisis
Avoid stimulation that can
cause increased BP
Administer Anti-
hypertensive agents like
alpha-adrenergic blockers-
FJRC.MS.MetabolicAlterations 102
Prepare Phentolamine for
hypertensive crisis
Monitor blood glucose and
urine glucose
Promote adequate rest and
sleep periods
FJRC.MS.MetabolicAlterations 103
Provide HIGH calorie foods
and Vitamins/mineral
supplements
Prepare patient for
possible surgery
FJRC.MS.MetabolicAlterations 104
AN TER IOR
PIT UIT ARY
DI SO RDE RS
FJRC.MS.MetabolicAlterations 105
Hyposecretion of the anterior
pituitary gland
FJRC.MS.MetabolicAlterations 106
Depends on the major
hormone/s depleted
Findings
Retarded physical growth due
to decreased GH dwarfism
Low intellectual development
Poor development of
secondary sexual
FJRC.MS.MetabolicAlterations 107
FJRC.MS.MetabolicAlterations 108
Provide emotional support
to the family
Encourage client and family
to express feelings
Administer prescribed
hormonal replacement
therapy
FJRC.MS.MetabolicAlterations 109
The hyper-secretion of the
gland
ACROMEGALY
CAUSES: tumor, congenital
disorder
FJRC.MS.MetabolicAlterations 110
Depends on the
hormone/s that
is/are increased
FJRC.MS.MetabolicAlterations 111
FJRC.MS.MetabolicAlterations 112
Increased growth
Gigantism or Acromegaly
Large and thick hands and
feet
Visual disturbances
Hypertension,
hyperglycemia
Organomegaly
FJRC.MS.MetabolicAlterations 113
Provide emotional support
to clients and family
Provide frequent skin care
Prepare patient for surgery-
removal of pituitary gland
FJRC.MS.MetabolicAlterations 114
Monitor VS, LOC and
neurologic status
Place patient on Semi-
Fowler’s
Monitor for Increased ICP,
bleeding, CSF leakage
Instruct patient to AVOID
sneezing, coughing and
nose-blowing
FJRC.MS.MetabolicAlterations 115
Monitor development of DI-
measure I and O
Administer prescribed
medications- antibiotics,
analgesics and steroids
FJRC.MS.MetabolicAlterations 116
POS TER IOR
PIT UIT ARY
DI SO RDE RS
FJRC.MS.MetabolicAlterations 117
A hypo-secretion of ADH
CAUSES:
Conditions that increase
ICP, Surgical removal of
post pit. tumor
FJRC.MS.MetabolicAlterations 118
Decreased ADH failure of
tubular re-absorption of
water increased urine
volume
FJRC.MS.MetabolicAlterations 119
FJRC.MS.MetabolicAlterations 120
Polyuria of more than 4
liters of urine/day
Polydipsia
Signs of Dehydration
Muscle pain and weakness
Postural hypotension and
tachycardia
FJRC.MS.MetabolicAlterations 121
Urinary Specific gravity
very low, 1.006 or less
Serum Sodium levels high
FJRC.MS.MetabolicAlterations 122
Monitor VS, neurologic
status and cardiovascular
status
Administer Chlorpropamide
or Clofibrate as prescribed
to increase the action of
ADH if decreased
Administer VASOPRESIN.
Desmopressin or Lypressin
are given intranasal.
Pitressin is given IM
FJRC.MS.MetabolicAlterations 124
Hyper-secretion of ADH
abnormally
CAUSES:
Tumor, paraneoplastic
syndromes
FJRC.MS.MetabolicAlterations 125
Increased ADH water re-
absorption water
intoxication, hypervolemia
FJRC.MS.MetabolicAlterations 126
Urine specific gravity is
increased (concentrated)
Hyponatremia
FJRC.MS.MetabolicAlterations 128
Hypertension
HYPOnatremia
FJRC.MS.MetabolicAlterations 129
Monitor VS and neurologic
status
Administer prescribed
Demeclocycline to inhibit
action of ADH in the kidney
FJRC.MS.MetabolicAlterations 131
END O-P AN CRE AS
DI SO RDE R
FJRC.MS.MetabolicAlterations 132
General information
Diabetes mellitus represents a
heterogeneous group of chronic
disorders characterized by
hyperglycemia.
Hyperglycemia is due to total or partial
insulin deficiency or insensitivity of the
cells to insulin.
Characterized by disorders in the
metabolism of carbohydrates, fat and
protein, as well as changes in the
structure and function of blood vessels
FJRC.MS.MetabolicAlterations 133
Most common endocrine problem;
affects over 11 million people in
the US
Exact etiology unknown,
causative factors may include
Genetics, viruses, and/or
autoimmune response in type I
Genetics and obesity in type II
FJRC.MS.MetabolicAlterations 134
Types
Type I (insulin-
dependent
diabetes
mellitus
[IDDM]) cells in
the islets of
Langerhans in
the pancreas
resulting in little
or no insulin
production;
requires insulin
injections
Usually occurs in
children or in
nonobese adults
FJRC.MS.MetabolicAlterations 135
Type II (non-insulin-dependent
diabetes mellitus [NIDDM])
May result from a partial deficiency of insulin
production and/or an insensitivity of the cells to
insulin
Usually occurs in obese adults over 40
Diabetes associated with other conditions
or syndromes, e.g., pancreatic disease,
Cushing’s syndrome, use of certain drugs
(steroids, thiazide diuretics, oral
contraceptives)
FJRC.MS.MetabolicAlterations 136
Lack of insulin causes hyperglycemia
(insulin is necessary for the transport of
glucose across the cell membrane).
Hypergycemia leads to osmotic diuresis
as large amounts of glucose pas through
the kidney; results in polyuria and
glycosuria
Diuresis leads to cellular dehydration and
fluid and electrolyte depletion causing
polydipsia (excessive thirst).
Polyphagia (hunger and increased
appetite) results from cellular starvation137
FJRC.MS.MetabolicAlterations
The body turns to fats and protein for energy;
but in the absence of glucose in the cell, fats
cannot be completely metabolized and ketones
(intermediate products of fat metabolism) are
produced.
This leads to ketonemia, ketonuria (contributes
to osmotic diuresis), and metabolic acidosis
(ketones are acid bodies)
Ketones act as CNS depressants and can cause
coma.
Excess loss of fluids and electrolytes leads to
hypovolemia, hypotension renal failure, and
decreased blood flow to the brain resulting in
coma and death unless treated.
Acute complications of diabetes include diabetic
ketoacidosis insulin reaction hyperglycemic
insulin reaction FJRC.MS.MetabolicAlterations
hyperglycemic 138
Type I: insulin, diet, exercise
Type II: ideally managed by diet and
exercise; may need oral
hypoglycemic or occasionally insulin
if diet and exercise are not effective
in controlling hyperglycemia; insulin
needed for acute stresses, e.g.,
surgery, infection
FJRC.MS.MetabolicAlterations 139
Diet
Type I: consistency is imperative to
avoid hypoglycemia
Type II: weight loss is important since it
decreases insulin resistance
High fiber, low fat diet also
recommended
FJRC.MS.MetabolicAlterations 140
Drug therapy
Insulin: used for Type I diabetes (also
occasionally used in Type II diabetes)
short acting: used in treating ketoacidosis;
during surgery, infection, trauma;
management of poorly controlled diabetes;
to supplement longer-acting insulin’s
intermediate; used for maintenance
therapy
Long acting: used for maintenance therapy
in clients who experience hyperglycemia
during the night with intermediate-acting
insulin
FJRC.MS.MetabolicAlterations 141
Various preparations of short-,
intermediate-, and long acting insulins
are available
Insulin preparations can consist of
mixture of beef and pork insulin, pure
beef, pure pork, or human insulin.
Human insulin is the purest insulin and
has the lowest antigenic effect.
Human insulin is recommended for all
newly diagnosed Type I diabetics, Type
II diabetics who need short-term insulin
therapy, the pregnant client, and
diabetic clients with insulin allergy or
severe insulin resistance.
FJRC.MS.MetabolicAlterations 142
Insulin pumps are small,
externally worn devices that closely
mimic normal pancreatic
functioning. Insulin pumps contain
a 3 ml sringe attached to a long (42
inch), narrow-lumen tube with a
needle or Teflon catheter is
inserted into the subcutaneous
tissue (usually on the abdomen)
and secured with tape or a
transparent dressing. The needle
or catheter is changed at least
every 3 days. The pump is worn
either on a belt or in a pocket. The
pump uses only regular insulin.
Insulin can be administered via the
basal rate (usually 0.5-2.0 units/hr)
and by a bolus dose (which is
activated by a series of button
pushes) prior to each meal.
FJRC.MS.MetabolicAlterations 143
FJRC.MS.MetabolicAlterations 144
All types: polyuria, polydipsia,
polyphagia, fatigue, blurred vision,
susceptibility to infection
Type I: anorexia, nausea, vomiting,
weight loss
Type II: obesity; frequently no other
symptoms
FJRC.MS.MetabolicAlterations 145
Diagnostic tests
Fasting blood sugar
a level of 140 mg/dl or greater on at least
two occasions confirms diabetes mellitus
may normal in Type II diabetes
Postprandial blood sugar: elevated
Oral glucose tolerance test (most
sensitive test): elevated
Glycosolated hemoglobin (hemoglobin
A) elevated
FJRC.MS.MetabolicAlterations 146
Administer insulin or oral hypoglycemic agents
as ordered; monitor for hypoglycemia,
especially during period of drug’s speak action
Provide special diet as ordered
Ensure that the client is eating all meals.
If all food is not ingested, provide appropriate
substitutes according to the exchange lists or give
measured amount of orange juice to substitute for
leftover food; provide snack later in the day.
Monitor urine sugar and acetone (freshly
avoided specimen)
Perform finger sticks to monitor blood glucose
levels as ordered (more accurate than urine
tests).
FJRC.MS.MetabolicAlterations 147
Observe for signs of hypo/hyperglycemia.
Provide meticulous skin care and
prevent injury.
Maintain I&O; weight daily.
Provide emotional support; assist
client in adapting to change n life-
style and body image.
FJRC.MS.MetabolicAlterations 148
Observe for chronic complications and
plan care accordingly.
Atherosclerosis: leads to coronary artery
disease, MI, CVA, and peripheral vascular
disease.
Microangiopathy: most commonly affects
eyes and kidneys
Kidney disease
recurrent pyelonephritis
diabetic nephropathy
Ocular disorders
1. premature cataracts
2. diabetic retinopathy
Peripheral neuropathy
1. affects peripheral and autonomic nervous
systems.
2. causes diarrhea, constipation, neurogenic
FJRC.MS.MetabolicAlterations 149
bladder, impotence, decreased sweating
Provide client teaching and
discharge planning concerning
Disease process
Diet
Client should be able to plan meals using
exchange lists before discharge
emphasize importance of regularity of
meals; never skip meals
FJRC.MS.MetabolicAlterations 150
Insulin
How to draw up into syringe
gently roll vial between palms of hands
draw up insulin using sterile technique.
Injection technique
systematically rotate sites to prevent
lipodystrophy (hypertrophy or atrophy of tissue)
insert needle at a 45˚ or 90˚ angle depending
on amount of adipose tissue
May store current vial of insulin at room
temperature; refrigerate extra supplies.
Provide many opportunities for return
demonstration
Oral hypoglycemic agents
stress importance of taking the drug
regularly
FJRC.MS.MetabolicAlterations 151
avoid alcohol intake while on medication
Urine testing (not very accurate
reflection of blood glucose level)
May be satisfactory for Type II diabetics
since therapy are more stable.
Use Clinitest, Test-tape, Diastix for glucose
testing
Perform tests before meals and at bedtime.
Use freshly voided specimen.
FJRC.MS.MetabolicAlterations 152
Be consistent in brand of urine test used.
Report result in percentages.
Report results to physician if results are
greater than 1%, especially if experiencing
symptoms of hyperglycemia
Urine testing for ketones should be done
by Type I diabetic clients when there is
persistent glycosuria, increased blood
glucose levels, or if the client is not feeling
well (Acetest
FJRC.MS.MetabolicAlterations 153
Blood glucose
monitoring
Instruct 1. Use
for Type I
diabetic clients
since it gives
exact blood
glucose level and
also detects
hypoglycemia.
client in finger-
stick technique,
use of monitor
device (if used),
and recording
and utilization of
test results.
FJRC.MS.MetabolicAlterations 154
General care
perform good oral hygiene and have
regular dental exams.
have regular eye exams.
care for “sick days” (e.g., cold or flu)
a. do not omit insulin or oral hypoglycemic
agents since infection causes increased blood
sugar.
b. notify physician.
c. monitor urine or blood glucose levels and
urine ketones frequently.
d. if nausea and/or vomiting occurs, sip on clear
liquids with simple sugars.
FJRC.MS.MetabolicAlterations 155
Foot care
wash feet with mild soap and
water and p at dry.
apply lanolin to feet to prevent
drying and cracking
cut toenails straight across
avoid constricting garments
such s garters.
wear clean, absorbent socks
(cotton or wool)
purchase properly fitting shoes
and bread new shoes in
gradually
never go barefoot
inspect feet daily and notify
physician if cuts, blisters, or
breaks in skin occur.
FJRC.MS.MetabolicAlterations 156
Exercise
undertake regular exercise; avoid sporadic,
vigorous exercise
food intake may need to be increased
before exercising
exercise is best performed after meals
when the blood sugar is rising
Complications
learn to recognize signs and symptoms of
hypo/hyperglycemia
eat candy or drink orange juice with sugar
added for insulin reaction (hypoglycemia).
Need to wear a Medic- Alert bracelet
FJRC.MS.MetabolicAlterations 157
Sel ec ted
End oc rin e
PHA RM ACO LOGY
FJRC.MS.MetabolicAlterations 158
En docrine Medic ations
SIDE-effects
Flushing and headache
Water intoxication
FJRC.MS.MetabolicAlterations 160
Th yr oid Me dic atio ns
Levothyroxine (Synthroid)
and Liothyroxine
(Cytomel)
Replace hormonal deficit
in the treatment of
HYPOTHYROIDSM
FJRC.MS.MetabolicAlterations 161
Th yr oid Me dic atio ns
Signs of increased
metabolism=
tachycardia,
hypertension
FJRC.MS.MetabolicAlterations 162
Th yr oid Me dic atio ns
Monitor weight, VS
Instruct client to take daily
medication the same time
each morning WITHOUT
FOOD
FJRC.MS.MetabolicAlterations 163
Th yr oid Me dic atio ns
Advise to report palpitation,
tachycardia, and chest pain
Instruct to avoid foods that
inhibit thyroid secretions
like cabbage, spinach and
radishes
FJRC.MS.MetabolicAlterations 164
ANT I-Th yro id
Me dications
Methimazole (Tapazole)
PTU (prophylthiouracil)
Iodine solution- SSKI and
Lugol’s solution
FJRC.MS.MetabolicAlterations 165
ANT I-Th yro id
Me dications
N/V
Diarrhea
AGRANULOCYTOSIS
Most important to monitor
FJRC.MS.MetabolicAlterations 166
ANT I-Th yro id
Me dications
FJRC.MS.MetabolicAlterations 169
STER OI DS
Side-effects
HYPERglycemia
Increased susceptibility
to infection
Hypokalemia
Edema
FJRC.MS.MetabolicAlterations 170
STER OI DS
Side-effects
If high doses-
osteoporosis, growth
retardation, peptic
ulcer, hypertension,
cataract, mood
changes, hirsutism,
and fragile skin
FJRC.MS.MetabolicAlterations 171
STER OI DS
Nursing responsibilities
1. Monitor VS, electrolytes,
glucose
2. Monitor weight edema
and I/O
FJRC.MS.MetabolicAlterations 172
STER OI DS
3. Protect patient from
infection
4. Handle patient gently
5. Instruct to take meds
WITH MEALS to prevent
gastric ulcer formation
FJRC.MS.MetabolicAlterations 173
STER OI DS
Nursing responsibilities
6. Caution the patient NOT
to abruptly stop the drug
7. Drug is tapered to allow
the adrenal gland to
secrete endogenous
hormones FJRC.MS.MetabolicAlterations 174
Hyp oth yro idism
Hyposecretion of thyroid hormones
Common causes: Iodine deficiency,
Hashimotos
Manifestations: related to hypo-
metabolic state: constipation, weight
gain, cold intolerance, poor appetite,
mental slowness
Nursing Management:
Provide warm environment
LOW calorie diet, HIGH fiber
Avoid sedatives
Drugs: Hormone replacement
FJRC.MS.MetabolicAlterations 175
Hyp ert hyroid ism
Hyper-secretion of thyroid
hormones
Common cause: Graves, Toxic
goiter
Manifestation: increased
metabolism: weight loss, diarrhea,
heat intolerance, hypertension
Nursing Management:
Adequate rest and sleep
Cool environment
HIGH calorie foods
Eye care FJRC.MS.MetabolicAlterations 176
Drugs: anti-thyroid: PTU and
EXO -P AN CRE AT IC
AN D BI LIARY
DI SO RDE RS
FJRC.MS.MetabolicAlterations 177
PAN CREA TIT IS
FJRC.MS.MetabolicAlterations 178
CHO LECY STI TI S/ CHO L
EL ITH IA SI S
Cholecystitis: inflammation of the
gallbladder
Cholelithiasis: occurs when gallstones
are formed due to bile that is usually
stored in the gallbladder hardening into
stonelike material
Cholesterol, bilirubin, and calcium
precipitates
FJRC.MS.MetabolicAlterations 179
HE PAT IC
DIS OR DE RS
FJRC.MS.MetabolicAlterations 180
FJRC.MS.MetabolicAlterations 181
FJRC.MS.MetabolicAlterations 182