ENDOCRINE NURSING

By : JOHN MARK B. POCSIDIO, RN, MSN

Functions of endocrine system

 Response to stress and injury.

 Growth and development.

 Reproduction.

 Homeostasis

 Energy metabolism.

Endocrine glands
 Endocrine glands are specialized cluster of cells that secrete hormones.

o Secreted hormones go directly into the blood stream (ductless gland ) in respond to the
nervous system stimulation.

HORMONES
 Hormones are chemical messengers secreted by endocrine organs and transported
throughout the body where they exert their action on specific cells called target cells.
 Hormones do not cause reactions but rather they are regulator of tissue responses.

Mechanisms of Hormones
 Hormones interact with high-affinity receptors
o These are linked to one or more effector system in the cell
 Some receptors are located on the surface of the cell
o These act through second messenger mechanisms
 Others are located in the cell
o They modulate the synthesis of enzymes, transport proteins, or structural proteins
 Binding to Target Cells

Hormones
 Maintain homeostatic balance utilizing a feedback mechanism that involves other
hormones, blood or chemicals, and the nervous system.
“The Sequence”
Hypothalamus
↓
Pituitary Gland or Hypophysis
Anterior or Adenohypophysis
Posterior or Neurohypophysis
↓
Target Glands

HYPOTHALAMUS
 The hypothalamus is the site of the hunger center and is involved in appetite control. It contains
centers that regulate the sleep–wake cycle, blood pressure, aggressive and sexual behavior, and
emotional responses (ie, blushing, rage, depression, panic, and fear). The hypothalamus also
controls and regulates the autonomic nervous system.
The ANATOMY of the Endocrine System
Pituitary Gland
 Is a gland located below the hypothalamus at the base of the brain
 The optic chiasm passes over this structure

 Is divided into two parts- the anterior or adenohypophysis and the posterior or the
neurohypophysis

ANTERIOR
Secretes the following hormones:
1. Growth hormone
2. Prolactin
3. Gonadotrophins- LH and FSH
4. Stimulating hormones and trophic hormones
ACTH
TSH
MSH

The PHYSIOLOGY of the Endocrine System: Posterior Pituitary

Stores and releases
1. OXYTOCIN
2. ADH/Vasopressin

Radioactive iodine uptake test (raiu)

 Administration of I 123 or I 131 orally; measurement by a counter of the amount of radioactive
iodine taken up by the gland after 24 hours.

 Increased uptake may indicate HYPERfunctioning gland

 Decreased uptake my indicate HYPOfunctioning gland
 Normal values: 5-30% in 24 hours

COMMON BOARD QUESTION

REMEMBER:
 Not radioactive after procedure----CGFNS/ NCLEX
 Avoid cough syrup before test.(7-10 days prior)
 Temporarily discontinue contraceptive pills

THYRIOD SCAN
Administration of radioactive isotope ( oral / IV) & visualization by a scanner of the distribution of
radioactivity in the gland. (scintillation detector, gamma camera)
Performed to determine location, size, shape, & anatomic function of thyroid gland; identifies
areas of increased or decreased uptake; valuable in evaluating thyroid nodules.

COMMON LABORATORY PROCEDURES

 Thyroid Scan
 Pretest- Check for pregnancy, Thyroid medication may be withheld temporarily, advise
NPO
 Post-test- Ensure proper disposal of body wastes
 Nursing care usually the same as RAIU

Prohibited during thyroid studies

 1. TOPICAL ANTISEPTICS
2. MULTIVITAMIN PREPARATIONS
3. FOOD SUPPLEMENTS
4. COUGH SYRUPS-------- LOCAL/ CGFNS
5. AMIODARONE
6. ANTIARRYTHMIC AGENTS
CONT. ( may affect test results)
7. ESTROGENS
8. SALICYLATES
9. AMPHETAMINES
10. CHEMOTHERAPEUTIC AGENTS
11. ANTIBIOTICS
12. CORTICOSTERIODS
13.MERCURIAL DIURETICS

BMR
 It measures the oxygen consumption under basal conditions of overnight fast and rest
from mental and physical exertion.
 it can be estimated from the oxygen consumed over a timed interval by analysis of
samples of expired air

Points to remember BMR

 BMR- measures oxygen consumption at the lowest cellular activity.
 PREPARATION
 NPO 10-12 hours
 Night sleep 8-10 hours
 Do not get up from bed the following morning until the test is done.
 A device with a nose clip & a mouthpiece is used, the client performs deep breathing
exercises.
 NORMAL: +20% ( EUTHYRIOD)

FASTING BLOOD GLUCOSE

 Aids in the diagnosis of Diabetes
 Pre-test: NPO for 8 hours( midnight before the test)
 Normal FBS- 80-109 mg/dL
 DM- 126 mg/dL and above
 QUESTION? Patient can drink water or not???????

GLUCOSE tolerance test

 Aids in the diagnosis of DM
 Pre-test: Provide high-carbohydrate foods x 3 days, instruct to avoid caffeine, alcohol and
smoking for 36 hours before the test.
 Fast for 10 to 16 hours before the test.
 Withhold morning insulin or oral hypoglycemic medication ( client with diabetes mellitus)---
NCLEX
 The test will take 3 to 5 hours, requires intravenous or oral administration of glucose, and multiple
blood samples.
Post-test:
 avoid strenuous activity for 8 hours
 Normal OGTT- 1 and 2 hours post-prandial- glucose is less than 200 mg/Dl
Glycosylated Hemoglobin A 1-C
 Blood glucose bound to RBC hemoglobin
 Reflects how well blood glucose is controlled for the past 3 months
 FASTING is NOT required!

Glycosylated Hemoglobin A 1-C

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

ENDOCRINE DISORDERS
By: JOHN MARK B. POCSIDIO, RN, USRN, MSN
Disorders of the pituitary gland

HYPERPITIUTARISM
 Hyperfunctioning of the pituitary gland
 Over secretion of one or more of the anterior pituitary hormones
 Can lead to acromegaly/ gigantism
COMMON CAUSE:
 Benign pituitary adenoma
 Hyperplasia of the pituitary tissue
.
.
SIGNS & SYMPTOMS:
 Enlarged hands and extremities-CBQ
 Prominent supraorbital ridge
 Spade shape hands & feet
 Large nose and jaw, teeth are separated
 Cardiomegaly, enlarged liver- CBQ
 Abnormal glucose level
 Hypertrophy of the sweat and sebaceous gland
 Galactorrhoea ( prolactin)
 Peripheral neuropathy
 Arthrosis
 Sexual dysfunction

DIAGNOSTIC TEST:
 Skull X-ray, CT scan, MRI
NURSING INTERVENTIONS
 Provide emotional support to clients and family
 Provide frequent skin care
 Prepare patient for surgery- removal of pituitary gland( transphenoidal hypophysectomy)
 CBQ? LOCATION? Between the upper lip & gum
Post-operative care
  Monitor VS, LOC and neurologic status ( monitor packing & reinforce as needed)
 Place patient on Semi-Fowler’s
 Monitor for Increased ICP, bleeding, CSF leakage
 Instruct patient to AVOID sneezing, coughing and nose-blowing
 CBA- deep breathing is good just avoid coughing
 CBA- provide mouth care with saline or toothettes ( avoid toothbrush)
 Monitor development of DI/ SIADH measure I and O
 Administer prescribed medications- antibiotics, analgesics and steroids
MEDICAL THERAPY:
OCTREOTIDE ACETATE SC 3x/ week( analog of somatostatin)– produces feedback inhibition on GH
SANDOSTATIN (IM 20-30mg) ---Effectively inhibits GH secretion for 30 days with just one IM injection of
20-30mg.- CBQ
BROMOCRIPTINE( long acting dopamine agonist)– can reduce growth hormone levels.

HYPOPITUITARISM
 Hyposecretion of the anterior pituitary gland

CAUSES:
 Congenital
 Post-partal necrosis( Sheehan's syndrome)
 Infection
 Surgery
 Radiation therapy
ASSESSMENT Findings
 Retarded physical growth due to decreased GH dwarfism
 Low intellectual development
 poor development of secondary sexual characteristics
Dwarfism, Cretenism, Achondroplasia

Diagnostics
 Physical examination and history
 CT scan
 MRI
 Hormone levels determination

NURSING INTERVENTIONS
 Provide emotional support to the family
 Encourage client and family to express feelings
 Administer prescribed hormonal replacement therapy (GH)
GROWTH HORMONES
SERMORELIN (GEREF)-----IV
SOMATREM (PROTROPIN)----IM/SC
SOMATROPIN (HUMATROPE) ---IM/ SC
( ORAL ROUTE IS INACTIVATED BY ENZYMES)
---use cautiously to diabetic patients
SideEffect?
Peripheral edema, arthralgias, myalgias, carpal tunnel syndrome, paresthisias, decrease glucose
tolerance.
 DIABETES INSIPIDUS
 Hypo functioning of the posterior pituitary gland
 A hypo-secretion of ADH
Most common cause???? Neurosurgery, trauma-CBQ

SIGNS AND SYMPTOMS:

 Polyuria- CBQ
 Dehydration-CBQ
 Polydipsia
 Muscle pain and weakness ( hypo K)
 Postural hypotension and tachycardia

Diagnostic test
 Fluid deprivation test – 8-12 hrs or 3-5% wt loss. Inability to increase specific gravity and
osmolality
 CGFNS: WATCH OUT FOR??????!!!!!
 Urinary Specific gravity very low, 1.006 or less
 Serum Sodium levels  high

NURSING INTERVENTIONS
 Monitor VS, neurologic status and cardiovascular status
 Monitor Intake and Output/ Daily weights
 Monitor urine specific gravity
 Provide adequate fluids
 Avoid!!!
 Coffee, tea, alcohol
MEDS: VASOPRESSIN/ DESMOPRESSIN- CBQ

SIADH
 Hyperfunctioning of the posterior pituitary gland
 Hyper-secretion of ADH abnormally
 Most common cause??? Neurosurgery/ trauma- CBQ
SIGNS & SYMPTOMS
 Mental status changes ( confusion)- CBQ
 Abnormal weight gain
 Hypervolemia
 Hypertension
 Hyponatremia
 Anorexia/ N/V

DIAGNOSTIC TEST
 Urine specific gravity is increased (concentrated)
 Hyponatremia
 CBC shows hemodilution

NURSING INTERVENTIONS
 Monitor VS and neurologic status
 Provide safe environment
 Restrict fluid intake (less than 500cc/day)
 Monitor I and O and daily weight
 Administer Diuretics and IVF carefully
 Administer prescribed Demeclocycline
  QUESTION???? SALINE OR WATER??? (TUBE FEEDINGS, NGT IRRIGATION)

DISORDERS OF THYRIOD
By: JOHN MARK B. POCSIDIO, RN, USRN, MSN

HYPERTHYROIDISM
 Called GRAVE’S DISEASE
 Hyperfunctioning of the thyroid gland
 A hyperthyroid state characterized by increased circulating T3 and T4, thyrocalcitonin

POSSIBLE CAUSES:
 Autoimmune
 Thyroiditis
 Infection
 Tumor
 Radiation

SIGNS & SYMPTOMS

 Weight loss
 HEAT intolerance
 Hypertension
 Tachycardia
 Exopthalmos
 diarrhea
 Warm skin
 Diaphoresis
 Smooth & soft skin
 Fine tremors

DIAGNOSTICS
 Thyroid gland enlarged
 T3, T4 elevated
 RAIU: Increased uptake

NURSING INTERVENTIONS
 Rest ( quiet room)
 Administer anti-thyroid Methimazole and PTU
 Provide a HIGH-calorie diet, HIGH protein
 Manage diarrhea
 Provide a cool and quiet environment
 Avoid giving stimulants
 Provide eye care
 Administer PROPANOLOL for tachycardia
 Administer IODIONE preparation- Lugol’s solution
 Prepare clients for Radioactive iodine therapy
 Prepare patient for thyroidectomy
 NO ASPIRIN!!!!- CBQ
 COMPLICATION? Thyroid storm
 Manage Seizures as required.
 Provide a quiet environment
 THYROIDECTOMY
 Removal of the thyroid gland

PRE-OPERATIVE CARE - Thyroidectomy

 Obtain VS and weight
 Assess for Electrolyte levels, glucose levels and T3/T4 levels
 Teach to support neck while moving-CBQ
POST-OPERATIVE CARE - Thyroidectomy
 Position: semi-fowlers ( neck midline)
 What to bring?: tracheostomy set, O2 tank, suction machine, calcium gluconate
 Check for SIGNS bleeding
 QUESTION??? Frequent swallowing or nape?????
 Assess for hoarseness
 Monitor for signs of hypocalcemia

HYPOTHYROIDISM
 Hypo functioning of the thyroid gland
 Hypo secretion of thyroid hormones
 Decreased T3 and T4 decreased basal metabolism

SIGNS & SYMPTOMS

 Lethargy and fatigue
 Weakness and paresthesia
 COLD intolerance- CBQ
 Weight gain
 Bradycardia-CBQ
 Constipation-CBQ
 Dry hair and skin-CBQ
 Generalized puffiness and edema around the eyes and face
 Menstrual irregularities

Diagnostic Tests

 SERUM T3 and T4 level low

 SERUM CHOLESTEROL level elevated
 RAIU DECREASED

NURSING INTERVENTIONS
 Monitor VS especially HR
 Administer meds: LEVOTHYROXINE
 Diet: low calories, low cholesterol, low fat
 Provide warm environment
 Manage constipation appropriately
 Avoid!!!!!
 Sedatives
 anesthetics
 Narcotics
 Stress
 Infection
 Exposure to extreme cold
 Hypoparathyroidism
 Hypo functioning of the parathyroid gland
 Hypo secretion of the parathyroid gland
Most common cause?
 Accidental removal of the parathyroids
 Autoimmune
 Radiation
.
SIGNS & SYMPTOMS:
 Signs of HYPOCALCEMIA
 Numbness and tingling sensation on the face ( Trosseau’s, chvostek)
 Muscle cramps
 Bronchospasms, laryngospasms-CBQ
 Seizure-CBQ
 Cardiac dysrhythmias-CBQ
 Hypotension

NURSING INTERVENTIONS
 Monitor VS and signs of Hypocalcaemia
 Initiate seizure precautions
 Place a tracheostomy set. O2 tank and suction at the bedside
 Prepare CALCIUM gluconate
 Provide a HIGH-calcium and LOW phosphate diet -CBQ
 Eat VIT D rich foods
 AVOID!!! Carbonated beverage & digitalis- CBQ

Hyperparathyroidism
 Hyper functioning of the parathyroid gland
 Hyper secretion of the parathyroid hormones
Most common cause?:
 Renal failure
 Vit D deficiency
 Adenoma

SIGNS& SYMPTOMS:
 Fatigue and muscle weakness/pain
 Skeletal pain and tenderness
 Fractures
 Osteoporosis
 Cardiac Dysrhythmias
 Renal Stones
 Constipation
 Anorexia, N/V

NURSING INTERVENTIONS
 Monitor VS, Cardiac rhythm, I and O
 Handle body parts carefully
 REMEMBER: LIFT sheet
 Increase fluids- CBQ
 Administer diuretics as ordered-CBQ
 Administer calcitonin as ordered
  Administer FOSAMAX as ordered

 Give calcium regulators as prescribed like ALENDRONATE (FOSAMAX)

 CBQ
 Should not be chewed
 Should be taken with water at least 30 minutes before breakfast and remain upright for at least 30
min.

CUSHING’S DISEASE
 Hypersecretion of adrenal cortex hormones (glucocorticoid, mineralocorticoid, androgen and
estrogen)

SIGNS & SYMPTOMS:

 Hypervolemia
 Hypo K
 Hypertension
 Edema
 Hyperglycemia
 Moon face, buffalo hump, truncal obesity
 Hirsutism
DIAGNOSTIC TEST:
o Dexamethasone suppression test:
o Overnight DEXA:
given in the evening 1 mg (oral, midnight),
blood is withdrawn in the morning 8AM (next day) normal result is less than 140 nmol/L or
5 mcg/dl (plasma cortisol)
High level of ACTH indicates Secondary Cushing’s
o 24 hour urine cortisol:
greater than 275 nmol/L is suggestive of abnormal condition

INTERVENTIONS:
 Monitor VS, observe for hypertension-CBQ
 Measure Intake & Output & daily weights-CBQ
 Protect client from exposure to infection-CBQ
 Minimize stress in the environment-CBQ
 Prevent accidents & falls & provide adequate rest
 Monitor urine for glucose & acetone
 DIET: LOW SODIUM, HIGH K- CBQ
 Maintain muscle tone
 Maintain skin integrity
 Prepare for surgery( adrenalectomy/ hypophysectomy)

ADDISON’S DISEASE
 Hyposecretion of adrenal cortex hormones
 Hypo functioning of the adrenal cortex
SIGNS & SYMPTOMS:
 Hypotension
 Hypovolemia
  Weight loss
 Hyper K
 Hypoglycemia
 Decrease ability to combat stress and infection
 Bronze skin
 Sparse axillary hair/ pubic hair

NURSING INTERVENTION
 Provide rest
 Administer hormone replacement therapy as ordered.-CBQ
 Glucocorticoids ( cortisone , hydrocortisone)
 Mineralocorticoids
 Monitor vital signs
 Check I & O/ Daily weights-CBQ
 Decrease stress in the environment
 Prevent exposure of infection
 DIET: HIGH SODIUM, LOW K-CBQ

PHEOCHROMOCYTOMA
 Benign tumor of the chromaffin cells of the adrenal medulla
 Peak incidence is ages 20 to 50 years
 Stimulates hyper secretion of cathecholamines (epinephrine and norepinephrine)

SNS over-activity

“5 H’s”
Hypertension
Headache
Hyperhidrosis
Hypermetabolism
Hyperglycemia

Diagnostic tests:
Vanillylmandelic Acid test (VMA test)
24 hour urine specimen
Instruct the patient to avoid the following medications and foods which may alter the result
Coffee
Tea
Bananas
Chocolate
Vanilla- CBQ
Aspirin
Normal 0.7-6.8mg/24hrs

Cont.
CT Scan, MRI, Ultrasound
To localize the pheochromocytoma

Nursing intervention:
 Monitor VS especially BP.
 POSITION? HOB elevated
 Administer meds as ordered to control BP.
  Phentolamine (Regitine)
 Na Nitroprusside (Nipride)
 Promote rest; decrease stimuli.
 Monitor urine test for glucose & acetone.
 Provide high calorie, well-balanced diet; avoid stimulants such as coffee or tea.
 Prepare for adrenalectomy
 QUESTION???? CAN YOU PALPATE ABS???

DIABETES MELLITUS

 A chronic disorder of impaired glucose metabolism, protein and fat metabolism

RISK FACTORS for Diabetes Mellitus
 Family History of diabetes
 Obesity
 Race/Ethnicity
 Age of more than 45
 Hypertension
 Hyperlipidemia
 History of Gestational Diabetes Mellitus

TYP
DRUG THERAPY( for DM type 1)
ID
  Insulin points to remember:
 Route? SC do not massage.
 Clear first before cloudy
 Inject air in the NPH insulin vial or regular?????
 Administer insulin at room temperature.
 Rotate the site of injection
 Store insulin at the refrigerator
 Gently roll vial in between palms do not shake.

IN
Drug therapy ( for dm type 2)
Oral hypoglycemic agents (oha)
 Drug of choice for type 2 diabetes mellitus.
 Stimulate the pancreas to secrete insulin----CGFNS
 Oral hypoglycemic agents are contraindicated during pregnancy-----LOCAL
DIAGNOSTIC TESTS
1. FBS- > 126
2. RBS- >200
3. OGTT- > 200
4. HgbA1- above 7 %----NCLEX
5. Urine glucose
6. Urine ketones

NURSING MANAGEMENT OF DM
 The main goal is to NORMALIZE insulin activity and blood glucose level by:

NUTRITIONAL MODIFICATION
 NUTRITIONAL ASPECT:
  Balanced diet is the best diet for diabetes mellitus------NCLEX
 Carefully follow the exchange list of the diet.
 Do not skip meals

EXERCISE
 All exercise must be carefully planned, suggest 6-7 days a week, the same time each day to
facilitate glucose control
 Exercise enhances effects of insulin so it may cause hypoglycemia.
 Blood glucose monitoring before and after exercise.----LOCAL
 Before doing strenuous activity have a light snack-----LOCAL

FOOT CARE
 Inspect feet daily for dryness, cracks or ingrown toenails using mirror.----LOCAL
 Thoroughly cleanse and dry feet and in between toes daily.
 Place skin moisturizers on feet to prevent cracking.-----LOCAL
 Never walk around barefooted
 Always wear socks with shoes
 Allow only podiatrist to care for corns, callouses, toenails.
 Must be aggressive in treating any foot wounds

DURING ILLNESS OR SURGERY

 Must continue to take medication- CBQ
 More insulin will be required.- CBQ
 Increase frequency of blood glucose monitoring.
 If unable to eat, take & increased fluids, simple carbohydrates.

HYPOGLYCEMIA
 Blood glucose level less than 50 to 60 mg/dL
 Causes: Too much insulin/OHA, too little food and excessive physical activity
 Mild- 40-60
 Moderate- 20-40
 Severe- less than 20
SIGNS and symptoms???
REMEMBER!!!!
S--- hakiness
H---unger
R---apid pulse
I----rritability
L---oss of concentration
S----eizure
HYPOGLYCEMIA
Nursing Interventions
1. Immediate treatment with the use of foods with simple sugar- glucose tablets, fruit juice, table
sugar, honey or hard candies
2. For unconscious patients- glucagon injection 1 mg IM/SQ; or IV 25 to 50 mL of D50/50
3. re-test glucose level in 15 minutes and re-treat if less than 75 mg/dL
4. Teach patient to refrain from eating high-calorie, high-fat desserts
5. Advise in-between snacks, especially when physical activity is increased
6. Teach the importance of compliance to medications

THE END
REFERENCES:
PORTH, CAROL MATSON, “ Essentials of pathophysiology, 2nd ed, 2007 lippincott ,USA
STEIN, ALICE M., “ NSNA 5TH Edition, Delmar learning ,2005
HURST, MARLENE, “Pathophysiology review”, Mc graw companies Inc. 2008, USA
SMELTZER, SUZANNE C. “ Brunner & suddarth’s textbook of medical surgical nursing 9th ed.,lippincott
2000
SILVESTRI, LINDA, “ Comprehensive review of NCLEX-RN examination, 3rd edition 2005 Elsevier Inc.
KRENTZ, ANDREW, “ Churchill’s pocketbook of Diabetes, 2000, Elsevier Inc.
UDAN, JOSIE QUIAMBAO, “ Medical surgical nursing: concepts & clinical application, 2002 Educational
publishing house, Philippines