THYROID HORMONES

 Triiodothyronine (T3)
 Thyroxine (T4)
 T3 and t4: Increase the metabolic rate; increase protein and bone tuenover;
increase responsiveness to catecholamines
 Thyrocalcitonin: promote calcium resorption

Thyroid Disorders:
 Goiter
 Hypothyroidism
 Hyperthyroidism
 Thyroiditis
 Thyroid tumor

 SIMPLE GOITER
A.PREDISPOSING FACTORS
1.Goiter belt area
2.Increase intake of goitrogenic foods
•cabbage, turnips, radish, strawberry, carrots, sweet potato, broccoli, all
nuts
3.Goitrogenic drugs
a.Anti Thyroid Agent – Prophylthiuracil (PTU)
b.Lithium Carbonate
c.ASA (Aspirin)
d.Cobalt
e.Phenylbutazones (NSAIDs)

A.
SIGNS AND SYMPTOMS
1. Enlarged thyroid gland
2. Mild dysphagia
3. Mild restlessness
B. DIAGNOSTIC PROCEDURES
1. Decreased serum T3 and T4
 2. Thyroid Scan –enlarged thyroid gland
3. Thyroid Stimulating Hormone (TSH) – increased
CONFIRMATORY DIAGNOSTIC TEST

C. NURSING MANAGEMENT
1. Enforce complete bed rest
2. Administer medications as ordered
a. LUGOL’S SOLUTION / SSKI
ADMINISTER VIA STRAW TO PREVENT

STAINING OF TEETH

Medications to be taken via straw:

LUGOL’S, IRON, TETRACYCLINE, NITROFURANTOIN

b. THYROID HORMONES
• LEVOTHYROXINE (SYNTHROID)
• LIOTHYRONINE (CYTOMEL)
• THYROID EXTRACTS
Nursing management when giving thyroid hormones:
1. Instruct client to take in the morning to prevent insomnia
2. Monitor vital signs especially heart rate
because drug causes tachycardia and
palpitations
3. Monitor side effects insomnia, tachycardia, palpitations,
hypertension, heat intolerance
 4. Increase dietary intake of foods rich in iodine
• seaweeds
• seafood’s like oyster, crabs, clams and lobster
but not shrimps because it contains lesser
amount of iodine.
• iodized salt, best taken raw because it is easily destroyed by
heat
5. Assist in SUBTOTAL THYROIDECTOMY

HYPOTHYROIDISM HYPERTHYROIDISM
DIAGNOSTIC TESTS: DIAGNOSTIC TESTS:
1. Serum T3 and T4 is DECREASED 1. Serum T3 and T4 is INCREASED
2. Serum Cholesterol is INCREASED 2. RAIU is INCREASED
3. RAIU is DECREASED 3. Thyroid Scan - reveals an
ENLARGED
THYROID GLAND

NURSING MANAGEMENT: NURSING MANAGEMENT:

1. Monitor strictly vital signs and intake and
output to determine presence of:
1. Monitor strictly vital signs
and intake and output to
• MYXEDEMA COMA is a severe form of
determine presence of:
hypothyroidism is characterized by severe
• THYROID STORM is a severe form of
hypotension, bradycardia, bradypnea,
hyperthyroidism is characterized by
hypoventilation, hyponatremia, hypoglycemia severe hypertension, tachycardia,
leading to progressive stupor and coma. tachypnea, hyperventilation,
hyperpyrexia, altered neurologic or
mental state, which frequently appears
as delirium psychosis, somnolence, or
coma

NURSING MANAGEMENT FOR NURSING

MYXEDEMA MANAGEMENT
COMA FOR
 Assist in mechanical ventilation THYROTOXICOSI
S
 Administer thyroid hormones as ordered  Cool quiet environment
 Force fluids  O2 inhalation
 IV fluids (hypertonic)
2. Force fluids
 Antithyroid agents
3. Administer isotonic fluid solution as ordered
2. Administer medications as ordered
4. Administer medications: Antithyroid
Thyroid Agents
Hormo PROPHYT
nes HIORACIL
LEVOT (PTU)
HYRO METHYMA
XINE ZOLE
LEOTH (TAPAZOL
YRON E)
INE Side effects:
THYR AGRANULOCYTO
OID SIS
EXTRA
CTS • increase lymphocytes and

5. Provide dietary intake that is monocytes, fever and

chills, sore throat,
LOW IN CALORIES leukocytosis (CBC)

6. Provide comfortable and warm BETA

-
environment
BLO
7. Provide meticulous skin care CKE
RS
PRO
PAN
OLOL
(IND
ERAL
)
ATE
NOL
OL
(TEN
ORM
IN)
 3. Provide dietary intake that is
INCREASED IN
CALORIES.

NURSING MANAGEMENT: NURSING MANAGEMENT:

8. Provide client health teaching and 4. Provide meticulous skin care
discharge
planning concerning: 5. Comfortable and cold environment
a. Avoid precipitating factors leading to
myxedema coma
6. Maintain side rails
• stress
7. Provide bilateral eye patch to
prevent drying
• infection of the eyes.

• cold intolerance 8. Assist in surgical procedures:

SUBTOTAL
• use of anesthetics, THYROIDECTO
narcotics, and sedatives MY
• prevent complications
• Before thyroidectomy administer
LUGOL’S SOLUTION, SSKI,
(myxedema coma, POTASSIUM IODIDE to
hypovolemic shock decrease bleeding and
• hormonal replacement therapy for
hemorrhage.

lifetime
• importance of follow up care

• Alert physician to medications taken that can alter results of

diagnostic tests, especially estrogen, salicylates, amphetamines,
antibiotics, corticosteroids, and mercurial diuretics
• Modify client activity to accommodate fatigue
• Promote independence in self-care activities
• Provide extra layers of clothing or extra blanket
• Monitor body temperature and report decreases from
baseline
• Provide foods high in fiber
• Monitor respiratory rate, depth, pattern, pulse oximetry, and
arterial blood gas
• Orient client to time, place, and events
• Monitor for increasing severity of decreased LOC, VS
changes, and increasing difficulty in arousal
• Position a newborn with a goiter with the neck hyperextended
to aid breathing; provide supplemental oxygen; and have a
 tracheostomy set immediately available in case tracheal
compression by the goiter requires emergency ventilation.

• Monitor VS especially heart rate and rhythm

• Monitor serum albumin, hemoglobin, and lymphocyte levels
• Encourage a diet high in calories, proteins, and carbohydrates
• Encourage six meals per day
• Weigh at least weekly
• Assess for visual changes: photophobia, decreased acuity, or ability to close eyes
• If exophthalmos is present, protect eyes with glasses, wet with artificial tears,
elevate head of bed at night; avoid sleeping in a prone position and wear a
patch at night if eyelids do not fully close
• Assess level of mentation for impending storm

ADDISON’S VERSUS CUSHING’S DISEASE

ADDISON’S CUSHING’S

RISK FACTORS: RISK FACTORS:

1. Atrophy of adrenal glands 1. Hyperplasia of adrenal gland

2. Fungal infections

SIGNS AND SYMPTOMS: SIGNS AND SYMPTOMS:

1. HYPOGLYCEMIA 1. Increase susceptibility to infections

2. Decrease tolerance to stress 2. HYPERNATREMIA

3. HYPONATREMIA • Hypertension, edema, weight gain, MOON FACE

APPEARANCE AND BUFFALO HUMP, obese trunk,
• hypotension pendulous abdomen, thin extremities

• signs of dehydration •
• weight loss •
4. HYPERKALEMIA

• agitation

• diarrhea

• arrhythmia

5. Decrease libido
 6. Loss of pubic and axillary hair

7. BRONZE LIKE SKIN

PIGMENTATION

•
3. HYPOKALEMIA

• Weakness and fatigue, constipation, U wave upon

ECG (T wave hyperkalemia)
5. Hirsutism

6. Acne and striae

7. Easy bruising

8. INCREASE MASCULINITY AMONG FEMALES

DIAGNOSTIC PROCEDURES:
DIAGNOSTIC PROCEDURES:
1. FBS is INCREASED
1. FBS is DECREASED 2. Plasma cortisol is INCREASED
2. Plasma cortisol is 3. Serum sodium is INCREASED
DECREASED Serum potassium is DECREASED
3. Serum sodium is
DECREASED
Serum potassium is INCREASED
NURSING MANAGEMENT: NURSING MANAGEMENT:
1. Monitor strictly vital signs, 1. Monitor strictly vital signs and
input and output to intake and output
determine presence of 2. Weigh patient daily and assess for
ADDISONIAN CRISIS pitting edema
Addisonian crisis characterized by: 3. Measure abdominal girth daily and notify physician
a. severe hypotension 4. Restrict sodium intake
b. hypovolemic shock 5. Provide meticulous skin care
c. hyponatremia leading 6. Administer medications as ordered
to progressive stupor a. Spinarolactone – potassium
and coma sparing diuretic
7. Prevent complications (DM)
8. Assist in surgical procedure
NURSING MANAGEMENT (BILATERAL ADRENALECTOMY)
FOR ADDISONIAN CRISIS: 9. Hormonal replacement for lifetime
1. Assist in mechanical 10. Importance of follow up care
ventilation,
2. Administer ISOTONIC
FLUID
SOLUTION as ordered
3. Force fluids
 4. Administer medications as
ordered:
CORTICOSTEROIDS:
a. DEXAMETHASONE
(DECADRONE)
b. PREDNISONE
c. HYDROCORTISONE
(CORTISON)

•Interventions to promote fluid balance and monitor for fluid deficit — Weigh daily,
record I&O
•Assess VS every 1–4 hours
•Kayexalate may be needed if severe hyperkalemia is present
•Monitor blood glucose levels every 4 hours for hypoglycemia.
•Manage activity intolerance with gradual increases in self-care activities
•Alert client to strategies to minimize anxiety and stress
•Monitor for electrolyte imbalances, hyperglycemia, and opportunistic infections
•Provide a diet low in sodium, high in potassium, limited in calories and with
increased amounts of calcium and vitamin D
•Provide measures to prevent skin breakdown
•Assist the client in avoiding pathologic fractures
•Monitor and manage potential for Addisonian crisis, which can result from
withdrawal of exogenous
•Monitor for electrolyte imbalances, hyperglycemia, and opportunistic infections
•Provide a diet low in sodium, high in potassium, limited in calories and with
increased amounts of calcium and vitamin D
•Provide measures to prevent skin breakdown
•Assist the client in avoiding pathologic fractures

NURSING MANAGEMENT WHEN GIVING STEROIDS

1. Instruct client to take 2/3 dose in the morning and 1/3 dose in the
afternoon to mimic the normal diurnal rhythm
2. Monitor side effects
a. HYPERTENSION
b. EDEMA
c. HIRSUTISM
d. INCREASED SUSCEPTIBILITY TO INFECTION
e. MOON FACE APPEARANCE
3. Provide dietary intake, INCREASE CALORIES, CARBOHYDRATES,
PROTEIN but DECREASE IN POTASSIUM

4. Provide meticulous skin care

5. Provide client health teaching and discharge planning
a. avoid precipitating factor leading to Addisonian crisis:
• stress
• infection
• sudden withdrawal to steroids
b. prevent complications
• Addisonian crisis
• hypovolemic shock
c. hormonal replacement for lifetime
d. importance of follow up care

PREOPERATIVE CARE
• Monitor the patient for electrolyte imbalance and hyperglycemia.
• To prevent adrenal crisis, glucocorticoids are administered because
removal of the
adrenals causes a sudden drop in adrenal hormones.

POSTOPERATIVE CARE
• The patient is closely monitored for changes in fluid
and electrolyte balance and adrenal crisis.
• Patients must take replacement glucocorticoid and mineralocorticoid
hormones for the remainder of their life

DIABETES MELLITUS

 metabolic disorder characterized by non-utilization of CHO, CHON and FAT

metabolism

DM I (IDDM) DM II (NIDDM)

Definition Juvenile Onset/ Non-obese; Adult Onset/Obese (40 yo

children; BRITTLE DISEASE above) Maturity-onset
type

Incidence 10% of general population 90% of the general

Rate population
Predisposing 1. Hereditary – total Obesity  lack of insulin
Factors destruction of pancreatic receptor binding sites
cells
2. Viruses
3. Toxicities (CCl4)
4. Drugs, steroids and loop
diuretics (furosemide)
Signs and 1. Polyuria, polydipsia, Usually asymptomatic
polyphagia (3P’s +1G, weight gain)
Symptoms 2. Glucosuria
3. Weight loss, anorexia, Absence of lypolysis
nausea and vomiting
4. Blurring of vision
5. Increased susceptibility to
infection
6. Poor/delayed wound healing
(lower extremity – distal to
the heart)
Treatment 1. Insulin 1. OHA
2. Exercise 2. Diet
3. Diet 3. Exercise
4. Sodium Bicarbonate for 4. Insulin used during
acidosis emergency situation
Complication DKA that may lead to diabetic HONK
s coma

 Acute complication of type 1

DM due to hyperglycemia
leading to severe CNS
depression
 Predisposing Factors:
 Hyperglycemia
 Stress
 Infection
 Signs and symptoms
 3P’s and G
 Weight loss
 Anorexia, nausea and
vomiting
 Acetone breath,
kussmaul’s,
decreased LOC 
coma
 Dx: elevated FBS, BUN,
Crea and Hct

Main Anabolism Catabolism

food
Stuff

CHO Glucose Glycogen

CHON Amino Nitrogen

acids

FATS Fatty acids Free fatty acids 

ketones and cholesterol

 Food  CHO  glucose  insulin aids in absorption of glucose  Cells 

ATP (main fuel of the cells)
 GLUCONEOGENESIS – formation of glucose from non-carbohydrate
sources (CHON and fats)
 Liver  glycogenesis and glycogenolysis  glucose in bloodstream
 Increased fat metabolism release of FFA
 Cholesterol  deposition in arteries  HPN  CVA, MI  death
 Increased CHON catabolism  -N balance  tissue wasting 
cachexia
 Ketones (CNS depressant)  DKA  Kussmaul’s respiration 
acetone breath  diabetic coma
 DM  hyperglycemia  increased osmotic diuresis
 Polyuria  cellular dehydration  stimulates thirst center 
polydipsia
 Glucosuria  cellular starvation  stimulate appetite center 
polyphagia

 DIAGNOSTICS:
1. FBS if elevated 3 consecutive times +3Ps and G = DM
Normal: Less than 100 mg/dL
Pre-diabetes: 100-125 mg/dL (5.6 to 6.9 mmol/L)
Diabetes: 126 mg/dL (7 mmol/L) or higher on 2 separate
occasions/test
2. Alpha Glycosylated Hgb increased – DM is confirmed if the result is 7%
or higher

 DM management
1. Monitor for peak action of OHA and insulin
2. Administer insulin/OHA as ordered
a. Brain can tolerate elevated glucose levels but not decreased
glucose
3. Monitor strictly VS, CBG, I/O
4. Monitor for s/sx of hypogly and hypergly and notify MD
5. Diabetic diet: CHO 50%, CHON 30%, Fats 20%
a. Offer alternative food substitutes
b. Give orange juice if patient refuses to eat
6. Exercise after meals when blood glucose is rising
7. Monitor for Sx complications
a. Atherosclerosis  HPN  MI or CVA
b. Microangiopathies
 Eyes
 Blindness or Retinopathy
 Premature Cataract – hazy vision, decreased
color vision; use mydriatics
 Kidneys
 Recurrent pyelonephritis (inflammation of renal
pelvis
 Renal failure ( common causes: HPN, DM)
 Gangrene formation
 Shock
 Peripheral neuropathy
 Diarrhea, constipation
 Sexual impotence (HPN, DM)

8. Foot care management

a. Avoid walking barefooted
b. Cut toenails straight
c. Apply lanolin to prevent skin breakdown
d. (-) constricting garments
9. Encourage annual eye and kidney exam
10. Monitor for signs of DKA or HONK
11. Assist in surgical wound debridement
a. Administer analgesics prior to debridement
b. Assist in surgical procedures such as amputation