ENDOCRINE Too much iodine (T3+T4)
Toxic nodular goiter
Thyroid replacement medication
(toxicity)
Lab values:
HIGH T3 and T4
Low TSH
Signs and Symptoms:
EENT- Exophthalmos (dry, sun, sleep)
ANTERIOR POSTERIOR METABOLISM-Low weight
1. Growth Hormone 1. Oxytocin- milk GIT-Increased appetite
2. Thyroid Stimulating ejection, uterine SNS-Sleep disturbance, insomnia
Hormone contraction GIT-Diarrhea
3. Prolactin 2. Antidiuretic V/S-Elevated temperature,
4. Adrenal Gland Hormone
tachycardia
5. Adrenocorticotropic (vasopressin)-
Hormone fluid retention INTEGUMENTARY-Diaphoresis,
6. Luteinizing Hormone Smooth skin
7. Follicle stimulating Amenorrhea due to negative feedback
Hormone mechanism
8. Melanocytes High ALL, low weight, TSH,
Stimulating Hormone menstruation
THYROID STORM/THYROID CRISIS
High vital signs, 80/120, tachycardia,
increased HR
THYROID GLAND Severe form
Found in trachea, butterfly-shaped Management:
Sympathetic Nervous system
Enhances catecholamines, adrenergic 1. Exophthalmos – eye drops/artificial
1. T3 (triiodothyronine)- tears
METABOLISM, GIT Put on sunglasses
2. T4 (thyroxine)- HEAT PAD, SKIN Tape the eyelids/ put eyepatch
Position: SEMI-FOWLER’S
HYPERTHYROIDISM DRUGS
Steroids
Cause: “Grave’s disease”
Teprotumumab
Autoimmune, Hyperactive TG (+goiter), 2. Low weight + increase appetite
increase TH Monitor Daily weight
Autoimmune causes inflammation in the Increase calories
fatpads (behind the eyes) 3. Diarrhea
Metabolism is increased (always Low-fiber diet
burning energy/body weight low but Increase fluids
high appetite) 4. Heat intolerance
Provide cool environment/ private room
Pathology:
5. Hyperactivity- non-stimulating 5. Laryngeal nerve damage
environment WOF: DYSPHONIA (severe
Give sedatives hoarseness)
Avoid stimulants Avoid talking too much
6. Increase V/S (HR)- always monitor q4 May speak every hour
7. Thyroid storm
HYPOTHYROIDISM
A-irway
Cause: Hashimoto’s Disease
B-reathing (expansion of the lungs)
Autoimmune, hypoactive, (-) or (+)
C-irculation goiter, low TH
Independent Nursing interventions Pathology:
DRUGS: Not enough iodine
Thyroidectomy
1. Thioamides – Anti-TH
Anti-thyroid medications
PROPYLTHIOURACIL (PTU)
Pituitary hormone
METHIMAZOLE
Affects women more
Taken with milks (because GI
irritants) Lab values:
WOF: Agranulocytosis (low WBC,
Low t3/t4, high TSH, high body weight
low platelets)
WOF: fever, sore throat, bleeding Signs and Symptoms:
(immediately report)
METABOLISM- Increased weight,
Surgery: loss of appetite (Anorexia)
GIT- Constipation
1. Thyroidectomy
Low T4- low Heat Pad+ Cold
Complication: Hypoparathyroidism, tetany, intolerance
low calcium Skin- dry and hair loss
low SNS- Hypoactive
WOF: spasm, twitching
low v/s (HR)
DOC: Calcium gluconate (should always be everything is slow and dry
available) decreased LOC
2. Thyroid Storm (emergency) MYXEDEMA COMA
WOF: Increased v/s
puffiness of face
Management: Report
severe form of hypothyroidism
3. Bleeding
WOF: Anterior/Posterior (Neck) Management:
AVOID flexion/hyperextension
1. increased weight, loss of appetite
Position: SEMI-FOWLER’S (to
Constipation- HIGH FIBER,
expand the lungs)
increased fluids
2. Cold
4. Laryngospasm
Thick multiple layers of clothing
WOF: Airway obstruction
Warm environment
Tracheostomy set should be always
3. Hypoactive
available
Monitor LOC High PTH increases blood calcium
AVOID Sedative High blood calcium, low calcium
4. Monitor HR
Signs and Symptoms:
5. Myxedema Coma
Assess facial features 1. High Calcium, low P = Hypoactive,
“ABC” (airway, breathing, circulation) constipation
DOC: IV 2. Weak bones= bone, joints pain,
pathologic fracture
Medications: “dagdagan ng Levo-Levo”
3. Heart- Arrythmia, high BP
1. Levothyroxine- thyroid hormone 4. Kidneys- polyuria
replacement
Management:
Take on Empty stomach
Give on morning before breakfast 1. Increase Calcium
(can cause insomnia) Decrease calcium diet
WOF: “hypothyroidism” DOC: Calcitonin
Report Side Effect/ Adverse Effect: 2. Low phosphorus
Hyperthyroidism Increase diet (Protein)
PARATHYROID GLAND DOC: IV, Phosphorus
1. Parathyroid Hormone 3. Weak Bones
Transfers calcium from the bones going Priority: SAFETY
to the blood Moderate Exercise (returns calcium to
Blood- Increased Calcium, Bone- the bones)
decreased Calcium DRUGS: ALENDRONATE
Weakens bones (FOSAMAX)
2. Calcitonin 4. Constipation- HIGH FIBER, increased
Blood- decrease calcium fluids
Bone- increase calcitonin 5. Arrythmia- monitor HR and BP
Strengthens bones 6. Kidneys- polyuria
7. Renal Calculi
Neuromuscular activity:
Decrease calcium= hyperactive muscle
(twitching, hyperreflexia)
Increase calcium- hypoactive muscle
(weakness, hyporeflexia)
Cardio:
Low calcium= low BP
High calcium= high BP HYPOPARATHYROIDISM
Kidneys: Cause: Thyroidectomy, low PTH, low blood
High Calcium= supersaturated/ solid calcium, high bone calcium
in urine Signs and Symptoms
HYPERPARATHYROIDISM 1. Low Ca, high Phosphorus
Cause: Tumor (ectopic) Twitching, Spasm
2. Tetany a) Aldosterone “salt”
Trousseau’s sign – “tapon sapatos Sodium and water retention
gamit kamay” corpo-pedal spasm (arm) Potassium excretion
Chvotek’s sign- facial twitching 3. ANDROGEN “Sex”
(cheeks)
CUSHING’S SUNDROME
Spasm- laryngospasm. Bronchospasm
Seizure Cause: Adrenal adenoma, prolonged steroid
3. Arrythmia- low BP therapy
Management: Signs and symptoms:
1. Low calcium- Increase calcium diet + Full Moon-face
vit. D Buffalo hump CLASSIC
Central obesity SIGN
DOC: Calcium Gluconate
Hypersecretion
2. High Phosphorus= decrease Increase suppress immunity= Increase
Phosphorus diet (protein) infection
Hypocalcemia
DOC: Aluminum Hydroxide (Phosphate
Easy bruising
Binder)
Hirsutism
3. Laryngospasm – tracheostomy set Obese trunk, thin arms and legs
4. Bronchospasm- DOC: Bronchodilator Edema, striae
5. Seizure precaution Hypertension, virilization,
6. Arrythmia- low BP, Monitor HR/BP hypernatremia
ADRENAL GLAND 1. Glucocorticoids
Parts of Adrenal Gland: Increase cortisol= increase sugar=
increase insulin = increase Adipocytes
Medulla (central)
2. Mineralocorticoids
Release catecholamines
High sodium and high h20, decrease K
(Norepinephrine,
3. Androgen- common in female
Epinephrine(adrenergic)
Management: (same with steroid management)
Cortex (anterior pituitary gland)
1. Increase cortisol- AVOID stress
Steroids hormones (ATCH, MSH)
2. Increase sugar- monitor blood glucose
3. Increase infection- AVOID crowded
and ill person
4. Decrease protein- HIGH PROTEIN
1. GLUCOCORTICOIDS “sugar” diet
a) Cortisol 5. Decrease calcium- increase calcium
releases during morning, increases diet and Vit. D
source of sugar/blood glucose 6. Increase Na and increase H20 – daily
release during stress (resistance) weight (1 kg = 1 L)
suppress immunity (immunosuppressed) 7. Hypokalemia- INCREASE
decreases calcium POTASSIUM DIET
2. MINERALOCORTICOIDS 8. Disturbed Body Image – “therapeutic
communication”
Medications: (decrease production of steroids) 3. Hypercalcemia- LOW CALCIUM diet
4. Hypernatremia+ low H20- MONITOR
1. Mitotone
DAILY WEIGHT
2. Metyrapone
3. Ketoconazole Drugs:
Surgery: 1. Corticosteroids “sone”
Taken in the morning with meals
1. Adrenalectomy
Refer to Management of Steroids
WOF: ADDISON’S WOF: Cushing’s
ADDISON’S DISEASE SYNDROME OF INAPPROPRIATE ADH
SECRETION (SIADH)
Cause: Adrenalectomy
Cause: Tumor, increase ADH (kidneys)
“Adrenal Insufficiency”, Autoimmune
Symptoms:
Signs and Symptoms:
Fluid restriction
Hyperpigmentation (bronze skin) Distended neck vein
Hyperkalemia Cerebral edema
Decreased cortisol hypersecretion of ADH
Hypotension
Dehydration Management:
Hypoglycemia
1. Increase ADH – DOC: Democlocyclin
hypernatremia
(ADH Blocker)
Hair loss, menstrual changes
2. FVE- daily weight, h20 restriction (800-
1. Glucocorticoids – “SSSPC”
1000ml/day)
S-ugar low 3. Oliguria- Input and ouput
S- tress low
S-upression
P-rotein (breakdown)
C-alcium increased]
ADDISONIAN CRISIS
Severe form of addison’s disease
Profound fatigue
DIABETES INSIPIDUS
Dehydration= shock
Renal failure Decrease in ADH, H20, USG
Vascular collapse
Cause: trauma and surgery
Hyponatremia
hyperkalemia Signs and Symptoms:
Management: Fluid volume deficit
Dehydration
1. Low cortisol- AVOID STRESS
Administration of ADH
2. Low sugar- monitor BG
Dilute urine
polydipsia DMI DMII
decrease ADH, kidneys= polyuria= fluid DIET- complex D
vein distention carbohydrates I
increase NA, polydipsia, brain shrinkage Insulin- DOC E
Exercise- moderate O
Management: 3-5/weeks H
Avoid stress- Increase A
1.decrease ADH cortisol= increase
DOC: ADH/Vasopressin (desmopressin) glucose
oral, intranasal, SC, IV
WOF: FVE/H20
PANCREAS
1. Exocrine- pancreatic enzyme
a) Amylase- carbohydrates
b) Lipase- fat
c) Protease- protein
2. Endocrine- islet of langerhans
a) Alpha- glucogen = increases glucose
b) Beta= insulin= decreases glucose
c) Delta= somatastatin= decrease gastin =
decrease HCL (Anti-GH)
DIABETES MELLITUS
DMI DMII
Early, late, adult onset
juvenile obese
onset metabolic
Thin syndrome/sydnrome X
Autoimmun increase LDL, HPN,
e- increase sugar,
destruction increase triglycerides,
of pancreas insulin resistance
Absence/ Hyperosmolar/
decrease Hyperglycemic Non-
insulin (no Ketonic Syndrome
metabolism (600 mg/dL)
of
Carbohydrat
es)
Diabetic
Ketoacidosi
s (250
mg/dL)
MANAGEMENT:
