LLANERA, Daniel Kevin P. Mrs.
Rowena Escolar-Chua, RN, MAN
BSN III – 6 RLE 2 September 15, 2010
SUMMARY: Care of Patients with Endocrine Disorders
Disease Condition and Main Problem Signs and Symptoms Management
Pituitary Tumors Eosinophilic Diagnostics:
an abnormal growth in the pituitary gland thus the early gigantism (maybe 7 ft) Physical examination
inability of the body to regulate its balance of lethargic and weak CT and MRI
hormones acromegaly (in adult onset) Serum levels of pituitary hormones and endocrine
severe headaches and visual disturbances organ hormones
decalcification of bones Medical:
muscular weakness Hypophysectomy
hyperthyroidism-like symptoms Radiation therapy – stereotactic or conventional
Basophilic Bromocriptine – dopamine antagonist
Cushing’s syndrome Octreotide – synthetic analog of GH
Masculinization Replacement therapy – corticosteroids and thyroid
Amenorrhea hormone
Truncal obesity Nursing:
Hypertension Postoperative care
Osteoporosis Teaching patients for long term management and
Polycythemia medication therapy
Chromophobic (causes hypopituitarism)
Obesity
Somnolent
Fine scanty hair
Dry soft skin
Pasty complexion
Small bones
Headaches, loss of libido, visual defects (may lead to
blindness)
Others: polyuria, polyphagia, low BMR, subnormal body
temperature
Diabetes Insipidus Polyuria Diagnostics:
Posterior pituitary gland disorder characterized by a Water-like urine (spg = 1.001-1.005) Fluid deprivation test (8-12 hours of no FI or until
deficiency of ADH (vasopressin) (-) abnormal substance in urine like glucose and albumin 3%-5% of BW is lost)
Intense thirst for cold water o Frequent weighing
Polydipsia (2-20 L/day) o Serum/urine osmolality evaluation at
Onset: birth (if hereditary) or abrupt (if adult) beginning and end
Fluid restriction may result to hyponatremia and severe o Frequent monitoring
dehydration o (+) – tachycardia, excessive weight loss,
hypotension
ADH level monitoring
Medical:
GOALS:
o To replace ADH – long term
o To ensure adequate fluid replacement
o To identify and correct the underlying
intracranial pathology
Desmopressin (DDAVP) – synthetic vasopressin
o Intranasal, 1-2/day
o Caution in CAD patients
IM ADH/vasopressin tanate
o Every 24-96 hours
o Warmed and shaken before administration
o HS
o Rotate site to prevent lipodystrophy
Clofibrate (Atromid-S; hypolipidemic agent) – has
antidiuretic effect
Chlorpropamide (Diabinese) and thiazide diuretics –
potentiate ADH action
Nursing:
Follow up care and emergency measures and verbal
and written instructions on pharmacologic information
Return demonstrations for relatives regarding correct
drug administrations
Provide information regarding signs and symptoms of
hyponatremia
Advise wearing a medical ID and carrying medication
and information about DI at all times
Syndrome of Inappropriate ADH Hyponatremia Medical:
Excessive ADH secretion from PPG even in the face Confusion Treatment of underlying cause
of subnormal serum osmolality Nausea Restrict fluid intake
Altered mood Furosemide
Seizures Nursing:
Loss of consciousness Strick I/O monitoring
Daily weight, urine, blood chemistries, and neurologic
status monitoring
Supportive measures and explanations of procedures
and treatments
Hypothyroidism Fatigue Inadequate ventilation and Medical:
Suboptimal levels of thyroid hormones Weakness sleep apnea Synthetic levothyroxime (Synthroid or Levothroid)
Weight gain or Pleural and pericardial Prevention of cardiac dysfunction
increased difficulty effusion Prevention of medication interactions – insulin, oral
losing weight Respiratory muscular hypoglycemic agents, digoxin, anticoagulants,
Coarse, dry hair depression indomethacin, phenytoin, tricyclic antidepressants,
Dry, rough pale skin Hypercholesterolemia calcium
Brittle nails Atherosclerosis ABG monitoring
paraesthesia CAD MechVen
Hair loss Left CHF Pulse oximetry
Cold intolerance Myxedema coma – Corticosteroid therapy
Muscle cramps and hyperthermic and Nursing:
frequent muscle unconscious Activity intolerance
aches Sensitivity to analgesics, o Proper spacing of activities
Constipation sedatives and anesthetic o Assist when fatigued
Depression agents o Provide stimulation through nonstressful
Irritability Decreased libido activities
Memory loss Personality and cognitive o Monitor response to increasing activities
Abnormal menstrual characteristics of dementia Risk for imbalanced body temperature
cycles o Provide extra layer of clothing/blanket
o Avoid use of external heat source
o Monitor body temperature
o Protect from exposure to cold
Constipation
o High fiber; increase fluid intake within fluid
restriction
o Encourage exercise
Knowledge deficit
Ineffective breathing pattern related to depressed
ventilation
o Monitor respiration
o Encourage DBCE
o Suction as needed
Myxedema and coma
o Monitor GCS/VS frequently
o Turn and reposition at intervals
o Avoid CNS depressants
Hyperthyroidism Palpitations Medical:
Excessive output of thyroid hormones Heat intolerance Irradiation with radioisotope iodine 131 (at risk for
Nervousness AR: thyroid storms – cardiac dysrhythmias, fever,
Insomnia neurologic impairment; treat with propranolol)
Breathlessness Antithyroid medications – propylthiouracil (PTU) or
Increased bowel movements methimazole (Tapazole)
Light or absent menstrual periods Thyroidectomy
Fatigue Nursing:
Fast heart rate Maintain a calm, cool environment
Trembling hands Nurse should be calm & unrushed
Weight loss Procedures should be done slowly
Muscle weakness Avoid: upsetting visitors & topics
Warm moist skin Quiet roommate
Hair loss Promote safety - prone to accidents
Staring gaze Eye care - artificial tears, HOB elevated, dark glasses,
if unable to close protect mask
Diet- increased calories, protein, CHO, vitamins &
minerals
Avoid stimulants - caffeine, spice, nicotine
Acute Thyroiditis Anterior neck pain and swelling ATB
Infection of the thyroid gland; most common: S. Fever Fluid replacement
aureus Dysphagia Surgical incision and drainage - abscess
Dysphonia
Pharyngitis or pharyngeal pain
Subacute granulomatous thyroiditis (de Quervain’s Myalgias NSAIDS
thyroiditis) Pharyngitis No ASA
Inflammation of the thyroid gland; women of 40-50 Low-grade fever Beta-blockers to control hyperthyroidism symptoms
years old – high risk; viral – coxsackievirus group A Fatigue Steroids
and B and echovirus Painful swelling of anterior neck – lasts 1-2 months
Dysphagia
Irritability, nervousness and insomnia
Weight loss
chills
Subacute lymphocytic thyroiditis (painless or silent Hypo/hyperthyroidism symptoms Symptomatic treatment
thyroiditis)
Inflammation of thyroid gland; often in postpartum
period; autoimmune
Chronic thyroiditis (Hashimoto’s Disease) Normal to low thyroid activity Thyroid hormone therapy
Inflammation of the thyroid gland; common in 30-50 Symptoms of hypothyroidism if left untreated Surgery if pressure symptoms persists
year old women
Endemic goiter (iron-deficient) Hyperthyroidism symptoms Supplementary iodine – SSKI
Caused by iodine deficiency or consumption of large thyroidectomy
quantities of goitrogenic substances
Hypertrophy of the thyroid gland caused by
stimulation of the pituitary gland
Increased secretion of TSH
Nodular Goiter no specific symptoms but pressure symptoms may occur surgery
hyperplasia of areas of the thyroid gland
Thyroid Cancer Problems with swallowing Medical:
malignancy of thyroid tumors/nodules Hoarseness Total or near total thyroidectomy
Enlarged lymph nodes in the neck Radioactive iodine therapy
Breathing difficulty Hormone therapy (postop)
Pain in the throat and/or neck External radiation therapy
Lesions that are single, hard and fixed on palpation Chemotherapy
Nursing:
Diet- increased calories, protein, CHO, vitamins &
minerals
Avoid stimulants - caffeine, spice, nicotine
Perioperative care and teachings
Monitor for signs of bleeding, respiratory distress,
pain
Semi -fowler’s
No flexion or hyperextension – use small pillow
Position hands behind neck to stabilize neck when
moving
Inspect dressing under neck for hidden haemorrhage
Talk as little as possible post op
Ambulate asap
Monitor for hypocalcemia (Chvostek’s or
Trousseau’s)– ready IV calcium gluconate
Hyperparathyroidism May be asymptomatic Medical:
Overproduction of parathormone by the parathyroid weakness and fatigue, depression, or aches and pains Parathyroidectomy
glands loss of appetite, nausea, vomiting, constipation, confusion 2000ml or more daily fluid intake
Primary – 2-4x more in women; 60-70 y/o; 50% are or impaired thinking and memory, and increased thirst and Acidify urine
asymptomatic urination Encourage exercise
Secondary – CRF or renal rickets; increased phosphaturia and hypercalciuria Avoid restrictive or excess calcium diet
stimulation of PT glands and increased apathy, hypertension, cardiac dysrhythmias Nursing:
parathormone secretion joint and back pain, pain on weight-bearing Postoperative considerations
pathologic fractures Monitor for signs of hypercalcemia
deformities
shortening of body stature
high incidence of peptic ulcer and pancreatitis
Hypoparathyroidism Muscle spasm or cramping, typically in hands or feet Medical:
Inadequate secretion of parathormone resulting (tetany) Parenteral parathormone
from decreased blood supply, removal of parathyroid Hair loss IV calcium gluconate for hypocalcemia or tetany
gland during thyroidectomy, parathyroidectomy, or Dry skin or malformed nails episodes
radial neck dissection or atrophy of the said gland Numbness, tingling, or burning, especially around the Tracheostomy or mechven
mouth and fingers High calcium, low phosphorus diet
Candidiasis (yeast infection) Vitamin D administration
Seizures Nursing:
Chvostek’s sign and Trousseau’s sign Early detection of signs of hypocalcemia and tetany,
seizures and respiratory distress
FOR CHILDREN: Calcium gluconate at bedside
o Poor tooth development Continuous cardiac monitoring
o Vomiting Teach about medication and diet therapy
o Headaches
o Mental deficiency
Pheochromocytoma High blood pressure Medical:
A tumor that is usually benign and originates from Rapid heart rate Alpha-adrenergic blocking agents and smooth muscle
the chromaffin cells of the adrenal medulla Forceful heartbeat relaxants for hypertensive crisis
Profound sweating Calcium channel blockers
Abdominal pain Beta-blockers
Sudden-onset headaches — usually severe — of varying Catecholamine synthesis inhibitors
duration Adrenalectomy
Feeling of anxiety Corticosteroid therapy
Feeling of extreme fright Nursing:
Pale skin Teach about medication and compliance to regimen
Weight loss Follow up
Addison’s Disease (adrenocortical insufficiency) chronic, worsening fatigue Medical:
Adrenal cortex function is inadequate to meet the muscle weakness restoring blood circulation
patient’s need for cortical hormones loss of appetite administer fluids and corticosteroids
weight loss monitor VS
Addisonian crisis – cyanosis, pallor, apprehension, rapid place patient in recumbent position with legs elevated
and weak pulse, rapid respirations, and low blood pressure ATB if with infection
nausea Nursing:
vomiting Monitor for signs and symptoms of addisonian crisis
diarrhea Encourage to consume foods and fluids that assist in
low blood pressure that falls further when standing, restoring and maintaining fluid and electrolyte
causing dizziness or fainting balance
irritability and depression Avoid unnecessary activity and stress
a craving for salty foods due to salt loss
hypoglycemia, or low blood glucose
headache
sweating
in women, irregular or absent menstrual periods
Cushing’s Syndrome upper body obesity disturbed sleep pattern Medical:
Excessive adrenocortical activity a rounded face muscle wasting transsphenoidal hypophysectomy
increased fat around osteoporosis radiation of pituitary gland
the neck kyphosis adrenalectomy
relatively slender arms back ache adrenal enzyme inhibitors – metyrapone,
and legs compression fractures aminoglutethimide, mitotane, ketoconazole
glucose intolerance moon-faced appearance corticosteroids
buffalo hump in neck weight gain Nursing:
and supraclavicular slow healing establish protective environment
areas virilisation in women prevent exposure to infection
heavy trunk psychosis postoperative care and teaching
thin extremities ecchymoses and striae encourage rest and activity
thin, fragile and easily promote skin integrity
traumatized skin monitor for signs of addisonian crisis and
weakness and lassitude hyperglycemia
Primary Aldosteronism Hypokalemia – muscle weakness, fatigue, cramping Medical:
excessive production of aldosterone Alkalosis adrenalectomy
Hypertension spironolactone for hypertension
Polyuria insulin
Diluted urine diet modifications
High serum osmolality IV fluids
Polydipsia Nursing:
Hypocalemia and hyperglycemia risk Monitor for signs of adrenocortical insufficiency and
crisis and haemorrhage
Diabetes Mellitus Polyuria Medical:
A group of metabolic diseases characterized by Polydipsia Insulin therapy
hyperglycemia resulting from defects in inuslin Polyphagia Oral hypoglycemic agents
secretion, insulin action or both Weakness Medical nutrition therapy
Type 1 (IDDM), Type 2 (NIDDM), Gestational Sudden vision changes Pramlintide
Paresthesia of hands and feet Exenatide
Dry skin Nursing:
Slow healing Providing education to patient
Recurrent infection Monitor for signs of hypo/hyperglycemia and
Sudden weight loss ketoacidosis and hyperglycemic hyperosmolar
n/v nonketotic syndrome (HHNS)
abdominal pain Prevention of long term complications of diabetes
