Adult Health 1 - Endocrine System & Diabetes

General Functions of Hormones

1. Stimulate growth and development

2. Role in reproductive and CNS development

3. Maintaining Homeostasis

4. Responding to emergency demands

5. Sexual Reproduction

Water Soluble Hormones

Circulate freely in the blood

Act directly on target cells

E: prolactin, insulin, GH

Lipid Soluble Hormones

Bound to plasma proteins as they travel to target cells

Cross the cell membrane through diffusion

Ex: thyroid

Pineal Gland

Sleep/wake cycle

Produces melatonin

Hypothalamus

Releases substances to stimulate or inhibit production and release of hormones from the pituitary gland

Pituitary Gland

"Master Gland"

Relies on hypothalamus

Anterior Pituitary

Accounts for 80% of the gland by weight

Regulate by hypothalamus

Releases TSH, ACTH, FSH, LH, GH, and Prolactin

Posterior Pituitary

Comprised of nerve tissue and is extension of the hypothalamus

Hormones secreted by this gland are made in the hypothalamus, travel down nerve tracts, and are then stored until triggered to release by stimuli

Released ADH and Oxytocin

Thyroid GLand

Anterior part of the neck in front of the trachea

Highly vascular

Makes and secretes 3 hormones:

- Thyroxine (T4) - accounts for 90% of thyroid hormone

- Triiodothyronine (T3) - more potent and has greater metabolic effects

- Calcitonin - made by C-Cells in response to high circulating calcium levels. Helps regulate calcium in body with PTH

Parathyroid Gland (PTH)

2 pairs of parathyroid glands behind each thyroid lobe. Can range from 2-6

Secretes PTH

-plays major role in regulating serum calcium

- When serum calcium and magnesium levels are low, PTH secretion increases

- When serum calcium or active Vit D levels are high, PTH secretion decreases

- Serum calcium out of normal ranges = further PTH testing

High Thyroxine s/s

rapid heart beat

weight loss

nervousness

heat intolerance due to an elevated metabolic rate

Bug eyes

Low thyroxine s/s

fatigue

weight gain

cold intolerance

dry skin

hair loss due to slowed metabolic rate decreased energy production

fertility issues

Adrenal medulla

Inner part of the adrenal gland that acts independently of the cortex

Highly vascular

Essential part of the fight or flight response

Adrenal Medulla Secretions

Secretes catecholamines:

- Epinephrine

- Norepinephrine

- Dopamine

Adrenal cortex

Outer part of the adrenal gland

Highly vascular

Adrenal Cortex Secretions

Secretes several steroid hormones:

- Glucocorticoids (cortisol)

- Mineralcorticoids (aldosterone)

- Androgens (dehydroepiandrosterone - DHEA)

Glucocorticoids (cortisol)

helps maintain life and protect the body from stress

Regulates blood glucose and decreases the inflammatory response

Stress = increased cortisol levels

High Cortisol s/s

digestion/motility decreases

immune system decreases

weight gain

anxiousness

Mineralcorticoids (aldosterone)

Maintains extracellular fluid volume and is essential for fluid and electrolyte balance

Increased Mineralcorticoids (aldosterone)

Hyponatremia

hyperkalemia

Androgens (dehydroepiandrosterone - DHEA)

small amounts secreted and then converted to sex steroids in peripheral tissues.

Main source of estrogen in postmenopausal women.

High epinephrine s/s

increased HR, RR, and blood glucose

Sweating

Anxiety

Decreased GI motility

Heightened alertness as part o the body's fight or flight response

Low epinephrine s/s

Fatigue

low BP

Weakness

Difficulty in responding to stressful situations due to insufficient activation of the fight or flight response

Pancreas

Long, tapered, lobular, soft gland behind the stomach

Pancreas 2 functions

exocrine: releases enzymes that help with digestion and neutralize stomach acid

endocrine: secretes hormones directly into the blood stream

Islets of Langerhans

<2% of pancreas gland

hormones secreting part of the pancreas

Makes and secretes 4 types of hormones

Islets of Langerhans Secretions

Alpha (glucagon) - stimulates blood glucose release

Beta - insulin and amylin release

Delta - somatostatin - Growth Inhibiting Hormone

F (PP) - pancreatic polypeptide

Ovaries

Produces Estrogen

Controls developmental changes in females, such as breast development and the release of egg cells, which marks the beginning of menstruation

High Estrogen s/s

heavy/irregular menstruation

tender breasts

weight gain

Low estrogen s/s

Missed menstruation cycle

mood swings

hot flashes and night sweats

Testosterone

Produced by testes

It controls the developmental changes in males such as deeper voice, facial hair, and pubic hair and growth in muscle and bone strength

High Testosterone

Acne

Increased muscle mass

low sperm count

fertility issues

prostate enlargement (can cause difficulty when urinating)

Low Testosterone

Less body and facial hair

less muscle mass

hot flashes

brittle bones

decreased libido

BOX 52.5

Palpating thyroid (done by Doc)

Right hand palpates, while left hand displaces

Then have patient swallowing, feeling for lump

Levothyroxine NC

May take up to 8 weeks before full effect of hormone therapy is seen

Hypothyroidism/Levothyroxine Patient Teaching

avoid skin break down

warm environment

regular follow ups

Type 1 Diabetics Exercise Patient Teaching

Don't let the patient exercise if their BG is less than 100 or if above 250

Don't exercise if ketones are present

Fruity Breath

Indicates high ketones

Hyperglycemia

Kussmaul respirations

Kussmaul Respirations

Indicates metabolic acidosis

Shallow, fast breathing, retractions

Compensates to expel CO2

Normal Range BG

74-106

DKA s/s

Kussmaul respirations (hallmark)

Fruity breath

Ketones in urine (ketonuria)

Metabolic Acidosis (Typically partially compensated)

Decreased BP, Elevated HR

Potential Fever

Lethargy

dehydration

What do ketones in the urine suggest?

the body is breaking down fat for energy due to insufficient insulin

Fever related to DKA

DKA can be triggered by fever from infection

OR

Fever can be the result of metabolic disturbances associated with DKA

DKA BG

Exceeds 250

often 500-800

DKA Tx

Fluid Bolus (NS or LS) (first)

Insulin Drip (Regular insulin)

Watch electrolyte levels

Correct acidosis

Insulin drip NC

Insulin decreases serum K+

DKA monitoring NC

Telemetry

BG levels

Electrolytes

Urine output

ABGs

Rapid Acting Insulin

Lispro/humalog

Aspart/Novolog/Fiasp

Glulisine/Apidra

Rapid Acting Insulin Onset, Peak, & Duration

Onset: 10-30 minutes

Peak: 30 min-3 hours

Duration: 3-5 hours

Regular/Short Acting Insulin

Only insulin that can be given IV

Humulin R

Novolin R

Regular/Short Acting Insulin Onset, Peak, & Duration

Onset: 30 min - 1 hr

Peak: 2 - 5 hrs

Duration: 5-8 hrs

Intermediate Acting Insulin

NPH

Humulin N

Novolin N

Intermediate Acting Insulin Onset, Peak & Duration

Onset: 1.5-4 hrs

Peak: 4-12 hrs

Duration: 12-18 hrs

Long Acting Insulin

glargine

detemir

degludec

Long Acting Insulin Onset, Peak, & Duration

Onset: 0.8-4 hrs

Peak: less defined or nor pronounced peak

Duration: 16-24 hrs

Inhaled insulin

Afrezza

Inhaled insulin onset, peak & duration

Onset: 12-15 min

Peak: 1 hr

Duration: 2.5-3 hours

HbA1c prediabetic

5.7-6.4% = prediabetic