Endocrine

Endocrine System: Pathophysiology

  • Overview: The endocrine system consists of glands that store and secrete hormones regulating homeostasis in the body.

  • Hypothalamus: Coordinates hormone production and release.

  • Pituitary Gland: Secretes hormones that regulate other endocrine glands.

Hyperglycemia

Pathophysiology

  • Pancreas has 2 Functions:

    • Endocrine Function: Secretes insulin or glucagon to regulate blood glucose levels.

    • Exocrine Function: Secretes digestive enzymes (e.g., amylase, lipase).

  • Hormonal Functions:

    • Glucagon: Released when blood glucose is low to prevent hypoglycemia.

    • Insulin: Key hormone facilitating glucose absorption into cells.

  • Pancreas anatomy diagram
Cycle of Hyperglycemia:

  1. Carbohydrates are digested into glucose.

  2. Glucose is transported via the circulatory system to the brain and muscles.

  3. Insulin is produced by pancreatic beta cells and binds to cell receptors to decrease circulating glucose levels

Lack of Insulin Effects

  • Without insulin, cells cannot uptake glucose, leading to glucose release from liver stores via gluconeogenesis and glycogenolysis:

    • Gluconeogenesis: Generation of glucose from non-carbohydrate substances.

    • Glycogenolysis: Breakdown of glycogen to glucose, occurring primarily in the liver and muscles.

Risk Factors for Hyperglycemia

  • Obesity

  • Smoking

  • Medications

  • Illness/Infection

  • Genetics

  • Chronic stress

  • Insomnia

  • Sedentary lifestyle

Complications of Hyperglycemia

  • Comorbidities and complications include:

    • Metabolic syndrome

    • Coma

    • Death

    • Damage to blood vessels and nerves

    • Coronary artery disease

    • Stroke

    • Peripheral vascular disease

    • Retinopathy

    • Nephropathy(nerve damage)

    • Poor wound healing

    • Depression

Comorbidities with Hyperglycemia

  • Autoimmune disorders

  • Hyperlipidemia

  • Hypertension

  • Gestational diabetes

  • Polycystic ovary syndrome

  • Cushing’s syndrome

  • Acromegaly

  • Pheochromocytoma

  • IF someone has diabetic neuropathy what do you educate them on?

    • control blood sugar/glucose

    • daily foot care

  • IF someone has diabetic retinopathy what do you educate them on?

    • control blood sugar/glucose

    • yearly eye exams

Impact on Overall Health

  • Symptoms include polyuria(constant pee), polydipsia(constant drinking), and polyphagia(excessive eating)

  • ^^^These are LATE signs of hyperglycemia

Clinical Presentation

  • Symptoms include:

    • Increased urine output

    • Thirst

    • Weight loss

    • Dry mucous membranes

    • Low blood pressure

    • Increased heart rate

    • Altered cognition

    • Abdominal pain

    • Nausea and vomiting

    • Fruity breath

    • Fast, shallow respirations (kusmal)

Lab Testing and Diagnostic Studies

  • Blood Glucose Testing:

    • Fasting: Greater than 125{ mg/dL}

    • Postprandial: Greater than 180{ mg/dL}

    • ^^^Postprandial(after eating)

  • Hemoglobin A1c (HbA1c):

  • blood sugar over last 3 monthsI got better at taking blood sugar readings, I built rapport with the patients even the ones that were initially unwilling, I regularly took not of vitals and was able to compare them with my baseline knowledge of reference ranges


  • Measures average glucose over the previous 2-3 months; goal is less than 6 .

Role of the Nurse

  • Responsibilities include:

    • Glucose monitoring

    • Medication administration

    • Collaborate with healthcare team

  • Teaching clients

  • How to monitor blood glucose

  • Setting goals for blood glucose levels

  • Safe storage of equipment

  • Instruction on sharps disposal

  • Minimize infection risk

  • Monitoring urine for ketones

  • Managing triggers for hyperglycemia

  • Medication Management

Nursing Process

Assessment: Recognize cues by monitoring:

Blood glucose levels (random, fasting, postprandial)

Symptoms of hyperglycemia.

Analysis: Analyze cues and prioritize treatment to prevent crises.

Planning: Generate solutions to lower blood glucose levels.

Implementation: Carry out medication administration and lifestyle changes.

Evaluation: Assess outcome improvements or changes in state.

Treatment and Therapies for Hyperglycemia

  • Approaches include:

    • Diet adjustments

    • Exercise

    • Oral medications

    • Insulin therapy

    • Collaborate with endocrinology for management.

Hypoglycemia

Pathophysiology

  • Hypoglycemia is defined as blood glucose levels of 70 ext{ mg/dL} or less.

  • The sympathetic nervous system triggers epinephrine and norepinephrine release to elevate blood glucose levels.

  • Glucagon is also released by the pancreas to elevate glucose.

Risk Factors that can cause hypoglycemia

  • Diabetes management changes

  • Fasting or unpredictable food access

  • Increased exercise

  • Travel affecting schedule

  • Use of certain medications (i.e., beta-blockers, insulin, sulfonylureas).

Impact on Overall Health

  • Frequent hypoglycemia can lead to:

    • Hypoglycemia unawareness

    • Increased risk for falls, fractures, early dementia, seizure, coma, death, accidents, and other complications in older adults.

Clinical Presentation

  • Symptoms commonly present as:

    • Headache, sweating, tachycardia, irritability, restlessness, excessive hunger, dizziness.

    • Headche

    • sweating

    • tachycardia

    • irritability

    • restlessness

    • excessive hunger

    • dizzyniess

Laboratory and Diagnostic Testing

  • Blood glucose testing includes:

    • Random and fasting tests.

Role of the Nurse

  • Key responsibilities consist of:

    • Monitoring blood glucose levels

    • Administering medications

    • Educating on hypoglycemia prevention and treatment.

Nursing Process for Hypoglycemia

  • Assessment: Recognize symptoms and assess consciousness. determine glucose level

  • Analysis: Evaluate risk for severe hypoglycemia.

  • Planning: Formulate strategies to prevent hypoglycemia.

  • Implementation: Include monitoring and ensuring adequate nutrition. Administer glucose by oral/IV dextrose/glucagon

  • Evaluation: Assess patient response to interventions.

Treatments and Therapies

  • Immediate treatment includes 15-20g of fast-acting carbohydrates (e.g., fruit juice, sugar, NON diet soda/juice, glucose taablet).

  • Injectable glucagon for clients unable to orally consume glucose.

Type 1 Diabetes

Pathophysiology

  • Type 1 Diabetes Mellitus (DMT1) is characterized by the autoimmune destruction of pancreatic beta cells, leading to a lack of insulin production, making glucose absorption impossible.

  • Loss of insulin production-glucose absorption is not possible

  • NOT curable

Risk Factors

  • Genetic predisposition, viral infections, environmental triggers, family history, and age (sort of but )contribute.

Complications

  • stroke

  • heart attack

  • diabetic neuropathy

  • cataracts—annual eye exam

  • glaucoma—get annual eye exams

  • diabetic foot—daily foot checks, supportive shoes

  • diabetic nephropathy

  • peripheral neuropathy

  • metabolic dysregulation

Clinical Presentation

  • Symptoms include:

    • Rapid onset manifestations: polyuria, polydipsia, polyphagia, weight loss, infections, and visual changes.

Laboratory & Diagnostic Testing

  • Diagnosing consists of:

    • Non-fasting blood glucose of ext{≥}200 ext{ mg/dL}

    • Fasting blood glucose of ext{≥}126 ext{ mg/dL}

    • HbA1c target of ext{≥}7 ext{%}.

Role of the Nurse

  • goal on managing the disease, client education, monitoring lab results, and facilitating referrals.

  • skin/wound care

Client Education

  • Teaching includes diabetes management, insulin administration, and recognition of hyper/hypoglycemia.

  • dietary recommendations, foot care, how to recognize and treat hypo/hyper glycemia

The Nursing Process ()

  • Recognizing Cues: Assess for control, complications, and manifestations of DKA.

  • Analyzing: Prioritize problems like hyperglycemia and hypoglycemia.

  • Planning: Optimize glycemic control while preventing long-term complications.

The Nursing Process ()

  • Implementation: Conduct administering insulin, education on self-care and recognizing complications.

  • Evaluation: Assess outcomes of intervention as improved, worsened, or unchanged.

Treatment and Therapies

  • Monitoring blood glucose levels, administration of insulin (via pen, pump, vial), HbA1c tracking, and adherence to dietary guidelines.

INSULIN SAFETY

ACCURATE dosage

Verify with the second nurse

Combine insulins that can be mixed

tore in refridgerator

Type 2 Diabetes—7th leading cause of death in US

Pathophysiology

  • In contrast to Type 1, Type 2 Diabetes arises when the pancreas cannot produce sufficient insulin and cells become resistant to insulin action.

Risk Factors

  • Includes age, obesity, genetic factors, smoking, sedentary lifestyle, and hypertension.

Comorbidities and Complications

  • Includes relationships with severe health outcomes such as cardiovascular disease, diabetic retinopathy, and increased mortality.

Impact on Overall Health

  • Quality of life is affected by mental health challenges and physical health issues.

Clinical Presentation

  • Symptoms manifest slowly, including fatigue, weight changes, skin issues, and increased thirst/urination.

  • Skin/weight change

  • Gangrene

  • bowel dysfunction

  • polydipsia

Lab and Diagnostic Testing

  • Requires two abnormal results on different days for diagnosis, including various methods of blood glucose testing.

Role of the Nurse

  • Responsibilities encompass stabilizing blood glucose levels, educating the client, and modifying lifestyle interventions.

The Nursing Process ()

  • Recognizing Cues: Assess various levels of glycemic control and signs/symptoms of related complications.

The Nursing Process ()

  • Planning and Implementation: Optimize glycemic control and educate on lifestyle modifications. Evaluate the outcomes resulting from intervention strategies.

Treatments and Therapies

  • First-line treatment includes dietary and exercise modifications alongside possible medication use.

Metabolic Syndrome

Pathophysiology

  • A cluster of conditions that includes obesity, hypertension, insulin resistance, high triglycerides, and low HDL cholesterol levels.

Risk Factors

  • Central obesity, family history, age, lifestyle choices, and other health conditions.

Complications and Comorbidities

  • Encompasses severe diabetes, dyslipidemia, cardiovascular issues, and more.

Impact on Overall Health

  • Affects vascularity and nerve health, contributing to broader systemic complications.

Clinical Presentation

  • Generally asymptomatic but often requires assessment through labs to diagnose.

Role of the Nurse

  • Involves identification of risk factors, medication administration, and educational support on lifestyle changes.

The Nursing Process ()

  • Involves assessment through laboratory results, vital signs, and a physical examination.

The Nursing Process ()

  • Develop a plan to optimize patient health through lifestyle alterations and medication management. Evaluate outcomes for improved health status.

Hypothyroidism

Physiology

  • Anterior pituitary releases TSH, stimulating thyroid gland functions in metabolism regulation.

Risk Factors

  • Includes iodine deficiency, autoimmune disorders, certain medications, and thyroid surgery history.

Complications

  • Hair loss, fatigue, weight gain, mood changes, and potential myxedema coma from severe cases.

Impact on Overall Health

  • Results in widespread slowing of metabolism affecting multiple systems.

Clinical Presentation

  • Symptoms can be vague but include fatigue, weight changes, and skin/hair issues.

Lab and Diagnostic Testing

  • Diagnosed through elevated TSH and low T4 tests, potentially alongside lipid abnormalities.

Role of the Nurse

  • Duties include administering medications, monitoring lab results, and conducting patient education.

The Nursing Process ()

  • Focused assessment on lab findings and presenting symptoms to prevent myxedema coma.

The Nursing Process ()

  • Set comprehensive plans for hormone replacement and symptom management.

Treatments and Therapies

  • Typical treatment involves levothyroxine administration with education on management issues for clients.

CLASS NOTES

if client is HANGRY its likely hypoglycemia

endogenous —insulin procuded by ones body

pernicious anemia—deficency of b12

myxedoma coma— emergent condition

HHS

neuropathy

postprandial glucose—glucose lvl after a meal

graves disease— an autoimmune disorder that results in the overproduction of thyroid hormones, which can lead to symptoms such as weight loss, increased heart rate, and anxiety.

hyperthyroidism

TSH hormone stimulates

kussmaul respirations

metabolic syndri

hypoglycemia unawer

hashimoto

somogi effect too much insulin at

where a med alert band when excercise

cushington disease pt needs to check for hypertension, and daily weight

calcium decreases after parathyroidectomy

graves disease causes trouble sleeping and eyes bulge (exopthalamagy

diabete insipidious— monitor polyguria

cushing synd