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Physiologic Adaptation: Disturbance in
Metabolism- Responses to Altered Endocrine
Functions
John Paul M. Tagapan
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Disorder of the Thyroid Gland
1.Hyperthyroidism
2.Hypothyroidism
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Disorder of the Thyroid Gland
Hyperthyroidism
Graves disease is an autoimmune disorder that leads
to over activity of the thyroid gland(hyperthyroidism)
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Disorder of the Thyroid Gland
Manifestation
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Disorder of the Thyroid Gland
Laboratory Findings
Test Normal Values Findings
Serum TA Negative to 1:20 increased
Serum TSH 2-10 mU/ ml Decreased in primary
Serum T4 5-12 mcg/dL Increased
Serum T3 80-200 mg/dL Increased
T3uptake 25-35 relative
percentage
Increased
Thyroid
suppression
Increase RAI uptake
and T4levels
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Disorder of the Thyroid Gland
Nursing Diagnosis Risk for Decreased Cardiac Output
Disturbed sensory Perception: Visual
Imbalanced Nutrition: Less than body requirement
Disturbed Body Image
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Disorder of the Thyroid Gland
MedicationIodine Sources
a) Strong Iodine Solution (lugolsSolution)
b) Potassium Iodide ( SSKI, Thyro-Block, Pima)
Antithyroid Drugs
a) Methimazole ( Tapazole)
b) Propylthiouracil ( PTU, Propyl-thyracil)
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Disorder of the Thyroid Gland
Radio Iodine Therapy
Radioactive iodine is a medicine that you take one time.
After you swallow it, it is taken up by your thyroid gland.Depending on the dosage used, the radioactivity in the iodine
destroys most or all of the tissue in your thyroid gland, but it does
not harm any other parts of your body.
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Disorder of the Thyroid Gland
Surgery
a) thyroidectomy
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Disorder of the Thyroid Gland
HYPOTHYROIDISM
Hypothyroidism is a disorder that results when the thyroid
glands produces an insufficient amount of TH (Lemone 2008)
Hypothyroidism is a condition in which the thyroid gland does
not make enough thyroid hormone (Medline Plus)
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Disorder of the Thyroid Gland
Manifestation
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Disorder of the Thyroid Gland
Nursing Diagnosis Decreased Cardiac Output
Constipation
Risk for Impaired Skin Integrity
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Disorder of the Parathyroid Gland
1. Hyperparathyroidim
2. Hypoparathyroidism
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Disorder in Parathyroid Gland
HYPERPARATHYROIDISM
Result from an increase in secretion of parathyroid hormone
(PTH) which regulates normal serum calcium. The increase in
PTH affects the kidney and bones ( Lemone, 2008)
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Disorder in Parathyroid Gland
Manifestation Musculoskeletal: bone pain (back, joint, shins); pathologic
fracture ( women); muscle weakness; muscle atrophy
Renal effects: renal calculi; polyuria; polydipsia
Gastrointestinal: abdominal pain, peptic ulcers, pancreatitis;
nausea; constipation
Cardiovascular: arrhythmias; Hypertension
CNS: parenthesia; depression; psychosis
Metabolic effects: Acidosis; weight loss
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Disorder in Parathyroid Gland
Laboratory Findings Serum electrolytes shows total serum calcium greater than
10.0 mg/dL
ECG changes in hypercalcemia include a shortened QT
interval, shortened and depressed ST segment and wined T
wave. Bradycardia or heart block may be identified on ECG
Bone density scan may be done to monitor bone reabsorption
and effect of treatment measure on mineralization.
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Disorder in Parathyroid Gland
Medication
Biphosphonate ( pamidronate and etidronate)
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Disorder in Parathyroid Gland
Nursing Intervention Risk for injury
Risk for Excess Fluid Volume
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Disorder in Parathyroid Gland
Laboratory Findings Serum electrolytes shows total serum calcium greater than
10.0 mg/dL
ECG changes in hypercalcemia include a shortened QT
interval, shortened and depressed ST segment and wined T
wave. Bradycardia or heart block may be identified on ECG
Bone density scan may be done to monitor bone reabsorption
and effect of treatment measure on mineralization.
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Disorder in Parathyroid Gland
HYPOPARATHYROID
Result from abnormally low PTH levels. The most common
cause is damage to or removal of the parathyroid glands during
thyroidectomy. The lack of circulating PTH cause
hypocalcemia and an elevated blood phosphate levels (
Lemone, 2008).
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Disorder in Parathyroid Gland
Manifestation Chvostek's sign- Contraction of the lateral facial muscles in
response to tapping the face in front of the ear; caused by
decreased blood calcium levels.
Trousseau's sign- Contraction of the hand and fingers in
response to occlusion of the blood supply by a blood pressure
cuff; caused by decreased blood calcium levels.
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Disorder in Parathyroid Gland
Medication
Calcium salts ( Calcium carbonate, calcium chloride, calcium
citrate, calcium glubionate, calcium gluceptate, calcium
gluconate, calcium lactate)
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Disorder in Parathyroid Gland
Nursing Diagnosis Risk for Injury
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DISORDER OF THE ADRENAL GLAND
1. HYPERCORTISOLISM ( Cushings Syndrome)
2. ADDISONS DISEASE
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DISORDER OF THE ADRENAL GLAND
HYPERCORTISOLISM ( Cushings Syndrome)
Cushing's syndrome is a disease caused by increased
production of cortisol, or by excessive use of cortisol or other
steroid hormones.
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DISORDER OF THE ADRENAL GLAND
Manifestation
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DISORDER OF THE ADRENAL GLAND
Laboratory Findings
Test Normal Values Findings
Serum Cortisol 8am-10am
5-23 mcg/dL
4pm-6pm
3-13 mcg/dL
increased
Blood Urea nitrogen 5-25 mg/dl Normal
Sodium 135-145 mEq/L Increased
Potassium 3.4-5.0 mEq/L Increased
Glucose 70-100 mg/dL Increased
Urine 17-KS Male: 5-25 mg/24h
Female: 5-15 mg/24h
Age 65:4 -
8mg/24h
Increase
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DISORDER OF THE ADRENAL GLAND
Medication Mitotate directly suppresses activity of adrenal cortex and
decrease peripheral metabolism of corticosteroid.
Aminoglutemide or ketoconazole
Somastostatin
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DISORDER OF THE ADRENAL GLAND
Nursing Diagnosis Fluid Volume Excess
Risk for injury
Disturbed Body Image
Risk for Infection
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DISORDER OF THE ADRENAL GLAND
ADDISONS DISEASE
Addison's disease is a disorder that occurs when the adrenal
glands do not produce enough of their hormones
Addison's disease results from damage to the adrenal cortex.
The damage causes the cortex to produce less of its hormones.
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DISORDER OF THE ADRENAL GLAND
Manifestation
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DISORDER OF THE ADRENAL GLAND
Laboratory FindingsTest
Normal Values
Findings
Serum Cortisol 8am-10am
5-23 mcg/dL
4pm-6pm
3-13 mcg/dL
Decreased
Blood Urea nitrogen
5-25 mg/dl
Increased
Sodium 135-145 mEq/L Decreased
Potassium 3.4-5.0 mEq/L Increased
Glucose 70-100 mg/dL Decreased
Urine
17-KS
Male: 5-25 mg/24hFemale: 5-15 mg/24h
Age 65:4 -8mg/24h
Low or absent
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DISORDER OF THE ADRENAL GLAND
Medication The primary medical treatment of Addisons disease is
replacement of corticosteroid, accompanied by increase
sodium diet. Hydrocortisone is given orally to replace cortisol.Fludrocortisone is given orally to replace mineralocorticoids.
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DISORDER OF THE ADRENAL GLAND
Nursing Diagnosis Deficient Fluid Volume
Risk for Ineffective regimen management
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DISORDER OF THE PITUITARY GLANDS
1. Anterior Pituitary Gland
Hyper function of the pituitary gland, characterized by excess
production and secretion of one or more tropic hormones is
usually the result of pituitary tumor or pituitary hyperplasia.(Gigantism)
Hypo function of anterior glands results in deficiency of one or
more of the glands hormone. ( Acromegaly)
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DISORDER OF THE PITUITARY GLANDS
Posterior Pituitary Gland
SYNDROME OF THE INAPPROPRIATE ADH
PRODUCTION
High levels of ADH in the absence of serum hypo-osmolality.
This order is often caused by the ectopic production of ADH
by malignant tumors ( Lemone 2008).
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DISORDER OF THE PITUITARY GLANDS
DIABETES INSIPIDUS
Result of ADH insufficiency
a) Neurogenic Diabetes Insipidus: disruption of Hypothalamus
and pituitary gland
b) Neprogenic Diabetes Insipidus: renal tubules are sensitive to
ADH.
May result to a brain tumor or infections of pituitary surgery,
cerebral vascular accidents and renal and organ failure.
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DISORDER OF THE PITUITARY GLANDS
Interdisciplinary Care
SIADH is treated by correcting underlying causes, treating the
hyponatremia with intravenous hypertonic saline, and restricting oral fluids
to less than 800 mL/day
Diabetes Insipidus is also treated by correcting the underlying cause. If
possible. Other medical intervention includes administering IV hypotonic
saline, Increase Fluid intake and replacing ADH hormone. Desmopressin
acetate, administration intranasally orally, or parenterally.
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DISORDERS IN PANCREAS
DIABETES MELLITUS
Type 1 DM is the result of pancreatic islet cell destruction and
a total deficit of circulating insulin;
Type 2 DM results from insulin resistance with a defect incompensatory insulin secretion.
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CLASSIFICATION AND TYPES OF DIABETES
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CLASSIFICATION AND TYPES OF DIABETES
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