endocrine diseases and conditions
DESCRIPTION
Endocrine Diseases and Conditions. Diabetes. Type I or Type II. Symptoms – Type I Frequent urination Unusual thirst Extreme hunger Unusual weight loss Extreme fatigue and irritability. Symptoms – Type II Any of the type I symptoms Frequent infections Blurred vision - PowerPoint PPT PresentationTRANSCRIPT
ENDOCRINE DISEASES AND CONDITIONS
DIABETES
Type I or Type II
Type I Type IIJuvenile diabetes Most common form of
diabetesUsually diagnosed in children and young adults
Millions diagnosed and many unaware they have it
Body will not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
Only 5% of diabetics are a type I
Symptoms – Type I
Frequent urination
Unusual thirst
Extreme hunger
Unusual weight loss
Extreme fatigue and irritability
Symptoms – Type II
Any of the type I symptoms
Frequent infections
Blurred vision
Cuts and bruises that are slow to heal
Tingling or numbness in the hands or feet
Recurring skin, gum or bladder infections
Prevention
Type II can be prevented or delayed
Lead a healthy lifestyle
Change your diet
Increase your physical activity
Maintain a health weight
Myths
• Diabetes is not that serious of a disease
• If you are over weight you will eventually develop type II diabetes
• Eating too much sugar can cause diabetes
• People with diabetes must eat special foods
• People with diabetes cannot eat carbs or sugars
• It is ok to eat as much fruit as you want because it is healthy
Diabetic Ketoacidosis (DKA)
Insulin deficiency and excessive stress hormone
Typically in Type I but can be in Type II
Elevated glucose promotes osmotic diuresis and dehydration
• Stress hormones stimulate free fatty acids which cause a release of ketones
• Causes decreased myocardial contractility and cerebral function
• Usually brought on by infection and stress
Interventions
• Gradually return to normal metabolic balances
• FSBS and notify the MD of the results
• 2 large bore IV’s• NS at a rate of 1 liter per hour• O2 and maintain ABC’s• Insulin drip per protocol• Monitor patient every 5-15 minutes
until stable• Closely monitor intake and output• Cardiac monitor
Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC)
• Occurs in type II• Profound dehydration from elevated
glucose and osmotic diuresis• No ketones-not enough insulin to start
the process• Can be caused by infection, stroke or
sepsis• High mortality rates
Interventions
• FSBS and notify the MD of the results• May require intubation• 2 large bore IV’s• NS 1 liter over 1 hour• Insulin drip per protocol• Monitor the patient every 5-15
minutes until stable• Closely monitor the intake and output• Cardiac monitor
Hypoglycemia
• Serum glucose drops below 50• Below 35-the brain cannot adequately
extract oxygen• Results in hypoxia and eventually
coma• Any person with an altered level of
consciousness should be considered to have low glucose until proven otherwise
Interventions
• O2 and maintain ABC’s• FSBS and notify MD of results• If alert and oriented x3, give oral
glucose solutions (oj, milk, etc. )• Establish IV• ½ to 1 amp of 50% dextrose (D50) per
MD’s orders• Monitor the mental status closely• Monitor the FSBS every 15-30 minutes• Order a meal tray STAT• Cardiac Monitor
ADRENAL CRISIS Addison’s Disease (adrenal insufficiency) Adrenal cortex ceases to produce
glucocorticoid and mineralocorticoid hormones
Acute stressors, infection, hemorrhage, trauma, surgery, burns, pregnancy, or abrupt cessation for Addison’s disease
Life threatening because hormones are necessary for the maintenance of blood volume, BP, and glucose homeostasis
ADRENAL CRISIS
Suspect with patients who have septicemia with unexplained deterioration, major illness who have abdominal, flank, or chest pain, with dehydration, fever, hypotension, or shock, and adrenal hemorrhage
Death because of circulatory collapse and hyperkalemia- induced dysrhythmia
ADRENAL CRISIS- ASSESSMENT
Subjective data History of present illness
Rapid worsening of symptoms of adrenal insufficiency
Fever Nonspecific abdominal pain; may simulate acute abdomen
N&V
ADRENAL CRISIS- ASSESSMENT Medical history
Primary adrenal insufficiency Hyperpigmentation of skin Weakness, fatigue, lethargy Anorexia and weight loss Nausea, vomiting, diarrhea Salt craving Postural hypotension Allergies Medications
ADRENAL CRISISPhysical examinationAppears acutely illSigns of shock as a result of dehydration
Hypotension, but may have warm extremities
Tachycardia Tachypnea Orthostatic hypotension
ADRENAL CRISIS
Physical examination Fever Altered mental status, confusion Hyperpigmentation of skin Very soft heart sounds
ADRENAL CRISISDiagnostic proceduresCBC: anemia of chronic diseaseElectrolyte levels
Hyponatremia Hyperkalemia
Blood glucose level: hypoglycemiaBUN: elevated (azotemia secondary to dehydration)
UA
ADRENAL CRISIS
UA Blood cultures Plasma cortisol level ECG
Low voltage Flat or inverted T wave Prolonged QT, QRS, or PR intervals CXR CT of abdomen: if diagnosis not clear
ADRENAL CRISIS
Interventions O2, IV, monitor VS, with Orthostatic VS I&O Weight Monitor signs of adequate tissue perfusion:
capillary refill and skin temperature and moisture
ADRENAL CRISIS Medications
Dexamethasone Hydrocortisone Corticotropin Glucose Vasopressors
Monitor electrolytes Monitor cardiac function Prepare for admission Instruct about disease process
MYXEDEMA COMA Severe form of hypothyroidism Marked impairment of CNS and cardiovascular decompensation
Recognition of this illness is hampered by its insidious onset and rarity
Winter, elderly women with HX of hypothyroidism Precipitating factors include: serious infection (pneumonia and UTI), sedative or tranquilizer use, stroke, exposure to cold environment, and termination or thyroid hormone replacement
Death is common, but can survive if prompt adequate care
MYXEDEMA COMA History of present illness
Recent illness Progressive decline in intellectual status Apathy, self-neglect Emotional labiality Anorexia Recent weight gain
Medical history Hypothyroidism or thyroid surgery Allergies Medications: thyroid replacement hormone, recent use of tranquilizers and sedatives
MYXEDEMA COMAObjective dataPhysical exam
Decreased mental status Depressed mental acuteness Confusion or psychosis Pale, waxy, edematous face with periorbital edema
Dry, cold, pale skin
MYXEDEMA COMAObjective dataPhysical exam
Non-pitting extremity edema Thin eyebrows Deep, coarse voice Scar form prior thyroidectomy Vital Signs
Hypothermia, usually above 95 F Bradycardia with distant heart sounds Hypoventilation, Hypotension
MYXEDEMA COMA Diagnostic procedures
Electrolytes: hyponatremia ABG’s: hypoxia and hypercarbia Thyroid studies: low thyroxine (T4),
elevated thyrotropin (thyroid stimulating hormone [TSH])
MYXEDEMA COMA ECG
Low voltage Sinus bradycardia Prolonged QT interval CBC: anemia and decreased WBC BUN and creatinine: elevated Blood sugar: variable hypoglycemia CXR UA Obtain pretreatment plasma cortisol level
MYXEDEMA COMA
InterventionsMonitor airway, breathing, circulation, and other vital signs
O2 as orderedIV, IV fluids
Hypertonic salineCrystalloidsWhole blood
MYXEDEMA COMA
Interventions Meds as ordered
IV thyroid hormone Glucocorticoid Vasoconstrictors
Rewarm patient Use passive rewarming with blankets and increased room temperature
Avoid rapid rewarming Be prepared for seizures
THYROID STORM
Extreme and rare form of thyrotoxicosis High mortality Untreated or inadequately treated
hyperthyroidism, who experiences surgery, infection, trauma, or emotional upset; thyroid surgery; radioactive iodine administration
Cardiac decompensation with CHF (terminal event), CNS dysfunction, GI disorders
Life-threatening emergency
THYROID STORM- ASSESSMENT
History of present illness Fever N&V&D Abdominal pain Worsening of thyrotoxicosis symptoms Anxiety Restlessness, nervousness, irritability Generalized weakness Possible coma Precipitation event or intercurrent illness
THYROID STORM Medical history
Thyrotoxicosis Thyroid disease Easy fatigability Weight loss Sweating Body heat loss and heat intolerance
THYROID STORM Objective data
Physical exam Fever: temp may exceed 104 Tachycardia (120-200), systolic
hypertension Chest: crackles
THYROID STORM
Warm, moist, velvety skin; becomes dry as dehydration develops
Spider angiomasTremulousnessDelirium, agitation, confusion, comaThin silky hairEnlarged thyroid gland with thrill or bruit
THYROID STORM
Eye signsLid lagStareExophthalmosPeriorbital edema
Hepatic tenderness or jaundice
THYROID STORM Diagnostic procedures
Cardiac monitoring/ECG: sinus tachycardia wand atrial fibrillation/flutter
Thyroid function studies T4: elevated Triiodothyronine (T3): elevated resin
uptake TSH: decreased
Serum cholesterol level: decreased
THYROID STORM
Diagnostic procedures Electrolyte levels Serum glucose increased CBC: increased WBC with left shift BUN or creatinine level Hepatic studies: increased liver enzymes UA Cultures and radiographs and indicated
THYROID STORM
Interventions O2, airway,
breathing, circulation, VS
IV of D5 and isotonic solution
Cardiac monitoring
Meds as ordered Vasopressors Antipyretic D50 Propylthiouracil every 8 hours Glucocorticoids, hydrocortisone Iodine: lugol’s solution,
potassium iodide Digitalis, propranolol Antibiotics Vitamins and thiamine Sedatives
THYROID STORM
Use cooling blanket, cold packs
Prepare patient/significant others for patient’s admission
Explain procedures to patient/significant others
References
American Diabetic Association
Emergency Nursing Core Curriculum, ENA
Fundamentals of Nursing, Potter and Perry