ENDOCRINE NURSING

By : JOHN MARK B. POCSIDIO, RN, MSN

Functions of endocrine system

Response to stress and injury.

Growth and development.

Reproduction.

Homeostasis

Energy metabolism.

Endocrine glands
Endocrine glands are specialized cluster of cells that secrete hormones.

o Secreted hormones go directly into the blood stream (ductless gland ) in

respond to the nervous system stimulation.

HORMONES
Hormones are chemical messengers secreted by endocrine organs and
transported throughout the body where they exert their action on specific
cells called target cells.
Hormones do not cause reactions but rather they are regulator of tissue
responses.

Mechanisms of Hormones
Hormones interact with high-affinity receptors
o These are linked to one or more effector system in the cell
Some receptors are located on the surface of the cell
o These act through second messenger mechanisms
Others are located in the cell
o They modulate the synthesis of enzymes, transport proteins, or structural
proteins
Binding to Target Cells

Hormones
Maintain homeostatic balance utilizing a feedback mechanism that involves
other hormones, blood or chemicals, and the nervous system.
The Sequence
Hypothalamus

Pituitary Gland or Hypophysis
Anterior or Adenohypophysis
Posterior or Neurohypophysis

Target Glands

HYPOTHALAMUS
The hypothalamus is the site of the hunger center and is involved in appetite
control. It contains centers that regulate the sleepwake cycle, blood pressure,
aggressive and sexual behavior, and emotional responses (ie, blushing, rage,
depression, panic, and fear). The hypothalamus also controls and regulates the
autonomic nervous system.

The ANATOMY of the Endocrine System

Pituitary Gland
Is a gland located below the hypothalamus at the base of the brain
The optic chiasm passes over this structure

Is divided into two parts- the anterior or adenohypophysis and the

posterior or the neurohypophysis

ANTERIOR
Secretes the following hormones:
1. Growth hormone
2. Prolactin
3. Gonadotrophins- LH and FSH
4. Stimulating hormones and trophic hormones
ACTH
TSH
MSH

The PHYSIOLOGY of the Endocrine System: Posterior Pituitary

Stores and releases
1. OXYTOCIN
2. ADH/Vasopressin

Radioactive iodine uptake test (raiu)

easurement by a counter of the amount
Administration of I 123 or I 131 orally; m
 of radioactive iodine taken up by the gland after 24 hours.

Increased uptake may indicate H YPERfunctioning gland

Decreased uptake my indicate HYPOfunctioning g land
Normal values: 5-30% in 24 hours

COMMON BOARD QUESTION

REMEMBER:
Not radioactive after procedure----CGFNS/ NCLEX
Avoid cough syrup before test.(7-10 days prior)
Temporarily discontinue contraceptive pills

THYRIOD SCAN
Administration of radioactive isotope ( oral / IV) & visualization by a scanner of
the distribution of radioactivity in the gland. (scintillation detector, gamma
camera)
Performed to determine location, size, shape, & anatomic function of thyroid
gland; identifies areas of increased or decreased uptake; valuable in evaluating
thyroid nodules.

COMMON LABORATORY PROCEDURES

Thyroid Scan
Pretest- Check for pregnancy, Thyroid medication may be withheld
temporarily, advise NPO
Post-test- Ensure proper disposal of body wastes
Nursing care usually the same as RAIU

Prohibited during thyroid studies

1. TOPICAL ANTISEPTICS
2. MULTIVITAMIN PREPARATIONS
3. FOOD SUPPLEMENTS
4. COUGH SYRUPS-------- LOCAL/ CGFNS
5. AMIODARONE
6. ANTIARRYTHMIC AGENTS
CONT. ( may affect test results)
7. ESTROGENS
8. SALICYLATES
9. AMPHETAMINES
10. CHEMOTHERAPEUTIC AGENTS
11. ANTIBIOTICS
12. CORTICOSTERIODS
13.MERCURIAL DIURETICS
BMR
It measures the oxygen consumption under basal conditions of overnight
fast and rest from mental and physical exertion.
it can be estimated from the oxygen consumed over a timed interval by
analysis of samples of expired air

Points to remember BMR

BMR- measures oxygen consumption at the lowest cellular activity.
PREPARATION
NPO 10-12 hours
Night sleep 8-10 hours
Do not get up from bed the following morning until the test is done.
A device with a nose clip & a mouthpiece is used, the client performs deep
breathing exercises.
NORMAL: +20% ( EUTHYRIOD)

FASTING BLOOD GLUCOSE

Aids in the diagnosis of Diabetes
Pre-test: NPO for 8 hours( midnight before the test)
Normal FBS- 80-109 mg/dL
DM- 126 mg/dL and above
QUESTION? Patient can drink water or not???????

GLUCOSE tolerance test

Aids in the diagnosis of DM
Pre-test: Provide high-carbohydrate foods x 3 days, instruct to avoid
caffeine, alcohol and s
moking for 36 hours before the test.
Fast for 10 to 16 hours before the test.
Withhold morning insulin or oral hypoglycemic medication ( client with diabetes
mellitus)--- NCLEX
The test will take 3 to 5 hours, requires intravenous or oral administration of
glucose, and multiple blood samples.
Post-test:
avoid strenuous activity for 8 hours
Normal OGTT- 1 and 2 hours post-prandial- glucose is less than 200 mg/Dl
Glycosylated Hemoglobin A 1-C
Blood glucose bound to RBC hemoglobin
Reflects how well blood glucose is controlled for the past 3 months
FASTING is NOT required!

Glycosylated Hemoglobin A 1-C

Normal level- expressed as percentage of total hemoglobin
N- 4-7%
Good control- 7.5%or less
Fair control- 7.5 % to 8.9%
Poor control- 9% and above

ENDOCRINE DISORDERS
By: JOHN MARK B. POCSIDIO, RN, USRN, MSN
Disorders of the pituitary gland

HYPERPITIUTARISM
Hyperfunctioning of the pituitary gland
Over secretion of one or more of the anterior pituitary hormones
Can lead to acromegaly/ gigantism
COMMON CAUSE:
Benign pituitary adenoma
Hyperplasia of the pituitary tissue
.
.
SIGNS & SYMPTOMS:
Enlarged hands and extremities-CBQ
Prominent supraorbital ridge
Spade shape hands & feet
Large nose and jaw, teeth are separated
Cardiomegaly, enlarged liver- CBQ
Abnormal glucose level
Hypertrophy of the sweat and sebaceous gland
Galactorrhoea ( prolactin)
Peripheral neuropathy
Arthrosis
Sexual dysfunction

DIAGNOSTIC TEST:
 Skull X-ray, CT scan, MRI
NURSING INTERVENTIONS
Provide emotional support to clients and family
Provide frequent skin care
Prepare patient for surgery- removal of pituitary gland( transphenoidal
hypophysectomy)
CBQ? LOCATION? Between the upper lip & gum
Post-operative care
Monitor VS, LOC and neurologic status ( monitor packing & reinforce as
needed)
Place patient on Semi-Fowlers
Monitor for Increased ICP, bleeding, CSF leakage
Instruct patient to AVOID sneezing, coughing and nose-blowing
CBA- deep breathing is good just avoid coughing
CBA- provide mouth care with saline or toothettes ( avoid toothbrush)
Monitor development of DI/ SIADH measure I and O
Administer prescribed medications- antibiotics, analgesics and steroids
MEDICAL THERAPY:
OCTREOTIDE ACETATE SC 3x/ week( analog of somatostatin) produces feedback
inhibition on GH
SANDOSTATIN (IM 20-30mg) ---Effectively inhibits GH secretion for 30 days with just
one IM injection of 20-30mg.- CBQ
BROMOCRIPTINE( long acting dopamine agonist) can reduce growth hormone
levels.

HYPOPITUITARISM
Hyposecretion of the anterior pituitary gland

CAUSES:
Congenital
Post-partal necrosis( Sheehan's syndrome)
Infection
Surgery
Radiation therapy
ASSESSMENT Findings
Retarded physical growth due to decreased GH dwarfism
Low intellectual development
poor development of secondary sexual characteristics
Dwarfism, Cretenism, Achondroplasia
Diagnostics
Physical examination and history
CT scan
MRI
Hormone levels determination

NURSING INTERVENTIONS
Provide emotional support to the family
Encourage client and family to express feelings
Administer prescribed hormonal replacement therapy (GH)
GROWTH HORMONES
SERMORELIN (GEREF)-----IV
SOMATREM (PROTROPIN)----IM/SC
SOMATROPIN (HUMATROPE) ---IM/ SC
( ORAL ROUTE IS INACTIVATED BY ENZYMES)
---use cautiously to diabetic patients
SideEffect?
Peripheral edema, arthralgias, myalgias, carpal tunnel syndrome, paresthisias,
decrease glucose tolerance.

DIABETES INSIPIDUS
Hypo functioning of the posterior pituitary gland
A hypo-secretion of ADH
Most common cause???? Neurosurgery, trauma-CBQ

SIGNS AND SYMPTOMS:

Polyuria- CBQ
Dehydration-CBQ
Polydipsia
Muscle pain and weakness ( hypo K)
Postural hypotension and tachycardia

Diagnostic test
Fluid deprivation test 8-12 hrs or 3-5% wt loss. Inability to increase specific
gravity and osmolality
CGFNS: WATCH OUT FOR??????!!!!!
Urinary Specific gravity very low, 1.006 or less
Serum Sodium levels high

NURSING INTERVENTIONS
Monitor VS, neurologic status and cardiovascular status
 Monitor Intake and Output/ Daily weights
Monitor urine specific gravity
Provide adequate fluids
Avoid!!!
Coffee, tea, alcohol
MEDS: VASOPRESSIN/ DESMOPRESSIN- CBQ

SIADH
Hyperfunctioning of the posterior pituitary gland
Hyper-secretion of ADH abnormally
Most common cause??? Neurosurgery/ trauma- CBQ
SIGNS & SYMPTOMS
Mental status changes ( confusion)- CBQ
Abnormal weight gain
Hypervolemia
Hypertension
Hyponatremia
Anorexia/ N/V

DIAGNOSTIC TEST
Urine specific gravity is increased (concentrated)
Hyponatremia
CBC shows hemodilution

NURSING INTERVENTIONS
Monitor VS and neurologic status
Provide safe environment
Restrict fluid intake (less than 500cc/day)
Monitor I and O and daily weight
Administer Diuretics and IVF carefully
Administer prescribed Demeclocycline
QUESTION???? SALINE OR WATER??? (TUBE FEEDINGS, NGT
IRRIGATION)

ISORDERS OF THYRIOD
D
By: JOHN MARK B. POCSIDIO, RN, USRN, MSN

HYPERTHYROIDISM
Called GRAVES DISEASE
Hyperfunctioning of the thyroid gland
 A hyperthyroid state characterized by increased circulating T3 and T4,
thyrocalcitonin

POSSIBLE CAUSES:
Autoimmune
Thyroiditis
Infection
Tumor
Radiation

SIGNS & SYMPTOMS

Weight loss
HEAT intolerance
Hypertension
Tachycardia
Exopthalmos
diarrhea
Warm skin
Diaphoresis
Smooth & soft skin
Fine tremors

DIAGNOSTICS
Thyroid gland enlarged
T3, T4 elevated
RAIU: Increased uptake

NURSING INTERVENTIONS
Rest ( quiet room)
Administer anti-thyroid Methimazole and PTU
Provide a HIGH-calorie diet, HIGH protein
Manage diarrhea
Provide a cool and quiet environment
Avoid giving stimulants
Provide eye care
Administer PROPANOLOL for tachycardia
Administer IODIONE preparation- L ugols solution
Prepare clients for Radioactive iodine therapy
Prepare patient for thyroidectomy
NO ASPIRIN!!!!- CBQ
COMPLICATION? Thyroid storm
Manage Seizures as required.
 Provide a quiet environment

THYROIDECTOMY
Removal of the thyroid gland

PRE-OPERATIVE CARE - Thyroidectomy

Obtain VS and weight
Assess for Electrolyte levels, glucose levels and T3/T4 levels
Teach to support neck while moving-CBQ
POST-OPERATIVE CARE - Thyroidectomy
Position: semi-fowlers ( neck midline)
What to bring?: tracheostomy set, O2 tank, suction machine, calcium
gluconate
Check for SIGNS bleeding
QUESTION??? Frequent swallowing or nape?????
Assess for hoarseness
Monitor for signs of hypocalcemia

HYPOTHYROIDISM
Hypo functioning of the thyroid gland
Hypo secretion of thyroid hormones
Decreased T3 and T4 decreased basal metabolism

SIGNS & SYMPTOMS

Lethargy and fatigue
Weakness and paresthesia
COLD intolerance- CBQ
Weight gain
Bradycardia-CBQ
Constipation-CBQ
Dry hair and skin-CBQ
Generalized puffiness and edema around the eyes and face
Menstrual irregularities

Diagnostic Tests

SERUM T3 and T4 level low

SERUM CHOLESTEROL level elevated
RAIU DECREASED

NURSING INTERVENTIONS
Monitor VS especially HR
Administer meds: LEVOTHYROXINE
 Diet: low calories, low cholesterol, low fat
Provide warm environment
Manage constipation appropriately
Avoid!!!!!
Sedatives
anesthetics
Narcotics
Stress
Infection
Exposure to extreme cold

Hypoparathyroidism
Hypo functioning of the parathyroid gland
Hypo secretion of the parathyroid gland
Most common cause?
Accidental removal of the parathyroids
Autoimmune
Radiation
.
SIGNS & SYMPTOMS:
Signs of HYPOCALCEMIA
Numbness and tingling sensation on the face ( Trosseaus, chvostek)
Muscle cramps
Bronchospasms, laryngospasms-CBQ
Seizure-CBQ
Cardiac dysrhythmias-CBQ
Hypotension

NURSING INTERVENTIONS
Monitor VS and signs of Hypocalcaemia
Initiate seizure precautions
Place a tracheostomy set. O2 tank and suction at the bedside
Prepare CALCIUM gluconate
Provide a HIGH-calcium and LOW phosphate diet -CBQ
Eat VIT D rich foods
AVOID!!! Carbonated beverage & digitalis- CBQ

Hyperparathyroidism
Hyper functioning of the parathyroid gland
Hyper secretion of the parathyroid hormones
 Most common cause?:
Renal failure
Vit D deficiency
Adenoma

SIGNS& SYMPTOMS:
Fatigue and muscle weakness/pain
Skeletal pain and tenderness
Fractures
Osteoporosis
Cardiac Dysrhythmias
Renal Stones
Constipation
Anorexia, N/V

NURSING INTERVENTIONS
Monitor VS, Cardiac rhythm, I and O
Handle body parts carefully
REMEMBER: LIFT sheet
Increase fluids- CBQ
Administer diuretics as ordered-CBQ
Administer calcitonin as ordered
Administer FOSAMAX as ordered

Give calcium regulators as prescribed like ALENDRONATE (FOSAMAX)

CBQ
Should not be chewed
Should be taken with water at least 30 minutes before breakfast and remain
upright for at least 30 min.

CUSHINGS DISEASE
Hypersecretion of adrenal cortex hormones (glucocorticoid, mineralocorticoid,
androgen and estrogen)

SIGNS & SYMPTOMS:

Hypervolemia
Hypo K
Hypertension
Edema
Hyperglycemia
Moon face, buffalo hump, truncal obesity
 Hirsutism
DIAGNOSTIC TEST:
o Dexamethasone suppression test:
o Overnight DEXA:
given in the evening 1 mg (oral, midnight),
blood is withdrawn in the morning 8AM (next day) normal result is less than
140 nmol/L or 5 mcg/dl (plasma cortisol)
High level of ACTH indicates Secondary Cushings
o 24 hour urine cortisol:
greater than 275 nmol/L is suggestive of abnormal condition

INTERVENTIONS:
Monitor VS, observe for hypertension-CBQ
Measure Intake & Output & daily weights-CBQ
Protect client from exposure to infection-CBQ
Minimize stress in the environment-CBQ
Prevent accidents & falls & provide adequate rest
Monitor urine for glucose & acetone
DIET: LOW SODIUM, HIGH K- CBQ
Maintain muscle tone
Maintain skin integrity
Prepare for surgery( adrenalectomy/ hypophysectomy)

ADDISONS DISEASE
Hyposecretion of adrenal cortex hormones
Hypo functioning of the adrenal cortex
SIGNS & SYMPTOMS:
Hypotension
Hypovolemia
Weight loss
Hyper K
Hypoglycemia
Decrease ability to combat stress and infection
Bronze skin
Sparse axillary hair/ pubic hair

NURSING INTERVENTION
Provide rest
Administer hormone replacement therapy as ordered.-CBQ
Glucocorticoids ( cortisone , hydrocortisone)
 Mineralocorticoids
Monitor vital signs
Check I & O/ Daily weights-CBQ
Decrease stress in the environment
Prevent exposure of infection
DIET: HIGH SODIUM, LOW K-CBQ

PHEOCHROMOCYTOMA
Benign tumor of the chromaffin cells of the adrenal medulla
Peak incidence is ages 20 to 50 years
Stimulates hyper secretion of cathecholamines (epinephrine and
norepinephrine)

SNS over-activity

5 Hs
Hypertension
Headache
Hyperhidrosis
Hypermetabolism
Hyperglycemia

Diagnostic tests:
Vanillylmandelic Acid test (VMA test)
24 hour urine specimen
Instruct the patient to avoid the following medications and foods which may
alter the result
Coffee
Tea
Bananas
Chocolate
Vanilla- CBQ
Aspirin
Normal 0.7-6.8mg/24hrs

Cont.
CT Scan, MRI, Ultrasound
To localize the pheochromocytoma

Nursing intervention:
Monitor VS especially BP.
 POSITION? HOB elevated
Administer meds as ordered to control BP.
Phentolamine (Regitine)
Na Nitroprusside (Nipride)
Promote rest; decrease stimuli.
Monitor urine test for glucose & acetone.
Provide high calorie, well-balanced diet; avoid stimulants such as coffee or
tea.
Prepare for adrenalectomy
QUESTION???? CAN YOU PALPATE ABS???

DIABETES MELLITUS

A chronic disorder of impaired glucose metabolism, protein and fat metabolism

RISK FACTORS for Diabetes Mellitus
Family History of diabetes
Obesity
Race/Ethnicity
Age of more than 45
Hypertension
Hyperlipidemia
History of Gestational Diabetes Mellitus
DRUG THERAPY( for DM type 1)

Insulin points to remember:

Route? SC do not massage.
Clear first before cloudy
Inject air in the NPH insulin vial or regular?????
Administer insulin at room temperature.
Rotate the site of injection
Store insulin at the refrigerator
Gently roll vial in between palms do not shake.

Drug therapy ( for dm type 2)

Oral hypoglycemic agents (oha)
Drug of choice for type 2 diabetes mellitus.
Stimulate the pancreas to secrete insulin----CGFNS
Oral hypoglycemic agents are contraindicated during pregnancy-----LOCAL
DIAGNOSTIC TESTS
1. FBS- > 126
2. RBS- >200
3. OGTT- > 200
4. HgbA1- above 7 %----NCLEX
5. Urine glucose
6. Urine ketones

NURSING MANAGEMENT OF DM
The main goal is to NORMALIZE insulin activity and blood glucose level
by:

NUTRITIONAL MODIFICATION
NUTRITIONAL ASPECT:
Balanced diet is the best diet for diabetes mellitus------NCLEX
Carefully follow the exchange list of the diet.
Do not skip meals

EXERCISE
All exercise must be carefully planned, suggest 6-7 days a week, the same time
each day to facilitate glucose control
Exercise enhances effects of insulin so it may cause hypoglycemia.
Blood glucose monitoring before and after exercise.----LOCAL
Before doing strenuous activity have a light snack-----LOCAL

FOOT CARE
Inspect feet daily for dryness, cracks or ingrown toenails using mirror.----LOCAL
Thoroughly cleanse and dry feet and in between toes daily.
Place skin moisturizers on feet to prevent cracking.-----LOCAL
Never walk around barefooted
Always wear socks with shoes
Allow only podiatrist to care for corns, callouses, toenails.
Must be aggressive in treating any foot wounds

DURING ILLNESS OR SURGERY

Must continue to take medication- CBQ
More insulin will be required.- CBQ
Increase frequency of blood glucose monitoring.
If unable to eat, take & increased fluids, simple carbohydrates.

HYPOGLYCEMIA
Blood glucose level less than 50 to 60 mg/dL
Causes: Too much insulin/OHA, too little food and excessive physical
activity
 Mild- 40-60
Moderate- 20-40
Severe- less than 20
SIGNS and symptoms???
REMEMBER!!!!
S--- hakiness
H---unger
R---apid pulse
I----rritability
L---oss of concentration
S----eizure
HYPOGLYCEMIA
Nursing Interventions
1. Immediate treatment with the use of foods with simple sugar- glucose tablets,
fruit juice, table sugar, honey or hard candies
2. For unconscious patients- glucagon injection 1 mg IM/SQ; or IV 25 to 50 mL of
D50/50
3. re-test glucose level in 15 minutes and re-treat if less than 75 mg/dL
4. Teach patient to refrain from eating high-calorie, high-fat desserts
5. Advise in-between snacks, especially when physical activity is increased
6. Teach the importance of compliance to medications

THE END
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,USA
STEIN, ALICE M., NSNA 5TH Edition, Delmar learning ,2005
HURST, MARLENE, Pathophysiology review, Mc graw companies Inc. 2008, USA
SMELTZER, SUZANNE C. Brunner & suddarths textbook of medical surgical nursing
9th ed.,lippincott 2000
SILVESTRI, LINDA, Comprehensive review of NCLEX-RN examination, 3rd edition
2005 Elsevier Inc.
KRENTZ, ANDREW, Churchills pocketbook of Diabetes, 2000, Elsevier Inc.
UDAN, JOSIE QUIAMBAO, Medical surgical nursing: concepts & clinical application,
2002 Educational publishing house, Philippines