Medical-Surgical Nursing
Endocrine System
Nursing Board Review
Ramil Austria
The ENDOCRINE SYSTEM
Review of the Anatomy and
Physiology of the endocrine
glands
Review of the Common
Laboratory procedures
Review of the Common endocrine
disorders
Review of Diabetes Mellitus
The ANATOMY of the Endocrine
System
The endocrine system is
composed of ductless
glands that release their
hormones directly into
the bloodstream
The ANATOMY of the Endocrine
System
The Hypothalamus
controls most of the
endocrinal activity of the
pituitary gland
The ANATOMY of the Endocrine
System
The pituitary gland
controls most of the
activities of the other
endocrine glands
The ANATOMY of the Endocrine
System
Hypothalamus
Pituitary Gland
Endocrine gland
Increased Hormones
The ANATOMY of the Endocrine
System
The Hypothalamus
This part of the
DIENCEPHALON is located
below the thalamus and is
connected to the pituitary
gland by a stalk
The PHYSIOLOGY of the
Endocrine System: Hypothalamus
Secretes RELEASING
HORMONES for the
pituitary gland
Releasing hormones= hypothalamus
The PHYSIOLOGY of the
Endocrine System: Hypothalamus
Secretes OXYTOCIN
that is stored in the
Posterior pituitary
gland
The PHYSIOLOGY of the
Endocrine System: Hypothalamus
Secretes Anti-Diuretic
Hormone or
VASOPRESSIN that is
stored also in the
posterior pituitary gland
The ANATOMY of the Endocrine
System
The Pituitary Gland
Is a gland located
below the
hypothalamus at the
base of the brain
The ANATOMY of the Endocrine
System
The Pituitary Gland
The optic chiasm
passes over this
structure
The ANATOMY of the Endocrine
System
The Pituitary Gland
Is divided into two
parts- the anterior or
adenohypophysis and
the posterior or the
neurohypophysis
The PHYSIOLOGY of the
Endocrine System: Anterior
Pituitary
Secretes the following
hormones:
1. Growth hormone
2. Prolactin
The PHYSIOLOGY of the
Endocrine System: Anterior
Pituitary
Secretes the following hormones:
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
The ANATOMY of the Endocrine
System
The THYROID gland
Located in the anterior
neck lateral to the
trachea
The ANATOMY of the Endocrine
System
The THYROID gland
Contains two lobes
connected by the isthmus
Microscopically composed
of thyroid follicles where
the hormones are produced
and stored
The PHYSIOLOGY of the
Endocrine System: Thyroid
Produces the thyroid
hormones by the thyroid
follicles:
1. Tri-iodothyronine or T3
2. Tetra-iodothyronine or
thyroxine or T4
The PHYSIOLOGY of the
Endocrine System: Thyroid
The Parafollicular cells
secrete CALCITONIN
The ANATOMY of the Endocrine
System
The PARAthyroid glands
Located at the back of the
thyroid glands
Four in number
The PHYSIOLOGY of the
Endocrine System: Parathyroid
gland
Secretes PARATHYROID
hormone (PTH) that controls
calcium and phosphorus
levels
PTH is stimulated by a
DECREASED Calcium level
The PHYSIOLOGY of the
Endocrine System: Parathyroid
gland
Parathyroid Hormone is Calcitonin is stimulated
released in by HYPERCALCEMIA
HYPOCALCEMIA
Parathyroid hormone is Calcitonin is inhibited
NOT secreted in by HYPOCALCEMIA
HYPERCALCEMIA
The ANATOMY of the Endocrine
System
The Adrenal Glands
Located above the kidneys
Composed of two parts- the
outer Adrenal Cortex and the
inner Adrenal medulla
The PHYSIOLOGY of the
Endocrine System: Adrenal
Cortex
Secretes three types of
STEROID hormones
1. Glucocorticoids- like
Cortisol, cortisone and
corticosterone
The PHYSIOLOGY of the
Endocrine System: Adrenal
Cortex
Secretes three types of
STEROID hormones
2. Mineralocorticoids- like
Aldosterone
3. Sex hormones- like
estrogen and testosterone
The PHYSIOLOGY of the
Endocrine System: Adrenal
Medulla
Essentially a part of the
SYMPATHETIC autonomic
system
Secretes Adrenergic
Hormones:
1. Epinephrine
2. Nor-epinephrine
The ANATOMY of the Endocrine
System
The Pancreas
This retroperitoneal
organ has both
endocrine and exocrine
functions
The ANATOMY of the Endocrine
System
The Pancreas
The endocrine function
resides in the ISLETS of
Langerhans
The islets have three types
of cells- alpha, beta and
delta cells
The PHYSIOLOGY of the
Endocrine System: The Pancreas
The ALPHA cells secrete
GLUCAGON
The BETA cells secrete
INSULIN
The DELTA cells secrete
SOMATOSTATIN
The ANATOMY of the Endocrine
System
The GONADS- Ovaries
These two almond-shaped
glands are found in the
pelvic cavity attached to the
uterus by the ovarian
ligament
The ANATOMY of the Endocrine
System
The GONADS- Testes
These two oval-shaped
glands are found in the
scrotum
The PHYSIOLOGY of the
Endocrine System: Gonads
The Ovaries contains
Granulosa and Theca
cells which secrete
ESTROGEN and
Progesterone
The PHYSIOLOGY of the
Endocrine System: Gonads
The testes contains
Leydig cells that secrete
Testosterone
COMMON
LABORATORY
PROCEDURES
COMMON LABORATORY
PROCEDURES
Hormone Levels Assay
These are blood
examinations for the
levels of individual
hormones
COMMON LABORATORY
PROCEDURES
Hormone Levels Assay
Measurements can also be
done after stimulation and
suppression of the
secretions- Stimulation and
Suppression tests
COMMON LABORATORY
PROCEDURES
Hormone Levels of T3/T4
Usually done to diagnose
hypo/hyperthyroidism
COMMON LABORATORY
PROCEDURES
Hormone Levels of T3/T4
If T3 is elevated, T4 is
elevated and TSH is
depressed Primary
HYPERthyroidism
COMMON LABORATORY
PROCEDURES
Hormone Levels of T3/T4
If T3 is depressed,T4 is
depressed and TSH is
elevated Primary
HYPOthyoidism
COMMON LABORATORY
PROCEDURES
Radio-Active iodine uptake
(RAI)
This is a thyroid function
test to measure the
absorption of the injected
iodine isotope by the
thyroid tissue
COMMON LABORATORY
PROCEDURES
Radio-Active iodine uptake
(RAI)
Increased uptake may
indicate HYPERfunctioning
gland
Decreased uptake my indicate
HYPOfunctioning gland
COMMON LABORATORY
PROCEDURES
Thyroid Scan
Performed to identify
nodules or growth in the
thyroid gland
RAI is used
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
COMMON LABORATORY
PROCEDURES
The BMR has a long history in the evaluation
of thyroid function.
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
COMMON LABORATORY
BMR PROCEDURES
The test indirectly measures metabolic energy
expenditure or heat production.
Results are expressed as the percentage of
deviation from normal after appropriate
corrections have been made for age, sex, and
body surface area.
Low values are suggestive of
hypothyroidism, and high values reflect
thyrotoxicosis.
COMMON LABORATORY
PROCEDURES
FASTING BLOOD GLUCOSE
Aids in the diagnosis of
Diabetes
Pre-test: NPO for 8 hours
Normal FBS- 80-109 mg/dL
DM- 126 mg/dL and above
COMMON LABORATORY
PROCEDURES
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!
COMMON LABORATORY
PROCEDURES
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
DISORDERS OF THE ENDOCRINE
GLAND
Disorders are generally
grouped into:
1. HYPER- when the gland
secretes excessive hormones
2. HYPO- when the gland
does not secrete enough
hormones
DISORDERS OF THE ENDOCRINE
GLAND
Hyper and Hypo can be
classified as PRIMARY
when the Gland itself is the
problem or SECONDARY
when the pituitary or the
hypothalamus is causing
the problem
Disorders of the
PITUITARY GLAND
DISORDERS OF the PITUITARY
GLAND
HYPOPITUITARISM
Hyposecretion of the
anterior pituitary gland
CAUSES: Congenital, Post-
partal necrosis, infection
and tumor
DISORDERS OF the PITUITARY
GLAND
HYPOPITUITARISM
PATHOPHYSIOLOGY:
Depends on the major
hormone/s depleted
DISORDERS OF the PITUITARY
GLAND
Hypopituitarism: ASSESSMENT
Findings
1. Retarded physical growth due
to decreased GH dwarfism
2. Low intellectual development
3. poor development of
secondary sexual characteristics
DISORDERS OF the PITUITARY
GLAND
NURSING INTERVENTIONS
1. Provide emotional support
to the family
2. Encourage client and family
to express feelings
3. Administer prescribed
hormonal replacement therapy
DISORDERS OF the PITUITARY
GLAND
HYPERPITUITARISM
The hyper-secretion of
the gland
ACROMEGALY
CAUSES: tumor, congenital
disorder
DISORDERS OF the PITUITARY
GLAND
HYPERPITUITARISM
PATHOPHYSIOLOGY
Depends on the
hormone/s that is/are
increased
DISORDERS OF the PITUITARY
GLAND
ASSESSMENT FINDINGS for
Hyper-pituitarism
1. Increased growth
Gigantism or Acromegaly
2. large and thick hands and
feet
DISORDERS OF the PITUITARY
GLAND
ASSESSMENT FINDINGS for
Hyper-pituitarism
3. Visual disturbances
4. Hypertension,
hyperglycemia
5. Organomegaly
DISORDERS OF the PITUITARY
GLAND
NURSING INTERVENTIONS
1. Provide emotional support
to clients and family
2. Provide frequent skin care
3. Prepare patient for surgery-
removal of pituitary gland
DISORDERS OF the PITUITARY
GLAND
NURSING INTERVENTIONS
Post-operative care
1. Monitor VS, LOC and
neurologic status
2. Place patient on Semi-
Fowler’s
DISORDERS OF the PITUITARY
GLAND
NURSING INTERVENTIONS
Post-operative care
3. Monitor for Increased ICP,
bleeding, CSF leakage
4. Instruct patient to AVOID
sneezing, coughing and nose-
blowing
DISORDERS OF the PITUITARY
GLAND
NURSING INTERVENTIONS
Post-operative care
5. Monitor development of
DI- measure I and O
6. Administer prescribed
medications- antibiotics,
analgesics and steroids
DISORDERS OF the PITUITARY
GLAND: Posterior gland
DIABETES INSIPIDUS
A hypo-secretion of ADH
CAUSES: Conditions that
increase ICP, Surgical
removal of post pit.
tumor
DISORDERS OF the PITUITARY
GLAND: Posterior gland
DIABETES INSIPIDUS
PATHOPHYSIOLOGY
Decreased ADH failure of
tubular re-absorption of
water increased urine
volume
DISORDERS OF the PITUITARY
GLAND: Posterior gland
ASSESSMENT findings
1. Polyuria of more
than 4 liters of
urine/day
2. Polydipsia
DISORDERS OF the PITUITARY
GLAND: Posterior gland
ASSESSMENT findings
3. Signs of Dehydration
4. Muscle pain and
weakness
5. Postural hypotension and
tachycardia
DISORDERS OF the PITUITARY
GLAND: Posterior gland
DIAGNOSTIC TEST
1. Urinary Specific
gravity very low, 1.006
or less
2. Serum Sodium
levels high
DISORDERS OF the PITUITARY
GLAND: Posterior gland
NURSING INTERVENTIONS
1.Monitor VS, neurologic
status and cardiovascular
status
2. Monitor Intake and
Output
3. Monitor urine specific
gravity
DISORDERS OF the PITUITARY
GLAND: Posterior gland
NURSING INTERVENTIONS
4. Provide adequate fluids
5. Administer
Chlorpropamide or Clofibrate
as prescribed to increase the
action of ADH if decreased
DISORDERS OF the PITUITARY
GLAND: Posterior gland
NURSING INTERVENTIONS
6. Administer VASOPRESIN.
Desmopressin or Lypressin
are given intranasal.
Pitressin is given IM
DISORDERS OF the PITUITARY
GLAND: Posterior gland
SIADH
Hyper-secretion of ADH
CAUSES: tumor, paraneoplastic
syndromes
DISORDERS OF the PITUITARY
GLAND: Posterior gland
SIADH
PATHOPHYSIOLOGY
Increased ADH water
re-absorption water
intoxication,
hypervolemia
DISORDERS OF the PITUITARY
GLAND: Posterior gland
DIAGNOSTIC TEST for SIADH
1. Urine specific gravity is
increased (concentrated)
2. Hyponatremia
3. CBC shows hemodilution
DISORDERS OF the PITUITARY
GLAND: Posterior gland
ASSESSMENT findings
1. Signs of Hypervolemia
2. Mental status changes
3. Abnormal weight gain
DISORDERS OF the PITUITARY
GLAND: Posterior gland
ASSESSMENT findings
4. Hypertension
5. Anorexia, Nausea and
Vomiting
6. HYPOnatremia
DISORDERS OF the PITUITARY
GLAND: Posterior gland
NURSING INTERVENTIONS
1. Monitor VS and neurologic
status
2. Provide safe environment
3. Restrict fluid intake (less
than 500cc/day)
DISORDERS OF the PITUITARY
GLAND: Posterior gland
NURSING INTERVENTIONS
4. Monitor I and O and daily
weight
5. Administer Diuretics and IVF
carefully
6. Administer prescribed
Demeclocycline to inhibit action
of ADH in the kidney
Disorders of the
ADRENAL GLAND
DISORDERS OF the ADRENAL
GLAND
Hypo-secretion: ADDISON’S
Disease
Decreased secretion of
adrenal cortex hormones,
especially glucocorticoids
and mineralocorticoids
CAUSE: autoimmune
DISORDERS OF the ADRENAL
GLAND
PATHOPHYSIOLOGY
Decreased
Glucocorticoids
decreased resistance to
stress
DISORDERS OF the ADRENAL
GLAND
PATHOPHYSIOLOGY
Decreased mineralocorticoids
decreased retention of sodium
and water
Hypovolemia
Pathophysiology
Normal functions of Cortisol HYPO functions
1. Gluconeogenesis HYPOGLYCEMIA
Pathophysiology
Functions of HYPO functions
Mineralocorticoids
1. Sodium Retention HYPOnatremia
2.Secondary water HYPOvolemia-
retention HYPOtension
Weight LOSS
3. Potassium excretion HYPERKALEMIA
Function of androgen: Decreased libido
Libido
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT Findings for
Addison’s disease
1. Weight loss
2. GI disturbances
3. Muscle weakness, lethargy
and fatigue
4. Hyponatremia
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT Findings for
Addison’s disease
5. Hyperkalemia
6. Hypoglycemia
7. dehydration and hypovolemia
8. Increased skin pigmentation
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
1. Monitor VS especially BP
2. Monitor weight and I and O
3. Monitor blood glucose level
and K
4. Administer hormonal agents
as prescribed
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
5. Observe for ADDISONIAN
crisis
6. Educate the client
regarding lifelong treatment,
avoidance of strenuous
activities, stress and seeking
prompt consult during illness
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
7. Provide a high-protein,
high carbohydrate and
increased sodium intake
DISORDERS OF the ADRENAL
GLAND
ADDISONIAN crisis
A life-threatening disorders
caused by acute severe
adrenal insufficiency
CAUSES: Severe stress,
infection, trauma or surgery
DISORDERS OF the ADRENAL
GLAND
ADDISONIAN crisis
PATHOPHYSIOLOGY
Overwhelming stimuli
mobilize body defense
decreased stress
hormones inadequate
coping
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT Findings for Addisonian
Crisis= “severe lahat”
1. Severe headache
2. Severe pain
3. Severe weakness
4. Severe hypotension
5. Signs of Shock
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
1. Administer IV glucocorticoids,
usually hydrocortisone
2. Monitor VS frequently
3. Monitor I and O, neurological
status, electrolyte imbalances
and blood glucose
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
4. Administer IVF
5. Maintain bed rest
6. Administer prescribed
antibiotics
DISORDERS OF the ADRENAL
GLAND
Hyper-secretion: CUSHING’S
DISEASE
A condition resulting from the
hyper-secretion of glucocorticoids
from the adrenal cortex
CAUSES: Pituitary tumor, adrenal
tumor, abuse of steroids
DISORDERS OF the ADRENAL
GLAND
Hyper-secretion: CUSHING’S
DISEASE
PATHOPHYSIOLOGY
Increased Glucocorticoids
exaggerated effects of the
hormone
Pathophysiology
Normal functions of Cortisol Exaggerated functions
1. Gluconeogenesis HYPERGLYCEMIA
2. Protein breakdown OSTEOPOROSIS,
delayed wound healing
Purplish striae ,
Bleeding
Muscle wasting
3. Fat breakdown THIN extremity,
Truncal deposition
4. Decreased WBC IMMUNOSUPPRESSION
Pathophysiology
Functions of Exaggerated functions
Mineralocorticoids
1. Sodium Retention Hypernatremia
2.Secondary water Hypervolema-
retention Hypertension
3. Potassium excretion HYPOKALEMIA
Function of androgen: HIRSUTISM
Hair growth
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT FINDINGS for
Cushing
1. Generalized muscle
weakness and wasting
2. Truncal obesity
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT FINDINGS
for Cushing
3. Moon-face
4. Buffalo hump
5. Easy bruisability
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT FINDINGS for
Cushing
6. Reddish-purplish striae
on the abdomen and thighs
7. Hirsutism and acne
8. Hypertension
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT FINDINGS for
Cushing
9. Hyperglycemia
10. Osteoporosis
11. Amenorrhea
DISORDERS OF the ADRENAL
GLAND
DIAGNOSTIC TESTS
1. Serum cortisol level
2. Serum glucose and
electrolytes
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
1. Monitor I and O , weight
and VS
2. Monitor laboratory
values- glucose, Na, K and
Ca
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
3. Provide meticulous skin
care
4. Administer prescribed
medications like
aminogluthetimide to inhibit
adrenal hyperfunctioning
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
5. Prepare client for surgical
management- pituitary
surgery and adrenalectomy
6. Protect patient from
infection
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
7. Improve body image
8. Provide a LOW
carbohydrate, LOW sodium
and HIGH protein diet,high
Ca and Vitamin D.
DISORDERS OF the ADRENAL
GLAND
Hyper-secretion: CONN’S
DISEASE
Hyper-secretion of Aldosterone
from the adrenal cortex
CAUSES: pituitary tumor, adrenal
tumor
DISORDERS OF the ADRENAL
GLAND
Hypersecretion: CONN’S
DISEASE
PATHOPHYSIOLOGY
Increased Aldosterone
exaggerated effects
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT findings in CONN’S
disease
1. Symptoms of HYPOkalemia
2. Hypertension
3. Hypernatremia
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT findings in
CONN’S disease
4. Headache, N/V
5. Visual changes
6. Muscles weakness, fatigue
and nocturia
DISORDERS OF the ADRENAL
GLAND
DIAGNOSTIC TEST
1. Urine gravity- low (due to
polyuria)
2. Serum Sodium- high
3. Serum Potassium- very low
4. Increased urinary Aldosterone
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
1. Monitor VS, I and O and
urine sp gravity
2. Monitor serum K and Na
3. Provide Potassium rich
foods and supplements
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
4. Administer prescribed
diuretic- Spironolactone
5. Maintain sodium-
restricted diet
DISORDERS OF the ADRENAL
GLAND
NURSING
INTERVENTIONS
6. Prepare patient for
possible surgical
interventions
DISORDERS OF the ADRENAL
GLAND
Hyper-secretion:
Pheochromocytoma
Increased secretion of
epinephrine and nor-epinephrine
by the adrenal medulla
CAUSE: tumor
DISORDERS OF the ADRENAL
GLAND
Hypersecretion:
Pheochromocytoma
PATHOPHYSIOLOGY
Increased Adrenergic
hormones exaggerated
sympathetic effects
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT Findings in
Pheochromocytoma
1. Hypertension
2. Severe headache
3. Palpitations
4. Tachycardia
DISORDERS OF the ADRENAL
GLAND
ASSESSMENT Findings in
Pheochromocytoma
5. Profuse sweating and
Flushing
6. Weight loss, tremors
7. Hyperglycemia and
glycosuria
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
1. Monitor VS especially BP
2. Monitor for
HYPERTENSIVE crisis
3. Avoid stimulation that
can cause increased BP
DISORDERS OF the ADRENAL
GLAND
NURSING INTERVENTIONS
4. Administer Anti-
hypertensive agents like
alpha-adrenergic blockers-
Phenoxybenzamine
5. Prepare Phentolamine for
hypertensive crisis
DISORDERS OF the ADRENAL
GLAND
6. Monitor blood glucose
and urine glucose
7. Promote adequate rest
and sleep periods
DISORDERS OF the ADRENAL
GLAND
8. provide HIGH calorie
foods and Vitamins/mineral
supplements
9. Prepare patient for
possible surgery
Disorders of the
THYROID GLAND
DISORDERS OF the THYROID
GLAND
HYPOsecretion: HYPOTHYROIDISM
A hypothyroid state characterized by
decreased secretions of T3 and T4
CAUSES: Hypofunctioning
tumor,Pituitary tumor, Surgical
removal of thyroid
DISORDERS OF the THYROID
GLAND
HYPOsecretion:
HYPOTHYROIDISM
PATHOPHYSIOLOGY
Decreased T3 and T4
decreased basal
metabolism
DISORDERS OF the THYROID
GLAND
ASSESSMENT findings for
Hypothyroidism
1. Lethargy and fatigue
2. Weakness and paresthesia
3. COLD intolerance
DISORDERS OF the THYROID
GLAND
ASSESSMENT findings for
Hypothyroidism
4. Weight gain
5. Bradycardia, constipation
DISORDERS OF the THYROID
GLAND
ASSESSMENT findings for
Hypothyroidism
6. Dry hair and skin, loss of
body hair
7. Generalized puffiness and
edema around the eyes and
face
DISORDERS OF the THYROID
GLAND
ASSESSMENT findings for
Hypothyroidism
8. Forgetfulness and memory
loss
9. Slowness of movement
10. Menstrual irregularities
and cardiac irregularities
DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
1. Monitor VS especially HR
2. Administer hormone
replacement: usually
Levothyroxine( Synthroid)-
should be taken on an
empty stomach
DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
3. Instruct patient to eat LOW
calorie, LOW cholesterol and
LOW fat diet
4. Manage constipation
appropriately
5. Provide a WARM environment
DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
6. Avoid sedatives and
narcotics because of
increased sensitivity to these
medications
7. Instruct patient to report
chest pain promptly
DISORDERS OF the THYROID
GLAND
HYPERfunctioning:
HYPERTHYROIDISM
M.c. type- GRAVE’S DISEASE
A hyperthyroid state
characterized by increased
circulating T3 and T4
DISORDERS OF the THYROID
GLAND
HYPERfunctioning:
HYPERTHYROIDISM
CAUSES: Auto-immune disorder,
toxic goiter and tumor
PATHOPHYSIOLOGY
Increased hormone activity
increased Basal Metabolism
DISORDERS OF the THYROID
GLAND
ASSESSMENT Findings for
Hyperthyroidism
1. Weight loss
2. HEAT intolerance
3. Hypertension
DISORDERS OF the THYROID
GLAND
ASSESSMENT Findings for
Hyperthyroidism
4. Tachycardia and
palpitations
5. Exopthalmos
6. Diarrhea
DISORDERS OF the THYROID
GLAND
ASSESSMENT Findings for
Hyperthyroidism
7. Warm skin
8. Diaphoresis
9. Smooth and soft skin
Oligomenorrhea to amenorrhea
DISORDERS OF the THYROID
GLAND
ASSESSMENT Findings for
Hyperthyroidism
10. Fine tremors and
nervousness
11. Irritability, mood
swings, personality changes
and agitation
DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
1. Provide adequate rest periods
in a cool, quiet room
2. Administer anti-thyroid
medications that block hormone
synthesis- Methimazole and PTU
3. Provide a HIGH-calorie diet,
HIGH protein
DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
4. Manage diarrhea
5. Provide a cool and quiet
environment
6. Avoid giving stimulants
7. Provide eye care
Hypoallergenic tape for eyelid
closure
DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
7. Administer PROPRANOLOL
for tachycardia
8. Administer IODIONE
preparation- Lugol’s solution
and SSKI to inhibit the
release of T3 and T4
DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
9. Prepare clients for
Radioactive iodine therapy
10. Prepare patient for
thyroidectomy
11. Manage thyroid storm
appropriately
DISORDERS OF the THYROID
GLAND
Thyroid storm
An acute LIFE-
threatening condition
characterized by
excessive thyroid
hormone
DISORDERS OF the THYROID
GLAND
Thyroid storm
CAUSE: Manipulation of the
thyroid during surgery
causing the release of
excessive hormones in the
blood
DISORDERS OF the THYROID
GLAND
ASSESSMENT Findings for
Thyroid Storm
1. HIGH fever
2. Tachycardia and
Tachypnea
3. Systolic HYPERtension
DISORDERS OF the THYROID
GLAND
ASSESSMENT Findings for
Thyroid Storm
4. Delirium and coma
5. Severe vomiting and
diarrhea
6. Restlessness, Agitation,
confusion and Seizures
DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
1. Maintain PATENT airway
and adequate ventilation
2. Administer anti-thyroid
medications such as Lugol’s
solution, Propranolol, and
Glucocorticoids
DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
3. Monitor VS
4. Monitor Cardiac rhythms
5. Administer PARACETAMOL
( not Aspirin) for FEVER
DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS
6. Manage Seizures as
required.
7. Provide a quiet
environment
DISORDERS OF the THYROID
GLAND
THYROIDECTOMY
Removal of the thyroid gland
DISORDERS OF the THYROID
GLAND
PRE-OPERATIVE CARE -
Thyroidectomy
1. Obtain VS and weight
2. Assess for Electrolyte
levels, glucose levels and
T3/T4 levels
DISORDERS OF the THYROID
GLAND
PRE-OPERATIVE CARE -
Thyroidectomy
3. Provide pre-operative
teaching like coughing and deep
breathing, early ambulation and
support of the neck when
moving
4. Administer prescribed
medications
DISORDERS OF the THYROID
GLAND
POST-OPERATIVE CARE - Thyroidectomy
1. Position patient: Semi-
Fowler’s, neck on neutral position
2. Monitor for respiratory
distress- apparatus at bedside-
tracheostomy set, O2 tank and
suction machine!
DISORDERS OF the THYROID
GLAND
POST-OPERATIVE CARE - Thyroidectomy
3. Check for edema and
bleeding by noting the
dressing anteriorly and at the
back of the neck
DISORDERS OF the THYROID
GLAND
POST-OPERATIVE CARE - Thyroidectomy
4. LIMIT client talking
5. Assess for HOARSENESS
Expected to be present only
initially, limit excess vocalization
If persistent, may indicate damage
to laryngeal nerve!
DISORDERS OF the THYROID
GLAND
POST-OPERATIVE CARE - Thyroidectomy
6. Monitor for Laryngeal Nerve
damage – Respiratory distress,
Dysphonia, voice changes,
Dysphagia and restlessness
DISORDERS OF the THYROID
GLAND
POST-OPERATIVE CARE - Thyroidectomy
7. Monitor for signs of
HYPOCALCEMIA and tetany due to
trauma of the parathyroid
8. Prepare Calcium gluconate
9. Monitor for thyroid storm
DISORDERS OF the
PARATHYROID GLAND
Hypo-functioning:
HYPOPARATHYROIDISM
Hypo-secretion of
parathyroid hormone
CAUSES: tumor, removal of the
gland during thyroid surgery
DISORDERS OF the
PARATHYROID GLAND
Hypo-functioning:
HYPOPARATHYROIDISM
PATHOPHYSIOLOGY
Decreased PTH deranged
calcium metabolism
DISORDERS OF the
PARATHYROID GLAND
ASSESSMENT Findings for
HypoParaThyroidism
1. Signs of HYPOCALCEMIA
2. Numbness and tingling
sensation on the face
3. Muscle cramps
DISORDERS OF the
PARATHYROID GLAND
ASSESSMENT Findings for
HypoParaThyroidism
4. (+) Trosseau’s and (+)
Chvostek’s signs
5. Bronchospasms,
laryngospasms, and
dysphagia
DISORDERS OF the
PARATHYROID GLAND
ASSESSMENT Findings for
HypoParaThyroidism
6. Cardiac dysrhythmias
7. Hypotension
8. Anxiety, irritability ands
depression
DISORDERS OF the
PARATHYROID GLAND
NURSING INTERVENTIONS
1. Monitor VS and signs of
HYPOcalcemia
2. Initiate seizure
precautions and
management
DISORDERS OF the
PARATHYROID GLAND
NURSING INTERVENTIONS
3. Place a tracheostomy set.
O2 tank and suction at the
bedside
4. Prepare CALCIUM gluconate
5. Provide a HIGH-calcium and
LOW phosphate diet
DISORDERS OF the
PARATHYROID GLAND
NURSING INTERVENTIONS
6. Advise client to eat
Vitamin D rich foods
7. Administer Phosphate
binding drugs
DISORDERS OF the
PARATHYROID GLAND
Hyper-functioning:
HYPERPARATHYROIDISM
Hyper-secretion of the
gland
CAUSE: Tumor
DISORDERS OF the
PARATHYROID GLAND
Hyper-functioning:
HYPERPARATHYROIDISM
PATHOPHYSIOLOGY
Increase PTH increased
CALCIUM levels in the body
DISORDERS OF the
PARATHYROID GLAND
ASSESSMENT Findings for
Hyperparathyroidism
1. Fatigue and muscle
weakness/pain
2. Skeletal pain and tenderness
3. Fractures
DISORDERS OF the
PARATHYROID GLAND
ASSESSMENT Findings for
Hyperparathyroidism
4. Anorexia/N/V epigastric
pain
5. Constipation
DISORDERS OF the
PARATHYROID GLAND
ASSESSMENT Findings for
Hyperparathyroidism
6. Hypertension
7. Cardiac Dysrhythmias
8. Renal Stones
DISORDERS OF the
PARATHYROID GLAND
NURSING INTERVENTIONS
1. Monitor VS, Cardiac
rhythm, I and O
2. Monitor for signs of renal
stones, skeletal fractures.
Strain all urine.
DISORDERS OF the
PARATHYROID GLAND
NURSING INTERVENTIONS
3. Provide adequate fluids-
force fluids
4. Administer prescribed
Furosemide to lower calcium
levels
5. Administer NORMAL saline
DISORDERS OF the
PARATHYROID GLAND
NURSING INTERVENTIONS
6. Administer calcium
chelators
7. Administer CALCITONIN
8. Prepare the patient for
surgery
Selected Endocrine
PHARMACOLOGY
Endocrine Medications
Anti-diuretic hormones
Enhance re-absorption of
water in the kidneys
Used in DI
1. Desmopressin and Lypressin
intranasally
2. Pitressin IM
Endocrine Medications
Anti-diuretic hormones
SIDE-effects
Flushing and headache
Water intoxication
Thyroid Medications
Thyroid hormones
Levothyroxine (Synthroid) and
Liothyroxine (Cytomel)
Replace hormonal deficit in the
treatment of
HYPOTHYROIDSM
Thyroid Medications
Thyroid hormones
Side-effects
1. Nausea and Vomiting
2. Signs of increased
metabolism= tachycardia,
hypertension
Thyroid Medications
Thyroid hormones
Nursing responsibility
1. Monitor weight, VS
2. Instruct client to take daily
medication the same time
each morning WITHOUT
FOOD
Thyroid Medications
Thyroid hormones
Nursing responsibility
3. Advise to report palpitation,
tachycardia, and chest pain
4. Instruct to avoid foods that
inhibit thyroid secretions like
cabbage, spinach and radishes
ANTI-Thyroid Medications
ANTI-THYROID medications
Inhibit the synthesis of
thyroid hormones
1. Methimazole (Tapazole)
2. PTU (prophylthiouracil)
3. Iodine solution- SSKI and
Lugol’s solution
ANTI-Thyroid Medications
ANTI-THYROID medications
Side-effects
N/V
Diarrhea
AGRANULOCYTOSIS
Most important to monitor
ANTI-Thyroid Medications
ANTI-THYROID medications
Nursing responsibilities
1. Monitor VS, T3 and T4,
weight
2. The medications WITH
MEALS to avoid gastric
upset
ANTI-Thyroid Medications
ANTI-THYROID medications
Nursing responsibilities
3. Instruct to report SORE
THROAT or unexplained
FEVER
4. Monitor for signs of
hypothyroidism. Instruct not
to stop abrupt medication
ANTI-Thyroid Medications
ANTI-THYROID medications
Lugol’s Solution
Used to decrease the
vascularity of the thyroid
T3 and T4 production
diminishes
Given per orem, can be diluted
with juice
Use straw
STEROIDS
Replaces the steroids in
the body
Cortisol, cortisone,
betamethasone, and
hydrocortisone
STEROIDS
Side-effects
HYPERglycemia
Increased susceptibility to
infection
Hypokalemia
Edema
STEROIDS
Side-effects
If high doses-
osteoporosis, growth
retardation, peptic ulcer,
hypertension, cataract,
mood changes, hirsutism,
and fragile skin
STEROIDS
Nursing responsibilities
1. Monitor VS,
electrolytes, glucose
2. Monitor weight edema
and I/O
STEROIDS
Nursing responsibilities
3. Protect patient from
infection
4. Handle patient gently
5. Instruct to take meds
WITH MEALS to prevent
gastric ulcer formation
STEROIDS
Nursing responsibilities
6. Caution the patient NOT to
abruptly stop the drug
7. Drug is tapered to allow
the adrenal gland to secrete
endogenous hormones
Quick Review
Hypothyroidism
Hyposecretion of thyroid hormones
Common causes: Iodine deficiency, Hashimotos
Manifestations: related to hypo-metabolic state:
constipation, weight gain, cold intolerance, poor
appetite, mental slowness
Nursing Management:
Provide warm environment
LOW calorie diet, HIGH fiber
Avoid sedatives
Drugs: Hormone replacement
Hyperthyroidism
Hyper-secretion of thyroid hormones
Common cause: Graves, Toxic goiter
Manifestation: increased metabolism:
weight loss, diarrhea, heat intolerance,
hypertension
Nursing Management:
Adequate rest and sleep
Cool environment
HIGH calorie foods
Eye care
Drugs: anti-thyroid: PTU and methimazole,
propranolol
Care of patients after thyroidectomy
