Endocrine disorder Jundell a castardo Hyperactivity of gland and hypoactivity of the gland Hyperactivity tumor (abnormal growth in the

e body) Hypoactivity congenital (inborn), idiopathic atrophy (unknown), surgical removal Treatment addition and suppression HRT (hormone replacement therapy) Hormone is a medication Pituitary gland can be found at the base of the brain , two lobes (anterior and posterior) Anterior ACTH Adreno corticosteroid hormone(adrenal cortex) FSH (follicle stimulating hormone) ovaries estrogen GH (growth hormone) growth bones LH (lieutenizing hormone) progesterone MSH (melanocytes stimulating hormone) skin melanin Prolactin (mammary glands) milk production TSH (thyroid stimulating hormone) thyroid glands Posterior Oxytocin uterus (contraction) breast (milk ejection reflex) ADH (vasopressin) retention Hyperpituitarism Hypopituitarism Pituitary Dwarfism Hormone replacement therapy: Somatropin (humatrope) Somatrem (protropin) Pituitary adenoma the tumor Hypophysectomy surgical removal of the pituitary gland Radiation therapy to shrink the tumor Transphenoidal site of incision (upper lip) semi fowlers, nasal pack in the nose, frequent oral care Most common complication diabetes insipidus Gigantism plate is open Acromegaly plate is close Prognatism protrusion of the jaw Enlarge larynx deep voice

Chin lengthening Hypertrophy of soft tissues, increase bone thickness Broad hand, spade like fingers Macroglossia tongue Epiphyseal plate 18 21 yrs old Posterior pituitary gland ADH (diabetes insipidus) 1.5L a day but for adh its 15 L a day polydipsia (excessive thirst) diabetes insipidus s/sx: FVD (fluid volume deficit / dehyrdration) urine output 15 29 L / day polyuria polydipsia diluted urine decrease urine specific gravity fluid and electrolyte imbalance hypotension weight loss medication: addition of ADH pitressin - im vasopressin im drug of choice , fast reacting shorter duration every 8 hours desmopressin nasal spray / intranasally lipodystrophy (rotate injection sites) SIADH syndrome of inappropriate antidiuretic hormone secretion s/sx: FVE (fluid volume excess) edema oliguria concentrated urine increase urine specific gravity dilutional hyponatremia hypertension weight gain medication: demeclocycline (declomycin) suppressor

parathyroid gland two per lobes in the thyroid glands parahormone or parathyroid hormone level of function and phosphorous bone absorption (calcitonin) released by thyroid glands bone resorption (parathyroid hormone) released by the parathyroid gland 99% calcium is in the bone (makapagahi sa bukog) 1% calcium in the blood is muscle contraction, transmission of nerve impulses, blood clotting and most abundant mineral in the body hypoparathyroidism decrease resorption decrease pth decrease ptg hypocalcemia hallmark manifestation is tetany (spasm or irritability of the muscles in the body) earlier signs can be found in the mouth or around the lips (circomoral tetany) and fingers sites in eliciting chvosteks sign facial nerve trosseaus sign = carpo pedal spasm very prone to seizures spasm / constriction (vasospasm / vasoconstriction) diet: high in calcium low in phosphorous calcium supplements calcium gluconate, calcium lactate, calcium bicarbonate vitamin d increase absorption calceferol phosphate binders decrease phosphate (aluminum containing antacids) example: aluminum hydroxide (amphojel), calcium carbonate expelled through feces increase ptg increase pth increase resorption hypercalcemia hypophosphatemia osteoporosis pathologic fractures (when the bone is weaker than the usual) renal stones (calcium deposits) fluid therapy or hydration therapy provide calcitonin (nasal spray) provide diuretics except thiazide diuretics hypercalcemic crisis can lead to cardiac arrest, BP (decrease bp) 3.5 11 mg/dl (normal calcium) if level goes to 14 it is hypercalcemic crisis last resort is hemodialysis hyperphosphatemia caused by hypocalcemia

Adrenal Glands kidneys * Medulla Corticosteroids Cathecolamines: epinephrine and norepinephrine Sympatheric response Cortex Steroids Cushings disease (hyperactive adrenal cortex) overproduction of steroids Sugar hyperglycemia, buffalo hump, moon facies Salt hyervolemia, increase bp, edema, anasarca (truncal obesity, slender extremities) decrease potassium, increase sodium Sex virilism, hirsutism, masculinization, enlarged clitoris, gynecomastia, amenorrhea, increase capillary fragility

Glucocorticoids Cortisol, cortisone, corticosterone Gluconeogenolysis, anti inflammatory response, resistance to stress Mineralocorticoid Aldosterone - Promotes sodium retention and potassium excretion Salt hormone of the body Sex hormones Androgen , estrogen Glycogen (in the liver) release glucagon to glycogenolysis Interventions 1. Surgery adrenalectomy 2. Cortisol inhibitors aminogluthetemide - trilostane - metyrapone, mitotane 3. Diet: increase potassium and decrease sodium Addisons disease (hypoactive adrenal cortex) Sugar: hypoglycemia Salt: hypovolemia, decrease bp, decrease sodium, increase potassium cardiac Dysrhythmia cardiac arrest Sex loss of axillary / pubic hair, breast atrophy, increase MSH = hyperpigmentation or discoloration of skin and mucous membrane tan or bronze- skinned individual

Interventions 1. receive steroidal preparation prednisone, dexamethasone, hydrocortisone should be given with meals, Diet: High CHON, high CHO, increase sodium, decrease potassium Addisonian crisis (adrenal crisis) provide steroids through iv route Conns Disease (primary hyperaldosteronism) Has benign tumor adrenal cortex Increase salt potassium sparing diuretics (aldactone drug of choice) Hypernatremia, hypokalemia, hypervolemia, edema, increase bp Intervention: adrenalectomy Pheochromocytoma Has benign tumor medulla Sympathetic signs and symptoms 5Hs 1. hypertension 2. Headache 3. Hyperglycemia 4. Hypermetabolism 5. Hyperhydrosis (excessive sweating) Anhydrosis (absence) Intervention: adrenalectomy VMA (Vanillylmandilic Acid Test) Normal result: 0.2 mg 7 mg / 24 hours Stimulants should not be taken within 2 3 days before the testing date Thyroid gland front T3 thyronine T4 thyroxine Functions of t3 and t4: 1. growth and brain development 2. reproduction 3. essential for metabolism most common and most dangerous graves disease thyroid crisis or thyroid storm hypermetabolism goiter attack of antibodies eyes signs 1. von graefes sign (lid lag) sleepy looking always

2. 3. 4. 5.

proptosis downward displacement of the eyeball dalrymples sign infrequent blinking, fixed stare periorbital edema exophthalmos

management of graves disease treatment modalities 1. anti-thyroid preparation methimazole (tapazole) propylthiouracil (PTU) Neomercazole (Carbimazole) Long term agranulocytosis Early sign sore throat 2. Iodine preparation Lugols solution / KISS (potassium iodide saturated solution) 3. adrenergic blocking agent = sympathetic propranolol (Inderal) drug of choice 4. RAI 131 Radiation (Medical Thyroidectomy) Postoperative care: thyroidectomy 1. 2. 3. 4. hemorrhage respiratory obstruction hypoparathyroidism laryngeal nerve damage hoarseness aphonia bilateral

hashimoto hashimotos thyroiditis autoimmune myxedema coma congenital hypothyroidism cretinism manifestations hypometabolism slow bmr cold cold intolerance warm environment place blanket physical and mental hypoactivity lethargy fatigue weight gain obese risk for heart attack and stroke anorexia

high calorie low fat low cholesterol laxatives high fiber diet stool softener dry skin moisturizing lotion lower vital signs interventions levothyroxine (synthroid) prothyroid morning time 30 minutes before meals report chest pain Levine sign gikumot ang chest for heart attack Myxedema coma Intervention IV levochyroxine (synthroid) Thyroid storm Antithyroid meds (PTU) beta blockers Beta cells insulin It is both exocrine (secreting pancreatic juice containing digestive enzymes) and endocrine (producing insulin and glucagon) 1 hour after ingestion of food highest sugar blood sugar is food of cells 180 200 mg/dl threshold dk hhnks regular insulin iv fluid of choice isotonic solutions LRS or NSS Juvenile Onset ( type 1) Slender Absolute insulin deficiency (little or no insulin) Autoantibodies Insulin Maturity onset (type 2) Obese

Relative insulin deficiency (decrease insulin production or increase insulin resistance) Oral Hypoglycemic Agents 1st. sulfonylureas (stimulate pancreas to release more insulin) 2nd biguanides (stimulate pancreas to decrease insulin production) metformin (glucophage) diagnostic tests: DM 1. fasting blood sugar (FBS) normal: 70 100 mg/dl 6-8 hours 2. Random Plasma Glucose (RPG) normal < 200 mg/dl 3. Postprandial Blood Sugar (PPBS) Normal < 145 mg/dl 2 hours after meal 4. Capillary Blood Glucose (CBG) / hemoglucose test (HGT) Normal: 70-100 mg/dl 5. oral glucose tolerance test (ogtt) normal: <200 mg/dl after 2 hours test 6. gylcoselated hemoglobin (hba1c) normal: 4-7% = good control 7-8.9% - fair control 9% and above poor control Type of insulin RAPID ACTING Lispro (Humalog) Insulin aspart (novolog) Onset: 15 minutes Peak (hours) 1 3 Duration (hours) 3 5 Short acting Regular insulin (Humulin R, Noyolin R) Semilente, Crystalline zinc, velosulin Onset 30 minutes Peak 2 4 Duration 6 8 Color: clear / colorless Intermediate acting NPH (neutral protamine hagedon) (humulin N, novolin n) Lente (Humulin L, novolin l) Monotard

Onset 1 2 hours Peak 6 14 hours Duration 24 hours Color turbid / cloudy LONG ACTING Ultralente (humulin u) PZI (prttamine zinc insulin) Onset 6 hours Peak 18 24 Duration 36 hours 2.5 cm gauge 27 29 length is long RENAL FAILURE Defined as the loss of kidney function 2 types 1. acture rf w/o warning prerenal (no circulation) intrarenal / renal cause 2. chronic rf phases of acute renal failure 1. oliguric 2. diuretic 3. recovery phases of acutre renal failure 1. oliguric 2. diuretic 3. recovery stages of chronic renal failure stage 1. Diminished renal reserve 30 % damaged nocturia and polyuria (manifestations) stage 2. Renal insufficiency 50 60% stage 3. End stage renal disease 5% - organ transplant Christian Barnard cape town south Africa Cyclosporine first med accepted Azathioprine (Imuran)

Functions of the kidney 1. excretion of the waste products low protein diet uremia brain damage increased creatinine (delirium, seizures) uremic frost use cool water / tepid water oatmeal soap light clothing materials lower gi fresh upper gi - dark hematocezia - fresh melena dark 2. regulation of electrolyte excretion hyperphosphatemia drug of choice calcium carbonate kayeaxelate 3. regulation of acid excretion metabolic acidosis sodium bicarbonate hyperkalemia dialysis number one reason 4. regulation of water excretion pulmonary edema congestive heart failure (rales or crackles) hypertension 5. autoregulation of blood pressure RAAS Hypertension manifestations Propranolol 6.regulation of rbc production erythropoiesis erythropoietin epogen (erythropoietin ) 7.activation of vitamin d 8.regulation of acid base balance 7.35 7.45 carbon dioxide acidic kidneys regulate bicarbonate sodium bicarbonate

urinary tract infection (UTI) number one nosocomial infection cystitis inflammation of the bladder urethritis inflammation of the urethra ureteritis inflammation of the ureters pyelonephritis inflammation of the kidney predisposing factors to UTI: 1. female - mubo ra ang urethra ( 3 4 inches) male 6 to 8 inches 2. catheterization / instrumentation cystoscopy 3. immobility 4. pregnancy 5. sexual activity 6. poor hygiene assessment for uti 1. flank pain 2. cva tenderness (costo vertebral tenderness) 3. frequency, urgency, cloudy urine, bloody urine, foul smell 4. low grade fever drugs for uti urinary tract antiseptics nitrofurantoin (macrobid) - brown methenamine (mandelamine) red / orange Urinary Tract analgesic Phenazopyridine (pyridium) Fruits are alkaline ash Cranberry juice acidic2 glasses / day Health teachings for utis Hot sitz bath Application of warm on the hypogastrium / supra pubic region Avoid coffee , cola, alcohol Increase fluid intake Avoid bubble baths and avoid vaginal deodorants or sprays Void every 2 3 hours Health teachings for utis Void and drink a glass of water after intercourse for the female client Avoid scented, perfumed sanitary napkin, toilet paper or panty shields

Wear cotton underwear, avoid synthetic panties Female should wear cotton pants and avoid wearing tight clothes or pantyhose with slacks Avoid sitting on a wet bathing suit for prolonged periods of time Urolithiasis Nephrolithiasis Pyelolithiasis Ureterolithiasis Cystolithiasis Predisposing factors Immobility Chronic uti Hyperparathyroidism Instrumentation / catheterization Obstruction and urinary stasis Diet high in calcium, vit d, milk, protein, oxalate and purines Elevated uric acid (gout) Alkaline Stones 1. Ca (oxalate, phosphate) 2. Struvite (triple phosphate) stones of UTI Acid stones 1. uric acid for alcoholic 2. cystine protein stone assessment renal colic severe sharp sudden onset lumbar or lower back pain nausea and vomiting triggered the emetic zone in the medulla oblongata signs of uti low grade fever hematuria relief of pain encourage increase in fluid intake up to 3L/day strain all urine send stones to the laboratory asap provide warm bath or heat to flank area administer narcotic analgesics iv fluids turn and reposition immobilized clients acid ash diet outcome acidify the urine foods to include

alkaline ash diet outcome: alkaline urine fruits except pruines, plums, and cranberries Milk Vegetables Extracorporeal shockwave lithotripsy (ESWL) Glomerulonephritis Nephritic syndrome Inflammation and scarring of the glomerulus Due to bacteria (GABHS group a beta hemolytic streptococcus upper respiratory tract) Anti streptolycin o titer check Penicillin Any history of sore throat or upper respiratory tract infection in the last two to three weeks? 1. Hypertension 2. hematuria (tea colored) 3. proteinuria (albuminuria) check for albumin serum urinalysis for protein nephrosis nephrotic syndrome unknown cause (autoimmune disorder) the kidney is very permeable to the protein steroids 1. hypoprotenimia / hypoalbunemia 2. massive proteinuria plus IV 3. anasarka generalized edema 4. hyperlipidemia high in protein low sodium low in fat