Endocrine system - glands which secrete biochemicals that have direct affect on body functions. Hormones are constantly adjusted to meet the body’s needs. Refer to your textbook pg 379
Major structures
Hypothalamus- located below the thalamus gland in the neck. Modulates the activities of the anterior and posterior lobes of the pituitary. Has a "releasing" and "inhibiting" function.
Pituitary- located in the base of the brain. It synthesizes and releases several protein hormones needed in normal growth and development and the stimulation of target glands. Refer to your textbook pg 379
Thyroid gland-located in the neck just below the larynx. Refer to your textbook pg 379-380
Parathyroid glands-four small glands which are located in the neck, behind the thyroid. Refer to your textbook pg 380
Adrenal glands-located at the top of each kidney. Produce adrenocorticosteroids. Refer to your textbook pg 380
Pancreas gland-located in the abdomen-left side, near the stomach. Refer to your textbook pg 380
Gonads-include the ovaries (female, egg-producing) and testes (male, sperm producing). Refer to your textbook pg 381
Regulatory Mechanisms-numerous feedback relationships exist among the structures of the endocrine system and the rest of the body. These involve complex changes in function, growth, development, and processes. Some of the more important things to know about the regulatory functions are as follows. Refer to your textbook pg 381
Pituitary-adrenocorticotropic hormone (ACTH) stimulates the adrenal cortex.
Adrenal cortex-corticosteroids regulate the use of sugars and proteins by the cells. Glucocorticoids regulate the metabolism of carbohydrates and fats and have an anti-inflammatory effect. Mineral corticoids regulate the re-absorption of fluids and salts in the kidney; promote sodium and water retention and urinary excretion of potassium.
Pituitary-anti-diuretic hormone (ADH) or vasopressin acts to promote water conservation by the kidney. It can also cause vasoconstriction in high concentrations. Like aldosterone, ADH helps maintain fluid balance.
Pituitary-thyroid stimulating hormone (TSH) stimulates the thyroid.
Thyroid-thyroxine controls metabolism-the rate at which cells produce energy (heat, muscle strength, etc.). Iodine is needed for the thyroid to produce thyroxine.
Parathyroid-parathormone (PTH) controls the calcium content of the blood. Calcium is needed in the blood for the muscles to work properly, including the heart muscle. Extra calcium is stored in the bones, and when calcium is needed parathormone causes calcium to be released from the bones into the bloodstream.
Adrenal-; epinephrine and norepinephrine (also called adrenaline) prepare the body for "fight or flight" when there is perceived threat, stress or an emergency situation. Heart rate increases, pupils dilate, extra sugar is released for large muscles to use, increase blood pressure, and bronchial tubes dilate to enhance breathing.
Pancreas-insulin controls the use of sugars by the cells, causes the liver to store sugar in the form of glycogen. Glucagon causes the liver to release stored sugar into the bloodstream for extra energy when it is needed.
Disorders of the endocrine system Refer to your textbook pg 381-385 (Pay close attention to Table 15.1)
Terms-"hypo" means too little; "hyper" means too much. Imbalances in the endocrine system cause abnormal functions of the body. The causes of the imbalances vary. Goiter is an enlargement of the thyroid gland.
Hypothyroidism-thyroid produces too little hormone. It is more common than hyperthyroidism and typically results in dryness of skin, hair, nails, low blood pressure, sluggishness of functions, constipation, subnormal temperature, intolerance to cold. Mild hypothyroidism is common in elderly women. Example: "Myxedema"
Hyperthyroidism-thyroid produces excess hormone. It is less common and typically results in increase in body temperature, respiration and heart rate, nervousness, feeling of warmth (heat intolerance), increased sweating, goiter, hair and weight loss, hand tremors, change in skin thickness, and sometimes protruding eyeballs. Example: "Graves' disease”.
Hyperparathyroidism-too much parathormone is released which causes too much calcium to be released into the blood.
Hypoparathyroidism-too little parathormone is released which causes too little calcium in the blood. Spasms of the muscles, mostly the face and hands, but can also affect the heart and other muscles.
Diabetes Mellitus-pancreas does not secrete insulin or the insulin produced is inadequately utilized.
Insulin Dependent Diabetes Mellitus (IDDM)--onset is usually before age 25. Insulin is not produced by the pancreas~ Also called Type I diabetes. Insulin must be administered by injection.
Non-Insulin Dependent Diabetes Mellitus (NIDDM)--onset is usually after the age of 40. Also called Type II diabetes. Often can be controlled with diet and exercise and anti-diabetic drugs.
Insulin shock - caused by an overdose of insulin resulting in hypoglycemia.
Ketoacidosis - occurs when insulin has metabolized available glucose and fat is broken down for energy, causes the release of ketenes which increases the acidity of the blood. Can lead to coma and death.
Related medications and treatment: Refer to your textbook pg 385
Hormone replacement therapies-replace the hormone which is either inadequately produced or is missing.
Thyroid-levothyroxine (Synthroid, Levothroid, Levoxyl) are synthetic thyroid.
Insulin-is an injection administered by a licensed nurse.
Oral anti-diabetics (Precose, Glucotrol, Amaryl).
Pituitary-ACTH may be given to stimulate adrenal function or to diagnose an adrenal problem.
Pituitary-Vasopressin (Pitressin) replaces the anti-diuretic hormone in cases of diabetes insipidus.
Corticosteroids. Generally used to: (1) supplement or replace inadequately produced hormones, and (2) suppress inflammation and immune response, reduce pain, edema, erythema, fever, itching associated with allergies, skin disorders, cancer, respiratory diseases (such as asthma), 'autoimmune' diseases (Rheumatoid arthritis, Lupus Erythematosus). Two major types are:
Glucocorticoids-protecting against stress, affect protein and carbohydrate metabolism.
Prednisone (Deltasone)
Prednisolone (prelone)
Dexamethasone (Decadron)
Methyl prednisolone (Medrol, Solu-Medrol)
Triamcinolone (Aristocort, Kenacort)
Mineralocorticoids-regulate sal1Jwater balance.
Aldosterone
Desoxycorticosterone
Fludrocortisone (Florinef)
Complementary/alternative therapies-may include prescriptive diet, herbal supplements, vitamins, minerals. All therapies should be under the physician's order and supervision. Some herbs, vitamins and mineral supplements can interfere with medications.
Low thyroid-diet with iodine-rich foods such as vegetables, seafood, iodized salt, molasses, egg yolks, parsley, apricots, dates and prunes. Avoid processed and refined foods, including white flour and sugar. Vitamins and mineral supplements may include: Kelp, L-Tyrosine, B Complex, extra B 2 and B 12, essential fatty acids, Vitamins A, C, E, beta-carotene. Large doses of Vitamin C may be avoided because of its affect on thyroid hormone production. Herbs such as bayberry, black cohosh.
Diabetes-diet rich with fresh fruits and vegetables (green leafy), brown rice, nuts, legumes, whole grains, fish. Garlic, onions, shiitake mushrooms and pearl barley may stimulate the immune system. Avoid fats, fried foods, ham, pork, highly processed foods, red meats, sodas, sugar and white flour. Similarly, alcohol, caffeine and tobacco should be limited or avoided. Attending physician may order supplements or herbs. These are only administered with physician's order. Supplementary vitamins/minerals:
Herbs and Vitamins: Vitamin B complex, Vitamin C, L-tyrosine, Coenzyme Q10, multivitamin and mineral complex, zinc. Herbs: Astragalus improves adrenal gland function and aids in stress reduction. Echinacea can increase white blood count; milk thistle extract aids liver function, which in turn helps adrenal function. Residents who report allergies to pollen, ragweed, hay fever, molds, dust, etc. may have negative reactions to herbal supplements.
Nursing care and implications:
Thyroid replacement therapy Side effects are uncommon since dosage is regulated individually. Excessive dosage produces effects similar to hyperthyroidism. Watch for changes/increases in vital signs, nervousness, weight loss, tremors, and nervousness. Monitor appetite and sleep pattern. Medication should be given at the same time, each day, preferably in the morning.
Insulin Several types which vary in their effect (Fast-acting = regular insulin and Semilente; Intermediate-acting =NPH insulin; Long-acting = Ultralente insulin). Sometimes are given together in one dose, then another dose later in the day when blood sugar normally rises. When regular insulin is given in the morning, it will rapidly lower the blood sugar level so the resident needs to eat within at least 30 minutes after the insulin is given. Having too low blood sugar can result in "insulin reaction”. Insulin used to be made from pancreases of animals, but today it is usually manufactured in a laboratory through genetic engineering, and is called "Handlin" insulin Refer to your textbook pg 385-391
Need for insulin varies according to diet, exercise, emotions or illness.
Changes in these factors affect the insulin need.
Too little insulin = "hyperglycemia”. Symptoms are "dry" and "drowsy”.
Treatment is for licensed nurse to give extra insulin.
Too much insulin = "hypoglycemia”. Symptoms are ''wet'' and ''wild’’, sudden onset, hunger, sweating, nervousness, heart palpitations and confusion. Treatment is to give glucose (or sugar) in some form. It is better to give milk with bread or crackers. Juice is only given for urgent response, to prevent loss of consciousness. DONOT give anything by mouth if person is unconscious.
Make sure residents eat something within at least 30 minutes of the time they get their moming insulin to prevent hypoglycemic episodes.
Watch for hypoglycemic reactions at other times when you know the insulin's action is peaking. This depends on type of insulin administered.
Good foot and good oral care are essential.
Recognize and report any signs of hypoglycemia immediately.
Be aware of medications that commonly interact with Insulin.
Administering Insulin Refer to your textbook pg 393-394
Drugs that increase glucose
CNS stimulants
Corticosteroids
Diuretics
Estrogen
Nicotine
Drugs that decrease glucose
Alcohol
Salicylates
Sulfonamides
Glucometer testing requires use of electronic devices that can analyze the test strip and give a numerical readout of the glucose level. A finger is pricked with a lancet; a drop of blood is placed on test strip and placed in the machine for analysis. The machine gives an immediate blood sugar result. (Normal blood sugar level 60-110 mg/dl.)
NOTE: Policy for glucometer testing will be according to your facility. A medication aide in the state of Kansas should refuse to perform test unless he/she is properly trained. Medication aides must be trained and found to be competent before performing glucose testing.
Oral Anti-diabetic Medications. Used for stable adult-onset diabetes mellitus Type II (NIDDM). Cause the pancreas to release insulin, improve the effect of insulin.
Most common side effect is hypoglycemia.
Allergies should be identified before these products are given as hypersensitive reactions may occur.
Should not be used in diabetic ketoacidosis, juvenile diabetes, severe renal disease, or severe hepatic disease.
Should be used with caution in the elderly, in cardiac disease, pregnancy, lactation, and in the presence of alcohol.
Side effects for corticosteroids are limited in short term use.
Resident will receive a decreasing dose of corticosteroids over time rather than immediate discontinuation of medication. Abrupt withdrawal or omitting a dose may cause severe, even life-threatening symptoms.
Long term side effects may include:
Weight gain (extreme hunger, hyperglycemia).
Fluid retention ("Moon Face").
Increase in BP.
Interferes with healing and lowers resistance to infection. Prevents the body's usual response to infections.
Personality changes.
Diabetes, easy bruising, thinning of the skin, gastric ulcers.
Osteoporosis.
Corticosteroid therapy interferes with the normal feedback mechanism that controls hormone production, so when the drug is withdrawn it takes weeks or even months for the gland to begin producing on its own.
Refer to your textbook pg 394 diagram 15.3for Oral Hypoglycemic Agents for NIDDM
Pay close attention to your textbook pg 395-396 regarding Representative Hormones and Hormone-like Drugs.
Unit 18
pricked with a lancet; a drop of blood is placed on test strip and placed in the machine for analysis. The machine gives an immediate blood sugar result. (Normal blood sugar level 60-110 mg/dl.)