Endo System

7/30/2019 Endo System

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ENDOCRINE SYSTEM

Main gland

Pituitary gland located at base of brain of Stella Turcica- Master gland of body- Master clock of body

1. Anterior pituitary gland adenohypophysis2. Posterior pituitary gland neurohypophysis

Posterior Pituitary Gland1.) Oxytocin

a.) Promotes uterine contraction preventing bleeding/ hemorrhage.- Give after placental delivery to prevent uterine atony.

b.) Milk letdown reflex with help of prolactin.2.)ADH(vasopressin)

antidiuretic hormone-Prevents urination conserve H2O

Anterior Pituitary Gland adeno

Growth hormone (GH)

- Somatotropic hormone- Elongation of long bones

1. Decrease GH dwarfism children2. Increase GH gigantism3. Increase GH acromegaly adult

Puberty 9 yo 21 yoEpiphyseal plate closes at 21 yo

Square faceSquare jaw

Drug of choice in acromegaly: Ocreotide (Sandostatin)S/E dizziness

Somatostatin Hormone antagonizes the release of of GH

Melanocytes stimulating hormone (MSH)- Skin pigmentation

Prolactin/luteotrpic hormone/ lactogenic hormone- Promotes development of mammary gland

(Oxytocin-Initiates milk letdown reflex)

Adrenocorticotropic hormone (ACTH)- Development & maturation of adrenal cortex

Luteinizing hormoneproduces progesterone

Follicle Stimulating Hormone

- produces estrogen

DIABETIS INSIPIDUS(DI)(DI- dalas ihi)

hyposecretion of ADH* alcohol inhibits release of ADH


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Cause: idiopathic/ unknown

Predisposing Factor:1. Pituitary surgery2. Trauma/ head injury3. Tumor4. Inflammation

Signs & Symptoms:1. Polyuria2. Sx of dehydration

- Excessive thirst (adult) (1st sx of dehydration in children-tachycardia)- Agitation- Poor skin turgor- Dry mucus membrane

3. Weakness & fatigue4. Hypotension if left untreated -5. Hypovolemic shockAnuria late sign hypovolemic shock

Diagnostic Procedure:1. Decrease urine specific gravity- concentrated urine

N= 1.015 1.035

2. Serum Na = increase (N=135 -145 meq/L) Hypernatremia

Nursing Management:1. Force fluid 2,000 3,000ml/day2. Administer IV fluid replacement as ordered3. Monitor VS, I&O4. Administer meds as ordered

a.) Pitresin (vasopressin) IM5. Prevent complications

Most feared complication Hypovolemic shock

SYNDROME OF INAPPROPRIATE ANTI-DIURETIC HORMONE (SIADH)- Increase ADH- Idiopathic/ unknown

Predisposing Factor:1. Head injury2. Related to Bronchogenic cancer or lung caner-Early Sign of Lung Ca - Cough 1. non productive 2. productive

3. Hyperplasia of Pit glandIncrease size of organ

Signs & Symptoms:1. Fluid retention2. Increase BP HPN3. Edema4. Wt gain5. Danger of H2O intoxication6. Complications:

1. cerebral edema increase ICP2. seizure

Diagnostic Procedure:

1. Urine specific gravity increase diluted urine2. Hyponatremia Decreased Na

Nursing Management:1. Restrict fluid2. Administer meds as ordered eg. Diuretics: Loop and Osmotic


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3. Monitorstrictly V/S, I&O, neuro check increase ICP4. Weigh daily5. Assess for presence edema6. Provide meticulous skin care7. Prevent complications increase ICP & seizures activity

PINEAL GLAND1. Secretes Melatonin inhibits lutenizing hormone (LH) secretion

THYROID GLAND (TG)

Question: Normal physical finding on TG:a. With tenderness thyroid never tenderb. With nodular consistency- answerc. Marked asymmetry only 1 TGd. Palpable upon swallowing - Normal TG never palpable unless with goiter

THYROID GLAND HORMONES

1.)Triodothyronine T3- 3 molecules of iodine

Metabolic hormone

2.)Tetraiodothyronine/ Tyroxine T4- 4 molecules of iodine

3.) Thyocalcitonin antagonizes effects of parathormone

Hypo T3 T4 - lethargy & memory impairment Hyper T3 T4 - agitation, restlessness, and hallucination

SIMPLE GOITER enlarged thyroid gland - iodine deficiency

Predisposing Factor:1. Goiter belt area - Place far from sea no iodine. Seafoods rich in iodine2. Mountainous area increase intake of goitrogenic foods (US: Midwest, NE, Salt Lake)

Cabbage has progoitrin an anti thyroid agent with no iodine

Example: Turnips (singkamas), radish, peas, strawberries, potato, beans, kamote, cassava(root crops), all nuts.3. Goitrogenic drugs:

Anti thyroid agents :(PTU) prophylthiouracilLithium carbonate, Aspirin PASACobalt, Phenyl butasone

Endemic goiter cause # 1Sporadic goiter caused by #2 & 3

Signs & Symptoms:

enlarged TG Mild restlessness Mild dysphagia

Diagnostic Procedure:1. Thyroid scan reveals enlarged TG2. Serum TSH increase (confirmatory)3. Serum T3, T4 N or below N


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Predisposing Factor:1. Autoimmune disease release of long acting thyroid stimulator (LATS)

ExopthalmosEnopthalmos severe dehydration depressed eye

2. Excessive iodine intake3. Hyperplasia of TG

Signs & Symptoms:

1. Increase in appetite hyperphagia wt loss due to increase metabolism2. Skin is moist - perspiration3. Heat intolerance4. Diarrhea increase motility5. All VS increase = HPN, tachycardia, tachypnea, hyperthermia6. CNS changes1. Irritability & agitation, restlessness, tremors, insomnia, hallucinations7. Goiter8. Exopthalmos pathognomonic sx9. Amenorrhea


1. Serum T3 & T4 - increased2. Radio iodine uptake increase3. Thyroid scan reveals enlarged TG

Nursing Management:1. Monitor VS & I & O determine presence of thyroid storm or most feared complication:

Thyrotoxicosis

2. Administer medsa. Antithyroid agents

1. Prophylthiuracil (PTU)

2. Methimazole (Tapazole)Most toxic s/e agranulocytosis- fever, sore throat, leukocytosis=inc wbc: check cbc and

throat swab cultureMost feared complication : Thrombosis stroke CVS

3. Diet increase calorie to correct wt loss4. Skin care 5. Comfy & cool environment6. Maintain siderails- due agitation/restlessness7. Provide bilateral eye patch to prevent drying of eyes- exopthalmos8. Assist in surgery subtotal thyroidectomy

Nsg Mgt: pre-opAdm Lugols solution (SSKI) K iodide

2. To decrease vascularity of TG3. To prevent bleeding & hemorrhage

Complication:1. Watch out for signs of thyroid storm or thyrotoxicosis

Triad signs of thyroidstorm;a. Tachycardia /palpitationb. Hyperthermiac. Agitation

Nursing Management Thyroid Storm:

1. Monitor VS & neuro check- Agitated might decrease LOC2. Antipyretic fever

Tachycardia - blockers (-lol)3. Siderails agitated


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Complication2. Watch for inadvertent (accidental) removal of parathyroid gland

Secretes Parath hormone

If removed, hypocalcemiaSigns & Symptoms:

tetany 1. .(+) Trousseau sign 2. Chvostecks sign

Nursing Management:- Adm calcium gluconate slowly to prevent arrhythmia- Ca gluconate toxicity antidote MgSO4

Complication3.Laryngeal (voice box) nerve damage (accidental)Signs & Symptoms:

- hoarseness of voice***Encourage pt to talk or speak post operatively asap to determine laryngeal nerve damage

Notify physician!

4. Signs of bleeding post subtotal thyroidectomy- Feeling of fullness at incision site

Nursing Management:Check soiled dressing at nape area

5. Signs of laryngeal spasma. DOBb. SOB

Prepare at bedside tracheostomy

6. Hormonal replacement therapy - lifetime7. Importance of follow up care

PARATHYROID GLAND pair of small nodules located behind the TG

1.) Parathyroid Hormone promotes Ca reabsorption

Thyrocalcitonin antagonises secretion of parathyroid hormone

1. Hypoparthroidism of parathyroid hormone2. Hyperparathroidsm -

HYPOPARATHYROIDISM decreased parathormone

Hypocalcemia Hyperphosphatemia(Or tetany)

[If Ca decreases, phosphate increases]

Predisposing Factor:

1. Following subtotal thyroidectomy2. Atrophy of parathyroid gland due to

a. Irradiationb. Trauma


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Signs & Symptoms:1. Acute tetany

a. Tingling sensationb. Paresthesiac. Dysphagiad. Laryngospasme. Bronchospasm

f. Seizure complicationg. Arrhythmia

Pathognomonic Sign of TETANY(+) Trousseaus or carpopedial spasm(+) Chvostecks sign

2. Chronic tetanya. Loss of tooth enamelb. Photophobia & cataract formationc. GIT changes anorexia, n/v, general body malaised. CNS changes memory impairment, irritability


1. Serum calcium decrease (N 8.5 11 mg/100ml)2. Serum phosphate increase (N 2.5 4.5 mg/100ml)3. X-ray of long bone decrease bone density4. CT Scan reveals degeneration of basal ganglia

Nursing Management:Administration of meds:

a.) Acute tetany-Ca gluconate IV, slowly

b.) Chronic tetany1. Oral Ca supplementsEx. Ca gluconate

Ca carbonateCa lactate

Vit D (Cholecalceferol)

Drug diet sunlight

Cholecalceferol calcidiol calcitriol 7am 9am

2. Phosphate binder- Alumminum DH gel (ampho gel)

S/E constipation

AntacidAAC MAD

Aluminum containing acids Mg containing antacidsEx. Milk or magnesia

Aluminum OH gel Diarrhea

Constipation Maalox magnesium & aluminum - Less s/e

2. Avoid precipitating stimulus such as bright lights & noise: photophobia leading to seizure3. Diet increase Ca & decrease phosphorus

- Dont give milk due to increase phosphorusExample:a.)anchovies increase Ca, decrease phosphorus + uric acid.


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b.)Tuna & green turnips- Ca.4. Bedside tracheostomy set due to laryngospasm5. Encourage to breath with paper bag in order to produce mild respiratory acidosis to promoteincrease ionized Ca levels7. Hormonal replacement therapy - lifetime8. Important fallow up care

HYPERPARATHYROIDISM- increase parathormone. Complication: Renal failureHypercalcemia can lead to Hypophosphatemia

Bone disease kidney stonesdemineralization

Leading to bone fracture

Ca 99% bones1% serum blood

Predisposing Factor:1. Hyperplasia parathyroid gland (PTG)2. Over compensation of PTG due to Vit D deficiency

Children Rickets Vit DAdults Osteomalacia deficiency

Sippys diet Vit D diet not good for pt with ulcer2 -4 cups of milk & butter

Karrels diet Vit D diet not good for pt with ulcer6 cups of milk & whole cream

Food rich in CHON eggnog combination of egg & milk

Signs & Symptoms:Bone fracture

1. Bone pain (especially at back), bone fracture2. Kidney stone

a. Renal colicb. Cool moist skin

3. GIT changes anorexia, n/v, ulcerations4. CNS involvement irritability, memory impairment


1. Serum Ca increase2. Serum phosphorus decreases3. X-ray long bones reveals bone demineralization

Nursing Management:for Kidney Stone

1. Force fluids 2,000 3,000/day or 2-3L/day2. Isotonic solution3. Warm sitz bath for comfort4. Strain all urine with gauze pad5. Acid ash diet cranberry, plum, grapefruit, vit C, calamansi to acidify urine

6. Administration of meds

a. Narcotic analgesic Morphine SO4, Demerol (Meperidine Hcl)S/E resp depression. Monitor RR)*Narcan/ Naloxone antidote

Naloxone toxicity tremors

7. Siderails


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8. Assist in ambulation

9. Diet low in Ca, increase phosphorus lean meat10.Assist surgical procedure parathyroidectomy11.Impt ff up care12.Hormonal replacement- lifetime

ADRENAL GLAND- Atop of @ kidney

2 Parts

1.)Adrenal cortex outermost layer

a) Zona fasiculata secrets glucocorticoidsEx. Cortisol - Controls glucose metabolism (SUGAR)

b) Zona reticularis secrets traces of glucocorticoids & androgenic hormonesM testosteroneF estrogen & progesterone

Fx promotes development of secondary sexual characteristics

c) Zona glomerulosa - secretes mineralcortisoneEx. Aldosterone

Fx: promotes Na & H2O reabsorption & excretion of potassium (SALT)

2.)Adrenal medulla - innermost layera.)Secrets cathecolaminesb.)Epinephrine / Norephinephrine potent vasoconstrictor adrenaline=Increase BP

Adrenal Medullas only disease:

PHEOCHROMOCYTOMA

- presence of tumor at adrenal medulla

- increase nor/epinephrine- with HPN and resistant to drugs- drug of choice: beta blockers- complication: HPN crisis = lead to stroke

- no valsalva maneuver

ADDISONS DISEASE Steroids-lifetime

Decreased adrenocortical hormones leading to:a.) Metabolic disturbances (sugar)b.) F&E imbalances- Na, H2O, Kc.) Deficiency of neuromuscular function (salt & sex)

Predisposing Factor:1. Atrophy of adrenal gland2. Fungal infections3. Tubercular infections

Signs & Symptoms:

1. Decrease sugar Hypoglycemia Decreased glucocorticoids - cortisol

T tremors, tachycardiaI - irritabilityR - restlessness

E extreme fatigueD diaphoresis, depression

2. Decrease plasma cortisol

Decrease tolerance to stress lead to Addisonians crisis


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2. Stress3. Infection4. Trauma5. Surgery

b.)Prevent complicationsAddisonian crisis & Hypovolemic shock

8. Hormonal replacement therapy lifetime9. Important: follow up care

CUSHINGS SYNDROME

increase secretion of adrenocortical hormone

Predisposing Factor:1. Hyperplasia of adrenal gland2. Tubercular infection milliary TB

Signs & Symptoms:1. Increase sugar Hyperglycemia

3 Ps1. Polyuria

2. Polydipsia increase thirst3. Polyphagia increase appetite

Classic Sx of DM 3 Ps & glycosuria + wt loss2. Increase susceptibility to infection due to increased corticosteroid

3. Hypernatrermiaa. HPNb. Edemac. Wt gaind. Moon face

Buffalo humpObese trunk classic signs

Pendulous abdomenThin extremities

4. Hypokalemiaa. Weakness & fatigueb. Constipationc. ECG (+) U wave

5. Hirsutism increase sex6. Acne & striae7. Increase muscularity of female

Diagnostic Procedure:1. FBS increase (N: 80-120mg/dL)2. Plasma cortisol increase

3. Na increase (135-145 meq/L)4. K- decrease (3.5-5.5 meq/L)

Nursing Management:1. Monitor VS, I&O2. Administer medsa. K- sparing diuretics (Aldactone) Spironolactone

- promotes excretion of NA while conserving potassium

Not lasix due to S/E hypoK & Hyperglycemia!

3. Restrict Na4. Provide Dietary intake low in CHO, low in Na & fats

High in CHON & K


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5. Weigh pt daily & assess presence of edema- measure abdominal girth- notify doc.6. Reverse isolation

7. Skin care due acne & striae 8. Prevent complication

- Most feared arrhythmia & DM(Endocrine disorder lead to MI Hypothyroidism & DM)

9. Surgical bilateral Adrenolectomy10.Hormonal replacement therapy lifetime due to adrenal gland removal- no more corticosteroid!

PANCREAS behind the stomach, mixed gland both endocrine and exocrine gland

Acinar cells (exocrine gland) Islets of Langerhans (endocrine gland ductless)

Secrete pancreatic juices at pancreatic ducts. cells

Aids in digestion (in stomach) secrets glucagon

Fxn: hyperglycemia (high glucose)

Cells

Secrets insulin

Fxn: hypoglycemia

Delta Cells

Secrets somatostatin

Fxn: antagonizes growth hormone

3 disorders of the Pancreas1. DM2. Pancreatic Cancer3. Pancreatitis

PANCREATITIS

- acute inflammation of pancreas leading to pancreatic edema, hemorrhage & necrosis due to

- Autodigestion self-digestion

Cause: unknown/idiopathic4. Or alcoholism

Pathognomonic sign- (+) Cullens sign - Ecchymosis of umbilicus (bluish color)- pasa(+) Grey turners sign ecchymosis of flank area

Both sx means hemorrhage

PANCREATITIS acute or chronic inflammation of pancreas leading to pancreatic edema,

hemorrhage & necrosis due to auto digestion.Bleeding of pancreas - Cullens sign at umbilicus

Predisposing Factor:1. Chronic alcoholism


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2. Hepatobilary disease3. Obesity4. Hyperlipidemia5. Hyperparathyroidism6. Drugs Thiazide diuretics, pills Pentamidine HCL (Pentam)7. Diet increase saturated fats

Signs & Symptoms:

1. Severe Lt epigastric pain radiates from back &flank area- Aggravated by eating, with DOB2. N/V3. Tachycardia4. Palpitation due to pain5. Dyspepsia indigestion6. Decrease bowel sounds

7. (+) Cullens sign - ecchymosis of umbilicus hemorrhage8. (+) Grey Turners spots ecchymosis of flank area9. Hypocalcemia


1. Serum amylase & lipase increase2. Urine lipase increase3. Serum Ca decrease

Nursing Management:1. administration of Medicines

a.) Narcotic analgesic - Meperidine Hcl (Demerol)Dont give Morphine SO4 will cause spasm of sphincter.

b.) Smooth muscle relaxant/ anti cholinergic- Ex. Papavarine Hcl

Prophantheline Bromide (Profanthene)c.) Vasodilator NTGd.) Antacid Maalox

e.) H2 receptor antagonist - Ranitidin (Zantac) to decrease pancreatic stimulationf.) Ca gluconate

2. Withold food & fluid aggravates pain3. Assist in Total Parenteral Nutrition (TPN) or hyperalimentation

Complications of TPN1. Infection2. Embolism3. Hyperglycemia

4. Institute stress mgt techa.) DBEb.) Biofeedback

5. Comfy position - Knee chest or fetal likeposition6. If pt can tolerate food, give increase CHO, decrease fats, and increase CHON7. Complications: Chronic hemorrhagic pancreatitis

CHRONIC HEMORRHAGIC PANCREATITIS- bangugot

Predisposing Factor:- unknown

Risk factor:1. History of hepatobiliary disorder2. Alcohol3. Drugs thiazide diuretics, oral contraceptives, aspirin, penthan4. Obesity


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1. Asymptomatic2. 3 Ps and 1G

Treatment Management1. Oral Hypoglycemic Agents (OHA)2. Diet3. Exercise

Complication: HONKCH hyperO osmolarN nonK ketoticC coma

GESTATIONAL DM

occurs during pregnancy & terminates upon delivery of child

Predisposing Factor:1. Unknown/ idiopathic

2. Influence of maternal hormones

Signs & Symptoms:Same as type II

1. Asymptomatic2. 3 Ps & 1G

Type of delivery CS due to large babySx of hypoglycemia on infant

1. High pitched shrill cry2. Poor sucking reflex

IV. DM ASSOCIATED WITH OTHER DISORDERa.) Pancreatic tumorb.) Cancerc.) Cushings syndrome

3 MAIN FOOD GROUPSAnabolism Catabolism

1. CHON glucose glycogen2. CHON amino acids nitrogen3. Fats fatty acids free fatty acids (FFA) Cholesterol & Ketones

Pancreas glucose ATP (Main fuel/energy of cell )Reserve glucose glycogenLiver will undergo glucogenesis synthesis of glucagons

& Glycogenolysis breakdown of glucagons& Gluconeogenesis formation of glucose form CHO sources CHON & fats


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HYPERGLYCEMIA

pancreas will not release insulin. Glucose cant go to cell, stays at circulation causinghyperglycemia.

increase osmotic diuresis glycosuriaLead to cellular starvation

Lead to wt loss stimulates the appetite/ satiety center polyuria(Hypothalamus)

Cellular dehydration

Polyphagia Stimulates thirst center(hypothalamus)

Polydipsia

Increased CHON catabolism

Lead to (-) nitrogen balance

Tissue wasting (cachexia)

Increase fat catabolism

Free fatty acids

Cholesterol ketones DKA

Atherosclerosis coma

HPN death

MI stroke

DIABETIC KETOACIDOSIS (DKA)- Acute complication of Type I DM due to severe hyperglycemia leading to CNS depression &

Coma.- Ketones- a CNS depressant

Predisposing Factor:1. Stress between stress and infection, stress causes DKA more.2. Hyperglycemia3. Infection

Signs & Symptoms:

3 Ps & 1G1. Polyuria2. Polydipsia

3. Polyphagia4. Glycosuria5. Wt loss6. Anorexia, N/V

7. (+) Acetone breath odor- fruity odor pathognomonic DKA


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8. Kussmaul's resp-rapid shallowrespiration9. CNS depression10.Coma

Diagnostic Procedure:1. FBS increase, Hct increase (compensate due to dehydration)

N =BUN 10 -20 mg/100ml --increased due to severe dehydrationCrea - .8 1 mg/100ml

Hct 42% (should be 3x high)-nto hgb

Nursing Management:1. Can lead to coma assist mechanical ventilation2. Administer .9NaCl isotonic solution

Followed by .45NaCl hypotonic solutionTo counteract dehydration.

3. Monitor VS, I&O, blood sugar levels4. Administer meds as ordered:

a.) Insulin therapy IV push

Regular Acting Insulin clear (2-4hrs, peak action)b.)To counteract acidosis Na HCO3c.) Antibiotic to prevent infection

Insulin Therapy

A. Sources:1. Animal source beef/ pork-rarely used. Causes severe allergic reaction.2. Human has less antigenecity property

Cause less allergic reaction. Humulin

If kid is allergic to chicken dont give measles vaccine due it comes from chicken embryo.3. Artificially compound

B. Types of Insulin

1. Regular Insulin - Ex. Regular acting I2. Intermediate acting I - Ex. NPH (non-protamine Hagedorn I)3. Long acting I - Ex. Ultra lente

Types of Insulin color & consistency onset peak duration1. Regular clear - 2-4h -2. Intermediate cloudy - 6-12h -3. Long acting cloudy - 12-24h -

Ex. 5am Hemoglucose test (HGT)

250 mg/dlAdm 5 units of RA IPeak 7-9am monitor hypoglycemic reaction at this time- TIRED

Nursing Management:upon injection of insulin:

1.Administer insulin at room temp! To prevent lipodystrophy = atrophy/ hypertrophy of SQtissues2. Insulin is only refrigerated once opened!3. Gently roll vial bet palms. Avoid shaking to prevent formation of bubbles.4. Use gauge 25 26needle tuberculin syringe

5. Administer insulin at either 45(for skinny pt) or 90 (taba pt)depending on the client tissuedeposit.6. Dont aspirate after injection7. Rotate injection site to prevent lipodystrophy8. Most accessible site abdomen


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9. When mixing 2 types of insulin, aspirate1st regular/ clear before cloudy to prevent contaminating clear insulin & to promote

accurate calibration.10. Monitor signs of complications:

a. Allergic reactions lipodystrophyb. Somogyis phenomenon hypoglycemia followed by periods of hyperglycemia or

rebound effect of insulin.

11. 1ml or cc of tuberculin = 100 units of insulin

- - 1 cc = 100 units

- - .5cc = 50 units

- - .1 cc = 10 units

6 units RA

Most Feared Complication of Type II DM

Hyper osmolarity = severe dehydrationOsmolar

Non - absence of lipolysisKetotic - no ketone formation

COMA

Signs & Symptoms: headache, restlessness, seizure, decrease LOC

Nursing Management:- same as DKA except dont give NaHCO3!

1.Can lead to coma assist mechanical ventilation

2. Administer .9NaCl isotonic solution

Followed by .45NaCl hypotonic solution (To counteract dehydration.)

3.Monitor VS, I&O, blood sugar levels4.Administer meds

a.) Insulin therapy IVb.) Antibiotic to prevent infection

Treatment Management

O ralH ypoglycemicA gents

5. Stimulates pancreas to secrete insulin

Classifications of OHA

1. First generation Sulfonylureasa. Chlorpropamide (diabenase)b. Tolbutamide (orinase)c. Tolazamide (tolinase)

2. 2nd generation sulfonylureasa. Diabeta (Micronase)

b. Glipizide (Glucotrol)c.


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Nursing Management:or OHA

1. Administer with meals to lessen GIT irritation & prevent hypoglycemia

2. Avoid alcohol (alcohol + OHA = severe hypoglycemic reaction=CNSdepression=coma) Antabuse-Disufram3.

Diagnostic Procedure:for DM

1. FBS N 80 120 mg/dl = Increased for 3 consecutive times =confirms DM!!+ 3 Ps & 1G

2. Oral glucose tolerance (OGTT) - Most sensitive test3. Random blood sugar increased4. Alpha Glucosylated Hgb elevated

Nursing Management:

1. Monitor for PEAK action of OHA & insulinNotify Doc

2. Monitor VS, I&O, neurocheck, blood sugar levels.3. Administer insulin & OHA therapy as ordered.4. Monitor signs of hyper & hypoglycemia.

Pt DM hinimatay You dont know if hypo or hyperglycemia.

Give simple sugar (Brain can tolerate high sugar, but brain cant tolerate low sugar!)Cold, clammy skin hypo Orange Juice or simple sugar /Warm to touch hyper administer insulin

5. Provide nutritional intake ofdiabetic diet:CHO 50%CHON 30%Fats 20%

-Or offer alternative food products or beverage.-Glass of orange juice.

6. Exercise after meals when blood glucose is rising.

7. Monitor complications of DMa. Atherosclerosis HPN, MI, CVAb. Microangiopathy small blood vessels

Eyes diabetic retinopathy , premature cataract & blindnessKidneys recurrent pyelonephritis & Renal Failure

(2 common causes of Renal Failure : DM & HPN)c. Gangrene formation

d. Peripheral neuropathy1. Diarrhea/ constipation2. Sexual impotence

e. Shock due to cellular dehydration

8. Foot care mgta. Avoid waking barefootedb. Cut toe nails straightc. Apply lanolin lotion prevent skin breakdownd. Avoid wearing constrictive garments

9. Annual eye & kidney exam10.Monitor urinalysis for presence of ketonesBlood or serum more accurate

11.Assist in surgical wound debridement12.Monitor signs or DKA & HONKC13.Assist surgical procedure


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BKA or above knee amputation

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Endo System