Endocrine System notes
👉Ductless glands -Products of endocrine glands circulate in blood directly without ducts.
Hypothalamus :- Situated in the cerebrum, below the thalamus.Releases GHRH & GHRIH
- Inhibit growth.
- Inhibit Insulin & Glucagon.
👉Hypothalamus hormone :
(1) Corticotropin releasing hormone (CRH).
(2) Gonadotropin releasing hormone (GnRH).
(3) Growth hormone releasing hormone (GHRH).
(4) Thyrotropin releasing hormone (TRH).
(5) Growth hormone inhibiting hormone (GHIH). (Somatostatine) (Imp. Q )
- Inhibit growth.
- Inhibit Insulin & Glucagon.
(7) Prolactin releasing hormone (PRH).
Largest endocrine gland :- Thyroid (Imp. Q )
Largest exocrine gland- Liver (Imp. Q )
nursing officer app download link-https://edumartin.page.link/wWac
1. Pituitary (Hypophyseal) Gland.
Anterior pituitary Lobe
👉Anterior gland Hormone :
(1) Growth hormone
(2) TSH (Thyroid Stimulating Hormone)
(3) ACTH (Adrenocorticotropic Hormone)
(4) FSH
(5) LH
(6) Prolactine
(7) MSH ( Melanocyte-stimulating hormone )
👉Posterior gland Hormone :
(1) Oxytocin
(2) Vasopressin (ADH) (Antidiuretic hormone.)
Synthesize in hypothalamus & Storage in posterior Pituitary & Released by Posterior pituitary.
I. Gigantism :- Before bone epiphyseal closure Occurs in child (Whole body enlarge )
II. Acromegaly. :- After bone epiphyseal closure In adult ( Extremities enlarged )
Somatostatin Replace
b) Decreased
I. Dwarfism
II. Growth retardation (Shunting) to switch Growth hormone replaced
(2) TSH (Thyroid Stimulating Hormone):- It is controlled by Thyrotropin-releasing hormone TRH → From hypothalamus
↓
Stimulate thyroid gland to release
↓
T3 (Tri-iodo thyronine) and T4 (Thyroxine)
Q.: The Impact of ↑ed T3 & T4 on TSH is
Ans. ↓TSH, Rationale : (By negative feedback)
(3) ACTH ( Adrenocorticotropic hormone ) - It is regulated by ACTRH (From hypothalamus)
(2) Vasopressin (ADH).
Intervention :
(1) Safe environment
(2) Avoid food or liquid that produce diuresis.
👉Sever DI
(1) Safe environment. (2) Restrict fluid Intake.
(3) Give diuretics & I.V. fluid (NS or hypertonic saline).
Pan-hypo-pituitarism :- Decrease all hormones of pituitary gland
Simmond's Syndrome /Sheehan's syndrome.
Hypo-physe-ctomy :- (Pituitary adenectomy, transsphenoidal)
Pituitary surgery (Endoscopic trans-nasal) -
(1) Elevate the head of the bed.
(2) instruct client to avoid sneezing, coughing, blowing of the nose (to prevent ↑ICP).
(3) Monitor for Diabetes insipidus or SIADH.
(4) Avoid water intoxication.
(5) Administer glucocorticoids
(6) After transsphenoidal hypophysectomy-Check nasal discharge for glucose presence of glucose in nasal if discharges indicate leakage of CSF.
nursing officer app download link-https://edumartin.page.link/wWac
Parafollicular cells (C - cells)- these are between the follicles of thyroid gland.
Q: Levothyroxine Sodium may cause (Imp. Q )
Ans: ↑Heart rate.
Nurse action → Monitor vital signs, specifically Heart rate.
Goiter :- Enlargement of thyroid gland & T3& T4 ↓se.
Autoimmune Goiter (Hashimoto's disease)
Endemic Goiter (Iodine deficiency goiter)
nursing officer app download link-https://edumartin.page.link/wWac
↑ed temperature, tachycardia. Systolic HTN, Delirium, coma
Do Not give salicylates (They ↑free thyroid hormone level.)(Imp. Q )
treatment :-
Preoperative :
(1) Check vital signs, weight, electrolyte level.
(2) Assess for hyper-glycemia.
(3) Check for thyroid storm & give medicine.
Post operative :
(1) Monitor for respiratory distress.
(2) Have a tracheostomy set, O2 & suction at bedside.(Imp. Q )
(3) Limit talking, assess level of hoarseness.
(4) If parathyroid damage-Assess for hypocalcemia & tetany.
(5) For tetany-Give calcium gluconate.
(6) Give a semi fowler position.(Imp. Q )
Endocrine /Metabolic disorder of pancreas
DIABETES MELLITUS (Imp. Q )
Symbol for DM is Blue circle
> Normal Glucose:- 70-110 mg/dl
Prediabetic :- 100-125 mg/dl
Diabetic :-> 126 mg/dl (Fasting level)
DM -Mechanism of onset of clinical features :
decrease Insulin
↓
↑serum glucose level
↓
Osmolarity ↑
Transport of fluid into blood vessels.
↓
GFR ↑se
nursing officer app online test series link- https://tinyurl.com/yfyq5nyr?utm_source%3Dcopy-link%26utm_medium%3Dtutor-course-referral%26utm_campaign%3Dcourse-overview-app
Investigations:
Fingertip method :- Reliable method to diagnose DM.: Punctare lateral side, not midpoint bcoz nerve + nt
OGTT :- Oral glucose tolerance test - Confirmatory test 75gm sugar add in 300ml of H20. (Range 50– 200gm).
Sample after 2 hour = PP Sample > 200mg/dl 👉DM.
Post prandial sugar: (2 hour after eating)
RBS (Random blood sugar)
Normal - < 200 mg/dl
Diabetic -> 200 mg/dl. (At last on 2 occasions.)
DKA.(Diabetic ketoacidosis):
Mechanism :
↑ Blood Glucose
↓
↓es cellular glucose level
↓
Starvation in cells
↓
More eating (Polyphagia)
↓
More sugar level ↑es in blood & cellular level is deprecated
↓
Starvation in cells
↓
Body weight↓ (Cachexia);
II. Short acting
Ultralente
Injection site :- Arm, thigh, Abdomen, buttocks
Forearm most common site in adult
In periumbilical region: 1 inch away from umbilicus
Lipo-hyper-trophy Elevation of tissue at injection site; So administer Insulin at different site in rotatory manner.
Lipo_atrophy / Lipo_dystrophy > Irritation & damage of SC tissue & fat
In DKA Notify physician when : Vomiting, diarrhoea, fever persists.
Glucose - 250-300mg/dl.
Adrenal Gland
1. Cortex - Hormones released are
Pheochromocytoma :- Tumour of Adrenal medulla. Benign tumour
Increase Secretion of catecholamines (Increase Epinephrine & nor-epinephrine)
Metabolism of catecholamines forms VMA (Vanillylmandelic acid)
VMA test: For confirmation of Pheochromocytoma 24 hour urine sampling needed (Imp. Q )
> 10mg = Indicate pheochromocytoma
Glucocorticoids :- Gluconeogenesis ( ↑blood glucose level)
Aldosterone :- Fluid & Electrolyte balance.
Androgen :- Growth of genitals.
(1) Cushing syndrome → ↑ed glucocorticoids
Clinical features :- Moon face, buffalo hump (fat deposition) Hyperglycemia, ↓ed Immunity
Electrolyte imbalance.
(2) Conn's Syndrome :- Hyper_aldosteronism.
-Fluid & electrolyte imbalance.
(T wave elevated, QRS wide - Hyperkalemia) (Imp. Q )
(Imp. Q ) Decrease calcium in blood Causes Tetany- It is manifested by Spasm of larynx
Treatment :- Calcium gluconate
Hydroxide = ↓es adsorption of phosphate from GIT.
Milk, cheese, dairy products are not given in hypoparathyroidism.
Because it increases serum phosphate.
Hypo-parathyroidism :- ↓ed parathormone.
C/M
Hypo-calcemia & hyper-phosphatemia.
Numbness & tingling in face.
+ ve Trousseau's sign & Chvostek's sign (Tapping on facial nerve](Imp. Q )
Hypotension, bronchospasm, laryngospasm, dysphagia.
Intervention :
(1) Place tracheostomy set, O2, Suction catheter at bedside.(Imp. Q )
(2) Give calcium gluconate.
(3) Give a high calcium, low phosphorus diet.
(4) Give vitamine D.
(5) Give phosphate binders to excrete phosphate.
Hyperparathyroidism :-↑ Parathormone.
Anorexia, Nausea, Vomiting, Constipation
Hypercalcemia & hypophosphatemia Weight loss
Hypertension, Cardiac dysrhythmias, Renal stone.
Intervention :
(1) Monitor B.P.
(2) Give furosemide-To lower ca+
Parathyroidectomy: - Removal of one or more parathyroid glands.
Post operatively :
(1) Monitor for respiratory distress
(2) Tracheostomy set, O2, Suctioning at bedside.
(3) Semi fowler position.
(4) Assess neck dressing for bleeding.
(5) Monitor for hypocalcemia & tetany,
(6) Monitor for laryngeal nerve damage
(7) Give ca+ & vit D.
nursing officer app online test series link- https://tinyurl.com/yfyq5nyr?utm_source%3Dcopy-link%26utm_medium%3Dtutor-course-referral%26utm_campaign%3Dcourse-overview-app
Thymus - Anatomical location. In the thoracic cavity.
Secretes Thymosin hormone
↓
Maturation of T-Lymphocyte (Imp. Q )
↓
Cell mediated immunity.
Attached to Lateral ventricle.
Hormome → Melatonin
DIAGNOSTIC test : (Imp. Q )
test (1) Stimulation testing - Stimulate gland → Normal secretion not occur → Hypofunction
test (2) Suppression testing -Suppress gland → Secretion not ↓es →Hyperfunction.
test (3) Radioactive iodine uptake-To check thyroid function.
👉 Radioactive iodine uptake↓ed - hypothyroidism.
(4) T3 & T4 resin uptake test.
↑sed - In hyper ↓sed - In hypothyroidism,
(5) TSH level-(Normal – 0.2 to 5.4 microunit/ml).
TSH ↑sed - Hypothyroidism.
TSH ↓sed - Hyperthyroidism or secondary hypothyroidism.
(6) Thyroid scan-Identify nodules in thyroid gland.
Radioisotope of iodine or technician is administered
Test is contraindicated in pregnancy (Imp. Q )
(7) Glucose tolerance test - D.M. (Imp. Q )
PD (Postprandial) blood sugar > 200mg/dl- D.M. + ve.
Before 36 hour of tests, avoid alcohol, caffee, smoking (Imp. Q )
10-12 hours NPO for fasting sugar check.
After taking a fasting blood sample, a glucose drink is given & then check blood at 30 minute interval of 2 hours
(8) Glycosylated Hb - blood glucose bound to Hb.
HbA1C =Glycosylated HbA1C indicate increased glucose from past 3-4 month. (Imp. Q )
Pituitary (Hypophyseal) Gland
1. Pituitary (Hypophyseal) Gland.
- Master gland Hypothalamus → Control pituitary gland
- Pea shape
- note- (Split pea shape - Parathyroid gland).
- Weight :- 500 mg
- Located in sella turcica cavity of sphenoid bone.
Anterior pituitary Lobe
- Adenohypophysis- Connected by blood vessels with Hypothalamus.
- Neurohypophysis- Connected by nerve c̅ Hypothalamus.
- (Both Lobes are :- Connected by Intermediate lobe.)
👉Anterior gland Hormone :
(1) Growth hormone
(2) TSH (Thyroid Stimulating Hormone)
(3) ACTH (Adrenocorticotropic Hormone)
(4) FSH
(5) LH
(6) Prolactine
(7) MSH ( Melanocyte-stimulating hormone )
👉Posterior gland Hormone :
(1) Oxytocin
(2) Vasopressin (ADH) (Antidiuretic hormone.)
Synthesize in hypothalamus & Storage in posterior Pituitary & Released by Posterior pituitary.
(1) Growth hormone :
a) IncreasedI. Gigantism :- Before bone epiphyseal closure Occurs in child (Whole body enlarge )
II. Acromegaly. :- After bone epiphyseal closure In adult ( Extremities enlarged )
Somatostatin Replace
b) Decreased
I. Dwarfism
II. Growth retardation (Shunting) to switch Growth hormone replaced
(2) TSH (Thyroid Stimulating Hormone):- It is controlled by Thyrotropin-releasing hormone TRH → From hypothalamus
↓
Stimulate thyroid gland to release
↓
T3 (Tri-iodo thyronine) and T4 (Thyroxine)
Q.: The Impact of ↑ed T3 & T4 on TSH is
Ans. ↓TSH, Rationale : (By negative feedback)
(3) ACTH ( Adrenocorticotropic hormone ) - It is regulated by ACTRH (From hypothalamus)
↓
It has control over Adrenal Gland
(4) FSH - Follicle stimulating hormone. It Matures ovarian follicles in the ovarian cortex. Growing follicles releases estrogen
Estrogen ↑ then FSH ↓se & LH ↑es.
(5) LH-Luteinizing hormone.
(6) Prolactin :- Production/Synthesis of milk.
It has control over Adrenal Gland
(4) FSH - Follicle stimulating hormone. It Matures ovarian follicles in the ovarian cortex. Growing follicles releases estrogen
Estrogen ↑ then FSH ↓se & LH ↑es.
(5) LH-Luteinizing hormone.
- Function :- Rupture of Graffian follicle.
- Maintenance of corpus luteum.
- Progesterone ↓ then LH ↓es & FSH ↑es.
(6) Prolactin :- Production/Synthesis of milk.
- For breast alveoli functioning & maturation
- Natural contraception due to prolactin hormone.
- It inhibits estrogen & progesterone.
- Anovulatory menses occurs during EBF.
-Ve Feedback Mainly maintained
like this ↓TSH, Rationale : (By negative feedback)
↑ = ↓
↓ = ↑
+ Feedback like this
↓ = ↓
↑ = ↑
Eg-Labour Contraction ↑ , Oxytocin ↑ .
Posterior Pituitary -
(1) Milk ejection hormone - Oxytocin
Milk releasing hormone - Oxytocin
like this ↓TSH, Rationale : (By negative feedback)
↑ = ↓
↓ = ↑
+ Feedback like this
↓ = ↓
↑ = ↑
Eg-Labour Contraction ↑ , Oxytocin ↑ .
Posterior Pituitary -
(1) Milk ejection hormone - Oxytocin
Milk releasing hormone - Oxytocin
(note- Prolactin :- Production/Synthesis of milk. )
(2) Vasopressin (ADH).
nursing officer app online test series link- https://tinyurl.com/yfyq5nyr?utm_source%3Dcopy-link%26utm_medium%3Dtutor-course-referral%26utm_campaign%3Dcourse-overview-app
👉ADH Decreased
it may cause loss of body weight.
👉ADH:- Act on nephron tubules to reabsorb H2O.
S/S :-
👉ADH Decreased
- DI (Diabetes insipidus)
- ADH↓= Urinary output ↑se (Polyuria=5-25 L/day)
- Increased Thirst → Polydipsia.
- Treatment :- Give ADH.
- SIADH (Syndrome of Inappropriate ADH).
- ADH↑ = Urinary output ↓se.
- Blood volume ↑se.
- Electrolyte imbalance.
- Hyponatremia
- Water intoxication (Due to increased fluid or water loss dehydration may occur. )
it may cause loss of body weight.
- If 5% body weight loss →Mild dehydration
- 5-10% body weight loss = Moderate dehydration
- > 10% body weight loss → Severe dehydration
👉ADH:- Act on nephron tubules to reabsorb H2O.
S/S :-
- Polyuria 5 to 24 L/day (Most Indicative)
- Polydipsia :-increased thirst due to Dehydration
- Urine specific gravity (1.006 or lower)
- Postural hypotension :- Tachycardia.
Intervention :
(1) Safe environment
(2) Avoid food or liquid that produce diuresis.
👉Sever DI
- Give vasopressin tannate IM/Orally.
- Give desmopressin acetate (DDAVP).
- SIADH (Syndrome of Inappropriate ADH )
- Excess ADH released without body needs.
- Results in water intoxication & hyponatremia.
- S/S:- Wt gain, HTN, Tachycardia, Fluid overload; change in level of consciousness.
(1) Safe environment. (2) Restrict fluid Intake.
(3) Give diuretics & I.V. fluid (NS or hypertonic saline).
Pan-hypo-pituitarism :- Decrease all hormones of pituitary gland
Simmond's Syndrome /Sheehan's syndrome.
Hypo-physe-ctomy :- (Pituitary adenectomy, transsphenoidal)
Pituitary surgery (Endoscopic trans-nasal) -
- Removal of pituitary tumour via craniotomy or trans-Sphenoidal approach.
(1) Elevate the head of the bed.
(2) instruct client to avoid sneezing, coughing, blowing of the nose (to prevent ↑ICP).
(3) Monitor for Diabetes insipidus or SIADH.
(4) Avoid water intoxication.
(5) Administer glucocorticoids
(6) After transsphenoidal hypophysectomy-Check nasal discharge for glucose presence of glucose in nasal if discharges indicate leakage of CSF.
nursing officer app download link-https://edumartin.page.link/wWac
Thyroid Gland
Largest endocrine gland. SIZE- 5 x3 x2 cm(note- Largest gland liver )
Anatomical location : C-5, C-6, C-7
WEIGHT: -30 gm ,Two lobes, Connected by Isthmus
Lobes are made of Lobules, Lobules are made of Acini that Releases thyroid hormone (T3 &T4)
Anatomical location : C-5, C-6, C-7
WEIGHT: -30 gm ,Two lobes, Connected by Isthmus
Lobes are made of Lobules, Lobules are made of Acini that Releases thyroid hormone (T3 &T4)
T3 -0.5 ug/dl & T4 - 0.8 ug/dl
Parafollicular cells (C - cells)- these are between the follicles of thyroid gland.
C-cells release Calcitonin
Function of calcitonin are - Decrease Serum calcium By
↓Calcitonin :- Hypercalcemia -Cause urolithiasis.
Q.: In case of ↓Calcitonin which disorder may оссur.
(1) Cholelithiasis → ↑es cholesterol
(2) Urolithiasis. (Calcium oxalate - most common stone in kidney.)
(3) Tetany due to increased calcitonin
(4) All of above
ANSWER: 2
Thyroid hormone
A) ↑(Hyper-thyroidism)
(1) Grave's disease (toxic diffuse goiter )
• Metabolic rate ↑es.
• Weight loss, temperature ↑ Dry skin
• Heat Intolerance, Diarrhoea, Tachycardia
• Exophthalmos
• Eye protrusion (classical sign)
Anti-thyroid drug- to ↓ T4 & T3
* Drug of choice.- PTU (Propyl-thio-uracil). (Imp. Q )
- Potassium Iodide.
- Radioactive iodine (I131) (Imp. Q )
↓
Damage tumour cells.
PTU Side effect = Agranulocytosis. (WBC) (Imp. Q )
B) ↓(Hypothyroidism)
(1) Cretinism :- In child
(2) Myxedema :- In adult
(3) Goiter :- Autoimmune Goiter
Endemic Goiter- due to iodine deficiency
• Cold Intolerance
• Weight gain
• Temp ↓es, ↓appetite
• Constipation
• Moist skin, Bradycardia
Treatment
Thyroid replacement
Levothyroxine sodium(Drug of choice)(Imp. Q )
Cardiac Stimulant = ↑HR
👉 Environment in Hyperthyroidism :- Cool environment
👉 Environment in Hypothyroidism :-Hot environment
👉 Diet in Hyperthyroidism :- High calorie
👉 Diet in Hypothyroidism :- Low calorie
Function of calcitonin are - Decrease Serum calcium By
- Bone mineralization ↑se
- Intestinal absorption ↓se
Calcitonin↑ Hypocalcemia (↓Serum calcium level) → Tetany
Chvostek Sign → Facial spasm
Trousseau's Sign → Carpal spasm.
Management :
Calcium gluconate -10meq /10ml/ 10minute
Chvostek Sign → Facial spasm
Trousseau's Sign → Carpal spasm.
Management :
Calcium gluconate -10meq /10ml/ 10minute
↓Calcitonin :- Hypercalcemia -Cause urolithiasis.
Q.: In case of ↓Calcitonin which disorder may оссur.
(1) Cholelithiasis → ↑es cholesterol
(2) Urolithiasis. (Calcium oxalate - most common stone in kidney.)
(3) Tetany due to increased calcitonin
(4) All of above
ANSWER: 2
(Calcium oxalate - most common stone in kidney.)
Function of thyroid gland :- Metabolism
- Growth & Development
Thyroid hormone
A) ↑(Hyper-thyroidism)
(1) Grave's disease (toxic diffuse goiter )
• Metabolic rate ↑es.
• Weight loss, temperature ↑ Dry skin
• Heat Intolerance, Diarrhoea, Tachycardia
• Exophthalmos
• Eye protrusion (classical sign)
Anti-thyroid drug- to ↓ T4 & T3
* Drug of choice.- PTU (Propyl-thio-uracil). (Imp. Q )
- Potassium Iodide.
- Radioactive iodine (I131) (Imp. Q )
↓
Damage tumour cells.
PTU Side effect = Agranulocytosis. (WBC) (Imp. Q )
B) ↓(Hypothyroidism)
(1) Cretinism :- In child
(2) Myxedema :- In adult
(3) Goiter :- Autoimmune Goiter
Endemic Goiter- due to iodine deficiency
• Cold Intolerance
• Weight gain
• Temp ↓es, ↓appetite
• Constipation
• Moist skin, Bradycardia
Treatment
Thyroid replacement
Levothyroxine sodium(Drug of choice)(Imp. Q )
Cardiac Stimulant = ↑HR
👉 Environment in Hyperthyroidism :- Cool environment
👉 Environment in Hypothyroidism :-Hot environment
👉 Diet in Hyperthyroidism :- High calorie
👉 Diet in Hypothyroidism :- Low calorie
Q: Levothyroxine Sodium may cause (Imp. Q )
Ans: ↑Heart rate.
Nurse action → Monitor vital signs, specifically Heart rate.
Goiter :- Enlargement of thyroid gland & T3& T4 ↓se.
Autoimmune Goiter (Hashimoto's disease)
Endemic Goiter (Iodine deficiency goiter)
nursing officer app download link-https://edumartin.page.link/wWac
Myxedema coma - Serious hypothyroidism.
c/s
- Hypotension
- Hypothermia
- Hyponatremia
- Bradycardia
- Respiratory failure.
- Coma.
↑ed temperature, tachycardia. Systolic HTN, Delirium, coma
Do Not give salicylates (They ↑free thyroid hormone level.)(Imp. Q )
treatment :-
- Glucose I.V
- Levothyroxine Sodium.
- I.V. fluid.
- Patient airway maintains
Preoperative :
(1) Check vital signs, weight, electrolyte level.
(2) Assess for hyper-glycemia.
(3) Check for thyroid storm & give medicine.
Post operative :
(1) Monitor for respiratory distress.
(2) Have a tracheostomy set, O2 & suction at bedside.(Imp. Q )
(3) Limit talking, assess level of hoarseness.
(4) If parathyroid damage-Assess for hypocalcemia & tetany.
(5) For tetany-Give calcium gluconate.
(6) Give a semi fowler position.(Imp. Q )
Endocrine /Metabolic disorder of pancreas
DIABETES MELLITUS (Imp. Q )
Symbol for DM is Blue circle
> Normal Glucose:- 70-110 mg/dl
Prediabetic :- 100-125 mg/dl
Diabetic :-> 126 mg/dl (Fasting level)
DM -Mechanism of onset of clinical features :
decrease Insulin
↓
↑serum glucose level
↓
Osmolarity ↑
Transport of fluid into blood vessels.
↓
GFR ↑se
↓
Polyuria (Imp. Q )
Baroreceptor Stimulation
↓
Thirst centre stimulate
Polyuria (Imp. Q )
Baroreceptor Stimulation
↓
Thirst centre stimulate
↓
Thirst↑ (Polydipsia) (Imp. Q )
Thirst↑ (Polydipsia) (Imp. Q )
↓
Appetite increases : Polyphagia (Imp. Q )
Secondary DM.
(1) (Cushing syndrome)
Types of DM
I. IDDM (Type 1)
Juvenile DM Non functioning of beta cells
Exogenous Insulin is effective to treat type IDM
Complications are: DKA (Diabetes ketoacidosis) (Imp. Q )
II. NIDDM (Type II)
Maturity onset Diabetes
Increases Resistance of Cells to insulin.
Obesity is a common cause
Oral hypoglycemic/Antidiabetic drug given to treat type II DM.
HHNDKA - Hyperglycemic hyperosmolar Non diabetic ketoacidosis (Imp. Q )
Appetite increases : Polyphagia (Imp. Q )
Secondary DM.
(1) (Cushing syndrome)
- ↑Gluconeogenesis
- ↑ Glucocorticoids
Types of DM
I. IDDM (Type 1)
Juvenile DM Non functioning of beta cells
Exogenous Insulin is effective to treat type IDM
Complications are: DKA (Diabetes ketoacidosis) (Imp. Q )
II. NIDDM (Type II)
Maturity onset Diabetes
Increases Resistance of Cells to insulin.
Obesity is a common cause
Oral hypoglycemic/Antidiabetic drug given to treat type II DM.
HHNDKA - Hyperglycemic hyperosmolar Non diabetic ketoacidosis (Imp. Q )
nursing officer app online test series link- https://tinyurl.com/yfyq5nyr?utm_source%3Dcopy-link%26utm_medium%3Dtutor-course-referral%26utm_campaign%3Dcourse-overview-app
Investigations:
Fingertip method :- Reliable method to diagnose DM.: Punctare lateral side, not midpoint bcoz nerve + nt
OGTT :- Oral glucose tolerance test - Confirmatory test 75gm sugar add in 300ml of H20. (Range 50– 200gm).
Sample after 2 hour = PP Sample > 200mg/dl 👉DM.
Post prandial sugar: (2 hour after eating)
RBS (Random blood sugar)
Normal - < 200 mg/dl
Diabetic -> 200 mg/dl. (At last on 2 occasions.)
Glycosylated Hb - blood glucose bound to Hb.
HbA1C =Glycosylated HbA1C indicate increased glucose from past 3-4 month. (Imp. Q )
HbA1C =Glycosylated HbA1C indicate increased glucose from past 3-4 month. (Imp. Q )
- Normal Value HbA1C -(4-6 %)
- In DM Value HbA1C - (7%) & more
In this test fasting is not required.
DKA.(Diabetic ketoacidosis):
Mechanism :
↑ Blood Glucose
↓
↓es cellular glucose level
↓
Starvation in cells
↓
More eating (Polyphagia)
↓
More sugar level ↑es in blood & cellular level is deprecated
↓
Starvation in cells
↓
Body weight↓ (Cachexia);
Fat metabolism occurs
↓
Ketone bodies form
↓
Kaussmal's respiration (Regular, deep & rapid)
Ketone bodies form
↓
Kaussmal's respiration (Regular, deep & rapid)
( 3P + Weight loss + Kaussmal breathing
P-Polyuria
P-Polyuria
P -Polydipsia
P-Polyphagia
- DKA :-Glucose => 250-300 mg/dl.
- PH = < 7.35 (Acidic)
- Bicarbonate = < 15 meq/1
Clinical features :
Kaussmaul's respiration, fruity breath odour, nausea, abdominal pain-Due to ketosis.
Polyuria, Polydipsia, weight loss, dry skin, blurred vision,
lethargy, coma-Due to dehydration.
- Fruity breath odour. (Sweet)
- Ketonuria (Rothera's test)
- Dehydration.
Diabetic coma Due to excess ketone in blood.
In DKA:
In DKA:
- Ketosis & acidosis occurs & K+ level ↑es,
- (Priority:Rehydration is done c̅ I. V. Infusion of NS 0.9% or 0.45%),
- then serum K+ level ↓es & need K+ replacement.
- After this < 240 mg/dl then give I.V. fluid c̅ 5% dextrose.
- Use regular Insulin only to treat DKA.(5 to 10 uint)
- In DKA glucose level (> 250 mg/dl)
- In DKA PH (< 7.35)
- In DKA Plasma bicarbonate (< 15 meq/L)
- Urine Ketone +nt.
C/M
Kaussmaul's respiration, fruity breath odour, nausea, abdominal pain-Due to ketosis.
Polyuria, Polydipsia, weight loss, dry skin, blurred vision,
lethargy, coma-Due to dehydration.
Hyperglycemic hyperosmolar nonketotic syndrome (IIHNS)- In type II DM.
Extreme hyperglycemia without ketosis & acidosis
Rehydration (NS) alone may decrise glucose level
C/M
Extreme hyperglycemia without ketosis & acidosis
Rehydration (NS) alone may decrise glucose level
C/M
- Altered CNS function c̅ neurologic symptoms.
- Other than DKA.
- Serum Glucose = > 800 mg/dl.
- PH= > 7.4
- HCO3 = > 20 meq/L.
- Ketone = Negative.
Gestational DM =
Type I :- Insulin therapy. Route: SC-45° or IV infusion
Type II :- Sulfonylurea-Choice of drug.
Types of Insulin
Activity Profiles of Different Types of Insulin
1. Immediate acting :- Lispro,
- Newborn of a diabetic mother :- Macrosomic, Hypoglycemic.
Type I :- Insulin therapy. Route: SC-45° or IV infusion
Type II :- Sulfonylurea-Choice of drug.
- Oral antidiabetic/Hypoglycemic drugs.
Chronic Complication of DM:
(1) Diabetic retinopathy :- Impaired retinal circulation & hemorrhage.
Early T/t - Control HTN & blood glucose level.
(2) Diabetic Neuropathy :
(3) cardiovascular & peripheral vascular disease
(1) Diabetic retinopathy :- Impaired retinal circulation & hemorrhage.
Early T/t - Control HTN & blood glucose level.
(2) Diabetic Neuropathy :
- Complication-Non healing ulcer of foot, gastroparesis, erectile dysfunction.
- Mostly damage to IV & VI cranial nerves.
- Cause orthostatic hypotension.
- Skin breakdown, sign of infection (Check for ↑ed temp)
- Foot care is needed - Never remain barefoot.
(3) cardiovascular & peripheral vascular disease
Acute complication
(1) Hypoglycemia
(2) DKA
(3) Hyperosmolar hyperglycemic state.
(1) Hypoglycemia
(2) DKA
(3) Hyperosmolar hyperglycemic state.
Activity Profiles of Different Types of Insulin
1. Immediate acting :- Lispro,
- Contraindicated in Pregnancy induced DM (Gestational DM)
- Onset of action :- 5-15 minutes
II. Short acting
- Semilentle (Regular)
- Onset of action: 30 minutes
- Lente
- NPH
- Onset of action: 60 minutes
Ultralente
- Best Combination : - Regular Insulin + NPH
- syringe; Iml = 40 unit
- I unit - 0.25ml
- Store in Refrigerator
- Open vial used for: 28 day
Injection site :- Arm, thigh, Abdomen, buttocks
Forearm most common site in adult
In periumbilical region: 1 inch away from umbilicus
Lipo-hyper-trophy Elevation of tissue at injection site; So administer Insulin at different site in rotatory manner.
Lipo_atrophy / Lipo_dystrophy > Irritation & damage of SC tissue & fat
Complication of Insulin therapy :
(1) Redness, swelling, tenderness at site of Injection.
* Clean the skin with alcohol before injection.
(2) Insulin lipoatrophy-loss of SC fat & slight dimpling or pitting at the injection site.
Lipo-hyper-trophy-Develop fibrous fatty masses at Injection site.
So rotate Injection site.
(3) Dawn phenomenon
Hyperglycemia (5 to 8 AM.) → Pre Breakfast, caused by nocturnal release of GH.
Tlt - Evening dose of Intermediate acting Insulin at about 10 PM is Increased.
(4) Somogyi phenomenon
Elevated blood glucose level at bedtime, hypoglycemia at 2-3 AM,
counter regulatory hormone acts & at 7AM, hyperglycemic occurs.
Tlt - Evening dose of Intermediate acting Insulin is decreased
(5) Insulin resistance-Body cells not responsive to Insuline
(6) hypoglycemia
(1) Redness, swelling, tenderness at site of Injection.
* Clean the skin with alcohol before injection.
(2) Insulin lipoatrophy-loss of SC fat & slight dimpling or pitting at the injection site.
Lipo-hyper-trophy-Develop fibrous fatty masses at Injection site.
So rotate Injection site.
(3) Dawn phenomenon
Hyperglycemia (5 to 8 AM.) → Pre Breakfast, caused by nocturnal release of GH.
Tlt - Evening dose of Intermediate acting Insulin at about 10 PM is Increased.
(4) Somogyi phenomenon
Elevated blood glucose level at bedtime, hypoglycemia at 2-3 AM,
counter regulatory hormone acts & at 7AM, hyperglycemic occurs.
Tlt - Evening dose of Intermediate acting Insulin is decreased
(5) Insulin resistance-Body cells not responsive to Insuline
(6) hypoglycemia
- Mild hypoglycemia - Blood sugar< 60 mg/dl
- Moderate hypoglycemia - < 40 mg/dl
- Severe hypoglycemia - < 20 mg/dl
C/M- Confusion, diaphoresis, Tremors, Irritability, Nervousness, Slurred speech, Palpitation
In unconscious or semi conscious people - Not giving oral food having severe hypoglycemic bcoz risk for aspiration
In unconscious or semi conscious people - Not giving oral food having severe hypoglycemic bcoz risk for aspiration
Give IM. or S/C. glucagon or In hospital 25-50 ml of 50% dextrose (IV)
In DKA Notify physician when : Vomiting, diarrhoea, fever persists.
Glucose - 250-300mg/dl.
- Superior border of Kidney.
- Retroperitoneal
- size- 3 x 2 x 1 cm, Weight = 5 gm
1. Cortex - Hormones released are
- Glucocorticoid (Cortisol/Steroid)
- Mineralocorticoid (Aldosterone)
- Some Adnrogen (Sex/Gonadal hormone
Pheochromocytoma :- Tumour of Adrenal medulla. Benign tumour
Increase Secretion of catecholamines (Increase Epinephrine & nor-epinephrine)
Metabolism of catecholamines forms VMA (Vanillylmandelic acid)
VMA test: For confirmation of Pheochromocytoma 24 hour urine sampling needed (Imp. Q )
> 10mg = Indicate pheochromocytoma
Glucocorticoids :- Gluconeogenesis ( ↑blood glucose level)
- Immunosuppressant
- Glycogenolysis.
- Delay wound healing
Aldosterone :- Fluid & Electrolyte balance.
Androgen :- Growth of genitals.
(1) Cushing syndrome → ↑ed glucocorticoids
Clinical features :- Moon face, buffalo hump (fat deposition) Hyperglycemia, ↓ed Immunity
Electrolyte imbalance.
(2) Conn's Syndrome :- Hyper_aldosteronism.
-Fluid & electrolyte imbalance.
- ↑es water + Sodium retention. (Hypernatremia)
- ↓es potassium (Hypokalemia)
- Hypertension.
(T wave elevated, QRS wide - Hyperkalemia) (Imp. Q )
ECG quickly revision notes इस से best notes आप की कही भी नही मिलेंगे -https://www.nursingofficer.net/2020/08/ecg.html
Fluid & electrolyte balance through Renin Angiotensin- Aldosterone Axis
Angiotensinogen (Liver)
Angiotensinogen (Liver)
↓- Renin(by Kidney)
Angiotensin I
↓ ACE (Lungs)
Angiotensin II
↓
Aldosterone.
↓
Sodium & water reabsorption & Vaso- constriction
Q. A patient is on steroid therapy with Investigation is most Important
(1) Urea breath test
(2) Uric acid test
(3) Serum glucose test
(4) VMA test
ANSWER: 3
Angiotensin II
↓
Aldosterone.
↓
Sodium & water reabsorption & Vaso- constriction
Q. A patient is on steroid therapy with Investigation is most Important
(1) Urea breath test
(2) Uric acid test
(3) Serum glucose test
(4) VMA test
ANSWER: 3
- Urea breath test is for H. pylori
- VMA (Normal 4-6 ng/dl, more than 10 abnormal)
- test is for Pheochromocytoma.
- serum Uric acid for renal failure
nursing officer app download link-https://edumartin.page.link/wWac
Addison's disease :- most common symptoms hyper pigmentation of skin (albright syndrome)
Steroids may be :
Long acting :- Dexamethasone-Drug given in → Tapered fashion
Intermediate acting :- Prednisolone
Short acting :- Hydrocortisone
Adrenal gland disorder :
Function of glucocorticoids :- Gluconeogenesis, Anti inflammatory, Immunosuppressant
Function of mineralocorticoids:- Na & H2O reabsorption. (Aldosterone)
In both check B.P., Glucose & Electrolyte level
Addison's Disease
Hyposecretion of cortex hormone (Glucocorticoid, Mineralocorticoid)
S/S
Cushing's disease/Syndrome - Hyper-cortisolism.
Hypersecretion of glucocorticoids from cortex.
S/S
Addison's disease :- most common symptoms hyper pigmentation of skin (albright syndrome)
- Hypoglycemia
- Hypotension
- Hyponatremia
- Hyperkalemia.
Steroids may be :
Long acting :- Dexamethasone-Drug given in → Tapered fashion
Intermediate acting :- Prednisolone
Short acting :- Hydrocortisone
Adrenal gland disorder :
Function of glucocorticoids :- Gluconeogenesis, Anti inflammatory, Immunosuppressant
Function of mineralocorticoids:- Na & H2O reabsorption. (Aldosterone)
In both check B.P., Glucose & Electrolyte level
Addison's Disease
Hyposecretion of cortex hormone (Glucocorticoid, Mineralocorticoid)
S/S
- Weight loss
- Hypoglycemia
- Hyponatremia
- Hyperkalemia, hypercalcemia
- Postural hypotension
- Hyperpigmentation of skin.
- GI disturbances.
- Lethargy, fatigue, muscle weakness.
Cushing's disease/Syndrome - Hyper-cortisolism.
Hypersecretion of glucocorticoids from cortex.
S/S
- Weight gain.
- Hypernatremia.
- Hypokalemia, hypocalcemia.
- HTN
- Truncal obesity, c̅ thin extremities,
- Moon-face.
- Buffalo hump.
- Muscle wasting & weakness
- Fragile skin.
- Labile mood, Psychosis, Euphoria.
Hypophysectomy (When ↑ACTH is a cause)
Adrenalectomy
Diet
Addisonian Crisis
Hyposecretion of adrenal gland.
Life threatening disorder caused by acute adrenal insufficiency
Precipitate by stress, Infection, trauma, Surgery
C/S
Initially give- Hydrocortisone sodium succinate.
Diet
- High protein & high carbohydrate & Normal Na+
- Need for life long glucocorticoid therapy.(Imp. Q )
Addisonian Crisis
Hyposecretion of adrenal gland.
Life threatening disorder caused by acute adrenal insufficiency
Precipitate by stress, Infection, trauma, Surgery
C/S
- Severe headache, severe abdominal, leg, lower back pain.
- Weakness, Irritability & Confusion.
- Severe hypotension, Shock.
Initially give- Hydrocortisone sodium succinate.
Conn's Syndrome. (Hyperaldosteronism) ↑aldosterone.
Cause-Adenoma (Imp. Q )
S/S
* HTN is hallmark (Imp. Q )
treatment
* High calories, vitamins & minerals.
Adrenalectomy :
Lifelong gluco & mineralocorticoid is necessary
Catecholamines drop, check for cardiovascular collapse, hypotension, shock.
Hemorrhage may occur - Adrenal gland is highly vascular
Preoperative :
(1) Monitor for hyperglycemia, electrolyte level & prevent infection.
Postoperative :
(1) If Urine output < 30 ml/hr, notify physician, (renal failure, shock may occur).(Imp. Q )
(2) Monitor for hemorrhage (24 - 48 hour)
(3) Paralytic Ileus-Sign-Abdominal distension, pain, nausea, vomiting, ↓ed bowel sound. Occur due to internal bleeding, anesthesia effect.
(4) Prevent atelectasis.
4. Parathyroid Gland
Split pea shape, 4 Lobe
↑ Activity of Osteoclast cells, Serum calcium increases, Serum phosphate ↓es
Parathyroid works Opposite to Calcitonin
Parathyroid ↑es -Hypercalcemia(increase Serum Ca.) (Urolithiasis)
Cause-Adenoma (Imp. Q )
S/S
- Hypokalemia Hypernatremia, HTN
- Polydipsia & Polyuria.
- Specific gravity of urine is low
- Metabolic alkalosis.
- Spironolactone (K+ Sparing diuretic)
- Adrenalectomy. (Give corticosteroid postoperatively)
* HTN is hallmark (Imp. Q )
- Catecholamine-producing tumor
- Benign tumour.
- Excessive epinephrine & norepinephrine secreted.
- HTN, Hyperglycemia, Diaphoresis.
- Pain in chest & abdomen c̅ nausea & vomiting
- Weight loss. - Heat Intolerance
- Dysrhythmia. - Heart beat ↑es & Irregular
- Vanillyl mandelic acid (VMA)-24 hour urine collection - Check for VMA
- (Normal - 10 mcg/100ml) - ↑ed in pheochromocytoma.
- Avoid, Abdominal pressure, Vigorous abdominal palpation
treatment
- Adrenal gland removal.
- Give rest & non stressful environment & avoid stimuli.
- Monitor for hypertensive crisis.
* High calories, vitamins & minerals.
Adrenalectomy :
Lifelong gluco & mineralocorticoid is necessary
Catecholamines drop, check for cardiovascular collapse, hypotension, shock.
Hemorrhage may occur - Adrenal gland is highly vascular
Preoperative :
(1) Monitor for hyperglycemia, electrolyte level & prevent infection.
Postoperative :
(1) If Urine output < 30 ml/hr, notify physician, (renal failure, shock may occur).(Imp. Q )
(2) Monitor for hemorrhage (24 - 48 hour)
(3) Paralytic Ileus-Sign-Abdominal distension, pain, nausea, vomiting, ↓ed bowel sound. Occur due to internal bleeding, anesthesia effect.
(4) Prevent atelectasis.
4. Parathyroid Gland
Split pea shape, 4 Lobe
↑ Activity of Osteoclast cells, Serum calcium increases, Serum phosphate ↓es
Parathyroid works Opposite to Calcitonin
Parathyroid ↑es -Hypercalcemia(increase Serum Ca.) (Urolithiasis)
Parathyroid ↓es - ↓ Serum Calcium ↑ Phosphate
(Imp. Q ) Decrease calcium in blood Causes Tetany- It is manifested by Spasm of larynx
- Chovestik sing (facial spasm)
- Trousseau's sign (carpal spasm)
Treatment :- Calcium gluconate
- 10 : 10 : 10
- Meq : ml : nin
Hydroxide = ↓es adsorption of phosphate from GIT.
Milk, cheese, dairy products are not given in hypoparathyroidism.
Because it increases serum phosphate.
Hypo-parathyroidism :- ↓ed parathormone.
C/M
Hypo-calcemia & hyper-phosphatemia.
Numbness & tingling in face.
+ ve Trousseau's sign & Chvostek's sign (Tapping on facial nerve](Imp. Q )
Hypotension, bronchospasm, laryngospasm, dysphagia.
Intervention :
(1) Place tracheostomy set, O2, Suction catheter at bedside.(Imp. Q )
(2) Give calcium gluconate.
(3) Give a high calcium, low phosphorus diet.
(4) Give vitamine D.
(5) Give phosphate binders to excrete phosphate.
Hyperparathyroidism :-↑ Parathormone.
Anorexia, Nausea, Vomiting, Constipation
Hypercalcemia & hypophosphatemia Weight loss
Hypertension, Cardiac dysrhythmias, Renal stone.
Intervention :
(1) Monitor B.P.
(2) Give furosemide-To lower ca+
Parathyroidectomy: - Removal of one or more parathyroid glands.
Post operatively :
(1) Monitor for respiratory distress
(2) Tracheostomy set, O2, Suctioning at bedside.
(3) Semi fowler position.
(4) Assess neck dressing for bleeding.
(5) Monitor for hypocalcemia & tetany,
(6) Monitor for laryngeal nerve damage
(7) Give ca+ & vit D.
nursing officer app online test series link- https://tinyurl.com/yfyq5nyr?utm_source%3Dcopy-link%26utm_medium%3Dtutor-course-referral%26utm_campaign%3Dcourse-overview-app
Thymus - Anatomical location. In the thoracic cavity.
Secretes Thymosin hormone
↓
Maturation of T-Lymphocyte (Imp. Q )
↓
Cell mediated immunity.
Pineal Gland
Anatomical location: MidbrainAttached to Lateral ventricle.
Hormome → Melatonin
DIAGNOSTIC test : (Imp. Q )
test (1) Stimulation testing - Stimulate gland → Normal secretion not occur → Hypofunction
test (2) Suppression testing -Suppress gland → Secretion not ↓es →Hyperfunction.
test (3) Radioactive iodine uptake-To check thyroid function.
- Radioactive Iodine is given.
- 2 to 4 hour after giving - 3%-10% Normal value.
- 24 hour after given - 5 to 30%
👉 Radioactive iodine uptake↓ed - hypothyroidism.
(4) T3 & T4 resin uptake test.
↑sed - In hyper ↓sed - In hypothyroidism,
(5) TSH level-(Normal – 0.2 to 5.4 microunit/ml).
TSH ↑sed - Hypothyroidism.
TSH ↓sed - Hyperthyroidism or secondary hypothyroidism.
(6) Thyroid scan-Identify nodules in thyroid gland.
Radioisotope of iodine or technician is administered
Test is contraindicated in pregnancy (Imp. Q )
(7) Glucose tolerance test - D.M. (Imp. Q )
PD (Postprandial) blood sugar > 200mg/dl- D.M. + ve.
Before 36 hour of tests, avoid alcohol, caffee, smoking (Imp. Q )
10-12 hours NPO for fasting sugar check.
After taking a fasting blood sample, a glucose drink is given & then check blood at 30 minute interval of 2 hours
(8) Glycosylated Hb - blood glucose bound to Hb.
HbA1C =Glycosylated HbA1C indicate increased glucose from past 3-4 month. (Imp. Q )
- Normal Value HbA1C -(4-6 %)
- In DM Value HbA1C - (7%) & more
In this test fasting is not required.
(9) Glycosylated serum albumin (Fructosamine) -
(9) Glycosylated serum albumin (Fructosamine) -
- Non Diabetic - 1.5 to 2.7 mmol/L. More sensitive
- Diabetic pt - 2 to 5 mmol/L. Than HbAIC
nursing officer app online test series link- https://tinyurl.com/yfyq5nyr?utm_source%3Dcopy-link%26utm_medium%3Dtutor-course-referral%26utm_campaign%3Dcourse-overview-app
I think best website for Pharmacy students is https://remixeducation.in
जवाब देंहटाएंRemix education is power full platform for pharmacy students
Si from where i can download these notes
जवाब देंहटाएं