Adult Nursing Department

Course: theroritical Adult Nursing 2

Faculty of Nursing
Pre-Master 3rd semister
Cairo University

Endocrine System

Prepared by:
C.I. Karim Ramadan Ibrahim

Under Supervision of:

Prof. Dr. Amal Fakhry.
Academic Year
Prof. Dr. Nagat AlMorsy.
2023-2024
Prof. Dr. Hanan Alkafafi.
Dr. Basma Magdy.
Dr. Samah Wahed
 ILOs:

At the end of this lecture the learner will be able to:

• Discuss an overview of endocrine system and it's disorders

• Identify what the meaning of diabetes mellitus

• Identify the international and national incidence of diabetes mellitus

• Explain the pathophysiology of diabetes mellitus

• Discuss the risk factors of diabetes mellitus

• Discuss Investigations and diagnosis for diabetes mellitus

• Identify different treatments and approaches to manage diabetes mellitus

• Emphasize of the important of nursing role in managing the patients with diabetes
mellitus
 Outlines:
We will cover these outlines about DM-:
• Overview of endocrine system and it's
disorders
• Definition.
• Incidence of the disorder.
• Risk factors & causes of the disorder.
• Pathophysiology.
• Clinical manifestations.
• Investigations and diagnosis.
• Common and new trend treatment.
• Nursing Management and Care plan.
 Introduction
• Most hormones secreted from endocrine
glands are released directly into the
bloodstream.

• Exocrine glands, such as sweat glands,

secrete their products through ducts onto
epithelial surfaces or into the GI tract.
Exocrine Glands
Endocrine Glands
 PANCREAS
• Located behind stomach
• Functions as:
– Exocrine gland
• Secretes pancreatic juices into small
intestine to become digestive juices
– Endocrine gland
• Produces insulin and glucagon
 The Pancreatic Hormones
Insulin
 Lowers blood glucose levels by increasing glucose
transport into the body cells and increasing
glycogen synthesis in liver and muscle cells
HYPERSECRETION - Hypoglycaemia
HYPOSSECRETION - Hyperglycaemia
• low levels of insulin leads to diabetes mellitus type
2 (NIDDM), no insulin leads to diabetes mellitus
type 1 (IDDM)
Glucagon
 Raises blood glucose levels by inhibiting glucose
uptake and liberating glucose stored as glycogen.
 Diabetes Mellitus
• Diabetes is a group of metabolic diseases
characterized by hyperglycemia (an
elevated level of glucose in the blood)
resulting from defects in insulin secretion,
insulin action, or both
[CDC] 2020).
• A metabolic disorder due to Absolute or
Relative insulin deficiency.
National Incidence of diabetes
mellitus
Regulation of Plasma
Glucose Level
 Diabetes Mellitus
Care of the patient with diabetes requires an
understanding of the epidemiology,
pathophysiology, diagnostic testing, medical
and nursing care, and rehabilitation of patients
with diabetes.
The field of diabetes is dynamic with constant
advances in technology, research, and
medications that can improve the life and well-
being of people with diabetes. Nurses care for
patients with diabetes in all settings
 Classification
The major classifications of diabetes are:-
• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes
• Latent autoimmune diabetes of adults (LADA)
• Diabetes associated with other conditions or
syndromes
(American Diabetes Association [ADA], 2020)
Classification
Pathophysiology
Pathophysiology
 Clinical manifestations

• Clinical manifestations depend on the

patient’s level of hyperglycemia. Classic
clinical manifestations of diabetes include
the “three Ps”:
• polyuria
• Polydipsia
• polyphagia.
 Clinical manifestations
• Other symptoms include fatigue and
weakness, sudden vision changes, tingling
or numbness in hands or feet, dry skin,
skin lesions or wounds that are slow to
heal, and recurrent infections
• The onset of type 1 diabetes may also be
associated with sudden weight loss or
nausea, vomiting, or abdominal pains
Investigations and diagnosis
Investigations and diagnosis
Investigations and diagnosis
Investigations and diagnosis
• Postprandial glucose
(≥200mg/dL)

• Urine analysisby strip

Glucosuria and Ketonuria
Investigations and diagnosis.
 Common and new trend treatment.

The main goal of diabetes treatment is to

normalize insulin activity and blood glucose levels
to reduce the development of complications such
as :-
• retinopathy (damage to the retina)
• nephropathy (damage to kidney cells)
• neuropathy (damage to nerve cells).
Common and new trend treatment
 Common and new trend treatment
• The first line treatment for patients with
prediabetes or type 2 diabetes, prior to
starting any medications, should be
conservative management with lifestyle and
diet modifications to reduce blood sugar
levels.
• Diet and exercise can also help prevent the
progression of prediabetes to type 2
diabetes.
• Patients will be encouraged to eat a balanced
diet, exercise regularly, and stop smoking.
 Diet Management
Diet may include:-
• More fiber-rich fruits and vegetables - Apples,
berries, bananas, broccoli, leafy greens, etc.
• More high fiber, complex carbohydrates (good
carbs) - Brown rice, brown bread, whole wheat,
whole grains, etc.
• Less low fiber, simple carbohydrates (bad carbs) -
White rice, white bread, pastas, etc.
• Less simple sugars - Soda, candy, fruit juice
concentrates, etc.
• Low calorie diet
The Plate Method
 The Plate Method
• It’s easy to eat more food than you need
without realizing it.
• The plate method is a simple, visual way
to make sure you get enough nonstarchy
vegetables and lean protein while limiting
the amount of higher-carb foods you eat
that have the highest impact on your blood
sugar.
 Glycemic Index
• One of the main goals of diet therapy in
diabetes is to avoid sharp, rapid increases
in blood glucose levels after food is eaten.
The term glycemic index is used to
describe how much a given food increases
the blood glucose level compared with an
equivalent amount of glucose.
(ADA, 2020; Evert et al., 2019)
Exercises
 Exercises
• Aerobic Exercise - 150 minutes/week
(walking, biking, swimming, etc.)
• Resistance Exercise - 2-3 times/week
(yoga, weightlifting, etc.)
• Limit inactivity
• If the patient is overweight, then the
primary care staff may encourage the
patient to lose 5-10% of their body weight.
 Monitoring of Blood Glucose
• before each meal 3times daily with insulin injection
• Who take insulin at bedtime or who use an insulin infusion pump
should also test daily
• Not receiving insulin instructed to assess their blood glucose levels
at least 2 or 3 times per week, including a 2-hour postprandial test.
• For all patients, testing is recommended whenever hypoglycemia,
hyperglycemia , changes in medications, activity, diet, with stress
or illness.
• Every 6-12 months compare with lab

• (Q 3 months) Glycosylated Hemoglobin HgbA1c

 pharmacological therapy
The pharmacological therapy depends on the
type of diabetes & the patient’s status,
include:
Insulin
Oral Antidiabetic drugs:
• Insulin Secretagogues: Sulphonylureas &
Meglitinides(Glinides)
• Insulin Sensitizers: Biguanides & Glitazones
• Inhibitors of Glucose Absorption: Acarbose &
Miglitol
 Preparations of Insulin

Ultra- Intermediat
short
Short e
Long

Lispro - Regular Isophane insulin Insulin glargine

Aspart- (NPH)
 Type of preparation Onset Peak Duration

1) Ultrashort Acting
5-15 min 30-90 4-6 hrs
Insulin Lispro minutes
Insulin Aspart
2) Short Acting
30-60 min 2-3 6-8 hrs
Crystalline Zinc Insulin (soluble, regular )
hours

3) Intermediate Acting
2-4 hours 4-10 hrs Up to 18
Isophane (NPH= neutral protamine
hrs
hagedorn)

4) Long Acting
No
Insulin Glargine 2-4 hours peak Up to 24
hrs
Insulin Detemir 1-2 hours No 16-24 hrs
peak
Insulin delivery devices
 Common injection sites

Abdomen : most preferred site

Other sites: Buttocks, thighs and arms.
Site Rotation is essential
 Adverse effects of Insulin:
1)Hypoglycemia (most serious)
2) Lipodystrophy

3) Allergy

4) Hypokalemia

5) Insulin Resistance
 general principles for rotation of Insulin
Injections
• First, patients should try not to use the same site
more than once in 2 to 3 weeks.
• In addition, if the patient is planning to exercise,
insulin should not be injected into the limb that will
be exercised, because it will be absorbed faster,
result in hypoglycemia.
• patients should be encouraged to use all available
injection sites within one area (0.5 to 1 inch (2.5 cm)
away from the previous) injection rather than
randomly rotating sites from area to area.
• The speed of absorption is greatest in the abdomen
and decreases progressively in the arm, thigh
 Complications

A- Short term B- Long term

Hypogly Macro- Micro-

DKA HHNS vascular
cemia vascular
 Nursing Management
Nursing Assessment
Diabetes symptoms depend on hyperglycemia
levels, including polyuria, polydipsia, and
polyphagia.
Other symptoms include fatigue, vision
changes, numbness, dry skin, slow wound
healing, and infections. Diagnosis involves
measuring blood glucose levels. Ongoing
specialized assessment and evaluation for
complications are essential for diabetes
management
 Nursing Assessment
• Polyuria. Increased urination due to excess loss of
fluid caused by osmotic diuresis.
• Polydipsia. Increased thirst as a result of fluid loss
and dehydration.
• Polyphagia. Increased appetite resulting from the
catabolic state caused by insulin deficiency and
breakdown of proteins and fats.
• Fatigue and weakness. Feeling tired and lacking
energy.
• Sudden vision changes. Rapid alterations in visual
acuity.
• Tingling or numbness in hands or feet. Sensations
of pins and needles or loss of sensation in extremities.
 Nursing Assessment
• Dry skin. Skin lacking moisture and becoming
rough or flaky.
• Slow-healing skin lesions or wounds. Delayed
wound healing and impaired skin regeneration.
• Recurrent infections. Frequent and persistent
infections due to compromised immune function.
• Sudden weight loss Unexplained and rapid
weight loss.
• Nausea, vomiting, or abdominal pain (Type 1
diabetes with DKA). Symptoms associated
with diabetic ketoacidosis, such as gastrointestinal
distress.
 Nursing Diagnosis
• Imbalanced nutrition related to imbalance of insulin,
food, and physical activity
• Deficient knowledge about diabetes self-care
skills/information
• Anxiety related to loss of control, fear of inability to
manage diabetes misinformation related to diabetes
• Potential self-care deficit related to physical
impairments or social factors
• Risk for fluid volume deficit related to polyuria and
dehydration
 Risk for impaired skin integrity related to immobility
and lack of sensation (caused by neuropathy)
 Nursing Interventions
Initiating diabetes education
• Provide simple, direct information to dispel
misconceptions and address any
misinformation
• Educate patients on the basic
pathophysiology of diabetes, including the
definition of diabetes, normal blood glucose
ranges, and target blood glucose levels.
• Educate patients on recognizing, treating,
and preventing acute complications such as
hypoglycemia and hyperglycemia.
 Nursing Interventions
• Regularly evaluate self-care skills, such as
insulin administration, blood glucose
monitoring, foot care, and diet planning,
especially in patients with deteriorating
vision
• Provide written instructions with handouts
for patients to take home, facilitating
diabetes management in the home setting.
• Involve family members in assisting with
diabetes basic skills when appropriate.
 Nursing Interventions
• Educate the patient on proper self-monitoring
of blood glucose (SMBG) techniques.
• Assess the patient’s visual acuity, fine motor
coordination, and cognitive abilities to
determine the appropriate SMBG method.
• Encourage regular calibration of blood
glucose readings to plasma values and check
the validity of readings with control solutions.
 Nursing Interventions
• Provide guidance on the frequency of
SMBG based on the patient’s insulin
therapy and individual needs.
• Teach patients how to keep a record or
logbook (or use an app) of blood glucose
levels and interpret patterns.
• Educate the patient on the significance of
glycated hemoglobin (HbA1C) testing and
its interpretation.
 Nursing Interventions
• Monitor blood glucose levels closely
during periods of physiologic stress, such
as infections or surgery.
• Teach stress management techniques and
coping strategies to the patient.
• Assess and monitor for local allergic
reactions at the injection site.
 Nursing Interventions
• Educate the patient about insulin
lipodystrophy and the importance of
rotation of injection sites.
• Conduct a comprehensive assessment of
the patient’s dietary history, food
preferences, lifestyle, and cultural
background.
• Simplify meal planning information and
provide opportunities for practice
 FOOT CARE
• Check feet daily
• Check the entire surface of both feet for skin
breaks, blisters, swelling, or redness.
• Don't forget to look between and
underneath toes where damage can be
hidden.
• Use a mirror if it is difficult to see all parts of
feet or ask a caregiver to help.
• Don’t walk bare feet
 FOOT CARE
• Protect feet from hot and cold
• Choose socks and shoes carefully
• Select cotton socks that fit loosely
• change socks every day.
• Select shoes that are snug but not tight,
• Make good foot care a habit
 References
• Hinkle, J. L., Cheever, K. H., & Overbaugh,
K. J. (2022). Brunner & Suddarth's textbook
of medical-surgical nursing. 15th edition.
Philadelphia, Wolters Kluwer Health.
• Wexler D., Nathan D., Rubinow K.; Patient
education: Type 2 diabetes: Insulin treatment
(Beyond the Basics); Last Reviewed May
2023; Accessed June 2023;
https://www.uptodate.com/contents/type-2-
diabetes-insulin-treatment-beyond-the-basics
• Kudva Y.; Diabetes Diagnosis; Mayo Clinic;
May 2023; Accessed June 2023;
https://www.mayoclinic.org/diseases-
conditions/diabetes/diagnosis-treatment/drc-
20371451