lOMoARcPSD|38779317

Endocrine and GIT - Toprank

Nursing Care Of Clients With Life Threatening Conditions, Acutely Ill/ Multi-Organ
Problems, High Acuity And Emergency Situation, Acute And Chronic (Nueva Ecija
University of Science and Technology)

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TOPRANK - ENDOCRINE and GIT

RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

Signs and Symptoms:

(All are INCREASE except TSH, menstruation, and body weight)
ENDOCRINE DISORDERS (FAST and WET)
➢ Exophthalmos
➢ Decrease body weight (muscle wasting)
Thyroid Gland ➢ Diarrhea
● Is a butterfly shape gland located at the base of the neck ➢ Heat Intolerance
○ Nakasabit sa larynx ➢ Agitated
● Sa lalaki madali lang ma-palpate, kasi nasa ilalim lang ng ➢ Restless
Adam’s apple ➢ Tremors → Seizure (Thyroid Storm/ Crisis)
● ➢ Hypertensive Crisis, Hyperpyrexia, Tachycardia
➢ Hypocalcemia
Metabolism Center
● Controlled by the pituitary gland (specifically in the anterior
pituitary gland) → pituitary gland is located at the base of the
Complications:
skull
1. Thyroid storm after thyroidectomy
● APG → produces the thyroid stimulating hormone → related
2. Increase heart rate, workload, inc o2 demand, arrhythmias,
to follicle stimulating hormone and luteinizing hormone
cardiac arrest
● TSH → will then now stimulate the thyroid gland → TG
3. Infertility increases thyroid hormone - increases prolactin -
produces two thyroid hormones which is the T3 and T4
decreased fertilization rate
● T3 is the metabolism or breakdown of energy → related to
GIT
Management:
● T4 heat production kaya if nag breakdown ng energy nag
1. LOW body weight → HIGH appetite → Provide HIGH -Calorie
poproduce ang katawan ng heat
intake →
● Thyroid Hormones enhances the SNS → related to the
2. DIARRHEA → Give LOW fiber diet → INCREASE fluid intake
development of brain
because of dehydration
3. HEAT INTOLERANCE → Provide COOL environment
HYPERTHYROIDISM
4. HYPERACTIVITY → Provide a NON-STIMULATING
environment (private room)
● Number 1 cause: Grave’s Disease → it is an autoimmune
5. THYROID STORM (deadly) → REPORT to the physician
disorder causes HYPERACTIVITY of the TG → causes
6. EXOPTHALMOS
Thyroid Hormones to INCREASE
- Dryness of the eyes → Give EYEDROPS or
○ Due to autoimmune → it will now produce fat pads
ARTIFICIAL TEARS
behind the eyes and will push forward →
- Problem to sunlight → Advised to WEAR
EXOPTHALMOS (abnormal protrusion of the
SUNGLASSES
eyeball) → dry eyes, problem to sunlight, sleep
- Sleep disturbance → COVER using EYEPATCH or
disturbance
TAPE
● Possible Cause
- Eye patch is commonly used for
○ Tumor (no function or worsens the function,
Myasthenia Gravis and nystagmus
steals glucose) Hyperfunctioning thyroid
- Patch the strong eye para ma-
nodules
exercise si weak eye
○ Thyroiditis; Autoimmune; Idiopathic;
Pregnancy
Medication:
● APG → TSH → FSH and LH
1. DOC: THIOAMIDES → Antithyroid Hormones
● TSH → TG → T3 and T4
a. Methimazole
● INCREASE TG → EXCESSIVE T3 and T4
b. Propylthiouracil (PTU) - BEST DRUG AFTER
○ T3 → increase metabolism → DECREASE body
THYROID STORM
weight → increase appetite → HYPERACTIVE
i. Fast acting (1-2 hours activated na)
GIT → increase peristalsis → DIARRHEA
ii. Also safe in pregnancy
■ Bakit hindi tumataba kahit matakaw?
c. WOF: GI Irritation
Kasi nga you eat, you burn; you eat, you
i. Take it with meals
burn
d. WOF: Agranulocytosis
○ T4 - increase heat production → HEAT
i. LABS → bagsak ang WBC at
INTOLERANCE
PLATELET → HIGH RISK FOR
○ TH → increase SNS → HYPERACTIVITY →
INFECTION and BLEEDING
AGITATED → RESTLESS → TREMORS →
■ Check for Fever and
increase V/S → THYROID STORM/ CRISIS
Sorethroat
(severe form of hyperthyroidism)
Surgery:
● Once mataas na ang TH → it will give signal to the pituitary page :29
1. Thyroidectomy
gland → TSH will now decreases para hindi na tumaas ang
Complications
Thyroid Hormones → DECREASE FSH and LH →
Amenorrhea ⑪
a. Hypoparathyroidism or Hypocalcemia or Tetany
i. WOF: Muscle twitching and spasm

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TOPRANK - ENDOCRINE and GIT

RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

■
Chvostek's sign twitching of (All are DECREASE except TSH, mens and body weight)
facial muscles (SLOW and DRY)
■ Trousseau’s sign carpopedal a. Menorrhagia
b. Weight gain
spasm
c. Anorexia
ii. DOC: Calcium Gluconate d. Constipation
b. Thyroid Storm due to leakage
2. e. Cold Intolerance
i. WOF: Increasing V/S severe hyper thy Moidism f. Lethargic
ii. Mgt: Report to the doctor priority "ABC"t Report g. Apathetic :

c. Laryngospasm inflammation ; bleeding

21 . -
ICa h. Coarse facial features
or

i. WOF: Respiratory Distress or i. Periorbital edema

ii. Facial edema
Difficulty of Breathing or Any signs of
iii. Dull blank expression
Airway Obstruction iv. Thick tongue (affects the speech)
ii. Mgt: Tracheostomy set /kitI I should be on the i. Myxedema Coma
bedside or readily available
d. Bleeding
#3 i.
.

WOF: Anterior or Posterior bleeding Complication:

of the neck/ Frequent swallowing 1. Myxedema coma - hypothermia - hypotension
ii. Mgt: Avoid flexion and hyperextension of 2. Slower functioning and movement
the neck 3. Infertility - prevents release of eggs
iii. Check the nape for bleeding 4. Increased LDL - atherosclerosis - ischemic stroke
iv. Tight the dressing
v. Position in a semi-fowler’s Management:
e. Laryngeal nerve damage 1. Increase body weight → Anorexia → Provide LOW -CALORE
5 .

Dysphonia

i. WOF: Severe hoarseness of the voice INTAKE

ii. Mgt: Advised px to talk, speaking or 2. Constipation → Give HIGH-FIBER → INCREASE OFI to
talking should be EVERY ONE HOUR prevent dryness
Monitor speech/voice :
3. Cold Intolerance → Provide a WARM environment → give
every hour

Talking
Avoid : too much

Note: blankets
4. Hypoactive → Monitor LOC → Avoid SEDATIVES
Tonsillectomy → if for Frequent swallowing 5. Myxedema Coma → assess facial features and ABC’s of life
Thyroidectomy → Anterior or Posterior bleeding of the neck
Medication:
Summary of Complication:
1. Hypoparathyroidism/ Hypocalcemia/ Tetany 1. DOC: Levothyroxine → Thyroid Hormone replacement
2. Thyroid Storm a. Taken in the MORNING/ BEFORE BREAKFAST →
3. Laryngospasm because it will cause Insomnia
4. Bleeding b. Taken on EMPTY stomach → to increase
5. Laryngeal nerve damage absorption
c. Side Effect: Symptoms of Hyperthyroidism
HYPOTHYROIDISM i. Diaphoresis
ii. Palpitations
● Number 1 cause: Hashimoto’s Thyroiditis/ Disease →
iii. Heat intolerance
autoimmune → HYPOACTIVE of Thyroid Gland →
DECREASE Thyroid Hormone
BOARD QUESTION:
● Other possible cause:
○ Thyroidectomy If a patient is taking Levothyroxine how will you know if he/she is
-

○ Anti-thyroid drugs manifesting a side or adverse effect?

○ Radiation possibility of tumor a. ↑ Weight
○ Myxedema coma commonly related to adults b. ↓ BP
● APG → TSH → TG c. ↓ RR
d. Heat Intolerance
● Problem is on the THYROID GLAND
● T3 → LOW metabolism → INCREASE body weight kasi hindi
nag buburn ng energy → ANOREXIA(loss of appetite) →
decrease peristalsis → CONSTIPATION Clinical Manifestation
● Increase cholesterol → atherosclerosis; ischemic stroke 1. Increased metabolism (HYPER)
● T4 → COLD INTOLERANCE 2. Weight loss (HYPER)
● SNS → HYPOACTIVITY → LETHARGIC → APATHETIC → 3. Amenorrhea (HYPER)
LOW v/s → MYXEDEMA COMA → puffy face 4. Hypoactivity (HYPO)
● TH will give a signal to the TSH → TSH will INCREASE 5. Tachycardia (HYPER)
6. Cold intolerance (HYPO)
7. Diarrhea (HYPER)
8. Myxedema (HYPO)
Signs and Symptoms:
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TOPRANK - ENDOCRINE and GIT

RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

9. Exophthalmos (HYPER) 5. Polyuria → FVD → INCREASE OFI

10. Anorexia (HYPO) 6. Renal Calculi → INCREASE OFI
11. Levothyroxine (HYPO)
12. Propylthiouracil (HYPER) Medication:
1. Drug of Choice: Calcitonin
a. Para ibalik ang Ca sa bones
2. IV Phosphorus
PARATHYROID GLAND 3. Alendronate (Fusomax)

Note:
● Nakasabit sa thyroid gland
● Promotes bone decalcification = sinisira niya yung buto Diuretics is hindi binibigay, but Thiazide can be just watch out for
● Releases parathyroid hormone (PTH) → Calcium in the Intake and Output
BONE==S is LOW while Calcium in the BLOOD is HIGH
○ Nililipat niya ang calcium sa blood instead na nasa
bones → WEAKENS the bones HYPOPARATHYROIDISM
● Calcitonin (is produced by TG) → HIGH Calcium in the
BONES; LOW Ca on the BLOOD → STRENGTHENS the ● Cause: Thyroidectomy → LOW PTH → INCREASE Ca in
bones the bone → DECREASE Ca in the blood
● Cacium → kabaliktaran ni Phosphorus
● Calcitonin promotes calcium from blood to the bones 1. Hypocalcemia → Hyperphosphatemia
a. Hyperactive Muscle
Characteristics if Calcium b. Tetany (intermittent muscle spasm/ twitching)
a. Inversely proportional with Phosporus c. Clinical Manifestation:
b. Neuromuscular → irritability/ excitability (inverse) i. Chvostek's sign - face/ cheeks
c. Main components of the bones ii. Trousseau’s sign - carpopedal spasm
d. In kidneys → it ATTRACTS water, and becomes d. GIT → Diarrhea
SUPERSATURATED → solid/ namumuo e. Seizure

Remember Management:
1. Hypocalcemia → HIGH Ca diet and Vitamin D
LOW Ca → INCREASE Irritability → konting stimulus mag tu-twitch a. DOC: Calcium Gluconate
→ HYPERACTIVE MUSCLE 2. HIgh phosphorus → LOW Phosphorus diet → AVOID
peanuts
HIGH Ca → LOW irritability → HYPOACTIVE MUSCLE
a. DOC: Aluminum Hydroxide
3. Diarrhea → LOW Fiber → INCREASE OFI
HYPERPARATHYROIDISM 4. Seizure precautions
a. Prevent restraining the px
● Produces tumor (e.g ectopic) b. After the seizure, position in a side-lying to prevent
● High PTH → LOW Ca (Bones) → HIGH Ca (blood) aspiration
c. Avoid putting tongue depressor kasi masisira ang
1. HIGH Ca → Hypophosphatemia oral cavity, pwede mabasag ang ngipin
○ LOW muscle irritability → HYPOACTIVE muscle
Produces tumor (e.g ectopic)
○ High PTH → LOW Ca (Bones) → HIGH Ca Medication
(blood) 1. Drug of Choice: Calcium Gluconate → can also be given
○ HIGH Ca → Hypophosphatemia as an antidote for potassium and magnesium
○ LOW muscle irritability → HYPOACTIVE → 2. Antacid: Aluminum Hydroxide (Amphogel) → Phosphate
SLOW GIT → CONSTIPATION binder

2. LOW Ca in the Bones → weak bones → bone disorder →

Clinical Manifestation:
pain, pathologic fracture, osteoporosis etc.
1. Hypocalcemia (hypopara)
2. Chvostek’s sign (hypopara)
3. Kidneys → polyuria → Fluid volume deficit
3. Diarrhea (hypopara)
Supersaturated → Renal calculi
4. Weak bones (hyperpara)
5. Calcitonin (hyperpara)
Management:
6. Polyuria (hyperpara)
1. Hypercalcemia → LOW Ca diet
7. Renal calculi (hyperpara)
a. DOV: Calcitonin
8. Aluminum hydroxide (hypopara)
2. Low phosphorus → HIGH Phosporus diet (protein and nuts)
9. Calcium gluconate (hypopara)
a. DOC: IV Phosphorus
10. Constipation (hyperpara)
3. Constipation → HIGH fiber and INCREASE OFI
4. Weak bones → protect from injury → By slowly moving the
patient → advised to DO EXERCISE ADRENAL GLANDS
a. DOC: Alendronate (Fosamax)

PASCUAL I PAULO I 3

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TOPRANK - ENDOCRINE and GIT

RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

iii. Hirsutism
Process: iv. Amennorhea
● SALT-SEX-SUGAR b. INCREASE Estrogen manifestations
● Medulla → releases catecholamines (epi and norepi) i. Common to male
● Cortex → releases steroids hormones that made up of lipids ii. Feminization
or fats (GMA) → controlled by the APG → Adrenocorticotropic iii. Gynecomastia
hormone ACTH and Melanocyte stimulating hormone iv. Genital atrophy
● ACTH → adrenal cortex → GMA v. Purple striae skin
● MSH → skin → produces Melanin
Management:
1. Glucocorticoids → cortisol → naturally released in the 1. Increase cortisol → avoid stress
MORNING → also releases when an individual is stress to 2. Hyperglycemia → since it is not dietary just Monitor the blood
provide resistance to stress → increases glucose → glucose level
decreases/ suppresses immune system → breakdown 3. High risk for infection → avoid crowded place and ill
protein and bones → osteoporosis person
2. Mineralocorticoids → aldosterone 4. Weak bones → High Ca diet
a. Sodium and water retention 5. Hypernatremia and fluid volume excess → restrict fluids
b. Potassium is decreased/ excreted 6. Hypokalemia → give high potassium diet
3. Androgen 7. Disturbed body image → depressing → can be related to
a. Related to sex hormones psychiatric illness → Allow the client to explore feelings using
b. Testosterone → later on excess testosterone will THERACOM
be converted to estrogen → hypertrophy
c. Estrogen Medication:
1. Drug of Choice: MMK → this decreases the production of
Note: steroids
a. Mitotane
Bakit sa umaga nag rerelease ang glucocorticoids? b. Metyropone
- Kasi kailangan ng energy
c. Ketoconazole
Surgery:
CUSHING’S SYNDROME
1. Adernalectomy
1. Cause: adrenal adenoma and/ or steroids therapy → a. WOF: Addison’s features
INCREASES GMA
ADDISON’S SYNDROME
● Glucocorticoids → INCREASE cortisol and glucose →
1. Caused by adrenalectomy
INSULIN is HIGH → Adipocytes (excessive glucose will be
2. Adrenal insufficiency
stored in the cells or tissues) → usually seen in the
3. Autoimmune
PERIPHERAL part of the body
4. Decrease GMA
a. FULL MOON FACE → observed on the dorso
cervical/ nape
● APG → ACTH and MSH
b. Buffalo hump
● ACTH → Adrenal cortex → GMA
c. Central/truncal obesity
○ In Addison's sira ang adrenal cortex kaya babagsak
d. Immunity is low → high risk for infection
ang GMA
e. Breakdown of protein → skin and extremities
● MSH → skin → melanin
i. Legs is thin
○ Increase ang MSH → too much melatonin →
ii. Fragile skin → easy bruising
Bronze/tan skin (hyperpigmentation) pati gums
iii. Striae (stretchmarks)
maitim
f. Breakdown of the bones → weak bones
i. Osteoporosis
● Glucocorticoids → decrease cortisol → decrease glucose
● Mineralocorticoids
→ decrease resistance to stress.
a. Aldosterone
● Mineralocorticoids → aldosterone
i. Sodium and water retention
○ Sodium and water depleted
■ WOF: distended neck vein,
■ WOF: flat neck veins, dry skin,
edema, crackles → hyper-
dehydration, poor skin turgor, low body
tachy-tachy, weight gain
weight, hypo-tachy-tachy
ii. Potassium excretion
○ Potassium is retained = hyperkalemia
iii.
● Androgen
● Androgen
○ Commonly affected is female
a. INCREASE Testosterone manifestations
■ Hair loss
i. Common to female
■ Menstrual changes
ii. Viritlization
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TOPRANK - ENDOCRINE and GIT

RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

13. Moon face (C)

Note: 14. Hypertension (C)
15. Virilization (C)
ALL are DECREASE except ACTH, Bronze-skin, and Potassium 16. Hypernatremia (C)
17. Bronze skin (A)

Sign and Symptoms:

1. Decreased BP
2. Weight loss ADH/ VASOPRESSIN
3. Decreased sugar
4. Decreased energy
5. Alopecia ● Problem is DECREASED ang fluids → ADH is ni-rerelease sa
6. Salt cravings Posterior Pituitary Gland → ADH/ Vasopressin → Kidneys →
fluid retention/ reabsorption → decreased urine output
Management: ● Syndrome of Inappropriate ADH Secretion
1. Hypoglycemia → Monitor BG
2. Low resistance to stress → avoid stress
3. Hyponatremia and fluid volume deficit → INCREASE OFI or SYNDROME OF INAPPROPRIATE ADH SECRETION (SIADH)
do Water replacement
● “Sobra” → ADH → WATER → and Urine Specific Gravity
4. Hyperkalemia → Low potassium diet → High Sodium
● Cause:
a. Tumor → INCREASE ADH
Medication:
b. Kidneys → FLUID RETENTION → Fluid volume
1. Drug of Choice: Corticosteroids “sone” medications
excess →Sodium depleted → Delusional
a. Fludrocortisone
Hyponatremia → Cerebral Edema
b. Take it lifetime
c. Oliguria → urine specific gravity → if konti urine
c. WOF: GI irritant
output → high → concentrated → dark urine
i. Should be taken WITH MEALS
- Normal urine SG: 1.010-1.020
ii. To mimic the natural disease it should be
● Low sodium → low concentration of the blood → fluids in the
taken in the MORNING with breakfast
blood will go to the cell → swell → cellular edema
d. WOF: Cushing’s features, high risk for infection
● WOF: Fluid Volume Excess

Management:
ADDISONIAN’S CRISIS
1. For increased ADH → Drug of Choice: Demeclocycline
● Severe form of Addison’s syndrome a. Blocks ADH
● Happens if mali ang pag inom ng steroids 2. For FVE
a. Avoid abruptly stopping taking steroids because it a. Monitor daily weight 1kg is to 1L (1:1)
may cause addisonian’s crisis b. Restrict fluids
● For example, 3. Oliguria → Drug of Choice: Diuresis
a. If nag take ng steroids (Exogenous) → later on a. Except for Thiazide because it will cause
pwede pumunta sa bloodstream → adrenal cortex paradoxical or opposite effect instead of excretion
will not produce GMA (endogenous steroids) → if it will retain the water in the body
adrenal cortex stop its function → it will lead to non- b. Monitor Intake and Output
functional atrophy
b. WOF: Abdominal pain DIABETES INSIPIDUS
c. Usually caused of death →SHOCK
Types:
d. DOC: Corticosteroids via IV
1. Neurogenic/ Central Type
a. Cause:
Clinical Manifestations:
i. Trauma or Injury
1. Obese trunk (C) ii. Surgery → ADH decreases kaya
2. Thin arms and legs (C) tumataas urine output
3. Hyperkalemia (A) 2. Nephrogenic
4. Edema (C) a. Cause:
5. Decreased cortisol (A)
i. Abnormal kidney
6. Striae (C)
7. Hirsutism (C) ii. Normal ADH, pag sira ang kidney hindi
8. Hyponatremia (A) gagana ang ADH kahit normal yan →
9. Hypotension (A) POLYURIA → “dami ihi” → fluid volume
10. Buffalo hump (C) deficit → HIGH sodium → POLYDIPSIA
11. Dehydration (A) → “dami inom”
12. Hypoglycemia (A) iii. USG → low → “diluted ihi”

PASCUAL I PAULO I 5

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TOPRANK - ENDOCRINE and GIT

RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

Juvenile Onset Adult Onset

Management:
1. Neurogenic Thin Obese
A. DOC: Vasopressin (Desmopressin)
a. WOF: FVE → Water intoxication Absence of insulin Insulin resistance/ low insulin
B. Advised px to decreased fluid intake
DKA HHNS
250 mg/dL 600 mg/dL
2. Nephrogenic
a. Abnormal kidneys
Priority Nursing Diagnosis: Fluid Priority Nursing Diagnosis: Fluid
b. DOC: Volume Deficit Volume Deficit
i. Thiazide
ii. Clofibrate MGT: DIE MGT: DIE OHA
iii. Chlorpropamide Diet Diet
● Give complex carbs yung Insulin
iv. These drugs increases ADH sensitivity mga food na matagal Exercise
maging sugar (e.g. rice,
3. Fluid volume deficit grains, wheat) Oral Hypoglycemic Agents
● Good for controlling - Biguanide
a. Monitor daily weight sugar - Metformin
b. Fluid replacement Insulin - Drug of Choice - Decreases glucose
production by the liver
Exercise
4. Polyuria
● 3-5 times a week
a. Monitor I and O ● Avoid stress → increases
cortisol→ tataas ang
glucose
Clinical Manifestations:
● Increases use of glucose
1. Fluid restriction (SIADH) so it will manifest S/Sx of
2. Fluid volume deficit (DI) Hypoglycemia → advised
3. Distended neck vein (SIADH) patient to eat complex
4. Dehydration (DI) carbs before exercising
5. Cerebral edema (SIADH)
6. Diuretics (SIADH)
7. Chlorpropamide (DI) Clinical Manifestations: Cause:
8. Dermeclycline (SIADH) - Increase serum - Stress → increase
9. Hypersecretion of ADH (SIADH) osmolarity or cortisol → increase
hyperosmolarity glucose
10. Administration of ADH (DI)
- Viscous blood → poor - Stress is at risk for:
11. Dilute urine (DI) circulation - Infection
12. Polydipsia (DI) - Hyperglycemia - Surgery
13. Administration of Thiazide diuretics (SIADH) - Metabolic acidosis - Trauma
- Kussmaul’s respiration
(compensatory Most significant V/S: Body
mechanism due to M. temperature → to check for fever
acidosis) → (deep and and possible infection
labored breathing)
PANCREAS
- Increased urinary output
- Dry mucous membranes
● Endocrine → islet of langerhans Complication:
■ Alpha - glucagon → increases glucose, - Diabetic retinopathy
acts on the liver → production of new - Nephropathy
- Neuropathy
glucose → gluconeogenesis
■ Beta - insulin → decreases glucose
■ Delta - somatostatin → decreases growth Normal ba na nag mimix ang Cells has no breakdown / ketosis
hormone and gastrin glucose kay kidney? HINDI
- Kidneys has SGLT2 Hyperosmolarity
- mas mataas kesa kay
for reabsorption of DKA
glucose Hyperglycemic
- Normal SGLT2 (200 Non-Ketotic
mg/dL) - Kasi may insulin naman
- Once na nag exceed siya
sa normal range → Syndrome
mag mimix na siya sa
urine → HHNS → cause of death
DIABETES MELLITUS
GLYCOSURIA → DEHYDRATION
attracts water →
DM1 DM2 polyuria → FVD →
excessive thirst →
Insulin dependent Non-Insulin Dependent polydipsia

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TOPRANK - ENDOCRINE and GIT

RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

- Coke
- Pag walang insulin → - Cake
cell → starvation → 2. Recheck blood glucose after 15 mins
polyphagia → - 1st-3rd: 15-30g
breakdown of protein - 4th time → give glucagon
→ thin 3. If unconscious, give glucagon via IM, Subq or IV
- Fats → increases - Glucagon increases sugar → fast-acting
ketones → DKA →
Metabolic Acidosis
(low ph, low HCO3)
Drugs acts by decreasing the amount of glucose produced by the liver
- In the lungs → fruity
odor = Biguanides
- In the kidneys →
ketonuria
- In the brain →
decease LOC

DKA HHNS

Cause:
- Stress → increase cortisol → increase glucose
- Stress is at risk for:
- Infection
- Surgery
- Trauma

Most significant V/S: Body temperature → to check for fever and possible
infection

MGT:
1. IV NSS → Increase circulation
2. IV Regular insulin (shoRt-acting)

BOARD QUESTION:

The client has DKA, which is your priority nursing intervention?

a. ECG
b. D5W - WRONG, kasi may dextrose yan, eh hyperglycemia
na nga ang problem
c. IV Regular insulin
d. NPH

HYPOGLYCEMIA

- <60mg/dL
Clinical Manifestations:
- “Hunger”
- S/Sx:
- SNS → Damaged nerves
- “Diaphoresis”
- Tachycardia/ Palpitations
- Tremors
- Light headedness
- Weakness
- Decrease LOC → COMA
Management:
1. 15 - 15 rule for 3X
- Give 15-30g of of simple carbohydrates
- Non-fat milk
- Candy
- Lifesaver

PASCUAL I PAULO I 7

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TOPRANK - ENDOCRINE and GIT

RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

Medications:
1. AVOID:
GASTROINTESTINAL DISORDERS
a. Anticholinergic/ Antispasmodic
i. Decreases the activity of GIT →
- Esophagus decrease motility → slow down the
- Lower esophageal sphincter (LES)→ prevents back flow digestion of food
- Stomach → digestion/ dilution → Hcl and Pepsin b. NSAID/ Aspirin
- Pylorus → pyloric sphincter i. GI irritants
ii. Anti-inflammatory or Anti-prostaglandin
- If may food na sa stomach → LES nag ko-close → pyloric iii. Will increase Hcl → backflow
sphincter close to allow digestion for about 2-3 hours 2. Antacids
- Pag bumukas na ang pyloric sphincter → gastric 3. H2 blocker
emptying 4. Proton Pump Inhibitor
- Carbs → fast digestion a. Given 1-3 weeks
- Fat and Protein → slow digestion 5. Prokinetics
a. Increases motility
GASTROESOPHAGEAL REFLUX DISEASE (GERD) b. Anti-emetic : Metoclopramide

Weak LES → backflow → gastric contents → esophagus Surgery:

1. Fundoplication
Causes: a. The fundus is wrapped around the LES
5C AFPS
1. Coffee HIATAL HERNIA
2. Citrus Signs and Symptoms and Management → REFER TO GERD
3. Cigarette - Because of the same clinical manifestation
4. Carbonated
5. Chocolate
6. Alcohol PEPTIC ULCER
7. Fatty foods
8. Peppermint 1. H. Pylori → nakukuha sa raw meat
9. Spicy 2. Increase Hcl and Pepsin
3. Decreases Mucus → decrease protection
Sign and Symptoms:
- Pyrosis (heartburn) Additional:
● Burning sensation in the chest after eating Burns → fluid shifting → decrease blood volume → hypoactive
(nagbacklow ang Hcl) stomach → decrease mucus → magkakaroon ng ulceration →
- Dyspepsia (indigestion) Curling’s ulcer
● Nausea and vomiting - Kaya wag mag taka if ginagamitan ng medication na pang
● Saliva increase peptic ulcer ang burns
- Dysphagia (difficulty in swallowing)
- Odynophagia (painful swallowing)
Cause:
Management: 1. Stress
“FOOD SHOULD GO DOWN” a. Increase ang acetylcholine (PNS) → High Hcl
1. Upright position after eating 2. Cigarette smoking
a. Head of bed elevated (30 degrees) 3. Alcohol
b. Turn to left side 4. Caffeine
2. High carbohydrates diet 5. Aspirin and NSAID
3. High fiber diet 6. Zollinger-Ellison Syndrome
a. Increases the feeling of fullness (satiety) which a. A pancreatic tumor that releases hormone →
prevents overeating increases gastin → increases Hcl0
4. Small frequent feeing 7. Irregular and hurried meals
a. 6-10 meals/day a. Decrease chewing → increase Hcl
5. Avoid activity that increases intra-abdominal pressure by: 8. Type a personality
a. Use loose clothing a. Workaholic → increase stress
b. Decreased body weight 9. Type o blood
c. Avoid lifting objects a. Increase pepsin
d. Avoid bending below the waist after eating 10. Genetics
e. Avoid straining a. Increase parietal → increase Hcl

PASCUAL I PAULO I 8

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RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

Medications: b. Given at bedtime → decreases HCl

1. DOC: Metronidazole c. Ranitidine
a. DO NOT TAKE alcohol → will cause disulfiram like 5. PPI
reaction a. “prazole”
b. Taken before meal → decreases Hcl
6. Cytoprotective drugs
GASTRIC ULCER DUODENAL ULCER
a. “Protect fate”
(Most Common)
b. Sucralate
Poor man’s or laborer’s ulcer Executive ulcer c. Taken before meal
- Low food intake - Increase stress d. Serves as a barrier
7. Prostaglandins
20% incidence 80% incidence a. Misoprostol (Cytotec)
i. Two routes:
Common in people 50 yrs old and Common in people 25-50 y/o
1. Oral
above - Career stage - increase
- low food intake stress 2. Intra-vagina
b. Decreases Hcl and increases mucus
Malnourished Well nourished c. Promotes inflammation and uterine contraction
- Weight loss contraindicated to pregnant women
8. Hormone
Pain - ½ 1 hour after meal Pain - 2-3 hours after meal
- w/food - Empty a. Octreotide
- Open ang sphincter → b. Somatostatin → decreases gastin → decreases
baba ang food → Hcl
gagasgas → tatama sa
ulcer
Surgery:
Pain is triggered by food intake Pain is relieved by food intake 1. Vagotomy → decreased Hcl production
a. Surgical division of the vagus nerve to eliminate the
Pain relieved by vomiting Pain is common at night vagal impulses that stimulate hydrochloric acid
- empty secretion in the stomach
2. Gastrectomy → decreases parietal cell → low Hcl; to
Nausea, vomiting and hematemesis Melena prevent perforation
a. Total
i. Removal of the stomach, with attachment
Management: of the esophagus to the jejunum or
1. Monitor for signs of bleeding duodenum
a. Hematemesis b. Subtotal/ antrectomy
b. Melena i. Removal of lower half or ⅔ of the
2. Diet stomach
a. AVOID Milk 3. Anastomosis
b. SFF a. Billroth I - gastroduodenostomy
c. INCREASE chewing i. Partial gastrectomy, with remaining
i. Slowly and thoroughly segment anastomosed to the duodenum
d. AS TOLERATED food b. Billroth II - gastrojejunostomy
i. BLAND diet is for GASTRITIS i. Partial gastrectomy, with remaining
3. Avoid causes/ factors segment anastomosed to the jejunum
4. Stress reduction

Medications: DUMPING SYNDROME

1. Antacids
a. Neutralize acid at around 5 pH RAPID gastric emptying → food will not be diluted evenly → high
b. Given 1-2 hours after meal concentration of food → bababa sa small intestine → hyperglycemia →
c. Aluminum hydroxide increase insulin → decreases glucose → post-prandial hypoglycemia
i. SE: ALA tae (constipation) (after eating hypogly)
d. Magnesium hydroxide - Blood will have decrease concentration → decrease fluids →
i. SE: MAG tae (diarrhea) shock-like manifestation
e. Aluminum and Magnesium can be taken together
2. Calcium Carbonate (Maalox/Tums)
3. Sodium Bicarbonate Signs and Symptoms:
a. SE: Metabolic Alkalosis 1. Increase fluid
4. Histamine 2 receptor blockers a. → shock
a. “Tidine” b. hypo-tachy-tachy

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RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

2. Diarrhea → Increase borborygmi → crumpy

diarrhea
3. Distended abdomen
4. Cyanosis
5. Decreased LOC Management: for constipation Management:
6. Hypoglycemia
1. High Fiber diet Acute phase: “Painful episodes”
7. Moist skin 2. Increase Fluid intake Any acute phase → rest the bowel
8. syncope 3. Medication → decrease peristalsis
9. dizziness a. Laxative
1. Low Fiber
2. Without Oral intake
Management: a. NPO
“FOOD SHOULD STAY) b. IV fluids only
3. Activity
1. Diet
a. Bed rest
a. High Protein 4. Medication
b. High Fat a. Antispasmodi
c. High Fiber c/
anticholinergi
i. Oatmeal c
d. Low Carbohydrate 5. Monitor for perforation
e. SFF Meals a. Peritonitis
(rigid board-
f. Avoid Fluids during meals like abdomen)
i. Drink fluids in between meals b. Paralytic ileus
g. AVOID Salt, sugar,milk, soda and caffeine (absence of
bowel sound)
i. Will cause fluid shifting
2. Position
a. Lie down → turn to left
3. Medication APPENDICITIS
a. Give Anticholinergic/antispasmodic
Appendix is located on the lower right side of the abdomen (RLQ)

DIVERTICULOSIS and DIVERTICULITIS Most Common Cause: Fecalith → obstruction → injury → infection →
inflammation

DIVERTICULOSIS DIVERTICULITIS
Anything that increases peristalsis → rupture → peritonitis → diffuse
pain
Outpouching of intestinal mucosa Inflammation of 1 or more diverticula

Common site: Sigmoid Colon Remember that a sudden relief of pain means rupture

Clinical Manifestation:
Cause: Low fiber diet → can lead to Cause: Accumulation of fecal
constipation material 1. McBurney’s Point
a. Started in the RLQ → pupuntang umbilical →
Increase pressure → weakening → tapos bababa sa iliac spine
outpouching in the sigmoid colon →
pag napasukan ng tubig → 2. Rovsing’s sign
obstruction → injury → infection and a. Nag palpate sa LLQ → tapos yung pain
inflammation → diverticulitis mararamdaman sa RLQ
3. Dunphy’s sign
Clinical manifestation: Clinical manifestation: a. Once umubo nagkakaroon ng pain
Asymptomatic Inflammation 4. Blumberg’s sign
- Abdominal pain a. Rebound tenderness
- Crumpy pain on the LLQ b. Sumasakit upon release/ removal of pressure
→ worsen when straining
5. Increase WBC
Infection 6. Decreases bowel sound
- Fever 7. Psoas sign
- Increase WBC
a. Naka Left side lying → fiflex backward and leg →
Injury will trigger pain → IlioPsoas
- Blood in stool 8. Obturator sign
- Can be seen in the occult
a. Naka supine → fiflex ang right knee at 90 degrees
blood test
→ will trigger pain kasi tatamas ang obturator
Obstruction (increase gas) muscle sa appendix
- “kinakabag”
- Bloating and flatulence
- Chronic constipation Management: “decrease peristalsis”
with episodes of 1. Avoid oral intake

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RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

a. NPO ii. HIGH ESTROGEN → GYNECOMASTIA

2. IV fluids only → ATROPHY OF GENITALS
3. Bed rest iii. Vasodilation → palmar erythema →
4. Cold compress SPIDER ANGIOMA
5. Avoid analgesic
6. Avoid anything that may increase peristalsis 4. Low albumin → mawawala ang oncotic pressure → matitira si
a. Laxatives hydrostatic pressure → moving out ng water → ascites and
b. Enema edema
c. Heat application
5. Hemoglobin → increase bilirubin → skin will become jaundice
Surgery and is accompanied by pruritus
1. Appendectomy
a. Teach deep breathing and coughing In kidneys → dark urine
i. Advised to do it by splinting
1. Lalagay ng pillow or towel sa No emulsification of fats → stool → steatorrhea
abdomen - Stool will become clay-colored or pale
b. Encourage to ambulate
i. To prevent DVT 6. Protein → amino acid → will become ammonia → ammonia
c. WOF: Evisceration will go to the liver → will convert it to urea → pupunta sa BUN
i. Lumabas/ protrusion of intestines → excreted sa kidneys
1. Lagyan ng moist gauze
dressing, then report Ammonia → neurotoxic → hepatic encephalopathy
d. WOF: Dehiscence
i. Bumukas yung wound a. Asterixis
i. Flapping tremors
b. Decrease LOC
LIVER CIRRHOSIS c. Constructional apraxia
i. Inability to make 3d shapes
The only organ na kapag tinapyas mo, bumabalik din, pero kapag may d. Fetor hepaticus
repeated injury → fibrosis (Scar) → loss of function of the liver i. Bad breath

Types: 7. Portal circulation

1. Laennec’s cirrhosis (most common)
a. Caused by alcohol Heart supplies blood to the GIT → liver → back to the heart
b. Fatty liver → kidneys
2. Post necrotic
a. Caused by Hepa B and C a. Liver → once nasira → fibrosis → will cause
b. Hepatotoxin obstruction → increase blood → liver will become
3. Biliary cirrhosis enlarged (hepatomegaly) → portal hypertension
a. Caused by obstruction (gallstones)
4. Cardiac cirrhosis b. Decrease blood flow sa heart and kidneys →
a. Caused by Right-sided heart failure hepatorenal syndrome → renal failure

Clinical Manifestations: c. GIT

1. Metabolism of nutrients i. Ascites
a. In liver cirrhosis, patient is MALNOURISHED → ii. Caput medusa
ANOREXIA and MALAISE iii. Hemorrhoids
2. Kupffer cell → phagocytosis → immune system iv. Esophageal varices
a. Sirang kupffer cell → low immune system v.
3. Removal of GMA
a. Glucocorticoids → cortisol → glucose
i. In liver cirrhosis, HYPERGLYCEMIA SUMMARY OF CLINICAL MANIFESTATION:
1. Anorexia
b. Mineralcorticoids → aldosterone → Na and H20
2. Body malaise
retention, potassium secretion 3. High risk for infection
i. FLUID VOLUME EXCESS → EDEMA 4. Hyperglycema
ii. LOW POTASSIUM 5. Edema
c. Androgen → testosterone and estrogen → could 6. Ascites
lead to vasodilation 7. Sodium and water retention
i. HIGH TESTOSTERONE → HIRSUTISM 8. Hypokalemia
9. Hirsutism
→ AMENORRHEA

PASCUAL I PAULO I 11

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RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

1. Senstaken tube
10. Amenorrhea
11. Gynecomastia
12. Genital atrophy Medications:
13. Spider angioma 1. Spironolactone
14. Steatorrhea a. Tx for ascites and edema
15. Jaundice with pruritus 2. IV albumin
16. Dark urine a. To increase oncotic pressure
17. Clay-colored stool or pale 3. Lactulose
18. Asterixis
a. To increase defecation
19. Decrease LOC
20. Constructional apraxia 4. Neomycin
21. Fetor hepaticus
22. Portal hypertension
23. Caput medisae CHOLECYSTITIS and CHOLELITHIASIS
24. Hemorrhoids
25. Esophageal varices
26. Renal failure CHOLECYSTITIS CHOLELITHIASIS

Types: Caused by supersaturation of urine

Laboratory Test: 1. Calculus 1. Cholesterol (most
1. Albumin a. Caused by common)
2. Bilirubin (hemolysis)
a. LOW gallstones
b. Normal: 3.5-5 g/dL (most Gallstones → obstruction →
2. PTT common) distention → inflammation →
a. Prolonged
2. Acalculous trapped bile → indigestion of fats
a. Caused by
b. Normal: 25-35 sec/ 11-14sec/ .8-.12 surgery Factors: 5Fs
3. Serum bilirubin trauma or 1. Fair
a. High 2. fat
infection
3. Female
b. Normal: .03-1.9 mg/dL 4. Fertile
4. AST/SGOT 5. Forty
a. High
b. Normal: 10-40 u/L
5. ALT/SGPT Clinical manifestations
a. High
b. Normal: 7-56 u/L Inflammation
a. Biliary colic = severe pain
6. Bilirubin b. Murphy’s sign = naka supine position si client tapos ilalagay ang
a. Low kamay ng nag assess sa hepatic margin located sa baba ng ribs
→ sabihan si patient na mag inhale → it will trigger pain
c. Abdominal pain = located on the RUQ
Management:
d. Rebound tenderness
1. High calorie intake e. Radiating on the right shoulder
a. High carbs f. Usually after a fatty or heavy meal
2. Low protein diet
Indigestion
a. To prevent high ammonia a. Nausea and vomiting
3. Low fat diet b. Belching
4. Restrict sodium and fluids c. Flatulence
5. Hepatic encephalopathy Obstruction
a. Asterixis a. Skin
i. Extend the arms i. jaundice
b. Stool
b. Constructional apraxia i. pale/ clay
c. Decrease LOC ii. steatorrhea
i. Avoid sedatives c. Urine
dark
d. Fetor hepaticus d. Vitamin deficiency
6. Esophageal varices i. Vitamin K high risk for bleeding
a. Avoid increase pressure to prevent rupture Infecrion
a. Fever
i. Avoid
i. Insensible fluid loss
1. spicy foods b. Dehydration
2. Straining
MGT:
1. Acute phase “painful episode → need to decrease activity of GIT
a. Oral intake
i. NPO
b. Fluids
i. IV fluids only
Surgery:

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RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

b.
Weight loss
c. N and V
i. NGT for decompression Cullen’s amd Grey turner’s sign
c.
d. Medication i. Cullens
i. Anticholinergic 1. Ecchymosis at the umbiliCus
ii. Antiemetics
2. Diet or periumbilical area
a. Fat ii. Grey Turner’s
i. Low fat 1. “Turn” back
b. Meal
i. SFF
2. Ecchymosis located at the
c. Avoid Gas forming foods flank or back
i. Gulay na nasa ground (kamate, egg, Laboratory Findings:
patata, cabbage, cauliflower, broccoli)
1. Increase WBC
3. Medications
a. Ursodeoxycholic acid (UCDA) 2. Increase Glucose can lead to DM
i. Binigay pag mild pa lang yung sakit to 3. High Bilirubin
dissolve the stones or kaya pa tunawin ang
4. High Alkaline phosphate
stone
b. Chenodeoxycholic acid (chenodiol or CDCA) 5. High Serum and urinary amylase
6. High Serum lipase
a. These two are best parameters for recovery
Surgery:
1. Cholecystectomy
2. Choledeocholithotomy Management:
a. Removal of stone in the common bile duct ACUTE PHASE
3. T-tube
a. Position in a semi-fowlers 1. Oral intake
i. Need naka elevate to increase drainage a. NPO
b. Drainage system 2. IV Fluids
i. Below
ii. Color 3. Nutrition
1. First 24 hours red color a. Should be TPN
2. After 24 hours, brown or green 4. NGT
color
iii. Amount
a. Not use for nutrition, but for LAVAGE → removal of
1. <500ml a day Hcl
2. If nag exceed, report
c. Irrigation, aspiration and clamping Medication:
i. Dapat w/ prescription
d. Bago kumain si patient 1. H2 receptor blocker
i. Oorder muna dapat ni doc na i-clamp ang 2. PPI
tube a. These two decreases Hcl → decrease pancreatic
ii. WOF:abdominal pain and N and V
enzyme
1. If na experience ni client ito,
unclamp the tube kasi sign na 3. Morphine
bumabalik ang bile a. For pain
b. But avoid DEMEROL → may cause seizure
4. Anticholinergic
a. Atropine
PANCREATITIS

Cause: BOARD QUESTION:

1. Alcohol
2. Obstruction of gallstones (most common) →trapped → The patient ask you if he/she can already eat, what will be your nursing response?
pancreas → autodigestion → injury → bleeding →
inflammation Answer: HINDI PA, pwede lang once na bumaba na ang AMYLASE at LIPASE

Clinical Manifestation
1. Inflammation
a. Pain CHRONIC PANCREATITIS
i. Located on the LUQ
ii. Radiating at the back kasi ang pancreas Caused by repeated injury → healing → fibrosis → loss of function →
is located sa likod ng stomach decreases p. Enzyme and insulin
b. Aggravated by:
i. Fat Diet Clinical manifestation
ii. Alcoholic Beverage 1. Inflammation
a. Abdominal pain located on LUQ
iii. Supine Position
2. Fibrosis
c. Decrease Bowel sound
a. Mass on LUQ
d. Nausea and Vomiting b. Hypocalcemia
2. Bleeding 3. Loss of function
a. Dehydration a. Low weight

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Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

b. High bilirubin → JAUNDICE

c. Steatorrhea
d. High glucose

Management:
1. Diet
a. Bland diet
b. SFF
c. Low fat; low protein
d. High calorie intake; high carbs
2. Medications
a. Pancreatin
b. Pancrelipase
i. Pancreatic enzyme supplement
c. Insulin and OHA
i. Because blood glucose is high

PASCUAL I PAULO I 14

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RN MAY 2023: BATCH HIRAYA
Matthews 19:26 “Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”
Lecturer/s: Keith Garino

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