med surg

• hyperpituitarism
• atherosclerosis
• gigantism
• acromegaly
• prolactinemia
• hypopituitarism
• dwarfism
• panhypopituitarism

• excess production of one or more
• gh, prolactin, fsh, lh, acth

overproduction of gh, increased gh elevates free fatty acids in bldstream which can stimulate the development of atherosclerosis which leads to cad and cvd. also antagonizes insulin and interferes w its effects causing hyperglycemia and dm

increased gh occurs in early childhood or puberty while lone bones are still growing. before epiphyseal plates close the diaphysis or long long shaft of the bone continue to grow to great lengths when stimulated by excess gh. reach hts of to 8 ft and wts over 300#. mult health probs, die early

incr gh have pit macroadenomas. symptoms appear in 4th or 5th decade of life. excess gh production occurs after epiphyseal closure preventing longitudinal growth of bones, instead bones incr in thickness and width. affects cardiovascular, digestive, nerv, and genitourinary systems

incr prolactin causes amenorrhea, decr vaginal lube impotence and decr libido in men, depression, anx, vision loss

decr gh

attainment of max ht that is usually 40% below normal. shorter life by 20y

growth has been completed and some pathological process impairs the pit function. causes sheehan syndrome, tumor of pit, cranial tumors impinging of pit, chronic recurrent infections, total or subtotal destruciton of pit, suppression of pit tropic hormones. decr muscle and organ size due to decr gh. absence of scth affects ability to cope w stress which affects ability to metabolize glucose and hypoglycemia may result

• microvascular changes
• retinopathy
• macular edema
• nephropathy
• atherosclerosis
• neuropathy
• foot complications

pathological changes to nerve tis

• mono
• poly
• auto

• single nerve/groups
• inadequate bld supplyu

• sensory and autonomic nerves
• both legs pain

• sympathetic and parasumpathetic nerv sys
• pupillary response

• 15-30
• 30-90
• 3-5

• 30-1
• 2-4
• 5-8

• 1-2
• 4-10
• 18-24

• 1-4
• minimal
• up to 24 h

• lispro Humalog
• aspart Novolog
• glulisine Apidra

• Regular
• HumulinR
• NovolinR
• ReliOnR

• NPH
• HumulinN
• NovolinN
• ReliOnN

• glargine Lantus
• detemir Levemir

Lantus and levemir

Intermediate NPH

• small hemorrhages and aneurysms in retina
• hard lipid and protein exudates leak from bld vessels
• infarcted nerve fibers
• changes retinal veins

• growth of abnormal caps on retinal and optic disk
• fragile vessels penetrate vitreous humor and rupture
• cloudy and lose vision
• bld reabsorbed but scars causing traction on retina and detaches

• edema of macula
• loss of central vision
• floaters cobwebs
• no warning signs

nephropathy

effects peripheral, carotid, cerebral, and coronary bld vessels

• diabetes insipidous
• type 1 dm
• type 2 dm
• gestational

• inherited
• renal tubes dont reabsorb h2o

defect in production/secretion adh

serum osmololity decr = decr adh secretion

chronic impaired metabolism and vascular and neurologic complications

• absence of endogenous insulin
• autoimmune/virus

inadequae endogenous insulin and bds ability to use it

• sx equip[ment
• laryngoscope
• ett
• o2
• emergency trach tray

• incr cal, vit, min
• in bw snacks and supplements
• additional fluids

• reduced cal
• balanced diet

• monitor wt
• pleasent atmosphere

• incr prot, low carb
• salt ok
• fd preferences
• atmosphere
• rest periods
• freq snacks