learning Objectives - Describe the management of patients with metabolic and endocrinal disorders. Demonstrate skills in caring for the clients with metabolic and endocrinal disorders.
Hours - 15
Teaching and Learning Activities - Lecture cum discussion Charts Simulation Clinical teaching Exposure to diagnostic procedures Videos and Films
Assessment Methods - Short answer Objective type Essay type
Content of the chapter
a) Assessment of Hepatic and biliary functions
– History
– Physical examination
– Diagnostic measures
b) Management of patients with hepatic
disorders
– Jaundice
– Hepatic cirrhosis
– Portal hypertension
– Ascites
– Hepatic Encephalopathy and coma
– Viral hepatitis
– Tumors and cyst of the liver
– Liver abscess
c) Management of patients with biliary
disorders
– Cholecystitis
– Cholelithiasis
– Choledocolithiasis
– Acute and chronic pancreatitis
– Cancer of pancreas
d) Assessment of Endocrinal function
– History
– Physical examination
– Diagnostic evaluation
c) Management of endocrinal disorders
– Pituitary disorders
– Thyroid disorders
• Hyperthyroidism
• Hypothyroidism
• Thyroid tumors
• Goiter
– Parathyroid disorders
– Pancreas disorder
• Diabetes mellitus
– Adrenal disorders
• Pheochromocytoma
• Addison’s disease
• Cushing’s syndrome
– Tumors of the endocrine glands
f) Alternate therapies
g) Drugs used in treatment of metabolic and
Endocrine disorder
Nursing Management of Patients with Metabolic and Endocrinal Disorders
Metabolic and endocrinal disorders result from hormonal imbalance and impaired metabolism, affecting growth, energy balance and organ function. Nursing care focuses on assessment, early detection, supportive management, prevention of complications and patient education.
a) Assessment of Hepatic and Biliary Functions
1. History
- Jaundice, itching, abdominal pain
- Nausea, vomiting, anorexia
- Alcohol intake and drug history
- Previous liver disease or hepatitis
- Family history of liver disorders
- Clay-colored stool, dark urine
2. Physical Examination
- Inspection:
- Jaundice of skin and sclera
- Abdominal distension
- Spider nevi, palmar erythema
- Palpation:
- Hepatomegaly
- Splenomegaly
- Ascites
- Percussion:
- Liver span
- Neurological signs:
- Flapping tremor (asterixis)
3. Diagnostic Measures
- Liver function tests (LFT)
- Serum bilirubin
- PT/INR
- Ultrasound abdomen
- CT/MRI
- Liver biopsy
- Viral markers (HBsAg, Anti-HCV)
b) Management of Patients with Hepatic Disorders
1. Jaundice
- Treat underlying cause
- High-carbohydrate, low-fat diet
- Monitor LFTs
- Skin care for itching
2. Hepatic Cirrhosis
- Low-sodium diet
- Avoid alcohol
- Vitamin supplementation
- Monitor bleeding tendency
3. Portal Hypertension
- Beta blockers as prescribed
- Monitor for variceal bleeding
- Prepare for endoscopic procedures
4. Ascites
- Salt restriction
- Diuretics
- Abdominal girth measurement
- Paracentesis care
5. Hepatic Encephalopathy & Coma
- Reduce protein intake
- Administer lactulose
- Maintain airway
- Monitor level of consciousness
6. Viral Hepatitis
- Bed rest
- Adequate nutrition
- Infection control
- Patient education
7. Liver Tumors / Cysts / Abscess
- Antibiotics
- Drainage if required
- Pre- and post-operative care
- Pain management
c) Management of Patients with Biliary Disorders
Cholecystitis / Cholelithiasis / Choledocholithiasis
- NPO during acute attack
- Pain management
- Antibiotics
- Pre- and post-cholecystectomy care
Pancreatitis (Acute & Chronic)
- NPO and IV fluids
- Pain relief
- Monitor electrolytes
- Enzyme replacement (chronic)
Cancer of Pancreas
- Pain management
- Nutritional support
- Psychological care
d) Assessment of Endocrinal Function
1. History
- Weight changes
- Heat or cold intolerance
- Polyuria, polydipsia
- Menstrual irregularities
- Fatigue and weakness
2. Physical Examination
- Body weight and height
- Skin and hair changes
- Thyroid enlargement
- Blood pressure and pulse
- Signs of hormonal imbalance
3. Diagnostic Evaluation
- Hormonal assays
- Blood glucose levels
- Thyroid function tests
- Imaging (CT, MRI)
- Stimulation and suppression tests
e) Management of Endocrinal Disorders
Pituitary Disorders
- Hormone replacement
- Post-hypophysectomy care
- Monitor fluid balance
Thyroid Disorders
Hyperthyroidism
- High-calorie diet
- Beta blockers
- Anti-thyroid drugs
Hypothyroidism
- Thyroxine replacement
- Warm environment
- Monitor weight
Goiter / Thyroid Tumors
- Iodine supplementation
- Pre- and post-thyroidectomy care
Parathyroid Disorders
- Monitor calcium levels
- Treat hypo/hypercalcemia
- Vitamin D supplementation
Pancreatic Disorder – Diabetes Mellitus
- Blood glucose monitoring
- Insulin / oral hypoglycemics
- Diet and exercise education
- Prevention of complications
Adrenal Disorders
Pheochromocytoma
- BP monitoring
- Pre-operative care
Addison’s Disease
- Steroid replacement
- Prevent adrenal crisis
Cushing’s Syndrome
- Monitor BP and glucose
- Skin care
- Infection prevention
Tumors of Endocrine Glands
- Surgical preparation
- Hormonal therapy
- Psychological support
f) Alternate Therapies
- Diet modification
- Yoga and stress management
- Lifestyle changes
- Herbal therapy (with medical advice)
g) Drugs Used in Metabolic and Endocrine Disorders
- Hepatic: Lactulose, Ursodeoxycholic acid
- Diuretics: Spironolactone, Furosemide
- Antidiabetics: Insulin, Metformin
- Thyroid drugs: Carbimazole, Levothyroxine
- Steroids: Hydrocortisone, Prednisolone
- Calcium & Vitamin D
- Beta blockers: Propranolol
Conclusion
Nursing management of metabolic and endocrinal disorders emphasizes early assessment, hormonal balance, nutritional support, patient education and prevention of complications. Effective nursing care improves quality of life and long-term outcomes.