ENDO Flashcards
In patients with Endocrine disorders, what signs and symptoms should you look for during the physical assessment?
General changes in energy levels and fatigue (hyperactive or lethargic?) Heat and cold intolerance, Changes in weight, Fluid imbalances, Electrolyte changes, Physical appearance, Cardiovascular status (vital signs), Sexual function, sex characteristics
For patients with Endocrine disorders, you should examine for the following?
Prominent forehead, Prominent jaw, Round or puffy face, Dull or flat expression, Exophthalmos, Vitiligo, Striae, Hirsutism
Exophthalmos is a classic symptom of hypothyroidism?
False. Exophthalmos is a classic sign of Hyperthyroidism.
What reason do patients with Endocrine disorders have for seeking healthcare?
Energy levels have changed, elimination patterns have changed, they’ve experienced a change in sexual and reproductive functions, their physical appearance has changed.
True or False. Endocrine glands can be palpated?
True. The thyroids and testes can and should be palpated during assessment.
Why is it important to assess the client’s coping skills for Endocrine dysfunction?
Because a lot of hormonal changes make patients feel like they’re not themselves (moody, irritable, angry). As nurses we must evaluate how the patient feels about these behavioral changes and determine if a referral to social service may be required.
When palpating the thyroid glands, what are you feeling for?
Bumps, irregular edges, enlargement, shrinkage.
What diagnostic test are used to identify Endocrine disorders?
Blood tests (hormone levels, antibodies, blood glucose), Radioimmunoassay, Urine tests (Free catecholamines, Ketones), Biopsies, CT, MRI.
What laboratory values would you expect to see in a patient with HYPERTHYROIDISM?
Elevated serum thyroid antibodies, Increased T3, Increased T4, Decreased TSH.
What laboratory values would you expect to see in a patient with HYPOTHYROIDISM?
Decreased T3, Decreased T4, Increased TSH.
What is a goiter? Who gets them?
A goiter describes an enlargement of thyroid gland. It may be present in patients with hyperthyroidism or hypothyroidism.
Hyperthyroidism
Increases metabolic rate, increased hormone. Caused by excessive secretion of TSH (hypothalamus), excessive T3 and T4, or when you have a brain disorder that’s causing you to produce too much TSH (stimulating hormone).
Hypothyroidism
Decreased metabolic rate, decreased hormone. Low TSH, Low T3 and T4
Nursing problems that can occur in patients with severe HYPERTHYROIDISM
Nutritional problems because of increased metabolism, coping, cardiac perfusion (elevated BP and HR all the time), temperature (intolerance to heat), thyroid storm.
What is thyroid storm?
An endocrine emergency and life- threatening condition which describes an extreme state of hyperthyroidism. It leads to extreme hyperthermia (102 to 106F), tachycardia, agitation, seizures
What are the general clinical manifestations of HYPERTHYROIDISM?
Emotional lability, agitation, exophthalmos, increased reflexes, tachycardia, diarrhea, muscle weakness, fatigue, flushed skin, heat intolerance, hyperthermia, goiter, weight loss, diaphoresis. (hint, everything is elevated except weight).
What are the general clinical manifestations of HYPOTHYROIDISM?
Lethargy, memory impairment, confusion, decreased reflexes, periorbital edema, hypotension, bradycardia, constipation, muscle weakness, goiter, edema, weight gain, hypothermia, cold intolerance. (hint: everything is decreased except weight and fluid volum
True or False. Auscultation is used to establish baseline vital signs and to assess cardiac rate and rhythm?
True.
What are the biggest postoperative concerns following a thyroidectomy?
Risk of laryngeal nerve damage, bleeding, hemorrhage, aspiration, loss of gag reflex, loss of cough reflex, respiratory distress, hypocalcemia, tetany (positive Chvostek’s and Trousseau’s signs), and thyroid storm (thyroid crisis).
What should be at the bedside during and after a thyroidectomy?
Trach tray and injectable calcium, in case the patient goes into tetany.
Why are we worried about Hypocalcemia?
PARATHYROIDS keep calcium up, not thyroids. Parathyroid’s are often damaged during a thyroidectomy and if you don’t have parathyroid, you’ll be hypocalcemic.
Hyperthyroid treatment options include?
Radioactive IODINE therapy and surgery
What are priority nursing diagnoses for HYPERTHYROID disorders?
Activity intolerance, imbalanced nutrition (less than), hyperthermia, risk for injury
What are the priority nursing diagnoses for HYPOTHYROID disorders?
Decreased cardiac output, ineffective breathing pattern, disturbed thought process, hypothermia, risk for injury
Identify 2 interventions for decreased Cardiac Output?
Monitor circulatory status, monitor for signs of inadequate tissue oxygenation, monitor for changes in mental status, monitor fluid status and heart rate, administer oxygen or mechanical ventilation, as approp.
Identify 3 interventions for Ineffective Breathing Pattern?
Observe and record rate and depth of respirations, Auscultate the lungs, Assess for respiratory distress, Assess the client receiving sedation for respiratory adequacy.
Cyanosis, coughing, and frothy sputum production are all signs of what?
Respiratory distress
Identify 3 interventions for Disturbed Thought Processes
Assess lethargy, drowsiness, memory deficit, poor attention span, and difficulty communicating (these problems should decrease with thyroid hormone treatment), Provide a safe environment, Provide family teaching.
This life- threatening condition results from extreme or prolonged HYPOTHYROIDISM. It is characterized by a severe hypometabolic state: coma, respiratory failure, hypotension, hyponatremia, hypothermia, hypoglycemia, bradycardia
Myxedema Coma
What Antithyroid medications would you expect a patient with HYPERTHYROIDISM to have a prescription for?
Methimazole (Tapazole) and Propylthiouracil (PTU, Propacil)
In addition to Antithyroid medications, Iodine is another effective treatment option for HYPOTHYROIDISM?
False, it’s effective in managing HYPERTHYROIDISM.
True or False. Levothyroxine (Synthroid, Levothroid) is an example of a Thyroid Replacement medication available for patients with HYPOTHYROIDISM?
TRUE
True or False, Thyroid Replacement medications can cause an arrhythmia, angina, and increased oxygen demand?
TRUE
The biggest problems associated with Myxedema Coma are?
Decreased cardiac output, decreased perfusion, less stimulus for breathing, respiratory failure.
Emergency care related to Myxedema Coma includes?
Giving thyroid replacement and doing supportive interventions, such as ventilation (CiPap, BiPap) and monitoring for low calcium.
What is the ONE thing parathyroid glands do?
Their major function is to maintain normal serum calcium levels by secreting parathyroid hormone (PTH), which increases bone reabsorption of calcium. (Calcium and phosphate balance).
Hyperparathyroidism
An increase in PTH, which leads to hypercalcemia, hypophosphatemia, bone damage, and renal damage.
Hypoparathyroidism
A decrease in PTH, which leads to hypocalcemia, hyperphosphatemia, hyperreflexia, and an altered sensorium. (Decreased function of the parathyroid gland).
True or False. Parathyroids are often removed?
False. They are rarely removed and often transplanted into the arm to keep PTH, PTH keeps calcium up. Calcium is harder to regulate without it.
Nonsurgical management of hyperparathyroidism includes?
Diuretics and fluid therapy, drug therapy: phosphates, calcitonin, calcium chelators.
Mr. Williams is scheduled for a parathyroidectomy, what preoperative care will he need?
The patient must be stabilized, calcium levels should be normalized, assess bleeding, clotting times, and CBC, teach patient the importance of coughing, deep breathing exercises, and having neck support.
Postoperative care following a parathyroidectomy includes?
Observe for respiratory distress, Keep emergency equipment at bedside (Ca injection) because a hypocalcemic crisis can occur, Recurrent laryngeal nerve damage can occur.
Name the top 3 concerns of a thyroidectomy and parathyroidectomy
Bleeding, laryngeal edema, hormone fluctuations. The main problems are the surgical site and inability to maintain serum calcium.
Nursing interventions for Hypoparathyroidism include?
Correcting hypocalcemia, vitamin D deficiency, and hypomagnesemia
Iatrogenic vs. Idiopathic Hypoparathyroidism
Iatrogenic means it was caused by the treatment, or by the doctor. So iatrogenic hyperthyroidism means the hyperthyroidism was caused by taking too much thyroid hormone. Idiopathic hypoparathyroidism may be inherited or acquired later in life.
Name 2 examples of Posterior Pituitary Disorders
Diabetes Insipidus (DI) and Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
ADH
Also known as Vasopressin, is a hormone secreted from the posterior pituitary gland. It’s main purpose is to control serum osmolarity and water balance.
Diabetes Insipidus (DI)
Results from ADH insufficiency (too little), leading to excess fluid excretion (polyuria, up to 12L a day). When the post. pituitary does not produce enough or any ADH, patients cannot reabsorb water.
SIADH
Results from excessive excretion of ADH (too much ADH) and excessive water retention.
What is the cardinal symptom of DI?
Polyuria
What causes DI?
Head trauma with damage to the pituitary, subdural hematomas, pituitary tumors
What will happen to a patient experiencing excess fluid excretion as a result of DI?
The patient will become hypernatremic
What causes SIADH?
This condition is often associated with the ectopic production of ADH by malignant tumors. For example, lung cancers can mimic and create a clone of ADH. So it’s not the pituitary that producing too much ADH, it’s the cancer cells.
True or False. Hypernatremia is the primary problem of SIADH?
False, Hyponatremia is the primary problem because the Na becomes too diluted during fluid overload.
If a patient’s urine output is greater than 400ml an hour, you should suspect SIADH? T or F?
False, you should worry about DI.
Why do patients with DI need fluid replacement?
Because all of their symptoms are being caused by high Na levels.
Prevents or controls thirst and frequent urination caused by diabetes insipidus and certain brain injuries.
DDAVP, replaces vasopressin
Treating DI includes?
Hormone and fluid replacement (vasopressin)
Treating SIADH includes administering diuretics and restricting fluids. T or F?
TRUE, fluid intake should be restricted so that further dilution of Na won’t continue
Identify 3 Nursing Management interventions for ADH disorders
Monitor: Fluid balance, electrolyte balance, cardiac conduction, cardiac output an d perfusion, mental and neuro status.
Diabetes Mellitus (DM)
Occurs when the pancreas fails to secrete an adequate amount of insulin. Most common chronic disorder of the endocrine system.
Type I (DM)
Insulin dependent
Type II (DM)
Patients still produce some insulin, but it’s not as effective. May require oral hypoglycemics, but can be managed with diet and exercise.
True or False. Gestational, stress, and steroids are all examples of variant types of DM?
TRUE
Cortisol
Stress response causes increased levels of cortisol in your body, cortisol increased blood glucose and blocks insulin.
Polyuria, polydipsia, and polyphagia are common clinical manifestations of Type II Diabetes?
False, only polyuria and polydipsia (thirst) are common symptoms. Polyphagia (hungry) is only seen in Type I diabetics.
Why do Type I patients get hungry?
Because of a lack of insulin, their body must use and breakdown proteins and fats for energy. This use of fats results in ketones. As ketones build up, acidosis occurs. This breakdown of nutritional stores leads to excessive hunger.
What is the only difference between Type I and Type II?
Type II have enough insulin to prevent the breakdown of fats and muscles for energy.
Diabetic Ketoacidosis (DKA)
Results in severe metabolic, fluid, and electrolyte disturbances, and is a life threatening condition of hyperglycemia and metabolic acidosis, requiring immediate action.
Abdominal pain, weakness, fatigue, nausea, vomiting, metabolic acidosis, fruity breath odor, Kussmaul respirations, decreased LOC, coma, and death if untreated are all examples of what disorder?
DKA
How will you know your patient is developing DKA?
They will appear lethargic or unconscious, have cold and dry skin, have breath that smells like acetone
Name 4 things that occur during the ABSENCE of insulin
Hyperglycemia, Polyuria Polydipsia Polyphagia, Hemoconcentration, hypervolemia, hyperviscosity, hypoperfusion, and hypoxia, Acidosis, Kussmaul respiration, Hypokalemia, hyperkalemia, or normal serum potassium levels
Fluid replacement and insulin are essential in treating DKA, T or F?
TRUE, however it must be done slowly to prevent blood sugar from dropping too low.
Kussmaul respirations
Symptoms of all DKA patients. Compensatory way of breathing, occurs when patient is not getting rid of CO2.
Fasting Blood Sugar (FBS)
Should be between 70 and 100, anything above 126mg L is a sign of diabetes
True or False, a 2 hr PPT greater than 200 is a sign of diabetes?
TRUE
What is the desired amount for HgAic (glycosolated Hgb)?
4 to 6 percent
What other diagnostic tests can help identify DM?
Altered electrolytes (K, CO2), elevated cholesterol and triglycerides (result of breaking down fats for glucose), I and O assessment for the presence of ketones.
True or False, when physically examining patients for DM, it’s important to assess for bruises and peripheral neuropathy
TRUE, however these are chronic complications that can take 10 to 20 years to develop.
Urine tests are used to test for which of the following. Ketones, Renal Function, or Glucose?
All of the above, not done very often but patients are now being encouraged to check their own urine at home.
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) vs. DKA
Symptoms are the same except patients with HHNS won’t have an acetone odor because they’re not breaking down protein to have ketones. They’ll still be lethargic, have dry skin, and blood glucose levels between 800 and 1000.
What is the most common complication in both Type I and Type II
Hypoglycemia
What symptoms will patients with very LOW blood sugars have?
HA, they’ll also appear jumpy and irritable and shocky
What will a patient with HIGH blood sugar look like?
Lethargic or not moving and exhibit signs of a diabetic coma.
What should you give to an unconscious patient with LOW blood sugar?
IV glucagon or Dextrose IV solution
Oral hypoglycemics
Stimulate the pancreas to make more insulin or improve the efficiency of the existing insulin, or some work in the liver to block over production. Only effective in Type II, Type I need must have insulin replacement.
Name 3 types of Insulin
Aspart (Novolog, Insulin Glargine (Lantus), Lente, Lispro (Humalog), NPH, Premixed, Regular, Ultralente
Sulfonylureas
Stimulate your pancreas to make more insulin
Biguanides
Decrease the amount of glucose made by your liver
Alpha-glucosidase inhibitors
slow the absorption of the starches you eat.
Thiazolidinediones
make you more sensitive to insulin
Meglitinides
stimulate your pancreas to make more insulin
D-phenylalanine
derivatives help your pancreas make more insulin quickly
True or False, weight changes the way glucose is processed?
True. Type II diabetics can control their diabetes with diet and exercise. Increased activity and weight loss significantly decreases long term complications.
True or False, Type I can be controlled with diet and exercise?
False, this condition is irreversible, but ANY type of diabetic should watch their diet so that they don’t have upswings and low swings of blood sugars
What long term complications can result from uncontrolled diabetes?
Peripheral neuropathy, arthrosclerosis, arteriosclerosis, cardiac disease, blindness
Why is AiC so important?
AiC shows how well the patient has managed and controlled their diabetes within the last 3 months.
What’s the advantage of constant insulin?
Keeps BS low because the insulin is always there. Whatever you eat is controlled right away.
What are the benefits of exercise?
Lowers BS, however anyone who changes their activity level needs to know that they may need to change their medication regimen.
Name 3 Alternative methods of insulin administration
Continuous subcutaneous infusion of insulin, Implanted insulin pumps, Injection devices, New technology includes Inhaled insulin, Transdermal patch (being tested)
Complications of Insulin Therapy
Hypoglycemia, Lipoatrophy, Dawn phenomenon, Somagyi’s phenomenon
Dawn Phenomenon
3 am glucose levels start to rise, connected to GH secretion
Insulin Waning
NPH given at dinner, too long interval to am
Somagyi Effect
Nocturnal hypoglycemia (2 to 3 am) with rebound hyperglycemia.
Interventions for Potential DKA include?
Monitoring for manifestations, Assessment of airway, level of consciousness, hydration status, blood glucose level, Management of fluid and electrolytes, Drug therapy goal is to lower serum glucose by 75 to 150, Management of acidosis, Client education
Interventions for Potential HHNSC include?
Monitoring Fluid therapy, to rehydrate the client and restore normal blood glucose levels within 36 to 72 hr, Continuing therapy with IV regular insulin at 10 units a hr, often needed to reduce blood glucose levels
Interventions for Potential Hypoglycemic episode include?
Carbohydrate replacement, Drug therapy (glucagon, 50 dextrose, diazoxide, octreotide, Prevention strategies for Insulin excess, Deficient food intake, Exercise, Alcohol
Priority Nursing Dx for DM
Imbalanced nutrition, risk for self care deficit, fluid volume deficit, risk for impaired skin integrity, risk for knowledge deficit.
In patients with HYPERTHYROIDISM, what should you assess for?
Eyes, VS, skin, weight, fluid status, goiter, muscle strength and appearance, reproductive hx, signs of HF, reports of GI distress
In patients with HYPOTHYROIDISM, what should you assess for?
neurological assessment, presence of periorbital edema, VS, cardiac rhythm, bowel habits, muscle strength, skin, presence of goiter, reproductive hx, fluid status, weight, activity tolerance, respiratory status.
Hypercalcemia
Nausea and vomiting, Loss of appetite, Excessive thirst, Frequent urination, Constipation, Abdominal pain, Muscle weakness, Muscle and joint aches, Confusion, Lethargy and fatigue
Hypocalcemia
Neuromuscular irritability (spasm or twitch), Muscle cramps in legs or arms, numbness or tingling in the fingers or toes, irritable and depressed mood, confusion or disorientation, irregular heart contractions,
135 to 145
Normal serum Sodium (Na)
3.5 to 5.2
Normal serum Potassium (K)
Radioactive Iodine Therapy
Drug therapy used to treat HYPERTHYROIDISM, it helps to destroy thyroid cells in order to reduce production of TH. Not used in pregnant women, additional drug therapy may be needed, implement radiation precautions, monitor regularly for changes in thyroid
