endocrine ngn Flashcards
The following flashcards are going to be talking about the endocrine NGN case study
question 1
this first question in the endocrine case study is discussing how to recognize signs and symptoms for hypoglycemia a patient who has been diagnosed with diabetes.
select all that apply (7)
- fatigue
- nausea
- weakness
- nervousness
- heart pounding
- increase thirst
- increased perspiration
- hunger
- confusion
why do you think those that are selected are the symptoms of hypoglycemia, explain like the patho for each one?
tell me why the other two were not selected?
what are symptoms for hyperglycemia that we have to tell someone?
what is the anagram for a patient who is going to go into hypoglycemia?
( think of what Rickerby said)
what is the treatment we can do for hypoglycemia ?
what is the treatment we can do for hyperglycemia ?
fatigue - related
weakness - due to the decrease in glucose within the central nervous system
nervousness
heart pounding-
nervousness and heart pounding are caused by an increase adrenergic activity and increased in secretion of catecholamines
increased perspiration
hunger
- increased perspiration and hunger are usually related to some cholinergic symptoms
confusion
- a neuroglycopenic symptom
nausea is related to hyperglycemia, same with increased thirst (polydipsia ) and its a cardinal manifestation of diabetes mellitus
the anagram is cold and clammy, give me some candy!
treatment for hypoglycemia in an emergency is glucogon followed by a carbohydrate
- non emergency would be giving orange juice and crackers
treatment for hyperglycemia is insulin
Question 2 of the NGN case study is discussing about the hypo functioning of the adrenal gland, based on the findings we saw in the case study, which would apply?(6)
- increased calcium
- decreased cortisol
- weight loss
- decreased sodium
- vitiligo
- decreased potassium
- increased glucose
- hyperpigmentation
when you are answering this select all that apply, make sure you are talking about how each one is related to Addison disease ^
before you answer this question, what does adrenal gland do?
what does it mean for your adrenal gland to be hypo functioning?
- what is the name of this condition ^
what does it mean for your adrenal glands to be hyperfunctioning?
- what is the name of this condition ^
remember the two anagrams I made for each condition, same them out loud
why are the other options related to Cushing syndrome?
increased calcium
- hypofunctioning of the adrenal gland is manifested by increase calcium and decreased serum cortisol
decreased cortisol
weight loss
- anorexia and weight loss are gi symptoms associated
decreased sodium
- decreased sodium levels is common, thats why “Addison has bronze skinned and is very salty about it !
vitiligo
hyperpigmentation
the adrenal gland helps with producing hormones to aid with regulating your immune system, metabolic system, blood pressure and response to stress.
when your adrenal glands are hypofunctioning, its simply stating that they are not producing enough or any hormones to be able to perform, in other words, hormone insufficiency
- addison disease
when your adrenal glands are producing too much cortisol
- Cushing syndrome
Addison
- she is bronze and salty!
Cushing
- he has too much sugar, moon faced, hump back and can’t control his stress!
decreased potassium and bicarbonate and increase in glucose are all associated with Cushing
question 3 for the ngn case study is discussing about a client who came into the clinic office talking about her frequent waking up in the middle of the night.
the question states that the nurse suspects that the client has hyperpituitarism.
what questions asked by the nurse are relevant to the diagnosis?
select all that apply? (6)
- is there any change in your vision
- do you experience severe headaches
- are you suffering from frequent urination
- have you noticed any back pain
- do you eat more than five times a day
- do you experience joint pain
- is there any change in your menstural cycle
- do your shoes feel tight when you put them on
before answering the question, what does hyperpituitarism mean?
- what is mainly the cause for this ^
what does hypopituitarism mean?
why did we select the ones that we did ?
why did we not select those two options?
- is there any change in your vision
- do you experience severe headaches
- have you noticed any back pain
- do you experience joint pain
- is there any change in your menstural cycle
- do your shoes feel tight when you put them on
hyperpituitarism is a hyper secretion of hormones from your pitituairy gland
- the main cause for this would be pituitary tumors
hypo is the lack of secretion of hormones from your pituituary gland
change in vision and severe headaches are simply due to the fact that the tumor is in the head
back pain and joint pain can be due to the fact that there is an increased of growth hormone
a change in menstural cycle can be do to the hyper secretion of prolactin in females
because of the increased in growth hormone, clients may notice a change in size of shoes, rings, and hats
frequent urination is related to diabetes, and patients diagnose with diabetes also experience an intense hunger
question 4 is about a patient who was going into the clinic for a annual exam. He reports unexplained nausea, vomiting and diarrhea with weight loss over the past 2 months. He also states that standing at times can be dizzy. The doctor has ordered a 24-hour urine specimen to assess the presence of vanillymandelic acid (VMA ) in order to confirm his diagnosis of pheochromocytoma?
what information should the nurse include in the teaching plan regarding this test? select all that apply(4)
- the client may take chlorpromazine during the test
- encourage the client to engage in usual activites while testing
- only salicylates can be taken for discomfort during the test
- all urine excreted over the 24-hour period must be saved and refrigerated
- avoid chocolate and citrus fruit for 3 days before and during the test
- fluids can include coffee and tea but avoid colored drinks and sodas
- the client should avoid skipping meals while testing
- the use of monamine oxidase inhibitors (MAOI) should be reported before testing
before anything what is pheochromocytoma ?
what symptoms can cause a patient to have when having pheochromocytoma?
why do we do we 24-hour urine test for the presence of vanillymandelic acid in order to confirm our suspicion of diagnosis for the patient?
why do you think we selected the 4 that we did?
why did we not select the rest? (4)
- remember to explain in everything
I know im gonna forget, but does colored drinks affect the results?
does toilet paper affect the results?
what does maoi do to these medications and results?
what does starvation do to these results?
there is only one that decreases it, and what is that one.
- all urine excreted over the 24-hour period must be saved and refrigerated
- avoid chocolate and citrus fruit for 3 days before and during the test
- the client should avoid skipping meals while testing
- the use of Maoi should be reported before testing
it is a rare tumor that usually starts in one of your cells in the adrenal gland
nausea, vomiting, diarrhea, weight loss, high blood pressure, sweating and headaches
the reason why we do a VMA test is because it aids with detecting active tumors in the adrenal gland
- all urine should be collected and placed in a cold environment like the fridge during the 24 hours test.
( important to note that toilet paper and feces will not contaminate the specimen ) - coffee, chocolate and virtual fruit, in addition to mints, bananas, vanilla and tea will increase the VMA level and should be avoided 3 days before and during the test to not disturb the results
- starvation is associated with increase VMA levels, so it should be told to the client to not skip meals and instead eat.
- MAOI can falsely decrease the results, however its important to tell your doctor that youre on this before going cold Turkey because of the heavy side effects that can occur
the reason why we did not choose the others.
- chlorpromazine causes an elevation in the via level and should be avoided, instead of being told that its fine to consume
- the client should rest and avoid physical activity because it can increase the VMA levels
- salicylates, like aspirin will increase the VMA levels and should be avoided
- colored drinks do not affect vma results, however coffee and tea can increase the VMA levels and should be avoided.
question 5 is a patient who came into the clinic for a routine check up and was concerned about her episodes of emotional instability and what seems to be a manic behavior, she has a history of hyperthyroidisms and chronic asthma.
the question is talking about what would the nurse expect to be presented with hyperthyroidism? select all that apply (6)
- bradycardia
- blurred vision
- cold intolerance
- tremors
- insomnia
- increased appetite
- widened pulse pressure
- diaphoresis
why did we select the ones that we did ?
why did we not select the rest?
what is hyperthrydoisim ?
what is hypothrydoism?
- what are two things that can help me differentiate the two ^
- blurred vision
- tremors
- insomnia
- increased appetite
( it increased because its an attempt to meet the caloric needs of the body ) - widened pulse pressure
- diaphoresis
it would be tachycardia because of the increased needed for metabolic rate and it would be intolerance to heart because of the same increased need for metabolic rate
the other two options are associated with hypothyroidism
hyperthyroidism is when the body releases too much thyroid hormone, meaning too much T3 and T4 and too little TSH
hypothyroidism is when the body doesn’t release enough thyroid hormone, meaning too much TSH and too little T3 and T4
question 6
the following NGN practice was a little different since it was a drag and drop. However to provide context, the patient was found unconscious and rushed to the er. she has been drinking and urinating frequency, with a massive weight loss in the past week. Ketones were present in her urine, indicating the patient was going into DKA.
the following were the correct answers
potential complication
- dehydration
actions to take
- normal saline administer
- 2L oxygen
things to monitor
- urine output
- glucose level
why we select these options ?
why did we not choose hypoglycemia as a potential complication?
why did we not choose SIADH as a potential complication?
Why did we not choose chronic kidney disease as a potential complications?
why would be not begin a NPH insulin drip to treat hyperglycemia, even though its insulin?
why would we not give glucagon ?
why would we not assess her deep tendon reflexes and instead her level of consciousness?
why would we want an electrocardiogram and not a echocardiogram?
why would we not monitor for gi status ?
we understand the diagnosis was DKA the second we saw ketones in her urine, which causes dehydration. Clinical manifestation include, increase urination and thirst and decreased weight loss, poor skin turgor and soft sunken eyes.
the reason why we have to give her fluids, is because her body truly thinks she doesn’t have any, she drinks but then her body literally pees it out within seconds, meaning dehydration is at a high risk.
oxygen is also selected because we need to treat her hypoxemia, Lowe oxygen saturation and mkussmual respiration
urine output must me monitored in order to evaluate her hydration status and effectiveness of treatment
her glucose level should be monitored with the infusion of insulin to make sure it doesn’t drop too fast but also its working effectively
Hypoglycemia was not selected because the patients blood glucose was at 487, not below the 70 for an adult range ( 70-99 )
- additional manifestation would be shakiness, palpitations, nervousness, diaphoresis and anxiety
SIADH Is not a complication because this is where the body makes too much ADH, meaning the body will retain fluid, but our patient is clearly urinating too much.
Chronic kidney disease is not a complication because that would be fluid overload, meaning fluid retention/edema and imbalanced electrolytes, mainly her sodium but that was found to be normal in her lab.
we would not give her NPH insulin because that would take too long to work effectivly, but also the only insulin that can be given through IV is regular.
we would not give glucogon because that would only increase the blood sugar, and its already elevated.
we would assess her LOC instead of deep tendon reflexes, one because she is already unconsciousness, however her deep tendon reflexes would not be bothered, remember too much glucose in the brain is bad.
the client would need and electrocardiogram to see how the heart is pumping and not complicatoins
we would need to worry about fluid status instead of gi status cause the patient does not have constipation or diarrhea, instead theyve been vomiting
question 7 on the NGN case study was a little different as well, this time we had to highlight the following concerns that we wanted to address as a nurse when the patient came into the ER.
these were the ones we ended up selecting and were correct.
- confused and stated slurring words this morning
- medical alert bracelet indicates insulin-dependent diabetes mellitus
- 22 units of neutral protamine Hagedorn (NPH) each morning at 0700
- diaphoretic and reports feeling shaky
based on these answers that we selected, what condition do you think the patient is experiencing?
why did we not select the following
- heart rate 88
- UTI, urgency, dysuria and right flank pain with costovertrebral angle tenderness
- pain of 4
she is experiencing a hypoglycemia event which can be life threatening if not treated.
heart rate is within normal limits 60-100
UTI symptoms are all concerning but not life threatening at this point, hypoglycemia is our main concern, then we come back to the UTI
pain of 4 is something we need to treat, however it is also not life threatening and can wait until afterwards, meaning hypoglycemia comes first before anything else at the moment.
question 8 on the NGN practice case study follows the same patient from before, of her expericing a hypoglycemia event. this question is a sentence formation that we need to add missing informaiton
this is the correct order
the nurse would immediately obtain
- blood glucose
as evidenced by
- did not eat breakfast
and
- 22 units of NPH 2.5 hours ago
why is this correct
what is the onset and peak of NPH insulin ?
remember the patient hasn’t eaten told by the roommate, she has a medical bracelet indicating that she has diabetes, she also noted in her notebook that she took her insulin, causing her blood sugar to be dropped because insulin lowers it.
these steps would aid in helping the patient be diagnosed with hypoglycemia.
1-3hours
peaks at 4-12hours
the following question 9 would be the same patient.
based upon the clients assessment findings, the nurse would first address
which one
- hypoglycemia unawarness - urinary dysuria and frequency
- self-manamgent of nutrition therapy
- pain
- hypoglycemia symptomology
why did we choose that one?
why did we not choose the rest? explain each
the highest priority would be to explain to he patient hypoglycemia symotmology. the patient had many symptoms before she become unconcious, indicating that she was unaware and needed to be treated for the symptoms before we explained what they are.
hypoglycemia unawares requiring additional actions regarding lifestyle changes. but the assessment findings indicate hypoglycemia, meaning we treat the actual condition then we tell how to change lifestyle
we dont pick urinary tract infection because this is not the first cancer
we dont pick self manamgemt life style changes until after the intervening of the priotyr problems
and then once again, pain comes last because its not life threanting likee hypoglycemia
question 10 also follows the same hypoglycemia patient.
choose the most likely option for the information missing from the statement by selecting form the list of options provided.
the nurse would first
- administer 1/2 cup of non diet soft drink (cola)
and then
- recheck blood glucose in 15minutes
why did we select this one and not the others like
- provide 120 ml of orange
- contact parents prior to treatment
- give the client 6 saltines
- administer 10% dextrose IV
- transport to local ED
- give the client 3 graham crackers
we would want to give 1/2 cup of non diet soft drink cola instead of the orange juice because its high in potassium, which should be avoided.
the client is a minor but the parents should be notified, however this is a emergency situation.
the six saltines are an option, but the client has disoreitntion issues and the liquid carbohydrate option is better.
the reason why we want to check glucose 15minutes after intervention is to determine the effect of carbohydrates after the consumption of sugar
- remember sugar followed by a carbo
there is no need to administer 10% dextrose since the patient can drink
there is no need to go to the ED for treatment of mild hypoglycemia
and 3 graham crackers is not needed since the cola was better
question 11 is following up on the same patients and this time we have to select if the following is indicated or contraindicated.
use of sick-day rules at college
regular timing and quantity of food intake
keep easy-to-reach snacks available when driving and studying
take 1 teaspoon of honey for low blood glucose events
add protein to carbohydrate intake to improve blood glucose response
effects of stress on blood sugar
explain why each is indicated or contraindicated.
- indicated
- when youre sick and having an emergency, take those days off - indiciated
- its best to keep a schedule and track what youre eating to help avoid hypoglycemia events - indicated
- incase you feel any symptom, its best to have some small snacks nearby - contraindicated
- 1 teaspoon of honey is not going to be enough, its a tablespoon and 15 quick acting carbohydrates. - contraindicated
- protein does not help as much as high-carbohydrate foods - indicated
- stress levels affect blood sugar so the student should learn how the body responses to stress and how to avoid being too stressed in order to avoid and manage glucose
last question 12, is still on the same patient with hypoglycemia, however this time we are going to be placing if it was effected nutritional self manamgent or managing psychosocial stress.
- obtained a 7-day meal plan for university meal options
- average premeal blood glucose is 90
- hbA1C value of 6.8
- has not missed class or exams since initial vist
- carbohydrate counting
- taught roommate signs of hypoglycemia
- parents insurance pays for the insulin pump and monitoring
- effective nutrition
- effective nutiriton
- effective nutrition
- psychostress
- effective nutrition
- psychostress
- pyschostres
