Endocrine Focus Points
Endocrine Focus Points
3. What is adipsia?
Adipsia is a disease characterized by the absence of thirst even in the presence of body water depletion or salt excess.
10. What are the effects of catecholamines (noriepe & epi) on the body?
Catecholamine-producing tumors arising in the adrenal medulla Pheochromocytoma
Epi- ^ HR, sends blood to brain and muscles
Noriepi- Vasoconstrictive ^ BP
11. What are the characteristics of metabolic syndrome?
Male waist circumference 44 inches, 35 inches (88 cm) or more for women, Triglyceride value of 162 mg/dL, Blood
pressure 135/85(systolic 130 or higher, diastolic 85 or higher) , Patient is taking blood pressure medication, fasting blood
glucose level of 100 mg/dL or more or on drug treatment for elevated blood glucose levels,
17. What is some reportable info for a patient who has undergone a thyroidectomy?
Hypocalcemia and tetany = due to low calcium levels characterized by numbness and tingling fingers and mouth,
REPORT IMMEDIATELY!!
20. What are labs and their results related to Addison’s disease?
ACTH Stimulation Test is most definitive test!!
27. What drug helps to block adrenal steroid productions for patients diagnosed with Cushing’s?
Ketoconazole
35. Why is hypertension treatment managed in patients with DM, even if the patient doesn’t have HTN?
Risk factors for decreased vision= HTN, Risk factors for kidney disease= HTN, Risk factor for cardiovascular
disorders= HTN, Risk factor for diabetic neuropathy= HTN
37. What are signs that a patient is improving from acute adrenal insufficiency?
40. What are the adverse effects of a thyroidectomy adverse effects and how do you treat it?
Hypothyroidism often occurs after surgery, and people then have to take replacement thyroid hormone for the rest of their
life.Rare complications of surgery include paralysis of the vocal cords and damage to the parathyroid glands (the tiny
glands behind the thyroid gland that control calcium levels in the blood).
41. What should the nurse monitor for in a patient who has had a hypophysectomy?
Report any postnasal drip., Keep the head of the bed elevated, Have the patient avoid coughing soon after surgery, Monitor
for a light-yellow color at the edge of clear drainage (cerebral spinal fluid)
42. The nurse should assess what before potential problem or expected problem?
Actual problem
43. What are the effects of ADH on body (on kidney tubules)?
ADH – responsible for reabsorption of water by distal tubules and collecting ducts of kidneys.
45. What should an assessment include for a patient diagnosed with SIADH?
Pancreatic Cancer and some forms of Lung Cancer may be abnormal sites of producing an – like substance, Certain
antidepressants, chemotherapeutic and general anesthetic agents may increase ADH secretion, CNS infections, Brain
Tumor affecting pituitary function, Complication of Diabetes Insipidus, Recent head trauma, Cerebrovascular disease,
Tuberculosis or other pulmonary disease, Cancer, All past and current drug use, Decrease in serum sodium levels
46. What should the treatment for a patient diagnosed with SIADH include?
Fluid restriction (less than 1000ml per day), Drug therapy (tolvaptan or conivaptin, diuretics, hypertonic saline,
demeclocycline), Monitor for fluid overload at least q 2 hours, Safe environment, Neurologic assessment (seizures) q 2
hours, If due to an inoperable cancer, Lasix and Declomycin may be indicated to block the action of ADH in the kidney, IV
Hypertonic Saline Solutions, Oral Salt.
48. What kind of IV Solution should patient with SIADH have administer?
IV Hypertonic Saline Solution
49. If due to inoperable cancer, what drugs may be indicated to block the action od ADH in the kidney?
Lasix and Declomycin
54. What would you educate a patient on who is taking antithyroid medication?
59. Onset, peak and duration of all types of insulin SEE INSULIN CHART ON D2L
Fluid/Electrolyte management – assess for dehydration (remember s/s), restore fluid volume, fluids depend on BP,
hydration status, etc, watch for fluid overload with trmt,
Drug Therapy – regular insulin IV, start subq when out of DK and can take oral,
Acidosis management– normal anion gap is 7-9mEq/mL, greater than 10 is metabolic acidosis, assess for hypokalemia due
to insulin tx, correction of acidosis, and volume expansion, bicarb only used when very severe
66. What are the ranges of lab results for HgA1C and what do they indicate?
Glycohemoglobin (glycosylated hemoglobin or HbA1c)Gathers baseline data and monitors progress of BS
controlShows average BS for last 2-3 months,
Normal 4% to 6%, above this shows pt
5.7 to 6.4 is increased risk for DM
6.5 or greater diagnoses diabetes
> than 8.0 means poor DM control
69. What is the difference between the diagnosis of Type 1 and Type 2 DM?
SEE ABOVE
70. What is metformin (Glucophage) used for and how could the nurse educate the patient?
See list of medications in Table 40.5 (know Januvia, Metformin, Actos, Avandia, Glipizide, Glimeperide, Glyburide)
74. What is some patient education for hypoglycemia treatment and sick day procedures?
75. When taking steroids what must you teach the patient?
Insulin will need to be adjusted due to steroids causing your sugar levels to increase. Growth Hormone, Epi, and Norepi
can also cause this.
80. What type of diet does a patient with Addison’s disease need?
Low potassium, high carb, protein, and sodium.
87. What two hormones work together to regulate calcium levels in the body?
Calcitonin and parathyroid hormone
93. What would you expect to see with a tumor that is stressing the medulla?
Nervous system will be affected, catecholamines are being pushed out causing flight or fight= tachy, decreased peristalsis,
hyper, ^ BP, decreased urine output
96. What is the contraindication for Metformin and patients taking opioids?
Metformin may decrease the excretion rate of Naloxone
100. What patient would you not want to give androgen therapy, and why?
Patient’s with prostate cancer, gynecomastia
A 23-year-old patient with a history of type 1 diabetes is admitted to the ED with nausea and abdominal pain. His respiratory rate is
34/min with deep breaths and a fruity smell to his breath. He is responsive, but difficult to arouse.
What does the nurse suspect is happening with this patient? The manifestations point to diabetic ketoacidosis (DKA).
What serum glucose level would the nurse expect to see with this patient? The patient’s glucose level is most likely >300 mg/dL.
The student nurse asks why the patient is breathing so rapidly and deeply. What is the nurse’s best response?
What is the nurse’s first priority for managing this condition? Airway assessment
Twenty minutes later, the patient is admitted to the ICU for DKA management. The patient is receiving IV regular insulin with frequent
finger sticks to check his glucose level. His potassium level is 2.5, and IV potassium supplements have been ordered.
What assessment must the nurse make before giving the IV potassium? Production of at least 30 mL/hr of urine
Two days later the patient is recovered and is preparing for discharge. His wife asks about what they can do to prevent this from
happening again.
What should the nurse teach the patient and his wife? (Select all that apply.) ACDE
C. Watch for and report any illness lasting more than 1 to 2 days.
D. Check blood glucose levels every 4 to 6 hours if anorexia, nausea, or vomiting is experienced.
E. Check urine ketones when blood glucose is greater than 300 mg/dL.
A nurse is teaching a group of patients about Metabolic syndrome. Which assessment features are associated with the syndrome? (Select
all that apply.) ACDE
Confusion
The nurse is teaching a patient with type 1 diabetes about exercise. The nurse understands the patient should avoid exercise during what
time? When ketones are present in the urine
A 56-year-old woman is admitted to the ED with a blood pressure of 168/92 and reports of fatigue and muscle weakness. She has
bruising on her arms and 2+ swelling in her ankles. Her weight has gone from 150 to 185 lbs over the past 6 months. Assessment reveals
that she has truncal obesity and thin extremities. Which diagnosis does the nurse suspect? Hypercortisolism (Cushing’s disease)
The patient is admitted to the acute medical care unit for a workup for Cushing’s disease. When she is assessed, she is found sitting at
the bedside crying. She states, “I just don’t know what to do. I feel so confused and down in the dumps.” What is the nurse’s best
response? “Have you noticed if your mood goes quickly from happy to sad?”
The next day, a student nurse is caring for the patient, who is scheduled for an MRI of the head. The student nurse asks why a patient
with Cushing’s disease needs this test. What is the nurse’s best response? “The most common cause of Cushing’s is a pituitary tumor
called an adenoma.”
The student nurse is creating a care plan for the patient. Which priority problems should be the focus of the care plan? (Select all that
apply.) BDE
A. Fatigue
B. Fluid overload
C. Sleep deprivation
E. Predisposition to injury
During evening shift, the patient’s MRI reveals the presence of a pituitary adenoma. The following day, surgery is performed to remove
the tumor. What is the nurse’s priority concern for the patient postoperatively? Monitoring for neurologic changes
Which key interventions should be implemented postoperatively for the patient after undergoing a hypophysectomy? (Select all that
apply.) ABCD
E. Instruct the patient to take thyroid and glucocorticoid replacement for at least 6 months.
The nurse is caring for a patient diagnosed with small cell lung cancer. The nurse understands the patient may also present with which
endocrine disorder? Syndrome of inappropriate antidiuretic hormone (SIADH)
Which priority question should the nurse ask a patient with a pituitary tumor? “Do you have any changes in your visual acuity?”
The nurse knows which patient with Cushing’s disease is at greatest risk for developing heart failure? 42-year-old with a serum
creatinine level of 3.7 mg/Dl- compromised kidney function ^ risk for heart failure.
As the nurse is assessing a patient with Grave’s disease, which finding requires immediate attention? Elevated temperature
What is the priority nursing intervention for an older female patient with a history of hyperparathyroidism? Implement fall precautions.
When developing a postoperative plan of care for a patient after a total thyroidectomy, the nurse knows the plan should include which
intervention? Avoiding extending the patient’s neck