Endocrine

what corrects hypoparathyroidism

IV calcium corrects hypoparathyroidism

an elevated tsh level indiates what and s/s

- elevated tsh level indiated hypothyroidism, which is characterized by -weight gain -bradycardia -cold intolerance -paresthesia -hearing loss - depression.

pt who has aderalectomy

- has increased BG levels due to increase in production of glucocorticoids. glucocorticoids stimulate gluconeogenesis and are not given to inhbit glucose metabolism -pt who has aderanalectomy has fluid retention from the increased production of glucocorticoids. glucocorticoids have fluid retention properties and do not act as diuretoc to increase urine output -pt who has aderalectomy has higher risk of infection due to increased production of glucocorticoids which have potent anti-inflammatory and immunosuppressive properties

Diabetes insipidus:

- increased thirst (polydipsia), -polyuria -pt will increase excrete large quantities of urine with very low specific gravity. -increase h&h and BUN -tachycardia

somogyi effect nursing considerations

- is high BG in the morn aftet an extremely low BG level during night. -monitor pt nighttime BG level overtime can provide an accurate diagnosis of smogyi. - administer smaller dose of intermediate acting insulin at bedtime or increase the pt bedtime snacks to avoid condtion that can lead to somogyi. -evalute the pt evening cal intake based on the insulin dose and exercise programs during the day to avoid conditions that can lead to somogyi effect. -ensure the pt received bedtime snack to decrease the chance of hypoglycemia during night.

Dialysis Nursing Considerations

- nurse should warm the dialysate solution prior to administration to prevent pain and abdominal cramping. -cleanse the catheter site using a circular motion while moving outward. -place the drainage bag below the level of the client's abdomen to enhance gravity of the fluid. -apply sterile gloves and use 3 cotton swabs soaked in povidone-iodine to cleanse the catheter site; This destroys the bacteria around the site and prevents infection.

insulin education

- pt should avoid exercising within 1 hour of receiving insulin or at the peak time of insulin, bc exercise can increase the absorption of insulin at the injection site and cause a marked drop in blood sugar at the insulin peak time. -pt should plan to eat at least 1 hour before exercise and drink a carbohydrate liquid to decrease the risk of a hypoglycemic response. -pt who has poorly controlled insulin-dependent diabetes mellitus should not exercise when BG levels are >250 mg/dL or if ketones are noted in the urine; this is because there is an inadequate amount of insulin for transporting glucose.

Parathyroid hormone regulates what

- regulates calcium, phosphorus, and magnesium balance within the client's blood and bones by maintaining mineral levels. -Hyperparathyroidism is associated with hypercalcemia; therefore, a decreased calcium level indicates an improvement in the client's condition.

TPN:

- weight the pt daily due to risk of f&e imbalance; -change tubing 24 hrs to prevent bacteria from developing in tubing -check BG every 4 hr (hyperglycemia is AE of TPN) -nurse should apply a new dressing to the pt IV site every 24 to 72 hrs -nurse should observe the site at this time for redness, irritation or indication of infection

client who has a diabetic foot ulcer about foot care.

-"I will let my feet air dry after washing- wrong" client should dry their feet thoroughly after washing to prevent bacterial growth between the toes -client should wear closed-toe shoes to prevent injury to their feet. -Topical OTC med can impair skin integrity and lead to further injury.

hypotonic solution nursing consideration

-0.45% sodium cL is a hypotonic solution and is contraindicated for pt whi have burns. -hypotonic fluid has an osmolarity value of <270 mOsm/L, which is less than the expected refernece range of the osmolarity value for plasma and body fluid of 285 to 295 mOsm/L.

24 hr urine specime for 17-OHCS is used to determine what

-24 hr urine specime for 17-OHCS is used to determine if the pt is producing an adequate amount of CORTISOL. an increase of cortisol in the specimen can indiacte cushings disease -24-hour urine specimen for creatinine clearance is used to evaluate the client's renal function by calculating GFR of the kidneys.

A nurse is accepting a transfer from the postanesthesia care unit (PACU) of a client who has had a subtotal thyroidectomy. Which of the following pieces of equipment should the nurse have available at the bedside for this client?

-Bc of the laryngeal edema that is common after a thyroidectomy, respiratory distress could result in airway obstruction. Emergency intubation can be difficult due to laryngeal swelling, and endotracheal intubation can increase the risk of hemorrhage by increasing tension on the incision during insertion. The nurse should have a tracheostomy tray available for pt. -Unless pt has a pre-existing cardiac dysrhythmia or is at risk for dysrhythmias, cardiac monitoring is not essential after a thyroidectomy. -A defibrillator should be available on every nursing unit. However, unless pt has a hx of cardiopulmonary arrest or is a particular risk for this condition, having a defibrillator nearby is not essential following a thyroidectomy. -Unless pt has a hx of pneumothorax or is at risk for pneumothorax, a thoracotomy is not essential following a thyroidectomy.

accurate check for diabetes

-Checking glycosylated hemoglobin levels (HbA1c) is an accurate method of determining if the client is routinely compliant for DM -Urine sugar and acetone levels reflect how well-controlled the client has been for the last few hours. -A glucose tolerance test is used to diagnose DM and commonly identifies type 2 and gi diabetes. -A fasting serum glucose provides information about the previous 24 hours.

DM 2

-DM 2 will have resistance to insulin and decrease in the secretion of insulin by pancreatic beta cells. -does not secrete enough insulin by the pancreatic beta cells to break down sufficient glucose.

PSA test:

-Ejaculation within 24 hours prior to the test can falsely elevate levels of PSA. -PSA testing at the age of 50. Men who have a family history of prostate cancer or men of African descent should discuss with their provider the possible benefits of initiating testing at age 45. -expected PSA value increasing with age.

thyroid storm s/s

-HTN, Abd pain, diarrhea, n/v, restlessness, confusion, and possible seizures, tachycardia -hyperthyroidism can lead to congestive heart failure and pulmonary edema can develop rapidly and lead to death.

thyroidectomy

-Laryngeal stridor and hoarseness are unexpected findings and can indicate swelling in the area of the surgery or damage to the laryngeal nerve. This should be reported to the provider -Laryngeal stridor is a high-pitched, harsh breathing sound that indicates respiratory distress due to swelling, tetany, or laryngeal spasms. -> prepare tracheostomy -dont hyperextend the pt bc it can place tention on the incision and cause bleeding -elevate head of the of pt bed to promote ventilation. -dont administer analgesic bc this can cause resp distress -productive cough can occur after general anesthesia due to a buildup of secretions caused by endotracheal intubation. -Pain with hyperextension of the neck is an expected finding after a thyroidectomy. The nurse should use pillows to support the client's head and neck. -hoarse and weak voice is common after general anesthesia as a result of endotracheal intubation. If hoarseness continues, it could indicate laryngeal nerve damage, which is usually transient

DM 1

-Pt who has DM 1 does not secrete insulin bc of the destruction of the beta cells by the body. Although insulin is still produced in this condition, it is not sufficient to maintain homeostasis. -Pt who has DM 1 has destruction of the beta cells bc of the production of blood antibodies. This is not a manifestation of type 2 diabetes mellitus.

tx for SIADH

-SIADH is a disorder of water intoxication due to the inappropriate continuous secretion of antidiuretic hormone by the posterior pituitary gland, causing hypervolemia and hyponatremia. -Treatment of SIADH includes fluid restriction, sodium replacement with small amounts of 0.9% sodium chloride, and a vasopressin antagonist such as tolvaptan. - Tolvaptan promotes the excretion of water, which helps correct the fluid imbalance in clients who have SIADH.

DM client's meal plan.

-Sweet desserts are not prohibited for clients who have diabetes mellitus. Instead, they should be consumed in moderation and substituted for other carbohydrates in the client's meal plan. -pts with DM have the same fiber requirements as the general population. Fiber content can be increased by substituting white bread, which is made with refined grains, with whole-grain bread, which retains the outer layer of the grain that is higher in fiber. -Sucralose is a non-nutritive sweetener that has been approved by the Food and Drug Administration for this use. It is considered safe for clients who have diabetes mellitus. -Although Pts who have DM can consume alcohol in moderation, nurse should instruct the client to consume alcohol with food to avoid hypoglycemia.

manifestation of grave disease (5)

-Temors (hyperthy). -low grade fever, diaphoresis -TSH level are decreased. manifestation include -heat tolerance

what is VMA test

-VMA test is used to determine if the pt has pheochromocytoma, which measure the level of catecholamine metabolites in 24 hrs urine sample. -pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines epinephrine and noreepinephrine, which are hormone that regulates BP and HR

acromegaly

-acromegaly will present with an enlarged head size due to the excessive production of GH after closing of the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. This results in the gradual enlargement of the client's body tissues such as the bones of the face, jaw, hands, feet, and skull. -will have skeletal thickening due to the increased GH secreted by the pituitary gland. -acromegaly will have a barrel-shaped chest due to the increased GH that enlarge the skeletal system. -Pt who has acromegaly will have vocal deepening due to hypertrophy of the vocal cords from the increased GH secreted by the pituitary gland.

addison disease : nurse should anticipate

-addison disease : nurse should anticipate administering f&e to the pt to restore the volume lost. -nurse should expect weight loss in a client who has Addison's disease.

nursing consideration for new dressing to the pt IV sites

-apply new dressing to the pt IV sites every 48 to 72 hrs as per facility protocol to maintain the IV site =inspect the pt skin for irritation and infection

DKA :expected lab value

-bicarb <15, BG >250, ph <7.3 -diabetic ketoacidosis should have a blood glucose level that is >250 mg/dL, which will cause spilling of ketones in the urine and development of metabolic acidosis.

cushings syndrom :

-check specific gravity to assess for fluid volume overload, hyperglycemia, weigh pt same time each day -A rounded face, or a moon-shaped face -HTN, weight gain, thinning of skin -pot bally, buffalo hump

hb1c-

-client does not need to fast before blood sampling for HbA1c. What the client eats the day before has no effect on the results of this test. -HbA1c reflects the client's glucose levels over a 120-day period, which is the life span of RBCs. -client should use capillary blood glucose levels to adjust daily insulin doses with the provider's approval.

A nurse is teaching a client who has type 1 diabetes mellitus about how to prevent complications during illness. Which of the following statements by the client indicates an understanding of the teaching

-client should check their urine for ketones when blood glucose levels are greater than 240 mg/dL. -The client should call the provider if their blood glucose levels exceed 250 mg/dL during illness. -client should check their blood glucose level every 4 hr during illness.

A nurse is preparing a teaching plan for a client who has diabetes insipidus and requires intranasal desmopressin. Which of the following information should the nurse include?

-client should drink an amount of fluid equal to his urine output each day. -client should weigh himself daily to detect dehydration in its early stage. -weight gain or loss of 0.45 kg (1 lb) per week is not enough to suggest overhydration or dehydration. -client should take the initial dose of desmopressin in the evening. The provider will increase the dosage until the client no longer has nocturia.

thyroid hormone: manifestation

-confusion -abd pain, vomiting - restlessness -possible seizure

indication of hypothyroidism.

-constipation -Hypotension is an expected finding of hypothyroidism, along with bradypnea, dysrhythmias, cold intolerance, and cool, dry skin.

pancreatitis: lab indication

-decrease in Mg -hypocalcemia

An older adult client who has an infection can have manifestations of (6)

-disorientation, confusion - low-grade fever. -fatigue -malaise -tachypnea.

A nurse is caring for a client who has a pheochromocytoma. Which of the following actions should the nurse take?

-elevate the head of the client's bed to reduce BP and abdominal pressure. -should not palpate the abdomen of a client who has a pheochromocytoma, because this can cause release of catecholamines and increase blood pressure. -monitor for HTN -nurse should monitor the urine specific gravity of a client who has diabetes insipidus.

planning dietry teaching :

-first ask the pt about individual food preference to provide opportunity for the nurse to include these foods in her diet. -involving the pt in the planning will promote her adherence to the dietary plan (always begin with assessment or data collection)

indication of hyperglycemia and DKA :

-fruity odor breathe, - dry mouth, extreme thirst, dehydration which cause ortho hypotention -abd cramping -vital signs -rapid, deep resp

increased hunger is a manifestation of

-increased hunger is a manifestation of hypoglycemia due to a cholinergic response to central glucose deprivation. -Cold, clammy skin is a manifestation of hypoglycemia due to a cholinergic response to central glucose deprivation. -Tremulousness is a manifestation of hypoglycemia due to an adrenergic response to central glucose deprivation.

A nurse is teaching a client who has diabetes mellitus about insulin injections. The client's prescription includes evening doses of insulin glargine and regular insulin. Which of the following instructions should the nurse include?

-instruct the client to draw up the insulins into separate syringes because insulin glargine is not compatible with other insulins. -instruct the client to expect both insulins to appear clear and to discard any that appear cloudy. -instruct the client to gently mix the insulin vials prior to administration to prevent altering the chemistry of the medication.

A nurse is providing discharge teaching to a client who has diabetes insipidus and a new prescription for desmopressin nasal spray. Which of the following instructions should the nurse include in the teaching?

-instruct the client to prime the nasal spray pump by pressing down four times before the initial use. -instruct the client to blow his nose gently prior to using the spray. This action prevents dilution of the medication with nasal secretions. -instruct the client to sit upright with their head tilted forward slightly when administering the spray. This upright position prevents the spray from going down the client's throat.

hypoparathyroidism manifestation

-involuntary muscle spasms as an indication of hypoparathyroidism -Muscle twitching and paresthesias can result due to decreased parathyroid hormone levels and calcium deficiency.

DKA manifestations

-kussmaul respiration which is deep, rapid, labor, resp is body attempt to exhale CO2 to reverse metabolic acidosis, -ketones present in blood and urine -signs of dehydration which are flattened neck veins, hypotention, dry skin, and sunken eyeballs, orthostatic hypotention due to excessive BG and osmotic diuresis -increase UO, weight loss -BG >300

cusion syndrom lab values

-lymphocytes below expected range -K below expected range -Ca below expected range -BG elevated

hyperthyroidism manifestation

-muscle weakness and wasting can develop without adequate caloric and protein intake -often have low grade fever, diaphoresis due to hypermetabolic state, -often restless and have increased systolic BP, -a cool environment can decrease the discomfort of heat intolerance. -tachycardia, other dysrhythmias, tremors -during acute phase, increased activity is not appropriate recommendation. -insomnia, exophthalmos, which causes a wide-eyed or startled appearance.

A client who is having transient ischemic attack may present with

-neurological deficits such as dizzines -loss of vision in an eye, double vision, -weakness, and aphasia

A nurse is providing teaching to a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up." Which of the following responses should the nurse provide?

-nurse is capable of counseling clients and providing resources about appropriate dietary choices without consulting the provider. -Although this idea has some merit, the client is expressing dismay about giving up pasta. Often, there is no substitute for what the client really enjoys. -While reduced sodium intake is recommended for most clients, especially those who have hypertension, this is not a solution for this client's concern about pasta. Additionally, it does not relate to glycemic control, which is a critical issue for this client.

A nurse is planning to administer fluids to a client who has 25% total body surface area burns. The client has no prior medical history.

-nurse should plan to administer dextran 40 in 0.9% sodium chloride, which is an isotonic colloid solution, to increase the intravascular fluid volume. -nurse should plan to administer lactated Ringer's, which is an isotonic solution used to expand vascular volume.

A nurse is planning teaching for a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse plan to include?-

-nurse should recommend that male clients drink no more than two servings of alcohol per day, and female clients drink no more than one serving of alcohol per day. -Alcohol inhibits the liver's production of glucose. Consuming carbohydrates while drinking alcoholic beverages helps prevent hypoglycemia. -instruct the client to reduce insulin dosage before planned exercise to prevent hypoglycemia. -instruct the client to exercise at least three times per week and have no more than 2 consecutive days without exercise.

hyperglycemia s/s

-polyuria, polydipsia -dehydration such as dry mucous membrane -sunken eyeball

A nurse is teaching a client who is scheduled for a Vanillylmandelic acid test to screen for pheochromocytoma. Which of the following statements should the nurse include in the teaching?

-pt do not have to fast but should avoid coffee and tea, even if they are decaffeinated, bananas, chocolate, citrus fruits and vanilla for 2 to 3 days prior to the test. -Pt should avoid aspirin bc it can affect test results. -Pt should discard the first morning urine, and then collect all urine after that for 24 hr.

A client who has Addison's disease has

-pt who has Addison's disease has adrenal corticoid insufficiency, which is due to the pituitary's inability to produce cortisol. -Illness and stress can require steroids like hydrocortisone to restore hormone levels. -An Addisonian crisis can cause sudden destruction of the adrenal gland or pituitary and become life-threatening. -pts who have Addison's disease need fluid replacement due to volume loss.

pt who has aderanalectomy

-pt who has aderanalectomy requires glucocorticoids before, during and after surgery to prevent an aderal crisis caused by sudden drop in cortisol levels. -aderal gland produce cortisol n glucocorticoids. loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressor, if untx can be fetal

Addison disease nursing consideration

-pt with addison disease requires a diet low in potassium and high sodium, carb, and protein. -addison is a hormone difieciency caused by damage to the outer layer of adrenal gland, -addison occurs when the adrenal gland do not produce enough cortisol and in some cases aldostrone

hypoglycemia manifestation:

-shakiness, sweating -fatigue, nausea -difficulty thinking, h/a

A client who has hypoglycemia can have

-slurred speech, double vision, weakness , hunger - irritability, mental confusion, disorientation -tachycardia, diaphoresis, and palpitations. -confusion near meal time (before meal) each day because regular insulin peaks in 2 to 4 hours, causing a drop in the client's blood glucose.

Hyperthyroidism s/s

-thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in the loss of protein stores and a negative nitrogen balance -inability to sleep (suggest frequent rest periods in a quiet environment) -A decreased attention span and mild to severe hyperactivity are common

Addison disease Diet

-turkey + cheese sandwich high in protein, carb, and sodium. -bananas, baked potatoes, and plain yogurt with peaches are high in potassium. -pt who has addisons disease require a diet low in potassium bc this condtion causes hyperkalemia

VAGINA hysterectomy (ovaries removed):

-vaginal dryness is a manifestation of manopause after ovaries removed. -pt may require a water based lubricant when having sexual intercourse, hormone replacement therapy is perscribed but not birth control sincw reproductive system is removed -pt should expect a decrease in bloody vaginal drainage and report to the provider if vaginal drainage becomes bloodier, thicker, or found smelling, -pt should begin to ambulate slowly in the immediate postop period but avoid any type of strenuous physical activity for 2 to 6 weeks after surgery (like swimming, biking, garderning, dancing or jogging)

hypocalcemia s/s (3Bs : bone, blood (blood clotting), beats (Heart beats) (think of went on vacation)

-weak, thready pulse. -gi motility (diarrhea). -tingling, numbness, paresthesia, which usually starts in the hands and feet -positive Chvostek's sign (facial muscle spasm after tapping the facial nerve in front of the ear) -hyperactive deep-tendon reflexes.

Below 70 means hypoglycemia: Expected findings are

-weakness, hunger, diaphoresis, nausea, shakiness, and confusion.

DM 2 nursing consideration

-weal clean cotton socks everyday to absorb moisture and reduce risk of infection -avoid using a heating pad or hot water bottle on the feet because reduced sensation can lead to burns.

TPN nursing considerations

-weight daily bc pt are typically malnourished -fliuid retention also can be indication that the pt is not digesting the TPN, rate of transfusion might need to be decreased -BG every 4 hrs -IV tubing change every 24 hrs to prevent bacteria from entering -tpn through central line and partial parenteral nutrition can be given thru perpheral line

adrenal insufficiency labs?

-will have a calcium level above the expected reference range of 9.0 to 10.5 mg/dL -will have a sodium level below the expected reference range of 136 to 145 mEq/L -weight loss

without tx for addison what happens

-without tx for addison Na level fall, K+ increase. -Rapid infusion of IV fluids such as 0.9% sodium chloride and IV administration of high dose corticosteroids such as hydrocortisone are vital to correct the glucocorticoid deficiency.

diabetes insipidus diagnosis

A 24-hr measurement of I&O, a urine specific gravity test, and a test of urine osmolarity are used to diagnose diabetes insipidus.

A client who has Addison's disease will have what skin tone?

A client who has Addison's disease will have a darkening of the skin on both exposed and unexposed parts of the body due to a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex)= bronze pigmentation to skin

A client who has manifestations of dementia becomes

A client who has manifestations of dementia becomes cognitively impaired and can exhibit varying manifestations throughout each day e.g. confusion, disorientation, and difficulty with self-expression

Acute adrenal insufficiency causes what

Acute adrenal insufficiency causes hyperkalemia, which requires a potassium binding and excreting resin to treat, not additional potassium. -hypovelomia

Cushing's disease should have what

Cushing's disease should have purple striae (streaks or stripes) on the chest and abdomen.

Hyperparathyroidism is associated with what

Hyperparathyroidism is associated with hypophosphatemia; therefore, an increased phosphorous level indicates an improvement in the client's condition.

Increased urination is a manifestation of

Increased urination is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis.

what treat thyrotoxicosis

Iodine-containing agents treat thyrotoxicosis

Obesity is a risk factor

Obesity is a risk factor for type 2 diabetes, and moderate calorie restriction can improve control of diabetes, increase physical activity to reduce pt weight -DM pt should use a bath thermometer to ensure a water temp below 110° F or 43.3° C - DM pt to make sure they fit, pt should shop for shoes later in the day when the feet are likely to have slight swelling.

SIADH

SIADH will have hyponatremia caused by the excessive release of antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water, which causes dilutional hyponatremia, will retain free water and have decreased urine output with increased urine osmolarity, results hyponatermia due to dilutaion -experience hyperactive deep tendon reflexes of 3+ or 4+. -have decreased UO with increased urine osmolarity. -HYPOthermia resulting from a disturbance in the central nervous system

Diebetes pt education

The client should wear a medical alert identification tag in the event of a hypoglycemic response because exercise can potentiate the effects of insulin and cause blood glucose levels to decrease.

addison: monitor what

addison: monitor BP closely (hypotention), expect weight loss, salt craving

anterior pituitary gland is responsible

anterior pituitary gland is responsible for secreting GH

Dopamine

client who has Addison's disease and is experiencing an Addisonian crisis does not require a vasopressor such as dopamine. Dopamine is an intravenous vasopressor indicated for the treatment of shock that does not respond to IV fluid replacement. It should be given through a central venous catheter to minimize complications related to extravasation, as it can cause tissue necrosis with IV infiltration.

obsity and DM 2

high correlation between obesity and type 2 DM bc it decrease the number of available insulin receptors in skeletal muscle and fat cells, which is refereed to as peripheral insulin resistance. reduced calorie diet for obese pt tends to reverse the phenomenon of peripheral insulin resistence

dehydration and decreased skin turgor

dehydration and decreased skin turgor in a client who has hyperglycemia.

glucose in urine manifestation of what

glucose in urine manifestation of DM 1

which disease have jaundice of the face and sclera?

hepatic, biliary, or gallbladder disease should have jaundice of the face and sclera.

adrenocorticotropic hormone (ACTH) stimulation test.

instruct the client that the ACTH stimulation test is the standard test for Addison's disease. It measures the cortisol response to ACTH. The response is absent or very decreased in clients who have primary adrenal insufficiency.

diabetes diet:

nurse is capable of counseling pt + provide resources about appropriate dietary choices without counseling provider, usually, carb restriction for each pt, careful assessment of pt usual dietary practice and modification is an important part of teaching pt to manage this disorder.

when should pt receive whole blood

nurse should plan to administer whole blood to the pt if the pt heratocrit is <20 to 25% which can result from hemodilution caused by fluid replacement therapy

poteinuria manifestation of what

poteinuria manifestation of kidney disease, oliguria is manifestation of kidney failure.

smoking can cause what

smoking can produce CV and pulm complication, hepatitis risk of developing cirrhosis

kidney filters what

sodium, potassium filtration system of kidney

SLE have what

systemic lupus erythematosus should have a butterfly rash across the bridge of the nose.