Endocrine: Lewis
The nurse is admitting a client to rule out aldosteronism. Which assessment data support the client's diagnosis? 4. Blood pressure.
4. Blood pressure is affected by aldosteronism, with hypertension being the most prominent and universal sign of aldosteronism.
What should be taught to a person with Addison's disease? check all that apply
Adrenal insufficiency=cause (adrenalectomy or coming off steroids too fast), hirsutism (hair distribution changes, avoid stress (infection, rm changes, or arguing), STEROIDS rest of life in am, Diet: Salt and decreased K (no salt substitutes), Immunocompromised.
What are the S&S of Addisons?
Bronze pigmentation of skin, changes in distribution of body hair (hirsutism), weakness, weight loss, hypoglycemia, hypotension.
The client diagnosed with Cushing's disease has developed 1 peripheral edema. Theclient has received intravenous fluids at 100 mL/hr via IV pump for the past 79 hours. The client received IVPB medication in 50 mL of fluid every 6 hours for 15 doses. How many mL of fluid did the client receive? ________
The client has received 8,650 mL of intravenous fluid.
Can Cushing's patients have salt substitutes?
Yes bc they are low in Potassium
Can Addison's pts have steroids?
Yes because they increase Blood Sugar
When teaching a patient with chronic SIADH about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient says, a. "I need to shop for foods that are low in sodium and avoid adding salt to foods."
a. "I need to shop for foods that are low in sodium and avoid adding salt to foods." Rationale: Pts with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed.
A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, the nurse would expect to find a. HTN, peripheral edema, and petechiae
a. HTN, peripheral edema, and petechiae rationale- The effects of glucocorticoid excess include weight gain from accumulation and redistribution of adipose tissue, sodium and water retention, glucose intolerance, protein wasting, loss of bone structure, loss of collagen, and capillary fragility.
A patient with symptoms of DI is admitted to the hospital for evaluation and treatment of the condition. An appropriate nursing diagnosis for the patient is a. insomnia related to waking at night to void.
a. insomnia related to waking at night to void.
During care of a patient with syndrome of inappropriate ADH (SIADH), the nurse should a. monitor neurologic status Q2H or more often if needed
a. monitor neurologic status Q2H or more often if needed Rationale- the pt with SIADH has marked dilution hyponatremia and should be monitored for decreased neurologic function and convulsions every 2 hours.
A patient is hospitalized with possible SIADH. The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include a a. serum sodium of 125 mEq/L (125 mmol/L).
a. serum sodium of 125 mEq/L (125 mmol/L).
The nurse determines that the patient in acute adrenal insufficiency is responding favorably to treatment when a. the patient appears alert and oriented
a. the patient appears alert and oriented rationale- confusion, irritability, disorientation, or depression is often present in the patient with Addison's
A pt is admitted to the hospital in addisonian crisis 1 month after a diagnosis of Addison's disease. The nurse identifies the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge of management of condition when the patient says, b. "I had the stomach flu earlier this week and couldn't take the hydrocortisone."
b. "I had the stomach flu earlier this week and couldn't take the hydrocortisone."
A pt is taking high doses of prednisone to control the symptoms of an acute exacerbation of systemic lupus erythematosus. When teaching the pt about use of prednisone, which information is most important for the nurse to include? b. Do not stop taking the prednisone suddenly; it should be decreased gradually.
b. Do not stop taking the prednisone suddenly; it should be decreased gradually. R: Acute adrenal insufficiency may occur if exogenous glucocorticoids are suddenly stopped.
When developing a plan of care for a pt with SIADH, which interventions will the nurse include? b. Offer patient hard candies to suck on.
b. Offer patient hard candies to suck on. R: Sucking on hard candies decreases thirst for patient on a fluid restriction.
When providing postoperative care for a patient who has had bilateral adrenalectomy, which assessment information obtained by the nurse is most important to communicate to HCP? b. The patient's blood pressure is 102/50.
b. The patient's blood pressure is 102/50.
A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. The nurse anticipates that intervention will include b. administration of IV calcium gluconate.
b. administration of IV calcium gluconate.
The first nursing action indicated when a patient returns to the surgical nursing unit following a thyroidectomy is to b. assess respiratory rate and effort.
b. assess respiratory rate and effort
A pt is hospitalized with acute adrenal insufficiency. The nurse determines that the pt is responding favorably to treatment upon finding b. decreasing serum potassium.
b. decreasing serum potassium. R: CMs of Addison's disease include hyperkalemia
When the patient with parathyroid disease experiences symptoms of hypocalcemia, a measure that can be used to temporarily raise serum calcium levels is to b. have the patient rebreathe in a paper bag
b. have the patient rebreathe in a paper bag
An appropriate nursing intervention for the patient with hyperparathyroidism is to b. increase fluid intake to 3000 to 4000ml/day
b. increase fluid intake to 3000 to 4000ml/day Rationale-A high fluid intake is indicated in hyperparathyroidism to dilute hypercalcemia and flush the kidneys so that calcium stone formation is reduced
A patient with SIADH is treated with water restriction and administration of IV fluids. The nurses evaluates that treatment has been effective when the patient experiences b. increased urine output, increased serum sodium, and decreased urine specific gravity
b. increased urine output, increased serum sodium, and decreased urine specific gravity
When caring for a patient with nephrogenic DI, the nurse would expect treatment to include b. thiazide diuretics
b. thiazide diuretics Rationale- in nephrogenic Di the kidney is unable to respond to ADH, so vasopressin or hormone analogs are not effective.
A pt with Cushing syndrome is admitted to the hospital to have laparoscopic adrenalectomy. During the admission assessment, the patient tells the nurse, "The worst thing about this disease is how terrible I look. I feel awful about it." best response by the nurse is c. "Most of the physical and mental changes caused by the disease will gradually improve after surgery."
c. "Most of the physical and mental changes caused by the disease will gradually improve after surgery." Rationale: The most reassuring communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively.
A patient with Addison's disease comes to the emergency department with complaints of N/V/D, and fever. The nurse would expect collaborative care to include c. IV administration of hydrocortisone
c. IV administration of hydrocortisone rationale- vomiting and diarrhea are early indicators of addisonian crisis and fever indicates an infection, which s causing additional stress for the patient. treatment of a crisis requires immediate glucocorticoid replacement,
A patient with DI is treated with nasal desmopression. The nurse recognize that the drug is not having an adequate therapeutic effect the the patient experiences c. a urine specific gravity of 1.002
c. a urine specific gravity of 1.002 rationale- normal urine specific gravity is 1.003 to 1.030, and urine with a specific gravity of 1.002 is very dilute
When providing discharge instructions to a patient following a subtotal thyroidectomy, the nurse advises the patient to c. avoid eating foods such as soybeans, turnips, and rutabagas
c. avoid eating foods such as soybeans, turnips, and rutabagas Rationale- the patient should avoid goitrogens, foods that inhibit thyroid, such as soybeans, turnips, rutabagas, and peanut skins.
To prevent complications in the patient with Cushing syndrome, the nurse monitors the patient for c. cardiac arrhythmias
c. cardiac arrhythmias rationale- electrolyte changes that occur in Cushing syndrome include sodium retention and potassium excretion by the kidney, resulting in hypokalemia
A patient is scheduled for bilateral adrenalectomy. During the postoperative period, the nurse would expect administration of corticosteroids to be c. increased to promote an adequate response to the stress of surgery
c. increased to promote an adequate response to the stress of surgery rationale- although the patient with Cushing syndrome has excess corticosteroids, removal of the glands and the stress of surgery require that high doses of cortisone
A patient with Cushing syndrome returns to the surgical unit following an adrenalectomy. During the initial postoperative period, the nurse gives the highest priority to c. maintaining fluid and electrolyte status.
c. maintaining fluid and electrolyte status.
After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will plan to do discharge teaching about the need for c. oral corticosteroids to replace endogenous cortisol
c. oral corticosteroids to replace endogenous cortisol R: ADH, cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy.
A patient with an antidiuretic hormone (ADH)-secreting small-cell cancer of the lung is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the c. patient's urinary output is increased.
c. patient's urinary output is increased.
A nursing assessment of a patient with Cushing syndrome reveals that the patient has truncal obesity and thin arms and legs. An additional manifestation of Cushing syndrome that the nurse would expect to find is c. purplish red streaks on the abdomen.
c. purplish red streaks on the abdomen.
After receiving change-of-shift report about these pts, which patient should nurse assess first? d. A 70-year-old who recently started levothyroxine (Synthroid) to treat hypothyroidism and has an irregular pulse of 134.
d. A 70-year-old who recently started levothyroxine (Synthroid) to treat hypothyroidism and has an irregular pulse of 134. R: Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias.
Which information obtained when caring for a pt who has just been admitted for evaluation of DI will be of greatest concern to the nurse? d. The patient is confused and lethargic.
d. The patient is confused and lethargic.
A pt is admitted with possible SIADH. Which information obtained by nurse is most important to communicate rapidly to health care provider? d. The pt has a serum sodium level of 119 mEq/L.
d. The pt has a serum sodium level of 119 mEq/L.
A patient with primary hyperparathyroidism has a serum calcium level of 14 mg/dl (3.5 mmol/L), phosphorus of 1.7 mg/dl (0.55 mmol/L), serum creatinine of 2.2 mg/dl (194 mmol/L), and a high urine calcium. While the patient awaits surgery, the nurse should d. encourage the pt to drink 4000 ml of fluid daily.
d. encourage the pt to drink 4000 ml of fluid daily.
In a patient with central diabetes insipidus, administration of aqueous vasopressin during a water deprivation test will result in a d. increase in urine osmolality
d. increase in urine osmolality When vasopressin is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in blood pressure
A pt who uses every-other-day prednisone therapy for rheumatoid arthritis complains of not feeling as well on the non-prednisone days and asks nurse about taking prednisone daily instead. The best response to the pt is that d. there is less effect on normal adrenal function when prednisone is taken every other day.
d. there is less effect on normal adrenal function when prednisone is taken every other day.
What electrolytes/ values is Addison low in?
Everything except K (Na, H20, BP, and Blood Sugar)
What does a cushings syndrome diet look like?
Increased protein & K but decreased calories, carbs, Na.
What should you have at the bedside in case adrenal insuffiency arises?
Inderal (lowers BP/stress).
What values are Cushing's pts low in?
K only everything else is high (Na, H20, BP, BS)
What are the S&S of cushings syndrome? select all that apply
Moon face, hyperglycemia, purple striae, buffalo hump, GI distress, Na and fluid retention, everything increased except K (can have salt substitutes), and osteoporosis.
Can Cushing's patients have steroids?
NO because their blood sugar is already elevated.
Can Addison's pts have salt substitutes?
NO because they are straight potassium.
What are characteristics of an adrenal crisis?
Profound fatigue, dehydration, vascular collapse, renal shutdown, decreased serum Na, increased serum K.
What if the medical tx for cushings is unsuccessful?
Remove adrenal glands and turn into addisons patient (can control addisons with steroids)
The client has developed iatrogenic Cushing's disease. Which statement is the scientific rationale for the development of this diagnosis? 2. The client has been taking steroid medications for an extended period for another disease process
"Iatrogenic" means a problem has been caused by a medical treatment or procedure
The nurse is performing discharge teaching for a client diagnosed with Cushing's disease. Which statement by the client demonstrates an understanding of the instructions? 1. "I will be sure to notify my health-care provider if I start to run a fever."
. Cushing's syndrome/disease predis- poses the client to develop infections as a result of the immunosuppressive nature of the disease.
Which laboratory data make the nurse suspect the client with primaryhyperparathyroidism is experiencing a complication? 1. A serum creatinine level of 2.8 mg/dL.
1 . A serum creatinine level of 2.8 mg/dL indicates the client is in renal failure, which is a complication of hyperparathy- roidism.
The nurse is planning the care of a client diagnosed with Addison's disease. Which intervention should be included? 1. Administer steroid medications.
1 . Clients diagnosed with Addison's disease have adrenal gland hypofunction.
The client diagnosed with Addison's disease is admitted to the emergency department after a day at the lake. The client is lethargic, forgetful, and weak. Which intervention should the nurse implement? 1. Start an IV with an 18-gauge needle and infuse NS rapidly.
1 . The client was exposed to wind and sun at the lake during the hours prior to being admitted to the emergency department.
The client is admitted to rule out Cushing's syndrome. Which laboratory tests should the nurse anticipate being ordered? 2. Plasma levels of ACTH and cortisol.
2. The adrenal gland secretes cortisol and the pituitary gland secretes adrenocorticotropic hormone (ACTH), a hormone used by the body to stimulate the production of cortisol.
Which question should the nurse ask when assessing the client for an endocrine dysfunction? 2. "Have you had any unexplained weight loss?"
2. Weight loss with normal appetite may indicate hyperthyroidism.
Which sign/symptom indicates to the nurse the client is experiencing hyperparathyroidism? 2. A positive Chvostek's sign.
2. When a sharp tapping over the facial nerve elicits a spasm or twitching of the mouth, nose, or eyes, the client is hypocalcemic
The nurse writes a problem of "altered body image" for a 34-year-old client diagnosed with Cushing's disease. Which intervention should be implemented? 3. Use therapeutic communication to allow the client to discuss feelings.
3. Allowing the client to ventilate feelings about the altered body image is the most appropriate intervention.
The charge nurse of an intensive care unit is making assignments for the night shift.Which client should be assigned to the most experienced intensive care nurse? 3. The client diagnosed with Addison's disease who is lethargic and has a BP of 80/45, P 124, and R 28.
3. This client has a low blood pressure and tachycardia. This client may be experiencing an addisonian crisis
The client diagnosed with a pituitary tumor developed syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should the nurse implement? 2. Assess for nausea and vomiting and weigh daily.
2. Early signs and symptoms are nausea and vomiting.
