Health Alterations - LP2 Endocrine & Renal/Urinary

A client with a small nodule of the thyroid gland is to have a subtotal thyroidectomy and asks the nurse for clarification about what this surgery involves. Which information would the nurse include in a response to the question?

A small part of the gland is left intact

Which emergency equipment is most important for the inpatient unit nurse to have available for a client who underwent a subtotal thyroidectomy?

A tracheostomy tray

Which goal would the nurse expect a client receiving treatment for bacterial cystitis to achieve before their discharge from the hospital?

Achieve relief of clinical symptoms and maintain kidney function

Thyroid Gland

Anterior of trachea and inferior to the larynx. -Primary role is to increase metabolism -Secretes TH (T3 & T4), which is initiated by the release of TSH by pituitary gland and is dependent on adequate supply of iodine -Secretes calcitonin

-Partial or complete obstruction of urine flow -Decreased bladder compliance and contractibility -Urine retention

BPH Manifestations

Type 2 DM Goal

Best glycemic control -Diet and exercise -Oral medications -Possibly insulin injections

-Allows evaluation of kidney size, tumors, obstructions etc -Oral or IV contrast dye used to help visualize

CT of kidneys

Which sign is an associated complication of chronic kidney disease for a client undergoing peritoneal dialysis?

Cloudy return dialysate

-Ciprofloxacin -levofloxacin -sulfamethoxazole-trimethoprim

Common antibiotics for Cystitis

-Cranberry products -Blueberry juice -Herbal supplements (saw palmetto)

Complementary therapies for Cystitis/UTIs

-Used to evaluate kidney function -This is a by-product of the breakdown of muscle & excreted by kidneys -Normal value: 0.5-1.5 mg/dL

Creatinine

-Blood sample and 24-hr urine test used to evaluate GFR & renal function

Creatinine Clearance

-Inflammation of the urinary bladder -Most common UTI

Cystitis

What does ADH do?

Decreased urine production by causing the renal tubules to reabsorb water from the urine and return it to the circulating blood

What does calcitonin do?

Decreases excessive levels of calcium in the blood

What clinical manifestation would the nurse associate with benign prostatic hyperplasia?

Distention of the lower abdomen

Parathyroid glands

Embedded on the posterior surface of the lobes of they thyroid gland -Secrete PTH (parathyroid hormone)

What is the most common cause of hyperthyroidism?

Graves' Disease- (autoimmune disorder) Antibodies that bind to TSH receptors causing thyroid cells to hyperfunction -> oversecretion & enlargement

-Measures to prevent UTI -> hygiene, wiping front to back -Empty bladder frequently -S/S of UTI

Health promotion/education on UTI

A Nurse is providing dietary instructions to a client who is being treated with continuous ambulatory peritoneal dialysis (CAPD) for chronic glomerulonephritis. Which should the nurse include when discussing what the client needs?

High-quality protein

-Increased Calcium levels -Increased risk of kidney stones -Muscle weakness & atrophy -Pathologic fractures -Metabolic acidosis -Renal calculi -Polyuria -Abdominal pain -Constipation -Anorexia -Peptic ulcer formation -Dysrhythmia -Hypertenstion

Hyperparathyroid Manifestations

Which intervention would prevent urinary stasis and formation of renal calculi in an immobile client?

Increasing oral fluid intake to 2 to 3L/day

What does oxytocin do?

Induces contractions and also induces milk ejection

Thyroiditis

Inflammation of the thyroid gland -> results from viral infection of the thyroid gland -Inflammation -Increased TH effects

Urethritis

Inflammation of the urethra

-Onset: 2 hrs -Peak: 6-8 hrs -Duration of Action: 12-16 hrs

Intermediate-acting NPH insulin (Humulin N)

-Radiologic exam used to visualize the entire urinary tract to diagnose kidney disorders, stones, tumors, cysts -Can be performed alone or in conjunction with cystoscopy

Intravenous Pyelogram

Which information about benign prostatic hyperplasia is important for the nurse to consider when caring for a client with that condition?

It predisposes to hydronephrosis

Which statement by a client who has chronic kidney failure treated with continuous ambulatory peritoneal dialysis CAPD indicates understanding of the therapy?

It uses the peritoneum as a semipermeable membrane to clear toxins by osmosis and diffusion

The RN is caring for a client with renal calculi. To which health care professional will the RN delegate the task of administering oral medications to this client?

LPN

-Subnormal temp -Bradycardia -Weight gain -Decreased LOC -Thickened skin -Cardiac complications

Late Clinical Manifestations of Hypothyroidism

Stone formation

Lithiasis

What type of diet would the nurse recommend for a client who has renal calculi secondary to hyperparathyroidism?

Low calcium

Posterior pituitary gland

Made up of nerve tissue and it's primary function is to store and release ADH and oxytocin, produced in the hypothalamus

-Goiter -Fluid retention; edema -Decreased appetite -Fatigue, lethargy, listlessness -Intolerance to cold -Thick tongue/slow speech -Brittle nails & hair -Weight gain -Constipation -Dry skin (coarse & scaly) -Pallor -Hoarseness -Abnormal lipids -> high cholesterol levels

Manifestations of Hypothyroidism

-Symptoms will vary with size and location -Renal colic -> pain, severe flank pain on associated side -UTI, chills, frequency, urgency -N/V

Manifestations of Urinary Calculi

-Dysuria (painful or difficult urination) -Urgency (sudden need to void) -Nocturia (voiding 2 or more times at night) -Pyuria (foul odor & appears cloudy) -Hematuria (bloody urine) -Super pubic pain, tenderness

Manifestations of cystitis inflammatory process

-Hyperactive bowels; healthy appetite but weight loss -Hyper metabolism -Heat intolerance -Hand tremors -Insomnia; emotional liability -Palpitations -Increased sweating -Bulging eyes -Tachycardia -Finger clubbing -Fine, straight hair

Manifestations of hyperthyroidism

-Numbness & tingling round mouth & fingers -Spasms & tetany (Chvostek & Trousseaus) -Brittle nails -Hair loss -Dry, scaly skin -Abdominal cramps & malabsorption -Paresthesias of the lips, hands, and feet -Mood disorders (irritablity, depression, anxiety) -Hyperactive reflexes -Psychosis -Increased intracranial pressure -Dysrhythmias

Manifestations of hypoparathyroidism

Stone in kidney

Nephrolithiasis

-Mucosa of bladder becomes red -Hemorrhage or bleed -Inflammatory response -> pus formation

Pathophysiology of Cystitis

Endocrine System is composed of what?

Pituitary gland, thyroid gland, parathyroid glands, adrenal glands, pancreas, and reproductive glands

-Measures amount of urine left in the bladder after voiding -Normal value: <50mL

Post void residual

-Vitals & assessment -Assess pt's knowledge of procedure -Signed consent -Ensure NPO

Pre-Op care for calculi surgery

Thyroid Crisis (storm) Treatment

Rapid treatment = preserving life -Cool them -Replace fluids -Check glucose/electrolytes -Stabilize cardiac and respiratory function -Reduce TH secretion

Subtotal thyroidectomy

Removal of most of the thyroid to relieve hyperthyroidism. Remaining tissue usually supplies enough TH for normal function.

-Used to determine the cause of renal disease -Rule out cancer -Check for metastasis -Performed via excision or needle bx

Renal Biopsy

-Nocturia (voiding 2 or more times at night) -Decreased bladder capacity -Urinary Retention -> behavior changes, UTI -Weakened sphincter muscles & shortened urethra in women -Incontinence

Renal/Urinary changes with aging

What does LH and FSH do?

Reproductive hormones that stimulate the ovaries and testes

Anterior pituitary gland

Secrete hormones such as: -Growth hormone -Prolactin -TSH (thyroid stimulating hormone) -LH (luteinizing hormone) -FSH (follicle-stimulating hormone) -ACTH (adrenocorticotropic hormone)

Posterior pituitary gland

Secretes ADH(antidiuretic hormone) & oxytocin

-Onset: 0.5-1.0 hrs -Peak: 2-3 hrs -Duration of Action: 4-6 hrs

Short acting Regular insulin (humulin-R)

Adrenal gland

Sits on top of the kidneys Produces hormones: epinephrine, norepinephrine, and corticosteroids

Trousseau's sign

Test for hypocalcemia Results in tetany (tonic muscle spasms) by inflating a blood pressure cuff about the antecubital space to a point greater than systolic BP for 2-5 min. *Normal finding is NO carpal spasm in response to compression*

Chvostek Sign

Test for hypocalcemia Spasm of the facial muscles produced by sharply tapping over the facial nerve in front of the parotid gland and anterior to the ear. *Normal finding is NO facial grimacing in response to tapping*

Which complication would the nurse be concerned about if there is removal of the parathyroid glands during thyroidectomy?

Tetany

What happens when TH production decreases?

Thyroid gland enlarges to attempt to produce more hormone -> goiter

-Examines the constituents of urine -Establishes baseline -Provide data for diagnosis -Monitor treatment results

Urinalysis

What is Hemodialysis?

-A technique in which an artificial kidney machine removes waste products from the blood -Blood passes through a semipermeable membrane filter outside of the body and once it's been filtered it's returned to the body -Fistula is the method of choice

S/S of Hyperglycemia

-Blood glucose >200 mg/dL -Polyuria -Polydipsia -Polyphagia -Headache -Blurred vision -Dizziness -Irritability -Tachycardia -Sweating -Weakness/fatigue

S/S of Diabetic Ketoacidosis

-Blood glucose level >250 mg/dL -Fruity breath -Kassmaul respirations (increased rate & depth w/longer expiration) -Classic symptoms of hyperglycemia

Parathyroid Tests

-Calcium -Hypocalcemia - tingling sensations

Hypothyroidism Diagnosis

-Clinical manifestations -Decrease in TH -TSH is increased -Elevated LDL, triglycerides -Same laboratory diagnostic tests as Hyperthyroidism

The nurse would monitor a client for which manifestations indicating thyroid storm? SATA

-Increased HR -Increased temp

Which metabolic manifestations are likely to be observed in a client with hypothyroidism?

-Intolerance to cold -Decreased body temperature

Hypothyroidism Causes

-Iodine deficiency -> iodine is necessary for TH synthesis -Some medications -Hashimotos Thyroditis -> most common cause of goiter & hypothyroidism; autoimmune -> antibodies destroy thyroid tissue, replaced with fibrous tissue -> TH level decreases -Myxedema Coma -> complication of long standing, untreated hypothyroidism; severe metabolic disorders -> hyponatremia, hypoglycemia, & acidosis

What are the functions of the renal system?

-Kidneys ->Contains nephrons which process the blood to make urine -> filtration system -Ureters, bladder, and urethra -> transport urine from kidney -> to excrete from body

S/S of Hypoglycemia

-Low blood glucose <70 mg/dL -Hunger -Nausea -Anxiety -Pale, cool skin -Sweating -Shakiness -Irritability -Rapid pulse -Hypotension -Headache -Difficulty thinking -Decreased LOC

What is Continuous Bladder Irrigation (CBI)?

-Ongoing instillation of solution of gravity; sterile irrigation; 3- way catheter -Used to prevent the formation of blood clots after surgery, especially prostatectomy

S/S of Microvascular complications of DM

-Paresthesias (tingling, burning, prickling sensations)

How to diagnose BPH?

-Physical examination and PSA (prostate-specific antigen) levels -Increasing levels of PSA -> need further investigation and review of symptoms -Digital rectal examination (DRE) -Creatinine levels -Urinalysis for WBCs, RBCs, and bacteria -Residual urine -Subjective data

Secondary Hypothyroidism

-Pituitary TSH deficiency or peripheral resistance to TH

Pre-Dialysis Care

-Pre-vitals -weight -check vascular access

Toxic Multinodular Goiter

-Thyroid tumor characterized by small nodules, that secretes excessive TH -> manifests similar to hyperthyroidism -Cause unknown but genetic mutation -Common in post-menopausal women -Do not develop exophthalmos or dermopathy -Treatment involves radioactive iodine or surgery

-Phenazopyridine

-Urinary analgesic for Cystitis -Used for relief of pain, burning *patient education: can turn urine red/orange and can stain underwear; follow up in 10 days to 2 weeks with provider

Hyperparathyroidism Diagnosis

-excluding all other possible causes of hypercalcemia -At lease 6 months history of manifestations -Serum calcium and PTH levels

What is normal Creatinine?

0.5-1.2 mg/dL

What is normal BUN?

10-20 mg/dL

What is normal platelet count?

150,000-400,000/mm3

What is normal WBC count?

4,500-10,000/mm3

-Used to determine renal function and elimination of nitrogenous waste. -Urea rises in AKI and CKD. -Normal value: 5-12mg/dL

BUN

While obtaining a clients health history which factor would the nurse identify as predisposing the client to type 2 diabetes?

Being 20lbs overweight

Which condition would the nurse suspect in a client who complains of nocturia, bladder pain, urinary frequency, urgency and dribbling at the end of urination with a digital rectal examination report indicating smooth, firm and enlarged prostate tissue surrounding the urethra?

Benign prostatic hyperplasia (BPH)

Myxedema (edema throughout the body)

Chronic, untreated hypothyroid state in adults -Characteristic accumulation of nonpitting edema in connective tissues throughout body -Face = puffy; tongue is enlarged; voice is hoarse and husky

-Obstruction of urine flow; impairs renal function -Hydronephrosis ->distention of the renal elvis and calyces -Urinary Stasis with subsequent infection

Complications of Urinary Calculi

-Urinalysis -Urine culture & sensitivity -WBC -IVP -Cystoscopy

Cystitis Diagnosis

-Direct visualization of bladder wall and urethra -Can obtain tissue bx -Stents can be places -Removal of calculi -Assess for obstruction

Cystoscopy

Which intervention would be included in the plan of care for a client admitted to the hospital with primary hyperparathyroidism?

Ensure a large fluid intake

A child with type one diabetes is receiving 15 units of regular insulin and 20 unites of NPH insulin at 7:00 am each day. Which time would the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur?

In the afternoon

What does the thyroid-stimulating hormone test do?

In this blood test, levels of circulating TSH are measured, with levels above or below normal indicating thyroid disease. TSH levels are also compated with T4 levels to differentiate between pituitary and thyroid dysfunction. Normal value: <3 ng/MI T4: 1.0-2.3 (looks at thyroid vs. pituitary) decreased in both = pituitary issues T3: 80-200

Pancreas

Located behind the stomach between the spleen and the duodenum - both endocrine gland and exocrine gland -Produces hormones and digestive enzymes -Regulate carbohydrate metabolism -Alpha cells & Beta cells

-Onset: 1.1 hrs -Peak: 3-4 hrs -Duration of Action: 10-24 hrs

Long-acting Glargine (lantus) **NEVER mix - SubQ only**

What does the thyroid scan do?

Nuclear scan evaluates thyroid nodules. Radioactive isotopes are given orally and a scanner is passed over the thyroid to make a graphic record of the radiation emitted. Benign lesions appear as warm spots; malignant tumors appear as cold spots

Before administering contrast dye, what labs are important to know?

Nurses should know the BUN and creatinine levels because contrast dye is contraindicated in renal failure or any type of disease where creatinine and BUN are increased

-Vitals & assessment -Monitor urine -> amount, clarity, and color -Some amount of bleeding is normal and should diminish within 48 hrs -Encourage fluids -Stent education -Pain medication -Stent removal

Post-Op care for calculi surgery

What do Alpha cells do?

Produce glucagon - decreases glucose oxidation and promotes an increase in the blood glucose level

What do Beta cells do?

Produce insulin - which facilitates the uptake and use of glucose, thus, decreased blood glucose levels

The nurse teaches the client about endocrine function of part of the image labeled A. Which information from the client indicates successful learning?

Promotes growth

Which assessment in a female client suggests an abnormal endocrine finding?

Protruding eyes

What does the Radioactive iodine uptake test do?

Provides a direct measure of thyroid activity and is useful in evaluating the activity of solitary thyroid nodules. Radioactive iodine is given orally or IV, and the thyroid gland uptake is measured with a scanner at several hours intervalls -Normal value for uptake: 2-4 h: 3%-10% 24 h: 11%-30%

-Onset: 0.25hrs -Peak: 1-1.5 hrs -Duration of Action: 3-4 hrs

Rapid-acting -> needs to be eating within 15 min. Lispro (humalog)

What does the adrenal cortex do?

Secretes corticosteroids

What does growth hormone do?

Stimulates growth of the body by signaling cells to increase protein production and by stimulating the epiphyseal plates of the long bones

What does prolactin do?

Stimulates the production of breast milk

What does ACTH do?

Stimulates the release of hormones, especially glucocorticoids, from the adrenal cortex

What does TSH do?

Stimulates the thyroid to release T3 and T4

Urinary Calculi

Stones in the urinary tract

Pituitary Gland

The "master gland" of the body's hormone-producing system, which releases hormones that direct the functions of many other glands in the body

A 10-year-old child is diagnosed with lymphocytic thyroiditis (Hashimoto disease) and develops goiter. Which education would the nurse provide to the parents and child about this condition?

The child may need thyroid replacement

Oral Glucose Tolerance Testing (OGTT)

This blood and urine test is used to diagnose DM if prior fasting blood sugar findings are increased or inconsistent. A solution of 75-100 g of glucose is administered and samples of blood and urine are taken immediately and at 30, 60, and 120 min. Normal value: Values for 2hr plasma at 139 or below are considered normal

Glycosylated hemoglobin (Hgb A1c)

This blood test is used as a diagnostic tool and to monitor DM management. The results represent an average blood glucose level during the life of the red blood cell (90-120 days); an elevated level indicates poorly controlled DM and increased risk for complications. Average blood glucose level from 120 days. Normal value: 2-5%

Calcium Test

This blood test is used to check for serum calcium excess of deficit in parathyroid and bone disorders and to monitor calcium levels. - Normal values: 9.0-11.- mg/dL

Parathyroid hormone test

This blood test is used to identify hypoparathyroidism or hyperparathyroidism and is also used to monitor response to PTH therapy Normal value: Intact PTH: 11-54 pg/mL C-terminal PTH: 50-330 pg/mL N-terminal PTH: 8-24 pg/mL

Fasting blood sugar test

This blood test is used to identify or confirm a diagnosis of diabetes mellitus. It is also used to monitor treatment of DM. A finding of greater than 100 mg/dL, if confirmed with OGTT, and HbA1c is indicative of diabetes. Normal value: Serum/plasma: 70-110 mg/dL

How to calculate net urine outpute

Total amount emptied from drainage bag (foley bag) - Amount of irrigation solution that has been instilled -CNA empties 2500 mL from foley bag -Irrigation bag started with 3000 ml, current amount of solution left in irrigation bag is 1500mL -What is your net urine output? 3000 - 1500 = 1500 solution in patient 2500-1500 = 1000mL net urine

-Assess pain, location, severity, and intervene -Pain relief *#1 intervention*, positioning, relaxations techniques -Strain urine: passing of stone is possible -> leads to relief of pain -Procedures (if pt can't pass stone) -> Extracorporeal shock wave lithotripsy; Ureteral stent -Surgically removing the stone

Urinary Calculi Treatment

-Conducted to identify causative organism of UTI -Normal: <10,000 organisms/mL -Values >100,000 organism/mL indicate UTI

Urine Culture

Stone anywhere else in urinary tract

Urolithiasis

-Mahurkar (temporary) -AV fistula (permanent) -> palpable pulsation and bruit on auscultation -> avoid vein punctures, BPs, or lab draws on this side **LIMB ALERT**

Vascular access needed for hemodialysis

Which action would the nurse take before a clients scheduled hemodialysis treatment?

Weigh the client to establish a baseline for later comparison

Manifestations of Graves' disease

- Goiter - Exophthalmos (forward protrusion of the eyeballs) - Fatigue - Difficulty sleeping - weight loss - heat intolerance

Hypothyroidism Nursing Considerations

-Adequate iodine, low-fat -Medications (levothyroxine) are lifelong

Thyroidectomy Pre-op care

-Administer ordered antithyroid meds and iodine preparations -Teach pt to support neck by placing both hands behind neck when sitting, moving about, and coughing -Answer questions and allow time for pt to verbalize concerns -Teach pt to expect hoarseness due to generalized swelling at suture line

Benign Prostatic Hyperplasia (BPH)

-Age-related, nonmalignant enlargement of the prostate gland -Common disorder of the aging male -Benign hyperplasia ->increased number of cells

Type 2 DM Treatment

-Antidiabetic medication: Glipizide, glimepiride, metformin -Insulin -Goal is to see glucose improvement

How do we treat Hyperthyroidism

-Antithyroid medications - reduce TH production -Cardiac manifestations -> beta blocker "olol" -Therapeutic results - takes several weeks to achieve desired result -Radioactive Iodine therapy

Post Dialysis for Peritoneal

-Assess vitals -> temp, weight -Educate patient on self-administration

Primary Hypothyroidism (more common)

-Congenital defects in the gland -Loss of thyroid tissue following treatment for hyperthyroidism w/surgery or radiation, antithyroid medications, Hashimoto thyroiditis, or endemic iodine deficiency

Radioactive Iodine Therapy

-Damages and destroys thyroid cells so less TH is produced -Oral medication -6-8weeks for therapeutic results -contraindicated in pregnancy -Destroys tissue and cannot be regulated -> pt may develop hyPOthyroidism and require lifelong TH replacement

Hyperparathyroidism Treatment

-Decreasing serum calcium levels -Increase fluid intake -Medication to inhibit bone reabsorption and reduce hypercalcemia -> alendronate, Calcitonin

Hyperthyroidism (thyrotoxicosis)

-Disorder caused by excessive delivery of thyroid hormone (TH) to tissues -Excessive TH = increased metabolic rate throughout the body

Hypothyroidism

-Disorder that results when the thyroid gland produces an insufficient amount of TH -Decreased metabolic rate and heat production -Affects ALL body systems -Slow onset

Exercising with DM

-Exercise with DM, increases the uptake of glucose, potentially reducing the need for insulin. -Type 1 DM should make modifications in diet and insulin doses surrounding exercise -Type 2 DM, exercise may reduce the need for oral hypoglycemic agents if it can be maintained

Thyroid Crisis AKA Thyroid Storm

-Extreme state of hyperthyroidism -Occurs less now d/t diagnostics & treatments -Occurs d/t untreated hyperthyroidism or extreme stressors -***LIFE THREATENING*** -Rapid increase in metabolic rate

Pancreatic/Endocrine Tests

-Fasting blood sugar (FBS) -Oral glucose tolerance testing (OGTT) -Glycosylated hemoglobin (Hgb A1c)

Type 1 Diabetes Risk Factors

-Genetic predisposition -Environmental factors -> viral infection (mumps, rubella, or coxsackievirus B4), or a chemical toxin (smoked/cured meat).

Levothyroxine sodium (Hypothyroidism)

-Give 1 hour before, or 2 hours after meals -If pt is on anticoagulant, monitor for bruising, bleeding gums, and blood in urine -**Monitor for toxicity** -> severy anxiety -LIFELONG medication -If pt is diabetic, monitor closely as amount of insulin may need to be adjusted

Treatment for Hypoglycemia

-Glucagon -Rapid-acting carbohydrate -IV solution 50% glucose

DM Self Monitoring

-Goal is to achieve metabolic control & decrease complications

What is Kidney failure?

-Gradual decrease in kidney function -Leaves to metabolic waste being collected in the blood -Leads to altered fluid, electrolyte, and acid-base balance

Type 2 DM Manifestations

-Gradual onset -Hyperglycemia - but not as severe d/t presence of insulin -Polyuria & polydipsia -Blurred vision -Fatigue -Paresthesias -Skin infections -Ketoacidosis

Components of Assessing the Renal System

-Health hx interview ->Assess urinary elimination status -> focus questions on changes in patterns or urination, changes in urine, and pain -> assess for dysuria, lifestyle, diets, exposure to toxic environments, medications -Genetic considerations -> family hx bladder cancer, chronic kidney failure, diabetes, polycystic kidney disease -Physical Assessment -> percussion of kidneys, skin, abdomen, kidneys, bladder, and urinary meatus -> obtain clean catch urine sample and inspect for color, odor, and clarity before sending to lab -> Pain?? What type? -Diagnostic tests

DM Nutrition

-Healthy Carbs ->grains, legumes, fruits, and veggies -Protein -> low in sat. fat & cholesterol -> fish, lean poultry, egg whites, & beans -Fats -> limited and low sat., trans, and cholesterol -> consume healthful fat: peanut oil, olive oil, avocados, nuts & seeds, fish oils -Fiber ->Soluble fiber: dried beans, oats, barley, and some vegetables and fruits -> Insoluble fiber: wheat, corn, carrots, brussel sprouts, eggplant, pears, apples, strawberries -Sodium -> Table salts and processed foods high in sodium should be avoided in the DM meal plan -Sweeteners -> Artificial sweeteners/sugar alternatives should be used in moderation and nurses should educate the meaning of terms such as sugar free and dietetic on labels -Alcohol -> Drinking with DM is not encouraged, but is not totally prohibited. Alcohol consumption may ptentiate the hypoglycemic effects of insulin and oral agents ->light beer is the recommended alcoholic drink and should be consumed with meals and added to daily food intake

DM Diagnosis

-Hemoglobin A1c: Normal -> 2-5%; Prediabetes/high risk -> 5.7-6.4%; Diagnostic for diabetes -> 6.5% or higher -Fasting Plasma: >126 is diagnostic -Oral Glucose Tolerance Test: > 200 -Urine Test: looking for glucose, ketones, and albumin in the urine

Type 2 DM Risk Factors

-Heredity -Hx of DM in parents or siblings -Obesity - at least 20% over desired body weight or having a BMI of at least 27 -Physical inactivity -Race/Ethnicity -In women, a hx of GDM, polycystic ovarian syndrome, or delivering a baby over 9lbs -Prediabetes (impaired glucose tolerance) and metabolic syndrome

Diabetes Complications

-Hyperglycemia -Hypoglycemia -Diabetic Ketoacidosis -Macrovascular Complications -Microvascular Complications Increased susceptibility to infection -Delayed/non-wound healing

Type 2 Diabetes

-Hyperglycemia despite insulin: insulin is available but impaired function -Most common form of DM -Most common in middle age and older people -Liver produces more glucose, carbs not metabolized well, pancreas secretes less than adequate insulin

Manifestations of Thyroid crisis (storm)

-Hyperthermia -tachycardia -hypertension -dyspnea -GI distress -Seizures -Anxiety -Agitation

What are manifestations of TURP syndrome?

-Hyponatremia -Decreased hematocrit -Hypertension -Bradycardia -Nausea -Confusion

Which efforts does increased parathyroid hormone have on bones and electrolytes? Select all that apply

-Increased bone breakdown -Increased serum calcium levels -Increased net release of calcium and phosphorus

What does PTH do?

-Increases blood calcium levels -Controls phosphate metabolism

What does epinephrine do?

-Increases blood glucose levels and stimulates the release of ACTH from the pituitary -Increases the rate & force of cardiac contractions -Constricts blood vessels in skin, mucous membranes, and kidneys -Dilates blood vessels in the skeletal muscles, coronary arteries, and pulm. arteries

What does norepinephrine do?

-Increases heart rate and BP -Vasoconstricts blood vessels throughout the body

Hypoparathyroidism Treatment

-Increasing Ca levels -IV calcium gluconate will reduce tetany -Long-term therapy includes supplemental calcium, increased dietary calcium, and vitamin D therapy

S/S of Macrovascular complications of DM

-Loss of hair on lower leg, feet, and toes -Atrophic skin changes: shininess and thinning -Cold feet -Feet and ankles darker than leg -Dependent rubor, blanching on elevation -Thick toenails -Diminished or absent pulses -Nocturnal pain -Pain at rest, relieved by standing or walking -Intermittent claudication (pain) -Patchy areas of gangrene on feet and toes

Hypoparathyroidism Diagnosis

-Low serum calcium levels -High phosphate levels (in absence of renal failure, an absorption disorder, or a nutritional disorder)

What causes kidney failure?

-May be primary kidney disorder -May occur secondary to a systemic disease or other urologic defects -Hypertension -Diabetes -Infection -Overdose -Nephrotoxic drugs -Renal calculi

Health assessment interview - endocrine

-Medical hx -Social hx -Family hx -Diet/lifestyle -Eating habits, urinary habits

BPH Treatment

-Medications to decrease size of prostate: -Finasteride -Dutasteride -Medications to relieve obstruction and help increase urine flow -Terazosin -Tamsulosin -Surgery -Transurethral Surgery (TURP) Resection of Prostate -Obstructing tissue removed -Open Procedures: for more invasive concerns

Diabetes Mellitus

-Metabolic disease characterized by hyperglycemia -Results from: defects in secretion of insulin and/or action of insulin -Type 1: Beta cells destroyed - insulin deficiency -Type 2: Insulin resistance, insulin deficit

Hyperthyroidism Nursing Considerations

-Monitor & reduce risk for heart failure -Monitor vision changes -Limit weight loss -Monitor anxiety and mood disorders

What is the priority outcome for Diabetes Mellitus?

-Most effective way at preventing complications -Keeping blood glucose levels controlled at or near normal levels

What is Dialysis?

-Movement of fluid/molecules across a semipermeable membrane from one compartment to another -Used to remove excess fluid and metabolic waste products in acute kidney injury (AKI) and renal failure. -Blood is separated from a dialysis solution (dialysate)

How is Hyperthyroidism diagnosed?

-Presentation of manifestations -Elevated TH (t3&t4) -Decreased TSH - low because pituitary gland will try to compensate for high TH -> stop producing TSH to stop production of TH -Increased radioactive iodine (RAI) uptake -Thyroid scan - nodules, tumors

Thyroidectomy Considerations

-Prior to surgery, the pt should be in as nearly a euthyroid (normal function) state as possible -Use of antithyroid drugs/iodine preparations -Decreases vascularity and size of gland prior to surgery - reducing risk of hemorrhage

What is Diabetic Ketoacidosis?

-Profound deficiency of insulin characterized by hyperglycemia, ketosis, acidosis, and dehydration. Fat sores are broken down as a secondary source of fuel, producing ketones- a byproduct of fat metabolism that causes serious problems when they accumulate in the blood and the pH balance is altered causing metabolic acidosis. -**Life-threatening if left untreated** -Primarily in T1D

Thyroid Tests include

-Radioactive Iodine Uptake (RIA) -Thyroid scan -Thyroid-stimulating hormone

Hypothyroidism Treatment

-Replace TH hormone (medications) -Surgery -> goiter, respiratory issues, dysphagia

Type 1 DM Treatment & Monitoring

-Requires insulin injections for LIFE -No oral hypoglycemic medications -Self-monitoring blood glucose -Urine Ketone tests

Type 1 DM Manifestations

-Result from the lack of insulin -> glucose is not transported to the cells, rather accumulate in circulating blood -3 P's -> polyuria (frequent urination), polydypsia (increased thirst), polyphagia (excessive hunger) -Weight loss -Fatigue -Malaise -Blurred vision -Ketoacidosis

Hypoparathyroidism

-Results from abnormally low PTH levels -Most common cause: damage to or inadvertent removal of all of the parathyroid glands during thyroidectomy -Issues with hypocalcemia -Issues with hyperphosphatemia

Hyperparathyroidism

-Results from an increase in the secretion of PTH, which regulates normal serum levels of calcium -Affects the kidneys and bones ->increased resorption of calcium and excretion of phosphate -Issues with hypercalcemia -Issues with hypophosphatemia -Increased risk of metabolic acidosis and hypokalemia -bone decalcification -> formation of renal calculi

DM Treatment Education

-S/S of hypoglycemia -Aspirin therapy r/t cardiovascular complications/disease -Nutrition -Protein -Fat -Carbohydrates -Alcohol -Obesity and Eating Disorders -Exercise -Stress Management -Assessment of Efficacy

Thyroidectomy Post-op care

-Semi-fowlers position -Respiratory distress -> rate, rhythm, depth, & effort, maintain humidification as ordered, assist with C&DB, have suction equip., O2, & a tracheostomy set bedside -Hemorrhage -> assess dressing and area behind & under neck & shoulders for drainage. Monitor BP and pulse for hypovolemic shock. Assess tightness of dressing -Laryngeal nerve damage -> Assess ability to speak aloud; quality and tone. Tetany -> Assess for manifestations of latent tetany d/t calcium deficiency; tingling of toes, fingers, & lips; muscular twitches; +Chvostek & Trousseau signs; and decreased serum calcium levels. Keep calcium gluconate or calcium chloride available for immediate IV use

Physical assessment - endocrine

-Skin changes - color, even, appropriate for age/race -Nail & hair - normal texture, distributed evenly, normal for sex; nails should have even color w/smooth surfaces -Facial - symmetry, acromegaly (abnormal bone growth), hypersecretion, exophthalmos (protruding eyes - hyperthyroidism) -Palpate thyroid gland - looking at size and consistency -Motor & sensory - DTR, neuropathy, altered sensations -Musculoskeletal - side and proportion of body structure -Trousseau's & Chvostek's sign

If left untreated, what can happen with cystitis?

-Spread to kidneys -Cause ulcer formation or systemic spread -Urethritis (inflammation of urethra)

S/S of Hyperosmolar Hyperglycemic State (HHS)

-T2D -Blood glucose >400 mg/dL -Hypotension -Increased pulse -Lethargic -Increased thirst & fluid intake -N/V -Polyuria -Decreased LOC -Weight loss -Malaise -Seizures -Electrolyte imbalance

The nurse educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medications. Which instruction would the nurse include in the teaching plan?

-The client should obtain a finger-stick blood glucose reading before each meal -The teaching plan should include s/s of hypoglycemia -The teaching plan should include sick day rules.

Thyroidectomy (surgery)

-Thyroid gland is so enlarged that pressure on the esophagus or trachea causes breathing/airway obstruction -Subtotal thyroidectomy -Total when there is cancer of thyroid = requires lifelong TH replacement

What is Peritoneal dialysis?

-Uses the peritoneum surrounding the abdominal cavity as the dialyzing membrane -Fluid shift of solutes are more gradual in comparison -> less risk for unstable patients -> more flexibility -If dialysate comes back cloudy it could mean infection!!

Post Dialysis Care

-Vitals -Post weight -Monitor labs -> BUN, creatinine, electrolytes (Na, K+, Ca) -Assess site for bleeding

Pre Dialysis for Peritoneal

-Vitals & weight -Abdominal girth -Empty bladder prior -Dialysate is warmed to prevent hypothermia

DM Sick Day Management **Still requires insulin**

-When a pt w/DM is sick or has surgery, blood glucose levels increase d/t high metabolic needs -Monitor blood glucose as much as every 2-3 hrs -Test urine for ketones as often as q4h -Continue to take insulin (may switch to sliding scale) or oral hypoglycemic agent and adding correctional insulin doses as prescribed -Consume many clear liquids (no caffeine) -Call HCP if pt has fever for 2 days, V/D last for more than 6 hours or cannot keep fluids dow, if glucose is way out of range, if urine ketones are moderate or large, or if there are any signs of dehydration

What is the normal serum calcium concentration?

8.6-10.2 mg/dL