Endocrine

A client post thyroidectomy has been taking levothyroxine in increasing doses over the past week. Which findings, if present, would indicate to the nurse that the drug dosage is too high? Select all that apply. 1. Irritability 2. Wt. gain 3. Tachycardia 4. Tremors 5. Headache 6. Bradycardia

1,3,4,5 Rationale: if dose is too high, they will experience these same symptoms as hyperthyroidism 2. wt. gain is symptom is for decreased hypothyroidism 6. hypothyroidism symptom

A client who has diabetes calls the nurse hot-line reporting shakiness, nervousness, and palpitations. Which questions would yield info that would help the nurse decide that this is a hypoglycemic episode? Select all that apply. 1. What have you eaten today and at what times? 2. Are you using inuslin as a tx. of diabetes, and if so, what kind? 3. Do you feel hungry? 4. Do you have access to a glucose monitor to check your current glucose level? 5. Does your skin feel hot and dry?

1,2,3,4 Rationale: 1. give nurse info on how much time its been since last meal and indicate the amount of protein and carbs they are eating 2. Duration of action and peak is important for the insulin used 3. Hunger is a symptom of hypoglycemia 4. glu level could determine what needs to be done next 5. indicator of hyper

What medications would the nurse anticipate for the tx. of hyperthyroidism? Select all that apply. 1. Levothyroxine 2. Methimazole 3. Propranolol 4. Iodine compounds 5. Calcitonin

2,3,4 Rationale: 2. it decreases production of thyroid hormones, used to stun thyroid and "halt it" to temporarily stop producing hormones 3. beta blocker that decrease HR and anxiety, these will be increased in hyperthyroid client 4. decreased size and vascularity of thyroid gland, decreased bleeding and hemorrhage 1. would make it worse, synthetic form of T4 5. thyroid hormone too, don't need more

The nurse is caring for a client diagnosed with Addison's disease. Which finding would indicate to the nurse that a client has received excessive mineralcorticoid replacement? Select all that apply. 1. oily skin 2. wt. gain of 4 lbs in one week 3. loss of muscle mass in extremities 4. BG of 58 5. Serum K of 3.2

2,5 Rationale: 2. aldosterone is a mineralcorticoid which causes retention of sodium and water so wt. increases 5. too much aldosterone makes you retain too much Na and H20, so you lose K 1. False, oily would result in increase in sex hormones (testerone and estrogen) 3. and 4. False because these go with glucocorticoids

Too little hormones produced by adrenal glands results in...

Addison's Disease

The charge nurse has received report from the ED about a client diagnosed with Cushing's disease being admitted to the unit. Which client in a semi-private room would be appropriate for the charge nurse to have this client share? 1. client who has leukemia 2. client diagnosed with gastroenteritis 3. client who has a fractured hip 4. client diagnosed with bronchitis

3 Rationale: 1. more immunosuppressed than cushings client 2. and 4. risk of infection

A middle-aged client has a strong positive fam hx. of type 2 dm. What should the nurse teach the client regarding the best method to prevent or delay the development of this disease? Select all that apply. 1. test serum glucose values monthly 2. avoid starches and sugars in the diet 3. obtain a normal body weight 4. maintain a normal serum lipid panel 5. exercise regularly

3,5 Rationale: Exercise helps move glucose into the cell, so regular exercise will help to reduce insulin resistance. 1. wont delay it 4. wont help delay it 2. cant avoid these in diet

What is the priority assessment for a client post-op thyroidectomy? 1. mental status changes 2. carpal spasm 3. patency of airway 4. pain at incision site

3. Rationale: ABCs thyroidectomy - bleeding around incision cause pressure around airway, laryngeal nerve damage could cause vocal cord paralysis and close the airway, hypocalcemia can affect airway causing stridor making breathing difficult

A client is being admitted with new onset hyperthyroidism. Which medication is of concern to the nurse while reviewing the client's routine medications? 1. Cimetidine 2. Furosemide 3. Amiodarone 4. Propanolol

3. Rationale: Amio is a high alert drug that treats arrhythmias. However, amiodarone also can cause thyroid disfunction because of its high iodine content and its direct toxic effect on the thyroid. 1 and 2 have nothing to do with hyperthyroidism. 4 is a beta blocker and is given to hyperthyroid clients to decrease myocardial contractility, bp, and HR.

The nurse is caring for a controlled type 2 diabetic. Lab results include a BUN of 22 and a Cr of 1.9. The nurse checks a BS and it is 218. The client is currently taking metformin and exenatide. What is the priority concern because the client is taking metformin? 1. metformin is not controlling the BS 2. metformin can cause GI complaints 3. metformin can cause a decrease in appetite 4. metformin is contraindicated with an elevated Cr level

4 Rationale: metformin is eliminated by the kidneys

pharmacologic iodine

Cause temporary slowing of iodine uptake by the thyroid Very concentrated solutions

Too many hormones produced by adrenal glands results in...

Cushing's Disease Conn's Disease

Common cause of hyperthyroidism

Grave's disease (autoimmune disorder)

What do we need to make thyroid hormones? (T3, T4, calcitonin)

Iodine

Type 2 DM

Sedentary lifestyle & excess wt. sick pancreas cannot utilize glucose tx. with diet and exercise oral hypoglycemics and/or insulin HHNK

What are the main thyroid hormones?

T3, T4, calcitonin

gestational diabetes

a form of diabetes mellitus that occurs during some pregnancies; type 2 dm

A client presents to the stat care clinic stating that they have been experiencing diarrhea and feeling flushed and hot. The client also reported having recently lost weight. The wife reports that he can't remember anything and is short tempered. Vital signs are BP 182/100, Pulse 120, Respirations 18. Lab data indicates that the T3 and T4 levels are elevated. The client is diagnosed with hyperthyroidism.

background

Type 1 DM

early onset insulin dependent sick pancreas cannot utilize glucose DKA

dietary iodine

essential component of thyroid hormones T3 and T4

iodine foods sources

iodized salt dairy products seafood meat some breads eggs

What is basal/bolus insulin dose?

long acting insulin daily AND rapid acting insulin with meals

S/S of hyperthyroidism

nervous weight loss sweaty/hot exophthalmos decreased attention span increased appetite irritable increased BP enlarged thyroid increased GI motility

Metformin (Glucophage)

oral hypoglycemic class: biguanide major se: increased gastric emptying...diarrhea! first line oral hypoglycemic