Combo with "Chapter 48: Endocrine System (Nursing Assessment)" and 2 others

When the cause of hypoglycemia is organic and the effects mild, treatment usually consists of which of the following interventions?

A higher intake of protein and a reduction in carbohydrate intake will usually relieve hypoglycemic symptoms as long as they are organic in origin and the effects mild. - A higher intake of protein - A lower intake of carbohydrates

The outer part of the adrenal gland that secretes more than 50 steroid hormones is called:

Adrenal Cortex

The inner core of the adrenal gland that consists of sympathetic postganglionic neurons is called:

Adrenal medulla

Catecholamines bind to __________ receptors on cells.

Adrenergic

What hormone stimulates the adrenal cortex to secrete corticosteroids?

Adrenocorticotropic hormone

an important mineralocorticoid that maintains extracellular fluid volume by promoting the retention of sodium ions and the excretion of potassium and hydrogen ions from the body.

Aldosterone

Feedback that involves communication via hormones among several glands to turn on or turn off target organ hormone secretion.

Complex feedback

What information doses the nurse expect to include when tacking a patient with diabetes type 2 about glyburide (Micronase, DiaBeta, Glynase)?

Concurrent use of disulfiram may cause a reaction within a simultaneous use of alcohol. - Side effects include epigastric fullness, heartburn, and nausea. Erythema, photosensitivity, hypoglycemia, and skin eruptions. Serious Possible side effects include agranulocytosi, hemolytic anemia, thrombocytopenia, and cholecstatic jaundice. - Weight gain - The primary action of sulfonylureas is to increase insulin production form the pancreas. Therefore hypoglycemia is the major side effect with sulfonylureas.

In caring for the patient post-parathyroidectomy, what nursing action does the nurse expect to take if the patient develops tingling around the lips and a posive Trousseau's sign?

Confirm that a tracheostomy set, suction and O2 are available at bedside. Notify the healthcare provider immediately of hypocalcemia. - IV calcium may be given, IV calcium gluconate or gluceptate should be readily available for patients following parathyroidectomy in the event that acute tetany occurs.

Tropic hormones are hormones that:

Control the secretion of hormones by other glands.

What are the target tissues for T3 and T4?

All body tissues

What are the target tissues for glucocorticoids?

All body tissues

Steroid hormones include:

All hormones produced by the adrenal cortex and sex glands

Name the 4 types of hormone secreting cells that the islets of Langerhans consist of.

Alpha, beta, delta, and F (or PP) cells

What hormone reduces gastric motility, glucagon secretion, and endogenous glucose release from the liver and increases satiety

Amylin

Hyperglycemia

An absolute or relative deficiency of insulin.

Is insulin an anabolic or catabolic hormone?

Anabolic

Aldosterone synthesis and secretion are stimulated by _____, _____, and _____. It is inhibited by ____ and _____.

Angiotensin II, hyponatremia, and hyperkalemia; atrial natriuretic peptide and hypokalemia

ADH

Antidiuretic Hormone or vasopressin ~Target tissue-renal tubules, vascular smooth muscle ~Function-promotes reabsorption of water, vasoconstriction

What hormone regulates fluid volume by stimulating reabsorption of water in the renal tubules? It is also a vasoconstrictor.

Antidiuretic hormone

Intracellular hormone-receptor complexes bind to specific sites on _______ to ________ or _________ the synthesis of mRNA.

DNA; stimulate; inhibit

Appropriate nursing diagnosis for patient with hyperthyroidism: Hair loss and vitiligo

Disturbed body image related to change in body appearance

What data does the nurse plan to monitor closely in the patient receiving rosliglitazone (Avandia)? (Note: use of Avandia has been largely discontinued.

BP, HR, edema - Increased risk of myocardial infarction and stroke. - Do not use in patients with heart failure

What teaching does the nurse anticipate for patient with hyperthyroidism who is being treated with radioactive iodine (RAI)?

Because of the high frequency of hypothyroidism after RAI therapy, teach the patient and family about the symptoms of hypothyroidism and instruct to seek medical help if these symptoms occur. - Instruct the patient that radiation thyroiditis and parotididis are possible and may cause dryness and irritation of the mouth and throat. Relief may be obtained with frequent sips of water, ice chips, or the use of a salt and soda gargle three or four times per day. This gargle is made by dissolving 1 teaspoon of salt and 1 teaspoon of baking soda in 2 cups of warm water. The discomfort should subside in 3 to 4 days. p. 1266

What is the target tissue for calcitonin?

Bone tissue

What are the target tissues for parathyroid hormone?

Bone, intestine, kidneys

How are lipid-soluble hormones transported in the blood?

Bound to plasma proteins

How are hormones classified?

By their chemical structure: lipid-soluble and water-soluable hormones

What hormones are released as a response to stress? They enhance and prolong the effects of sympathetic nervous system.

Epinephrine and norepinephrine

Adrenal Medulla Hormones

Epinephrine-adrenaline Norepinephrine-noradrenaline "Fight or flight" hormones ~Target tissue-sympathetic effectors ~Function-Response to stress; enhances and prolongs effects of sympathetic nervous system

What do mineralocorticoids do?

Essential for the maintenance of fluid and electrolyte balance. (sodium and potassium balance)

What hormone stimulates the development of secondary sex characteristics, preparation of uterus for fertilization and fetal development? It stimulates bone growth.

Estrogen

Gonadotropic hormones

FSH Follicle-stimulating hormone LH Lutenizing hormone ~Target Tissue-Reproductive organs ~Function-Stimulate sex hormone, reproductive organ growth, reproductive processes

What hormone stimulates the secretion of estrogen and the development of ova in the female and sperm development in the male?

Follicle-stimulating hormone

What mineral is necessary for the synthesis of thyroid hormones?

Iodine

In caring for a hospitalized patient taking an oral diabetic medication for type 2 diabetes, what does the nurse anticipate for this patient as a result of taking a corticosteroid such as prednisone (Deltasone)?

It can induce diabetes in some people include corticosteroids (prednisone , thiazides,

What happens when new mRNA is synthesized?

It migrates to the cytoplasm where it stimulates the synthesis of new protein. These new proteins produce specific effects in the target cell.

What is the target tissue for the mineralocorticoids?

Kidney

Prolactin is aka:

Lactogenic hormone

Hormone receptors located within the cell are typically for:

Lipid-soluble hormones

What are the target tissues for amylin?

Liver, stomach

Thyroid gland

Located in the anterior part of the neck - Controls the rate of body metabolism and growth and produces thyroxine (T4), triiodothyronine (T3), and thyrocalcitionin.

Parathyroid glands

Located on the thyroid gland - Control calcium and phosphorus metabolism; produce parathyroid hormone

Pancreas

Located posteriorly to the stomach - Influences carbohydrate metabolism, indirectly influences fat and protein metabolism and produces insulin and glucagon.

Glucagon is synthesized and released in response to 3 things:

Low levels of blood glucose, protein ingestion, and exercise

What hormone stimulates ovulation in the female and secretion of sex hormones in both the male and female?

Luteinizing hormone

ADH

Major physiologic role of ADH is regulation of of fluid volume by stimulating reabsorption of water in the renal tubules. ADH, also called vasopressin, is also a potent vasoconstrictor.

What hormone increases melanin production in melanocytes to make skin darker in color?

Melanocyte-stimulating hormone

MSH

Melanocyte-stimulating hormone ~Target tissue-Melanocytes in skin ~Fucntions-increases melanin production in melanocytes to make skin darker in color.

What is the target tissue for melanocyte-stimulating hormone?

Melanocytes in skin

The function of the releasing and inhibiting hormones from the hypothalamus is to either stimulate or inhibit the secretion of hormones from:

The anterior pituitary

What particular considerations is the nurse aware of when providing care for a patient who has just returned to the unit post-adrenalectomey?

Patients may have a nasogastric tube, a urinary catheter, IV therapy, central venous pressure monitoring and leg sequential compression devices to prevent emboli. - Surgery on the adrenal glands poses risks beyond those of other type of operations. Because these glands are highly vascular, the risk of hemorrhage is increased. - BP, fluid balance, and electrolyte levels tend to be unstable because of hormone fluctuations. - High doses of corticosteroids are administer intravenously during surgery and for several days afterward to ensure adequate responses to the stress of the procedure. - Report any rapid or significant changes in BP, respirations, or heart rate. - Morning urine samples for cortisol measurement to evaluate the effectiveness of surgery.

A patient with hypothyroidism is treated with levothyroxin (Synthroid). When teaching the patient about the therapy the nurse.

Provides written instruction for all information related to the medication therapy. Rationale: Because of metal sluggishness, inattentiveness, and memory loss that occur with hypothyroidism is important to provide written instruction and repeat information when teaching the patient.

In the older patient diagnosed with hypothyroidism, what medication class. if prescribed to the patient, would cause the nurse particular concern and a need to consult with the healthcare provider before administering?

Sedatives - Older adults who are diagnosed with hypothyroidism should avoid sedatives. If they must be used, suggest that the lowest dose be used. Family members should closely monitor mental status, level of consciousness, and respirations. p. 1271

Alpha-Glucosidase Inhibitors (Acarbose and miglitol):

Should be taken with the first bite of a meal because these agents work by blunting an increased blood sugar level after a meal.

Name the 4 mechanisms that stimulate or inhibit hormone synthesis and secretion.

Simple feedback, complex feedback, nervous system control, and physiologic rhythms.

Sulfonylureas (glyburide): Action, side effects and contraindications

Sulfonylureas stimulate insulin secretion form the beta cells of the pancreas. In turn, the insulin carries glucose out of the blood and into the tissues, cells, and organs, where it is needed. - The most common side effects of sulfonylureas include epigastric fullness, heartburn and nausea. Patients may also experience erythema, photosensitivity, hypoglycemia, and skin eruptions. Serious thromobocytopenia, and cholestatic jaundice. - Concurrent use of disulfiram may cause a (antabuse) like reaction with the simultaneous use of alcohol.

What are the target tissues for epinephrine and norepinephrine?

Sympathetic effectors

Which thyroid hormone is more potent and has greater metabolic effects? T3 or T4?

T3

Which thyroid hormone is more abundant? T3 or T4?

T4

Lock & Key

Target receptor sites <=> correct hormone only A hormone will only act upon cells that have a receptor specific for that hormone.

What hormone stimulates the development of secondary sex characteristics and spermatogenesis?

Testosterone

Hormone receptors located within the cell membrane are typically for:

Water-soluble hormones

What type of hormones are the protein based hormones?

Water-soluble hormones

In completing an admission assessment for the patient diagnosed with Cushing syndrome, what signs and symptoms does the nurse expect to find?

Weight gain, the most common feature, results from the accumulation of adipose tissue in the trunk, face, and cervical spine area. - Hyperglycemia because of glucose intolerance

A patient has a total serum calcium level of 3mg/dL. If this finding reflects hypoparathyroidism, the nurse would expect further diagnostic testing to reveal a. decreased in PTH b. increased serum ACTH c. increased serum glucose d. decreased serum cortisol levels

a. decreased in PTH Rationale: Normal serum calcium level is 8.6 to 10.2 mg/dL. A low serum calcium level is found in hypoparathyroidism, and the serum parathyroid hormone (PTH) level is decreased.

A 72 year old woman is diagnosed with diabetes. The nurse recognizes that management of diabetes in the older adult a. does not require as tight glucose control as in younger diabetics. b. is usually not treated unless the patient becomes severely hyperglycemic. c. does not include treatment with insulin because of limited dexterity and vision. d. usually requires that a younger family member be responsible for care of the patient.

a. does not require as tight glucose control as in younger diabetics. Rationale: Because the clinical manifestations of long-term complications of diabetes take 10 to 20 years to develop, and because tight glucose control in the older patient is associated with an increased frequency of hypoglycemia, the goals for glycemic control are not as rigid as in the younger population.

A patient has a serum sodium level of 152 mEq/L. The normal hormonal response to this situation is a. release of ADH b. release of renin c. secretion of aldosterone d. secretion of corticotropin-releasing hormone

a. release of ADH Rationale: The most important stimulus of antidiuretic hormone (ADH) secretion is plasma osmolality, which is a measure of solute concentration of circulating blood. Plasma osmolality increases when there is a decrease in extracellular fluid or an increase in solute concentration. The increased plasma osmolality activates osmoreceptors, which are extremely sensitive, specialized neurons in the hypothalamus. These activated osmoreceptors stimulate ADH release. When ADH is released, the renal tubules reabsorb water, creating urine that is more concentrated.

Endocrine disorders often go unrecognized int he older adult becuase a. symptoms are often attributed to aging b. older adults rarely have identifiable symptoms. c. endocrine disorders are relatively rare in the older adult d. older adults usually have subclinical endocrine disorders that minimize symptoms

a. symptoms are often attributed to aging Rationale: Assessment of the effects of aging on the endocrine system is difficult because the subtle changes of aging often mimic manifestations of endocrine disorders.

ACTH

adrenocorticotropic hormone ~Target tissue- adrenal cortex ~Function- fosters growth of adrenal cortex; stimulates secretion of corticosteroids

Causes of primary hypothyroidism in adults include

autoimmune-induced atrophy of the thyroid gland. Rationale: Both Graves' disease and Hashimoto's thyroidiits are autoimmune disorders that eventually destroy the thyroid gland, leading to primary hypothyroidism.

An abnormal finding by the nurse during an endocrine assessment would be a. BP of 100/70mm Hg b. excessive facial hair on women c. soft, formed stool everyday d. 3-lb. weight gain in over 6 months e. hyperpigmented coloration in lower legs

b. excessive facial hair on women e. hyperpigmented coloration in lower legs Rationale: Hirsutism (i.e., excessive facial hair on women) may indicate Cushing syndrome or prolactinoma, a pituitary tumor. Hyperpigmentation (i.e., darkening of the skin, particularly in creases and skin folds) may indicate Addison's disease caused by increased secretion of melanocyte-stimulating hormone or indicate acanthosis nigricans.

A characteristic common to all hormones is that they: a. circulate in the blood bound to plasma proteins b. influence cellular activity of specific target hormones c. accelerate the metabolic processes of all body cells d. enter a cell to alter the cell's metabolism or gene expression

b. influence cellular activity of specific target hormones Rationale: A hormone is a chemical substance synthesized and secreted by a specific organ or tissue. Most hormones have common characteristics, including (1) secretion in small amounts at variable but predictable rates, (2) circulation through the blood, and (3) binding to specific cell receptors in the cell membrane or within the cell.

Goals of nutritional therapy for the patient with ape 2 diabetes include maintenance of a. ideal body weight b. normal serum glucose and lipid levels c. a special diabetic diet using dietetic foods. d. Five small meals per day with a bedtime snack

b. normal serum glucose and lipid levels Rationale: Maintenance of as near-normal blood glucose levels as possible and achievement of optimal serum lipid levels with dietary modifications are believed to be the most important factors in preventing both short and long term complications of diabetes.

Priority Decision: The nurse is assessing a newly admitted diabetic patient. Which of these observations should be addressed as a priority by the nurse? a. Bilateral numbness of both hands. b. Stage II pressure ulcer on the right heel c. Rapid respirations with deep inspiration d. Areas of lumps an dents on the abdomen

c. Rapid respirations with deep inspirations Rationale: Rapid deep respirations are symptoms of diabetic ketoacidosis (DKA). Stage II ulcers and bilateral numbness are chronic complications of diabetes. The lumps and dents on the abdomen indicate a need to teach the patient about site rotation.

All cells in the body are believed to to have intracellular receptors for a. insulin b. glucagon c. growth hormone d. thyroid hormone

d. thyroid hormone Rationale: There are two types of receptors: those that are within the cell (e.g., steroid and thyroid hormone receptors) and those that are on the cell membrane (e.g., protein-type hormone receptors). Thyroid hormone receptors are located inside the cell. Because these hormones are lipid soluble, they pass through the target cell membrane by passive diffusion and bind to receptor sites located in the cytoplasm or nucleus of the target cell. Intracellular hormone-receptor complexes bind to specific sites on deoxyribonucleic acid (DNA) to stimulate or inhibit the synthesis of messenger ribonucleic acid (mRNA). When new mRNA is synthesized, it migrates to the cytoplasm, where it instructs the synthesis of new protein. These new proteins produce specific effects in the target cell.

Diagnostic testing in the patient with Graves' disease will reveal an

decreased TSH level.

When replacement therapy is started for a patient with long-standing hypothyroidism, its is most important for the nurse to monitor the patient for

dysrhythmias Rationale: Myocardial oxygen consumption is increased, and the resultant oxygen demand may cause angina, cardiac dysrhythmias, and heart failure.

GH

growth hormone or somatotropin ~target tissue-all body cells ~function:promotes anabolism (growth, tissue repair) and lipid mobilization and catabolism

When the patient with parathyroid disease experiences symptoms of hypocalcemia, a measure that can be used to raise serum calcium levels temporarily is to

have a patient rebreathe in a paper bag. Rationale: Rebreathing in a paper bag promotes carbon dioxide retention in the blood, which lowers pH and creates an acidosis.

Endocrine glands

hypothalamus, pituitary, thyroid, parathyroids, adrenals, pancreas, ovaries, testes, and pineal gland

How are hormones transported?

in the blood to other sites in the body where their actions are exerted.

An appropriate nursing intervention for the patient with hyperparathyroidism is to

increase fluid intake to 3000 to 4000 mL daily. Rationale: A high fluid intake is indicated in hyperparathyroidism to dilute the hypercalcemia and flush the kidneys so that calcium stone formation is reduced.

Clinical manifestations of hyperthyroidism occur as a result of

increased metabolic rate and tissue sensitivity to the sympathetic nervous system.

Positive feedback

increases the target organ action beyond normal

Complex Feedback

involves communication via hormones among several glands to turn on and turn off target organ hormone secretion.

Carbohydrate counting is a:

meal planning technique that individuals with diabetes use to keep track of the amount of carbohydrates they eat with each meal and per day. With this method they set a limit for their maximum amount. The amount of total carbohydrates per day depends on age, weight, activity level, and medications that they take. - Instruct patient on the foods that contain carbohydrates and the appropriate serving size. Each serving of carbohydrates is 15g. They usually start with 45 to 60 g of carbohydrate at a meal. Teach the person with diabetes to read food labels as the is is very important with carbohydrate counting. - My plate and my pyramid guide.

Simple feedback

regulation of hormone levels in the blood; may be a hormone or other chemical compound regulated by, or responsive to, a hormone.

Important hormone functions are r/t

reproduction response to stress and injury electrolyte balance energy metabolism growth maturation aging play a role in the regulatory effect of the nervous system

Target tissue

the body tissue or organ that the hormone effects

Negative feedback

the most common type of feedback; the gland responds by increasing or decreasing the secretion of a hormone based on feedback from various factors.

Pituitary

this gland is very small-about the size of a pea; it is located in the sella turica under the hypothalamus at the base of the brain above the sphenoid bone; 2 parts-anterior & posterior

TSH

thyroid-stimulating hormone or thyrotropin ~target tissue-thyroid gland ~function-stimulates synthesis and release of thyroid hormones, growth and function of thyroid gland

A patient is receiving radiation therapy for cancer of the kidney. The nurse monitors the patient for s/s of damage to the: a. pancreas b. thyroid gland c. adrenal glands d. posterior pituitary glands

c. adrenal glands Rationale: The adrenal glands are small, paired, highly vascularized glands located on the upper portion of each kidney.

Insulin

~Target Tissue-general ~Function-Promotes movement of glucose out of cells and into blood.

Corticosteroids

~Target Tissues-All body tissues ~Function-promotes metabolism; response to stress; antiinflammatory

Mineralocorticoids

~Target tissue- Kidney ~Function-Regulates sodium and potassium balance and thus water balance.

Amylin

~Target tissue- liver, stomach ~Function-Decreased gastric motility, glucagon secretion, endogenous glucose release from liver and increased satiety

Progesterone

~Target tissue- reproductive system ~Function-Maintains lining of uterus necessary for successful pregnancy

Estrogen

~Target tissue- reproductive system, breasts ~Function-stimulate development of secondary sex characteristics, preparation of uterus for fertilization and fetal development, stimulates bone growth

Testosterone

~Target tissue- reproductive tissue ~Function- Stimulates development of secondary sex characteristics, spermatogenesis

Somatostatin

~Target tissue-Pancreas ~Function-inhibits insulin and glucagon secretion

Calcitonin

~Target tissue-bone tissue ~Function-Regulates calcium and phosphorus blood levels; decreases serum calcium levels.

Glucagon

~Target tissue-general ~Function-Stimulates glycogenesis and glucogenesis

Pancreatic polypeptide

~Target tissue-general ~Function-influences regulation of pancreatic exocrine function and metabolism of absorbed nutrients.

Prolactin

~Target tissue-ovary and mammary glands ~Functions-Stimulates milk production in lactating women, increases response of follicles to LH and FSH; has an unclear function in men.

Oxytocin

~Target tissue-uterus; mammary glands ~Function-Stimulates milk secretion, uterine contractility

Androgens

~Target tissues-reproductive organs ~Function-promotes masculinization in men. growth and sexual activity in women.

An appropriate technique to use during physical assessment of the thyroid gland is to a. asking the patient to hyperextend the neck during palpation b. percussing the neck for dullness to define the size of the thyroid c. having the patient swallow water during inspection and palpation of the gland d. using deep palpation to determine the extent of a visibly enlarged thyroid gland

c. having the patient swallow water during inspection and palpation of the gland Rationale: Water should always be available for the patient to swallow as part of inspection and palpation of the thyroid gland.

A patient with hypoparathyroidism result in form surgical treatment of hyperparthyroidism is preparing for discharge. The nurse teaches the patin that

calcium supplements with Vitamin D can effectively maintain calcium balance. Rationale: The hypocalcemia that results from parathyroid hormone (PTH) deficiency is controlled with calcium and vitamin D supplementation and possible oral phosphate binders.

Nursing Diagnosis for a patient with a hypothyroid and it's etiology with signs and symptoms that support the diagnosis.

- Disturbed sleep pattern related to depression and altered metabolism as evidence by excessive sleeping as manifested by no relief of somnolence and altered sleep stages. - Imbalanced nutrition: more than body requirements related to calorie intake greater than need; as evidenced by weight gain as manifested by weight gain and slow metabolism. - Disturbed thought processes related to slowed metabolism; as evidenced by personality changes as manifested by forgetfulness and memory loss. - Activity intolerance related to decreased metabolic rate and mucin deposits in joints; as evidenced by fatigue,as manifested by weakness and muscular aches and pains.

Effects of aging on the endocrine system

1) decreased hormone protection 2) altered hormone metabolism production and secretion 3) decreased responsiveness of target tissues to hormones 4) alterations in circadian rhythms

Common characteristic that most hormones have

1) secretion on small amounts at variable but predictable rates 2) circulation thru the blood 3) binding to specific cell receptors either in the cell membrane or within the wall.

In the patient newly diagnosed with Addison's disease, what teaching is appropriate for the nurse to offer?

1. Names, dosages, and actions of drugs 2. Symptoms of overdosage and under dosage 3. Conditions requiring increased medication (trauma, infection, surgery, emotional crisis) 4. Course of action to take relative to changes in medication - Increase in dose of corticosteroid - Administration of large dose of corticosteroid intramuscularly, including demonstration and return demonstration - Consultation with health care provider 5. Prevention of infection and need for prompt and vigorous treatment of existing infections. 6. Need for lifelong replacement therapy 7. Need for lifelong medical supervision 8. Need for medical identification device.

Name the 2 hormones of the ovaries.

-Estrogen -Progesterone

Critical Monitoring: IV Calcium infusion

- Dilute to reduce vein irritation and venospasm - Administer into a large central or deep vein. - Confirm latency of the IV prior to administration. - Monitor vital signs and serum calcium levels - Observe for hyperchloremic acidosis if calcium carbonate is administered. - Observe fro extravasation. Necrosis and sloughing may occur. - Inject 1 % procaine hydrochloride and hyaluronidase using a 25 to 27 gauge needle if extravasation occurs to reduce vasospasm.

Critical Monitoring: Thyrotoxicosis/Thyroid Strom: These manifestations should be monitored in a client who is thought at risk for thyroid storm:

- Anxiety, short attention span irritability - Hyperreflexia - Increased temperature (as high as 106 degrees) - Systolic hypertension - Dyspnea - Augmentation of other disorders, such as atrial fibrillation, heart failure, angina pectoris (chest pain), paranoia, and anxiety

Functions of Endocrine Glands

- Maintenance and regulation of vital functions - Response to stress and injury - Growth and development - Energy metabolism - Reproduction - Fluid, electrolyte, and acid-base balance

Name the tropic hormones.

-Gonadotropic hormones (follicle stimulating hormone and luteinizing hormone) -Thyroid-stimulating hormone -Adrenocorticotropic hormone

Name some common assessment abnormalities in the integument?

-Hyperpigmentation -Striae -Changes in skin texture -Changes in hair distribution -Skin ulceration -Edema

Antidiabetic drugs occasionally contribute to episodes of hypoglycemia, regardless of how well educated the patient is about diabetes mellitus. The nurse would teach the patient to watch out for which of the following hypoglycemia symptoms?

- Confusion - Diaphoresis - Decreased blood glucose readings on fingerstick - Irritability - Seizures - Tremors

What particular considerations is the nurse aware of when providing care for a patient who has just returned to the unit post-thyroidectomy?

- Possible Hemorrhage and fluid and electrolyte disturbance. - Mild or severe tetany - Monitor intake and output - Assess calcium, potassium, phosphate, and magnesium keels frequently, as well as Chvostek's and Trousseau's - Encourage mobility to promote bone calcification.

Name 4 factors that stimulate ADH release.

-Increased plasma osmolarity -Decreased fluid volume and Hypotension -Pain -Nausea and vomiting

Describe an appropriate general teaching plan for the patient newly diagnosed with type 2 diabetes?

- Include an introduction about the pancreas and the islets of Langerhans. - Describe how insulin is made and what affects its production. - Discuss the relationship of insulin and glucose. - Discuss the importance of regular exercise on the management of blood glucose, improvement of cardiovascular function, and general health. - Stress the importance of a well-balanced diet as part of diabetes management plan. - Explain the impact of carbohydrates on the glycemic index and blood glucose levels. - Ensure that the patient understands the proper use of insulin (see Table 49-5) and oral agents. - Account for a patient's physical limitations or inability for self- medication. - Discuss all side effects and safety issues regarding medication. You should include the following essential instructions for diabetes management.

Name the 5 hormones of the pancreas (Islets of Langerhans).

-Insulin -Amylin -Glucagon -Somatostatin -Pancreatic polypeptide

Name 8 factors that inhibit insulin secretion.

-Lowered glucose levels -Lowered amino acid levels -Lowered potassium levels (hypokalemia) -Raised Corticosteroid hormone levels -Raised Catecholamine levels -Raised Somatostatin levels -Raised Glucagon levels (usually) -Raised Insulin levels

Name the 2 hormones of the posterior pituitary (neurohypophysis).

-Oxytocin -Antidiuretic hormone (vasopressin)

Name the 1 hormone of the parathyroids.

-Parathyroid hormone (parathormone)

Name 5 factors that stimulate insulin secretion.

-Raised glucose levels -Raised amino acid levels -Raised GI hormone levels -Raised Vagal stimulation -Raised Fats

Emergency Care of the client during thyroid storm:

- Maintain a patent airway and adequate ventilation. - Give antithyroid drugs as prescribed: propyithiouracil (PTU, Propyl-Thyracil), 300 to 900 mg daily; ;methimazole (Tapazole), up to 60 mg daily. - Administer sodium iodide solution, 2 g IV daily as prescribed. - Give propranolol (Inderal, Detensol) - Give glucocorticoids as prescribed: - Monitor continually for cardiac dysrhythmias. - Monitor vital signs every 30 minutes. - Provide comfort measures, including a cooling blanket. - Give nonslicylate antipyretics as prescribed. - Correct dehydration with normal saline infusions. - Give aspirin or other antipyretic. - Apply cooling blanket or ice packs to reduce fever.

Name the 1 hormone of the testes.

-Testosterone

Name the 3 hormones of the thyroid.

-Thyroxine (T4) -Triiodothyronine (T3) -Calcitonin

Oral Antidiabetic Medications

- Sulfonylureas (glyburide) - Biguanides (metformin) - Thiazolidinedisone (rosiglitazone) - Medglitinides (repaglinide and nateglinide) - Alpha-Glucosidase Inhibitors (Acarbose and miglitol)

Meglitinides (repaglinide and nateglinide): action, indication

- They stimulate the release of insulin form pancreatic beta cells. - They may be used in the treatment of type 2 diabetes because: Some patients simply respond better to these drugs and achieve better glycemic control.

Thiazolidinedione (rosiglitazone): contraindication

- may cause moderate weight gain and edema as a result of fluid retention. - not recommended for patients with heart failure

Name the 2 hormones of the adrenal cortex.

-Corticosteriods (mineralocorticoids and glucocorticoids) -Androgens and estrogen

Name 4 factors that inhibit ADH release.

-Decreased plasma osmolarity -Increased fluid volume -Beta-adrenergic agonists -Alcohol

Name the 2 hormones of the adrenal medulla.

-Epinephrine (adrenaline) -Norepinephrine (noradrenaline)

What action(s) does the nurse anticipate while caring fora patient who is several hours post-surgery for a subtotal thyroidectiony, if the patient develops laryngeal stridor and a cramp in the right hand?

...

What is the most likely nursing action for the patient diagnosed with primary hyperparathyroidism who has developed elevated serum calcium levels?

...

What lab values will the nurse monitor closely in the patin receiving metformin (Glucophage)?

...

What questions will the nurse ask when obtaining a health history for a patient undergoing an oral glucose tolerance test?

...

Appropriate nursing diagnosis for patient with hyperthyroidism: Exhaustion and dyspnea

Activity intolerance related to fatigue and dyspnea

Pancreatic Hormones (Islets of Langerhans)

Insulin (from beta cells) Amylin (from beta cells) Glucagon (from alpha cells) Somatostatin Pancreatic polypeptide

Beta cells produce and secrete:

Insulin and amylin

Hormone classification

Classified by their chemical structure: lipid-soluble~> include steroid hormones (all hormones produced by the adrenal cortex and sex glands) water-soluble (protein-based)~> all other hormones

What hormone inhibits calcium resorption from bone, increases calcium storage in bone, and increases renal excretion of calcium and phosphorus thereby lowering serum calcium levels?

Calcitonin

In caring for the patient with a goiter and possible hypothyroidism, what is the most appropriate way to complete a physical assessment, and what are some interventions that the nurse anticipates?

Careful assessment may reveal early and subtle changes that indicate dysfunction. Your assessment of the patient who is suspected of having hypothyroidism should include questions about weight gain, mental changes, fatigue, slowed and slurred speech, cold intolerance, skin changes such as increased dryness or thickening, constipation, and dyspnea. Question the patient about the recent introduction of iodine containing medications. Assess the patient for bradycardia; distended abdomen; dry thick, cold skin; thick, brittle nails; paresthesias; and muscular aches and pains. p. 1271 Acute Interventions: - Most individuals with hypothyroidism are treated on an outpatient basis. The patine who develops myxedema coma requires acute nursing care, often in an intensive care setting. Mechanical respiratory support and cardiac monitoring are frequently necessary. - Administer thyroid hormone replacement therapy and all other medications intravenously because paralytic ileum may be present in myxedema coma. Monitor the core temperature because hypothermia often occurs in myxedema coma. - Monitor the patient's progress by assessing vital signs, body weight, fluid intake and output, and visible edema. Cardiac assessment is especially important because the cardiovascular response to the hormone determines the medication regimen. Note energy level and mental alertness. These should increase within 2 to 14 days and continue to rise steadily to normal levels. p. 1271

Neural involvement in the regulation of hormonal secretion is initiated by ________ and implemented by _________.

Central nervous system; sympathetic nervous system

What is the precursor for steroid hormone synthesis?

Cholesterol

Diabetes mellitus

Chronic disorder of impaired carbohydrate, protein, and lipid metabolism caused by a deficiency of insulin Type 2 Diabetes Mellitus is a relative lack of insulin or resistance to the action of insulin; usually, insulin is sufficient to stabilize fat and protein metabolism but not carbohydrate metabolism. - Can lead to chronic health problems and early death as a result of complications that occur in the large and small blood vessels in tissues and organs. - Macro-vascular complication include coronary artery disease, cardiomyopathy, hypertension, cerebrovascular disease, and peripheral vascular disease. - Microvascular complications include retinopathy, nephropathy, and neuropathy. - Infection is also a concern because of reduced healing ability. - Male erectile dysfunction can also occur as a result of the disease.

Darkening of the skin, particularly in creases and skinfolds

Hyperpigmentation

A term that refers to any of the hormones synthesized by the adrenal cortex (excluding androgens)

Corticosteriod

Adrenal Cortex Hormones

Corticosteroids (e.g. cortisol, hydrocortisone) Androgens (e.g. testosterone, androsterone) and estrogen Mineralocorticoids (e.g. aldosterone)

An important glucocorticoid that increases blood glucose levels and reduces inflammation.

Cortisol

What hormone has effects on all body tissues and affects the growth and development of skeletal muscles and long bones, affecting a person's size and height?

Growth hormone

The Dos and Don'ts of Diabetes management

DO - Monitor your blood glucose at home and record results in a log. - Take your insulin or OA as prescribed. - Obtain A1C blood test every 3-6 months as an indicator of your long-term blood glucose control. - Know the symptoms of a hypoglycemia and hyperglycemia - carry some form of glucose at all times so you can treat hypoglycemia quickly - Instruct family members in the use of glucagon administration in the case of emergencies due to hypoglycemia. - Learn how exercise and food affect your blood glucose levels. - Begin an exercise program after approval form health care provider. - Have an individualized meal plan created by a dietitian. - Follow your diet, eating regular meals at regular times. - Choose foods low in saturated and trans fat. - Learn your cholesterol level. - Obtain an annual eye examination by an ophthalmologist. - Obtain annual urine testing for protein. - Examine your feet at home. - Wear comfortable, well-fitting shoes to help prevent foot injury. Brak in new shoes gradually. - Always care identification that says you have diabetes. - Have other medical problems treated, especially high blood pressure and high cholesterol. - Quit cigarette smoking. DO NOT - skip doses of your insulin, especially when you are sick - Run out of insulin - Ignore the symptoms of hypoglycemia and hyperglycemia. - Forget that exercise will lower your blood glucose level. - Drink excessive amounts of alcohol because this may lead to unpredictable low blood glucose reactions. - Enroll in a fad diet. - Drink regular soda or lots of fruit juice. - Smoke cigarettes or use nicotine products. - Apply hot or cold directly to your feet. - Go barefoot - Put oil or lotion between your toes. ** you should be prepared to work with dietitians as part of an interdisciplinary diabetes care team.

Biguanides (metformin): Action, therapeutic effects and side effects

Decreases the production of glucose in the liver and increasing the sensitivity of peripheral tissues to insulin. - decreases hepatic production of glucose - decreases intestinal absorption of glucose. - increases insulin sensitivity. - Metformin may be used with a sulfonylurea to more effectively control the blood glucose level. - Rare but potentially fatal side effect: Lactic acidosis has a 50% mortality rate. - Abdominal bloating, cramping, nausea, and diarrhea are common side effects of a biguanide such as metformin but are not ordinarily fatal. - Metformin can leave a metallic taste in the mouth, alt hough this effect is rare.

Name the hormones of the anterior pituitary (adenohypophysis).

G.S.T.A.M.P. -Gonadotropic hormones (follicle stimulating hormone and luteinizing hormone) -Somatotropin (growth hormone) -Thyroid-stimulating hormone (thyrotropin) -Adrenocorticotropic hormone -Melanocyte-stimulating hormone -Prolactin

Anterior Pituitary Hormones

GH~growth hormone TSH~thyroid stimulating hormone ACTH~adrenocorticosteroid hormone FSH~follicle-stimulating hormone LH~luteinizing hormone MSH~melanocyte-stimulating hormone Prolactin

What are the target tissues for glucagon?

General

What are the target tissues for insulin?

General

What are the target tissues for pancreatic polypeptide?

General

What information does the nurse expect to provide when tacking a patient with type 2 diabetes about glipizide (Glucotrol)? How about metformin (Glucophage)?

Glipizide Stimulates release of insulin from pancreatic islets.; Side effects: weight gain, hypoglycemia Metformin decreases the rate of hepatic glucose production; augments glucose uptake by tissues, especially muscles; side effect: Diarrhea, lactic acidosis. - Needs to be held 1-2 days before IV contrast media given and for 48 hr after - Metformin may be used in combination with sulfonylurea to more effectively control the blood glucose level because they work throughout different mechanisms.

Alpha cells produce and secrete:

Glucagon

The steroid hormones secreted by the adrenal cortex are classified as:

Glucocorticoids, mineralocorticoids, and androgens

Exophthalmos may occur in:

Graves' disease

Two most common forms of hyperthyroidism are:

Graves' disease and toxic nodular goiters.

In obtaining a patient's general health history, what assessment data would indicate a need for further assessment of a patient's thyroid function?

Hypothyroidism - Changes in skin texture, thick, cold, dry skin - Changes in hair distribution - Puffiness, myxedema, preorbital edema, masklike affect - Goiter - Dysrhythmias, tachycardia, atrial fibrillation - Altered glucose levels: weight gain - Lethargy: state of mental sluggishness or somnolence - Constipation - Cold insensitivity - generalized edema - Seizure Hyperthyroidism - changes in skin texture, warm smooth, moist skin - hair loss - Exophthalmos - Goiter - Chest pain, dysrhythmias: tachycardia, atrial fibrillation - Hypertension - weight loss - Hyperreflexia - heat intolerance

Symptoms of Hyperthyroidism?

If there is too much thyroid hormone, every function of the body tends to speed up. - Nervousness, irritability, increased perspiration, heart racing, hand tremors, anxiety, difficulty sleeping, thinning of your skin, fine brittle hair and weakness in your muscles- especially in the upper arms and thighs. - You may have frequent bowel movements, but not diarrhea - You may lose weight despite a good appetite and, for women, menstrual flow may lighten and menstrual periods may occur less often. - initially have a lot of energy. However, as hyperthyroidism continues, the body tends to break down, so being tired is very common. ** At first the symptoms symptoms may be mistaken for simple nervousness due to stress. - In Graves' disease, which is the most common form of hyperthyroidism, the eyes may look enlarged because the upper lids are elevated. Sometimes, one or both eyes may bulge. Some patients have swelling of the front of the neck from an enlarged thyroid gland (a goiter)

Appropriate nursing diagnosis for patient with hyperthyroidism: Weight loss and hunger

Imbalanced nutrition: less than body requirements related to hyper-metabolism

What are the special nursing considerations in caring for the older adult diagnosed with hypothyroidism, who will be taking levothyroxine (Synthroid)? What would be a general teaching plan for a 35 year old patient receiving this medication?

In the older adult patient and the person with compromised cardiac status, a smaller initial dose is recommended because the usual dose may increase myocardial oxygen demand. The increased oxygen demand may cause angina and cardiac dysrhythmias. - Any chest pain experienced by a patient starting thyroid replacement should be reported immediately and an ECG and serum cardiac enzyme test must be performed. - In a patient without side effects, the dose is increased at 4-6 week intervals. it is important that the patient take replacement medication regularly. Lifelong thyroid replacement therapy is usually required.

In reviewing results of a patient's glycosylated hemoglobin (HbA1C), what information is the nurse able to determine?

Indicates the amount of glucose linked to hemoglobin. Measures degree of glucose control during previous 2-3 mo. Reference interval 4%-6% - Inform patient that fasting is not necessary and that blood sample will be drawn. Observe venipuncture site for bleeding or hematoma formation. (Lewis 1216)

High levels of active vitamin D _____ PTH.

Inhibit

What hormone is the principle regulator of the metabolism and storage of ingested carbohydrates, fats, and proteins. It facilitates glucose transport across cell membranes in most tissues.

Insulin

Adrenal gland

One adrenal gland is on top of each kidney. - Regulates sodium and electrolyte balance; affects carbohydrate, fat, and protein metabolism; influences the development of sexual characteristics; and sustains the fight -or flight response. Adrenal Cortex - The cortex is the outer shell of the adrenal gland. - The codex synthesizes glucocorticoids and mineralocorticoids and secretes small amounts of sex hormones (androgens, estrogens; Adrenal Medulla - The medulla is the inner core of the adrenal gland. - The medulla works as part of the sympathetic nervous system and produces epinephrine and norepinephrine.

What are the target tissues for prolactin?

Ovary and mammary glands in female

What causes Hyperthyroidism?

Overproduction of thyroid hormone by the entire thyroid gland. This condition is also known as Graves' disease - antibodies in the blood that turn on the thyroid and cause it to grow and secrete too much thyroid hormone. - tends to run in families and occurs more often in young women - One or more nodules or lumps in the thyroid that may gradually grow and increase their activity so that the total output of thyroid hormone into the blood is greater than normal. This condition is known as toxic nodular or multi-nodular goiter. - Peo;e may temporarily have symptoms of hyperthyroidism if they have a condition called thyroiditis. ** This condition is caused by a problem with the immune system or a viral infection that causes the gland to leak stored thyroid hormone. - Also caused by taking too much thyroid hormone in tablet form.

What hormone stimulates milk secretion and uterine contractility?

Oxytocin

Posterior Pituitary Hormones

Oxytocin ADH~Anti-diuretic hormone or vasopressin

Name the endocrine glands.

PPPPTTAG- Hypothalamus and pineal gland,the pancreas, the pituitary gland, the parathyroid gland, the thyroid gland, the thymus, the adrenal glands, and the gonads (ovaries and testes)

What is the target tissue for somatostatin?

Pancreas

What hormone influences the regulation of pancreatic exocrine function and the metabolism of absorbed nutrients?

Pancreatic polypeptide

F (or PP) cells secrete:

Pancreatic polypeptide (PP)

What hormone acts on bone, on the kidneys, and indirectly on the GI tract to increase serum calcium? It also helps regulate phosphate levels

Parathyroid hormone

PH

Parathyroid hormones-secreted by parathyroids ~Target tissue-bone, intestine, kidneys ~Function-regulates calcium and phosphorus blood levels; promotes bone demineralization and increases intestinal absorption of serum calcium; increases serum calcium levels.

The most important stimulus to antidiuretic hormone secretion is:

Plasma osmolarity

Hypothalamus

Portion of the diencephalon of the brain, forming the floor and part of the lateral wall of the third ventricle - Activates, controls, and integrates the peripheral autonomic nervous system, endocrine processes, and many somatic functions, such as body temperature, sleep, and appetite.

Simple feedback includes:

Positive and negative feedback

What hormone maintains the lining of the uterus necessary for a successful pregnancy?

Progesterone

What hormone stimulates breast development necessary (milk production) for lactation after childbirth?

Prolactin

Negative-Feedback loop

Regulates hormone secretion by the hypothalamus and pituitary gland - Increased amounts of target gland hormones in the blood stream decrease secretion of the same hormone and other hormones that stimulate its release.

What are the target tissues for antidiuretic hormone?

Renal tubules, vascular smooth muscle

What are the target tissues for androgens and estrogen?

Reproductive organs

What is the target tissue for progesterone?

Reproductive system

What is the target tissue for testosterone?

Reproductive system

What are the target tissues for estrogen?

Reproductive system, breasts

Appropriate nursing diagnosis for patient with hyperthyroidism: Exophthalmos

Risk for injury: corneal ulceration related to inability to close eyelids

Delta cells produce and secrete:

Somatostatin

What hormone inhibits insulin and glucagon secretion?

Somatostatin

Lipid-soluble hormones include ____________. All other hormones are water-soluble.

Steroid hormones and thyroid hormones

Low levels of magnesium ________ PTH secretion .

Stimulate

Factors affecting ADH release

Stimulate ADH: Increased plasma osmolity decreased fluid volume hypotension pain N/V Inhibit ADH: decreased plasma osmolity increased fluid volume Beta-adrenergic agonists alcohol

What do androgens do?

Stimulate pubic and axillary hair growth and sex drives in women. Promotes masculinization in men.

Purplish red marks below the skin surface--unually seen on abdomen, breasts, and buttocks.

Striae

In the patient admitted for tetany, what specific lab value(s) does the nurse plan to monitor, in addition to general monitoring of lab results?

Sudden decreases in calcium concentration cause tetany Decreased PTH levels and increased serum phosphate levels.

Hypothalamus

The hypothalamus and pituitary gland integrate communication between the nervous and endocrine system. The hypothalamus is located in the center of the diancephalon area of the brain and secretes 2 hormones: releasing hormones~(CRH) Corticotropin-releasing hormones, (TRH) Thyrotropin-releasing hormones, Growth hormone-releasing factor, Prolactin-releasing hormone. & Inhibiting hormones~Somatistatin-inhibits GH release, Prolactin-inhibiting hormone

The hormone secreting portion of the pancreas is referred to as:

The islets of Langerhans

Pituitary gland

The master gland; located at the base of the brain - Influenced by the hypothalamus; directly affects the function of the other endocrine glands - Promotes growth of body tissue, influences water absorption by the kidney, and controls sexual development and function.

In the patient displaying signs and symptoms of hypothyroidism, which lab values does the nurse plan to monitor, to determine if the condition is caused by malfunction of the anterior pituitary gland, or the thyroid gland?

The most common and reliable laboratory test for thyroid function are TSH and free T4. These valises, correlated with symptoms gathered form the history and physical examination, confirm the diagnosis. Serum TSH levels help determine the cause of hypothyroidism. Serum TSH is high when the defect is in the thyroid and low when it is in the pituitary or hypothalamus. An increase in TSH after TRH injection suggest hypothalamic dysfunction, whereas no change suggests anterior pituitary dysfunction. The presence of thyroid peroxidase antibodies suggests an autoimmune origin of the problem. Other abnormal laboratory findings are elevated cholestesterol and triglycerides, anemia, and increased creatine kinase.

Ovaries and testes

The ovaries are located in the pelvic cavity and produce estrogen and progesterone. - Testes are located in the scrotum, control the development of the secondary sex characteristics, and produce testosterone.

In planning teaching for the patient with hypothyroidism who has been admitted with myxedema coma, what considerations will the nurse take into account?

The patient who develops myxedema coma requires acute nursing care, often in a n intensive care setting. - Mechanical respiratory support and cardiac monitoring are frequently necessary. - Administer thyroid hormone replacement therapy and all other medications intravenously because paralytic ileum may be present in myxedema coma. Monitor the core temperature because hypothermia often occurs in myxedema coma. - Monitor the patient's progress by assessing vital signs, body weight, fluid intake and output, and visible edema. Cardiac assessment is especially important because the cardiovascular response to the hormone determines; the medication regimen. Not energy level and metal alertness.These should increase within 2 to 14 days and continue to rise steadily to normal levels. - It is important to provide written instructions, repeat the information often, and assess the patient's comprehension level. p1271

For the patient with hypoparathyroidism, what patient teaching is appropriate?

The patient with hypoparathyroidism needs instruction in the management of long-term drug therapy and nutrition. PTH replacement is not a recommended drug therapy because of the expense and the need for parenteral administration. - Oral calcium supplements of at least 1.5 to 3 g/day in divided doses are usually prescribed. Vitamin D is used in chronic and resistant hypocalcemia to enhance intestinal calcium absorption. - Preferred preparations are dihydrotachysterol (Hytakerol) and 1,25-dihydroxycholecalciferol (calcitriol (rocaltro). These drugs raise calcium levels rapidly and are quickly metabolized. Rapid metabolism is desired because vitamin D is a fat soluble vitamin and toxicity can cause irreversible renal impairment. - A calcium meal plan includes foods such as dark green vegetable, soybeans, and tofu. The the patient that foods congaing oxalic acid (spinach, rhubarb), physic acid (bran, whole grains), and phosphorus reduce calcium absorption. Instruct the patient about the need for lifelong treatment and follow up car including the monitoring of calcium levels three of four times a year.

Describe the water-soluble (protein) hormone receptor process.

The receptor is located in the cell membrane. The hormone-receptor interaction stimulates the production of a "second messenger" such as cAMP. cAMP works by activating enzymes to regulate intracellular activity.

What is Hyperthyroidism?

The term hyperthyroidism refers to any condition in which there is too much thyroid hormone produced in the body. In other words, the thyroid gland is overactive. Another term that you might hear for this problem is thyrotoxicosis, which refers to high thyroid hormone levels in the blood stream, irrespective of their source.

What hormones regulate metabolic rate of all cells and processes of cell growth and tissue differentiation?

The thyroid hormones (T3 and T4)

How are water-soluble hormones transported in the blood?

They circulate freely and are not dependent on proteins for transport

What do glucocorticoids do?

They regulate glucose metabolism

T4

Thyrocine ~Target Tissue- all body tissues ~Function-Precursor to T3

During the admission assessment, what nursing behavior is most appropriate with regard to palpation and assessment of a patient's thyroid glands?

Thyroid palpation requires considerable practice, as well as validation by a more experienced examiner. Water should always be available for the patient to swallow as part of this examination. There are two acceptable approaches to thyroid palpation: anterior or posterior. p. 1210

What hormone stimulates the thyroid gland to secrete thyroid hormones?

Thyroid-stimulating hormone

Thyroid hormones

Thyroxine (T4) Triiodothyronine (T3) Calcitonin

T3

Triiodothyronine ~Target tissue-all body tissues ~Function-Regulates metabolic rate of all cells and processes of cell growth and tissue differentiation

What are the target tissues for oxytocin?

Uterus, mammary glands

Gonads

Women: Ovaries (estrogen, progesterone) Men: Testes (testosterone)

In the patient with diabetes type 2 who has developed peripheral neuropahty and peripheral artery disease, what information will the nurse use in patient teaching?

You should include the following instructions when teaching the patient and / or caregiver about diabetic foot care. 1. Wash feet daily with mild soap and warm water. First test water temperature with hands. 2. Pat feet dry gently, especially between toes. 3. Examine feet daily for cuts, blisters, swelling, and red tender areas. Do not depend on feeling sores. If eyesight is poor, have others inspect feet. 4. Use lanolin on feet to prevent skin form drying and cracking. Do not apply between toes. 5. Use mild foot powder on sweaty feet. 6. Do not use commercial remedies to remove calluses or corns. 7. Cleanse cuts with warm water and mild soap, covering with clean dressing. Do not use iodine, rubbing alcohol, or strong adhesive. 8. Report skin infections or non healing sores to health care provider immediately. 9. Cut toenails evenly with rounded contour of toes. Do not cut down corners. The best time to trim nails is after a shower or bath. 10. Separtate overlapping toes with cotton or lamb's wool. 11. Avoid open-toe, open heel, an high-heel shoes. Leather shoes are preferred to plastic ones. Wear slippers with soles. Do not go barefoot. Shake out shoes before putting on. 12. Wear clean, absorbent (cotton or wool) socks or stockings that have not been mended. Colored socks must be colorfast. 13. Do not wear clothing that leaves impressions, hindering circulation 14. Do not use hot water bottles or heating pads to warm feet. Wear socks for warmth. 15. Guard against frostbite. 16. Exercise feet daily either by walking or by flexing and extending feet in suspended position. Avoid prolonged sitting, standing, and crossing of legs.

Hormone

a chemical substance synthesized and secreted by a specific organ or tissue; inactivated in the liver and excreted thru the kidneys.

Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80-90 mg/dL. The best response by the nurse is. a. "That is a good range for your glucose levels" b. "You should call your health care provider because you need to have your insulin increased." c. "That level is too low in view of your recent hypoglycemia, and you should increase your food intake" d. "You should only take half your insulin dosage for the next few days to get your glucose level back to normal"

a. "That is a good range for your glucose levels" Rationale: Blood glucose levels of 80 to 90 mg/dL (4.45-5 mmol/L) are within the normal range and are desired in the patient with diabetes, even following a recent hypoglycemic episode.

In nutritional management of all types of diabetes, it is important for the patient to a. eat regular meals at regular times b. restrict calories to promote moderate weight loss. c. eliminate sucrose and other simple sugars form the diet. d. limit saturated fat intake to 30% of dietary calorie intake.

a. eat regular meals at regular times. Rationale: The body requires food at regularly spaced intervals throughout the day and omission or delay of meals can result in hypoglycemia, especially for the patient taking insulin or oral hypoglycemic agents.

When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about a. energy level b. intake of vitamin C c. employment history d. frequency of sexual intercourse

a. energy level Rationale: The nurse should ask about energy levels, particularly compared with the patient's past energy level. Fatigue and hyperactivity are two common problems associated with endocrine problems.

To prevent hyperglycemia or hypoglycemia with exercise, the nurse teaches the patient using glucose-lowing agents that exercise should be undertaken. a. only after a 10- to 15-g carbohydrate snack is eaten. b. about 1 hour after eating, when blood glucose levels are rising. c. when glucose monitoring reveals that the blood glucose is in the normal range d. when blood glucose levels are high because exercise always has a hypoglycemic effect.

b. about 1 hour after eating, when blood glucose levels are rising. Rationale: During exercise, a diabetic person needs both adequate glucose to prevent exercise induced hypoglycemia and adequate insulin because e counterregulatory hormones are produced during the stress of exercise and may cause hyperglycemia.

Following the teaching of foot care to a diabetic patient, the nurse determines that additional instruction is needed when the patient says. a. "I should wash my feet daily with soap and warm water" b. "I should always wear shoes to protect my feet form injury" c. "If my feet are cold, I should wear socks instead of using a heating pad" d. "I'll know if I have sores or lesions on my feet because they will be painful."

d. "I'll know if I have sores or lesions on my feet because they will be painful" Rationale: Complete or partial loss of sensitivity of the feet is common with peripheral neuropathy of diabetes, and diabetics may suffer foot injury and ulceration without ever having pain. Feet must be inspected during daily care for any cuts, blisters, swelling, or reddened areas.

A patient with Graves' disease asks the nurse what caused the disorder. The best response by the ruse is, a. The cause of Graves' disease is not know, although it is thought to be genetic" b. "It is usually associated with goiter formation from an iodine deficiency over a long period of time" c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormone" d. "In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion'

d. "in genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion" Rationale: In Graves' disease, antibodies to the TSH receptor are domed, attach to the receptors, and stimulate the thyroid gland to release triiodothyronine (T3), thyroxine (T4), or both, creating hyperthyroidism. The disease is not directly genetic, but individuals appear to have a genetic susceptibility to the develop autoimmune antibodies.

Which of the following patients would a nurse plant to teach how to prevent or delay the development of diabetes? a. A 62 year old obese whit e man. b. An obese 50 year old Hispanic Woman. c. A child whose father has type 1 diabetes. d. A 34 year old woman whose parents both have type 2 diabetes.

d. A 34 year old woman whose parents both have type 2 diabetes Rationale: Type 2 diabetes has a strong genetic influence, and offspring of parents who both have type 2 diabetes have increased chance of developing it.