Managing Endocrine Disorders and Patient Assessment

Managing Endocrine Disorders

• Addison's Disease: Characterized by decreased hormone levels. Symptoms include hyponatremia, hypotension, decreased blood volume, hyperkalemia, and hypoglycemia.

• Cushing's Syndrome: Characterized by increased hormone levels. Symptoms include hypernatremia, hypertension, increased blood volume, hypokalemia, and hyperglycemia.

Fluid and Electrolyte Imbalances

• No Pee, No K: Do not administer potassium without adequate urine output.

Patient Assessment

• Appearance (A): Assess for color (all pink, pink and blue, or blue/pale).

• Pulse (P): Assess pulse rate (>100 bpm, <100 bpm, or absent).

• Grimace (G): Assess for signs of distress (coughing, grimacing, or no response).

• Activity (A): Assess for activity level (flexed, flaccid, or limp).

• Respiration (R): Assess respiratory effort (strong cry, weak cry, or absent).

Transmission-Based Precautions

Airborne

• MTV: Measles, Tuberculosis, Varicella (Chicken Pox), Herpes Zoster (Shingles). Use private negative-pressure rooms with 6-12 air exchanges per hour. TB requires N95 masks.

Droplet

• SPIDERMAN: Sepsis, Scarlet Fever, Streptococcal Pharyngitis, Parvovirus B19, Pneumonia, Pertussis, Influenza, Diptheria (Pharyngeal), Epiglottitis, Rubella, Mumps, Meningitis, Mycoplasma pneumonia, Adenovirus. Use private rooms or cohorting. Masks are typically necessary.

Contact

• MRS.WEE: Multidrug-resistant organisms, Respiratory infections, Skin infections, Wound infections, Enteric infections (e.g., C. difficile), Eye infections (e.g., conjunctivitis).

Skin Infections

• VCHIPS: Varicella (chickenpox), Cutaneous diphtheria, Herpes simplex, Impetigo, Pediculosis (lice), Scabies.

Positioning for Specific Conditions

• Pulmonary Embolism: Left side-lying, lower head of bed.
• Unreassuring FHR: Left side-lying, Supplemental oxygen, stop Pitocin, increase IV fluids.
• Tube Feeding/Decreased LOC: Right side-lying, HOB elevated.
• Epidural Puncture: Side-lying.
• Lumbar Puncture/Myelogram: Flat supine.
• Heat Stroke: Flat, legs elevated.
• CBI: Thigh taped, leg straight.
• Myringotomy: Side-lying on affected side.
• Cataract Surgery: Unaffected side, night shield.
• Thyroidectomy: Semi-Fowler's position, support head, neck, and shoulders.
• Spina Bifida: Prone.
• Buck's Traction: Elevate foot of bed.
• Total Hip Replacement: Avoid operated side, <45-60° hip flexion, <45° HOB elevation, maintain abduction.
• Prolapsed Cord: Knee-chest position or Trendelenburg.
• Cleft Lip: Back position or infant seat; upright feeding position.
• Dumping Syndrome: Reclining position after meals, lie down, restrict fluids, low CHO/fiber diet, small frequent meals.
• Above Knee Amputation: Elevate for 24 hrs, prone positioning for hip extension.
• Below Knee Amputation: Elevated foot of bed, prone positioning.
• Detached Retina: Area of detachment in dependent position.
• Enema: Left side-lying with flexed knee (Sims').
• Supratentorial Surgery: HOB 30-45 degrees.
• Infratentorial Surgery: Flat, either side-lying.
• Internal Radiation: Bedrest.
• Autonomic Dysreflexia: Sitting position (elevate HOB) first.
• Shock: Bedrest with extremities elevated 20 degrees, knees straight, slightly elevated head.
• Head Injury: HOB elevated 30 degrees.
• Peritoneal Dialysis (inadequate outflow): Side-to-side turning before checking for kinks in tubing.
• Lumbar Puncture (post-procedure): Supine for 4-12 hours.

Medications

• Demerol: For pancreatitis, not morphine sulfate.

Neurological Conditions

• Myasthenia Gravis: Worsens with exercise, improves with rest. Myasthenia Crisis: Positive Tensilon response (symptoms improve), Cholinergic Crisis: Excessive medication; stop medication, Tensilon worsens symptoms.

Medications and procedures

• Head injury medications: Mannitol (an osmotic diuretic) - Use filter needle always because it crystallizes at room temp.
• Liver biopsy: Assess prothrombin time prior.

Gastrointestinal Issues

• Diarrhea: Metabolic acidosis.
• Vomiting: Metabolic alkalosis.

Thyroid Disorders

• Hypothyroidism (Myxedema): Slowed physical and mental function, cold sensitivity, dry skin and hair.
• Hyperthyroidism (Graves' disease): Accelerated physical and mental function, heat sensitivity, fine/soft hair.
• Thyroid Storm: Increased temperature, pulse, and hypertension.
• Post-thyroidectomy: Semi-Fowler's position; prevent neck flexion/hyperextension; tracheostomy at bedside.

Parathyroid Disorders

• Hypoparathyroidism: CATS (convulsions, arrhythmias, tetany, spasms, stridor). Associated with decreased calcium, high calcium and low phosphorus diet.
• Hyperparathyroidism: Fatigue, muscle weakness, renal calculi, back and joint pain. Associated with increased calcium, low calcium and high phosphorus diet..

Fluid Volume Imbalances

• Hypovolemia: Increased temperature, rapid/weak pulse, increased respiration, hypotension, anxiety, urine specific gravity >1.030.
• Hypervolemia: Bounding pulse, shortness of breath, dyspnea, rales/crackles, peripheral edema, hypertension, urine specific gravity < 1.030.