Endocrine Disorders Outline (NR 710) - Franklin Pierce University PDF

Promoting health in patients with selected endocrine disorders NR 710 -- Week 4 Franklin Pierce University Objectives - Determine pertinent objective and subjective data necessary in the assessment of adults with alterations in endocrine function.  - Compare and contrast alterations in...

Promoting health in patients with selected endocrine disorders NR 710 -- Week 4 Franklin Pierce University Objectives - Determine pertinent objective and subjective data necessary in the assessment of adults with alterations in endocrine function.  - Compare and contrast alterations in endocrine function, including etiology, clinical management, and the nursing and collaborative management.  - Identify and create individualized plans of nursing care for patients receiving treatment for endocrine function.  - Identify the pharmacologic classification, mechanism of action, and common side effects of medications used to treat adults with alterations in endocrine function.  - Develop teaching strategies for assist patients with endocrine dysfunction. - Describe the role of nursing in coordinating care for patients undergoing surgery for endocrine alterations.  - Prioritize nursing assessments and interventions for patients with alterations in endocrine function. A&P review - Pancreas 1. Endocrine\* 1. Secretion of insulin and glucagon Exocrine 2. Enzyme secretion to help digest food - Cells need glucose for energy 3. Unable to absorb glucose -\> liver will release glucagon stores and stimulate hepatic glucose production (gluconeogenesis and glycogenolysis) Glucose Homeostasis Function of insulin at cell level Pancreatic Response to Glucose Levels Hyperglycemia - Fasting blood glucose \>126 mg/dL - Manifestation of type 1 diabetes mellitus and type 2 diabetes mellitus  - States of hyperglycemia -\> liver tries to compensate by releasing glucagon stores and stimulate hepatic glucose production  1. If hyperglycemia continues -\> cortisol, catecholamines, and growth hormones will be released -\> lipolysis and proteolysis occur to produce glucose -\> rapidly increasing blood glucose! Rising glucose -\> kidneys affected! Hyperglycemia: risk factors and causes - Steroids, phenytoin, and estrogen medications - Illness or infection - Chronic stress - Insomnia - Genetic/familial predisposition - Missing/insufficient diabetic medication - Poor technique for insulin administration - Expired insulin - Nonadherence to plan - Diet - TPN - Dextrose infusions - Overweight/obesity - Sedentary lifestyle - Smoking Hyperglycemia: manifestations - Polyuria - Polyphagia - Polydipsia - Weight loss - Dry mucous membranes - Confusion - Abdominal cramping - Flushing  Kussmaul breathing Hyperglycemia: diagnostics - Blood glucose testing  1. Fasting  (\>126 mg/dL) Postprandial levels (\>180mg/dL) - Hemoglobin A1C (HbA1c) - Unknown cause/suspected tumor/disease other than diabetes 3. CT scans, US, MRI Hyperglycemia: comorbidities and complications  Comorbidities - Autoimmune disorders - Hyperlipidemia - Hypertension - Gestational diabetes - Polycystic ovary syndrome (PCOS) - Metabolic syndrome - Cushing\'s syndrome - Acromegaly - Pheochromocytoma Complications - Metabolic syndrome - Fluid imbalances - Hypokalemia and hyponatremia - Depression  - Coma - Death - Damage to: blood vessels, nerves, tissues, and organs =\> CAD, CVA, PVD, retinopathy, nephropathy, poor wound healing Complications of hyperglycemia Hyperglycemia: treatment - Restore fluid and electrolyte balance - Lower glucose  - Diet - Exercise - Medications (Depends on etiology) 1. Insulin Sulfonylureas Thiazolidinediones Biguanides Dipeptidyl peptidase-4 (DPP-4 inhibitors) Sodium-glucose transport protein 2 (SGLT2) inhibitors  Hyperglycemia: interventions - Monitor glucose - Medication education, administration, monitoring - Monitor electrolytes - Monitor for s/s of dehydration - Monitor VS - Physical assessment  - I&O - Emotional support  - Education  Hypoglycemia - Low blood glucose  - Insufficient to meet demands of the cells of the body - Glucose \3.3 Typically started out by giving unit IV bolus...then start an infusion (checking blood glucoses around the clock...hospital protocols)...you will be titrating the insulin base on blood glucose checks. **NOTE**: if you rapidly bring a patient's blood glucose down (or up) the brain can't cope and water will be moved from the blood to the CSF and you will get cerebral edema and increased intracranial pressure What will you teach someone who has type 1 diabetes? Nursing Interventions -- Teaching Signs of hypo or hyperglycemia Subcutaneous insulin administration Medication education Regular blood glucose monitoring Healthy lifestyle Managing sick days Type 2 diabetes - Relative insulin deficiency occurs along with resistance to the actions of insulin in muscle, fat, and liver cells - Genetic and environmental component  - Usually diagnosed after age 40, but...... - - Type 2 diabetes: risks - \>45 years old - Overweight/obesity - Familial history - Environmental pollutants - Low birth weight - Energy dense foods/unbalanced diet - Sedentary lifestyle  - History of gestational diabetes  - Unhealthy sleep habits  - Tan or brown raised spots on skin Type 2 diabetes: manifestations - Polydipsia - Polyuria - Polyphagia - Thin limbs w/ fatty deposits around face, neck, and abdomen - Fatigue  - Weight loss - Blurred vision - Slow healing Type 2 diabetes: complications - Hyperglycemic hyperosmolar state (HHS) (type 2 diabetes) - Infection - Poor wound healing - Diabetic ulcers - Blurred vision Type 1 and 2 diabetes: long term complications - Cardiovascular disease  - Myocardial infarction - CVA (stroke) - Kidney disease - Nerve impairment - Vascular impairment - Diabetic ulcers, wounds - Amputation requirement  - Retinopathy  - Gangrene  - Hypertension Type 2 diabetes: management - Diagnostic 1. Labs 1. Fasting glucose \>/=126 mg/dL 2 hr post-prandial blood glucose \>/=200 mg/dL Random (non-fasting) blood glucose of \>/=200 mg/dL in symptomatic client HbA1C 6.5 % or higher H&P - Differentiation between type 1 and 2 3. Type 2: c-peptide will be normal or increased Islet cell antibodies DM1 - Medication 5. Oral antidiabetics Insulin  Type 1 & 2 diabetes: interventions - Vital signs - Physical assessment - Lab results review  - Insulin administration - Assess financial resources  - Podiatry consult - Nutrition consult - File nails - Education\*\* - Wound assessment - Diabetic educator consult Sulfonylureas Thiazolidinediones Biguanides Dipeptidyl peptidase-4 (DPP-4 inhibitors) Sodium-glucose transport protein 2 inhibitors  Metabolic syndrome - A group of conditions that together raise your risk of coronary heart disease, diabetes, stroke, and other serious health problems  - Insulin resistance - Components 1. Elevated blood pressure/hypertension Elevated glucose Elevated cholesterol Central obesity  - These components -- if not treated cause 5. Type 2 diabetes Cardiovascular disease  Metabolic syndrome: risk factors - Genetic link 1. Family history of gestational diabetes, ovarian cysts, type 2 diabetes - Increased age - Sedentary lifestyle  - Unbalanced diet  - Sleep apnea - Stress - Central obesity - Hyperglycemia - Hypertension Metabolic syndrome: management - Diagnosis  - 3 or more of the criteria - Hyperglycemia requiring medication or fasting blood glucose \>/= 100mg/dL - Hypertension requiring medication or blood pressure of \>/= 130/85 mm Hg  - Hypertriglyceridemia requiring medication therapy or triglycerides of \>/= 150 mg/dL - Decreased HDL requiring medication or low HDL (under 50 mg/dL in females or under 40 mg/dL males) - Central obesity  - Treatment - Treat and prevent obesity - Meds to treat: elevated lipids, diabetes, hypertension  - OSA treatment with c-pap - Bariatric surgery Metabolic syndrome: interventions - Regular physical activity - Eat a balanced diet - Weight loss - Stress management  - Medical management 1. Hypertension Hyperlipidemia Hyperglycemia  Thyroid gland Secretes Triiodothyronine (T3) Thyroxine (T4) Calcitonin  Hypothyroidism Decreased metabolism state Cause Autoimmune disease Thyroid surgery Radioactive iodine therapy Iodine deficiencies  Risks Deficient iodine intake Female \> male Older adults Medications Hashimoto\'s thyroiditis Autoimmune hypothyroidism Most common type Ages 30-50 Associated with other autoimmune diseases Hypothyroidism Clinical manifestations Fatigue, lethargy Weight gain Cold intolerance Increased sleep Cognitive or memory impairment Decreased appetite Bradycardia  Constipation Dry skin Thinning hair Hair loss Goiter Hypothyroidism: complications - Myxedema coma - Occurs if undiagnosed for a long time OR post thyroidectomy - Manifestations: - Hypothermia  - Extreme fatigue - Lethargy - Unconsciousness - Coma  - Depression - Low fertility - Heavy menses  - Constipation  - Goiters Hypothyroidism: management Diagnosis Labs: T3 = low T4 = low TSH High in primary hypothyroidism Low in secondary or tertiary hypothyroidism Antithyroid antibodies Treatment Replace thyroid hormone Levothyroxine Interventions VS  Physical assessment Monitor calcium levels Daily weight Administer prescribed treatments Symptom management Hyperthyroidism Accelerated metabolism state due to excessive thyroid hormone production Risk Females \> males Ages 20-40 Family history Recent pregnancy Graves\' disease Autoimmune hyperthyroidism Production of too much T4 Hyperthyroidism: clinical manifestations Increased metabolic rate Tachycardia and cardiac dysrhythmias AFIB Tachypnea  Heat intolerance Increased gastric activity Hypoglycemia  Increased appetite  Exophthalmos Goiter Weight loss Fatigue Nervousness Insomnia Light to absent menses Hair loss Hyperthyroidism: management Diagnosis Labs: T3 elevated T4 elevated TSH  Decreased in primary Elevated secondary and tertiary Imaging If goiter present  Antibodies Radioactive iodine uptake  Treatment Manage clinical manifestations Beta blockers Antithyroid medications Propylthiouracil (PTU) Methimazole (tapazole) Lithium carbonate Iodine Surgical intervention Total or subtotal thyroidectomy  Hyperthyroidism: management Interventions VS Physical assessment Encourage fluid intake Promote quiet and non stressful environment  Daily weights Monitor glucose I&O Goiter Seizure precautions Administer prescribed treatments  Administer eye lubricants  Hyperthyroidism: complications Irregular heart rhythm Blood clots Stroke Heart failure Fertility problems Osteoporosis **Thyroid storm** Thyroidectomy