Care Of The Patient With An Endocrine Disorder PDF

CARE OF THE PATIENT WITH AN ENDOCRINE DISORDER Disorders of the Thyroid, Parathyroid, and Adrenal Glands 081‐NP02L022 ELO B · Version 2.0 Foundations and Adult Health Nursing, 8th ed., Chapter 51, p. 1699; p. 1701; pp. 1709 ‐ 1723 TERMINAL LEARNING OBJECTIVE Given a patient with a disorder of the...

CARE OF THE PATIENT WITH AN ENDOCRINE DISORDER Disorders of the Thyroid, Parathyroid, and Adrenal Glands 081‐NP02L022 ELO B · Version 2.0 Foundations and Adult Health Nursing, 8th ed., Chapter 51, p. 1699; p. 1701; pp. 1709 ‐ 1723 TERMINAL LEARNING OBJECTIVE Given a patient with a disorder of the pituitary system determine approaches for safe and effective patient care. ENABLING LEARNING OBJECTIVE: B IDENTIFY THE FUNCTION OF THE THYROID, PARATHYROID, and ADRENAL GLANDS INDENTIFY THE FUNCTION OF THE THYROID GLAND Very Vascular Secretes T3 and T4  IDENTIFY LOCATION AND FUNCTION OF THE PARATHYROID GLAND Located on the posterior surface of thyroid gland Secretes PTH CHECK ON LEARNING What three things do the thyroid glands regulate? HYPERTHYROIDISM CLINICAL MANIFESTATIONS ASSESSMENT Subjective Objective DIAGNOSTIC EVALUATION LABORATORY TESTS RADIOACTIVE IODINE UPTAKE TEST (RAIU) THYROID SCAN  THYROID CRISIS / STORM First 12 hours post‐op Clinical manifestations of hyperthyroidism are exaggerated plus, SEVERE: TACHYCARDIA HYPERTENSION HYPERTHERMIA 3 GOALS Induce a Normal Thyroid State Prevent Cardio‐Vascular collapse Prevent Excessive Hyperthermia PROGNOSIS Normal Life Exophthalmos may persist CHECK ON LEARNING A nurse is caring for a client following thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to: a. Treat thyroid storm b. Prevent cardiac irritability c. Stimulate the release of parathyroid hormone d. Treat hypocalcemia tetany  HYPOTHYROIDISM Graves Disease Cretinism Fails to Secrete Sufficient Hormones Autoimmune response CLINICAL MANIFESTATIONS ASSESSMENT Subjective Objective DIAGNOSTIC EVALUATION PHYSICAL EXAMINATION PATIENT HISTORY LABORATORY TESTS MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL Replacement None Therapy PROGNOSIS Do well with Medical Supervision Medication will be lifelong CHECK ON LEARNING The nurse is monitoring a patient receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. a. Insomnia b. Weight loss c. Bradycardia d. Constipation e. Mild heat intolerance  SIMPLE GOITER Thyroid enlarges due to low iodine levels Unable to utilize iodine  CLINICAL MANIFESTATIONS Patients usually do not display Overt thyroid dysfunction ASSESSMENT Subjective Objective DIAGNOSTIC EVALUATION History and Physical Thyroid Scan Laboratory Tests MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL MEDICATION Thyroidectomy Shrink Thyroid Iodine NURSING IMPLICATIONS Potential for R/t physical appearance Distorted Body Image Emotional support Potential for Allow patient to express feelings Noncompliance Dietary and medication regimen Patient Need for Medical supervision Teaching Stress importance of medications PROGNOSIS Life span is normal May lead to Hypothyroidism CHECK ON LEARNING The recommended daily allowance (RDA) iodine in adult males and females is 150 mg/day. Even though only a small quantity is needed each day, what symptoms are apparent if the intake of this mineral is insufficient or there is a complete lack of it in the diet?  THYROID CANCER Types: Papillary Follicular Anaplastic CLINICAL MANIFESTATIONS ASSESSMENT Subjective Objective DIAGNOSTIC EVALUATION Thyroid Scan Ultrasound/CT Scan Needle Biopsy MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL Total Radiation Thyroidectomy Radical Neck Chemotherapy Dissection Radioactive Iodine NURSING IMPLICATIONS Monitor for s/s of decreased calcium Potential for Injury Monitor for s/s of hyperthyroidism and hypothyroidism Inadequate Monitor incision for increased drainage Fluid Volume Monitor I&O and vital signs Patient Medical follow‐up Teaching Need for thyroid hormone replacement PROGNOSIS Depends on the TYPE OF TUMOR Papillary Carcinomas = excellent Follicular and anaplastic Carcinomas much less favorable CHECK ON LEARNING What is the risk involved in needle biopsy? CHECK ON LEARNING What possible complications are associated with total thyroidectomy? HYPERPARATHYROIDISM Over production of parathyroid hormone (PTH) CLINICAL MANIFESTATIONS ASSESSMENT Subjective Objective DIAGNOSTIC EVALUATION Radiographic Examination Bone Density measurements Sestamibi Parathyroid Scan MRI/CT Scan/US Laboratory Tests MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL Removal of Close abnormal monitoring tissue Parathyroid Hormones NURSING IMPLICATIONS Monitor calcium level, I&O Post‐op Administer diuretics, strain urine for stones, decrease calcium intake Administer analgesics Pain Assess home for fall hazards Good body mechanics to prevent fractures Patient Teaching Monitor dietary calcium and Vitamin D and avoid smoking PROGNOSIS With treatment average life expectancy Parathyroid Carcinoma = grave  HYPOPARATHYROIDISM Decreased parathyroid Hormone Idiopathic CLINICAL MANIFESTATIONS ASSESSMENT Subjective Objective HYPOPARATHYROIDISM EVALUATION Decreased PTH Hypocalcemia, Hyperphosphatemia and Increased urinary calcium Rule Out= vitamin D deficiency, Kidney failure, Pancreatitis Post Thyroidectomy MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL IV calcium gluconate or None calcium chloride Vitamin D NURSING IMPLICATIONS Monitor IV site, give at a rate not to exceed 1 Patient ml/min, rapid infusion can cause Receiving IV hypotension, cardiac dysrhythmias, and calcium cardiac arrest Potential for Monitor calcium level Injury Monitor for s/s of hypocalcemia Patient Diet high in calcium and low in phosphorus Teaching PROGNOSIS Treatment keeps the Symptoms under control Normal life expectancy CHECK ON LEARNING Why is furosemide prescribed for a patient with hyperparathyroidism? a. Preserve kidney function b. Decreased fluid retention and edema c. Encourage the elimination of serum calcium d. Decrease blood pressure ADRENAL GLANDS LOCATION AND FUNCTION Sits on top of the Kidneys Glands contain Adrenal Cortex Mineralocorticoids Glucocorticoids Sex Hormones Adrenal Medulla Epinephrine Norepinephrine CHECK ON LEARNING Name the three types of steroids released by the Adrenal glands. CHECK ON LEARNING Cortisol is responsible for what bodily function? a. Regulates sodium levels b. Regulates potassium levels c. Provides energy during stress d. Responds to decreased  ADRENAL HYPERFUNCTION (CUSHING’S SYNDROME) Excessive Corticosteroid Glucocorticosteroid Hyperplasia Overstimulation of ACTH ACTH‐secreting Neoplasm Prolonged use of Corticosteroids CUSHING’S SYNDROME: CLINICAL MANIFESTATIONS ASSESSMENT Subjective Objective DIAGNOSTIC EVALUATION Clinical Appearance Plasma Cortisol and ACTH Levels Adrenal angiography Laboratory Tests 24‐hr urine Test MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL Root Cause Tumor Removal Gradually Discontinue Medical Corticosteroid Adrenalectomy therapy NURSING IMPLICATIONS Activity Intolerance Plan activity and rest periods Potential for Monitor for infection Infection Use of elbow and heel protectors Monitor blood glucose levels Wear Medical Alert tag Patient Teaching Monitor for depression and suicidal ideation PROGNOSIS Depends if etiology is benign or malignant, treatment is successful or unsuccessful Life expectancy is shortened due to complications CHECK ON LEARNING Overabundance of corticosteroids (such as aldosterone and cortisol) will produce what type of metabolic disturbances? CHECK ON LEARNING The patient with Cushing’s syndrome has high risk for skin break down. What instruction would the nurse give to the UAP (unlicensed assistive personnel) to prevent skin breakdown? a. Handle very gently to prevent bruising and ecchymosis b. Assess for signs of erythema, edema, or infection c. Frequently wash the skin to prevent irritation d. Assist females to remove extra hair with a safety razor ADRENAL HYPOFUNCTION (ADDISON’S DISEASE) Adrenocortical insufficiency Inadequate Glucocorticoids Mineralocorticoids Androgens Most Common Cause Autoimmune ADDISON’S DISEASE: CLINICAL MANIFESTATIONS ASSESSMENT Subjective Objective DIAGNOSTIC EVALUATION Plasma Cortisol and ACTH Levels Glucose Tolerance Test Laboratory Tests CT Scan/MRI MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL Restore fluid None and Electrolytes Hydrocortisone Increased glucocorticoids during stress Diet high in Sodium Low in Potassium NURSING IMPLICATIONS Monitor BP and Temperature Potential for Injury Monitor for dizziness Stress free environment Potential for Monitor for infection Infection Screen visitors for infectious diseases Lifelong replacement Avoid stress Patient Teaching Addison’s Crisis Wear Medical Alert tag PROGNOSIS Long‐Term Steroid Therapy Fair Prognosis CHECK ON LEARNING Deficiencies in aldosterone and cortisol will produce what type of metabolic disturbances? CHECK ON LEARNING The patient with Cushing’s syndrome has high risk for skin break down. What instruction would the nurse give to the UAP (unlicensed assistive personnel) to prevent skin breakdown? a. Handle very gently to prevent bruising and ecchymosis b. Assess for signs of erythema, edema, or infection c. Frequently wash the skin to prevent irritation d. Assist females to remove extra hair with a safety razor  ADDISON’S CRISIS Life‐Threatening Precipitating Factors Stress Surgery Infections Trauma Psychological Sudden withdrawal from corticosteroid hormone therapy Adrenal surgery  CUSHING’S SYNDROME: Nursing Care SHOCK MANAGEMENT CHECK ON LEARNING The nurse is caring for a patient who is admitted with Addison’s disease. During the AM assessment, the nurse notes very high temperature and orthostatic hypotension. Laboratory results shoe hyponatremia and hyperkalemia. How does the nurse interpret these findings? a. These are expected findings for this disorder; continue routine assessment b. The frequency of assessment should be increased; reassess status every 1‐2 hours c. These are signs of impending Addisonian crisis; notify the HCP d. These should be documented as abnormal findings; compare data for trends  PHEOCROMOCYTOMA Rare Tumor Adrenal Medulla Excessive secretion of Catecholamines CLINICAL MANIFESTATIONS ASSESSMENT Subjective Objective DIAGNOSTIC EVALUATION 24‐Hr urine Test MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL Blood Removal of Pressure Tumor Control Metyrosine NURSING IMPLICATIONS Decreased Monitor BP, pulse and I&O Cardiac Output Limit caffeine and smoking Activity Assist with position changes Intolerance Limit activity Monitor Blood Pressure Patient Wear Medical Alert tag Teaching PROGNOSIS Tumor removal = Good Non‐operable = depends on adequate medical treatment Undiagnosed/Untreated will lead to Death CHECK ON LEARNING The nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's syndrome. Which statement by the student indicates an accurate understanding of this disorder? a. "Cushing's syndrome is characterized by an oversecretion of insulin." b. "Cushing's syndrome is characterized by an oversecretion of glucocorticoid hormones." c. "Cushing's syndrome is characterized by an undersecretion of corticotropic hormones." d. "Cushing's syndrome is characterized by an undersecretion of glucocorticoid hormones." CHECK ON LEARNING Which nursing action would be appropriate to implement when a client has a diagnosis of pheochromocytoma? a. Weigh the client b. Test the client’s urine for glucose c. Monitor the client’s blood pressure d. Palpate the client’s skin to determine warmth CHECK ON LEARNING The nurse is caring for a client after a thyroidectomy and monitoring for signs of thyroid storm. The nurse determines that which sign/symptom is indicative that a thyroid storm may be occurring? a. Constipation b. Temperature of 96.6 F c. Blood pressure of 80/60 mm Hg d. Heart rate of 44 beats per minute CASE STUDY You are working in a community outpatient clinic where you perform the intake assessment on R.M., a 38‐year‐old woman who is attending graduate school and is very sedentary. Her chief complaint is overwhelming fatigue that is not relieved by rest. She is so exhausted that she has difficulty walking to classes and trouble concentrating when studying. She reports a recent weight gain of 15 pounds over 2 months without clear changes in her dietary habits. Her face looks puffy, she has experienced excessive hair loss, and her skin is dry and pale. She complains of generalized body aches and pains with frequent muscle cramps and constipation. You notice she is dressed inappropriately warmly for the weather. Vital Signs (VS) Blood pressure (BP) 142/84 mm Hg Heart rate 52 beats/min Respiratory rate 12 breaths/min Temperature 96.8° F (36° C) CASE STUDY 1. Compare her vital signs with those of a healthy person her same age. 2. List eight general questions you might ask R.M to assist in determining what is going on. 3. The practitioner affirms a diagnosis of hypothyroidism. With this diagnosis, what other signs and symptoms would you want to assess for in R.M.? 4. What teaching needs will you review with R.M. with regard to her medication? SUMMARY OF MAIN POINTS Location and function of the thyroid / parathyroid gland Hyperthyroidism / Hypothyroidism Goiter Thyroid cancer Hyperparathyroidism / Hypoparathyroidism QUESTIONS?