Promoting Health in Patients with Endocrine Disorders PDF

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

Promoting health in patients with selected endocrine disorders NR 710 – Week 4 Franklin Pierce University  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, Objectives 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 Endocrine* Secretion of insulin and glucagon Exocrine Enzyme secretion to help digest food Cells need glucose for energy 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 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 Diet medications Illness or infection TPN Chronic stress Dextrose infusions Insomnia Genetic/familial predisposition Overweight/obesity Missing/insufficient diabetic Sedentary lifestyle medication Poor technique for insulin Smoking administration Expired insulin Nonadherence to plan Hyperglycemia: manifestations Lethargy Polyuria Tachycardia, hypotension, elevated Polyphagia temp Polydipsia Kussmaul respirations Weight loss Nausea & vomiting Fruity breath Dry mucous membranes Anorexia Confusion Poor skin turgor Abdominal cramping Irritability Flushing Kussmaul breathing Hyperglycemia: diagnostics Blood glucose testing Fasting (>126 mg/dL) Postprandial levels (>180mg/dL) Hemoglobin A1C (HbA1c) Unknown cause/suspected tumor/disease other than diabetes CT scans, US, MRI Hyperglycemia: comorbidities and complications Comorbidities Complications Autoimmune disorders Metabolic syndrome Hyperlipidemia Fluid imbalances Hypertension Hypokalemia and hyponatremia Gestational diabetes Depression Polycystic ovary syndrome (PCOS) Coma Metabolic syndrome Death Cushing's syndrome Damage to: blood vessels, nerves, tissues, and organs => CAD, CVA, Acromegaly PVD, retinopathy, nephropathy, poor Pheochromocytoma wound healing Complications of hyperglycemia Hyperglycemia: treatment Restore fluid and electrolyte balance Lower glucose Diet Exercise Medications (Depends on etiology) Insulin Sulfonylureas Thiazolidinediones Biguanides Dipeptidyl peptidase-4 (DPP-4 inhibitors) Sodium-glucose transport protein 2 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…… https://www.cdc.gov/diabetes/prevent- type-2/type-2-kids.html 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 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 Vascular impairment Myocardial infarction Diabetic ulcers, wounds CVA (stroke) Amputation requirement Kidney disease Retinopathy Nerve impairment Gangrene Hypertension Type 2 diabetes: management Diagnostic Labs 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 Type 2: c-peptide will be normal or increased Islet cell antibodies DM1 Medication Oral antidiabetics Insulin Type 1 & 2 diabetes: interventions Vital signs Wound assessment Physical assessment Diabetic educator consult Lab results review Insulin administration Assess financial resources Podiatry consult Nutrition consult File nails Education** Sulfonylureas Drug example: Glyburide (Diabeta), glipizide (Glucotrol), glimepiride (Amaryl) Action: Decreases blood glucose by increasing insulin secretion from beta cells in the pancreas Use: Lower blood glucose in type 2 diabetes Adverse reactions: Hypoglycemia, weight gain, nausea, diarrhea, dizziness, headache, anemia (hemolytic, aplastic) Interventions: Monitor for hypoglycemia/glucose level Administration: PO Client instructions: Take 30 minutes before meals or with first meal of the day Monitor for s/s hypoglycemia Contraindications/ Ketoacidosis, diabetic coma, type 1 diabetes precautions: Caution: malnutrition, fevers, infection, renal Thiazolidinediones Drug example: Pioglitazone (Actos), rosiglitazone (Avandia) Action: Decreases resistance to insulin Use: Type 2 diabetes Adverse reactions: Liver toxicity, weight gain, edema, heart failure, liver failure, bladder cancer, rhabdomyolysis Interventions: Monitor for hypoglycemia/glucose level, monitor s/s of heart failure, monitor liver function Administration: PO Client instructions: May take with or without food, monitor for s/s liver issues, report changes in appetite, jaundice, abdominal pain, or dark urine Contraindications/ Type 1 diabetes, diabetic ketoacidosis, bladder precautions: cancer Biguanides Drug example: Metformin (glucophage) Action: Decreases amount of glucose produced in the liver and decreases amount of glucose absorbed from food; increases sensitivity to insulin Use: Type 2 diabetes to maintain glucose Adverse reactions: Indigestion, bloating, abdominal pain, constipation, headache, and metallic taste; rare lactic acidosis Interventions: When illness or lab abnormalities assess for acidosis, monitor renal therapy w/ initiation and annually Administration: PO Client instructions: Take 30 minutes before meals or with first meal of the day, do not take if NPO, hold for procedures requiring contrast dye, and monitor for s/s hypoglycemia Contraindications/ Hold for imaging studies which require dye precautions: Hold when dehydration risk Metabolic acidosis, severe renal impairment, Dipeptidyl peptidase-4 (DPP-4 inhibitors) Drug example: Sitagliptin (Januvia) Action: Increases insulin production and lowers glucagon secretion Use: Type 2 diabetes Adverse reactions: Upper respiratory infection, runny nose, indigestion, edema, changes in urination, diarrhea, pancreatitis, rhabdomyolysis, ARF Interventions: Monitor for s/s pancreatitis, monitor for hypoglycemia, monitor for s/s potential adverse effects Administration: How to deal with Client instructions: Monitor for kidney function, monitor for hypoglycemia, carry glucose with them Contraindications/ Type 1 diabetes, diabetic ketoacidosis, precautions: hypersensitivity Caution: renal impairment, hx pancreatitis, hx HF, hx renal impairment Sodium-glucose transport protein 2 inhibitors Drug example: Canagliflozin (Invokana), dapagliflozin (Forxiga), empagliflozin (Jardiance) Action: Decreases renal glucose reabsorption and increases elimination of glucose by urination Use: Type 2 diabetes – glucose control and reduce risk of cardiovascular death, MI, and stroke Adverse reactions: UTIs, increased urination, increased thirst, nausea, constipation, fungal infections, acidosis, urosepsis, AKI Interventions: Monitor kidney function, monitor for s/s of hypoglycemia, glucose level, monitor for s/s infection, HA1C Administration: PO Client instructions: Monitor renal function, take before first meal of the day, hold prior to surgical procedures, monitor for hypoglycemia, monitor for s/s infection 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 Elevated blood pressure/hypertension Elevated glucose Elevated cholesterol Central obesity These components – if not treated cause Type 2 diabetes Cardiovascular disease Metabolic syndrome: risk factors Genetic link 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 Hypertension Hyperlipidemia Hyperglycemia Thyroid gland Secretes Triiodothyronine (T3) Thyroxine (T4) Calcitonin Hypothyroidism Decreased metabolism state Hashimoto's thyroiditis Cause Autoimmune Autoimmune disease hypothyroidism Thyroid surgery Most common type Radioactive iodine therapy Ages 30-50 Iodine deficiencies Associated with other Risks autoimmune diseases Deficient iodine intake Female > male Older adults Medications  Hypothyroidis m 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 Treatment Labs: Replace thyroid hormone T3 = low Levothyroxine T4 = low Interventions TSH VS High in primary hypothyroidism Physical assessment Low in secondary or tertiary Monitor calcium levels hypothyroidism Daily weight Antithyroid antibodies 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 Exophthalmos Tachycardia and cardiac Goiter dysrhythmias Weight loss AFIB Fatigue Tachypnea Nervousness Heat intolerance Insomnia Increased gastric activity Light to absent menses Hypoglycemia Hair loss Increased appetite Hyperthyroidism: management Diagnosis Treatment Labs: Manage clinical manifestations T3 elevated Beta blockers T4 elevated Antithyroid medications TSH Propylthiouracil (PTU) Decreased in primary Methimazole (tapazole) Elevated secondary and tertiary Lithium carbonate Imaging Iodine If goiter present Surgical intervention Antibodies Total or subtotal thyroidectomy Radioactive iodine uptake 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 Hyperthyroidis m: complications Irregular heart rhythm Blood clots Stroke Heart failure Fertility problems Osteoporosis Thyroid storm  Post op: will need Post-op priorities thyroid replacement Airway Complications Hemorrhage Thyroidecto Hypoparathyroidism Hypocalcemia Laryngeal nerve my damage Laryngeal nerve