Care of the Patient with an Endocrine Disorders

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Care of the Patient with an Endocrine Disorders
2013-12-18 22:06:16
Endocrine Disorder

CH 51 Mosbys
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  1. Chvostek's sign
    an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in patients who are hypocalcemic
  2. dysphagia
    difficulty swallowing
  3. endocrinologist
    a physician who specializes in endocrinology
  4. glycosuria
    abnormal presence of a sugar, especially glucose, in the urine
  5. hyperglycemia
    greater than normal amounts of glucose in the blood
  6. polyuria
    excretion of an abnormally large quantity of urine
  7. polydipsia
    excessive thrist
  8. polyphagia
    eating to the point of gluttony
  9. ketoacidosis
    • DKA
    • acidosis accompanied by an accumulation of ketones in the blood
    • formerly called diabetic coma
  10. hirsutism
    excessive body hair in a masculine distribution
  11. hypocalcemia
    • a deficiency of calcium in the blood serum
    • S/S- tetany, cardiac dysrhythmias and carpopedal spasms
  12. hypokalemia
    inadequate amount of potassium a major cation in the circulating blood
  13. idiopathic hyperplasia
    an increase in the number of cells without a known cause
  14. ketone bodies
    normal metabolic products, such as b hydroxybutyric acid and aminoacetic acid, from which acetone may arise spontaneously
  15. lipodystrophy
    abnormality in the metabolism or deposition of fats; insulin lipodystrophy is the loss of local fat deposits
  16. neuropathy
    any abnormal condition characterized by inflammation and degeneration of the peripheral nerves
  17. Trousseaus's sign
    assesses for latent tetany; carpal spasm is induced by inflating a BP cuff on the upper arm to a pressure exceeding systolic BP for 3 min; a positive result may be seen in hypocalcemia and hypomagnesemia.
  18. turgor
    the normal resiliency of the skin
  19. type 1 diabetes mellitus
    results from progressive destruction of beta-cell function in the pancreas as a result of an autoimmune process in a susceptible individual.
  20. type 2 diabetes mellitus
    • decreased tissue responsiveness to insulin as a result of receptor or post-receptor defects
    • overproduction of insulin early in the disease, but eventual decreased secretion of insulin from beta-cell exhaustion
    • abnormal hepatic glucose regulation
  21. negative feedback
    • a decrease in function in response to stimuli
    • information is constantly being exchanged between the target organ and the pituitary gland via the bloodstream regarding the effect of the hormone on the target organ
  22. endocrine glands
    • ductless that release their secretions directly into the bloodstream
    • have regulatory function
  23. exocrine glands
    • secrete through a series of ducts (sebaceous and sudoriferous glands of the skin)
    • secretions are protective and functional
  24. hormones
    chemical messengers that travel through the bloodstream to their target organ
  25. acromegaly
    • an overproduction of somatotropin (growth hormone GH) in the adult
    • cause idiopathic hyperplasia or tumor growth
    • changes are irreversible
    • S/S: headaches, visual disturbances, painful stiff joints, sexual problems, bone enlargement, joint involvement, gait changes and decreasing ability to perform activities
    • NSG Interventions: supportive, assessment of ability to do ADL's, headaches may impair socialization and education, soft diet, allow adequate time during meals, frequent fluid intake, nonopiod analgesics , self esteem issues, enlarged liver, spleen and the heart, cardiac dysrhythmias, weight gain due to abdominal growth
  26. Glycosylated hemoglobin
    • test measures the amount of glucose that has become incorporated into the hemoglobin within an erythrocyte
    • because glycosylation occurs constantly during the 120 day life span of the erythrocyte this test reveals the effectiveness of diabetes therapy for the preceding 8-12 weeks.
    • A1C
  27. Diagnostic tests for DM
    • Fasting blood glucose (FBG): after 8 hour fast. Normal 60-110
    • Oral glucose tolerance test (OGTT): need accurate patient preparation
    • Serum insulin : Absent in type 1; normal to high in type 2
    • Postprandial (after meal) blood glucose (PPBG): give a fasting patient measured amount of carbohydrates either in solution or food and draw blood 2 hours after. Reading over 160 indicates possible DM
    • Patient self-monitoring of blood glucose (SMBG): patient self tests
    • Glycosylated hemoglobin (HbA1C): tests glucose levels from previous 8-12 weeks
    • C-peptide test: used in type 2 DM, normal 0.5-2 ng/mL. DM patients have lower levels of C-peptide
  28. Dietary interventions for Cushings
    • diet low in sodium to reduce edema
    • reduced calories and carbohydrates help control hyperglycemia
    • foods high in K help correct hypokalemia
  29. Relationship between diet and exercise for patient with DM
    Diet and exercise are tailored to the individual
  30. Long term complications with DM
    • blindness
    • nephropathy
    • amputation of a lower extremity
    • cardiovascular complications including heart disease
    • hypertension
    • stroke
  31. Thyroid crisis
    • AKA thyroid storm
    • rare after thyroidectomy, caused by manipulation of the thyroid during surgery causing the release of large amounts of thyroid hormones
    • occurs usually within 12 hours after surgery
    • S/S are exaggerated hyperthyroidism S/S as well as nausea, vomiting, sever tachycardia, sever hypertension and occasionally hyperthermia up to 106, extreme restlessness, cardiac dysrhythmia, delirium and heart failure and death
    • 3 goals of management: induce a normal thyroid state, prevent cardiovascular collapse and prevent excessive hyperthermia
    • treatment includes IV fluids, sodium iodide, corticosteroids, antipyretics, an antithyroid drug and oxygen
  32. Role of ADH and diabetes insipidus
    • decreased ADH
    • transient or permanent metabolic disorder of the posterior pituitary
    • may be primary or secondary to other conditions such as head injury, intracranial aneurysm, intracranial tumor or infarct, encephalitis or meningitis
    • occurs when the secretion or action of ADH goes awry
    • reduction of ADH results in electrolyte and fluid imbalances
    • caused by increased plasma osmolality and increased urinary output
  33. NSG Diagnosis and goiter
    risk for disturbed body image, related to altered physical appearance: develop open and trusting relationship so that the patient will express his or her feelings; discuss ways to disguise thyroid enlargement
  34. Diagnostic tests for hyperthyroidism
    • T3(serum triodothyronine): measures T3 in blood; normal is 65-195 ng/dL; accurate measurement of thyroid function; elevated T3 important for patient with normal T4 but S/S of hyperthyroidism
    • T4 (serum thyroxine): measures T4 levels in blood; normal is 5-12; medications such as contraceptives, steroids, estrogens and sulfonamides may be withheld for several hours before T3 and T4 tests, but food and fluid are not withheld; elevated levels indicate hyperthyroidism
    • Free T4 (FT4): measures active component of total T4; normal values are 1-3.5 ng/dL; used to diagnose hyper and hypothyroidism, high is hyper and low is hypo
    • thyroid-stimulating hormone (TSH): measures TSH; normal 0.3-5.4; considered most sensitive method for evaluating thyroid disease; recommended first test; TSH is suppressed in hyper and elevated in hypo
    • *Radioactive iodine uptake (RAIU): radioactive iodine is given by PO to fasting patient, after 2,4,6 and 24 hours a scintillation camera is held over the thyroid to measure how much of the isotope has been removed from the bloodstream; hyperactive thyroid may remove 35-95% of drug; test may be affected by prior ingestion of iodine containing substances or foods; note allergy to iodine
    • Thyroid scan: 131I is given PO or IV and scan done 30-60 minutes
  35. Medications for hyperthyroidism
    • Iodine or iodine products such as sodium iodide with strong iodine solution, potassium iodide, Lugol's solution
    • Radioactive iodine 131I or 125I
    • methimazole (tapazole), propylthiouracil (PTU)
  36. Medications for hypothyroidism
    • Levothyroxine (Levothroid, Synthroid, Eltroxin, Levo-T, Unithroid)
    • Liothyronine (Cytomel)
    • Liotrix (Thyrolar)
    • Thyroid (Armour Thyroid, Thyrar)
  37. Postoperative measures for patient with a thyroidectomy
    • semi fowlers with pillows supporting head and shoulders
    • pt avoid hyperextending the head
    • have suction and trach tray available
    • cool mist humidifier to soothe throat and prevent coughing
    • V/S often with special attention paid to the rate and depth of respirations and observations of dyspnea
    • check swallowing and gag reflex before PO food
    • alert for s/s of internal or external bleeding (restlessness, apprehension, increased pulse rate, decreased b/p and feeling of fullness in neck)
    • cyanosis indicates blocked airway
    • clear cool liquid diet
    • tetany
  38. Emergency post op care of pt with thyroidectomy
    tetany can occur and is treated with IV administration of calcium gluconate
  39. Physical changes that pt with Cushings disease may encounter
    • moon face
    • buffalo hump
    • weight gain from accumulation of adipose tissue in the trunk, face, and cervical spine
    • arms and legs become thin as a result of muscle wasting
    • osteoporosis
  40. hypothyroidism
    • decreased levels of PTH- parathyroid hormone
    • cause increase in serum phosphorus level and decreased serum calcium level resulting in neuromuscular hyperexcitability, involuntary and uncontrollable muscle spasms and hypocalcemic tetany
  41. Foot care and skin care for patient with DM
    • wash with mild soap and warm water
    • pat feet dry gently especially between toes
    • examine daily
    • use lanolin on feet
    • use mild foot powder
    • avoid open toes, open heel and high heel shoes, leather preferred
    • wear clean absorbent socks or stockings
    • nothing tight
    • no hot bottles or hot pads
    • watch for frostbite
    • exercise feet daily
  42. S/S of diabetic ketoacidosis
    • hot dry flushed skin
    • fruity breath
    • dry musous membranes
    • deep respirations
    • drowsiness/coma
    • low B/P
    • glucose in urine
    • nausea and vomitting
    • BG level of 300-800
    • administer regular insulin
  43. Lispro
    • Humalog
    • human clear
    • administer 5-15 min before meal
    • rapid acting, acts in 15-30 minutes
    • peak 1-2 hours
    • lasts 3-4 hours
  44. NPH
    • Humulin N, Novolin N, ReliOn N
    • human milky when mixed
    • administer 30 minutes before meal
    • intermediate acting, acts in 2-4 hours
    • peak 6-10 hours
    • lasts 12-16 hours
  45. Care of patient with hypothyroidism
    • room temp 70-74 and avoid chilling patient
    • allow extra time for care
    • accurate bowel records as constipation can occur
    • stool softners and bulk laxatives may be ordered
    • provide a high protein, high fiber, low calorie diet and encourage increased fluid intake
    • avoid concentrated carbs such as sweets
    • watch for chest pain
    • watch for decreased cardiac output
  46. Graves disease
    • hyperthyroidism
    • exophthalmic goiter and thyrotoxicosis
    • increase activity of the thyroid gland with overproduction of the thyroid hormones T4 and T3
    • may occur in pregnancy or adolescence
    • most frequent in woman 20-40 years old
    • visible edema of the anterior portion of the neck
    • bulging of eyeballs