Chapter 39 - Care of patients with endocrine disorders

Symptoms of syndrome of inappropriate antidiuretic hormone (SIADH)

Fluid overload evidenced by weight gain, hyponatremia, low serum osmolality, concentrated urine, muscle cramps and weakness due to electrolyte imbalance; if untreated, lethargy, confusion, seizures, coma, death

Symptoms of hypothyroidism

Bradycardia; cold intolerance; lethargy; memory loss; dry skin; brittle dry hair; decreased appetite; weight gain; constipation; increased serum lipids; decreased libido; erectile dysfunction

Nursing interventions for Activity intolerance related to fatigue secondary to hypothyroidism

Assist with activities of daily living (ADLs), allow rest between activities, protect skin from breakdown related to immobility

Symptoms of hyperthyroidism

Tachycardia; heat intolerance; fatigue; restlessness; tremor; emotional instability; insomnia; warm, moist skin; increased appetite, weight loss; frequent stools; decreased serum lipids; decreased libido; erectile dysfunction

Patient education for patients receiving low doses of radioactive iodine at home

Use agency guidelines for education. In general, teach patient to avoid close contact with family for about a week; to use careful handwashing after urinating; to avoid oral contact with others; to wash eating utensils carefully; to treat sore throat with

Symptoms of thyrotoxic crisis

Tachycardia, high fever, hypertension, dehydration, restlessness, delirium, coma, death if untreated

Symptoms and treatment of acute tetany

Numbness and tingling around mouth and fingers, muscle spasms, cardiac dysrythmias; treat with IV calcium gluconate

Interventions for Risk for Injury related to calcium imbalance secondary to hyperparathyroidism

Monitor calcium levels, encourage oral fluids, encourage weight-bearing exercises and ambulation with assistance, encourage smoking cessation, teach what symptoms to report

Patient education for Fluid Volume Deficit related to Addison's disease

Assess knowledge base, teach hormone replacement (2/3 of dose in A.m. and 1/3 in p.m., as ordered), teach how to recognize stress and alter treatment during stressful times. Patient may need increased sodium intake during hot weather, should wear Medic Al

Symptoms of Cushing's syndrome

Weight gain, truncal obesity, buffalo hump, moon face, glucose intolerance, muscle wasting, thin skin, osteoporosis, risk for infection, mental status changes, sodium and water retention

Autoimmune disorders in which the body attacks itself

Hashimoto's thyroiditis, Grave's disease

Goitrogens

Foods that can cause a goiter (ex. Turnips, cauliflower)

Ectopic hormones

When hormones are produced outside of the endocrine gland where they are normally produced

Euthyroid state

When the thyroid gland is functioning normally

Hyperplasia

When excess tissue develops in the endocrine glands and produces too much hormone

Hypophysectomy

Surgical removal of the pituitary gland.
POST-OP- Monitor dressing for CSF. (CSF has glucose so drainage checked by a BS test with a glucose strip
Use stool softeners and antitussives to prevent straining

Hypovolemic shock

Occurs if fluid deficit is not corrected

Myxedema

Nonpitting edema that occurs in hypothyroidism

Nocturia

excessive urination at night

Polydipsia

Excessive thirst

Mr. Lloyd is admitted to your unit for severe end-stage respiratory disease. He has been on medication for many years to control his airway inflammation and now has Cushing's syndrome

1. Cushing's syndrome is caused by exposure to excess cortisol. This can occur because of an adrenal problem, a pituitary problem, or from treatment with exogenous corticosteroids.
2. Hyperglycemia, moon face, thin skin, buffalo hump, truncal obesity, sod

Positive Trousseau sign

Is the indication of thumb and fingers spasm within 3 minutes of the sphygmomanometer is placed on the patients arm and pumped above the patients systolic pressure.

Malnutrition

Worldwide, most common sign of dwarfism.

A patient treated for Hodgkin's disease and reports feeling better but has gained weight and has muscle cramps. The nurse knows that syndrome of inappropriate antidiuretic hormone can be a complication of cancer and cancer treatment. Which lab results wou

Serum calcium and phosphate

The nurse is collecting data on a patient who reports fatigue, weight gain, constipation and dry skin. The physician suspects primary hypothyroidism. Which of the following test results would the nurse expect to see.

Low T3 and T4 levels, elevated thyroid-stimulating hormone levels

A patient with hyperthyroidism has been given an oral dose of radioactive iodine and is being released. The following should be included in discharge teaching.

1. Advise the patient to avoid close contact with family members for about 1 week.
2. Encourage the patient to drink plenty of fluids.
3. Inform the patient of the symptoms of hypothyroidism to report.
4. Tell the patient to be vigilent about careful hand

Which of the following assessment findings in a patient with hyperthyroidism being treated fro pneumonia should the nurse report to the physician immediately?

Temperature of 104 degrees and Tachycardia

A patient reports he is having one of his "attacks" of rapid heart rate, palpitations, diaphoresis, tremors and severe pounding headache. Assessment reveals BP 160/120mm Hg and heart rate of 116 beats per minute, other vitals are within normal limits. Pre

24-hour urine test for metanephrine and vanillylmandellic acid.

The nurse is assisting with the teaching for Addison's disease about new orders for hydrocortisone and fludrocortisone. This statements by the patient indicates that more teaching is necessary.

I will eat a low-sodium diet.

The nurse is caring for the patient 6-hours post-transsphenoidal hypophysectomy. What sign should the nurse report to the physician immediately?

The mustache dressing tests positive for glucose.

A patient who reports frequent urination and excessive thirst is being evaluated for possible diabetes insipidus. During the assessment the nurse notes poor skin turgor, BP 95/65 mm Hg and pale urine. What complication should the nurse be most concerned a

Hypovolemic shock

Which disorder results from too much cortisol secretion?

Cushing's syndrome (regardless of exogenous or endogenous, it is caused by excess cortisol)

A patient with SIADH asks the nurse why he has gained 10 lbs. What is the best response for the nurse?

You have too much of a hormone in your system that causes you to retain water. The extra 10 lbs. is likely water weight."
Antidiuretic hormone causes water retention without sodium or potassium retention.

Which assessment finding should the nurse expect to see in the patient with uncontrolled diabetes insipidus?

Polyuria, Polydipsia and Dehydration.
(Diabetes insipidus is caused by lack of antidiuretic hormone, which results in excess urination, thirst and dehydration.)

Which of the following nursing assessments is most important in the patient with hyperthyroidism and risk for thyrotoxic crisis.

Vital signs - Elevated vital signs can signal the onset of thyrotoxic crisis

What instructions should the nurse provide to the patient who is being discharged after a thyroidectomy?

You must take your thyroid replacement everyday just as the physician prescribed."
Thyroid hormone is essential to survival. If the thyroid gland has been removed, exogenous hormone replacement is required for life.

Which action by the nurse is most important following hypophysectomy?

Performing a routine neurologic assessment.
They are important to detect complications after surgery involving the central nervous system.

What statement by the patient with hypothyroidism indicates to the nurse that the plan of care is effective?

I feel so much better now that my energy is returning."
A patient with hypothyroidism typically is fatigued; returning energy is a sign of effective therapy.

Amenorrhea

Absence of menses

Dysphagia

Difficulty swallowing

Ectopic

When hormones are made outside of the endocrine gland.

Euthyroid state

A normal functioning thyroid gland.

Goiter

Enlargement of the thyroid gland. Usually non-toxic. (called endemic goiter when caused by iodine deficiency or other environmental factors.)
SIGNS AND SYMPTOMS- Enlarged thyroid, swelling at base of neck

Myxedema coma

Is caused by untreated hypothyroidism

Nocturia

Excessive urination at night

Polydipsea

Excessive thirst

Polyuria

Excessive urination

Pheochromocytoma

Tumor in the adrenal medulla

Diabeted Insipidus

HORMONE PROBLEM:
-antidiuretic hormone (ADH) deficiency
MAJOR SIGNS & SYMPTOMS
-Polyuria

(SIADH) syndrome of inappropriate ADH Secretion

HORMONE PROBLEM:
-ADH excess
MAJOR SIGNS & SYMPTOMS
-Water retention

Cushing's syndrome

HORMONE PROBLEM:
-Steroid excess
MAJOR SIGNS & SYMPTOMS
-Moon Face

Addison's disease

HORMONE PROBLEM:
-Deficient steroids
MAJOR SIGNS & SYMPTOMS
-Hypotension

Graves' Disease

HORMONE PROBLEM:
-High T3 and T4
MAJOR SIGNS & SYMPTOMS
-Exophthalmos

Hypothyroidism

HORMONE PROBLEM:
-Low T3 and T4
MAJOR SIGNS & SYMPTOMS
-Weight gain and fatigue

Pheochromocytoma

HORMONE PROBLEM:
-Epinephrine Excess
MAJOR SIGNS & SYMPTOMS
-Labile Hypertension

Hyperparathyroidism

HORMONE PROBLEM:
-High serum calcium
MAJOR SIGNS & SYMPTOMS
-Muscle weakness, brittle bones

Short stature

HORMONE PROBLEM:
-Growth hormone (GH) deficiency
MAJOR SIGNS & SYMPTOMS
-Failure to grow and develop

Acromegaly

HORMONE PROBLEM:
-Excess Growth hormone (GH)
MAJOR SIGNS & SYMPTOMS
-Growing hands and feet
-Curvature of spine
________________________________________(dopamine is an agonist to GH)
(Can cause swallowing problems or patients may need speech therapy)
THER

Hypoparathyroidism

HORMONE PROBLEM:
-Low serum calcium
MAJOR SIGNS & SYMPTOMS
-Tetany

Hyperthyroidism symptoms

*Results in excessive amounts of circulating thyroid hormone (thyrotoxicosis)
*Autoimmune disease that can be caused by Graves disease
*more common in young woman
*Multimodular goiter is more common in older women.
*Eyes wide open (Exophthalmos) caused by

Hypothyroidism symptoms

*Be careful, the thyroid is in front of the parathyroid.
*Can be caused by hyperthyroid treatments
CARDIOVASCULAR- Bradycardia, decreased cardiac output, cool skin, cold intolerance
NEUROLOGIC- Lethargy, slowed movements, memory loss, mental dullness, con

Following thyroidectomy, the nurse watches carefully for which signs of tetany?

Numb fingers and muscle cramps (caused by change in PH and low serum calcium)

What assessment findings should the nurse monitor to detect the onset of thyrotoxicosis in a patient with hyperthyroidism?

Vital Signs
(Thyrotoxicosis causes increases in BP, pulse, temp and respirations)

What dietary recommendations will reduce the risk of kidney stones in the patient with hyperparathyroidism?

Increase fluids

An excess of which hormone is responsible for acromegaly?

Growth hormone

Which nursing diagnosis is most appropriate for the patient admitted in addisonian crisis?

Addison's is associated with fluid loss so the nursing diagnosis would be Deficient fluid volume.

A 42-year old woman enters an outpatient clinic with symptoms of weight gain and fatigue. Lab studies are done, and she is diagnosed with primary hypothyroidism. She asks why her thyroid-stimulating hormone (TSH) level is elevated. How should the nurse re

The pituitary makes more TSH to try to stimulate the underactive thyroid.

Which nursing diagnosis is most appropriate for a patient with weight gain and fatigue related to hypothyroidism.

Activity Intolerance related to fatique.

A patient with hypothyroidism is started on levothyroxine (Synthroid), a synthetic thyroid hormone. You know she understands the side effects of this medication when she makes the following statement:

I know I should call my doctor if my heart races.

A 26-year old female patient is hospitalized for radioactive iodine treatment for hyperthyroidism. Which of the following precautions by the nurse is appropriate?

Wear gloves when changing bedside commode. (Output will be radioactive.)

The nurse needs to accomplish all the following interventions for a patient who is 24-hours post-thyroidectomy in this order:

1. Verify the airway is patent
2. Assess vital signs
3. Check the surgical site dressing for signs of bleeding
4. Administer and analgesic for post-operative pain.
5. Assist with range of motion exercises
6. Teach the patient about synthroid (levothyroxin

The nurse develops the nursing diagnosis of Acute pain r/t bone demineralization for a patient with hypoparathyroidism. What goal is most appropriate?

Patient will verbalize acceptable pain level.
(The nurse should address the pain)

A patient enters a clinic with possible Cushing's syndrome. Which of the following physical examination findings support this diagnosis?

Buffalo hump and easy bruising

What data is important for the nurse to monitor in a patient with a pheochromocytoma?

Vital signs

Goitrogenic

Medications like propylthiouracil, sulfonamides, lithium and salicylates that are goiter producing.

Hyperplasia

Excessive increase in the number of normal cells

Hypophysectomy

Surgical removal of the pituitary gland

Nephrogenic

Produced by the kidney

Osmolality

Osmotic concentration; ionic concentration of the dissolved substances per unit of solvent.

Pheochromocytoma

Rare tumor of he adrenal system that secretes catecholamines.
Causes hypersecretion of epinephrine and norepinephrine
Therapeutic measures-alpha-blocking meds phenoxybenzamine (Dibenzaline) to dilate blood vessels to control hypertension (blocks epinephri

Psychogenic

Related to the mind.

Tetany

Muscle spasms, numbness and tingling caused by changes in PH and low serum calcium.

Colorless urine

Can be caused by dehydration which can cause you to go into shock

Therapeutic measures for DM

Hydration medications (Hypotonic IV fluids) can be ordered to replace intravascular volume without adding excess sodium.
Vasopressins - nasal spray

If a tumor is surgically removed...

Test electrolyte measures

Insufficient ADH

DISORDER- Diabetes Insipidus
SIGNS AND SYMPTOMS-Polyuria, polydipsia, dehydration, dilute urine
DIAGNOSTIC TESTS-Urine specific gravity, urine and plasma osmolality, water deprivation test
THERAPEUTIC MEASURES- Synthetic ADH replacement
PRIORITY NURSING D

Excess ADH

DISORDER- SIADH
SIGNS AND SYMPTOMS-Fluid retention, weight gain, concentrated urine
DIAGNOSTIC TESTS-Serum and urine sodium osmolality; water load tes
THERAPEUTIC MEASURES- Treat cause
PRIORITY NURSING DIAGNOSES- Excess fluid volume, Risk for Ineffective

Manifestations of Dilutional Hyponatremia

Bounding pulse
Elevated or Normal BP
Muscle weakness
Headache
Personality changes
Nausea
Diarrhea
Convulsions
Coma

Insufficient PTH

DISORDER- Hypoparathyroidism
SIGNS AND SYMPTOMS- Hypocalcemia, neuromuscular irritability, tetany, positive Chvostek's and Trousseau's signs
DIAGNOSTIC TESTS- Serum PTH, calcium and phosphate
THERAPEUTIC MEASURES- Calcium and Vitamin D replacement; High c

Excess PTH

DISORDER- Hyperparathyroidism
SIGNS AND SYMPTOMS- Hypercalcemia, fatigue, pathological fractures
DIAGNOSTIC TESTS- Serum PTH, calcium and phosphate
THERAPEUTIC MEASURES- Calcitonin, parathyroidectomy.
PRIORITY NURSING DIAGNOSIS- Risk for Injury related to

HYPOFUNCTION of Adrenal Cortex Hormone

DISORDER- Adrenocortical insufficiency, Addison's disease
SIGNS AND SYMPTOMS- Sodium and water loss, hypotension, hypoglycemia, fatigue
DIAGNOSTIC TESTS- Serum and Urine Cortisol
THERAPEUTIC MEASURES- Glucocorticoid and mineralocorticoid replacement
PRIOR

HYPERFUNCTION of Adrenal Cortex Hormone

DISORDER- Cushing's syndrome
SIGNS AND SYMPTOMS- Weight gain, sodium and water retention, hyperglycemia, buffalo hump, moon face
DIAGNOSTIC TESTS- Serum and Urine Cortisol
THERAPEUTIC MEASURES- Alter steroid therapy dose or schedule; surgery if tumor
PRIO

To remember adrenal cortex hormones think Salt,
Sugar and
Sex

Aldosterone promotes salt retention
Cortisol affects sugar (carbohydrate) metabolism
Androgens are sex hormones