■ Corticotropin-releasing hormone (CRH)

■ Gonadotropin-releasing hormone (GnRH)

■ Growth hormone–inhibiting hormone (GHIH)

■ Growth hormone–releasing hormone (GHRH)

■ Melanocyte-inhibiting hormone (MIH)

■ Prolactin-inhibiting hormone (PIH)

■ Thyrotropin-releasing hormone (TRH) 

Anterior Lobe Production

■ Adrenocorticotropic hormone (ACTH)

■ Follicle-stimulating hormone (FSH)

■ Growth hormone (GH)

■ Luteinizing hormone (LH)

■ Melanocyte-stimulating hormone (MSH)

■ Prolactin (PRL)

■ Somatotropic growth-stimulating hormone

■ Thyroid-stimulating hormone (TSH)

Posterior Lobe

These hormones are produced by the hypothalamus, stored in the posterior lobe, and secreted into

the blood when needed: 

■ Oxytocin

■ Vasopressin, antidiuretic hormone (ADH)

Glucocorticoids: Cortisol, Cortisone, Corticosterone

■ Responsible for glucose metabolism, protein metabolism, fluid and electrolyte balance,

suppression of the inflammatory response to injury, protective immune response to invasion by

infectious agents, and resistance to stress

Mineralocorticoids: Aldosterone

■ Regulation of electrolyte balance by promoting sodium retention and potassium excretion 

a. In the client with suspected underactivity of an endocrine gland, a stimulus may be provided

to determine whether the gland is capable of normal hormone production.

b. Measured amounts of selected hormones or substances are administered to stimulate the

target gland to produce its hormone.

c. Hormone levels produced by the target gland are measured.

d. Failure of the hormone level to increase with stimulation indicates hypofunction. 

a. Suppression tests are used when hormone levels are high or in the upper range of normal.

b. Agents that normally induce a suppressed response are administered to determine whether

normal negative feedback is intact.

c. Failure of hormone production to be suppressed during standardized testing indicates

hyperfunction. 

1. This thyroid function test measures the absorption of an iodine isotope to determine how the

thyroid gland is functioning.

2. A small dose of radioactive iodine is given by mouth or intravenously; the amount of

radioactivity is measured in 2 to 4 hours and again at 24 hours.

3. Normal values are 3% to 10% at 2 to 4 hours, and 5% to 30% in 24 hours.

4. Elevated values indicate hyperthyroidism, decreased iodine intake, or increased iodine

excretion.

5. Decreased values indicate a low T4 level, the use of antithyroid medications, thyroiditis,

myxedema, or hypothyroidism.

6. The test is contraindicated in pregnancy. 

1. A thyroid scan is performed to identify nodules or growths in the thyroid gland.

2. A radioisotope of iodine or technetium is administered before scanning the thyroid gland.

3. Reassure the client that the level of radioactive medication is not dangerous to self or others.

4. Determine whether the client has received radiographic contrast agents within the past 3

months, because these may invalidate the scan.

5. Check with the health care provider (HCP) regarding discontinuing medications containing

iodine for 14 days before the test and the need to discontinue thyroid medication before the test.

6. Instruct the client to maintain NPO status after midnight on the day before the test; if iodine is

used, the client will fast for an additional 45 minutes after ingestion of the oral isotope and the scan will be performed in 24 hours.

7. If technetium is used, it is administered by the intravenous (IV) route 30 minutes before the

scan.

8. The test is contraindicated in pregnancy.

Eat a diet with at least 150 g of carbohydrates for 3 days before the test.

Avoid alcohol, coffee, and smoking for 36 hours before testing.

Fast for 10 to 12 hours before the test.

Avoid strenuous exercise for 8 hours before and after the test.

Withhold morning insulin or oral hypoglycemic medication (client with diabetes mellitus).

A sample is drawn for determination of the fasting blood glucose level and then the client will be

given a high-glucose drink.

Blood samples will be drawn at 30-minute intervals for a minimum of 2 hours. 

1. Description: Hyposecretion of one or more of the pituitary hormones caused by tumors, trauma,

encephalitis, autoimmunity, or stroke

2. Hormones most often affected are growth hormone (GH) and gonadotropic hormones

(luteinizing hormone, follicle-stimulating hormone), but thyroid-stimulating hormone (TSH),

adrenocorticotropic hormone (ACTH), or antidiuretic hormone (ADH) may be involved.

3. Assessment

a. Mild to moderate obesity (GH, TSH)

b. Reduced cardiac output (GH, ADH)

c. Infertility, sexual dysfunction (gonadotropins, ACTH)

d. Fatigue, low blood pressure (TSH, ADH, ACTH, GH)

e. Tumors of the pituitary also may cause headaches and visual defects (pituitary is located near

the optic nerve).

4. Interventions

a. Provide emotional support to the client and family.

b. Encourage the client and family to express feelings related to disturbed body image or sexual

dysfunction.

c. Client may need hormone replacement for the specific deficient hormones.

d. Client education is needed regarding the signs and symptoms of hypofunction and

hyperfunction related to insufficient or excess hormone replacement 

1. Description

a. Hypersecretion of growth hormone by the anterior pituitary gland in an adult; caused

primarily by pituitary tumors

b. Leads to conditions such as acromegaly and Cushing’s disease

2. Assessment

a. Large hands and feet

b. Thickening and protrusion of the jaw

c. Arthritic changes and joint pain

d. Visual disturbances

e. Diaphoresis

f. Oily, rough skin

g. Organomegaly

h. Hypertension

i. Dysphagia

j. Deepening of the voice

3. Interventions

a. Provide emotional support to the client and family, and encourage the client and family to

express feelings related to disturbed body image.

b. Provide frequent skin care.

c. Provide pharmacological and nonpharmacological interventions for joint pain.

d. Prepare the client for radiation of the pituitary gland if prescribed.

e. Prepare the client for hypophysectomy if planned. 

1. Description

a. Removal of a pituitary tumor via craniotomy or a transsphenoidal (endoscopic transnasal)

approach (latter approach is preferred because it is associated with fewer complications)

b. Complications for craniotomy include increased intracranial pressure, bleeding, meningitis,

and hypopituitarism.

c. Complications for the transsphenoidal surgery include cerebrospinal fluid leak, infection, and

hypopituitarism.

2. Postoperative interventions

a. Initial postoperative care is similar to craniotomy care.

b. Monitor vital signs, neurological status, and level of consciousness.

c. Elevate the head of the bed.

d. Monitor for increased intracranial pressure.

e. Monitor for bleeding.

f. Instruct the client to avoid sneezing, coughing, and blowing the nose.

g. Monitor for signs of temporary diabetes insipidus or syndrome of inappropriate antidiuretic

hormone secretion resulting from ADH disturbances.

h. Monitor intake and output, and avoid water intoxication.

i. Administer glucocorticoids and other hormone replacements as prescribed.

j. Administer antibiotics, analgesics, and antipyretics as prescribed.

k. Instruct the client in the administration of prescribed medications.

l. Administer oral mouth rinse as prescribed.

m. As prescribed, instruct the client to brush teeth gently with an ultrasoft toothbrush for at least 2 weeks following surgery.

Following transsphenoidal hypophysectomy, monitor for any postnasal drip or nasal

drainage, which might indicate leakage of cerebrospinal fluid (check the nasal drainage for

glucose).

1. Description

a. Hyposecretion of ADH caused by stroke or trauma, or may be idiopathic

b. Kidney tubules fail to reabsorb water.

2. Assessment

a. Excretion of large amounts of dilute urine

b. Polydipsia

c. Dehydration (decreased skin turgor and dry mucous membranes)

d. Inability to concentrate urine

e. Low urinary specific gravity, 1.006 or lower

f. Fatigue

g. Muscle pain and weakness

h. Headache

i. Postural hypotension that may progress to vascular collapse without rehydration

j. Tachycardia

3. Interventions

a. Monitor vital signs and neurological and cardiovascular status.

b. Provide a safe environment, particularly for the client with postural hypotension.

c. Monitor electrolyte values and for signs of dehydration.

d. Maintain client intake of adequate fluids.

e. Monitor intake and output, weight, serum osmolality, and specific gravity of urine.

f. Instruct the client to avoid foods or liquids that produce diuresis.

g. Vasopressin tannate (Pitressin) or desmopressin acetate (DDAVP, Stimate, Minirin) may be

prescribed; these are used when the ADH deficiency is severe or chronic.

h. Instruct the client in the administration of medications as prescribed; DDAVP may be

administered by injection, intranasally, or orally.

i. Instruct the client to wear a Medic-Alert bracelet. 

1. Description

a. Excess ADH is released, but not in response to the body’s need for it.

b. Causes include trauma, stroke, malignancies (often in the lungs or pancreas), medications,

and stress.

c. The syndrome results in water intoxication and hyponatremia.

2. Assessment

a. Signs of fluid volume overload

b. Changes in level of consciousness and mental status changes

c. Weight gain

d. Hypertension

e. Tachycardia

f. Anorexia, nausea, and vomiting

g. Hyponatremia

3. Interventions

a. Monitor vital signs and cardiac and neurological status.

b. Provide a safe environment, particularly for the client with changes in level of consciousness

or mental status.

c. Monitor intake and output and obtain weight daily.

d. Monitor fluid and electrolyte balance.

e. Monitor serum and urine osmolality.

f. Restrict fluid intake as prescribed.

g. Administer diuretics and IV fluids (usually normal saline or hypertonic saline) as prescribed; monitor IV fluids carefully because of the risk for fluid volume overload (IV solutions containing water are contraindicated because of the risk of water intoxication).

h. Medications that inhibit ADH-induced water reabsorption and produce water diuresis may be

prescribed.

1. Description

a. Hyposecretion of adrenal cortex hormones (glucocorticoids and mineralocorticoids)

b. Can be primary or secondary

c. The condition is fatal if left untreated.

2. Assessment

Lethargy, fatigue, and muscle weakness

Gastrointestinal disturbances

Weight loss

Menstrual changes in women; impotence in men

Hypoglycemia, hyponatremia

Hyperkalemia, hypercalcemia

Hypotension

Hyperpigmentation of skin (bronzed) with primary disease

3. Interventions

a. Monitor vital signs, particularly blood pressure, weight, and intake and output.

b. Monitor white blood cell (WBC) count; blood glucose; and potassium, sodium, and calcium

levels.

c. Administer glucocorticoid or mineralocorticoid medications as prescribed.

d. Observe for addisonian crisis caused by stress, infection, trauma, or surgery.

4. Client education

a. Avoid individuals with an infection.

b. Diet: High protein and high carbohydrate, normal sodium intake

c. Avoid strenuous exercise and stressful situations.

d. Need for lifelong glucocorticoid therapy

e. Avoid over-the-counter medications.

f. Wear a Medic-Alert bracelet.

g. Signs and symptoms of complications such as underreplacement and overreplacement of

hormones

1. Description 

■ A life-threatening disorder caused by acute adrenal insufficiency

■ Precipitated by stress, infection, trauma, surgery, or abrupt withdrawal of exogenous corticosteroid use

■ Can cause hyponatremia, hyperkalemia, hypoglycemia, and shock

2. Assessment

a. Severe headache

b. Severe abdominal, leg, and lower back pain

c. Generalized weakness

d. Irritability and confusion

e. Severe hypotension

f. Shock

3. Interventions

a. Prepare to administer glucocorticoids intravenously as prescribed; intravenous

hydrocortisone sodium succinate usually is prescribed initially.

b. Following resolution of the crisis, administer glucocorticoid and mineralocorticoid orally as

prescribed.

c. Monitor vital signs, particularly blood pressure.

d. Monitor neurological status, noting irritability and confusion.

e. Monitor intake and output.

f. Monitor laboratory values, particularly the sodium, potassium, and blood glucose levels.

g. Administer IV fluids as prescribed to restore electrolyte balance.

h. Protect the client from infection.

i. Maintain bed rest and provide a quiet environment.

Addison’s disease is characterized by the hyposecretion of adrenal cortex hormones

(glucocorticoids and mineralocorticoids), whereas Cushing’s disease is characterized by a hypersecretion of glucocorticoids.

(hypercortisolism)

1. Description

a. Characterized by a hypersecretion of glucocorticoids from the adrenal cortex

b. Cushing’s disease is a metabolic disorder characterized by abnormally increased secretion (endogenous) of cortisol, caused by increased amounts of ACTH secreted by the pituitary gland.

c. Cushing’s syndrome is a metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or by the administration of glucocorticoids in large doses for several weeks or longer (exogenous or iatrogenic).

2. Assessment

Generalized muscle wasting and weakness

Moon face, buffalo hump

Truncal obesity with thin extremities, supraclavicular fat pads; weight gain

Hirsutism (masculine characteristics in females)

Hyperglycemia, hypernatremia

Hypokalemia, hypocalcemia

Hypertension

Fragile skin that easily bruises

Reddish-purple striae on the abdomen and upper thighs

3. Interventions

a. Monitor vital signs, particularly blood pressure.

b. Monitor intake and output and weight.

c. Monitor laboratory values, particularly the white blood cell count, and serum glucose,

sodium, potassium, and calcium levels.

d. Provide meticulous skin care.

e. Allow the client to discuss feelings related to body appearance.

f. Administer chemotherapeutic agents as prescribed for inoperable adrenal tumors.

g. Prepare the client for radiation as prescribed if the condition results from a pituitary

adenoma.

h. Prepare the client for removal of pituitary tumor (hypophysectomy, transsphenoidal

adenectomy) if the condition results from increased pituitary secretion of ACTH.

i. Prepare the client for adrenalectomy if the condition results from an adrenal adenoma;

glucocorticoid replacement may be required following adrenalectomy.

1. Description

a. Hypersecretion of mineralocorticoids (aldosterone) from the adrenal cortex of the adrenal

gland

b. Most commonly caused by an adenoma

2. Assessment

a. Symptoms related to hypokalemia, hypernatremia, and hypertension

b. Headache, fatigue, muscle weakness, nocturia

c. Polydipsia and polyuria

d. Paresthesias

e. Visual changes

f. Low urine specific gravity and increased urinary aldosterone level

g. Elevated serum aldosterone levels

3. Interventions

a. Monitor vital signs, particularly blood pressure.

b. Monitor for signs of hypokalemia and hypernatremia.

c. Monitor intake and output and urine for specific gravity.

d. Spironolactone (Aldactone) may be prescribed to promote fluid balance and control

hypertension; this is a potassium-sparing diuretic and aldosterone antagonist, and clients

need to be monitored for hyperkalemia, particularly those with impaired renal function or

excessive potassium intake.

e. Administer potassium supplements as prescribed.

f. Prepare the client for adrenalectomy.

g. Maintain sodium restriction, if prescribed, preoperatively.

h. Administer glucocorticoids preoperatively, as prescribed, to prevent adrenal hypofunction.

i. Monitor the client for adrenal insufficiency postoperatively.

j. Instruct the client regarding the need for glucocorticoid therapy following adrenalectomy.

k. Instruct the client about the need to wear a Medic-Alert bracelet. 

1. Description

a. Catecholamine-producing tumor usually found in the adrenal medulla, but extraadrenal

locations include the chest, bladder, abdomen, and brain; typically is a benign tumor but can

be malignant

b. Excessive amounts of epinephrine and norepinephrine are secreted.

c. Diagnostic tests include a 24-hour urine collection for vanillylmandelic acid (VMA), a

product of catecholamine metabolism, metanephrine, and catecholamines, all of which are

elevated in the presence of pheochromocytoma; the normal range of urinary catecholamines

is up to 14 mcg/100 mL of urine, with higher levels occurring in pheochromocytoma.

d. Surgical removal of the adrenal gland is the primary treatment.

e. Symptomatic treatment is initiated if surgical removal is not possible.

f. The complications associated with pheochromocytoma include hypertensive crisis, including

hypertensive retinopathy and nephropathy, cardiac enlargement, and dysrhythmias, heart

failure, myocardial infarction, increased platelet aggregation, and stroke.

g. Death can occur from shock, stroke, renal failure, dysrhythmias, or dissecting aortic

aneurysm.

2. Assessment

a. Paroxysmal or sustained hypertension

b. Severe headaches

c. Palpitations

d. Flushing and profuse diaphoresis

e. Pain in the chest or abdomen with nausea and vomiting

f. Heat intolerance

g. Weight loss

h. Tremors

i. Hyperglycemia

3. Interventions

a. Monitor vital signs, particularly the blood pressure and heart rate.

b. Monitor for hypertensive crisis; monitor for complications that can occur with hypertensive

crisis, such as stroke, cardiac dysrhythmias, myocardial infarction.

c. Instruct the client not to smoke, drink caffeine-containing beverages, or change position

suddenly.

d. Prepare to administer a β-adrenergic blocking agent as prescribed to control hypertension.

e. Monitor serum glucose level.

f. Promote rest and a nonstressful environment.

g. Provide a diet high in calories, vitamins, and minerals.

h. Prepare the client for adrenalectomy.

For the client with pheochromocytoma, avoid stimuli that can precipitate a hypertensive

crisis, such as increased abdominal pressure and vigorous abdominal palpation. 

1. Description

Surgical removal of an adrenal gland

Lifelong glucocorticoid and mineralocorticoid replacement is necessary with bilateral

adrenalectomy.

Temporary glucocorticoid replacement, usually up to 2 years, is necessary after a unilateral adrenalectomy.

Catecholamine levels drop as a result of surgery, which can result in cardiovascular collapse, hypotension, and shock, and the client needs to be monitored closely.

Hemorrhage also can occur because of the high vascularity of the adrenal glands.

2. Preoperative interventions

a. Monitor electrolyte levels and correct electrolyte imbalances.

b. Assess for dysrhythmias.

c. Monitor for hyperglycemia.

d. Protect the client from infections.

e. Administer glucocorticoids as prescribed.

3. Postoperative interventions

a. Monitor vital signs.

b. Monitor intake and output; if the urinary output is lower than 30 mL/hour, notify the HCP,

because this may indicate renal failure and impending shock.

c. Monitor weight daily.

d. Monitor electrolyte and serum glucose levels.

e. Monitor for signs of hemorrhage and shock, particularly during the first 24 to 48 hours.

f. Monitor for manifestations of adrenal insufficiency (see Table 54-1).

g. Assess the dressing for drainage.

h. Monitor for paralytic ileus. Administer IV fluids as prescribed to maintain blood volume.

i. Administer glucocorticoids and mineralocorticoids as prescribed.

j. Administer pain medication as prescribed.

k. Provide pulmonary interventions to prevent atelectasis (cough and deep breathing, incentive

spirometry, splinting of incision).

l. Instruct the client in the importance of hormone replacement therapy following surgery.

m. Instruct the client regarding signs and symptoms of complications such as underreplacement

and overreplacement of hormones.

n. Instruct the client regarding the need to wear a Medic-Alert bracelet.

1. Description

a. Hypothyroid state resulting from hyposecretion of thyroid hormones T3 and T4.

b. Characterized by a decreased rate of body metabolism

2. Assessment

Lethargy and fatigue 

Weakness, muscle aches, paresthesias 

Intolerance to cold 

Weight gain 

Dry skin and hair and loss of body hair 

Bradycardia 

Constipation 

Generalized puffiness and edema around the eyes and face (myxedema)

Forgetfulness and loss of memory 

Menstrual disturbances 

Cardiac enlargement, tendency to develop heart failure

Goiter may or may not be present

3. Interventions

a. Monitor vital signs, including heart rate and rhythm.

b. Administer thyroid replacement; levothyroxine sodium (Synthroid) is most commonly

prescribed.

c. Instruct the client about thyroid replacement therapy and about the clinical manifestations of

both hypothyroidism and hyperthyroidism related to underreplacement or overreplacement of

the hormone.

d. Instruct the client in a low-calorie, low-cholesterol, low–saturated fat diet.

e. Assess the client for constipation; provide roughage and fluids to prevent constipation.

f. Provide a warm environment for the client.

g. Avoid sedatives and opioid analgesics because of increased sensitivity to these medications.

h. Monitor for overdose of thyroid medications, characterized by tachycardia, chest pain,

restlessness, nervousness, and insomnia.

i. Instruct the client to report episodes of chest pain or other signs of overdose immediately.

1. Description

This rare but serious disorder results from persistently low thyroid production.

Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and

surgery, hypothermia, or the use of sedatives and opioid analgesics.

2. Assessment

a. Hypotension

b. Bradycardia

c. Hypothermia

d. Hyponatremia

e. Hypoglycemia

f. Generalized edema

g. Respiratory failure

h. Coma

3. Interventions

a. Maintain a patent airway.

b. Institute aspiration precautions.

c. Administer IV fluids (normal or hypertonic saline) as prescribed.

d. Administer levothyroxine sodium intravenously as prescribed.

e. Administer glucose intravenously as prescribed.

f. Administer corticosteroids as prescribed.

g. Assess client’s temperature hourly.

h. Monitor blood pressure frequently.

i. Keep the client warm.

j. Monitor for changes in mental status.

k. Monitor electrolyte and glucose levels.

1. Description

a. Hyperthyroid state resulting from hypersecretion of thyroid hormones (T3 and T4)

b. Characterized by an increased rate of body metabolism

c. A common cause is Graves’ disease, also known as toxic diffuse goiter.

d. Clinical manifestations are referred to as thyrotoxicosis.

2. Assessment

Personality changes such as irritability, agitation, and mood swings

Nervousness and fine tremors of the hands

Heat intolerance

Weight loss

Smooth, soft skin and hair

Palpitations, cardiac dysrhythmias, such as tachycardia or atrial fibrillation

Diarrhea

Protruding eyeballs (exophthalmos) may be present 

Diaphoresis

Hypertension

Enlarged thyroid gland (goiter)

3. Interventions

a. Provide adequate rest.

b. Administer sedatives as prescribed.

c. Provide a cool and quiet environment.

d. Obtain weight daily.

e. Provide a high-calorie diet.

f. Avoid the administration of stimulants.

g. Administer antithyroid medications (propylthiouracil, PTU) that block thyroid synthesis as

prescribed.

h. Administer iodine preparations that inhibit the release of thyroid hormone as prescribed.

i. Administer propranolol (Inderal) for tachycardia as prescribed.

j. Prepare the client for radioactive iodine therapy, as prescribed, to destroy thyroid cells.

k. Prepare the client for thyroidectomy if prescribed.

1. Description

This acute and life-threatening condition occurs in a client with uncontrollable hyperthyroidism.

It can be caused by manipulation of the thyroid gland during surgery and the release of thyroid

hormone into the bloodstream; it also can occur from severe infection and stress.

Antithyroid medications, β-blockers, glucocorticoids, and iodides may be administered to the

client before thyroid surgery to prevent its occurrence.

2. Assessment

a. Elevated temperature (fever)

b. Tachycardia

c. Systolic hypertension

d. Nausea, vomiting, and diarrhea

e. Agitation, tremors, anxiety

f. Irritability, agitation, restlessness, confusion, and seizures as the condition progresses

g. Delirium and coma

3. Interventions

a. Maintain a patent airway and adequate ventilation.

b. Administer antithyroid medications, iodides, propranolol, and glucocorticoids as prescribed.

c. Monitor vital signs.

d. Monitor continually for cardiac dysrhythmias.

e. Administer nonsalicylate antipyretics as prescribed (salicylates increase free thyroid

hormone levels).

f. Use a cooling blanket to decrease temperature as prescribed.

1. Description

a. Removal of the thyroid gland

b. Performed when persistent hyperthyroidism exists

2. Preoperative interventions

a. Obtain vital signs and weight.

b. Assess electrolyte levels.

c. Assess for hyperglycemia.

d. Instruct the client in how to perform coughing and deep-breathing exercises and how to

support the neck in the postoperative period when coughing and moving.

e. Administer antithyroid medications, iodides, propranolol, and glucocorticoids as prescribed

to prevent the occurrence of thyroid storm.

3. Postoperative interventions

a. Monitor for respiratory distress.

b. Have a tracheotomy set, oxygen, and suction at the bedside.

c. Limit client talking, and assess level of hoarseness.

d. Monitor for laryngeal nerve damage, as evidenced by respiratory obstruction, dysphonia,

high-pitched voice, stridor, dysphagia, and restlessness.

e. Monitor for signs of hypocalcemia and tetany, which can be caused by trauma to the

parathyroid gland

f. Prepare to administer calcium gluconate as prescribed for tetany.

g. Monitor for thyroid storm.

Following thyroidectomy, maintain the client in a semi-Fowler’s position. Monitor the

surgical site for edema and for signs of bleeding and check the dressing anteriorly and at the

back of the neck.

■ Cardiac dysrhythmias

■ Carpopedal spasm

■ Dysphagia

■ Muscle and abdominal cramps

■ Numbness and tingling of the face and extremities

■ Positive Chvostek’s sign

■ Positive Trousseau’s sign

■ Visual disturbances (photophobia)

■ Wheezing and dyspnea (bronchospasm, laryngospasm)

■ Seizures 

1. Description

a. Condition caused by hyposecretion of parathyroid hormone by the parathyroid gland

b. Can occur following thyroidectomy because of removal of parathyroid tissue

2. Assessment

a. Hypocalcemia and hyperphosphatemia

b. Numbness and tingling in the face

c. Muscle cramps and cramps in the abdomen or in the extremities

d. Positive Trousseau’s sign or Chvostek’s sign

e. Signs of overt tetany, such as bronchospasm, laryngospasm, carpopedal spasm, dysphagia,

photophobia, cardiac dysrhythmias, seizures

f. Hypotension

g. Anxiety, irritability, depression

3. Interventions

a. Monitor vital signs.

b. Monitor for signs of hypocalcemia and tetany.

c. Initiate seizure precautions.

d. Place a tracheotomy set, oxygen, and suctioning equipment at the bedside.

e. Prepare to administer calcium gluconate intravenously for hypocalcemia.

f. Provide a high-calcium, low-phosphorus diet.

g. Instruct the client in the administration of calcium supplements as prescribed.

h. Instruct the client in the administration of vitamin D supplements as prescribed; vitamin D

enhances the absorption of calcium from the gastrointestinal tract.

i. Instruct the client in the administration of phosphate binders as prescribed to promote the

excretion of phosphate through the gastrointestinal tract.

j. Instruct the client to wear a Medic-Alert bracelet. 

1. Description: Condition caused by hypersecretion of parathyroid hormone by the parathyroid

gland

2. Assessment

a. Hypercalcemia and hypophosphatemia

b. Fatigue and muscle weakness

c. Skeletal pain and tenderness

d. Bone deformities that result in pathological fractures

e. Anorexia, nausea, vomiting, epigastric pain

f. Weight loss

g. Constipation

h. Hypertension

i. Cardiac dysrhythmias

j. Renal stones

3. Interventions

a. Monitor vital signs, particularly the blood pressure.

b. Monitor for cardiac dysrhythmias.

c. Monitor intake and output and for signs of renal stones.

d. Monitor for skeletal pain; move the client slowly and carefully.

e. Encourage fluid intake.

f. Administer furosemide (Lasix) as prescribed to lower calcium levels.

g. Administer normal saline intravenously as prescribed to maintain hydration.

h. Administer phosphates, which interfere with calcium reabsorption, as prescribed.

i. Administer calcitonin (Fortical; Miacalcin) as prescribed to decrease skeletal calcium

release and increase renal excretion of calcium.

j. Monitor calcium and phosphorus levels.

k. Prepare the client for parathyroidectomy as prescribed. 

1. Description: Removal of one or more of the parathyroid glands

2. Preoperative interventions

a. Monitor electrolytes, calcium, phosphate, and magnesium levels.

b. Ensure that calcium levels are decreased to near-normal values.

c. Inform the client that talking may be painful for the first day or two after surgery.

3. Postoperative interventions

a. Monitor for respiratory distress.

b. Place a tracheotomy set, oxygen, and suctioning equipment at the bedside.

c. Monitor vital signs.

d. Position the client in a semi-Fowler’s position.

e. Assess neck dressing for bleeding.

f. Monitor for hypocalcemic crisis, as evidenced by tingling and twitching in the extremities and

face.

g. Assess for positive Trousseau’s sign or Chvostek’s sign, which signals the potential for

tetany.

h. Monitor for changes in voice pattern and hoarseness.

i. Monitor for laryngeal nerve damage.

j. Instruct the client in the administration of calcium and vitamin D supplements as prescribed. 

1. Description

a. Chronic disorder of impaired carbohydrate, protein, and lipid metabolism caused by a

deficiency of insulin

b. An absolute or relative deficiency of insulin results in hyperglycemia.

c. Type 1 diabetes mellitus is a nearly absolute deficiency of insulin (primary beta cell

destruction); if insulin is not given, fats are metabolized for energy, resulting in ketonemia

(acidosis).

d. Type 2 diabetes mellitus is a relative lack of insulin or resistance to the action of insulin;

usually, insulin is sufficient to stabilize fat and protein metabolism but not carbohydrate

metabolism.

e. Metabolic syndrome is also known as syndrome X and the individual has coexisting risk

factors for developing type 2 diabetes mellitus; these risk factors include abdominal obesity,

hyperglycemia, hypertension, high triglyceride level, and a lowered HDL (high-density

lipoprotein) cholesterol level.

f. Diabetes mellitus can lead to chronic health problems and early death as a result of

complications that occur in the large and small blood vessels in tissues and organs.

g. Macrovascular complications include coronary artery disease, cardiomyopathy, hypertension,

cerebrovascular disease, and peripheral vascular disease. (Refer to Chapter 60 for

information on cardiovascular disorders.)

h. Microvascular complications include retinopathy, nephropathy, and neuropathy.

i. Infection is also a concern because of reduced healing ability.

j. Male erectile dysfunction can also occur as a result of the disease.

Obesity is a major risk factor for diabetes mellitus.

2. Assessment

a. Polyuria, polydipsia, polyphagia (more common in type 1 diabetes mellitus)

b. Hyperglycemia

c. Weight loss (common in type 1 diabetes mellitus, rare in type 2 diabetes mellitus)

d. Blurred vision

e. Slow wound healing

f. Vaginal infections

g. Weakness and paresthesias

h. Signs of inadequate circulation to the feet

i. Signs of accelerated atherosclerosis (renal, cerebral, cardiac, peripheral)

3. Diet

a. The diabetic client’s diet should take into account weight, medication, activity level, and other health problems.

b. Day-to-day consistency in timing and amount of food intake helps control the blood glucose level.

c. As prescribed by the HCP, the client may be advised to follow the recommendations of the

American Diabetic Association diet or U.S. dietary guidelines

d. Carbohydrate counting may be a simpler approach for some clients; it focuses on the total grams of carbohydrates eaten per meal. The client may be more compliant with carbohydrate counting, resulting in better glycemic control; it is usually necessary for clients undergoing intense insulin therapy.

e. Incorporate the diet into individual client needs, lifestyle, and cultural and socioeconomic patterns.

4. Exercise

a. Exercise lowers the blood glucose level, encourages weight loss, reduces cardiovascular risks, improves circulation and muscle tone, decreases total cholesterol and triglyceride levels, and decreases insulin resistance and glucose intolerance.

b. Instruct the client in dietary adjustments when exercising; dietary adjustments are individualized.

c. If the client requires extra food during exercise to prevent hypoglycemia, it need not be deducted from the regular meal plan.

d. If the blood glucose level is higher than 250 mg/dL and urinary ketones (type 1 diabetes mellitus) are present, the client is instructed not to exercise until the blood glucose level is closer to normal and urinary ketones are absent.

Instruct the client with diabetes mellitus to monitor the blood glucose level before, during, and after exercising.

5. Oral hypoglycemic medications: Oral medications are prescribed for clients with diabetes mellitus type 2 when diet and weight control therapy have failed to maintain satisfactory blood

glucose levels.

To prevent a serious reaction, inform the client taking a sulfonylurea to avoid consuming alcohol.

6. Insulin

a. Insulin is used to treat types 1 and 2 diabetes mellitus when diet, weight control therapy, and oral hypoglycemic agents have failed to maintain satisfactory blood glucose levels.

b. Illness, infection, and stress increase the blood glucose level and the need for insulin; insulin should not be withheld during illness, infection, or stress because hyperglycemia and diabetic ketoacidosis can result.

c. The peak action time of insulin is important to explain to the client because of the possibility of hypoglycemic reactions occurring during this time.

Only short-duration insulin (lispro, aspart, glulisine, and regular insulin) can be administered intravenously.

B. Complications of insulin therapy

1. Local allergic reactions

a. Redness, swelling, tenderness, and induration or a wheal at the site of injection may occur 1

to 2 hours after administration.

b. Reactions usually occur during the early stages of insulin therapy.

c. Instruct the client to cleanse the skin with alcohol before injection.

2. Insulin lipodystrophy

a. Lipoatrophy is loss of subcutaneous fat and appears as slight dimpling or more serious pitting of subcutaneous fat; the use of human insulin helps prevent this complication.

c. Instruct the client to avoid injecting insulin into affected sites.

d. Instruct the client about the importance of rotating insulin injection sites.

3. Insulin resistance

a. The client receiving insulin develops immune antibodies that bind the insulin, thereby

decreasing the insulin available for use in the body.

b. Treatment consists of administering a purer insulin preparation.

c. Insulin resistance is also the term used for lack of tissue sensitivity to the insulin from the

body, which results in hyperglycemia.

a. Dawn phenomenon results from reduced tissue sensitivity to insulin, and usually develops between 5 and 8 AM (prebreakfast hyperglycemia occurs); it may be caused by nocturnal release of growth hormone.

b. Treatment includes administering an evening dose (or increasing the amount of a current dose) of intermediate-acting insulin at about 10 PM.

a. Normal or elevated blood glucose levels are present at bedtime; hypoglycemia occurs at

about 2 to 3 AM, which causes an increase in the production of counterregulatory hormones.

b. By about 7 AM, in response to the counterregulatory hormones, the blood glucose rebounds

significantly to the hyperglycemic range.

c. Treatment includes decreasing the evening (predinner or bedtime) dose of intermediate-acting

insulin or increasing the bedtime snack. 

1. Subcutaneous injections and mixing insulin: See Chapter 55.

2. Insulin pumps

a. Continuous subcutaneous insulin infusion is administered by an externally worn device that

contains a syringe attached to a long, thin, narrow-lumen tube with a needle or Teflon

catheter attached to the end.

b. The client inserts the needle or Teflon catheter into the subcutaneous tissue (usually on the

abdomen) and secures it with tape or a transparent dressing; the pump is worn on a belt or in

a pocket; the needle or Teflon catheter is changed at least every 2 to 3 days.

c. A continuous basal rate of insulin infuses; in addition, on the basis of the blood glucose level,

the anticipated food intake, and the activity level, the client delivers a bolus of insulin before

each meal.

d. Both rapid-acting and regular short-acting insulin (buffered to prevent the precipitation of

insulin crystals within the catheter) are appropriate for use in these pumps.

3. Insulin pump and skin sensor

a. A skin sensor device that monitors the client’s blood glucose continuously; the information is

transmitted to the pump, determines the need for insulin, and then the insulin is injected.

b. The pump holds up to a 3-day supply of insulin and can be easily disconnected for activities

such as bathing.

4. Pancreas transplants

a. The goal of pancreatic transplantation is to halt or reverse the complications of diabetes

mellitus.

b. Transplantations are performed on a limited number of clients (in general, these are clients

who are undergoing kidney transplantation simultaneously).

c. Immunosuppressive therapy is prescribed to prevent and treat rejection.

D. Self-monitoring of blood glucose level

1. Self-monitoring provides the client with the current blood glucose level and information to

maintain good glycemic control.

2. Monitoring requires a finger prick to obtain a drop of blood for testing.

3. Alternative site testing (obtaining blood from the forearm, upper arm, abdomen, thigh, or calf)

is now available, using specific measurement devices.

4. Tests must be used with caution in clients with diabetic neuropathy.

5. Client Instructions: Monitoring of Blood Glucose Level

Use the proper procedure to obtain the sample for determining the blood glucose level.

Perform the procedure precisely to obtain accurate results.

Follow the manufacturer’s instructions for the glucometer.

Wash hands before and after performing the procedure to prevent infection.

Calibrate the monitor as instructed by the manufacturer.

Check the expiration date on the test strips.

If the blood glucose level results do not seem reasonable, reread the instructions, reassess technique, check the expiration date of the test strips, and perform the procedure again to verify results.

E. Urine testing

1. Urine testing for glucose is not a reliable indicator of the blood glucose level and is not used

for monitoring purposes.

2. Instruct the client in the procedure for testing for urine ketones.

3. The presence of ketones may indicate impending ketoacidosis.

4. Urine ketone testing should be performed during illness and whenever the client with type 1 diabetes mellitus has persistently elevated blood glucose levels (higher than 240 mg/dL or as prescribed for two consecutive testing periods).

1. Check the client’s blood glucose level.

2. Give the client a 10- to 15-g carbohydrate item such as ½ cup of fruit juice to drink.

3. Take the client’s vital signs.

4. Retest the blood glucose level

5. Give the client a small snack of carbohydrate and protein.

6. Document the client’s complaints, actions taken, and outcome.

If the client experiences symptoms of a hypoglycemic reaction such as hunger, irritability, shakiness, or weakness, the nurse first would check the client’s blood glucose level to verify that the client is experiencing hypoglycemia. Once this is verified, the nurse would give the client 10 to 15 g of carbohydrates. The nurse would retest the blood glucose level in 15 minutes. In the meantime, the nurse would check the client’s vital signs. The nurse would give the client another 10- to 15-g carbohydrate food item if the client’s symptoms do not resolve. Otherwise, the nurse would provide a small snack of carbohydrates and protein if the client’s next scheduled meal is more than an hour away from the time of the occurrence. Following treatment and resolution of the hypoglycemic event, the nurse would document the occurrence, actions taken, and outcome.

1. Description

a. Hypoglycemia occurs when the blood glucose level falls below 70 mg/dL or when the blood glucose level drops rapidly from an elevated level.

b. Hypoglycemia is caused by too much insulin or oral hypoglycemic agents, too little food, or excessive activity.

c. The client needs to be instructed always to carry some form of fast-acting simple

carbohydrate with him or her.

d. If the client has a hypoglycemic reaction and does not have any of the recommended emergency foods available, any available food should be eaten; high-fat foods slow the absorption of glucose and the hypoglycemic symptoms may not resolve quickly.

2. Assessment

Mild

■ Hunger

■ Nervousness

■ Palpitations

■ Sweating

■ Tachycardia

■ Tremor

Moderate

■ Confusion

■ Double vision

■ Drowsiness

■ Emotional changes

■ Headache

■ Impaired coordination

■ Inability to concentrate

■ Irrational or combative behavior

■ Light headedness

■ Numbness of the lips and tongue

■ Slurred speech

Severe

■ Difficulty arousing

■ Disoriented behavior

■ Loss of consciousness

■ Seizures

a. Mild hypoglycemia: The client remains fully awake but displays adrenergic symptoms; the blood glucose level is usually lower than 60 mg/dL.

b. Moderate hypoglycemia: The client displays symptoms of worsening hypoglycemia; the blood glucose level is usually lower than 40 mg/dL.

c. Severe hypoglycemia: The client displays severe neuroglycopenic symptoms; the blood glucose level is usually lower than 20 mg/dL.

3. Interventions: Mild hypoglycemia

a. Give 10 to 15 g of a fast-acting simple carbohydrate

■ Commercially prepared glucose tablets

■ 6 to 10 Life Savers or hard candy

■ 4 tsp of sugar

■ 4 sugar cubes

■ 1 Tbsp of honey or syrup

■ ½ cup of fruit juice or regular (nondiet) soft drink

■ 8 oz low-fat milk

■ 6 saltine crackers

■ 3 graham crackers

b. Retest the blood glucose level in 15 minutes and repeat the treatment if symptoms do not resolve.

c. Once symptoms resolve, a snack containing protein and carbohydrates, such as low-fat milk or cheese and crackers, is recommended unless the client plans to eat a regular meal within 60 minutes.

4. Interventions: Moderate hypoglycemia

a. Administer 15 to 30 g of a fast-acting simple carbohydrate.

b. Administer additional food such as low-fat milk or cheese and crackers after 10 to 15

minutes.

5. Interventions: Severe hypoglycemia

a. If the client is unconscious and cannot swallow, an injection of glucagon is administered subcutaneously or intramuscularly.

b. Administer a second dose in 10 minutes if the client remains unconscious.

c. A small meal is given to the client when the client awakens as long as the client is not nauseated.

d. The HCP is notified if a severe hypoglycemic reaction occurs.

e. Family members need to be instructed about the administration of glucagon. Do not attempt to administer oral food or fluids to the client experiencing a severe hypoglycemic reaction who is semiconscious or unconscious and is unable to swallow. This client is at risk for aspiration. For this client, an injection of glucagon is administered subcutaneously or intramuscularly. In the hospital or emergency department, the client may be treated with an IV injection of 25 to 50 mL of 50% dextrose in water.

1. Description

a. Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes mellitus that

develops when a severe insulin deficiency occurs.

b. The main clinical manifestations include hyperglycemia, dehydration, ketosis, and acidosis.

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2. Assessment

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3. Interventions

a. Restore circulating blood volume and protect against cerebral, coronary, and renal hypoperfusion.

b. Treat dehydration with rapid IV infusions of 0.9% or 0.45% normal saline (NS) as prescribed; dextrose is added to IV fluids when the blood glucose level reaches 250 to 300 mg/dL.

c. Treat hyperglycemia with insulin administered intravenously as prescribed.

d. Correct electrolyte imbalances (potassium level may be elevated as a result of dehydration and acidosis).

e. Monitor potassium level closely because when the client receives treatment for the dehydration and acidosis, the serum potassium level will decrease and potassium replacement may be required.

4. Insulin IV administration

a. Use short-duration insulin only.

b. An IV bolus dose of insulin (usually 5 to 10 units) may be prescribed before a continuous

infusion is begun.

c. Mix the prescribed IV dose of insulin for continuous infusion in 0.9% or 0.45% NS as prescribed.

d. Flush the insulin solution through the entire intravenous infusion set and discard the first 50 to

100 mL of solution before connecting and administering it to the client (insulin molecules adhere to the plastic of IV infusion sets)

e. Always place the insulin infusion on an IV infusion controller.

f. Insulin is infused continuously until subcutaneous administration resumes to prevent a rebound of the blood glucose level.

g. Monitor vital signs.

h. Monitor urinary output and for signs of fluid overload.

i. Monitor potassium and glucose levels and for signs of increased intracranial pressure.

j. The potassium level will fall rapidly within the first hour of treatment as the dehydration and the acidosis are treated.

k. Potassium is administered intravenously in a diluted solution as prescribed when the potassium reaches a normal level to prevent hypokalemia; ensure adequate renal function before administering potassium.

5. Client education

Take insulin or oral antidiabetic medications as prescribed.

Determine the blood glucose level and test the urine for ketones every 3 to 4 hours.

If the usual meal plan cannot be followed, substitute soft foods six to eight times a day.

If vomiting, diarrhea, or fever occurs, consume liquids every 30 to 60 minutes to prevent dehydration and to provide calories.

Notify the health care provider if vomiting, diarrhea, or fever persists, if blood glucose levels are higher than 250 to 300 mg/dL, when ketonuria is present for more than 24 hours, when unable to take food or fluids for a period of 4 hours, or when illness persists for more than 2 days.

Monitor the client being treated for DKA closely for signs of increased intracranial pressure. If the blood glucose level falls too far or too fast before the brain has time to equilibrate, water is pulled from the blood to the cerebrospinal fluid and the brain, causing cerebral edema and increased intracranial pressure.

1. Description

a. Extreme hyperglycemia occurs without ketosis or acidosis.

b. The syndrome occurs most often in individuals with type 2 diabetes mellitus.

c. The major difference between HHNS and DKA is that ketosis and acidosis do not occur with

HHNS; enough insulin is present with HHNS to prevent the breakdown of fats for energy,

thus preventing ketosis.

2. Assessment

[image]

3. Interventions

a. Treatment is similar to that for DKA.

b. Treatment includes fluid replacement, correction of electrolyte imbalances, and insulin administration.

c. Fluid replacement in the older client must be done very carefully because of the potential for heart failure.

d. Insulin plays a less critical role in the treatment of HHNS than it does for the treatment of DKA because ketosis and acidosis do not occur; rehydration alone may decrease glucose levels.

1. Description

a. Chronic and progressive impairment of the retinal circulation that eventually causes hemorrhage

b. Permanent vision changes and blindness can occur.

c. The client has difficulty with carrying out the daily tasks of blood glucose testing and insulin injections.

2. Assessment

a. A change in vision is caused by the rupture of small microaneurysms in retinal blood vessels.

b. Blurred vision results from macular edema.

c. Sudden loss of vision results from retinal detachment.

d. Cataracts result from lens opacity.

3. Interventions

a. Maintain safety.

b. Early prevention via the control of hypertension and blood glucose levels

c. Photocoagulation (laser therapy) may be done to remove hemorrhagic tissue to decrease scarring and prevent progression of the disease process.

d. Vitrectomy may be done to remove vitreous hemorrhages and thus decrease tension on the retina, preventing detachment.

e. Cataract removal with lens implantation improves vision.

1. Description: Progressive decrease in kidney function

2. Assessment

a. Microalbuminuria

b. Thirst

c. Fatigue

d. Anemia

e. Weight loss

f. Signs of malnutrition

g. Frequent urinary tract infections

h. Signs of a neurogenic bladder

3. Interventions

a. Early prevention measures include the control of hypertension and blood glucose levels.

b. Assess vital signs.

c. Monitor intake and output.

d. Monitor the blood urea nitrogen, creatinine and urine albumin levels.

e. Restrict dietary protein, sodium, and potassium intake as prescribed.

f. Avoid nephrotoxic medications.

g. Prepare the client for dialysis procedures if planned.

h. Prepare the client for kidney transplant if planned.

i. Prepare the client for pancreas transplant if planned. 

1. Description

a. General deterioration of the nervous system throughout the body

b. Complications include the development of nonhealing ulcers of the feet, gastric paresis, and

erectile dysfunction.

2. Classifications

a. Focal neuropathy or mononeuropathy: Involves a single nerve or group of nerves, most

frequently cranial nerves III (oculomotor) and VI (abducens), resulting in diplopia

b. Sensory or peripheral neuropathy: Affects distal portion of nerves, most frequently in the

lower extremities

c. Autonomic neuropathy: Symptoms vary according to organ system involved

d. Cardiovascular: Cardiac denervation syndrome (heart rate does not respond to changes in

oxygenation needs) and orthostatic hypotension occur.

e. Pupillary: Pupil does not dilate in response to decreased light.

f. Gastric: Decreased gastric emptying (gastroparesis)

g. Urinary: Neurogenic bladder

h. Skin: Decreased sweating

i. Adrenal: Hypoglycemic unawareness

j. Reproductive: Impotence (male), painful intercourse (female)

3. Assessment: Findings depend on the classification

a. Paresthesias

b. Decreased or absent reflexes

c. Decreased sensation to vibration or light touch

d. Pain, aching, and burning in the lower extremities

e. Poor peripheral pulses

f. Skin breakdown and signs of infection

g. Weakness or loss of sensation in cranial nerves III (oculomotor), IV (trochlear), V

(trigeminal), and VI (abducens)

h. Dizziness and postural hypotension

i. Nausea and vomiting

j. Diarrhea or constipation

k. Incontinence

l. Dyspareunia

m. Impotence

n. Hypoglycemic unawareness

4. Interventions

a. Early prevention measures include the control of hypertension and blood glucose levels.

b. Careful foot care is required to prevent trauma

c. Administer medications as prescribed for pain relief.

d. Initiate bladder training programs.

e. Instruct in the use of estrogen-containing lubricants for women with dyspareunia.

f. Prepare the male client with impotence for penile injections or other possible treatment

options as prescribed.

g. Prepare for surgical decompression of compression lesions related to the cranial nerves as

prescribed.

Preventive Foot Care Instructions 

Diabetic Neuropathy

Provide meticulous skin care and proper foot care.

Inspect feet daily and monitor feet for redness, swelling, or break in skin integrity.

Notify the health care provider if redness or a break in the skin occurs.

Avoid thermal injuries from hot water, heating pads, and baths.

Wash feet with warm (not hot) water and dry thoroughly (avoid foot soaks).

Avoid treating corns, blisters, or ingrown toenails.

Do not cross legs or wear tight garments that may constrict blood flow.

Apply moisturizing lotion to the feet but not between the toes.

Prevent moisture from accumulating between the toes.

Wear loose socks and well-fitting (not tight) shoes; do not go barefoot.

Wear clean cotton socks to keep the feet warm and change the socks daily.

Avoid wearing the same pair of shoes 2 days in a row.

Avoid wearing open-toed shoes or shoes with a strap that goes between the toes.

Check shoes for cracks or tears in the lining and for foreign objects before putting them on.

Break in new shoes gradually.

Cut toenails straight across and smooth nails with an emery board.

Avoid smoking.

A. Preoperative care

1. Check with HCP regarding withholding oral hypoglycemic medications or insulin.

2. Some long-acting oral antidiabetic medications are discontinued 24 to 48 hours before surgery.

3. Metformin (Glucophage) may need to be discontinued 48 hours before surgery and may not be

restarted until renal function is normal postoperatively.

4. All other oral antidiabetic medications are usually withheld the day of surgery.

5. Insulin dose may be adjusted or withheld if IV insulin administration during surgery is planned.

6. Monitor blood glucose level.

7. Administer IV fluids as prescribed.

B. Intraoperative care

1. Monitor blood glucose levels frequently.

2. Administer IV short- or rapid-acting insulin as prescribed to maintain the blood glucose level

lower than 200 mg/dL.

C. Postoperative care

1. Administer IV glucose and insulin infusions as prescribed until the client can tolerate oral

feedings.

2. Administer supplemental short-acting insulin as prescribed based on blood glucose results.

3. Monitor blood glucose levels frequently if the client is receiving parenteral nutrition.

4. When the client is tolerating food, ensure that the client receives an adequate amount of

carbohydrates daily to prevent hypoglycemia.

5. Client is at higher risk for cardiovascular and renal complications postoperatively.

6. Client is also at risk for impaired wound healing.