Term
| Explain how hormone receptors work and what happens if the receptor sites are blocked. |
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Definition
| Hormone receptors are located on the surfaces of target tissues and are receptive to specific hormones. Think of them like a lock and key, because only a specific hormone will fit into a specific receptor. If a receptor site is blocked then that hormone cannot act on its target tissue. |
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Term
| What gland produces melanocyte-stimulating hormone and what is its action in the body? |
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Definition
The anterior pituitary gland secretes melanocyte-stimulating hormone.
MSH promotes pigmentation in the skin. |
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Term
| What disease(s) is/are associated with a change in melanocyte-stimulating hormone? |
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Definition
| Addison’s disease presents with high levels of MSH and areas of increased pigmentation. |
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Term
| Explain in detail the instructions for collecting a 24 hour urine specimen for assessment of endocrine function. |
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Definition
Instruct the patient to begin urine collection by emptying the bladder, and not to save this urine.
Instruct the patient to note the time of the discarded specimen and to plan to collect all urine from this time until the same time the next day.
Instruct the patient to end the collection by emptying the bladder and collecting it at the same time as the beginning urine.
Check with the lab to determine any special handling of the urine specimen, such as a preservative.
Tell the patient that some preservatives can make the urine caustic and to be cautious.
Tell the patient to refrigerate the urine if necessary. |
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Term
| What do you instruct clients with hypopituitarism who are taking hormone replacements? |
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Definition
Teach client that dosage will need to be adjusted when you have the flu, experience nausea/vomiting, or surgery. Also with pregnancy and significant weight changes.
Teach patient to wear a medical alert bracelet. |
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Term
| What are the possible side effects or adverse events to watch for in the immediate post-operative period following trans-sphenoidal hypophysectomy (removal of the pituitary)? What discharge instructions will your client need prior to going home related to preventing complications during recovery? |
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Definition
| Monitor the patient’s neurological status hourly for the first 24 hours and then every 4 hours. Monitor fluid balance, especially for greater output than intake. Encourage the patient to maintain pulmonary hygiene with deep breathing exercises. Tell the patient not to cough, sneeze, or blow their nose. Instruct the patient to use mouth wash and floss instead of brushing teeth. Instruct the patient to avoid bending at the waist. Monitor nasal drip pad for halo. Monitor bowel movements to prevent constipation. Teach self-administration of hormone replacement medications. |
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Term
| What happens to natural hormone production when a client is taking high dose corticosteroid therapy for over 2 weeks? What happens if therapy is abruptly discontinued? |
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Definition
When a client is taking corticosteroid therapy natural hormone production decreases, and therefore if it is abruptly stopped, natural hormone production will not be sufficient to maintain normal corticosteroid levels.
Sudden cessation of long term therapy can cause secondary adrenal insufficiency (Addisonian Crisis) |
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Term
| What hormonal issues can be caused by head trauma? |
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Definition
| Head trauma can cause secondary diabetes insipidus, hypothyroidism, anterior hypopituitarism, SIADH (most common) |
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Term
| List topics to teach your diabetic client who needs to decrease insulin need. |
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Definition
Do not change diet or exercise regimens.
Monitor CBG levels daily and report any changes.
Comply with prescribed treatment program |
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Term
| What factors increase risk of type two diabetes? |
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Definition
Obesity
Hypertension
Hyperlipidemia |
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Term
| Compare tropic and non-tropic hormones. |
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Definition
Tropic hormones are hormones that stimulate other endocrine glands.
Non-tropic hormones stimulate non-endocrine target tissues. |
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Term
| What are the physical effects of excessive catecholamine release? |
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Definition
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Term
| What labs need to be monitored in SIADH? What are the normal values? |
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Definition
| The patient’s serum sodium levels needs to be monitored. Problems can occur when the serum sodium level falls below 120 mEq/L. Normal serum sodium levels are between 135-145 mEq/mL. |
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Term
| List hormones produced by the thyroid and parathyroid glands and their effects. |
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Definition
Triiodothyronine (T3)
Thyroxine (T4)
Calcitonin |
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Term
| Diabetics are at higher risk for: |
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Definition
Vessel damage
Myocardial infarction
DKA |
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Term
| What is the effect of low blood glucose (below 60 mg/dL) on the body? |
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Definition
Symptoms usually appear when blood sugar level fall below 70 mg/dL.
Presents as headache, hunger, nervousness, palpitations, shaking, sweating
Behavior changes |
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Term
| What dietary modifications need to be made in hypo and hyper thyroid conditions? |
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Definition
Hypothyroidism
i.Decrease total calorie count
Hyperthyroidism
i.Increase total calorie count
ii.Large amounts of calcium
iii.Adequate fiber and fluids to prevent constipation
iv.Iodized salt
v.No soda |
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Term
| List normal and abnormal lab values related to parathyroidectomy and physical manifestations suggesting abnormal values. |
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Definition
Parathyroidectomy, removal of the parathyroid glands, is the surgical management of hyperparathyroidism. Serum calcium levels must be monitored frequently after surgery. Immediately following the parathyroidectomy the remaining glands will have to learn to compensate for the missing glands. During this time period the patient can enter a hypocalcemic crisis so the serum calcium levels must be monitored every four hours until they stabilize.
Normal values of serum calcium are (Total) 9.0-10.5 mg/dL or 2.25-2.75 SI units or (Ionized) 4.64-5.28 mg/dL or 1.16-1.32 SI units
Other lab values associated with parathyroid function include serum phosphate, serum magnesium, serum PTH, vitamin D, and urine |
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Term
| 19. Describe how insulin therapy is used to control blood sugar in diabetes treatment including different types of insulin, their use and duration of action. Know common complications of insulin therapy and appropriate interventions for complications. List important points to teach clients regarding insulin therapy. |
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Definition
a. Insulin is a small protein that is quickly digested and inactivated in the GI tract it must be administered as an injection or by another route that bypasses the GI tract. Insulin regimens try to duplicate the normal insulin release pattern from the pancreas. The pancreas produces a( basal) amount of insulin that balances liver glucose production with glucose use and maintains normal blood glucose levels between meals.
b. DIFFERENT TYPES OF INSULIN
i. Lantus-there for the long haul with no peak effect. Duration of action is 70 min
ii. NPH- Start slowly and peak in 6 to 14 hrs. Onset of action 60-120 min
iii. Regular- I start fairly fast and peak in 1 to 5 hours Onset of action 30-60 min
iv. Extended- I start rapidly and peak in 0.5 to 1.5 hours
v. Lispro- I start rapidly and peak in 0.5 to 2.5 hours
c. COMPLICATIONS OF THERPAY
i. Lipoatrophy
ii. Lipohypertrophy
iii. Dawn phenomen
iv. Somogyi’s phenomenon |
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Term
| 20. List possible complications of diabetes especially when blood sugar is not closely controlled. |
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Definition
a. Acute
i. Diabetic ketoacidosis(DKA)
ii. Hyperglycemic-hyperosmolar state (HHS)
iii. Hypoglycemia
b. Chronic
i. Nephropathy
ii. Neuropathy
iii. Retinopathy
iv. Erectile dysfunction |
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Term
| 21. List potential immediate (within 24 hours) post-operative complications after total thyroidectomy and appropriate nursing interventions for those complications. |
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Definition
a. Tetany (hyperexcitability of nerves and muscles)
i. Ask the patient hourly about tingling around the mouth or of the toes and fingers
b. Hypocalcemia
i. Tetany is indicative of hypocalcemia
c. Hemorrhage
i. Inspect dressing and behind the patients neck
d. Respiratory distress
i. Can result from swelling, tetany, or damage to the laryngeal nerve
e. Thyroid storm
i. Key signs are fever, tachycardia, and systolic hypertension |
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Term
| 22. What are the clinical manifestations of adrenal hyperfunction? How can the nurse best support client responses to each of the manifestations? |
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Definition
a. Adrenal hyperfunction results in hypercortisolism (Cushing’s disease), hyperaldosteronism, or excessive androgen production.
b. Truncal obesity, moon face, buffalo hump, thinner arms and legs, and abdominal striae. |
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Term
| 23. What does a “fruity” odor on a type 1 diabetic’s breath indicate? What is the appropriate nursing response? |
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Definition
a. Fruity odor indicates Kussmaul respiration and ketoacidosis
b. The nurse should take a CGB reading and run an ABG |
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Term
| 24. Know the use and action of glucagon. |
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Definition
| a. Glucagon is a counterregulatory hormone that has actions opposite of insulin. |
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Term
| 25. What are the lab and clinical findings associated with aldosterone deficiency? |
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Definition
a. Sodium and potassium
b. Weight loss, GI disturbance, low BP, salt craving, dizziness, lightheadedness, palpitations, high blood potassium level, low blood sodium level, increased blood renin level |
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Term
| 26. What are the lab and clinical findings associated with acromegaly? |
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Definition
a. Acromegaly is the result of overproduction of GH in adults.
b. Increased skeletal thickness, hypertrophy of the skin, and enlargement of organs may also be present. |
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Term
| List the endocrine disorders that require hormone replacement and the duration of that replacement for each disorder. |
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Definition
Hypothyroid – lifelong
Hypopituitarism – lifelong |
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Term
| Know use and action of DDAVP including parameters the nurse will monitor to assess effectiveness of therapy. |
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Definition
| Desmopressin (DDAVP) is a synthetic type of ADH that serves as a replacement of ADH in diabetes insipidus. It binds to kidney receptors and enhances the reabsorption of water, thus reducing urine output. The nurse will need to monitor the patient’s weight daily. |
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Term
| Know acute life threatening complications of endocrine disorders, early signs of pending life threatening complications and appropriate nursing interventions. |
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Definition
Thyroid storm
Addisonian crisis
Acute complications of diabetes
Diabetic ketoacidosis(DKA)
Hyperglycemic-hyperosmolar state (HHS)
Hypoglycemia |
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Term
| List preventive health evaluations, including frequency of evaluations that are important for diabetic clients. |
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Definition
| a. Follow up with their provider regularly or endocrinologist, to have the eyes and vision tested yearly by an ophthalmologist and to have urine micro albumin levels assessed yearly. |
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Term
| List exercise recommendations and parameters including when to avoid physical exertion for diabetic clients |
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Definition
| a. Patients with fasting glucose higher than 250mg/dl and when ketones are present in the urine should avoid physical exertion. Parameters for diabetic clients regarding exercise recommendations: avoid strenuous lifting; harsh, high-impact activities; or placing the head in an inverted position for extended periods of time. |
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Term
| Know lab values needed to assess control of diabetes. (normal) |
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Definition
a. CBG
b. Hemoglobin A1c – 4-6%
c. Fasting blood glucose - <100 mg/dL
d. Glucose tolerance test - <140 mg/dL |
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Term
| Know the risk factors for developing diabetes. |
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Definition
Type 1
Genetics/family history
Pancreatic disease
Infection/illness
Type 2
Obesity
Poor diet
Lack of exercise |
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