Assessment
The RN knows, when assessing endocrine function, it is important to assess...
What is weight (gain or loss), energy levels, sleep pattern changes, reproductive system changes (tropic hormone imbalances!)?
The RN knows s/s hypothyroidism include...
What are tiredness, wt gain w/out change to diet, unusually cold, dry skin, low HR, constipation, slow speech, low T4 with increased TSH, memory issues, depression, difficulty managing daily tasks?
The RN knows these factors differentiate type 1 DM from type 2 DM...
What are type 1 is commonly autoimmune with the pancreas not producing insulin; insulin is needed for ALL type 1 diabetics; both may have a genetic link; type 2 more r/t poor diet & lack of exercise and may or may not be on insulin?
The RN knows lifestyle changes for DM2 include...
What is at least 150 min/w moderate exercise (walking good!), losing 5-7% of body weight, monitoring/limiting carb/sugar intake?
With HYPOparathyroidism, the RN knows the pt runs a risk of this electrolyte imbalance and education should include...
What is hypocalcemia and education should include regular weight bearing exercise, vit D & Ca+ supplementation at the same time each day, moderate exercise (150 min/wk of walking good), 2-3 L fluid to prevent kidney stones?
The RN knows the pituitary gland is called the "master gland" because it secretes many important hormones...name at least 3 hormones secreted by the anterior lobe
What is: TSH (thyroid stimulating hormone: tells thyroid to produce thyroid hormones), GH (growth hormone), ACTH (adrenocorticotropic hormone: stimulates adrenal gland to produce cortisol), FSH (follicle stimulating hormone) & LH (luteinizing hormone) (Gonadotropins), prolactin (breast milk production), MSH (skin melatonin/pigment production & appetite control)
The RN knows, with Grave's disease, if txment is working, these vitals & functions would show improvement...
What are HR & BP decrease, weight gain, temp WNL, TSH & T4 normal, improved sleep & reduced anxiety, decrease in heart palpitation & heat intolerance?
The RN knows, when assessing for increased growth hormone being secreted from the anterior pituitary expected s/s may include...
What is increasing fatigue, joint pain, frequent headaches, overgrown facial features, vision changes, abnormally large hands?
Acromegaly!
The RN knows this medication is used to replace thyroid hormone that the body is not making and administration instructions include...
What is Synthroid and what is take on an empty stomach and at least 30 min before breakfast?
The RN knows s/s low blood sugar include...
What is shaking, sweating, ALOC, seizure, coma, slurred speech?
The RN knows, pt education for a pt with DM2 should include...
What is monitor for s/s infection & delayed wound healing, daily feet inspection r/t peripheral neuropathy & wounds, med adherence, s/s of hypo & hyper glycemia, glucose monitoring?
The RN knows the pt with a thyroidectomy should be monitored for these s/s r/t HYPOcalcemia...
What are Chvostek's (cheek!) & Trousseau's (carpal pedal spasm w BP cuff) signs, circumoral tingling (tingling around mouth), s/s difficulty breathing?
The RN knows acromegaly is _____ and related concerns are ______.
What is acromegaly is caused by excessive growth hormone, usually related to a pituitary tumor; It causes enlarged hands, feet, and facial features, along with systemic complications like visual changes & headaches that may be r/t ICP, heart dysrhythmias like bradycardia or tachycardia; monitor for insulin resistance & hyperglycemia?
The RN knows, these s/s may indicate Grave's disease...
What is exophthalmos (protruding eyeballs), racing heart, sweating all the time, fine hand tremor, heat intolerance?
The RN knows the endocrine system regulates hormones using a...
What is a negative feedback loop? When a hormone is detected to be at a decreased level, that stimulates a gland to release a hormone that stimulates another gland to release another hormone, etc
The RN knows because depression is a common s/s related to hypothyroidism and may or may not improve even when hormone levels are WNL, a consult to this specialist may be appropriate...
What is a mental health professional?
This specialist may be able to help with s/s depression and psychosocial aspects.
The RN knows s/s of hyperglycemia may include...
What are the 3 Ps (polyuria, polydypsia, polyphagia), weight loss, fatigue?
For both DM1 & DM2:
The RN knows if a pt is experiencing a hypoglycemic episode and is awake, this would be administered...
The RN knows if the pt is experiencing a hypoglycemic episode & is unconscious, this would be administered...
What is PO carbs or glucose gel?
What is IV dextrose, IM glucagon if no IV access?
The RN knows with HYPERparathyroidism, patient education includes...
What is drink 2-3L fluid/d to help flush excess Ca+, limit dietary intake of Ca+, monitor s/s kidney stones, administer PO Phosphate supplements (pushes Ca+ back into the bones & binds w Ca+ to lower free Ca+ blood levels; Ca+ & Phosphorous have an inverse relationship); weight bearing exercises help push Ca+ back into bone; Calcitonin to push Ca+ back into bones; lifestyle changes (healthy weight, limit ETOH, check sugars regularly, complex carbs like whole grains & fruit, aim to lose 5-10% body weight, fiber rich foods
The RN knows with hypopituitary-ism, growth hormone deficiency...
What is slows bone growth and reduces bone density over time?
The RN knows s/s hyperthyroidism include...
What is anxiety, weight loss even when overeating & increased appetite, frequent bowel movements, tachycardia, restlessness, warm & moist skin, noticeable enlargement of thyroid gland?
If pt who is being treated for hormone imbalance continues presenting with s/s, the nurse should assess for...
What is medication compliance?
If patient is med compliant, then the physician would likely order labs and imaging to further assess levels and/or structural issues (tumors).
For thyroid issues, thyroid function test & Ca+ levels would be included.
The RN knows when a pt is taking synthroid, it is important to monitor for s/s of this _____ related to the synthroid dose potentially being too high...
What is HYPERthyroidism?
Remember: with any treatment that is a replacement therapy, we worry about over treating & tipping the pt the other direction
The RN knows a long acting insulin like glargine provides _____ and should not be skipped because _____?
What is basal coverage (base coverage; keeps the body from being at 0 insulin) and should not be skipped because the pt will likely experience a hypoglycemic episode over night?
The RN knows Dapagliflozin's mechanism of action is ____ and teaching should include_____
What is lowers blood sugar by increasing how much glucose is excreted in urine and teaching should include report reduction in BP (dehydration), increasing fluids, reporting s/s UTI (r/t increased sugar in urine)?
The RN knows with hyperparathyroidism there is a risk of hypercalcemia, which may have this effect on the heart...
What are dysrhythmias like bradycardia or tachycardia and the RN should expect to place the pt on cardiac monitoring?
The RN knows a hypophysectomy is used to _____ and RN considerations include______.
What is a transsphenoidal approach (through nose) to the pituitary gland to remove the gland usually r/t tumors that cause hormone imbalances & visual issue (pressing on the optic nerve); RN consideration monitoring for CSF leak (clear, salty, nasal drainage; blow nose gently to reduce risk), LOC, pupil response, I/O r/t potential for Diabetes Insipidus (Dry inside because of excessive urine output, s/s dehydration); med compliance because will have to take life long daily hormones
The RN knows dietary education for pts w hyperthyroidism include...
What are high calories & protein, avoid caffeine r/t reduction of palpitations & restlessness, small & frequent meals?
The RN knows s/s related to hyper or hypo calcemia may be related to these 2 endocrine glands...
What is the thyroid and/or the parathyroid?
The RN knows these are the labs associated with hypothyroidism...
What are elevated TSH, low T4 & T3?
So...if the pt is on synthroid and the dose is too high, what would the labs be?
What are decreased TSH, elevated T4 & T3?
The RN knows that related to meals, short acting insulin should be administered within this time frame...
What is not more than 30 minutes before a meal?
In the hospital, do not administer the insulin until you see the food tray at the pts bedside!!!!!
The RN knows the mechanism of action of insulin is...
The RN knows the mechanism of action of metformin is...
What is insulin moves sugar into cells?
What is metformin reduces glucose production in liver & improves insulin sensitivity?
The RN knows Parathyroid Hormone (PTH) is secreted by the parathyroid and functions to _____.
The RN also knows that Calcitonin secreted by the Thyroid functions to _____.
What is PTH increases Ca+ by releasing Ca+ from the bones, inhibiting Ca+ release by the kidneys, and increasing Ca+ gut absorption?
What is Calcitonin opposes PTH and lowers excess levels of Ca+? (we use Calcitonin r/t osteoporosis because it pushes Ca+ back into the bones)
The RN knows ACTH is ______ and if the pituitary gland is removed, the pt will be placed on lifelong ______ which need to be taken at the same time every day to best mimic the natural hormone cycle?
What is ACTH is cortisol (stress hormone!) and if the pituitary gland is removed, the pt will be placed on lifelong steroids to mimic cortisol and should be taken every day at the same time?
The RN knows radioactive iodine may be used as treatment because...
What is the thyroid has a natural affinity for iodine and so the iodine with the radioactive isotopes will be absorbed by the thyroid tissues, thus killing off the overactive thyroid cells and/or cancer cells?