Endocrine Part One
Hyperthyroidism dietary changes
DECREASE: Iodine and Caffeine
INCREASE: Calories and Carbohydrates
AVOID: Highly seasoned, high fiber foods
Electrolyte imbalances after a thyroidectomy
Hypocalcemia due to parathyroid gland damage
Hypomagnesemia
Hyponatremia (rare)
This type of phenomenon causes early morning rise in glucose
Who Am I?
Dawn phenomenon
DM2 Manifestations
Polyuria, polydipsia, polyphagia, blurred vision, slow-healing wounds
This test assesses diabetic peripheral neuropathy
Who Am I?
Monofilament test
Insulin peak times
Rapid-acting: 1-2 hours
Short-acting: 2-4 hours
Intermediate-acting: 4-12 hours
Long-acting: No peak, steady action
Acromegaly manifestations
Monofilament test
Stress and surgery DM2
Why? Stress can increase blood glucose and need to adjust insulin as needed
Monitor blood glucose closely
Adjust insulin/medication as needed
Manage stress through relaxation techniques
Coordinate with healthcare team for perioperative management
How would you start your Goiter assessment?
Listen for a bruit over thyroid gland
Indicates increased vascularity, common in Graves' disease
Prediabetic lifestyle changes
Regular exercise (150 minutes a week)
Balanced diet
Weight management
Stress reduction
Regular health check-ups
Hypoglycemia treatment
15-20g fast-acting carbohydrates
Recheck blood glucose after 15 minutes
Repeat if necessary
Follow with a small snack
Somogyi effect
Rebound hyperglycemia after nocturnal hypoglycemia
Teaching diet options for DM
Carbohydrate counting
Plate method (9" Plate)
Glycemic index
Mediterranean diet
DASH diet
Your patient has been diagnosed with hypothyroidism. Which medication would you expect to see within their chart?
Levothyroxine
GLP-1 contraindications
Metformin contraindications
Severe renal impairment
Acute or chronic metabolic acidosis
Severe liver disease
Conditions predisposing to hypoxemia
Acromegaly cause
Excess growth hormone production, usually from pituitary adenoma
Infection is priority for DM
Higher risk of infections
Impaired wound healing
Importance of foot care and hygiene
Prompt treatment of infections
RAI patient education
Sulfonylureas contraindications
DM diagnosis criteria
HbA1c ≥6.5%
Thyroidectomy complications
Hypocalcemia
Recurrent laryngeal nerve damage
Bleeding/hematoma
Hypothyroidism
Sick day rules for Type 1 DM
Continue insulin
Monitor blood glucose more frequently
Stay hydrated
Check for ketones
Have a sick day management plan
Sliding scale insulin
Variable insulin dosing based on blood glucose levels
Used in hospital settings or for short-term management
Hypoglycemia signs and symptoms
Glycosylated hemoglobin level
Normal: <5.7%
Prediabetes: 5.7-6.4%
Diabetes: ≥6.5%
Your patient is unconscious and is experiencing sever hypoglycemia, what are you giving to this patient?
D50
DM foot care teaching
Manifestations of liver damage
Thyroid assessment abnormality suggesting further follow-up
Nodules
Enlarged thyroid
Asymmetry
Pain or tenderness
You have a patient who is experiencing the following symptoms: Fatigue, Weight gain, Cold intolerance, Dry skin, Constipation, Depression. The patient's labs return and you see that their TSH is high and their T3 and T4 are low. What are you suspecting this patient has as the nurse?
Hypothyroidism
You have a patient with hypothyroidism and have an order for Levothyroxine, when would you give this med to this patient?
a) While the patient is eating OR b) on an empty stomach
B) On an empty stomach
Type 1 DM exercise and reduced need for insulin
Upon assessing your new patient, you notice Exophthalmos, a goiter, and Pretibial myxedema. What may you suspect your patient has?
Graves' Disease
Oral radioactive isotopes for thyroid scan pt teaching post scan
Avoid close contact with others for 24-48 hours
Proper disposal of bodily fluids
Drink plenty of fluids to flush out remaining isotope
The battle between insulin pens VS violas and syringes:
Between the two, which is more accurate?
Winner: Insulin Pens
You have a patient who is experiencing the following: Weight loss, Heat intolerance, Tremors, Tachycardia, Anxiety, Exophthalmos.
What do you as the nurse suspect the patient is having before labs have arrived?
Hyperthyroidism
Prediabetic lab values:
Fasting plasma glucose: 100-125 mg/dL
2-hour OGTT: 140-199 mg/dL
HbA1c: 5.7-6.4%
Your patient's labs have returned, and you notice they have elevated serum calcium, Elevated PTH, and Low phosphorus. What do you suspect?
Hyperparathyroidism
Which of the following is a contraindication for sulfonylurea use in diabetes management?
a) Obesity
b) Hypertension
c) Severe hepatic impairment
d) Hyperlipidemia
C) Sever Hepatic Impairment
What is the primary goal of using a monofilament test in diabetic patients?
a) To assess visual acuity
b) To evaluate peripheral neuropathy
c) To check for retinopathy
d) To measure blood glucose levels
B) to evaluate peripheral neuropathy
A patient with diabetes is using a sliding scale insulin regimen. What does this mean?
a) The insulin dose is fixed and never changes
b) Insulin is administered based on current blood glucose levels
c) Only long-acting insulin is used
d) Insulin is given at specific times regardless of blood glucose
B) Insulin is administered based on current blood glucose levels
Patients as active participants in their care is an appropriate goal for DM2:
Encourages self-management
Improves adherence to treatment
Enhances health outcomes
Which of the following is a contraindication for metformin use?
a) Hypertension b) Obesity c) Severe renal impairment d) Hyperlipidemia
C) Sever Renal Impairment