Care of the Patient with an Endocrine Disorders

an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in patients who are hypocalcemic

difficulty swallowing

a physician who specializes in endocrinology

abnormal presence of a sugar, especially glucose, in the urine

greater than normal amounts of glucose in the blood

excretion of an abnormally large quantity of urine

excessive thrist

eating to the point of gluttony

• DKA
• acidosis accompanied by an accumulation of ketones in the blood
• formerly called diabetic coma

excessive body hair in a masculine distribution

• a deficiency of calcium in the blood serum
• S/S- tetany, cardiac dysrhythmias and carpopedal spasms

inadequate amount of potassium a major cation in the circulating blood

an increase in the number of cells without a known cause

normal metabolic products, such as b hydroxybutyric acid and aminoacetic acid, from which acetone may arise spontaneously

abnormality in the metabolism or deposition of fats; insulin lipodystrophy is the loss of local fat deposits

any abnormal condition characterized by inflammation and degeneration of the peripheral nerves

assesses for latent tetany; carpal spasm is induced by inflating a BP cuff on the upper arm to a pressure exceeding systolic BP for 3 min; a positive result may be seen in hypocalcemia and hypomagnesemia.

the normal resiliency of the skin

results from progressive destruction of beta-cell function in the pancreas as a result of an autoimmune process in a susceptible individual.

• decreased tissue responsiveness to insulin as a result of receptor or post-receptor defects
• overproduction of insulin early in the disease, but eventual decreased secretion of insulin from beta-cell exhaustion
• abnormal hepatic glucose regulation

• a decrease in function in response to stimuli
• information is constantly being exchanged between the target organ and the pituitary gland via the bloodstream regarding the effect of the hormone on the target organ

• ductless that release their secretions directly into the bloodstream
• have regulatory function

• secrete through a series of ducts (sebaceous and sudoriferous glands of the skin)
• secretions are protective and functional

chemical messengers that travel through the bloodstream to their target organ

• an overproduction of somatotropin (growth hormone GH) in the adult
• cause idiopathic hyperplasia or tumor growth
• changes are irreversible
• S/S: headaches, visual disturbances, painful stiff joints, sexual problems, bone enlargement, joint involvement, gait changes and decreasing ability to perform activities
• NSG Interventions: supportive, assessment of ability to do ADL's, headaches may impair socialization and education, soft diet, allow adequate time during meals, frequent fluid intake, nonopiod analgesics , self esteem issues, enlarged liver, spleen and the heart, cardiac dysrhythmias, weight gain due to abdominal growth

• test measures the amount of glucose that has become incorporated into the hemoglobin within an erythrocyte
• because glycosylation occurs constantly during the 120 day life span of the erythrocyte this test reveals the effectiveness of diabetes therapy for the preceding 8-12 weeks.
• A1C

• Fasting blood glucose (FBG): after 8 hour fast. Normal 60-110
• Oral glucose tolerance test (OGTT): need accurate patient preparation
• Serum insulin : Absent in type 1; normal to high in type 2
• Postprandial (after meal) blood glucose (PPBG): give a fasting patient measured amount of carbohydrates either in solution or food and draw blood 2 hours after. Reading over 160 indicates possible DM
• Patient self-monitoring of blood glucose (SMBG): patient self tests
• Glycosylated hemoglobin (HbA1C): tests glucose levels from previous 8-12 weeks
• C-peptide test: used in type 2 DM, normal 0.5-2 ng/mL. DM patients have lower levels of C-peptide

• diet low in sodium to reduce edema
• reduced calories and carbohydrates help control hyperglycemia
• foods high in K help correct hypokalemia

Diet and exercise are tailored to the individual

• blindness
• nephropathy
• amputation of a lower extremity
• cardiovascular complications including heart disease
• hypertension
• stroke

• AKA thyroid storm
• rare after thyroidectomy, caused by manipulation of the thyroid during surgery causing the release of large amounts of thyroid hormones
• occurs usually within 12 hours after surgery
• S/S are exaggerated hyperthyroidism S/S as well as nausea, vomiting, sever tachycardia, sever hypertension and occasionally hyperthermia up to 106, extreme restlessness, cardiac dysrhythmia, delirium and heart failure and death
• 3 goals of management: induce a normal thyroid state, prevent cardiovascular collapse and prevent excessive hyperthermia
• treatment includes IV fluids, sodium iodide, corticosteroids, antipyretics, an antithyroid drug and oxygen

• decreased ADH
• transient or permanent metabolic disorder of the posterior pituitary
• may be primary or secondary to other conditions such as head injury, intracranial aneurysm, intracranial tumor or infarct, encephalitis or meningitis
• occurs when the secretion or action of ADH goes awry
• reduction of ADH results in electrolyte and fluid imbalances
• caused by increased plasma osmolality and increased urinary output

risk for disturbed body image, related to altered physical appearance: develop open and trusting relationship so that the patient will express his or her feelings; discuss ways to disguise thyroid enlargement

• T3(serum triodothyronine): measures T3 in blood; normal is 65-195 ng/dL; accurate measurement of thyroid function; elevated T3 important for patient with normal T4 but S/S of hyperthyroidism
• T4 (serum thyroxine): measures T4 levels in blood; normal is 5-12; medications such as contraceptives, steroids, estrogens and sulfonamides may be withheld for several hours before T3 and T4 tests, but food and fluid are not withheld; elevated levels indicate hyperthyroidism
• Free T4 (FT4): measures active component of total T4; normal values are 1-3.5 ng/dL; used to diagnose hyper and hypothyroidism, high is hyper and low is hypo
• thyroid-stimulating hormone (TSH): measures TSH; normal 0.3-5.4; considered most sensitive method for evaluating thyroid disease; recommended first test; TSH is suppressed in hyper and elevated in hypo
• *Radioactive iodine uptake (RAIU): radioactive iodine is given by PO to fasting patient, after 2,4,6 and 24 hours a scintillation camera is held over the thyroid to measure how much of the isotope has been removed from the bloodstream; hyperactive thyroid may remove 35-95% of drug; test may be affected by prior ingestion of iodine containing substances or foods; note allergy to iodine
• Thyroid scan: 131I is given PO or IV and scan done 30-60 minutes

• Iodine or iodine products such as sodium iodide with strong iodine solution, potassium iodide, Lugol's solution
• Radioactive iodine 131I or 125I
• methimazole (tapazole), propylthiouracil (PTU)

• Levothyroxine (Levothroid, Synthroid, Eltroxin, Levo-T, Unithroid)
• Liothyronine (Cytomel)
• Liotrix (Thyrolar)
• Thyroid (Armour Thyroid, Thyrar)

• semi fowlers with pillows supporting head and shoulders
• pt avoid hyperextending the head
• have suction and trach tray available
• cool mist humidifier to soothe throat and prevent coughing
• V/S often with special attention paid to the rate and depth of respirations and observations of dyspnea
• check swallowing and gag reflex before PO food
• alert for s/s of internal or external bleeding (restlessness, apprehension, increased pulse rate, decreased b/p and feeling of fullness in neck)
• cyanosis indicates blocked airway
• clear cool liquid diet
• tetany

tetany can occur and is treated with IV administration of calcium gluconate

• moon face
• buffalo hump
• weight gain from accumulation of adipose tissue in the trunk, face, and cervical spine
• arms and legs become thin as a result of muscle wasting
• osteoporosis

• decreased levels of PTH- parathyroid hormone
• cause increase in serum phosphorus level and decreased serum calcium level resulting in neuromuscular hyperexcitability, involuntary and uncontrollable muscle spasms and hypocalcemic tetany

• wash with mild soap and warm water
• pat feet dry gently especially between toes
• examine daily
• use lanolin on feet
• use mild foot powder
• avoid open toes, open heel and high heel shoes, leather preferred
• wear clean absorbent socks or stockings
• nothing tight
• no hot bottles or hot pads
• watch for frostbite
• exercise feet daily

• hot dry flushed skin
• fruity breath
• dry musous membranes
• deep respirations
• drowsiness/coma
• low B/P
• glucose in urine
• nausea and vomitting
• BG level of 300-800
• administer regular insulin

• Humalog
• human clear
• administer 5-15 min before meal
• rapid acting, acts in 15-30 minutes
• peak 1-2 hours
• lasts 3-4 hours

• Humulin N, Novolin N, ReliOn N
• human milky when mixed
• administer 30 minutes before meal
• intermediate acting, acts in 2-4 hours
• peak 6-10 hours
• lasts 12-16 hours

• room temp 70-74 and avoid chilling patient
• allow extra time for care
• accurate bowel records as constipation can occur
• stool softners and bulk laxatives may be ordered
• provide a high protein, high fiber, low calorie diet and encourage increased fluid intake
• avoid concentrated carbs such as sweets
• watch for chest pain
• watch for decreased cardiac output

• hyperthyroidism
• exophthalmic goiter and thyrotoxicosis
• increase activity of the thyroid gland with overproduction of the thyroid hormones T4 and T3
• may occur in pregnancy or adolescence
• most frequent in woman 20-40 years old
• visible edema of the anterior portion of the neck
• bulging of eyeballs