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Why is calcium gluconate prescribed for a pt after a thyroidectomy?
To treat hypocalcemic tetany
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What nursing action is appropriate for a pt after a thyroidectomy who has developed hoarseness and a weak voice?
Reassure the client that this is usually a temporary condition.
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What nursing action would the nurse prepare to carry out initially in a pt with a diagnosis of a myxedema coma?
Maintain a patent airway.
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What instruction should be included in the plan of proper foot care in the pt with diabetes mellitus?
Apply a moisturizing lotion to dry feet, but not between the toes.
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What statement by the pt indicates the need for further teaching about the diabetic diet in a pt diagnosed with diabetes mellitus?
�I need to buy special dietetic foods.�
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What information should the nurse teach when carrying out plans for discharge of the pt who has been newly diagnosed with diabetes mellitus and has been stabilized with daily insulin injections?
Rotate the insulin injection sites systematically.
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A client demonstrates an understanding the teaching of diabetes mellitus by stating that glucose will be taken if which symptom develops?
Shakiness
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What statement by the client would indicate that teaching about type 1 diabetes mellitus has been effective?
�I will notify my physician if my blood glucose level is greater than 250 mg/dl.�
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What would indicate hyperglycema and thus warrant physician notification n a pt newly diagnosed with diabetes mellitus?
Polyuria
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What instruction is important for the nurse to emphasize to the pt who is recovering from diabetic ketoacidosis?
Monitor blood glucose levels frequently.
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What statement by the client with Cushing�s syndrome indicates that the instructions related to dietary management were understood?
�I can eat foods that contain potassium.�
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What statement by the client indicates a correct understanding of NPH insulin and exercise?
�I should not exercise in the late afternoon.�
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What would require the nurse�s immediate attention when caring for a postop thyroidectomy pt?
Laryngeal stridor
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When a nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thights, what information should the nurse obtain from the client?
Plan of injection rotation.
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What nursing action would be appropriate to implement when a client has a diagnosis of pheochromocytoma?
Monitor the client�s blood pressure.
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Which client complaint would alert the nurse to a possible hypoglycemic reaction?
Tremors
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What is a priority nursing action preoperatively for a pt with pheochromocytoma who is scheduled for an adrenalectomy?
The vital signs.
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What is the appropriate choice for a pt with pheochromocytoma to meet their nutritional needs when the pt asks for a snack and something warm to drink?
Graham crackers and warm milk.
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What data would indicate a potential complication associated with pheochromocytoma?
Congestion heard on auscultation of the lungs
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A nurse is caring for a client after thyroidectomy and monitoring for signs of thyroid storm. What manifestation is associated with this disorder?
Hypotension
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When caring for a client who is having clear drainage from his nares after transsphenoidal hypophysectomy, which action by the nurse is appropriate?
Test the drainage for glucose
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After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which symptom is indicative of this disorder?
Polydipsia
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Which clinical manifestation should the nurse expect to note when assessing a client with Addison�s disease?
Hypotension
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What would the nurse anticipate being included in the plan of care for a client who has been diagnosed with Grave�s disease?
Provide a restful environment.
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When providing instructions to the pt taking fludrocrtisone (Florinef), what symptom should warrant the notification of the physician?
Swelling of the feet
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Which food item would the nurse instruct the client to avoid while taking calcitriol (Rocaltrol) for hypocalcemia?
Whole-grain cereals
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When is the best time for a pt take their daily dose of prednisone (Deltasone)?
Early morning.
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A patient is prescribed sildenafil (Viagra) to treat erectile dysfunction. What other medication would prompt the nurse to question this prescription?
The use of nitroglycerin
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A nurse is teaching the client how to mix regular insulin and NPH insulin in the same syringe. What action performed by the pt would indicate the need for further teaching?
If the pt withdraws the NPH insulin first
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How are unopened vials of NPH insulin stored?
In the refrigerator.
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How long will an unrefrigerated vial of insulin maintain its potency?
One month
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When is Lispro (Humalog) insulin administered?
Immediately before eating
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What should the pt avoid when taking tolbutamide (Orinase) for diabetes mellitus?
Alcohol
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What would indicate an averse effect of the medication desmopressin (DDAVP)?
Drowsiness
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When should a pt be instructed to take levothyroxine (Synthroid)?
One hour before breakfast
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When taking levothyroxine (Synthroid), what problem would warrant a call to their physician?
Tremors
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For what condition is propylthiouracil (PTU) taken daily?
Grave�s disease
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What side effect of propylthiouracil (PTU) would warrant a call to their physician?
Sore throat
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What is a chemical messenger, which travels throughout the bloodstream to its target organ?
Hormone
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What is known as the "master gland," and exerts control over the other glands?
Pituitary gland
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What disorder caused by secretion of insufficient amounts of antidiuretic hormone (ADH)?
Diabetes insipidus
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Appropriate nursing care for the patient with hypothyroidism would include what?
Encourage fluids
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What is a characteristic of hyperparathyroidism?
Increased serum calcium
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What is a feature of Cushing syndrome?
Increased susceptibility to infection
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What signs and laboratory values would you expect in a patient with Addison's disease?
Postural hypotension
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What is the main problem with diabetes mellitus type 2?
Abnormal resistance to insulin action.
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In caring for a patient with diabetes mellitus who is experiencing an acute hyperglycemic reaction (diabetic ketoacidosis), what interventions would be appropriate?
Insulin IV via infusion pump
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What signs or symptoms should be reported immediately to the RN/MD for further evaluation in the pt who has undergone a thyroidectomy?
Numbness in the fingers, Heart rate of 160, Noticeable arm twitching when you took patient's blood pressure
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What is acromegaly?
An overproduction of somatotropin (growth hormone)
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What causes acromegaly?
Either idiopathic hyperplasia of the anterior lobe of the pituitary gland or tumor growth
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What are the clinical manifestations of acromegaly?
Enlargement of the cranium and lower jaw, bulging forehead, bulbouse nose, thick lips, enlarged tongue
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What is the definite test for acromegaly?
Oral glucose challenge test
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What nursing diagnosis are associated with acromegaly?
Disturbed body image, activity intolerance
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What is diabetes insipidus?
A disorder of the pituitary in which ADH is deficient
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How much urine can a pt with diabetes insipidus lose in an hour?
200ml
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What are the characteristics of diabetes insipidus?
Polyuria and polydipsia
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What is the normal serum sodium level?
135-145
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What happens to urine specific gravity in a pt with diabetes insipidus?
it drops below 1.003
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How much fluid should a pt with diabetes insipidus intake?
2600 ml
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What are the 6 anterior pituitary gland hormones?
TSH, FSH, GH, ACTH, LH, Prolactin
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What are the 2 posterior pituitary gland hormones?
Oxytocin and ADH
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What is the function of ACTH?
It stimulates the adrenal cortex to increase in size and to secret its hormones
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What is the function of FSH?
Stimulates follicles in ovaries to grow and secrete estrogens
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What is the function of luteinizing hormone?
Causes ovulation, stimulates ovarian follicle and ovum to develop and mature
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What is the function of prolactin?
Stimulates breast development and milk production during pregnancy
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What is the function of oxytocin?
Promotes the release of milke and stimulates uterine contractions
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What is the function of ADH?
Causes the kidneys to conserve water by decreasing the amount of urine produced
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What are the three main functions of the thyroid gland?
Growth & development, metabolism, activity of the nervous system
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What is the function of parathyroid glands?
Secretes parathyroid hormone and tends to increase concentration of calcium in the blood & regulates the amount of phosphorus in the blood
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What are the 2 sections of the adrenal glands?
Outer � adrenal cortex; Inner � adrenal medulla
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What disease is the result of too much ephinephrine and norepinephrine?
Pheochromocytoma
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What disease is associated with an overproduction of ADH?
SIDAH
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What can happen if a pt does not consume enough iodine?
Simple goiter
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What 2 hormones are secreted in the pancreas?
Insulin and glucagon
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What is thymosin?
Hormone secreted by the thymus gland that helps the immune system
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What is the function of the pineal gland?
It secretes melatonin � prevent sexual maturation of the child�s body until adulthood. Also induces sleep
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What does a tropic gland do?
It stimulates other glands to work
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What is hyperthyroidism?
Overproduction of T4 and T3
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What is the diet therapy for a patient with hyperthyroidism?
Foods high n calories, vitamins, minerals, and carbs
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What are the clinical manifestations of hyperthyroidism?
Edema of the anterior portion of the neck, bulging eyes
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What does a radioactive iodine uptake test determine?
Hyperthyroidism
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How is the radioactive iodine given?
By mouth to the fasting patient
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What is important to obtain from a patient before a radioactive iodine uptake test?
Allergies and signed consent
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How is a pt placed after a thyroidectomy?
Supine with pillows supporting the head and shoulders
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What two conditions should the nurse monitor for after a thyroidectomy?
Tetany and edema
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What is Chvotek�s sign?
An abnormal spasm of the facial muscles elicited by light taps on the facial nerve
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What condition will cause a pt to have a positive Chvotek�s sign?
Hypocalcemia
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What is Trousseau�s sign?
A test in which a BP cuff is inflated to above systolic BP for 3 minutes.
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What will happen with a positive Trousseau�s sign?
Carpal spasm in pts with hypocalcemia and hypomagnesemia
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What is a thyroid storm?
A condition in which large amounts of thyroid hormones are released
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What is administered for the emergency treatment of tetany?
Calcium gluconate
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When does a thyroid crisis generally occur?
In the first 12 hours post op
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What are the signs and symptoms of a thyroid crisis?
Nausea, vomiting, severe tachycardia, hyperthermia, exaggerated symptoms of hyperthyroidism
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What are the three goals of thyroid storm management?
Induce normal thyroid state, prevent cardiovascular collapse, prevent excessive hyperthermia
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What is hypothyroidism?
A condition in which the thyroid fails to secrete sufficient hormones, resulting in a slowing of all of the body�s metabolic processes
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What type of diet is important for a patient with hypothyroidism?
High-protein, high-fiber, low-calorie
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What are the hormones responsible for �flight or fight�?
Epinephrine and norepinephrine
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What is the master gland of the body?
Pituitary gland
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What hormone is responsible for male secondary sex characteristics?
Testosterone
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What type of nurse cannot care for a patient who has received radioactive therapy?
A pregnant nurse
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What should the nurse administer immediately following signs of postoperative tetany?
Calcium gluconate IV
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What nursing diagnosis is of the greatest priority postoperatively in a pt who has had cranial surgery to remove a pituitary tumor?
Risk for deficient fluid volume, related to excessive loss via the urinary system
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What hormone levels are elevated in the pt with acromegaly?
GH
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What is a sign that damage to the laryngeal nerve may have occurred in a pt who has had a thyroidectomy?
The pt is becoming increasingly hoarse.
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What is of the greatest priority in the plan of care for a pt with IDDM?
Teach the pt the effect of diet, exercise, and insulin on blood glucose level
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What statement indicates that the pt with Type 1 DM needs more teaching?
�If I want to lose weight, all I have to do is increase my dose of insulin.�
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To meet the goal of prevention of injury to an IDDM pt, what nursing intervention is the most important?
Remove potentially hazardous objects from the pt�s environment
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What nursing diagnosis is of the greatest priority for a pt admitted to the hospital with complications from Addison�s disease?
Risk for deficient fluid volume
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What causes polydipisa and polyuria related to diabetes?
Fluid shifts resulting from the osmotic effect of hyperglycemia
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In planning care for a patient with type 2 diabetes admitted to the hospital with pneumonia, the nurse recognizes that the patient�.
May have sufficient endogenous insulin to prevent ketosis but is at risk for development of hyperosmolar coma
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At what time of day is a diabetic pt at risk for hypoglycemia?
In the late afternoon and at bedtime
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What is a diabetic diet designed to do?
Help normalize blood glucose through a balanced diet
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What is an appropriate instruction or the pt with diabetes related to care of the feet?
Inspect all surfaces of the feet daily
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Which oral hypoglycemic works primarily by reducing hepatic glucose production and lowers fasting blood glucose levels?
Metformin (Glucophage)
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What types of insulin are used in an insulin pump?
Regular and rapid-acting
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How long is the onset of regular insulin (Humulin R)?
30 minutes to an hour
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How long is the onset of action of Lispro (Humalog)?
15 minutes
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How long is the onset of action of NPH (Humulin N)?
2 hours
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Why is caffeine restricted in a pt with diabetes insipidus?
Because it acts as a diuretic
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What is deficient in a pt with diabetes insipidous?
ADH
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What are the clinical manifestations of SIADH?
Hyponatremia & water retention that progresses to water intoxication
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What is the medical management for IV treatment of SIADH?
Hypertonic saline solution at slow rate
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What drugs are given to treat hyperthyroid?
PTU, methimazole (Tapazole)
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What is the gold standard for treating hyperthyroidism?
Ablation therapy using radioactive iodine
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How often is the thyroid checked during a RAIU?
2, 6 & 24 hours
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What type of diet is important for a pt w/hyperthyroidism?
Foods high in calories, vitamins, minerals, and carbs
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What is severe hypothyroidism called?
Myxedema
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How should insulin be administered?
At room temperature
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What should the nurse watch for in a pt w/hypothyroidism that could indicate cardiac involvement?
Chest pain, dyspnea, changes in rate and rhythm.
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What causes a thyroid gland to develop into a goiter?
Low iodine levels
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What attributes to a goiter?
Insufficient intake of iodine
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What are the nursing interventions or a pt with a goiter after surgery?
Prevent bleeding, tetany, & thyroid crisis
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What is a thyroid crisis or storm?
When large amounts of thyroid hormones are released into the bloodstream
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When does a thyroid storm occur?
The first 12 hours post-op
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What are the signs and symptoms of a thyroid storm?
Exaggerated symptoms of hyperthyroidism, nausea, vomiting, severe tachycardia, severe hypertension, hypothermia
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What are the three goals of thyroid storm management?
Induce normal thyroid state; prevent cardiovascular collapse; prevent hyperthermia
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What are the three main functions of T4 & T3?
Growth and development; metabolism; activity of the nervous system
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What are the normal lab values for T3?
75-195
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What are the normal lab values for T4?
5-12
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What are the normal lab values for sodium?
135-145
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What are the normal lab values for potassium?
3.5-5.5
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What is the normal range for WBC?
5,000-10,000
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What is the normal range for hemoglobin?
12-18
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What is the normal range for hematocrit?
37%-52%
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What is hyperparathyroidism?
Overactivity of the parathyroid gland
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What causes hyperparathyroidism?
Hypertrophy of one or more of the parathyroid glands; adenoma
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What causes hypercalcemia in a pt with hyperparathyroidism?
Calcium leaves the bones and accumulates in the bloodstream
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What is the function of the parathyroid glands?
Increases calcium in blood and regulates phosphorus
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What is hyponatremia?
Watering down of the blood
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What happens to calcium & phosphorus levels in a pt with hyperparathyroidism?
Calcium increases & phosphorus decreases
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What is the treatment of hyperparathyroidism?
Surgical removal of a tumor or one of the parathyroid glands
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Why does a pt with hyperparathyroidism need to strain their urine?
The increased calcium can cause renal calculi
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What are the signs of hypocalcemia?
Tetany, cardiac dysrhythmias and carpopedal spasms
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What type of diet is given to a pt with hypoparathyroidism?
High calcium diet
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What are the clinical manifestations of hypoparathyroidism?
Numbness, tingling, anxious, irritable, depressed, headaches, & nausea
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What will happen to Chvotek�s & Trousseau�s signs in a pt with hypoparathyroidism?
They will be positive
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What type of diet is indicated for a pt with hypoparathyroidism?
High in calcium, dark green veggies, soybeans, canned fish with bones
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What causes Cushing Syndrome?
Overstimulation of ACTH
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What is hypokalema?
Not enough potassium
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What are the clinical manifestations of Cushing syndrome?
Moonface, buffalo hump
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What is striae?
A streak or linear scar that often results from stretching of the skin
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In the pt with Cushings syndrome, what results in hyperglycemia?
Impaired carbohydrate metabolism
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What type of diet is indicated for a pt with Cushings syndrome?
Low sodium, reduce calories and carbs, and high potassium
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When does Addison�s disease occur?
When the adrenal glands do not secrete adequate amounts of glucocorticosteroids, and mineralocorticoids
-
What can cause Addison�s disease?
Adrenalectomry, pituitary hypofunction, or long-standing steroid therapy
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What causes disturbances in the metabolism of carbs, fats, proteins, sodium, potassium and water?
Deficiencies in aldsoterone and cortisol
-
What will labs show in a pt with Addison�s disease?
Decreased serum sodium, increased serum potassium, and decreased serum glucose
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What are the symptoms of adrenal (addisonian) crisis?
Sudden severe drop in BP, nausea & vomiting, extremely high temp, cyanosis
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What is the emergency treatment of an adrenal crisis?
IV administration of corticosteroids in a solution of saline and glucose
-
What is pheochromocytoma?
A cell tumor that causes excessive secretion of epinephrine and norepinephrine
-
What type of diet is indicative in a pt with pheochromocytosis?
Free from stimulants and caffeine
-
What is diabetes mellitus?
Improper metabolism of carbs, fats, and proteins
-
When does insulin reach its peak level?
30 minutes after meals and returns to normal in 2-3 hours
-
What is the difference between type 1 and type 2 dibetes?
Type 1 is insulin dependent (IDDM) and Type 2 is non insulin dependent (NIDDM)
-
What causes IDDM?
Destruction of beta-cell function
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What are the causes of NIDDM?
Decreased tissue, overproduction of insulin, abnormal glucose regulation
-
How is glucose stored?
As glycogen in the liver
-
What must be present for muscle cells and other body cells to utilize glucose?
Insulin
-
What is hyperglycemia?
Excess glucose in the bloodstream
-
How does the body get rid of excess glucose in the bloodstream?
The kidneys will excrete it in urine, called glycosuria
-
What is a sign of diabetic ketoacidosis?
Fruity smell to the breath
-
What causes diabetic ketoacidosis?
Acute insulin deficiency, decreased peripheral glucose utilization, increased fat mobilization and ketogenesis
-
What are the normal lab values for fasting blood sugar?
60-110
-
What amount is considered abnormal in an FBS?
126 or more
-
What does the HbA1c measure?
The amount of glucose that has become incorporated into the hemoglobin within an erythrocyte
-
What is the normal lab value for HbA1c?
4%-6%
-
When is a postprandial blood sugar taken?
2 hours after a meal
-
What level may indicate the presence of DM in a PPBS?
Plasma glucose over 160
-
What affects the accuracy of an oral glucose tolerance test?
Adequate pt preparation and cooperation
-
What is the medical management for DM?
Education, monitoring, meal planning, medication, exercise
-
What type of diet is recommended for a pt with DM?
45%-50% carbs, 10%-20% proteins, no more than 30% fats
-
What is important about food intake for pts with IDDM?
It should be evenly distributed throughout the day
-
How long does exercise reduce insulin and increase glucose uptake?
72 hours
-
How often should blood glucose be monitored during the times of stress or illness?
Every 1-2 hours
-
When should the pt with DM be instructed to contact their physician?
When blood glucose level is 250 or more
-
When is insulin given intramuscularly?
During diabetic ketoacidosis
-
What are the classifications of insulin?
Rapid-acting, insulin apart, short-acting, intermediate acting, long acting
-
What is a �peakless� insulin that provides a continous insulin level?
Lantus
-
What is lipodystrophy?
The loss of local fat deposits
-
How can a nurse prevent lipodystrophy?
Administer insulin at room temp and rotate injection sites
-
How does a nurse prevent medication errors when administering insulin?
Have the dose drawn in the syringe and checked by another nurse
-
What is hypoglycemia?
Not enough glucose in the blood
-
What are the signs of hypoglycemia?
Faintness, weakness, excessive perspiration, irritability, hunger, palpitations, trembling, drowsiness
-
What are the signs and symptoms of hyperglycemia?
Polyuria, polydipsia, polyphagia
-
Why is insulin not injected into the muscle?
Because it enters the bloodstream too quickly and can cause hypoglycemia
-
Which part of the body provides the fastest, least variable absorption?
The abdomen
-
What is as close a substitute to a healthy, working pancrease?
An insulin pump
-
What is a bolus of insulin?
A quantity of insulin delivered to cover a carbohydrate meal
-
What is the function of metformin (glucophage)?
It reduces hepatic glucose production and lowers fasting blood glucose levels
-
What must a pt have for oral hypoglycemics to be effective?
Some function insulin production
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