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Problem Based Learning in Endocrine NursingInstruction:

This is an

INDIVIDUAL ACTIVITY

; credit will be given toyour class standing. The following situation is based on a client withEndocrine disorder. Present a

pathophysiology

of the condition to justifythe manifestation and your management to your client. Write your answer ina

legal size bond paper, double space, hand written

Due to technicalproblem, deadline of submission is move to on or before JULY 13, 20091:00 o’clock in the afternoon at the NURSING Office or at theDiagnostic Laboratory. Submit your paper to the INSTRUCTOR concern.

Case A

A young woman presents with complaints of palpitations, insomnia, weight lossand irritability. She further reveals heat intolerance and increased swelling.Physical examination reveals hand tremor, a pulse of 110, and a smoothlyenlarged thyroid. Her T4 level is twice normal.1. What is the differential diagnosis of the patient's condition?2. What investigations would you order to determine the cause of the patient'sproblem?3. What are the options in treatment for each of these diagnoses and theadvantages and disadvantages for each?4. What is thyroid storm? What are the clinical features? How would you treatthe problem?5. How would you prepare a patient with hyperthyroidism for surgery?6. What is the rationale for administering high-dose iodine to hyperthyroidpatients two weeks prior to surgical removal of the thyroid gland?7. In a normal thyroid, if a person is not able to ingest the daily dietary iodinerequirement temporarily, will he develop signs of iodine deficiency right away?What other sources of organic iodine does the thyroid use to form additionalthyroid hormones?8. Does the presence of goiter also signify the presence of hyperthyroidism? Isgoiter always associated with hyperthyroidism?

Case B

A 35 year old man has blood chemistries drawn at the time of a yearly physicalexamination. His calcium was noted to be elevated and a parathyroid hormone level isincreased.

1. Compare and contrast between primary, secondary and tertiaryhyperparathyroidism in terms of the following:

a.Disease conditionb.Sign and symptoms/manifestationc.Nursing Diagnosis(rank based on priority)d.Nursing Managemente.Medical Management2. What is the difference between parathyroid adenoma and hyperplasia and howmay this affect the surgical treatment? What is your Nursing intervention/Responsibility pre-operative and post-operative?3. What calcium management orders would you write for a patient who has hadparathyroid surgery and why?

Case C

Juanito Haber, has ahd type 1 diabetes for 15 years. He has just been admittedto the hospital with severe pyelonepritis, a kidney infection. He had infection for aweek and has developed mild ketoacidosis because of the infection. Analysis of arterial blood gases indicates that his serum bicarbonate level is low and hisserum pH is just below normal range.

1.Describe the pathophysiology of type 1 diabetes.2.Explain why urinary tract infections are common in people with diabetes. Explainhow acute renal failure could develop.3.Explain why infection may lead to ketoacidosis.4.Describe the characteristic of Juanito Haber respiratory that could expect toobserve while ketoacidosis is present. Include the rationale for your answer.5.If Juanito Haber serum pH continues to decrease below normal, how would that pH affect cell and organ function?6.Juanito Haber is voiding large volumes of urine (polyuria). Explain the reason for this.7.Describe three sign of excessive fluid loss.8.Juanito Haber’s vision has deteriorated in the last 3 years because of retinopathy.Explain how retinopathy impairs vision.9.Describe two problems related to diabetes that Juanito Haber might encounter because of his reduced vision. What will be your priority Nursing Diagnosis andyour Nursing Management?

Case D

Ryan Depollo was diagnosed with type 2 diabetes Mellitus at age 46. At this time, he wasoverweight, enjoyed foods with high carbohydrate and fat content and led a sedentarylife. His family history indicated that his mother and his brother had diabetes. Weightloss, appropriate diet and exercise were recommended to reduce blood glucose levels.1.List the factors contributing to diabetes mellitus in this case.At age 50, Ryan Depollo noticed that his vision was cloudy, particularly in one eye.Cataracts were removed from both eyes.