NUR 111/201 Focus Points for Endocrine Chapters

1. What is the function of releasing hormones?

Regulate secretion of other hormones in pituitary gland

2. What is the function of inhibiting hormones?

Turns off secretion of some hormones released from pituitary.

3. What is adipsia?
Adipsia is a disease characterized by the absence of thirst even in the presence of body water depletion or salt excess.

4. Understand how to collect 24 hr urine

Record the time that you have chosen to start the collection. Have patient start the urine collection with an empty bladder.
Therefore, at exactly this time, have patient empty bladder and discard the urine. (In other words, when you start the urine
collection, the patient should empty his bladder and do not add that urine to the jug).
Obtain a special container from the lab, one that is opaque and protects the contents from light. The container may or
may not have a preservative in it. Ask the lab if the specimen must be kept on ice or refrigerated while being collected
and if the patient is required to have any dietary restrictions.
 VMA (Vanillylmandelic acid)- 24 hour urine- Adrenal Medulaa- Epi/Noriepi- Tumors cause pheochromocytoma

5. Know about testosterone and when to adjust dose

6. What are the signs and symptoms of acromegaly?

Increased shoe size and visual changes, Increased bone size -hands, feet and face. (permanent), Long bones grow in width
not length, Increased Subq connective tissue
If tumor cause: - visual problems, ha, hormonal symptoms, Internal organs and glands enlarge, and Elevated blood glucose

7. What are the hormones of the Anterior Pituitary Gland?

ACTH, GROWTH HORMONE, THYROID STIMULATING HORMONE, fsh, lh, prolactin

8. How are Anterior Pituitary Gland hormones released?

In response to releasing hormones from the Hypothalamus

9. What are the hormones of Posterior Pituitary Gland?

ADH AND OXYTOCIN

10. What are the effects of catecholamines (noriepe & epi) on the body?
Catecholamine-producing tumors arising in the adrenal medulla Pheochromocytoma
Epi- ^ HR, sends blood to brain and muscles
Noriepi- Vasoconstrictive ^ BP
11. What are the characteristics of metabolic syndrome?
Male waist circumference 44 inches, 35 inches (88 cm) or more for women, Triglyceride value of 162 mg/dL, Blood
pressure 135/85(systolic 130 or higher, diastolic 85 or higher) , Patient is taking blood pressure medication, fasting blood
glucose level of 100 mg/dL or more or on drug treatment for elevated blood glucose levels,

12. Why is treatment needed for metabolic syndrome?

Group of risk factors that raises your risk for heart disease and other health problems, such as Type 2 DM. Excess fat in
stomach area is greater risk factor for heart disease than fat in other areas.

13. What are the sites for insulin?

Abdomen and Buttox

14. What are some nursing diagnoses for bilateral adrenalectomy?

Prevention and treatment of acute adrenal insufficiency is the priority after adrenalectomy.

15. What is T3, T4, and TSH relationship (inversely proportioned)?

T3 and T4 are high - TSH will be low
Hypothyroidism= T3 AND T4 = LOW TSH= HIGH

16. What are thyroidectomy postop care requirements?

 Cough, hoarseness, and headache are expected, Hypocalcemia and tetany = due to low calcium levels characterized by
numbness and tingling fingers and mouth, REPORT IMMEDIATELY!! Tetany often seen if parathyroids are
accidentally removed with surgery, needs calcium gluconate IV, Laryngeal nerve damage – assess voice every 2 hours,,
Hemorrhage – keep head of bed elevated Semi-Fowler’s, use sandbags to support neck and head, don’t extend neck back
to avoid suture line tension

17. What is some reportable info for a patient who has undergone a thyroidectomy?
Hypocalcemia and tetany = due to low calcium levels characterized by numbness and tingling fingers and mouth,
REPORT IMMEDIATELY!!

18. How do you treat hypoglycemia?

Blood glucose management – check BS before taking meds, betablockers make symptoms less intense so hard to recognize
drop in BS,
Nutrition therapy – 15-20g carbs if pt swallow, See Chart 64-7
Drug Therapy – glucagon SubQ or IM which can cause V, IV D50% which can cause extravasation because hyperosmolar,
will need simple carb after this treatment; diazoxide and octreotide can treat sulfonylurea-induced hypoglycemia

19. What are the symptoms of Addison’s disease symptom?

Hypotension, Hypoglycemia, Weakness, Fatigue, Bronze Skin, Nausea and Vomiting, vitiligo, decreased body hair,
hyperkalemia, hyponatremia

20. What are labs and their results related to Addison’s disease?
ACTH Stimulation Test is most definitive test!!

21. What are the treatments for Addison’s disease?

Fluid balance, Hormone management, hyperkalemia management, and hypoglycemia management
Glucocorticoids (hydrocortisone) and Mineralocorticoids (fludrocortisone) Daily for Life
 Two-thirds in AM, One-third in PM
 Double or Triple in Times of Stress
 May inject IM with emergency injection kit
High Sodium Diet especially during hot weather, AND Assess cardiac function due to high K+

22. What is an expected outcome for a patient with Addisonian’s Crisis?

Adrenal Crisis (Addison’s Crisis)- Profound Dehydration, Hypotension, Hypoglycemia, cardiac arrhythmia, Shock, Coma,
Death Treatment of adrenal crisis involves rapid fluid volume and cortisol level restoration with IVF and glucocorticoids
and electrolytes, need to treat cause
NEVER ABRUPTLY DISCONTINUE STEROIDS! Avoid Adrenal Crisis

23. What causes Cushing’s? Excess Cortisol

Primary hyperaldosteronism (Conn's syndrome) result of excessive secretion of aldosterone from one or both adrenal
glands

24. What are the signs and symptoms of Cushing’s?

Hypokalemia and elevated BP, HA, fatigue, muscle weakness, polydipsia, polyuria, paresthesia with K+ depletion, fluid
overload

25. What are lab results related to Cushing’s syndrome?

Diagnosed with lab – low K+, Na+ high, low renin, high aldosterone, loss of H+ so metabolic alkalosis so high pH, low
urine spec grav, and dexamethasone Suppression Test

26. What diet helps drug induced Cushing’s syndrome?

Low sodium, high potassium diet

27. What drug helps to block adrenal steroid productions for patients diagnosed with Cushing’s?
Ketoconazole

28. What is thyroid replacement therapy and it’s appropriate assessments?

 Diet should include fiber to prevent constipation – if see, dose may need to be increased. Sleep should be monitored
because when the patient has difficulty getting to sleep, the dose may need to be decreased. Changes in orientation, gait, or
development of tremors may require an alteration in dose of replacement thyroid hormone. Take at the same time daily. Do
not stop taking the medicine even when you feel better. Continue taking it exactly as your doctor prescribed. If you change
brands of thyroid medicine, let your doctor know. Your levels may need to be checked.

29. What are the signs and symptoms of hypothyroidism?

Fatigue, Weight gain, A puffy face, Cold intolerance (always cold), SOB, Heart failure, Hyperlipidemia, Joint and muscle
pain, Constipation, Dry skin, Dry, thinning hair, Decreased sweating, Heavy or irregular menstrual periods and fertility
problems, Depression, Slowed heart rate, In advanced disease may see Myxedema – non-pitting edema of face, hands, and
feet

30. What are the signs of hyperthyroidism?

Increased heart rate and blood pressure, Abnormal heart rhythms (arrhythmias), Excessive sweating and feeling too warm
(heat intolerance), Exophthalmos with Graves, Blood shot eyes with photophobia, Eye lag and globe(eyeball)lag, Hand
tremors (shakiness), Nervousness and anxiety, Difficulty sleeping (insomnia), Weight loss despite increased appetite,
Increased activity level despite weakness, Frequent bowel movements, occasionally with diarrhea, Tachycardia, Leads to
heart failure, Untreated patients can become manic or psychotic

31. What are some nursing interventions for pheochromocytoma?

Surgical removal of glands (Adrenalectomy), Lifelong replacement drugs if both glands removed, Need calcium channel
blockers and alpha blockers (Phenoxybenzamine [Dibenzyline]) before surgery to control HTN, and Beta Blockers
(Propranolol [Inderal]) to reduce fight or flight response

32. What are the signs and symptoms of pheochromocytoma?

(Fight or Flight)Hypertension, Tachycardia, Palpitations, Tremor, Diaphoresis, Anxiety, Hyperglycemia, Headache,
Vision Changes, Risk for Stroke, Risk for Organ Damage

33. What are some diagnostic tests to diagnose pheochromocytoma?

24-Hour Urine for metanephrine and vanillylmandelic acid (VMA), No Caffeine or Medications Before Test, CT or MRI
to Find Tumor

34. What is pan hypopituitarism and who is at risk?

Decreased production of all anterior pituitary hormones Most life-threatening deficiencies—ACTH and TSH because
cause decrease in vital hormones, Postpartum mothers

35. Why is hypertension treatment managed in patients with DM, even if the patient doesn’t have HTN?
Risk factors for decreased vision= HTN, Risk factors for kidney disease= HTN, Risk factor for cardiovascular
disorders= HTN, Risk factor for diabetic neuropathy= HTN

36. What are the causes of acute adrenal insufficiency?

Usually occurs in response to stressful event (surgery, trauma, infection)

37. What are signs that a patient is improving from acute adrenal insufficiency?

38. What are the expected labs with hyperaldosteronism?

Diagnosed with lab – low K+, Na+ high, low renin, high aldosterone, loss of H+ so metabolic alkalosis so high pH,
low urine spec grav

39. What should a patient be treated with before an adrenalectomy?

Hydrocortisone

40. What are the adverse effects of a thyroidectomy adverse effects and how do you treat it?
Hypothyroidism often occurs after surgery, and people then have to take replacement thyroid hormone for the rest of their
life.Rare complications of surgery include paralysis of the vocal cords and damage to the parathyroid glands (the tiny
glands behind the thyroid gland that control calcium levels in the blood).

41. What should the nurse monitor for in a patient who has had a hypophysectomy?
Report any postnasal drip., Keep the head of the bed elevated, Have the patient avoid coughing soon after surgery, Monitor
for a light-yellow color at the edge of clear drainage (cerebral spinal fluid)
42. The nurse should assess what before potential problem or expected problem?
Actual problem

43. What are the effects of ADH on body (on kidney tubules)?
ADH – responsible for reabsorption of water by distal tubules and collecting ducts of kidneys.

44. What is another name for ADH?

Vasopressin

45. What should an assessment include for a patient diagnosed with SIADH?
Pancreatic Cancer and some forms of Lung Cancer may be abnormal sites of producing an – like substance, Certain
antidepressants, chemotherapeutic and general anesthetic agents may increase ADH secretion, CNS infections, Brain
Tumor affecting pituitary function, Complication of Diabetes Insipidus, Recent head trauma, Cerebrovascular disease,
Tuberculosis or other pulmonary disease, Cancer, All past and current drug use, Decrease in serum sodium levels

46. What should the treatment for a patient diagnosed with SIADH include?
Fluid restriction (less than 1000ml per day), Drug therapy (tolvaptan or conivaptin, diuretics, hypertonic saline,
demeclocycline), Monitor for fluid overload at least q 2 hours, Safe environment, Neurologic assessment (seizures) q 2
hours, If due to an inoperable cancer, Lasix and Declomycin may be indicated to block the action of ADH in the kidney, IV
Hypertonic Saline Solutions, Oral Salt.

47. What are the signs and symptoms of SIADH?

Low urine output with very concentrated Urine, Serum osmolality is less than 275 mOsm/kg (Normal serum osmolality =
278–300 milliosmoles per kilogram (mOsm/kg) of water)

48. What kind of IV Solution should patient with SIADH have administer?
IV Hypertonic Saline Solution

49. If due to inoperable cancer, what drugs may be indicated to block the action od ADH in the kidney?
Lasix and Declomycin

50. What is diabetes insipidus and what causes it?

Caused by deficiency in ADH, ADH – responsible for reabsorption of water by distal tubules and collecting ducts of
kidneys. Nephrogenic - enough ADH, but kidneys are unresponsive -->Urination from 3L to 15L per day. Primary –
defect in hypothalamus or pituitary Secondary – tumor, head injury, infection, Drug-related – lithium and demeclocycline
because interfere with kidney’s response to ADH Psychogenic - Patient drinks large volumes of water in absence of true
disease. Occurs most often in males.

51. How is diabetes insipidus treated?

Hypotonic IV fluids (0.45% normal saline to replace intravascular volume without adding much sodium). Medical
Treatment involves replacement of ADHAcute cases require Vasopressin (synthetic ADH) given IV or SC along with IV
fluid replacement and For long-term therapy Synthetic ADH (desmopressin acetate or DDAVP) in nasal spray form is
given twice daily.

52. What are the signs and symptoms of thyroid storm?

All body functions are accelerated to dangerously high levels. Severe strain on the heart can lead to a life-threatening
irregular heartbeat (arrhythmia), tachycardia, high fever, HTN leading to heart failure, dehydration, restlessness, delirium
and coma, and eventual shock.

53. What causes thyroid storm?

Often seen after thyroid surgery

54. What would you educate a patient on who is taking antithyroid medication?

55. What are the signs and symptoms of myxedema?

Hypothermia – temp less than 95.0F , Decreased respirations, Low blood pressure so poor kidney perfusion, Low
blood sugar, Changes in mental status - Unresponsiveness, lethargy

56. What is the relationship of lithium to Hyperparathyroidism?

 Treatment is to increase fluids

57. What are the signs and symptoms of hyperglycemia?

Thirsty, hungry, peeing a lot

58. How do you prevent DM Type 2?

Diet and exercise, manage other comorbidities

59. Onset, peak and duration of all types of insulin SEE INSULIN CHART ON D2L

60. What types of insulins can be mixed?

Short/ Rapid and Intermediate

61. What is the difference between DKA and HHS?

DKA= KETONES, HHS= NO KETONES

62. How do you treat DKA?

Blood glucose management – monitor for s/s DK, assess airway, LOC, hydration, electrolytes and BS levels, BP-P-R q 15
min until stable, hourly urine output, temp, and LOC, once stable – q 4 hours, may have CVP line,

Fluid/Electrolyte management – assess for dehydration (remember s/s), restore fluid volume, fluids depend on BP,
hydration status, etc, watch for fluid overload with trmt,

Drug Therapy – regular insulin IV, start subq when out of DK and can take oral,

Acidosis management– normal anion gap is 7-9mEq/mL, greater than 10 is metabolic acidosis, assess for hypokalemia due
to insulin tx, correction of acidosis, and volume expansion, bicarb only used when very severe

63. How do you treat HHS?

First priority= increase blood volume!! Must replace half of deficit in the first 12hours, assess hourly for cerebral edema,
slow steady improvement in CNS status is best evidence of fluid management
Rate of infusion depends on: Body weight, Urine output, Kidney func, Presence or absence of pulm congestion or JVD

64. A patient with DKA would need what kind of monitoring?

EKG monitoring needed due to insulin effects on potassium levels.

65. What does DM foot care consist of?

Teach pt proper foot care: Cut toenails straight across, Clean and Inspect Feet Daily, Wear Well-Fitting Shoes, not
barefoot, Protect Feet from Injury and report breaks in skin

66. What are the ranges of lab results for HgA1C and what do they indicate?
Glycohemoglobin (glycosylated hemoglobin or HbA1c)Gathers baseline data and monitors progress of BS
controlShows average BS for last 2-3 months,
Normal 4% to 6%, above this shows pt
5.7 to 6.4 is increased risk for DM
6.5 or greater diagnoses diabetes
> than 8.0 means poor DM control

67. What does DM sick care management consist of?

68. What is the difference between Type 1 and Type 2 DM?

Type I - Patients with Type 1 diabetes have no insulin, and must take insulin every day for life. Requires injection of
insulin, not pills; autoimmune, idiopathic
Type II – Initially in Type 2 diabetes, insulin is produced, but the insulin doesn't function properly, leading to a condition
called insulin resistance, progressive disorder due to heredity, obesity and decreased phy act

69. What is the difference between the diagnosis of Type 1 and Type 2 DM?
SEE ABOVE

70. What is metformin (Glucophage) used for and how could the nurse educate the patient?
 See list of medications in Table 40.5 (know Januvia, Metformin, Actos, Avandia, Glipizide, Glimeperide, Glyburide)

71. What are the signs and symptoms of Diabetic Nephropathy?

Motor neuropathy – foot muscle damage causing deformities, Assess for Charcot foot – deformity with hallux valgus
(turned in great toe), see warm, swollen and painful, Autonomic neuropathy loss of normal sweating/skin temp
regulation causing dry, thin skin that cracks causing infections, Sensory neuropathy numb, stabbing, cramps,burning,
tingling sensation so don’t notice injury

72. What is Somogyi phenomenon?

Occurs in middle of night, or when too much insulin is circulating in the system, due to insulin working too strongly at the
wrong time causes BS to rise despite increasing insulin dose after an episode of low blood sugar, [WILL NEED LESS
INSULIN AT NIGHT]

73. What is dawn phenomenon?

All people have this, it is due to natural release of growth hormone and cortisol during early morning hours where the
blood sugar goes up.

74. What is some patient education for hypoglycemia treatment and sick day procedures?

75. When taking steroids what must you teach the patient?
Insulin will need to be adjusted due to steroids causing your sugar levels to increase. Growth Hormone, Epi, and Norepi
can also cause this.

76. What is the purpose of the hypothalamus?

To produce releasing hormones.

77. What is primary disorder?

Problem with the actual gland.

78. What is a secondary disorder?

Problem with the area where stimulating occurs

79. What is a tertiary disorder?

Problem with the hypothalamus

80. What type of diet does a patient with Addison’s disease need?
Low potassium, high carb, protein, and sodium.

81. What insulin is cloudy, and what insulin is clear?

NPH- cloudy Regular- clear

82. What are the signs and symptoms of hyperglycemia?

Increased hunger, thirst, and urination

83. What are the signs and symptoms of hypoglycemia?

Shakiness, anxious, sweating

84. What is a normal range for A1c?

4.0-6.0
5.7-6.4 Increased risk for DM
> 6.5= Diabetes
8.5 < = Uncontrolled Diabetes

85. What is the function of ACTH?

Stimulates the adrenal cortex to release corticosteroids
86. What is the function of ADH?
When there is decreased water content in the body, ADH increases the amount of water reabsorbed in the kidney tubules.
This decreases urine output to maintain blood volume and blood pressure.

87. What two hormones work together to regulate calcium levels in the body?
Calcitonin and parathyroid hormone

88. What is the parathyroid hormone stimulated and inhibited by?

Stimulated- hypocalcemia – causes kidneys to reabsorb calcium
Inhibited- hypercalcemia

89. Alpha, beta, and delta cells do what?

Alpha- secrete glucagon
Beta- secrete insulin
Delta- secrete somatostatin

90. Suppression tests are given to?

Suppress a hormone’s release (when levels are high)

91. Stimulation tests are given to?

Stimulate a gland (when levels are low)

92. What does a thyroid scan show?

The scan will show hot spots (nodules), which are not malignant or cold spots, (areas that do not take up the radioactive
material), which indicate malignancy.

93. What would you expect to see with a tumor that is stressing the medulla?
Nervous system will be affected, catecholamines are being pushed out causing flight or fight= tachy, decreased peristalsis,
hyper, ^ BP, decreased urine output

94. What is the most common cause of something to be in a hyper state?

Tumor, either fixed by antihormone or surgery

95. What are the signs and symptoms of tetany?

Cramping, twitching, periorbital numbness and tingling and around fingertips-> tap cheek instead of drawing labs first

96. What is the contraindication for Metformin and patients taking opioids?
Metformin may decrease the excretion rate of Naloxone

97. What class of drug is Metformin?

Biguanide

98. What is the first sign of hypopituitarism?

If caused by a tumor, visual changes.

99. What lab results will you have with hyperthyroidism?

Decreased TSH, elevated T4

100. What patient would you not want to give androgen therapy, and why?
Patient’s with prostate cancer, gynecomastia
A 23-year-old patient with a history of type 1 diabetes is admitted to the ED with nausea and abdominal pain. His respiratory rate is
34/min with deep breaths and a fruity smell to his breath. He is responsive, but difficult to arouse.

What does the nurse suspect is happening with this patient? The manifestations point to diabetic ketoacidosis (DKA).

What serum glucose level would the nurse expect to see with this patient? The patient’s glucose level is most likely >300 mg/dL.

The student nurse asks why the patient is breathing so rapidly and deeply. What is the nurse’s best response?

“His serum pH is low and this is a compensatory mechanism.”

In the ED, the patient is diagnosed with diabetic ketoacidosis (DKA).

What is the nurse’s first priority for managing this condition? Airway assessment

Twenty minutes later, the patient is admitted to the ICU for DKA management. The patient is receiving IV regular insulin with frequent
finger sticks to check his glucose level. His potassium level is 2.5, and IV potassium supplements have been ordered.

What assessment must the nurse make before giving the IV potassium? Production of at least 30 mL/hr of urine

Two days later the patient is recovered and is preparing for discharge. His wife asks about what they can do to prevent this from
happening again.

What should the nurse teach the patient and his wife? (Select all that apply.) ACDE

A. Monitor glucose whenever the patient is ill.

B. Decrease fluid intake when nausea and vomiting occur.

C. Watch for and report any illness lasting more than 1 to 2 days.

D. Check blood glucose levels every 4 to 6 hours if anorexia, nausea, or vomiting is experienced.

E. Check urine ketones when blood glucose is greater than 300 mg/dL.

A nurse is teaching a group of patients about Metabolic syndrome. Which assessment features are associated with the syndrome? (Select
all that apply.) ACDE

A. Male waist circumference 44 inches

B. Fasting blood glucose 66 mg/dL

C. Triglyceride value of 162 mg/dL

D. Blood pressure 135/85

E. Patient is taking blood pressure medication

When caring for a patient having a hypoglycemic episode, the nurse knows which symptom requires immediate intervention?

Confusion

The nurse is teaching a patient with type 1 diabetes about exercise. The nurse understands the patient should avoid exercise during what
time? When ketones are present in the urine

A 56-year-old woman is admitted to the ED with a blood pressure of 168/92 and reports of fatigue and muscle weakness. She has
bruising on her arms and 2+ swelling in her ankles. Her weight has gone from 150 to 185 lbs over the past 6 months. Assessment reveals
that she has truncal obesity and thin extremities. Which diagnosis does the nurse suspect? Hypercortisolism (Cushing’s disease)

The patient is admitted to the acute medical care unit for a workup for Cushing’s disease. When she is assessed, she is found sitting at
the bedside crying. She states, “I just don’t know what to do. I feel so confused and down in the dumps.” What is the nurse’s best
response? “Have you noticed if your mood goes quickly from happy to sad?”

The next day, a student nurse is caring for the patient, who is scheduled for an MRI of the head. The student nurse asks why a patient
with Cushing’s disease needs this test. What is the nurse’s best response? “The most common cause of Cushing’s is a pituitary tumor
called an adenoma.”

The student nurse is creating a care plan for the patient. Which priority problems should be the focus of the care plan? (Select all that
apply.) BDE

A. Fatigue

B. Fluid overload

C. Sleep deprivation

D. Potential for infection

E. Predisposition to injury

During evening shift, the patient’s MRI reveals the presence of a pituitary adenoma. The following day, surgery is performed to remove
the tumor. What is the nurse’s priority concern for the patient postoperatively? Monitoring for neurologic changes

Which key interventions should be implemented postoperatively for the patient after undergoing a hypophysectomy? (Select all that
apply.) ABCD

A. Report any postnasal drip.

B. Keep the head of the bed elevated.

C. Have the patient avoid coughing soon after surgery.

D. Monitor for a light-yellow color at the edge of clear drainage.

E. Instruct the patient to take thyroid and glucocorticoid replacement for at least 6 months.

The nurse is caring for a patient diagnosed with small cell lung cancer. The nurse understands the patient may also present with which
endocrine disorder? Syndrome of inappropriate antidiuretic hormone (SIADH)

Which priority question should the nurse ask a patient with a pituitary tumor? “Do you have any changes in your visual acuity?”

The nurse knows which patient with Cushing’s disease is at greatest risk for developing heart failure? 42-year-old with a serum
creatinine level of 3.7 mg/Dl- compromised kidney function ^ risk for heart failure.
As the nurse is assessing a patient with Grave’s disease, which finding requires immediate attention? Elevated temperature

What is the priority nursing intervention for an older female patient with a history of hyperparathyroidism? Implement fall precautions.

When developing a postoperative plan of care for a patient after a total thyroidectomy, the nurse knows the plan should include which
intervention? Avoiding extending the patient’s neck