Study Guide for LPNU 130 Exam #2 Endocrine

50 Questions: 28 Multiple Choice; 2 Select all; 16 matching; 3 problems; 1 blood gas

Chapter 22: Fluid and Electrolytes
 Assessing water balance

 Normal ranges for sodium, potassium, calcium

Sodium – 134 – 142 mEq/L
Potassium – 3.5 – 5 mEq/L
Calcium – 4.5 mEq/L or 8.4 10.6 mEq/L

 Signs and symptoms/associated medical problems of hypokalemia, hyperkalemia,

hypercalcemia, hypocalcemia – See handout and boxes in Chapter 22
670
Hypocalcemia – excess binding of calcium ions, large amounts of citrated blood,
excess alcohol, chronic renal failure, pancreatic disease, severe diarrhea, disease of
small bowel, anticonvulsants, diuretics, draining intestinal fistulas, deficiency of
parathyroid hormone or vitamin D, increased magnesium, thyroid surgery, injury
or disease of parathyroid gland, severe burns, low serum albumin levels

Signs and symptoms – anxiety, confusion, irritability, osteoporosis, pathologic

fractures, tingling around nose, mouth, ears, fingers, toes, twitching, muscle spasm
of feet and hands

 Blood gas interpretation

Chapter 51 Endocrine
 Endocrine glands: the hormones they produce.
Anterior pituitary – growth hormone (GH), adrenocorticotropic hormone
(ACTH), thyroid stimulating hormone (TSH), melanocyte stimulating hormone
(MSH), prolactin, gonadotropic hormone (FSH & LH) : follicle stimulation
hormone and luteinizing hormone

Posterior pituitary – antidiuretic hormone (ADH) –vasopressin, oxytocin

Thyroid gland – thyroxine (T4), Triiodothyronine (T3), calcitonin

Parathyroid gland – parathyroid hormone (PTH)

Adrenal cortex – mineralcorticoids (aldosterone), glucocorticoids (cortisol),
androgens & estrogens

Adrenal medulla – epinephrine (adrenaline) norepinephrine

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  Actions of hormones on target organs

 Give example of adrenocortical hormones: main glucocorticoid and main

mineralocorticoids; functions of glucocorticoids
Main glucocorticoids – Cortisol – involved in glucose metabolism – provides
energy reserves in times of stress

Mineralocorticoids – aldosterone – fluid and electrolyte balance

 Endocrine disorders and their underlying cause (pathophysiology); lab values

 How hormone levels are controlled

Endocrine glands communicate through hormones which are chemical messengers
that travel through the bloodstream to their target organ

 Acromegaly: pathophysiology; signs and symptoms

Patho – overproduction of growth hormone in the adult, idiopathic hyperplasia of
the anterior pituitary gland, tumor growth in the anterior pituitary gland, changes
are irreversible

Signs and symptoms – enlargement of the cranium and lower jaw, separation and
malocclusion of the teeth, bulging forehead, bulbous nose, thick lips, enlarged
tongue (effects speech), generalized coarsening of the facial features, enlarged
hands and feet, enlarged heart (leads to heart failure), liver and spleen

 Diabetes insipidus and SIADH: pathophysiology, laboratory findings; priority

nursing diagnoses

Diabetes insipidus
Patho – transient or permanent metabolic disorder of the posterior pituitary,
deficiency of antidiuretic hormone (ADH), ADH causes kidneys to conserve water
which decreases urine output, ADH also causes vasoconstriction which increases
blood pressure, secondary to head trauma, tumors, infarct, aneurism, encephalitis,
or meningitis

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 Lab findings – the urine specific gravity drops below 1.003 and the serum sodium
level increases to more than 145 mEq/L, the serum osmolality may be greater than
300 mOSm/kg

Priority nursing diagnosis – deficient fluid volume

SIADH
Patho – triggered by tumor, medication or disease process, excess production of
antidiuretic hormone (ADH), ADH causes kidneys to conserve water which
decreased urine output, ADH also causes vasoconstriction which increases blood
pressure

Lab findings – hyponatremia (sodium less than 134 mEq/L), serum osmolality is
less than 280 mmol/kg, urine specific gravity is greater than 1.032 and urine
sodium is elevated

Priority nursing diagnosis – excess fluid volume

Diabetes Insipidus – high urine output, low levels of ADH, hypernatremia,

dehydrated, lose too much fluid

SIADH – low urine output, high levels of ADH, hyponatremia, overhydrated,

retain too much fluid

 Diagnostic tests for thyroid disorders

Hyperthyroidism – T3 (serum triiodothyronine) measures the T3 level in the blood.
T4 (serum thyroxine) – measures the T4 level in the blood. Free T4 (FT4)
measures active component of total T4. Thyroid-stimulating hormone (TSH) –
measures the level of TSH, radioactive iodine uptake test (RAIU) – radioactive
iodine is given by mouth to the fasting pt. after 2, 6 and 24 hrs. a scintillation
camera is held over the thyroid to measure how much of the isotope has been
removed from the blood stream, thyroid scan – is given to the pt. either orally or
intravenously.

 Hyperthyroidism (Grave’s disease): medical treatment, complications

Medical management – medications that block production of thyroid hormones
(proplythiouracil (PTU), methmazole (tapazole ) – preferred because of once-a-
day dosage

Radioactive iodine – ablation therapy – side effect: hypothyroidism

Contraindicated if patient is pregnant – pregnant nurses should not be
assigned to this patient
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 Subtotal thyroidectomy – out of favor because of surgical risks: bleeding, vocal
cord paralysis hyperparathyroidism

• Preoperative teaching: How to support head when turning patient (nurse places
both hands behind the head to maintain anatomical alignment), teach deep
breathing, (would coughing be permitted?), voice rest up to 48 hours, voice
checks every 2-4 hours (say “ah”)
Postoperative care: semi-fowler’s position, pillow support to head, frequent vital
signs, cool-mist vaporizer, assess for signs of hemorrhage, diet clear liquid to soft,
Tracheostomy tray at bedside, also suction equipment

Complications – post op. tetany, test for hypocalcemia with Chovstek’s sign or
Trouseeau’s sign, bleeding or thyroid crisis

 Signs and symptoms of thyroid crisis or storm; potentially lethal complication

of thyroid crisis
Signs and symptoms – all the signs and symptoms of hyperthyroidism are
exaggerated, additionally pt. may develop nausea, vomiting, severe tachycardia,
severe hypertension, occasionally hyperthermia up to 106 F, extreme restlessness,
cardiac dysrhythmia and delirium –

Potentially lethal complication -the pt. may develop heart failure and die.

 Hypothyroidism: medical treatment; dietary considerations; patient teaching;

discharge instructions
Medical treatment – synthroid, levothyroid, proloid, cytomel

Dietary considerations – high protein, high fiber, low calorie diet

Pt. Teaching -teach patient about importance of regular follow-up with

physician to monitor drug levels and effectiveness

 Thyroidectomy: patient assessments, post-op care, post-op complications,

signs of post-op complications; treatment of post-op complications; 3 major
life-threatening complications

Pt. assessments –

Post op care –

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 Post op complications –

Signs of post of complications –

Treatment of post-op complications –

3 major life-threatening complications-

 Assessment findings in hypocalcemia

Tingling around nose, mouth ears, hands, feet, muscle spasms of feet and hands,
tetany – positive trousseau’s and Chvostek sign, diarrhea – hyperactive bowel
sounds

 Calcium regulation: control of serum levels

Parathormone (or parathyroid hormone) – moves calcium from the bones into the
blood stream and increases calcium absportion in bowels (increases serum calcium
levels)

 Hypoparathyroidism: complications

 Hyperparathyroidism: clinical manifestations

Hypercalcemia, skeletal pain, pain on weight bearing, pathological fractures,
kidney stones, fatigue, drowsiness, nausea, vomiting, anorexia

 Cushing’s syndrome: signs and symptoms, dietary considerations

Signs and symptoms
Moonface, buffalo hump, thin arms and legs, hypokalemia, proteinuria, increased
urinary calcium excretion, susceptible to infections, depression, loss of libido,
ecchymoses and petechiae, weight gain, abdominal enlargement, hirsutism in
women, menstrual irregularities, deepening of the voice

Dietary considerations – low sodium, high potassium

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