Endocrine Disorders

ENDOCRINE DISORDERS gestational diabetes (GDM) is the result of what? - insulin resistance due to the influence of pregnancy (placenta) what is postpartum thyroiditis? - • Autoimmune inflammation of the thyroid gland *within 1 year postpartum* • 50/50 hyper/ hypo • usually self-resolves what should TSH be tested in pregnant women? - with a prior history or symptoms of thyroid disease how is hyperthyroidism managed in pregnancy? - PTU and Methimazole - Avoid Methimazole in first trimester (fetal scalp defects) how is hypothyroidism treated in pregnancy? - Levothyroxine - increase dose ~25% what is the TSH goal in pregnancy + hypothroidism? - 2.5 when does GDM often subsite? - postpartum; 50% develop T2DM what can have an effect on glucose metabolism in pregnancy? - - Dietary habits frequently change in pregnancy - *Human placental lactogen (hPL)* - Estrogen and progesterone - Insulinase how does diet affect glucose metabolism in pregnancy? - - decreased intake due to N/V - Food aversions/ preferences what is human placental lactogen (hPL)? - Pregnancy-associated hormone produced in abundance by placenta how does hPL effect glucose metabolism? - decreases glucose metabolism creating an "anti-insulin" effect how does insulinase effect glucose metabolism in pregnancy? - degrades insulin to a limited extent what fetal morbidity/morality complications are associated with GDM? - - congenital anomalies - spontaneous abortion & still birth - macrosomia - polyhydramnios what are the MC congenital anomalies seen with GDM? - cardiac, CNS, renal and limb deformities The nurse working on an endocrine nursing unit understands that which correct concept is used in planning care? - Clients with hyperthyroidism must be monitored for weight gain. Clients who have diabetes insipidus should be assessed for fluid excess. - Clients who have hyperparathyroidism should be protected against falls. Clients with Cushing's syndrome are likely to experience episodic hypotension. The nurse educator is asking the nursing student to recall the signs/symptoms of hypothyroidism. The nurse educator determines that the student understands this disorder if which are included in the student's response? Select all that apply. - - Dry skin Irritability Palpitations Weight loss - Constipation - Cold intolerance When the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 diabetes mellitus, which statement by the client would indicate that teaching has been effective? - "I will stop taking my insulin if I'm too sick to eat." "I will decrease my insulin dose during times of illness." "I will adjust my insulin dose according to the level of glucose in my urine." - "I will notify my health care provider if my blood glucose level is consistently greater than 250 mg/dL." During data collection on a postoperative client who has undergone hypophysectomy, the client complains of thirst and frequent urination. Knowing the expected complication of this surgery, the nurse should check which parameter next? - Serum glucose Blood pressure Respiratory rate - Urine specific gravity The nurse should expect to note which interventions in the plan of care for a client with hypothyroidism? Select all that apply. - Provide a cool environment for the client. Instruct the client to consume a high-fat diet. - Instruct the client about thyroid replacement therapy. - Encourage the client to consume fluids and high-fiber foods in the diet. Inform the client that iodine preparations will be prescribed to treat the disorder. - Instruct the client to contact the health care provider if episodes of chest pain occur. Glucagon hydrochloride injection would most likely be prescribed for which disorder? - Thyroid crisis Hypoadrenalism - Type 1 diabetes mellitus Excess growth hormone secretion A client is brought to the emergency department with suspected diabetic ketoacidosis (DKA). Which finding should the nurse note as being consistent with this diagnosis? - High serum glucose level and low serum bicarbonate level The nurse is monitoring a client following a thyroidectomy for signs/symptoms of hypocalcemia. Which sign/symptom noted in the client indicates the presence of hypocalcemia? - Bradycardia Flaccid paralysis Negative Chvostek's sign - Tingling around the mouth The nurse in an outpatient diabetes clinic is assisting in caring for a client on insulin pump therapy. Which statement by the client indicates that a need for teaching regarding insulin pump therapy? - "I'll need to check my blood sugars before meals in case I need a premeal insulin bolus." "If my blood sugars are elevated, I can bolus myself with additional insulin as prescribed." - "Now that I have this pump, I don't have to worry about insulin reactions or ketoacidosis occurring again." "I still need to follow an appropriate diet and exercise plan even though I don't have to inject myself daily anymore." The nurse is preparing to discharge a client who has had a parathyroidectomy. When reinforcing instructions to the client about the prescribed oral calcium supplement, which information should the nurse include? - - Take the calcium 30 to 60 minutes following a meal. Avoid sunlight because it can cause skin color change. Store the calcium in the refrigerator to maintain potency. Check the pulse daily and hold the dosage if it is below 60 beats per minute. In planning nutrition for the client with hypoparathyroidism, which diet would be appropriate? - Low in vitamins A, D, E, and K Low in water and insoluble fiber - High in calcium and low phosphorous High in sodium with no fluid restriction After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which signs/symptoms are indicative of this disorder? - Blurred vision and hot, dry skin - Excessive thirst and urine output Diarrhea and decreased urine output Weight gain and increased urine specific gravity A client who returned to the nursing unit 8 hours ago after hypophysectomy has clear drainage saturating the nasal dressing. The nurse should take which action? - Put the head of the bed flat. - Test the drainage for glucose. Test the drainage for occult blood. Continue to observe for further drainage. The nurse is providing instructions to a client newly diagnosed with diabetes mellitus. The nurse gives the client a list of the signs of hyperglycemia. Which specific signs of this complication should be included on the list? - Shakiness - Increased thirst Profuse sweating Decreased urine output