Exam 2
Unit 3 – Metabolic Problems
Chapter 35: The Endocrine System
Chapter 36: Care of Patients with Pituitary, Thyroid, Parathyroid, and Adrenal Disorders
Chapter 37: Care of Patients with Diabetes and Hypoglycemia
• The Endocrine System (Chapter 35)
• A&P Review (p. 842-848)
o Effects of the Thyroid Hormones (p. 844)
• The thyroid gland secretes the hormones thyroxine (T4), triiodothyronine (T3), and
thyrocalcitonin. The 3 and the 4 indicate how many iodine atoms are attached
• Activate cellular production of heat; stimulate protein and lipid synthesis, mobilization, and
degradation
• Regulate many aspects of carbohydrate metabolism and affect tissue response to epi and
norepinephrine
o Functions of the Parathyroid Glands (p. 846)
• Low calcium levels will stimulate the release of parathyroid hormones, which increases the
plasma level of calcium
• A high level of calcium will inhibit the release of the hormone
• Acts on the renal tubules to increase the excretion of phosphorous in the urine and to
stimulate the reabsorption of calcium
• Stimulate the absorption of vitamin D, which enhances the absorption of calcium in the small
intestine
• Acts on the bone, releasing calcium into the bloodstream
• Calcitonin is the balance to parathyroid that causes calcium to go into the bones and allows
for renal excretion to reduce calcium levels in the blood
o Hormonal Function of the Pancreas (p. 847)
• Produces insulin and glucagon
• Beta cells are responsible for producing and secreting insulin
• Alpha cells release glucagon, which stimulates the liver to change glycogen into glucose
• Understand the concept of negative feedback for the endocrine system
• Safety Alert (p. 846)
o Parathyroid deficiency- a deficiency of parathyroid hormone causes muscle cramps and
twitching, and in some severe cases, convulsions because of hypocalcemia
• Age-related changes (p. 847)
• Health Promotion: Preventing Goiter (p. 849)- May be prevented by the consumption of iodine
• Table 35.2: Diagnostic Tests and Procedures of the Endocrine System (p. 850-851)
o Serum T4 (Total Thyroxine) and Serum T3 (Total Triiodothyronine)
▪ To evaluate the function of the thyroid
▪ Aspirin, iodine-containing medications, and contrast media may interfere
with this lab result
o TSH (Thyroid Stimulating Hormone)
▪ To differentiate between pituitary dysfunction and primary thyroid
dysfunction; diagnose hypothyroidism
▪ Aspirin, iodine-containing medications, and contrast media may interfere
with this lab result
, o Radioactive Iodine Uptake (RAIU)
▪ To assess the function of the thyroid gland and to measure the rate of uptake
of iodine by the thyroid
▪ Trace dose is given orally, the gamma counter is placed over the thyroid,
and it measures the amount of radioactive iodine uptake absorbed
▪ Should not be done during pregnancy or lactation, as it does not make the
patient radioactive; a small amount is used
o Thyroid Scan
▪ To determine the size, shape, and activity of the thyroid gland
▪ RAI is used a scintillation camera
▪ Patient must lie perfectly still
• Table 35.3: Diagnostic Tests for Detecting and Monitoring Diabetes Mellitus (p. 852-853)
• 2-hour Postprandial Blood Glucose
o To determine the need for a glucose tolerance test or to
change diabetes therapy
o Venous blood draw 2 hours after a meal
o Educate on the importance of arriving exactly 2h after a
meal
• Glucose Tolerance Test
o To detect abnormal glucose metabolism, to assist in the
diagnosis of DM
o Venous blood draw after a 10-12 hour fast, glucose load
given, venous blood samples drawn at 30 min intervals for
2h
o Instruct patients to eat a balanced diet and do regular
activity before the exam
o Instruct patients to notify you if they experience weakness,
dizziness, nervousness, and confusion
• Hemoglobin A1C (A1C ) o Normal value is 5 – 6% or less
o To determine degree of diabetic control of blood sugar over
the preceding 2-3 months
o Venous blood draw, no fasting required
o To determine the effectiveness of diabetes therapy
• Ketone Bodies (Urine Test)
o To determine ketones in the urine
o Fresh urine is tested with a dipstick
o Educate the patient that ketone testing should be done if
illness is present and abnormal eating or activity has
occurred for more than 24 hours or if hyperglycemia is
present
o Common Care Problems (Table 35.5 - p. 854-855)
▪ Altered Body Image due to changes in physical appearance
• Nursing Interventions:
• Allow patients to verbalize feelings, focus on strengths, and positive aspects.
▪ Insufficient Knowledge due to illness and treatment
• Nursing Interventions:
Unit 3 – Metabolic Problems
Chapter 35: The Endocrine System
Chapter 36: Care of Patients with Pituitary, Thyroid, Parathyroid, and Adrenal Disorders
Chapter 37: Care of Patients with Diabetes and Hypoglycemia
• The Endocrine System (Chapter 35)
• A&P Review (p. 842-848)
o Effects of the Thyroid Hormones (p. 844)
• The thyroid gland secretes the hormones thyroxine (T4), triiodothyronine (T3), and
thyrocalcitonin. The 3 and the 4 indicate how many iodine atoms are attached
• Activate cellular production of heat; stimulate protein and lipid synthesis, mobilization, and
degradation
• Regulate many aspects of carbohydrate metabolism and affect tissue response to epi and
norepinephrine
o Functions of the Parathyroid Glands (p. 846)
• Low calcium levels will stimulate the release of parathyroid hormones, which increases the
plasma level of calcium
• A high level of calcium will inhibit the release of the hormone
• Acts on the renal tubules to increase the excretion of phosphorous in the urine and to
stimulate the reabsorption of calcium
• Stimulate the absorption of vitamin D, which enhances the absorption of calcium in the small
intestine
• Acts on the bone, releasing calcium into the bloodstream
• Calcitonin is the balance to parathyroid that causes calcium to go into the bones and allows
for renal excretion to reduce calcium levels in the blood
o Hormonal Function of the Pancreas (p. 847)
• Produces insulin and glucagon
• Beta cells are responsible for producing and secreting insulin
• Alpha cells release glucagon, which stimulates the liver to change glycogen into glucose
• Understand the concept of negative feedback for the endocrine system
• Safety Alert (p. 846)
o Parathyroid deficiency- a deficiency of parathyroid hormone causes muscle cramps and
twitching, and in some severe cases, convulsions because of hypocalcemia
• Age-related changes (p. 847)
• Health Promotion: Preventing Goiter (p. 849)- May be prevented by the consumption of iodine
• Table 35.2: Diagnostic Tests and Procedures of the Endocrine System (p. 850-851)
o Serum T4 (Total Thyroxine) and Serum T3 (Total Triiodothyronine)
▪ To evaluate the function of the thyroid
▪ Aspirin, iodine-containing medications, and contrast media may interfere
with this lab result
o TSH (Thyroid Stimulating Hormone)
▪ To differentiate between pituitary dysfunction and primary thyroid
dysfunction; diagnose hypothyroidism
▪ Aspirin, iodine-containing medications, and contrast media may interfere
with this lab result
, o Radioactive Iodine Uptake (RAIU)
▪ To assess the function of the thyroid gland and to measure the rate of uptake
of iodine by the thyroid
▪ Trace dose is given orally, the gamma counter is placed over the thyroid,
and it measures the amount of radioactive iodine uptake absorbed
▪ Should not be done during pregnancy or lactation, as it does not make the
patient radioactive; a small amount is used
o Thyroid Scan
▪ To determine the size, shape, and activity of the thyroid gland
▪ RAI is used a scintillation camera
▪ Patient must lie perfectly still
• Table 35.3: Diagnostic Tests for Detecting and Monitoring Diabetes Mellitus (p. 852-853)
• 2-hour Postprandial Blood Glucose
o To determine the need for a glucose tolerance test or to
change diabetes therapy
o Venous blood draw 2 hours after a meal
o Educate on the importance of arriving exactly 2h after a
meal
• Glucose Tolerance Test
o To detect abnormal glucose metabolism, to assist in the
diagnosis of DM
o Venous blood draw after a 10-12 hour fast, glucose load
given, venous blood samples drawn at 30 min intervals for
2h
o Instruct patients to eat a balanced diet and do regular
activity before the exam
o Instruct patients to notify you if they experience weakness,
dizziness, nervousness, and confusion
• Hemoglobin A1C (A1C ) o Normal value is 5 – 6% or less
o To determine degree of diabetic control of blood sugar over
the preceding 2-3 months
o Venous blood draw, no fasting required
o To determine the effectiveness of diabetes therapy
• Ketone Bodies (Urine Test)
o To determine ketones in the urine
o Fresh urine is tested with a dipstick
o Educate the patient that ketone testing should be done if
illness is present and abnormal eating or activity has
occurred for more than 24 hours or if hyperglycemia is
present
o Common Care Problems (Table 35.5 - p. 854-855)
▪ Altered Body Image due to changes in physical appearance
• Nursing Interventions:
• Allow patients to verbalize feelings, focus on strengths, and positive aspects.
▪ Insufficient Knowledge due to illness and treatment
• Nursing Interventions:
