Chapter 39 Nursing Care of Patients with Endocrine Disorders

Answers CHAPTER 39 NURSING CARE OF PATIENTS WITH ENDOCRINE DISORDERS AUDIO CASE STUDY Alice and Cushing Syndrome 1. Chronic steroid use. 2. Buffalo hump, thin skin, moon-shaped face, easy bruising, osteoporosis, and hyperglycemia. 3. Steroids cause gluconeogenesis, which raises blood glucose. 4. Weaning off or reducing the dose of steroid or sometimes using an every-other-day schedule can help. Unfortunately, Alice needed the steroids to breathe, so the benefits of the steroids outweighed their risks. VOCABULARY 1. euthyroid 2. goitrogen 3. polydipsia 4. polyuria 5. pheochromocytoma 6. tetany 7. myxedema 8. Nocturia 9. amenorrhea 10. ectopic HORMONES Disorder A. Diabetes insipidus B. Syndrome of inappropriate antidiuretic hormone (SIADH) C. Cushing syndrome D. Addison disease E. Graves disesase F. Hypothyroidism G. Pheochromocytoma H. Hyperparathyroidism I. Short stature J. Acromegaly K. Hypoparathyroidism Hormone Problem 1. Antidiuretic hormone (ADH) deficiency 4. ADH excess 5. Steroid excess 6. Deficient steroids 11. High T3 and T4 9. Low T3 and T4 7. Epinephrine excess 3. High serum calcium 2. Growth hormone (GH) deficiency 8. GH excess 10. Low serum calcium Signs and Symptoms a. Polyuria h. Water retention c. k. j. i. d. f. g. b. e. Moon face Hypotension Exophthalmos Weight gain and fatigue Unstable hypertension Muscle weakness, brittle bones Failure to grow/develop Growing hands and feet Tetany 1 2 Chapter 39 Answers CRITICAL THINKING 1. Because Mr. Samuels has too much ADH, he will be retaining water. An appropriate nursing diagnosis would be Excess Fluid Volume. 2. The best way to monitor fluid balance is by daily weights, at the same time each day, on the same scale, and in about the same clothes. In addition to daily weights, intake and output, vital signs, urine specific gravity, lung sounds, and skin turgor can be monitored. 3. Mr. Samuels will retain water, which will reduce the osmolality of his blood. This in turn can cause cerebral edema, increased intracranial pressure, and seizures. 4. Mr. Samuels’s side rails should be padded. If a seizure occurs, he should be protected from harming himself. 5. Mr. Samuels’s urine will be very concentrated because he is not excreting much water. 6. When Mr. Samuels is effectively treated, his urine will look more diluted because he will be excreting more water. 7. A head injury can directly or indirectly damage the pituitary gland, placing the patient at risk for reduced ADH secretion and diabetes insipidus (DI). 8. Polyuria and polydipsia are symptoms of both DI and diabetes mellitus. 9. Mrs. Jorgensen’s urine specific gravity will be low because she is excreting too much water. 10. Mrs. Jorgensen’s serum osmolality will be high because she is losing water and becoming dehydrated. 11. Mrs. Jorgensen is at risk for Deficient Fluid Volume. 12. Mrs. Jorgensen should watch for signs of fluid overload, such as increasing weight and concentrated urine. THYROID DISORDERS 1. (O) 2. (O) 3. (R) 4. (R) 5. (O) 6. (O) 7. (R) 8. (R) 9. (O) 10. (R) 11. (R) 12. (O) REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (1) is correct. Numb fingers and muscle cramps are symptoms of tetany. (2, 3, 4) are not symptoms of tetany. 2. (3) is correct. Thyrotoxicosis causes blood pressure, pulse, temperature, and respiratory rate to rise. (1, 2, 4) are not affected by thyrotoxicosis; peripheral pulses may be indirectly affected. 3. (1) is correct. Fluids will help prevent kidney stones by flushing excess calcium through the kidneys. (2, 3, 4) will not help. 4. (4) is correct. Acromegaly is caused by an excess of growth hormone. (1, 2, 3) do not affect growth. 5. (2) is correct. Addison disease is associated with fluid loss. (1, 3, 4) are not relevant. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 6. (3) is correct. Negative feedback causes the pituitary gland to produce more thyroid stimulating hormone (TSH). (1) is incorrect. TSH does not take the place of triiodothyronine (T3) and thyroxine (T4). (2) is incorrect. TSH will not directly affect the metabolic rate. (4) is incorrect. Fat cells do not make TSH. 7. (3) is correct. The patient is experiencing fatigue. (1) is incorrect. There is no evidence in the data that the patient is overeating. (2) is incorrect. Weight gain does not necessarily affect gas exchange. (4) is incorrect. There is no evidence that the patient is experiencing depression. 8. (1) is correct. Tachycardia can occur if she gets too much levothyroxine (Synthroid). (2, 3) are incorrect. They are not side effects of levothyroxine (Synthroid). (4) is incorrect. She should lose excess weight, not gain weight, on levothyroxine (Synthroid). 9. (2) is correct. Body fluids will be radioactive. (1, 3) are not necessary. (4) is incorrect. Exposure to even small doses of radioactivity should be minimized. 10. (2, 3, 1, 4, 6, 5) is correct. (2) Airway is always a priority. (3) Vital signs are second because the patient must be monitored for thyrotoxicosis, which could be life-threatening. (1) Surgical site is third, because physiological problems take priority, and excessive bleeding could also be life- or health-threatening. (4) An analgesic is next, so the patient will be comfortable for (6) range-of-motion exercises. (5) Teaching is last; although it is important, it does not maintain the immediate physiological integrity of the patient. 11. (4) is correct. It is the only outcome that addresses pain. (1, 2, 3) may all be appropriate, but they are not related directly to the nursing diagnosis. 12. (2) is correct. Buffalo hump and easy bruising are often present in Cushing syndrome. (1, 3, 4) are not symptoms of Cushing syndrome. 13. (1) is correct. Vital signs are important because the patient with pheochromocytoma has labile hypertension. (2, 3, 4) are all part of a routine assessment, but they are not as important as vital signs in this case.