Flashcards in ENDO Deck (115)
In patients with Endocrine disorders, what signs and symptoms should you look for during the physical assessment?
General changes in energy levels and fatigue (hyperactive or lethargic?) Heat and cold intolerance, Changes in weight, Fluid imbalances, Electrolyte changes, Physical appearance, Cardiovascular status (vital signs), Sexual function, sex characteristics
For patients with Endocrine disorders, you should examine for the following?
Prominent forehead, Prominent jaw, Round or puffy face, Dull or flat expression, Exophthalmos, Vitiligo, Striae, Hirsutism
Exophthalmos is a classic symptom of hypothyroidism?
False. Exophthalmos is a classic sign of Hyperthyroidism.
What reason do patients with Endocrine disorders have for seeking healthcare?
Energy levels have changed, elimination patterns have changed, they've experienced a change in sexual and reproductive functions, their physical appearance has changed.
True or False. Endocrine glands can be palpated?
True. The thyroids and testes can and should be palpated during assessment.
Why is it important to assess the client's coping skills for Endocrine dysfunction?
Because a lot of hormonal changes make patients feel like they're not themselves (moody, irritable, angry). As nurses we must evaluate how the patient feels about these behavioral changes and determine if a referral to social service may be required.
When palpating the thyroid glands, what are you feeling for?
Bumps, irregular edges, enlargement, shrinkage.
What diagnostic test are used to identify Endocrine disorders?
Blood tests (hormone levels, antibodies, blood glucose), Radioimmunoassay, Urine tests (Free catecholamines, Ketones), Biopsies, CT, MRI.
What laboratory values would you expect to see in a patient with HYPERTHYROIDISM?
Elevated serum thyroid antibodies, Increased T3, Increased T4, Decreased TSH.
What laboratory values would you expect to see in a patient with HYPOTHYROIDISM?
Decreased T3, Decreased T4, Increased TSH.
What is a goiter? Who gets them?
A goiter describes an enlargement of thyroid gland. It may be present in patients with hyperthyroidism or hypothyroidism.
Increases metabolic rate, increased hormone. Caused by excessive secretion of TSH (hypothalamus), excessive T3 and T4, or when you have a brain disorder that's causing you to produce too much TSH (stimulating hormone).
Decreased metabolic rate, decreased hormone. Low TSH, Low T3 and T4
Nursing problems that can occur in patients with severe HYPERTHYROIDISM
Nutritional problems because of increased metabolism, coping, cardiac perfusion (elevated BP and HR all the time), temperature (intolerance to heat), thyroid storm.
What is thyroid storm?
An endocrine emergency and life- threatening condition which describes an extreme state of hyperthyroidism. It leads to extreme hyperthermia (102 to 106F), tachycardia, agitation, seizures
What are the general clinical manifestations of HYPERTHYROIDISM?
Emotional lability, agitation, exophthalmos, increased reflexes, tachycardia, diarrhea, muscle weakness, fatigue, flushed skin, heat intolerance, hyperthermia, goiter, weight loss, diaphoresis. (hint, everything is elevated except weight).
What are the general clinical manifestations of HYPOTHYROIDISM?
Lethargy, memory impairment, confusion, decreased reflexes, periorbital edema, hypotension, bradycardia, constipation, muscle weakness, goiter, edema, weight gain, hypothermia, cold intolerance. (hint: everything is decreased except weight and fluid volum
True or False. Auscultation is used to establish baseline vital signs and to assess cardiac rate and rhythm?
What are the biggest postoperative concerns following a thyroidectomy?
Risk of laryngeal nerve damage, bleeding, hemorrhage, aspiration, loss of gag reflex, loss of cough reflex, respiratory distress, hypocalcemia, tetany (positive Chvostek's and Trousseau's signs), and thyroid storm (thyroid crisis).
What should be at the bedside during and after a thyroidectomy?
Trach tray and injectable calcium, in case the patient goes into tetany.
Why are we worried about Hypocalcemia?
PARATHYROIDS keep calcium up, not thyroids. Parathyroid's are often damaged during a thyroidectomy and if you don't have parathyroid, you'll be hypocalcemic.
Hyperthyroid treatment options include?
Radioactive IODINE therapy and surgery
What are priority nursing diagnoses for HYPERTHYROID disorders?
Activity intolerance, imbalanced nutrition (less than), hyperthermia, risk for injury
What are the priority nursing diagnoses for HYPOTHYROID disorders?
Decreased cardiac output, ineffective breathing pattern, disturbed thought process, hypothermia, risk for injury
Identify 2 interventions for decreased Cardiac Output?
Monitor circulatory status, monitor for signs of inadequate tissue oxygenation, monitor for changes in mental status, monitor fluid status and heart rate, administer oxygen or mechanical ventilation, as approp.
Identify 3 interventions for Ineffective Breathing Pattern?
Observe and record rate and depth of respirations, Auscultate the lungs, Assess for respiratory distress, Assess the client receiving sedation for respiratory adequacy.
Cyanosis, coughing, and frothy sputum production are all signs of what?
Identify 3 interventions for Disturbed Thought Processes
Assess lethargy, drowsiness, memory deficit, poor attention span, and difficulty communicating (these problems should decrease with thyroid hormone treatment), Provide a safe environment, Provide family teaching.
This life- threatening condition results from extreme or prolonged HYPOTHYROIDISM. It is characterized by a severe hypometabolic state: coma, respiratory failure, hypotension, hyponatremia, hypothermia, hypoglycemia, bradycardia