Study Guide for Endocrine Exam.
Diabetes:
What is type I versus type II:
Type I: Pancreas does not produce insulin: is an autoimmune disorder
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Type I clinical manifestations:
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The 3 P’s-Polydipsia, Polyphagia, Polyuria
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Fatigue
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Blurry vision
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Frequency of infections
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Weight loss
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Lab Values:
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Glycate hemoglobin or A1C looks at a 2-3-month window. Levels then 6.5% is number
recommended by the American College of Endocrinology
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Fasting glucose levels are looking at levels for that time
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Normal glucose levels are between 74-106
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Treatment for Type I
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Insulin-May use short or rapid acting insulin alone or in combination with long acting
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Insulin pumps
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Diet and exercise
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Education on how to give self-insulin, take finger sticks
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Education on when to administer insulin-if using short acting or rapid acting insulin to be sure to
eat as soon as taking the insulin or right after eating.
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Always carry insulin, snacks incase blood sugar drops
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To wear identification stating they have diabetes.
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To do foot care
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To notify provider if they become ill. That also their glucose levels may increase if they are ill,
and they may require more insulin
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Also, if they are taking a steroid they will need to discuss any extra coverage with their provider.
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Type II clinical manifestations
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Type II is where the pancreas still makes insulin but it may not be enough to meet the bodies
needs.
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Frequent urination
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Blurry vision
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Slow wound healing
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Recurrent infection
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Treatment:
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Oral antidiabetic medications
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Diet and exercise
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Manage stress
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Education:
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Teach how to take medications
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To wear identification stating they have diabetes.
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To do finger sticks and have labs drawn per Primary recommendations
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To do foot care
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Other endocrine disorders:
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Clinical manifestations of Cushings:
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Abdominal Stria
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Buffalo hump
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Moon face
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Thickening of skin
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Pathophysiology
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Benign tumor is on the pituitary gland which causes it to produce to much ACTH which causes to
much cortisol to be secreted.
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Rare condition, usually found in women between the ages of 20 and 50.
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Diagnostic tests:
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24-hour urine collection
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Saliva test
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Imaging tests
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Treatment and education:
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Lower the high levels of cortisol. Depending on the cause will depend on the treatment. Oral
medications are typically used.
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Surgery to remove the tumor-hypophysectomy which is the removal of the pituitary gland.
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Radiation therapy
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Addisons Disease:
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Pathophysiology: to little cortisol. Adrenal insufficiency
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Autoimmune disease. The immune system attacks the adrenal glands
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Clinical manifestations:
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Hyperpigmentation or bronzing of the skin
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Extreme fatigue
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Weight loss and decreased appetite
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Nausea, diarrhea
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Diagnostic tests:
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ACTH stimulation test
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Insulin-induced hypoglycemia
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Imaging test
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Treatment and education
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Medication-hydrocortisone, prednisone
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Carry a medical alert card and bracelet at all times
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Extra medication on hand at all times
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Glucocorticoid kit on hand
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Acromegaly
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To much growth hormone. The cause is usually tumor on the pituitary gland
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Clinical manifestations
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Frontal bossing
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Enlarged hands and feet
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Skin tags, cardiomegaly
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Affects bones in the body to increase in size
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Affects middle aged adults
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Diagnostics:
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Growth hormone suppression test
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Imaging
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GH and IGF-I measurement to test for elevated hormone levels
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Treatment and education
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Aimed at lowering the production of the GH (growth hormone) and reducing the negative
effects of the tumor on the pituitary gland
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Surgery-removal of the tumor via transsphenoidal surgery.
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Medications to reduce excess growth hormone secretion
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Radiation
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Educate to notify provider if they notice their hands and/or feet are growing
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Go over how to take medication
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After surgery the nurse will monitor for:
Changes in vision; discharge from the nose; the patient is encouraged to not blow their nose for
a few weeks after surgery. Will have an altered sense of smell also.
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Hyperthyroidism:
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The thyroid gland produces too much thyroid hormone.
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Graves is most common
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Clinical manifestations:
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Nervousness
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Irritability
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Tremors
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Weight loss with increase in appetite
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Heat intolerance and increased sweating
Exophthalmos or bulging eyes
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Diagnostic
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Thyroid panel -TSH, T3, T4
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Palpation
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ACTH simulation test
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TRH stimulation test
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Treatment and education:
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Treatment with antithyroid medications
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Radioactive iodine ablation
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Surgical thyroidectomy
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After thyroidectomy have a trach kit in the room
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If during the procedure the provider is not able to save the surrounding parathyroid glands, the
labs that will be monitored will be calcium levels as well as thyroid levels.
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When the patient gets to the room be sure to assess how the patient is breathing, then once
that is assessed as adequate then do the assessment to the dressing, the patients’ pain, and vital signs.
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Hypothyroidism
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To little production of thyroid.
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Cold intolerance
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Fatigue
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Goiter
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Sore muscles and joints
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Weight gain
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Hair loss
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Diagnostic studies
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TSH, T4 labs
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Head to toe assessment
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Treatment and education
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This is lifelong medication therapy
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Educate the patient not to change manufacture of thyroid medication
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Take in the morning on an empty stomach
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Diabetes Education continued:
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Educate the patient and family members on some of the health complications that can happen.
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Diabetes can cause vascular issues; this is why teaching about foot care is essential
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Causes not only neuropathy but causes retinopathy, diabetic macular edema and is the leading
cause of no injury blindness
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Affects the kidneys-(nephropathy)=nephron=kidney; pathy=disease so : nephropathy = kidney
disease
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Exercise is important for those with diabetes so teach them to monitor their FSBS:
Before
During
After their exercise regimen
Be sure to take food or a snack in case they have an episode of hypoglycemia
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Remember rules of 15 for treatment of low blood sugar
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Remember that for either type of diabetes the goal is to have tight control over their blood
glucose levels. This will help minimize fluctuations during illness and delay vascular damage and damage
to other areas
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The patients need to know how to recognize hypoglycemia:
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Shakiness
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Dizziness
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Sweating
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Hunger
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Irritability
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Moodiness
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Anxiety
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Hyperglycemia
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Fatigue
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Blurry Vision
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Excessive thirst
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Fruity breath
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Educate the patient and family on how to recognize insulin reaction and what to do
(hypoglycemia)
Remember to think is it hyper or hypo:
Is there to much of something being secreted? Or not enough being secreted?
Also think along the lines of patient family teaching for each of the disorders
Transsphenoidal Hypophysectomy: Surgical procedure to remove the tumor on the Pituitary Gland. (I
misspelled transsphenoidal and left off Hypophysectomy)
Acromegaly-The change with the bones is from the excess growth hormone production causing the
bones to become thicker and wider which give them their frontal bossing and enlarged hands and feet.
Think of a Neanderthal look.
Pharm:
Thyroid Medications:
Thyroid medications are given to treat hypothyroidism.
Levothroid is the most used. What it does is to increase the metabolic rate, which can cause insomnia
and making it difficult to sleep.
Patient education with thyroid medication is: take it on an empty stomach to help enhance absorption,
and take in the morning since it enhances metabolism it may cause insomnia, taking it early in the day it
will prevent insomnia.
Also education on the fact that this is a lifetime treatment, and not to expect to feel immediately better
once starting this medication, it can take a few weeks (up to 3 weeks) for them to notice any changes
with symptoms, so not to stop taking it thinking it is not working. Monitoring TSH, T4 and T3 levels at
least monthly or every other month. To notify provider of upcoming surgical procedures. To report
excitability, irritability anxiety which indicate overdose.
Separate antacids, iron, calcium products by 4 hours
Anti-thyroid medications: Are meant to treat the symptoms or primary cause of the disease. Treated
with surgery, or radioactive isotopes of iodine.
Methimazole and propylthiouracil impede the formation of thyroid hormone PTU: Synthesis T3 and T4
and reduces or inhibits production of the thyroid hormone and can be used to help decrease the thyroid
gland vascularity. This is usually done prior to any type of surgical procedure to the thyroid.
Nursing considerations and patient teaching with PTU:
Monitor vital signs, assess for signs of hypothyroidism. Also emphasis restricting the consumption of
seafood, iodized salt (such as table salt) and even foods that people typically think are healthy, soy foods
should also be avoided when taking the medication PTU, also notify provider prior to any surgical
procedures. To also take with meals to reduce GI upset.
ANTIDIABETIC MEDICATIONS: Insulins are required to treat Type I diabetes, can also be used to help a
Type II have more control if diet and oral hypoglycemic medications are not working.
Insulins-Rapid Acting
:• Humalog (insulin lispro)
• Novolog (insulin Aspart)
• Aprida (insulin glulisine) rapid onset of 15 minutes as well as a shorter duration
Short-acting:
• Humulin R (regular insulin)
• Novolin R Intermediate-acting :
• NPH (insulin isophane suspension) this is the only available intermediate acting insulin product
Long-acting
:• Levemir (detemir)
• Lantus (glargine): If the patient is taking this and regular insulin, during patient teaching, teach them
that they cannot mix the two insulins, so they will have to have to injections. 24-hour duration. Usually
given at NOC.
Oral antidiabetics:
BIGUANIDE: Metformin only drug in this category
Works by decreasing glucose production by the liver, may also decrease intestinal absorption of glucose
and improve insulin receptor sensitivity Metformin does not stimulate insulin secretion
Does not cure diabetes. ADA guidelines recommend metformin as the initial oral antidiabetic drug for
treatment for newly diagnosed type II diabetics Can be used as monotherapy or in combination with
other oral antidiabetic medications Educate the patient that they need to take same time every day and
with food to help reduce any GI upset. do not double up on doses.
To tell PCP and other HCP that they are on metformin, If they are going to have a procedure, such as
heart Cath, which has contrast which contains iodine in it to hold the medication, metformin, for 48
hours after the procedure, and the day of the procedure. Sulfonylureas are the oldest group of oral
antidiabetic drugs Bind to specific receptors on beta cells in the pancreas to stimulate the release of
insulin Secondarily decrease the secretion of glucagon Most commonly used; Glipizide (Glucotrol)
Glyburide (Diabeta)
Glimepiride (Amaryl)Used as adjunctive therapy with metformin Educate the patient that with oral anti
diabetic, and insulin patients that some antibiotics and steroids will cause their blood sugars levels to
increase. And that sometimes the provider will have them use sliding scale insulin to deal with this short
term.
Patient education on signs and symptoms of hypoglycemia is also important when educating a newly
diagnosed diabetic. It is important that they understand how to recognize hypoglycemia, as it a very
serious side effect of antidiabetic medications but especially insulins. This is also important for you as a
nurse to be able to recognize. Always take a FSBS prior to administering insulin,
and know the symptoms of hypoglycemia and know how to treat.
Glucagon is a paste that you can give someone who is hypoglycemic, it will increase the sugar levels. It is
important also to remember that you will not give this if the patient cannot respond. Also educate the
patient that they need to wear a medic alert bracelet, always carry like candies, crackers and peanut
butter, and how to recognize when their blood sugar is getting low and what they need to do. They have
also developed new medications that will work as adjunctive therapy to those patients who are needing
that extra control, Trujeo, Byetta, Victoza to name the most used.