METROPOLITAN COMMUNITY COLLEGE NURSING PROGRAM NURS 1950 ENDOCRINE TAKE HOME DIRECTIONS: This test is over the endocrine unit(s). It is worth 25 points. You may use textbook or other resources to complete the answers. Please cite [using APA format] the resources that you used. If you cite from the text, please note the pages used. 1. Mrs. C has been experiencing severe thirst, which she reports ‘makes me go to the bathroom all the time, it seems.’ She is also dehydrated despite the large amounts of water she has been drinking. She is diagnosed with diabetes insipidus. [5 points] a. What two drugs may be used to treat diabetes insipidus? Desmopressin (Posterior pituitary hormones) and hydrochlorothiazide (thiazide diuretics) b. What are the possible complications/cautions to the use of these drugs? Desmopressin is - Contraindicated in patients hypersensitive to drug and in those with type IIB von Willebrand disease, contraindicated in patients with heart failure, uncontrolled hypertension contraindicated for patients with severe renal impairment. Contraindicated for patient who is taken a diuretic or use steroid medication. Desmopressin should be used cautiously in patients with coronary artery insufficiency, hypertensive CV disease, patients with fluid and electrolyte imbalances (cystic fibrosis), patients at risk for water intoxication with hyponatremia. (Pg 874-876) Hydrochlorothiazide is - Contraindicated in patients with anuria and patients hypersensitive to other thiazides or other sulfonamide derivatives. Hydrochlorothiazide must be used cautiously in patients with gout, in children and in patients with severe renal disease, diabetes, hypercholesterolemia, impaired hepatic function. c. The physician decides that Mrs. C should do well with vasopressin therapy. Indicate how you would describe the treatment and its therapeutic effects [i.e. how it mimics the natural hormone] to the patient. Vasopressin therapy consists of decreasing tubular reabsorption of water and decreasing urine output. And we know ADH is synthesized at the hypothalamus and released by the posterior lobe of the pituitary gland inhibits urine formation by increasing reabsorption of water from the distal and collecting tubules in the nephrons of the kidneys. Therapeutically Vasopressin has the same action as ADH hormone. Vasopressin replaces this hormone which is no longer naturally secreted. d. After your explanation, Mrs. C. says, ‘Okay, okay, but what does it do for me?’ Explain the physical improvements Mrs. C should be able to see. The physical improvement will be - urine volume and frequency regulation (decrease the amount of the urine), and a decrease in the excessive urge to drink water. - body electrolytes regulation, decrease in muscle cramps, 2. Alice occasionally experiences hypoglycemia as a result of her diabetes drug therapy. (3points) a. The nurse will teach Alice about what signs and symptoms of hypoglycemia? Irritability, dizziness, lack of coordination, inattention, confusion, sweating, seizure. b. The nurse knows that one of the early signs of hypoglycemia is irritability. Why is this true? The physiological response to hypoglycemia is a complex and organized process. Irritability appears first as a warning sign to signal the lack of glucose, related to the activation of the sympathetic system in the central nervous system. c. If Alice experiences hypoglycemia at home, what are the treatment options? The treatment option is to use the 15-15 rule: have 15 grams of carbs and check your blood sugar after 15 minutes. (4 ounces (½ cup) of juice or regular soda, 1 tablespoon of sugar, honey, or syrup). In case of severe hypoglycemia give to the person a fast-acting source of sugar (regular soft drink or fruit juice); and feed him with a long-acting source of sugar (crackers and cheese or a sandwich with meat). (Pg 822) 3. A newly graduated nurse is preparing a dose of Novolin-R insulin to administer to a patient. [3 points] a. Before the nurse administers the medication, how will the coworker verify the drug? The graduate nurse will check the order (dose, route) at least three times and the and the coworker or second nurse will check the amount or dose drawn up by the first nurse by comparing it with the order (dose that the patient will receive.) b. After examining the syringe, the nurse’s coworker tells the graduate nurse that the syringe must be discarded because the insulin is cloudy. The new graduate states, ‘Insulin is supposed to look this way.” Who is right? The coworker is right because Novolin-R insulin is regular insulin which supposed to be clear c. The nurse examines the vial. A date on the label indicates that it has been open in the pyxis for 2 months. Is this a problem? Yes, because Novolin-R can be stored for one month at room temperature. 4. Dennis takes glipizide. He comes to the emergency department late one Sunday evening complaining that he feels weak. He vomited earlier, has a headache and his face ‘feels hot.’. You note that Dennis has profound flushing and is sweating. [4 points] a. What do Dennis’ signs and symptoms indicate? Dennis has disulfiram reaction (related to the fact his take glipizide and alcohol together) b. What will you assess immediately? - Assess vital signs, Check glucose level c. What may have caused this? Alcohol consummation, that means Dennis drink alcohol or some substance containing alcohol. Taking Glipizide (Sulfonylureas) and drink alcohol, in addition to developing disulfiram reaction, Dennis will also have impaired glycemic control causing hypoglycemia. The combination of alcohol and Sulfonylureas drugs produces these two reactions (hypoglycemia, disulfiram-like reaction). 5. Goldie, a 38-year-old teacher, has come to the clinic complaining of having ‘no energy or appetite’, yet her weight has increased by 15 lbs. in the past month. You note that her hair is thin, and her skin is dull. Laboratory work reveals an elevated level of thyroid stimulating hormone [TSH]. A diagnosis of hypothyroidism is made. [5 points] a. What medication do you expect to be ordered for Goldie? Thyroid hormone medication: Levothyroxine (Pg 857 -860) b. Explain the concept of ‘euthyroid’ as it would relate to Goldie’s condition. Euthyroid means that the thyroid gland is functioning normally, which results in the proper functioning of the thyroid gland with hormone production, regulated by the feedback mechanism. Euthyroid means normal hormone production, which is not the case for Goldie who had a hypothyroidism diagnosis. (Pg 850- 851) c. One month after therapy has begun, Goldie calls the office to complain that she ‘can’t sleep at all’ since she started taking the medication. She says she tries to take it at the same time every morning but often forgets and takes it at dinnertime. What teaching, if any, does she need to help her with this problem? Levothyroxine is a drug used to treat hypothyroidism and results in sleep difficulty (insomnia) as an adverse effect. That's why he recommends taking it in the morning, for its effectiveness and reduces the impact it can have on lack of sleep. The patient should use a memo reminder to remember and take Levothyroxine in the morning (same time). 6. Julie is in the urgent care center because of an exacerbation of asthma. She is usually able to control it with inhaled bronchodilators, but the physician decides to give her a short course of prednisone in a dose that is started high and then tapered down over 2 weeks. [5 points] a. Why is the dose tapered instead of just discontinued after 1 week? Prednisone dose should be tapered instead of just discontinued after 1 week because a sudden stop will create prednisone withdrawal (Severe fatigue, weakness, body aches, lightheadedness). Prednisone is intermediate-acting corticosteroid, a hormone produced by the Adrenal gland. Gradually reducing Prednisone will allow the body (adrenal gland) to play its role again. (produce hormone normally) b. Julie is taking prednisone for only 2 weeks. What are the potential effects of long-term therapy for a month or more? - cushingoid effects (moon face, buffalo hump) osteoporosis, aseptic joint necrosis adrenal insufficiency, gastrointestinal, hepatic, and ophthalmologic effects, hyperlipidemia, growth suppression, and possible congenital malformations c. Julie tells the nurse that she takes an oral contraceptive and that she often uses ibuprofen for her aches and pains. What concerns are there about drug interactions? Explain your answer. Prednisone interacts with NSAIDs like Ibuprofen increasing the risk of GI distress (nausea, vomiting, diarrhea, abdominal pain, and cramping), bleeding, and dizziness. Prednisone acts at the level of the Genitourinary system causing menstrual irregularities. The association between prednisone and oral contraceptive will increase prednisone effect. d. At what time of day should she take this drug? Explain your answer. Prednisone should be taken in the morning (preferably at breakfast around 9 am and take the drug with food or milk) to avoid adverse effect on central nervous system reactions that can induce insomnia. References Adams, M., Holland, L. N., & Urban, C. Q. (2011). Pharmacology for nurses: A pathophysiologic approach. Upper Saddle River, N.J: Pearson Education. Frandsen, G., & Pennington, S. (2021). Abram's Clinical Drug Therapy. (Course Point Plus). 12th Ed. Wolters Kluwer Mathew, P., Thoppil, D., & McClinton, T. (2022). Hypoglycemia (Nursing). In StatPearls. StatPearls Publishing. Timby, B. K., & Smith, N. E. (2018). Introductory Medical-Surgical Nursing. Philadelphia: Wolters Kluwer. www.cdc.gov www.ncbi.nlm.nih.gov
