RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit IV - Care of the Client Experiencing Problems with the Endocrine System
1.
2.
3.
Behavioral Objectives
Apply the terms listed in the content
column appropriate to the client’s
situations.
Compare and contrast the normal
anatomy and physiology to the
pathophysiology of the selected
disease processes in the endocrine
system across the lifespan.
Analyze factors included in the
assessment of the client experiencing
selected complex problems of the
endocrine system, including the
developmental and cultural
considerations.
I.
Content Outline
Application of terms
A. Adrenal cortex
B. Amyloidosis
C. Cretinism
D. Endocrine glands
E. Exopthalmus
F. Hashimoto’s thyroiditis
II. Anatomy and physiology of the endocrine system
A. Developmental considerations
1. Infant
2. Child
3. Adolescent
4. Adult
5. Older adult
B. Pathophysiology of the endocrine system.
III. Endocrine system assessment
A. Interview
1. Chief complaint
2. History of present illness.
3. Prior medical history
4. Medication history (prescription/nonprescription)
5. Family/social/occupational history
6. Knowledge of health maintenance
7. Identify risk factors endocrine disease.
B. Physical exam
1. Eyes
2. Level of consciousness
3. Vital signs
4. Body shape
5. Skin/hair/nails
6. Muscle weakness/wasting
7. Hydration status/I&O
8. Weight gain/loss
9. Fatigue
10. Menstrual disturbance
11. Sleep pattern
Clinical Objectives
Identify short and long-term
goals/outcomes, select
interventions, and establish
priorities for care in
collaboration with the client.
Learning Opportunities
Readings:
Lewis 8th ed (2011)
Adams 3rd ed (2011)
McKinney 3rd
Use current technology and
evidence-based information to
formulate and modify the
nursing plan of care.
Contribute to the
interdisciplinary plan of care.
Communicate plan of care to
nurses and other
interdisciplinary health care
team members.
Initiate discharge planning in
collaboration with
interdisciplinary health care
team.
Implement plan of care to assist
clients to meet physiological
needs, including: circulation,
nutrition, oxygenation, activity,
elimination, comfort, pain
management, rest and sleep.
Implement nursing care to
promote health and manage
acute and chronic health
problems and disabilities.
Adjust priorities and implement
nursing interventions in
emergency situations.
ed
(2009)
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit IV - Care of the Client Experiencing Problems with the Endocrine System
Behavioral Objectives
Content Outline
12. Respiratory status
13. Bowels
C. Diagnostic tests
1. Radiology
a. Thyroid scan
b. Radioactive iodine uptake
c. Computerized axial tomography
(CT)
d. Magnetic resonance imaging (MRI)
e. Sonogram
2. Laboratory studies
a. Serum T4
b. Serum T3
c. T3 resin uptake
d. Thyroid Stimulating Hormone
(TSH)
e. Cholesterol
f. Muscle enzymes
1) ALT
2) SGPT
3) LDH
4) CK
g. Urine osmolality
h. Urinalysis
i. Electrolytes
j. Blood glucose
k. White blood cell count (WBC)
l. Cortisol
m. 17 hydroxycorticosteroids
n. ACTH stimulation
o. Dexamethasone suppression
p. 17 ketosteroids
q. ACTH radioimmunassay
r. Renin level
3. Other
a. Achilles tendon reflex
b. ECG
c. Fluid Challenge Test
D. Cultural influences
Clinical Objectives
Learning Opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit IV - Care of the Client Experiencing Problems with the Endocrine System
Behavioral Objectives
Content Outline
1. Hereditary
2. Environmental
3. Health beliefs/practices
E. Developmental
1. Age specific assessment data
a. Muscle tone
b. Vital signs
c. Fluid/electrolytes
d. Height, body structure
e. Nutritional
2. Behavioral/emotional response to health
care providers
4.
Differentiate between the etiology,
pathophysiology, and clinical
manifestations of selected complex
endocrine problems.
IV. Selected complex endocrine problems
A. Thyroid
1. Hyperthyroid
2. Hypothyroid
B. Diabetes insipidus
C. Syndrome of Inappropriate Diuretic
Hormones (SIADH)
D. Addison’s disease
E. Cushing’s disease
5.
Discuss analysis, planning
implementation and evaluation for
the nursing management of clients
with selected complex endocrine
problems.
V. Selected nursing diagnoses/implementation/
evaluation
A. Altered thought processes
1. Independent interventions
a. Level of awareness assessment
b. Age related hydration status
c. Intake & output
d. Monitor pertinent diagnostic tests
e. Maintain skin integrity
f. Orient to time, place, date and
events
g. Provide appropriate stimulation
h. Teach about change in cognitive
processes
i. Fall/safety precautions
2. Collaborative interventions
Clinical Objectives
Learning Opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit IV - Care of the Client Experiencing Problems with the Endocrine System
Behavioral Objectives
Content Outline
Administer replacement fluids
1) Oral
2) IV
b. Administer medications and monitor
for desired effects/adverse/side
effects/drug interactions
1) Thyroid hormones
2) Antithyroid
3) Beta adrenergic blocking agents
4) Steroids
5) Radioactive iodine
6) Anti-diuretic hormone
7) Thiazide diuretics
c. Restraints
3. Recognition of complications
a. Excessive vasoconstriction
b. Chronic rhinopharyngitis
c. Lipodystrophy
d. Dehydration
e. Addisonian crisis
f. Coma/death
g. Psychosis
h. Osteoporosis
i. Peptic ulcer
j. Pancreatitis
k. Hypertension
l. Shock
m. Metabolic alkalosis
n. Impotence
o. Sepsis/infection
p. Impaired wound healing
q. Body changes
r. Skin/hair/nail changes
s. Dysrhythmias
t. Depression
u. Hallucinations
v. Thyrotoxic crisis
w. Iodism
4. The client will have improved thought
a.
Clinical Objectives
Learning Opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit IV - Care of the Client Experiencing Problems with the Endocrine System
Behavioral Objectives
Content Outline
processes as evidenced by:
a. Oriented to person, place, time and
events
b. Demonstrate no sign and symptoms
of dehydration
c. Improved laboratory studies
d. Stable vital signs
B. High risk for postop complications
1. Surgical modalities
a. Adrenalectomy
b. Thyroidectomy
c. Intra-cranial surgery
1) Transsphenoidal
hypophysectomy
2. Independent interventions
a. Review all pertinent assessments
b. Nasal care/precautions
c. I&O
d. Vital signs
e. Antiembolic stockings
f. Ankle exercises; ROM
g. Monitor IV/site care
h. Position appropriate for surgery
i. Wound assessment/care
j. See NCP for pain
k. Encourage activity as tolerated
l. Deep breathing
m. Safety considerations
n. Monitor lab values
o. Report unexpected observations
p. Observe for thyroid crisis
3. Collaborative interventions
a. Administer medications and monitor
for desired/effects/adverse
effects/side effects
1) Antibiotics
2) Narcotics
3) Pain medication
b. Recognition of complications
Clinical Objectives
Learning Opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit IV - Care of the Client Experiencing Problems with the Endocrine System
Behavioral Objectives
c.
d.
N:Spring\RNSG 2414 Unit IV-Endocrine System
Content Outline
1) Hemorrhage
2) Infection/wound and systemic
3) Addisonian crisis
4) Delayed wound healing
5) Thyroid storm
Community resources
1) Home Health
The client will not experience
postop complications as evidenced
by:
1) Wound healing
2) Vital signs
3) Tolerates diet
4) Laboratory studies
5) No signs/symptoms of cortisone
deficit
Clinical Objectives
Learning Opportunities
Reviewed 06/11