Shirley, a 34 year old woman comes to the physician’s office complaining of feeling jittery all the time and suffering from intolerance to heat. The physician rules out menopause because Shirley is young. He suspects hyperthyroid disease.
What other symptoms will the physician look for in Shirley to suggest a diagnosis of hyperthyroid disease?
What tests are performed to confirm the diagnosis?
The physician decides to treat conservatively using medications. List the drugs and explain the action of medication given to treat hyperthyroidism.
How will blood tests be used to follow and evaluate the effect of medication?
Medication alone is not sufficient and so Shirley is scheduled for surgery. What are the surgical options for Shirley? Explain assessment observations for possible postoperative complications from a thyroidectomy.
What post-operative teaching about head control will Shirley need?
What teaching topics are necessary to prepare Shirley for life adjustment after thyroidectomy?
Explain the symptoms and treatment for thyroid storm.
List symptoms the nurse will observe if the parathyroid gland is injured or removed during surgery.
Case Study: Hypo Thyroid Disease – Myxedema
Jeanine has been dieting and exercise and trying unsuccessfully to lose weight. Her nutrition counselor suggests that Jeanine to her physician.
Whenever a person is over weight they may ask the physician the question, “Do I have low thyroid function?” (I hope) because it is much easier to take a pill to lose weight and regain energy than it is to tackle the alternative of diet and exercise.
List the symptoms of low thyroid function.
What tests will confirm the diagnosis?
List the drugs and explain the action of medication given to treat hypothyroid disease.
How will blood tests be used to follow and evaluate the effect of medication? Jeanine for life adjustment with hypothyroid disease?
What will precipitate a Myxedema coma?
Case Study Continued: Hypo Parathyroid Disease
During a postoperative checkup Shirley demonstrates a positive Chvosteck’s sign. The physician next tests for Trousseau’s sign, and then orders a bone scan.
How did Shirley develop hypoparathyroid disease?
Explain Chvosteck and Trusseau’s signs.
Why did the physician order a bone scan?
The physician may require Shirley to wear a Holter Monitor because….?
What is the function of parathyroid hormone? How is this related to calcium?
List blood studies the physician will use to follow parathyroid function.
What is the purpose of Shirley taking Vitamin D and Phosphate-binding drugs?
Describe patient teaching needed when taking Phosphate-binding drugs.
Case Study: Hyper Pituitary Secretion
Fred complains of joint pain. He has had to buy new shoes every month because the old ones feel too small. His wife says, “Fred looks different.” The physican’s diagnosis is Acromegaly caused by a pituitary tumor.
List the symptoms of Acromegaly.
Explain transsphenoidal pituitary surgery.
What are the complication for transsphenoidal surgery?
Is there cause for concern if Fred has a post nasal drip after surgery?
Why are the following medications prescribed for Fred? Vasopressin, Levothyroxine, somatrotropin, glucocorticoids?
Case Study: Diabetes Insipidus
After a stroke Samuel develops Diabetes Insipidus.
What are the symptoms of Diabetes Insipidus?
How is this connected with the kidney?
Describe the action and administration of DDAVP (Vasopressin).
Case Study: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Anthony says, “This is crazy. I have lung cancer, how did I get a disease of the Pituitary gland?”
List the symptoms of SIADH.
What is the connection between lung cancer and the pituitary gland?
Explain teaching for recording daily observation and restrictions Anthony will need to follow for managing SIADH?
Case Study: Diabetes Mellitus
I. Explain the physiology that creates the three symptoms of diabetes.
II. What is the function of each of these pancreas cells?
III. A client is admitted to the hospital with diabetic ketoacidosis. The nurse understands that the elevated ketones present in this disease is caused by the incomplete oxidation of ______________
IV. List five symptoms of hypoglycemia AND five symptoms of hyperglycermia.
V. Fill in the insulin times on this chart.
VI. What is an appropriate nursing action when patient’s blood sugar test is 50?
VII. Contrast DKA and HHNS. Compare means how are they different.
|Blood sugar level|
|Population who has complication|
|Treatment in order of priority|
|Teaching to prevent|
VIII. What is the triad of treatment for Diabetes Mellitus?
IX. Describe Dawn phenomenon and Somogi phenomenon.
Case Study: Hyper Secretion of Adrenal Gland – Cushing Disease
The adrenal gland is easy!
John is receiving large doses of prednisone for a chronic disease. The side effects of steroid medications like prednisone and decadron are the same as Cushing’s Syndrome which is over production and hyper secretion of corticosteroid hormone.
List the symptoms of Cushing’s Syndrome. Compare this list with a list of the side effects of steroid medications. See how they are the same.
The treatment is…….?
Look up a list of steroid mediation and review the differences in their use? Why are so many different steroid medications available in oral and parenteral form?
What is the difference between Cushing Disease and Cushing Syndrome?
If a person has an exacerbation of a chronic disease and prednisone is prescribed, what is the rationale for giving an initial large dose and then tapering doses?
Case Study: Hypo Secretion of the Adrenal Gland – Addison’s Disease
People are complementing John on his beautiful tan. The problem is John has not been out in the sun or to a tanning salon. In addition he has been losing weight.
List the symptoms of Addison’s Disease
Explain the physiology responsible for the symptoms of Addison’s Disease
What is the treatment for Addison’s Disease?
List medications used to treat Addison’s Disease.
Describe the immediate intervention for a person in Addisonian Crisis.
Case Study: Tumor of the Adrenal Gland
What is pheochromocytoma?
Describe collection procedure for 24 hour urine for VMA.
List symptoms when monitoring patient for hypertensive crisis.
What medications will be prescribed to treat hypertensive crisis?
How is life altered after an adrenalectomy?