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NCLEX-RN Exam Cram: Care of the Client with Endocrine Disorders

Dec 24, 2013

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Key Concepts

This chapter discussed alterations in the endocrine system. The nursing student should use these key concepts to answer questions as they relate to the care of this client. Remembering the pathophysiology of the disease process, the treatment, and the laboratory values will help you to be able to answer questions in the physiologic integrity portion of the NCLEX exam.

Key Terms

Acromegaly
Adrenocortical hyperplasia
Aldosterone
Androgens
Addison’s
Adrenal cortex
Adrenalectomy
Bromocriptine (Parlodel)
Buffalo hump
Corticosteroids
Cortisol
CT scan
Cushing’s disease
Diabetes insipidus
Dostinex (carbergoline)
Estrogen
FSH (follicle-stimulating hormone)
Gigantism
Gland
Gonadotrophins
Hirsutism
Hormones
Human growth hormone
Hypopituitarism
Hypothalamus
Luteinizing hormone
MRI (magnetic resonance imaging)
Ovaries
Parlodel (bromocriptine)
Parathyroid gland
Pituitary gland
Prednisone
Progesterone
Prolactin
Prolactinoma
Thymus
Thyroid gland
Transsphenoidal hyposection

Diagnostics

The exam reviewer should be knowledgeable of the preparation and care of clients receiving exams to diagnose endocrine disorders. While reviewing these diagnostic exams, the exam reviewer should be alert for information that would be an important part of nursing care for these clients. The pertinent labs and exams are as follows:

Laboratory test to determine hormone levels
X-rays to detect tumors
Computer tomography to detect tumors
Magnetic imaging to detect tumors

Pharmacological Agents Used to Treat Clients with Endocrine Disorders

An integral part of care to clients with endocrine disorders is pharmacological intervention. These medications provide an improvement or cure of the clients’ endocrine problems. The nursing exam reviewer needs to focus on the drugs in Table 4.1. Included in this table are the most common drugs used to treat endocrine disorders. These medications are not inclusive of all the agents used to treat endocrine disorders; therefore, you will want to keep a current pharmacology text handy for reference.

TABLE 4.1 Pharmacological Agents Used in the Treatment of Clients with Endocrine Disorders

Drug	Action	Side Effect	Nursing Care
Cortisone, hydro-cortisone, prednisone, and fludrocortisone (Florinet)	For replacement of a lack of cortisole or to suppress the immune response in a client suffering from allergic reaction, those with organ transplantation, or to suppress untoward effects of medications	Nausea and vomiting weight gain, decreased immunity.	Instruct the client to take the medication with meals. Instruct the client to report the signs or symptoms of excessive drug therapy: signs of Cushing‘s syndrome.
Propylthiouracil (PTU, Propyl-Thracil)	Used to treat hyperthyroidism	Slow heart rate, fatigue, drowsiness headache, neuritis, nausea, vomiting, diarrhea, and myelosuppression.	Measured dosage should be spread over 24 hours to prevent hormone release from the thyroid.
Methimazole (Tapazole)	Antithyroid medication	Same as above.	Monitor vital signs, weigh the client weekly, observe for throat soreness, fever, headache, and skin ulcers.
Iodine product, strong iodine (Lugol‘s solution)	Used to decrease the potential for a thyroid storm, which is an abrupt release of thyroid hormone	Same as above.	Bitter to taste, give with fruit juice.
SSKI (saturated solution of potassium iodide)	Used to treat and prevent thyroid storm	Same as above plus: metallic taste, stomatitis, salivation, coryza, hyperthyroid adenoma, irregular heart rate, and mental confusion.	Signs of hypothyroidism might necessitate discontinuation.
Potassium iodide tablets, solution, and syrup	Used to treat iodide deficiency that can lead to a goiter	Same as above.	Take after meals to increase absorption.
Lithium carbonate (Lithobid, Carbolith, Lithizine)	Used to treat hyperthyroidism	Dizziness, lethargy, drowsiness, fatigue, slurred speech, psychomotor retardation, incontinence, EEG changes, arrhythmias, hypotension, impaired vision, thyroid enlargement, dry mouth, abdominal pain, pruitus, and thinning hair.	Observe for hypothyroidism. Instruct the client to drink 8–12 glassfuls of fluids per day. Instruct the client to maintain adequate sodium intake to prevent toxicity.
Propanolol (Inderal, Detensol)	A beta blocker used to treat hyperthyroidism	Bradycardia, edema, lethargy, and bone marrow suppression.	Monitor pulse rate, CBC, and for signs of congestive heart failure. Take with food to decrease GI upset.
Atenolol (Tenormin)	Same as above	Same as above.	Same as above.
Levothyroixine (Levo-T, Levothroid, Levoxyl, Levothyroixine Sodium, Synthyroid)	Used to treat hypothyroidism	Tachycardia, nausea, vomiting, diarrhea, and insomnia.	Check pulse rate routinely.
Bromocriptine (Alphagen, Parlodel)	Used to treat parkinsonism or for prolactinomas	Hypotension, nausea, vomiting, blurred vision, dry mouth, urticaria, and fatigue.	Watch for orthostatic hypotension. Should not be used by pregnant clients. Dizziness, headaches, abnormal vision, constipation, hot flashes, and parathesia. Check serum prolactin levels <20mcg/liter in women or <1 5 mg.
Sulfonylureas
Carbergoline (Dostinex)	Used to treat prolactinomas; inhibits prolactin secretion	May cause headaches, depression, nervous- ness, and fatigue. Dysmenorrhea and facial flushing has also occurred.	Do not use with clients with liver disease.
Glimepride (Amaryl)	Used to treat hyperglycemia; works by increasing effects of client‘s own insulin	Hypoglycemia, watch for renal function.	Teach the client to watch for hypoglycemia, GI disturbance, allergic skin reactions, and photosensitivity. Take once daily before meals.
Glyburide (Micronase, Diabeta, glynase)	Same as above	Same as above, plus may cause gastrointestinal disturbance.	Watch for hypoglycemia. Take in divided doses.
Glipizide (Glucotrol, Glucotrol XL)	Same as above	Same as above.	Watch for hypoglycemia. Take before breakfast. Doses above 15mg should be divided. Glucotrol XL is long-acting, given one time per day.
Antidiabetic Medications—Meglitinides
Repaglinide (Prandin)	Used to treat hyperglycemia	May lead to hypoglycemia.	Watch for hypoglycemia. If NPO, withhold medication.
Antidiabetic Medications—Biguanides
Metformin (Glucophage)	Used to treat hyperglycemia; works by decreasing carbohydrate breakdown in the GI tract	Renal impairment, gastrointestinal upsepo, nausea, and vomiting.	Watch for hypoglycemia. Can cause GI disturbance, B-12 deficiencies, lactic acidosis, malaise, and respiratory dis-tress. Contraindicated in renal disease clients, liver disease, and congestive heart failure. Clients going for radiographic studies should have gluco-phage withheld for 48 hours or until renal function returns.
Antidiabetic Medications—Thiazolidinedione
Rosiglitazone (Avandia)	Used to treat hyperglycemia; works by decreasing carbohydrate breakdown in the GI tract	Abdominal pain, nausea, vomiting, anorexia, and hypoglycemia.	Watch for hypoglycemia. Clients with liver or renal disease should not take this drug. Monitor liver enzymes. It might decrease effects of oral contraceptives. Watch for signs of congestive heart failure.
Alpha-glucosidase inhibitor—Acarbose (Precose)	Used to treat hyperglycemia associated with diabetes	Flatulence, diarrhea, and abdominal discomfort.	Watch for hypoglycemia. Take with first bite of food. Contraindicated in clients with liver disease, inflammatory bowel disease, or renal disease.
Invokana (canagliflozin)	Used to treat hyperglycemia associated with diabetes. Works by decreasing renal reabsorption of glucose and increasing renal excretion of glucose.	Check renal function	Watch for hypoglycemia; Hypotension can occur with use. Watch for signs of hyperkalemia. Might cause a rise in cholesterol.
Insulins
Lispro (Humalog)	Onset five minutes, so have food available; peak 30–60 minutes; duration 2–4 hours; used to treat uncontrolled diabetes	Hypoglycemia	Watch for hypoglycemia.
Regular insulin	Onset 30–60 minutes; peak 2–4 hours; duration 6–8 hours	Hypoglycemia	Watch for hypoglycemia.
Intermediate-Acting Insulins
NPH	Onset 1–2 hours; peak 6–12 hours; duration 18–24 hours	Hypoglycemia	Watch for hypoglycemia.
Humulin N	Same as above	Hypoglycemia	Watch for hypoglycemia.
Humulin L	Same as above	Hypoglycemia	Watch for hypoglycemia.
Long-Acting Insulins
Ultra Lente	Onset 5–8 hours; peak 14–20 hours; duration 30–36 hours	Hypoglycemia	Watch for hypoglycemia.
Lantus	No peak; duration 24–36 hours	Hypoglycemia	Watch for hypoglycemia. Do not mix with other insulins. Usually given at night; however, the FDA has recently approved administration during the day.
Combination Insulins
Humulin 70/30	Onset 30 minutes; peak 4–8 hours; durations 22–24 hours	Hypoglycemia	Watch for hypoglycemia.
Humulin 50/50	Onset 30 minutes; peak 4–8 hours; durations 22–24 hours	Hypoglycemia	Watch for hypoglycemia.
Exubera	An inhaled form of insulin recently released and approved by the FDA; delivers insulin directly into the lungs; rapid onset; duration several	Hypoglycemia	Watch for hypoglycemia.

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