Please help me!!!

[Hischild777, ADN]

Hello everyone. I am 3 semester nursing student, and I need help! I have a test on sensory and endocrine. Does anyone out there have any suggestions that may help me. Websites? Anything that helped you, I am sure will help me! If anyone has any notes, outlines, or study guides please let me know! I will be so thankful! GOD BLESS YOU!!!!

[MassED, BSN, RN]

Hello everyone. I am 3 semester nursing student, and I need help! I have a test on sensory and endocrine. Does anyone out there have any suggestions that may help me. Websites? Anything that helped you, I am sure will help me! If anyone has any notes, outlines, or study guides please let me know! I will be so thankful! GOD BLESS YOU!!!!

sensory, be more specific, please. Endocrine, what do you need assistance with, exactly?

[pinkiepie_RN]

http://www.nlm.nih.gov/medlineplus/endocrinesystem.html - MedLine is usually a pretty good resource.

http://www.emedicine.com/endocrinology/index.shtml - EMedicine is also great.

I'm assuming by sensory you mean neuro. There are some great neuro links on both of those websites as well. Sometimes if I don't understand something, I google it and see what comes up. I may need to see some things a few times and explained a little differently before I finally "get" it, so the internet is definitely my friend. Good luck with your exam and don't forget that flashcards of terminology or signs/symptoms of diseases can be really helpful!

[MassED, BSN, RN]

the school that you are going to, do you have access to your college's online library? That is a great resource and you will find it to be very helpful as well. It will provide you access to article and information that is not accessible otherwise - such as netlibrary.com, my favorite.

[suzy253, RN]

http://www.endocrineweb.com/index.html

[Daytonite, BSN, RN]

i listed a whole bunch of links to websites on subjects related to the endocrine system on post #5 of this older thread:

• https://allnurses.com/forums/f50/enodcrine-system-help-157629.html - enodcrine system - help!

there are anatomy and physiology weblinks listed on post #45 of this sticky thread:

• https://allnurses.com/forums/f205/pathophysiology-p-fluid-electrolyte-resources-145201.html - pathophysiology/ a & p/ microbiology/ fluid & electrolyte resources

for assessment information of the endocrine and sensory system see:

• http://medicine.ucsd.edu/clinicalmed/introduction.htm
  
• http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/pd/contents.htm
  
• also, see the various weblinks on this sticky thread: https://allnurses.com/forums/f205/health-assessment-resources-techniques-forms-145091.html - health assessment resources, techniques, and forms

for information on specific diseases, search the webites listed on this thread:

• https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html - medical disease information/treatment/procedures/test reference websites

[bsugar888]

Medline plus has some good information.

[Esther2007]

- what are cushing’s syndrome, addison’s disease, diabetes insipidus and syndrome of inappropriate adh, giantism, and acromegaly?

o cushing’s syndrome is a chronic disorder in which hyper function of the adrenal gland cortex produces excessive amounts of circulating cortisol or acth.

o addison’s disease is a disorder resulting from destruction or dysfunction of the adrenal cortex. the result is chronic deficiency of cortisol, aldosterone, and adrenal androgens, accompanied by skin pigmentation.

o diabetes insipidus is a result of adh insufficiency; also a complication of a closed head trauma with increased icp. there are 2 kinds:

neurogenic di can either result from a disruption of the hypothalamus and pituitary gland (as from trauma, irradiation, or cranial surgery), or be idiopathic.

nephrogenic di is a disorder in which the renal tubules are not sensitive to adh. this may be familial in origin or the result of renal failure.

o syndrome of inappropriate adh secretion (siadh) is characterized by increased levels of adh in the absence of serum hypo-osmolality. this disorder is most often caused by the ectopic production of adh by malignant tumors.

o gigantism occurs when gh hypersecretion begins before puberty and the closure of the epiphyseal plates.

o acromegaly “enlarged extremities” occurs when sustained gh hypersecretion begins during adulthood, most commonly because of pituitary tumors. as a result of constant stimulation, bone, and connective tissue continue to grow.

- what are the clinical manifestations of these diseases?

o cushing’s syndrome: muscle weakness, muscle wasting, osteoporosis, this easily bruised skin, skin infections, ecchymosis, poor wound healing, purple striae (around thighs, breasts, and abdomen), hirsutism, psychoses, emotional lability, peptic ulcers, htn, renal calculi, polyuria, polydipsia, glycosuria, hypokalemia, hypernatremia, truncal obesity, oligomenorrhea or amenorrhea, impotence, decreased libido.

o addison’s disease: delayed wound healing, hyperpigmentation, postural ypotension, tachycardia arrhythmias, lethargy, tremors, confusion, emotional lability, weakness, muscle wasting, joint and muscle pain, anorexia, diarrhea, nausea and vomiting, menstrual changes, hyperkalemia, hyponatremia, hypoglycemia.

o diabetes insipidus: excretion of large amounts of dilute urine (polyuria), polydipsia, dehydration and hypernatremia occur is patient is unable to replace lost h2o.

o siadh: occurs as a result of water retention, hyponatremia, and serum hypo-osmolality. blood volume expands, but plasma is diluted. aldosterone is suppresses; renal excretion of sodium increases. headache, loc changes, muscle twitches, seizures, usually no edema.

o gigantism: person becomes abnormally tall, often exceeding 7 feet, but body proportions are relatively nl.

o acromegaly: as a result of constant stimulation, bone and connective tissue continue to grow. forehead enlarges, maxilla lengthens, voice deepens. overgrowth of bone and soft tissue in the hands and feet cause clients to buy increasingly larger rings, gloves, and shoes. peripheral nerve damage from entrapment of nerves, headache, htn, chf, seizures, and visual disturbances. impaired glucose tolerance and diabetes may occur.

- how are these diseases diagnosed?

o cushing’s syndrome: plasma cortisol levels are measures. plasma acth levels are measured to determine the etiology of the syndrome. 24 hour urine tests (17 ketosteroids and 17 hydroxy-corticosteroids) are conducted to measure free cortisol and androgens; these hormones are increased in cushing’s syndrome. serum potassium, calcium, and glucose levels are measured to identify electrolyte imbalances. acth suppression test may be conducted to identify the cause of the disorder.

o addison’s disease: serum cortisol levels decrease during adrenal insufficiency as well as blood glucose levels and serum sodium levels. serum potassium levels increase in adrenal insufficiency as well as bun. urinary 17 hydroxycorticoids and 17 ketosteroids decrease in adrenal insufficiency. plasma acth levels increase in primary adrenal insufficiency and decrease in secondary adrenal insufficiency. possibly acth stimulation test. ct scans of the head identify any intracranial lesion impinging on the pituitary gland.

- what medications are used and why and what are the nursing implications of using these meds?

o mitotane: directly suppresses activity of the adrenal cortex and decreases peripheral metabolism of corticosteroids.

o metyrapone (ketoconazole): inhibit cortisol synthesis by the adrenal cortex and may be administered to patients with ectopic acth secreting tumors that cannot be surgically removed.

o corticosteriods

o pitressin (vasopressin): inhibits urine production by causing the renal tubules to reabsorb water from the urine and return it to the circulating blood.

- what is addisonian crisis and how is it treated?

o addisonian crisis is a life-threatening response to acute adrenal insufficiency. treatment of the crisis is rapid iv replacement of fluids and glucocorticoids.

- what teaching is done for each of these patients?

o cushing’s syndrone: safety measures to prevent falls if fatigue, weakness, and osteoporosis are present. taking meds as prescribed – these patients often require meds for the rest of their lives. having regular med assessments. med alert bracelet.

addison’s disease: importance of continuing healthcare.

diabetes

• type i diabetes
  • insulin dependent
    
  • usually kids
    
  • no insulin produced ~ need outside source of insulin
    

  [*]type ii diabetes

  • usually developed later
    
  • because of obesity
    
  • 40+ y/o
    
  • sedentary lifestyle
    
  • familial tendency
    
  • average age 50 years
    
  • fatigue
    
  • decreased energy
    
  • recurrent infections
    
  • may be able to control with exercise and diet
    
  • usually put on hypoglycemic drugs
    • glucophage
      • side effects are very blurry vision and stress eating

  [*]gestational diabetes

  • women develop diabetes during pregnancy
    
  • many will develop type ii later in life

  [*]labs to dx diabetes

  • fasting blood sugar
    • 70-110 is nl
      
    • *fasting bg
    • random bg of 200+ ~ classified as diabetic and treat accordingly

    [*]2 hr. glucose tolerance test

    • take fasting bg
      
    • if 200+ ~ diabetic

    [*]hgb a1c should be less than 7%

  [*]meds that lower blood sugar

  • nsaids
    
  • sulfa drugs

  [*]meds that higher blood sugar

  • cortisone drugs
    
  • some birth control
    
  • calcium channel blockers

  [*]hypoglycemic drugs can cause birth defects in babies

  [*]common side effect of zantac or ranitidine is hypoglycemia

• insulin
  • provided because pancreas isn’t producing it
    
  • given at 45-90 degree angle (depends on patient’s size)
    
  • ***extremely rare to see nph given on day of surgery
    
  • regular = humulin
    • good for 1 month (30 days) out of the fridge
      
    • clear

    [*]nph

    • cloudy

    [*]need is higher during surgery

    [*]the heavier you are, the more insulin you need

    [*]sweeteners (nutra sweet and equal) are ok as substitutes

    [*]no etoh!!!!!

    • may need to increase insulin to cover drinks at celebrations (wedding)

  [*]sick day of a diabetic

  • continue to take insulin as scheduled
    
  • do smbg every few hours
    
  • call md if vomiting 24+ hours of if bg decreased ~ md will usually have patient come in and give 1-2 l d5w
    • also check urine for ketones

  [*]chem. strips come in a brown bottle because of exposure to light ~ make sure bottle is closed tightly!!!

  [*]exercise guide for diabetic fitness

  • frequency
    • 3x/week

    [*]intensity

    • 60-80% of maximal heart rate

    [*]time

    • aerobic activity for 20-30 minutes with 5 minute warm-up

  [*]what would you tech patient if you only have 5 minutes (about diabetes)?

  • s/s of hypoglycemia

  [*]**do not cut blood glucose strips in half

• diabetic ketoacidosis (dka)
  • usually when bg 250 or higher
    
  • usually results in metabolic acidosis
    
  • increased temperature
    
  • *onset slow ~ usually 4-10 hours
    
  • breath smells like juicy fruit gum
    
  • very tachycardic
    
  • hypotension
    
  • increased bg
    
  • *hypokalemia ~can go into cardiac arrest and arrhythmias
    
  • electrolytes initially nl and slowly fall over time
    
  • ph usually less than 7.35
    
  • plasma bicarbonate usually less than 5 meq

  [*]labs that will be elevated

  • hct
    
  • hgb
    
  • bun
    
  • creatinine
    
  • serum osmolality

  [*]probably give insulin via iv

  • frequent bg checks

• hyperosmolar ~ non-ketotic
  • see in patient with type ii diabetes
    
  • bg at least 600+
    • can very commonly be 1000+

    [*]if patient not cared for, can have altered loc of loss of consciousness and go into coma

  [*]caused by:

  • surgery
    
  • stress on body
    
  • infection
    
  • gi upset
    
  • dehydration

  [*]can happen to people on tpn (total parenteral nutrition)

  [*]*slow onset ~ 1 day to a couple weeks

  [*]problems with: (they start out nl and slowly fall

  • electrolytes
    
  • sodium
    
  • potassium

  [*]assessment

  • severely dehydrated
    
  • very dry skin
    
  • very thirsty
    
  • altered loc

  [*]interventions

  • rehydrate very quickly
    
  • regular insulin only!!!
    
  • electrolyte replacement
    
  • check vs’s
    
  • hyperthermia (???)
    
  • i/o
    
  • go over s/s of hyper and hypo glycemia with patient to prevent another incident

• hypoglycemia
  • below 60
    
  • tired
    • tachycardia
      
    • irritability
      
    • restless
      
    • excessive hunger
      
    • diaphoresis
      
    • depression

    [*]anxious

    [*]headache

    [*]blurred vision

    [*]shaky

  [*]usually caused by

  • taking excessive amount of insulin
    
  • increased/excess exercise
    
  • insufficient food

  [*]*onset rapid ~ 1-3 hours

  [*]if bg less than 60, usually take 15mg carbs & take bg again in 15 minutes

  • if it didn’t go up, eat exactly what you just ate and take bg again

  [*]for severe hypoglycemia, you can give

  • 50% glucose via iv
    
  • glucagons (iv or sq)
    • re-check bg and you may give another dose

  [*]patient should keep with them

  • glucometer
    
  • syringes
    
  • insulin
    
  • something to eat

• metrovascular
  
• diabetics are at risk for:
  • stroke
    
  • heart attack
    
  • peripheral vascular disease (legs)

  [*]women usually don’t have same symptoms as men when having a heart attack

  [*]women need complete physical exam q6mo

  [*]slower recovery time for diabetic

  [*]more apt to slurred speech and decreased vision

  [*]peripheral vascular disease (pcd)

  • arteries/veins in legs not working properly
    
  • palpate pedal pulses
    • listen with doppler if you don’t feel pedal pulses

  [*]prevention and tx

  • exercise
    
  • take meds
    
  • eat appropriate diet
    
  • get down to nl body weight

  [*]diabetic retinopathy

  • new vessels sprout from old vessels
    
  • usually with type i starts within 5-15 years after dx
    
  • clot
    
  • vessels constricted
    
  • can end up with detachment of retina if not picked up quickly
    
  • *for diabetics get eyes checked q6mo by ophthalmologist
    
  • can go blind if not corrected
    
  • can resume adl’s within a day or so if get argon laser

  [*]diabetics apt to develop glaucoma and cataracts sooner

• neprhopathy
  
• diabetics more apt to develop kidney infection if hyperglycemic
  • lot of yeast infections causes risk

  [*]usually end up with esrd ~ type i diabetes

  • 24 hour urine
    
  • albumin

  [*]take appropriate meds to bring htn down

  [*]affect ns

  [*]*people may have no feeling in feet

  [*]*can be presented as burning or tingling sensation

  [*]* very careful foot care!!*

  • recommend to wash with warm h2o and mild soap
    
  • pat dry ~ no rubbing
    
  • dry inbetween toes
    
  • put lotion on feet but not inbetween toes
    
  • wear closed shoes (toe and heal)
    
  • wear white wool or cotton socks (natural fibers that absorb fluids)
    
  • be sure shoes fit well
    
  • use mirror to check bottom of foot
    
  • *most diabetics will usually end up with amputation
    
  • if patient has corns or calluses ~ see podiatrist ~ don’t do self care!!!
    
  • cut nails straight across (to prevent ingrown nails)

• surgery for patients with diabetes
  
• ½ to 2/3 or regular dose of insulin (depends on person, type of surgery, liquids being given)

**make sure order is for regular insulin