Endocrine Conditions - NCLEX-PN

Peripheral neuropathy is a common condition among elderly diabetic patients. Due to the loss of sensation in fingers, arms, legs, and toes, these patients must be aware of their surroundings, use proper foot care, inspect feet daily (with a mirror if the patient is elderly or has decreased joint mobility), wear well-fitting shoes, avoid heating pads on feet, avoid walking barefoot, and cut toenails straight across without rounding corners. It is also important for the patient to avoid exercise when their condition is poorly controlled due to the increased demand for glucose. This patient must be sure to check the temperature of baths before using them, as the potential for burns is high in those with decreased sensation and neuropathy.

Cystic fibrosis is a disorder that mainly affects the lungs, but also alters fat metabolism from a lack of pancreatic enzymes. The disorder is treated with pancreatic enzyme replacement, which is best absorbed when taken before meals or with food. The best diet for cystic fibrosis is low-fat and cholesterol-restricted with good sources of protein, such as fruit, vegetables, lean meats, and cereals. These patients must avoid fatty, marbled meats such as bacon, fatty foods such as avocado, egg yolks, and butter. During illness, patients with cystic fibrosis have higher calorie and protein demands.

Patients with Addison’s disease are more susceptible to becoming dehydrated and may lose salts more quickly than others. Because of this, it is important to make sure these patients have a well-rounded diet with an emphasis on fluids. Protein, whole grains, and fibers are routinely recommended in a healthy, balanced diet, but it is not recommended to have a sodium-restricted diet.

The patient should refrain from ingesting any material that may contain sugar prior to a fasting blood glucose. However, is not necessary for a patient to be labeled NPO as they are still able to ingest water. All other preparations should be made.

The most characteristic sign of SLE is a butterfly rash across the bridge of nose and cheeks. The others listed are also signs and symptoms of SLE, but the most well-known sign that is specific to SLE is the butterfly rash. Arthritis and joint swelling, hematuria, lesions on extremities, and pain during exposure to cold (Raynaud’s phenomenon) may be signs of other diseases

The nurse should know the parathyroid glands regulate serum calcium levels; in hyperparathyroidism, serum calcium levels are elevated. Parathyroid hormones are not low in hyperparathyroidism due to the overactivity of the parathyroid glands. Urine calcium may be elevated due to spilling of the high serum calcium level into the urine. Vitamin D levels should be low, as the body will increase vitamin D in the blood to lower the calcium level.

The 5 year survival rate for aplastic carcinoma of the thyroid is 7-14%. The 5 year survival rates of papillary, medullary, and follicular thyroid carcinomas are close to 100% for stage I cancers. Survival rates decrease to approximately 50% for stage IV papillary and follicular carcinomas and 28% for stage IV medullary carcinoma.

Peripheral neuropathy is a common condition among elderly diabetic patients. Due to the loss of sensation in fingers, arms, legs, and toes, these patients must be aware of their surroundings, use proper foot care, inspect feet daily (with a mirror if the patient is elderly or has decreased joint mobility), wear well-fitting shoes, avoid heating pads on feet, avoid walking barefoot, and cut toenails straight across without rounding corners. It is also important for the patient to avoid exercise when their condition is poorly controlled due to the increased demand for glucose. This patient must be sure to check the temperature of baths before using them, as the potential for burns is high in those with decreased sensation and neuropathy.

Cystic fibrosis is a disorder that mainly affects the lungs, but also alters fat metabolism from a lack of pancreatic enzymes. The disorder is treated with pancreatic enzyme replacement, which is best absorbed when taken before meals or with food. The best diet for cystic fibrosis is low-fat and cholesterol-restricted with good sources of protein, such as fruit, vegetables, lean meats, and cereals. These patients must avoid fatty, marbled meats such as bacon, fatty foods such as avocado, egg yolks, and butter. During illness, patients with cystic fibrosis have higher calorie and protein demands.

Patients with Addison’s disease are more susceptible to becoming dehydrated and may lose salts more quickly than others. Because of this, it is important to make sure these patients have a well-rounded diet with an emphasis on fluids. Protein, whole grains, and fibers are routinely recommended in a healthy, balanced diet, but it is not recommended to have a sodium-restricted diet.

Type I diabetes is an autoimmune process that typically presents in young children in the form of DKA (diabetic ketoacidosis). This potentially life threatening condition is treated with IV insulin. Type II diabetes is insulin resistance, and is found in older adults (typically those who are overweight).

All of these symptoms are associated with a higher risk of developing diabetes. Turner syndrome is also know as XO, where the individual is a female, and is monosomic for the X-chromosome. Individuals with Turner syndrome are also at higher risk of heart disease, and hypothyroidism, and they are sterile. Down's syndrome is caused by trisomy of chromosome 21, and involves elevated risks for mental impairment, heart disease, and certain cancers. Kleinfelter's syndrome patients have the XXY-chromosomal expression. They are at a higher risk than the classically male or female public for osteoporosis, hypogonadism, and cardiovascular disorders.

80% of cases of Cushing's disease are caused by adrenocorticotropic hormone (ACTH)-secreting adenomas of the anterior pituitary. High ACTH ends up causes adrenal hyperplasia, which leads to secretion of extra cortisol. Corticosteroid use is the leading cause of Cushing syndrome, rather than Cushing's disease.

Smokers have higher levels of the chemical thiocyanate, a degradation product of cyanide in tobacco smoke, which can block iodine uptake by the thyroid. A high oxalate diet is associated with kidney stones, asbestos exposure is associated with mesothelioma, and nonsteroidal anti-inflammatory drugs (NSAIDs) use, while associated with several gastric disorders, has not been shown to have a significant effect on thyroid function.

Primary hyperparathyroidism is most commonly due to a parathyroid adenoma. 80-90% of cases of primary hyperparathyroidism are due to parathyroid adenoma. 10-15% cases are due to parathyroid hyperplasia, and parathyroid carcinoma accounts for 1-5% of all cases.

Insulin activates sodium-potassium ATPase in skeletal muscle cells causing an influx of potassium. Under certain circumstances, an incorrectly administered injection of insulin may kill patients due to its ability to acutely suppress plasma potassium concentrations.

GLUT-2 is the primary carrier for glucose transport into pancreatic beta cells. It does not depend on insulin to function. It thus aids the pancreatic beta cells sense glucose levels in the blood, which are then triggered to release insulin. GLUT-4 is active primarily in adipose and muscle tissue.

The first onset of diabetes is generally marked by the following three signs: polyuria - frequent urination, polydypsia - increased thirst & fluid intake, and polyphagia - increased appetite. In children with type 1 diabetes, enuresis (involuntary urination) is often the first sign noticed by parents, along with unexplained weight loss and recurrent infections.

Conn syndrome (primary hyperaldosteronism) is hypertension due to elevated levels of aldosterone. High aldosterone causes excretion of potassium and retention of sodium, which leads to water retention and increase in blood pressure. While elevated levels of vasopressin (antidiuretic hormone) would also cause hypertension, Conn syndrome refers to the hypersecretion of aldosterone.