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 / Clinical Objectives / Learning Opportunities
  1. Apply the terms listed in the content column appropriate to the client’s situations.
/
  1. Application of terms
  2. Adrenal cortex
  3. Amyloidosis
  4. Cretinism
  5. Endocrine glands
  6. Exopthalmus
  7. Hashimoto’s thyroiditis
/ Identify short and long-term goals/outcomes, select interventions, and establish priorities for care in collaboration with the client.
Use current technology and evidence-based information to / Readings:
Lewis 8th ed (2011)
Adams 3rd ed (2011)
McKinney 3rd ed (2009)
  1. Compare and contrast the normal anatomy and physiology to the pathophysiology of the selected disease processes in the endocrine system across the lifespan.
/
  1. Anatomy and physiology of the endocrine system
  2. Developmental considerations
  3. Infant
  4. Child
  5. Adolescent
  6. Adult
  7. Older adult
  8. Pathophysiology of the endocrine system.
/ 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
  1. Analyze factors included in the assessment of the client experiencing selected complex problems of the endocrine system, including the developmental and cultural considerations.
/
  1. Endocrine system assessment
  2. Interview
  3. Chief complaint
  4. History of present illness.
  5. Prior medical history
  6. Medication history (prescription/non-prescription)
  7. Family/social/occupational history
  8. Knowledge of health maintenance
  9. Identify risk factors endocrine disease.
  10. Physical exam
  11. Eyes
  12. Level of consciousness
  13. Vital signs
  14. Body shape
  15. Skin/hair/nails
  16. Muscle weakness/wasting
  17. Hydration status/I&O
  18. Weight gain/loss
  19. Fatigue
  20. Menstrual disturbance
  21. Sleep pattern
  22. Respiratory status
  23. Bowels
  24. Diagnostic tests
  25. Radiology
  26. Thyroid scan
  27. Radioactive iodine uptake
  28. Computerized axial tomography (CT)
  29. Magnetic resonance imaging (MRI)
  30. Sonogram
  31. Laboratory studies
  32. Serum T4
  33. Serum T3
  34. T3 resin uptake
  35. Thyroid Stimulating Hormone (TSH)
  36. Cholesterol
  37. Muscle enzymes
1)ALT
2)SGPT
3)LDH
4)CK
  1. Urine osmolality
  2. Urinalysis
  3. Electrolytes
  4. Blood glucose
  5. White blood cell count (WBC)
  6. Cortisol
  7. 17 hydroxycorticosteroids
  8. ACTH stimulation
  9. Dexamethasone suppression
  10. 17 ketosteroids
  11. ACTH radioimmunassay
  12. Renin level
  1. Other
  2. Achilles tendon reflex
  3. ECG
  4. Fluid Challenge Test
  1. Cultural influences
  2. Hereditary
  3. Environmental
  4. Health beliefs/practices
  5. Developmental
  6. Age specific assessment data
  7. Muscle tone
  8. Vital signs
  9. Fluid/electrolytes
  10. Height, body structure
  11. Nutritional
  12. Behavioral/emotional response to health care providers
/ 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.
  1. Differentiate between the etiology, pathophysiology, and clinical manifestations of selected complex endocrine problems.
/
  1. Selected complex endocrine problems
  2. Thyroid
  3. Hyperthyroid
  4. Hypothyroid
  5. Diabetes insipidus
  6. Syndrome of Inappropriate Diuretic Hormones (SIADH)
  7. Addison’s disease
  8. Cushing’s disease

  1. Discuss analysis, planning implementation and evaluation for the nursing management of clients with selected complex endocrine problems.
/
  1. Selected nursing diagnoses/implementation/ evaluation
  2. Altered thought processes
  3. Independent interventions
  4. Level of awareness assessment
  5. Age related hydration status
  6. Intake & output
  7. Monitor pertinent diagnostic tests
  8. Maintain skin integrity
  9. Orient to time, place, date and events
  10. Provide appropriate stimulation
  11. Teach about change in cognitive processes
  12. Fall/safety precautions
  13. Collaborative interventions
  14. Administer replacement fluids
1)Oral
2)IV
  1. 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
  1. Restraints
  1. Recognition of complications
  2. Excessive vasoconstriction
  3. Chronic rhinopharyngitis
  4. Lipodystrophy
  5. Dehydration
  6. Addisonian crisis
  7. Coma/death
  8. Psychosis
  9. Osteoporosis
  10. Peptic ulcer
  11. Pancreatitis
  12. Hypertension
  13. Shock
  14. Metabolic alkalosis
  15. Impotence
  16. Sepsis/infection
  17. Impaired wound healing
  18. Body changes
  19. Skin/hair/nail changes
  20. Dysrhythmias
  21. Depression
  22. Hallucinations
  23. Thyrotoxic crisis
  24. Iodism
  25. The client will have improved thought processes as evidenced by:
  26. Oriented to person, place, time and events
  27. Demonstrate no sign and symptoms of dehydration
  28. Improved laboratory studies
  29. Stable vital signs
  1. High risk for postop complications
  2. Surgical modalities
  3. Adrenalectomy
  4. Thyroidectomy
  5. Intra-cranial surgery
1)Transsphenoidal hypophysectomy
  1. Independent interventions
  2. Review all pertinent assessments
  3. Nasal care/precautions
  4. I&O
  5. Vital signs
  6. Antiembolic stockings
  7. Ankle exercises; ROM
  8. Monitor IV/site care
  9. Position appropriate for surgery
  10. Wound assessment/care
  11. See NCP for pain
  12. Encourage activity as tolerated
  13. Deep breathing
  14. Safety considerations
  15. Monitor lab values
  16. Report unexpected observations
  17. Observe for thyroid crisis
  18. Collaborative interventions
  19. Administer medications and monitor for desired/effects/adverse effects/side effects
1)Antibiotics
2)Narcotics
3)Pain medication
  1. Recognition of complications
1)Hemorrhage
2)Infection/wound and systemic
3)Addisonian crisis
4)Delayed wound healing
5)Thyroid storm
  1. Community resources
1)Home Health
  1. 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

N:Spring\RNSG 2414 Unit IV-Endocrine System Reviewed 06/11