Endocrine Case Studies Make a copy of this google document and share with your peers in your group and myself. Work in groups to complete the answers. Make sure each group member contributes and makes their section a different font color. Have a key or state the student name with each question. Have thorough answers. Try to only reference your textbook, lecture notes, etc. Read your partner’s responses to learn from them as well. All responses need to be in by the calendar due date for credit. Case Study: Hyperthyroidism Casey is a 35 yr old female who comes into the clinic after not feeling well for 1 week. She complains that she feels jittery and shaky. She also is always warm and cannot stand the heat. The provider rules out menopause because Casey is young. The provider suspects hyperthyroidism. 1. What other symptoms will the provider look for in Casey to suggest a diagnosis of hyperthyroid disease? 2. What tests/diagnostics are performed to confirm the diagnosis? 3. The provider decides to treat conservatively using medications. List the drugs and explain the action of medication given to treat hyperthyroidism. 4. How will blood tests be used to follow and evaluate the effect of medication? Casey comes back for a follow up. Medication alone is not sufficient and so Casey is scheduled for surgery. 5. What are the surgical options for Casey? Explain assessment observations for possible postoperative complications from a thyroidectomy. 6. What post-operative teaching will Casey need? 7. What teaching topics are necessary to prepare Casey for life adjustment after thyroidectomy? Case Study: Hypothyroidism Peter, a 45 yr old male, has been dieting, exercising and trying unsuccessfully to lose weight. His hair is brittle and he is complaining of constipation. His nutrition counselor suggests that Peter makes an appointment with his provider. Whenever a person is overweight, they may ask the provider the question, “Do I have low thyroid function? 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”. 8. List the symptoms of low thyroid function. 9. What tests/diagnostics will confirm the diagnosis? 10. List the drugs and explain the action of medication given to treat hypothyroid disease. Explain the action of medication and side effects to be aware of. 11. How will blood tests be used to follow and evaluate the effect of medication? Peter for life adjustment with hypothyroid disease? Peter comes back in for a follow up appointment. He complains that his heart is racing, he has trouble sleeping and he is now experiencing diarrhea. 12. What does the nurse suspect is happening to Peter? What orders does the nurse anticipate now for Peter? Case Study: Hyper Secretion of Adrenal Gland – Cushing Disease 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 overproduction and hyper secretion of corticosteroid hormone. 1. List the symptoms of Cushing’s Syndrome. 2. What diagnostics can be used to determine John has Cushing’s? 3. How do we treat Cushing’s? Include the nursing considerations for the medications 4. 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? 5. How would we know the treatment was effective? John comes back to the clinic and is complaining of feeling sluggish and dizzy when standing up. 6. What does the nurse suspect is happening to John? 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. 1. List the manifestations of Addison’s Disease. 2. Explain the physiology responsible for the symptoms of Addison’s Disease 3. How do we diagnose Addison’s? 4. What is the treatment for Addison’s Disease? 5. List medications used to treat Addison’s Disease including the nursing considerations. Case Study: Diabetes Mellitus Emily Smith is a 53 year old woman who was diagnosed with Type 2 Diabetes Mellitus (T2DM) 6 months ago, during a routine workup for surgery. She is married and is mother of five children. They live on a farm, tending to be self-sufficient growing their veggies, some fruit and have chicken and cows. She takes no specific medication for her diabetes, and has been told by her PCP to ‘watch what she eats’. She has no other past medical history of note. Emily says tearfully “I have been trying to eat right and exercise, but I can’t walk because of the pain in my knee and I was feeling down and eating ice cream. I have hardly eaten anything in the last week because I am trying to lose weight and get my blood sugar down.” Her mother and older sister were both diagnosed with DM in their early 50’s. Emily’s fasting blood glucose level (BGL) was 229 and HbA1c: 11% [normal <6.5%]. She has been fasting since midnight. She notes that she is feeling quite "stressed" about an upcoming surgery. Emily is distressed that her blood glucose level is elevated and asks you for help in understanding her diabetes. She tells you that she has a friend who is very overweight, eats lots of cake and hardly ever exercises, and he does not have diabetes. 1. Describe the pathophysiology of DM type 2. Include in your answer risk factors for DM type 2. 2. What are the possible complications of DM? 3. Identify at least 2 reasons Emily's BGL is high on admission. Discuss how each reason you identify affects BGLs. Emily's PCP states that she will need to start on oral antidiabetics. Emily needs to be educated on the new medications. 4. What are some of the options for oral antidiabetic medications? Include the classifications and the nursing considerations for each medication. Emily's PCP also stated that she may have to have insulin as well in her recovery post surgery. 5. Fill in the chart regarding insulins INSULIN ONSET PEAK DURATION Rapid-acting: Humalog (Lispro) Short-acting: Regular (R) Intermediate: NPH (N) Novolin 70/30 Long-acting: Lantus (Glargine) Ultralente 6. Differentiate between DM type 2 and DM type 1. 7. The nurse calls the PCP and states Emily's BG was 275 prior to lunch. The PCP orders for 7 units of Regular insulin. The nurse administers the insulin at 1215. At what time would the nurse assess for signs and symptoms of potential hypoglycemia?
Hypertrophic Pyloric Stenosis Case Study
Mr. and Mrs. B arrive in the emergency department with their 5-week-old infant, S. B. As the triage nurse, you ask the couple why they have brought S. B to the ED. Mrs. B. states, “My baby breastfed well for the first couple of weeks, but has recently been throwing up all the time, sometimes a lot and really forcefully. He looks skinny and is hungry and fussy all the time.” You determine that the couple is homeless and has been living out of their car for the past month. S. B. has had no primary care since discharge after delivery.
1. What additional information will you need to obtain from Mr. and Mrs. B?
Your primary assessment of the infant reveals the following: S. B. is alert and fussy and consoles with a bottle of Pedialyte (per physician’s orders). His anterior fontanel is slightly depressed and posterior fontanel cannot be palpated. You auscultate regular breath sounds at a rate of 24 breaths/min. No adventitious sounds. Pulse oximetry is 98% on room air. Heart rate is 140 beats/min with regular rate and rhythm. Brachial and pedal pulses are +3 and equal. Abdomen is round and nontender to palpation. Positive bowel sounds. Diaper is dry. S. B. moves all extremities and there are no rashes noted. Rectal temperature is 98.9°F. There is a quarter-sized flat red area on occiput that “has been there ever since he was born” according to his mother. Slight “tenting” noted.
You transport S. B. to radiology and he vomits a large amount of clear fluid. Patient returns to the room in his mother’s arms, awake and alert. The mother appears anxious and states, “I don’t know what’s wrong with my baby! Why can’t you people tell me anything?”
2. Your institution uses electronic charting. Based on the assessment described, which of the following systems would you mark as abnormal as you document your findings? State your abnormal findings and provide a brief narrative with the abnormal finding.
3. The emergency physician orders a complete blood count, complete metabolic profile, urinalysis, blood pH, and x-rays. The physician suspects dehydration and metabolic alkalosis secondary to hypertrophic pyloric stenosis. Which of the laboratory findings would you expect with metabolic alkalosis?
a. Na: 128 mEq/L, K: 2.6 mEq/L, Cl: 90 mEq/L, HCO3: 28 mEq/L
b. Na: 130 mEq/L, K: 5.7 mEq/L, Cl: 94 mEq/L, HCO3: 22 mEq/L
c. Na: 130 mEq/L, K: 3.9 mEq/L, Cl: 98 mEq/L, HCO3: 17 mEq/L
d. Na: 148 mEq/L, K: 4.1 mEq/L, Cl: 108 mEq/L, HCO3: 13 mEq/L
4. What is the underlying cause of S. B.’s diagnosis of metabolic alkalosis?
5. Which of these clinical manifestations might you find with metabolic acidosis? Select all that apply.
a. Increased respiratory rate
c. Increased risk for seizures
e. Neuromuscular irritability
S. B. is diagnosed with hypertrophic pyloric stenosis, admitted to the pediatric unit and scheduled for surgery.
6. S. B.’s parents are concerned that their living situation contributed to S. B’s diagnosis. How would you respond to their concerns?
7. Which of the following preoperative orders would you question?
- Vital signs q 4h
- Strict intake and output (I & O)
- 30 mL Pedialyte q3 h PO
- Place IV and begin D51/3NS at 50mL/hr
- Nasogastric (NG) tube placed to low continuous wall suction
- Daily weights
8. You note that your patient was hypokalemic and the fluids you hung per doctor’s orders do not include potassium. You contact the surgeon to clarify. You receive the following order:
“Discontinue D51/3NS at maintenance and hang D51/3NS with 20 mEq KCL/L at maintenance.” You obtain the new fluids and hang per orders.