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Problem Based Learning in Endocrine Nursing

Instruction: This is an INDIVIDUAL ACTIVITY; credit will be given to

your class standing. The following situation is based on a client with

Endocrine disorder. Present a pathophysiology of the condition to justify

the manifestation and your management to your client. Write your answer in

a legal size bond paper, double space, hand written. Due to technical

problem, deadline of submission is move to on or before JULY 13, 2009

1:00 oclock in the afternoon at the NURSING Office or at the

Diagnostic Laboratory. Submit your paper to the INSTRUCTOR

concern.

Case A

A young woman presents with complaints of palpitations, insomnia, weight lossand irritability. She further reveals heat intolerance and increased swelling.Physical examination reveals hand tremor, a pulse of 110, and a smoothlyenlarged thyroid. Her T4 level is twice normal.

1. What is the differential diagnosis of the patient's condition?

2. What investigations would you order to determine the cause of the patient'sproblem?

3. What are the options in treatment for each of these diagnoses and theadvantages and disadvantages for each?

4. What is thyroid storm? What are the clinical features? How would you treatthe problem?

5. How would you prepare a patient with hyperthyroidism for surgery?

6. What is the rationale for administering high-dose iodine to hyperthyroid

patients two weeks prior to surgical removal of the thyroid gland?

7. In a normal thyroid, if a person is not able to ingest the daily dietary iodinerequirement temporarily, will he develop signs of iodine deficiency right away?What other sources of organic iodine does the thyroid use to form additionalthyroid hormones?

8. Does the presence of goiter also signify the presence of hyperthyroidism? Isgoiter always associated with hyperthyroidism?

Case B

A 35 year old man has blood chemistries drawn at the time of a yearly physicalexamination. His calcium was noted to be elevated and a parathyroid hormone level is

increased.

1. Compare and contrast between primary, secondary and tertiaryhyperparathyroidism in terms of the following:

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a. Disease condition

b. Sign and symptoms/manifestation

c. Nursing Diagnosis(rank based on priority)

d. Nursing Management

e. Medical Management

2. What is the difference between parathyroid adenoma and hyperplasia and howmay this affect the surgical treatment? What is your Nursing intervention/Responsibility pre-operative and post-operative?

3. What calcium management orders would you write for a patient who has hadparathyroid surgery and why?

Case C

Juanito Haber, has ahd type 1 diabetes for 15 years. He has just been admittedto the hospital with severe pyelonepritis, a kidney infection. He had infection for aweek and has developed mild ketoacidosis because of the infection. Analysis ofarterial blood gases indicates that his serum bicarbonate level is low and hisserum pH is just below normal range.

1. Describe the pathophysiology of type 1 diabetes.

2. Explain why urinary tract infections are common in people with diabetes. Explain

how acute renal failure could develop.

3. Explain why infection may lead to ketoacidosis.

4. Describe the characteristic of Juanito Haber respiratory that could expect to

observe while ketoacidosis is present. Include the rationale for your answer.

5. If Juanito Haber serum pH continues to decrease below normal, how would that

pH affect cell and organ function?

6. Juanito Haber is voiding large volumes of urine (polyuria). Explain the reason for

this.

7. Describe three sign of excessive fluid loss.

8. Juanito Habers vision has deteriorated in the last 3 years because of retinopathy.

Explain how retinopathy impairs vision.

9. Describe two problems related to diabetes that Juanito Haber might encounterbecause of his reduced vision. What will be your priority Nursing Diagnosis and

your Nursing Management?

Case D

Ryan Depollo was diagnosed with type 2 diabetes Mellitus at age 46. At this time, he was

overweight, enjoyed foods with high carbohydrate and fat content and led a sedentarylife. His family history indicated that his mother and his brother had diabetes. Weight

loss, appropriate diet and exercise were recommended to reduce blood glucose levels.

1. List the factors contributing to diabetes mellitus in this case.

At age 50, Ryan Depollo noticed that his vision was cloudy, particularly in one eye.Cataracts were removed from both eyes.

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2. Describe a cataract and explain how diabetes promotes cataract formation.

3. Glyburide (Diabeta) was prescribed at this time. Describe the action of this drug(Indication, Contraindication, Adverse Effect and Nursing responsibility).

At age 56, a blister developed on the heel of one feet, which did not heal. An ulcer

formed and persisted. Finally the foot was placed in a cast for 13 weeks to promotehealing.

4. Explain several factors contributing to the delayed healing in Ryan Depollo.

5. Why was it necessary in this case, to remove the cast and replace it each week?

Peripheral neuropathy with total loss of sensory function had developed in both feet.

Motor function was not directly affected. Orthopedic shoes were ordered and

arrangements made for a podiatrist to provide regular foot care.

6. Why is it essential that Ryan Depollo examine his feet carefully each day?

At this time body weight had again increased substantially and blood pressure was

elevated. Fosinopril (Monopril) was prescribed, a long with recommendations for weight

loss and regular exercise.

7. Describe the usual manifestation of hypertension based on the development of

diabetes mellitus type 2.

At age 60, routine monitoring during a workout at the health club indicated atrial

fibrillation. During consultation, the cardiologist also noted his blood pressure was very

high.

8. State the Indication, Contraindication, Adverse Effects and your Nursingresponsibilities in the following:

A. Fosinopril (monopril)

B. Atorvastatin (Lipitor)

C. Amlopidine (Norvasc)

D. Warfarin (Coumadin)

E. Sotalol (Sotacor)

Which of the following drugs is best to manage the blood pressure of the client?

Since that time, continued regular exercise and dietary modification have maintained

weight at recommended levels. Blood pressure is within normal range, HbA is below 7

and atrial fibrillation is controlled.

9. What does this HbA value mean?

10. Why does Ryan Depollo bruise easily? What precautions would be advisable atthis time?

11. Briefly review the effects of diabetes over time in this case.