Endocrine System Disorders & Neurological Problems

What are some signs and symptoms of Hyperthyroidism?

• goiter

• sweating

• ophthalmopathy

• exophthalmos 

• insomnia

• nervousness

• tachycardia

What are some nursing actions and interventions for patients with Hyperthyroidism?

• monitor hormone balance periodically

• give meds when prescribed (antithyroid medications, radioactive iodine therapy, propranolol, beta blockers)

• monitor calcium if pt. gets thyroid removed

What are some patient teachings for Hyperthyroidism?

• tell pt. to increase caloric intake (4,000-5,000 cal/day)

• tell pt. to regularly exercise

• tell pt. to avoid high environmental temperatures

• tell pt. to increase protein intake (1 to 2 g/kg ideal body weight)

• tell pt. to increase carbohydrate intake

• tell pt. to avoid high fiber products and caffeine

What are some signs and symptoms of Thyrotoxic Crisis (Thyroid Storm)?

• severe tachycardia (HR >200)

• hyperthermia (up to 106 F)

• seizures

• delirium

• hypertension

What are some nursing actions and interventions for patients with Thyrotoxic Crisis (Thyroid Storm)?

• give meds when prescribed (PTU, Tapazole, Propranolol) 

• monitor for dysrhythmias

• ensure adequate oxygenation

• encourage and assist with exercise

• If exophthalmos is present:

  • apply artificial tears to relieve eye discomfort

  • restrict salt 

  • elevate HOB

  • tape eyelids shut if needed for sleep

  • ROM of intraocular muscles

What are some patient teachings for Thyrotoxic Crisis (Thyroid Storm)?

• tell pt. to wear dark glasses if exophthalmos occurs

• tell pt. they can tape their eyes closed in order to sleep

What are some signs and symptoms of Hypothyroidism?

• impaired memory

• weight gain

• cold intolerance

• husky voice

• thin, dry hair/skin

• thick brittle nails

• slow speech

• hypoglycemia 

What are some nursing actions and interventions for patients with Hypothyroidism?

• maintain euthyroid state

• give IV thyroid hormone replacement when prescribed

• skin care

• monitor VS, weight, I&Os, edema, energy levels, and mental alertness

• give levothyroxine (start low dose, monitor for chest pain, weight loss, tremors, insomnia; increase dose 4-6 week intervals prn based on TSH levels)

• Myxedema coma care:

  • cardiac monitoring

  • give IV thyroid hormone replacement when prescribed

  • monitor body core temperature

What are some patient teachings for Hypothyroidism?

• let pt. know that Levothyroxine is a lifelong therapy

• tell pt. to notify provider if chest pain, tremors, or insomnia occur

• tell pt. to not switch brands of meds

• tell pt. to do skin care to prevent skin breakdown

What are some signs and symptoms of Cushing Syndrome?

• tunical obesity

• moon face

• buffalo hump 

• supraclavicular fat pads

• thinning hair

• weight gain

What are some nursing actions and interventions for patients with Cushing Syndrome?

• Preoperative care:

  • control hypertension

  • control hyperglycemia

  • give high protein diet 

• Postoperative care:

  • morning urine sample to monitor cortisol levels

  • give cortisol through IV when ordered

What are some patient teachings for Cushing Syndrome?

• tell pt. they will need a home health nurse

• wear medical alert bracelet

• tell pt. to avoid high temperatures

• let pt. meds are lifelong replacement therapy

What are some signs and symptoms of Addison’s Disease?

• fatigue

• severe vomiting and diarrhea

• anorexia

• hypotension

• confusion 

What are some nursing actions and interventions for patients with Addison’s Disease?

• VS and neuro assessments

• daily weights, I&Os

• monitor for signs of Cushing

• monitor fluid and electrolyte status

• give high protein and carbohydrate diet

What are some nursing actions and interventions for patients with Addisonian Crisis?

• fluid resuscitation 

• give high-dose hydrocortisone when ordered

What are some patient teachings for Addison’s Disease?

• tell pt. to wear medical bracelet

• teach pt. how to administer IM hydrocortisone

• tell pt. to have emergency kit or written instructions 

• tell pt. to take mineralocorticoids once in the morning

What are some signs and symptoms of Hyperaldosteronism/ Conn’s Syndrome?

• sodium retention

• hypernatremia

• no edema

• HTN

What are some nursing actions and interventions for patients with Hyperaldosteronism/ Conn’s Syndrome?

• administer potassium-sparing diuretics, antihypertensives, oral potassium supplements

• restrict sodium 

• monitor electrolyte balance

• monitor cardiovascular status 

What are some patient teachings for Hyperaldosteronism/ Conn’s Syndrome?

• teach pt’ s/s of hypokalemia (fatigue, constipation, weakness)

• teach pt. s/s of hyperkalemia (numbness. tingling, n/v, shortness of breath, bradycardia) 

• tell pt. to rise slowly from laying down or sitting if on antihypertensives

What are some signs and symptoms of Type 1 Diabetes?

• weight loss

• weakness

• ketoacidosis

• polydipsia

• polyuria

• polyphagia 

• DKA (diabetic ketoacidosis)

  • hyperglycemia

  • ketosis

  • acidosis

  • dehydration

  • fruity breath

What are some patient teachings for all Diabetes?

• tell pt. insulin dose is based on carbs eaten 

• tell pt. to do moderate intensity aerobic exercise for about 150 minutes per week

• tell pt. to do resistance training 3 times per week

• tell pt. to monitor blood sugar

What are some signs and symptoms of Type 2 Diabetes?

• recurrent infections 

• recurrent vaginal yeast infection

• prolonged wound healing

• visual problems 

• Hyperosmolar hyperglycemia syndrome 

  • dehydration

  • confusion

  • dry mouth/tongue

What are some signs and symptoms of Gestational Diabetes?

newborn infant is large at birth

What are some signs and symptoms of Hypoglycemia?

• sweating

• anxiety

• shakiness

• palpitations

• dizziness

• blurred vision

What are some signs and symptoms of Hyperglycemia?

• polyuria

• fruity breath

• dry mouth

• shortness of breath

• polydipsia

• polyphagia

What is the peak for Rapid Acting Insulins?

• lispro (Humalog)

• aspart (NovoLog)

• glulisine (Apidra)

peak is 30 min - 3 hr

What is the duration for Rapid Acting Insulins?

• lispro (Humalog)

• aspart (NovoLog)

• glulisine (Apidra)

duration is 3-5 hr

What is the peak for Short Acting Insulins?

Regular insulin

• Humulin R

• Novolin R

peak is 2-5 hr

What is the duration for Short Acting Insulins?

Regular insulin

• Humulin R

• Novolin R

duration is 5-8 hr

What is the peak for Long Acting Insulins?

glargine (Lantus)

detemir (Levemir)

degludec (Tresiba)

there is no peak

What is the duration for Long Acting Insulins?

glargine (Lantus)

detemir (Levemir)

degludec (Tresiba)

duration is 16-24 hr

What are some nursing actions and interventions for patients with Increased Intracranial Pressure?

• Glasgow Coma Scale

• focused neuro assessment

• NIH stroke scale

• monitor vital signs

• monitor ICP

• monitor airway

• raise HOB 30 degrees

What are some nursing actions and interventions for patients with Bacterial Meningitis?

• manage pain/fever

• raise HOB to 30 degrees

• put pt. on droplet precautions (gown, gloves, mask with face shield)

What are some nursing actions and interventions for patients with Viral Meningitis?

• raise HOB 30 degrees

• initiate seizure precautions

• assess peripheral vascular status

• maintain isolation protocol 

What are some nursing actions and interventions for patients with Encephalitis?

• seizure precautions

• raise HOB 30 degrees

• assess VS every 4 hrs

• give small, frequent meals

What are some nursing actions and interventions for patients with Headaches?

• keep pt. in a quiet, dark room

• Tension headache and Migraine: administer meds (ASA, tylenol, NSAIDs)

• Cluster headache: administer triptans, give high-flow oxygen

What are some patient teachings for Headaches?

• tell pt. to keep a headache diary

• tell pt. to stay in a quiet, dark room when headache occurs

• tell pt. to identify triggers of headache 

• for tension headaches and migraines, tell pt. to drink caffeine 

• for cluster headache, tell pt. to take verapamil to prevent headache

What are some nursing actions and interventions for patients with Seizures?

• seizure precautions

• observe and record seizure details

• maintain airway when seizure occurs

• administer anti-seizure meds when ordered 

• give IV benz for status epilepticus

What are some patient teachings for Seizures?

• tell pt. to wear medical alert bracelet 

• tell pt. to avoid alcohol use

• tell pt. to get adequate amount of sleep 

• tell pt. to not let anyone put something in their mouth during a seizure

What are some nursing actions and interventions for patients with Multiple Sclerosis (MS)?

• administer meds (disease-modified drugs, immunosuppressants, corticosteroids, anticholinergics, TCAs, and antiseizure drugs)

• make sure pt. is going to physical therapy to help with symptoms 

• help with bladder control

What are some patient teachings for Multiple Sclerosis (MS)?

• let pt. know there is no cure for MS

• tell pt. physical therapy can help with symptoms

• talk to pt. about immobility 

• tell pt. they may experience constipation with meds

What are some nursing actions and interventions for patients with Parkinson’s Disease?

• administer meds (Levodopa/Carbidopa, anticholinergic drugs, MAOIs)

• assess gait 

• provide emotional support

What are some patient teachings for Parkinson’s Disease?

• let pt. know that disease may cause falls, choking and difficulty being able to get food to mouth

• let pt. know that meds may cause dizziness, N/V, insomnia, and low blood pressure

• tell pt. to rise slowly from laying or sitting position

What are some nursing actions and interventions for patients with Amyotrophic Lateral Sclerosis (ALS)?

• fall risk precautions

• may have to put pt. on artificial ventilator

• aspiration precautions

• patient and caregiver support

What are some patient teachings for Amyotrophic Lateral Sclerosis (ALS)?

• let pt. know there is not cure for ALS

• let pt. know that Rilutek can slow the progressive of ALS

• tell pt. that they will need a caregiver when symptoms worsen

What are some nursing actions and interventions for patients with Strokes?

• ABCs

• maintain oxygen

• monitor BP

• monitor fluid/electrolyte balance

What is the patient teaching for Strokes?

tell pt. to come in immediately when having symptoms of a stroke