Nursing Care of Patients with Endocrine Disorders

Endocrine Disorders

• Endocrine disorders involve either too much or too little hormone activity, affecting production/secretion or tissue sensitivity.

• Primary disorders originate within the gland itself.

• Secondary disorders stem from problems outside the gland, such as tropic hormone imbalances, drugs, trauma, surgery, or feedback mechanism issues.

Pituitary Disorders

Antidiuretic Hormone (ADH)

• ADH is made in the hypothalamus and stored/secreted by the posterior pituitary gland.

• It is responsible for water reabsorption.

• Too little ADH leads to increased urine output and diabetes insipidus (DI).

• Too much ADH leads to decreased urine output and syndrome of inappropriate ADH (SIADH).

• Table 39.2 on page 740 compares DI and SIADH.

Diabetes Insipidus

• Pathophysiology:

  • Insufficient ADH.

  • Kidneys do not reabsorb water.

  • Diuresis of 3 to 15 liters per day.

  • Leads to dehydration and increased serum osmolality.

• Causes:

  • Pituitary tumor.

  • Head trauma.

  • Problems in the hypothalamus or pituitary gland.

  • Surgery.

  • Certain drugs (glucocorticoids or alcohol).

• Signs and Symptoms:

  • Polyuria.

  • Polydipsia.

  • Nocturia.

  • Dilute (light-colored) urine with decreased urine specific gravity.

  • Dehydration.

  • Hypovolemic shock.

  • Decreased level of consciousness.

  • Death.

• Diagnostic Tests:

  • Urine specific gravity <1.005 (normal: 1.005-1.030).

  • Plasma osmolality increased.

  • Hypernatremia (from concentrated blood).

  • Computed tomography (CT) scan or magnetic resonance imaging (MRI) for cause.

  • Water deprivation test - Deprived of water for up to 6 hours.

• Therapeutic Interventions:

  • Hypotonic IV fluids - 0.45% NS.

  • IV or subcutaneous (SQ) vasopressin.

  • DDAVP (synthetic ADH for long-term treatment).

  • Hypophysectomy if tumor.

• Nursing Process:

  • Daily weights are the most reliable method for monitoring fluid loss.

  • Take accurate I&O’s.

  • Poor skin turgor, dry & sticky mucous membranes indicate dehydration.

  • Monitor skin integrity- dehydration increases risk of breakdown.

  • Monitor for fluid overload after treatment is started.

• Nursing Diagnosis:

  • Deficient Fluid Volume related to failure of regulatory mechanisms.

• Expected Outcome:

  • Patient’s fluid balance will be maintained as evidenced by:

    • Urine specific gravity between 1.005 and 1.030.

    • Skin turgor within normal limits.

    • Stable daily weight.

SIADH

• Pathophysiology:

  • Too much ADH.

  • Water retention.

  • Decreased serum osmolality.

• Causes:

  • Nervous system disorders.

  • Cancer.

  • Pulmonary diseases.

  • Medications that stimulate ADH release - Antipsychotics and histamines.

• Signs and Symptoms:

  • Weight gain without edema.

  • Dilutional hyponatremia <135 mEq/L (Normal: 135-145).

  • Serum osmolality <275 mOsm/kg.

  • Concentrated urine >1.030.

  • Muscle cramps and weakness.

  • Brain swelling- lethargy, confusion, seizures, coma, death.

• Diagnostic Tests:

  • Serum- sodium & osmolality (low).

  • Urine- sodium & osmolality (high).

  • Serum ADH (high).

  • CT scan or MRI for underlying cause.

• Therapeutic Interventions:

  • Eliminate cause.

  • Surgical removal of tumor.

  • Fluid restriction.

  • Hypertonic saline IV.

  • Oral sodium tablet.

  • Furosemide (Lasix).

  • Conivaptan (Vaprisol).

• Nursing Diagnosis:

  • Excess Fluid Volume related to compromised regulatory mechanism.

  • Monitor:

    • Vital signs

    • Daily weight

    • I & O

    • Urine specific gravity

    • Skin turgor

    • Serum sodium within normal limits

Activity: Cue Recognition 39.1

A 41-year-old male patient with a history of alcoholism presents with frequent urination and nocturia, constant thirst, and dizziness upon standing. His capillary blood glucose is 85 mg/dl. Immediate intervention is required for the dizziness when standing to assure his safety from falls. Check vital signs both sitting and standing (orthostatic blood pressure [BP]) and document.

• Rationale:

  • If he is dizzy when he stands up, his BP may be dropping. This can be confirmed with sitting and standing BP measurements.

  • Orthostatic hypotension can occur with fluid volume deficit. Be prepared to administer fluids and assist on a workup for diabetes insipidus.

  • Capillary blood glucose of 85 is normal.

Growth Hormone Imbalance

• Growth hormone (GH) also known as somatotropin.

• Secreted by the anterior pituitary gland.

• Too little GH results in short stature.

• Too much GH results in gigantism, acromegaly.

Growth Hormone Deficiency

• Pathophysiology:

  • Deficient growth hormone (GH) in childhood.

  • GH deficiency in adults does not affect growth.

• Causes:

  • Pituitary tumor.

  • Surgery.

  • Heredity.

  • Trauma.

  • Psychosocial.

  • Malnutrition.

  • Idiopathic.

• Signs and Symptoms:

  • In children:

    • Grow only to 3 to 4 feet (5th percentile).

    • Slowed sexual maturation.

    • May have developmental delays.

    • Other symptoms depend on other pituitary hormones involved.

  • In adults:

    • Fatigue, weakness.

    • Excess body fat.

    • Hypercholesterolemia.

    • Decreased muscle and bone mass.

    • Sexual dysfunction.

    • Risk for cardiovascular & cerebrovascular disease.

    • Headaches, mental slowness, and psychological disturbances.

• Diagnostic Tests:

  • GH level.

  • GH stimulation test- GH response to induced hypoglycemia.

  • MRI for tumor.

  • X-rays.

• Therapeutic Interventions:

  • SQ injection- Synthetic GH:

    • Somatropin (humatrope).

  • Surgery if a tumor is the cause.

• Nursing Care:

  • Approach with respect.

  • Ask about current problems or challenges.

  • Observe self-administration of somatropin.

  • Collaborate with registered nurse (RN) to educate patient.

Acromegaly

• Pathophysiology:

  • Excess GH in adults.

  • Long bones grow in width, not length.

  • Internal organs and glands enlarge.

  • Connective tissues increases causing a “fleshy” appearance.

  • Impaired tolerance of carbs leads to elevated blood glucose.

• Causes:

  • Pituitary hyperplasia.

  • Pituitary tumor.

  • Hypothalamic dysfunction.

• Signs and Symptoms:

  • Change in shoe or ring size.

  • Nose, jaw, brow enlarge (broaden).

  • Teeth may be displaced.

  • Tongue becomes thick causing difficulty speaking and swallowing.

  • Sleep apnea.

  • Headaches, visual changes.

  • Diabetes mellitus.

• Diagnostic Tests:

  • GH level.

  • Oral glucose tolerance test.

  • CT scan or MRI.

• Therapeutic Interventions:

  • Medications to block GH.

  • Hypophysectomy:

    • Removal of the pituitary gland.

    • Lifelong thyroid hormone (TH), steroid, sex hormone replacement.

  • Radiation may be indicated if a tumor is the cause.

Hypophysectomy

• Removal of the pituitary gland.

• Minimally invasive endoscopic surgery.

• Preoperative Care:

  • Collect baseline neurological data.

  • Preoperative care teaching:

    • Teach to avoid actions that increase pressure on surgical site (ex: coughing, sneezing, straining).

    • Teach deep-breathing exercises; incentive spirometry.

• Postoperative Care:

  • Neurological assessment.

  • Urine for specific gravity (risk for DI).

  • Nasal packing and “mustache” dressing.

  • Report cerebrospinal fluid drainage.

    • Contains glucose- use glucose testing strips to identify.

  • No coughing, sneezing, blowing nose, straining, bending.

  • Hormone replacement therapy with target hormones.

• Patient Education:

  • Blow nose gently.

  • Take stool softeners (to prevent straining) and antitussives (to prevent coughing) as needed.

  • Take care with brushing teeth, depending on location of incision.

  • Take hormones as prescribed (require lifelong hormone therapy).

  • Notify MD of fever, drainage, frequent urination, unusual thirst.

Activity: Cue Recognition 39.2

You are caring for a patient postoperative from a hypophysectomy. There is a small amount of clear drainage coming from the nose. Check fluid with a glucose testing strip.

• Rationale

  • Clear drainage from the nose following hypophysectomy could be cerebrospinal fluid (CSF).

  • CSF contains glucose. If test is negative, drainage is more likely from the nose.

Disorders of the Thyroid Gland

Thyroid Hormone

• T3 & T4: Thyroid hormones secreted by thyroid gland, collectively referred to as TH.

• Thyroid-Stimulating Hormone (TSH) secreted by pituitary gland.

• Thyroid hormone imbalance:

  • Hypothyroidism: Deficient secretion of TH.

  • Hyperthyroidism: Excess TH.

Hypothyroidism

• Pathophysiology:

  • TH deficiency.

  • Metabolic rate reduced.

  • Primary: Not enough TH.

  • Secondary: Not enough thyroid-stimulating hormone (TSH).

• Causes:

  • Congenital.

  • Inflammatory.

  • Iodine deficiency.

  • Thyroidectomy, or medication to treat hyperthyroidism.

  • Autoimmune (Hashimoto thyroiditis).

  • Lithium can reduce release of hormones.

  • Secondary/tertiary- lesion on pituitary or hypothalamus.

• Signs and Symptoms:

  • Fatigue.

  • Bradycardia.

  • Constipation.

  • Mental dullness.

  • Cold intolerance.

  • Shortness of breath (hypoventilation).

  • Dry skin and hair.

  • Weight gain.

  • Heart failure.

  • Hyperlipidemia.

  • Myxedema (progressive).

• Complications:

  • Myxedema coma:

    • Hypothermia.

    • Decreased vital signs and level of consciousness.

    • Respiratory failure.

    • Death.

    • Treatment:

      • Monitor vital signs.

      • Warming blanket.

      • Mechanical ventilation.

      • IV fluids.

      • IV levothyroxine (Synthroid).

• Diagnostic Tests:

  • T3 and T4 low.

  • TSH high in primary.

  • TSH low in secondary.

  • Serum cholesterol and triglycerides are elevated.

• Therapeutic Interventions:

  • Levothyroxine (Synthroid) - Oral hormone replacement.

  • Teach pt to comply with med administration to prevent myxedema coma.

• Nursing Diagnoses:

  • Fatigue.

  • Imbalanced Nutrition.

  • Constipation.

  • Impaired Skin Integrity.

• Patient Education:

  • Instruction on the importance of consistent thyroid replacement & regular blood tests.

  • Report symptoms of hyperthyroidism.

Hyperthyroidism

• Pathophysiology:

  • Increased metabolic rate.

  • Increased beta receptors- enhances fight or flight response.

  • Primary - Too much TH.

  • Secondary - Too much TSH.

• Causes:

  • Autoimmune (Graves disease) - Heredity can play a role.

  • Thyroid nodules that secrete excess TH.

  • Thyroiditis.

  • Thyroid tumor.

  • Pituitary tumor (secondary).

  • Levothyroxine (Synthroid) overdose.

• Signs and Symptoms:

  • Hypermetabolic state.

  • Heat intolerance.

  • Increased appetite.

  • Weight loss.

  • Frequent stools.

  • Nervousness.

  • Tachycardia, palpitations.

  • Tremor.

  • Heart failure.

  • Warm, smooth skin.

  • Exophthalmos (Graves disease).

• Signs and Symptoms in Elderly:

  • Heart failure.

  • Atrial fibrillation.

  • Fatigue.

  • Apathy.

  • Depression.

• Complications:

  • Thyrotoxic crisis (thyroid storm):

    • Tachycardia, extreme hypertension (can lead to heart failure & hypotension).

    • High fever, dehydration.

    • Restlessness, delirium.

    • Coma.

    • Death.

    • Report these symptoms immediately in a person with hyperthyroidism!

• Diagnostic Tests:

  • Elevated T3 and T4.

  • TSH low in primary.

  • TSH high in secondary.

  • Thyroid-stimulating immunoglobulin.

  • CT scan or MRI if tumor suspected.

• Therapeutic Interventions:

  • Methimazole (Tapazole).

  • Beta blockers.

  • Radioactive iodine (I-131 or RAI).

  • Thyroidectomy.

  • For thyrotoxic crisis:

    • IV fluids.

    • Cooling blanket.

    • Beta blocker.

    • Acetaminophen (avoid aspirin) for fever.

    • Oxygen, elevate head of bed.

• Nursing Care:

  • Never palpate the thyroid gland of a patient with hyperthyroidism.

• Nursing Diagnoses:

  • Hyperthermia.

  • Diarrhea.

  • Imbalanced Nutrition: less than.

  • Disturbed Sleep Pattern.

  • Anxiety.

  • Risk for Injury.

• Nursing Care of the Patient Receiving Radioactive Iodine

  • In hospital:

    • Limit time spent with patient.

    • Glove and gown.

    • Avoid being the caregiver if pregnant.

    • Take precautions with urine, emesis, body fluids.

    • Double flush toilet.

    • Call radiation safety officer for emesis or incontinence.

  • At home:

    • Avoid close contact with family members.

    • Sleep alone.

    • Wash hands carefully after urinating.

    • Avoid oral contact.

    • Wash eating utensils thoroughly

    • Drink plenty of fluids & void frequently.

    • Avoid pregnancy for at least a year.

Goiter

• Pathophysiology:

  • Enlarged thyroid gland.

  • Elevated TSH.

  • Autoimmune process (Graves disease).

• Causes:

  • Low TH.

  • Iodine deficiency.

  • Virus.

  • Genetic.

  • Goitrogens (medications).

• Signs and Symptoms:

  • Enlarged thyroid.

  • Swelling at the base of the neck.

  • Dysphagia.

  • Difficulty breathing.

  • Full sensation in the neck.

  • Hypothyroid or hyperthyroid, or euthyroid.

• Diagnostic Tests:

  • Thyroid scan (radioactive iodine is used to determine cause or evaluate size).

  • TSH, T3, and T4.

• Therapeutic Interventions:

  • Treat cause.

  • Avoid goitrogens.

  • Treat hypothyroidism or hyperthyroidism.

  • Thyroidectomy if size causing symptoms.

• Nursing Care:

  • Monitor breathing (stridor).

  • Swallowing evaluation.

  • Dietary consultation.

Cancer of the Thyroid Gland

• Tumor of the thyroid gland.

• Usually benign.

• More common in women.

• Causes:

  • Hyperplasia- enlargement of the gland.

  • Radiation exposure.

  • Genetics.

• Signs and Symptoms:

  • Hard, painless nodule.

  • Dysphagia.

  • Dyspnea if obstruction.

  • Persistent cough.

  • Changes in the voice.

  • TH usually normal.

• Diagnostic Tests:

  • Thyroid scan shows “cold spot” with malignancy.

  • Biopsy.

• Therapeutic Interventions:

  • Radioactive iodine therapy.

  • Chemotherapy.

  • Thyroidectomy (partial or total).

Thyroidectomy

• Preoperative Nursing Care:

  • Obtain baseline vital signs and voice quality to compare after surgery.

  • Explain what to expect before, during, and after surgery.

  • Administer iodine or antithyroid drugs as ordered to achieve euthyroid state.

• Preoperative Teaching:

  • Teach postoperative care:

    • Gentle range of motion.

    • Support neck during position changes.

    • Incentive spirometer

  • Make sure the patient understands that lifelong replacement hormone medication must be taken after a total thyroidectomy.

• Postoperative Care:

  • Monitor VS, O2 sat, drain, dressing q 15 mins and progressing to q 4hrs.

  • Decreased bp with increased pulse can indicate shock r/t blood loss.

  • Tachycardia, fever, mental status changes can indicate thyrotoxic crisis.

  • Check the back of the neck for pooling blood.

  • Watch for signs of respiratory distress, RR, dyspnea, stridor.

  • Listen for hoarseness.

  • Monitor calcium levels, watch for tetany.

• Complications:

  • Thyrotoxic crisis (thyroid storm).

  • Tetany – caused by low calcium levels and is characterized by tingling in the fingers, around the mouth, muscle spasms, twitching and cardiac arrhythmias

• Postoperative Nursing Diagnoses:

  • Risk for Ineffective Airway Clearance.

  • Risk for Injury (tetany, thyrotoxic crisis).

  • Acute Pain.

  • Ineffective Health Self-Management.

Disorders of the Parathyroid Glands

Parathyroid Hormone

• Secrete PTH in response to low serum calcium levels.

• Hypoparathyroidism: decreased PTH & hypocalcemia.

• Hyperparathyroidism: increased PTH & hypercalcemia.

Hypoparathyroidism

• Pathophysiology:

  • Decrease in parathyroid hormone (PTH).

  • Calcium stays in bones.

  • Hypocalcemia.

  • Hyperphosphatemia.

• Causes:

  • Heredity.

  • Accidental removal of parathyroid glands during thyroidectomy.

  • Hypomagnesemia (chronic alcoholism or other nutritional problem).

• Signs and Symptoms:

  • Tetany:

    • Neuromuscular irritability.

    • Numbness and tingling of fingers, tongue, lips.

    • Muscle spasms, twitching.

    • Cardiac arrhythmias.

  • Chronic hypocalcemia:

    • Lethargy, brain calcifications, cataracts, convulsions.

    • Bone changes on x-ray.

    • Cardiac arrhythmias and heart failure.

    • Laryngospasm can cause death.

Early indications of tetany:
* Positive Chvostek sign.
* Positive Trousseau sign.

• Diagnostic Tests:

  • PTH low.

  • Serum calcium low.

  • Serum phosphorus high.

  • ECG- cardiac function.

  • X-ray- bone changes.

• Therapeutic Interventions:

  • Acute:

    • IV calcium gluconate.

  • Long term:

    • High calcium diet.

    • Oral calcium with vitamin D.

• Nursing Diagnosis:

  • Risk for Injury (tetany) related to calcium imbalance.

Hyperparathyroidism

• Pathophysiology:

  • Overactivity.

  • Increased PTH.

  • Hypercalcemia.

  • Hypophosphatemia.

• Causes:

  • Parathyroid hyperplasia.

  • Benign parathyroid tumor.

  • Heredity.

• Signs and Symptoms:

  • Fatigue.

  • Depression.

  • Confusion.

  • Increased urination.

  • Anorexia.

  • Nausea and vomiting.

  • Kidney stones.

  • Cardiac arrhythmias.

  • Joint pain.

  • Pathological fractures.

  • Coma.

  • Cardiac arrest.

• Diagnostic Tests:

  • Serum calcium elevated.

  • PTH elevated.

  • Phosphate decreased.

  • 24-hour urine for calcium.

  • X-rays for bone density.

• Therapeutic Interventions:

  • Oral or IV fluids to dilute calcium.

  • Furosemide (Lasix).

  • Cinacalcet (Sensipar).

  • Calcitonin, Alendronate.

  • Estrogen therapy (women).

  • Parathyroidectomy.

  • Weight-bearing exercise (walking) to keep calcium in the bones.

• Nursing Diagnosis:

  • Risk for Injury (fracture, complications of hypercalcemia) related to calcium imbalance.

Disorders of the Adrenal Glands

Pheochromocytoma

• Adrenal disorder.

• Tumor of adrenal medulla.

• Causes hypersecretion of epinephrine and norepinephrine.

• Usually benign.

• Hereditary or cause unknown.

• Signs and Symptoms:

  • Exaggerated fight or flight symptoms:

    • Hypertension.

    • Tachycardia.

    • Palpitations.

    • Tremor.

    • Diaphoresis.

    • Anxiety.

    • Severe, pounding headache.

    • Intermittent unstable hypertension.

    • Risk for stroke.

    • Risk for organ damage.

• Diagnostic Tests:

  • 24-hour urine for metanephrines and VMA (end products of catecholamine metabolism).

  • CT scan or MRI to find tumor.

• Therapeutic Interventions:

  • Avoid high-tyramine foods.

  • Calcium channel blockers.

  • Alpha blockers.

  • Beta blockers.

  • Adrenalectomy.

Activity: Cue Recognition 39.3

You are caring for a patient with a pheochromocytoma who suddenly complains of a pounding headache. Measure pulse and BP.

• Rationale

  • Pounding headache is a sign of very high BP.

  • Check medication orders to determine whether the patient needs a dose of prn antihypertensive medication.

  • Collaborate with the RN to contact the health-care provider (HCP) if indicated.

Adrenal Cortex Hormone Imbalance

• Adrenal cortex hormones: aldosterone, cortisol, androgens & estrogens.

• Hyposecretion = Addison disease.

• Hypersecretion = Cushing syndrome.

Addison Disease

• Pathophysiology:

  • Deficient cortisol and/or aldosterone and/or androgens.

• Causes:

  • Autoimmune.

  • AIDS.

  • Cancer.

  • Pituitary or hypothalamus problem.

  • Abrupt discontinuance of long-term steroids.

• Signs and Symptoms:

  • Hypotension.

  • Sodium loss (patient may crave salt).

  • Potassium retention.

  • Hypoglycemia.

  • Weakness.

  • Fatigue.

  • Bronze skin.

  • Nausea and vomiting.

• Complications:

  • Addisonian (adrenal) crisis:

    • Profound hypotension.

    • Dehydration.

    • Tachycardia.

    • Hypoglycemia.

    • Cardiac arrhythmias.

    • Coma.

    • Death.

    • Caused by stress, infection, trauma, psychological pressure.

• Diagnostic Tests:

  • Serum and urine cortisol level.

  • Blood glucose.

  • Electrolytes.

  • Blood urea nitrogen and hematocrit levels.

  • Adrenocorticotropic hormone (ACTH) stimulation test.

  • CT or MRI.

• Therapeutic Interventions:

  • Glucocorticoids and mineralocorticoids daily for life; Double or triple in times of stress.

  • High-sodium diet.

• Nursing Diagnoses:

  • Risk for Deficient Fluid Volume.

  • Ineffective Health Self-Management.

• Crisis Prevention

  • NEVER ABRUPTLY DISCONTINUE LONG-TERM STEROIDS!

Cushing Syndrome

• Pathophysiology:

  • Excess adrenal cortex hormones (Cortisol, Aldosterone, Androgens).

• Causes:

  • Hypersecretion of ACTH.

  • Hypersecretion of cortisol.

  • Prolonged use of exogenous glucocorticoids.

• Signs and Symptoms:

  • Thinning hair

  • Red cheeks

  • Moon face

  • Fat pads (Buffalo hump)

  • Striae

  • Easy bruising (Ecchymoses)

  • Pendulous abdomen

  • Slow wound healing

  • Osteoporosis

  • Pathologic fractures

  • Thin extremities

  • Salt and water retention.

  • Hyperglycemia.

  • Thin, fragile skin.

  • Acne.

  • Facial hair in women.

  • Amenorrhea.

• Diagnostic tests:

  • Based on appearance.

  • Plasma and urine cortisol

  • ACTH

  • 24-hour urine test

  • Dexamethasone suppression test

• Therapeutic Interventions:

  • Surgery if tumor

  • Reduce dose of steroid

  • Change schedule of steroid administration

  • Low-sodium, high-potassium diet

  • Diabetes treatment

• Nursing diagnosis:

  • Excess Fluid Volume

  • Risk for Impaired Skin Integrity

  • Risk for Infection

  • Risk for Unstable Blood Glucose

  • Disturbed Body Image

Adrenalectomy

• Preoperative care:

  • Monitor electrolytes, glucose

  • Administer glucocorticoids as prescribed

• Postoperative care

  • Monitor for adrenal crisis

  • Lifelong hormone replacement (if both removed)

Review Questions and Answers

Question #1

A 21-year-old female patient with a history of SIADH comes into the emergency room (ER) with statements of feeling “full” in her abdomen, muscle cramps, and lethargy. Her serum osmolality is 220 mOsm/kg (nl 275-295 mOsm/kg). Which assessment finding requires immediate follow-up? Serum osmolality 220 mOsm/kg

Question #2

A 52-year-old male patient is admitted to the ER with statements of severe pounding headache and blood pressure of 220/120. The physician suspects pheochromocytoma and prescribes acetaminophen, a 24-hour urine test for metanephrines, and an alpha blocker. What should the nurse do first? Administer the alpha blocker.

Question #3

Which assessment is most important for the patient with SIADH? Daily weights.

Question #4

Which of the following signs and symptoms are associated with hyperthyroidism? Select all that apply. Tremor, Heat intolerance, Exophthalmos

Question #5

Which assessment finding in the post- thyroidectomy patient should be reported STAT? Tingling fingertips

Question #6

Which nursing diagnosis is the priority in the patient with hyperparathyroidism? Risk for Injury (fracture)

Question #7

A 38-year-old female comes to the clinic with statements of feeling depressed, gradual weight gain, lethargy, and very dry flaky skin. What laboratory tests should the nurse anticipate that the patient will need for diagnosis? T3, T4, and TSH

Question #8

A 24-year-old male patient comes to the emergency room (ER) with a diagnosis of possible Addison’s disease. Which of the following assessment findings requires immediate follow-up? Blood pressure (BP) 90/52

Question #9

A 42-year-old female patient comes to see the provider with statements of weight gain and mood swings. She also states that her face has developed a round appearance. Her BP is 150/86. For what other signs of Cushing syndrome should the nurse observe? Select all that apply. Thin, fragile skin, Elevated blood glucose, Fat pads on neck and shoulders