2020 Unit V Endocrine-Diabetes Mellitus Outline PDF

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Unit V Promoting Endocrine Health and Nursing the Patient with Alterations in Endocrine Health

Section 1: Assessment Section 2: Management of Diabetes Mellitus Section 3: Management of Endocrine Problems

Revised: 1/2020

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Required Readings/Assignments: For Unit V: Promoting Endocrine Health and Nursing the Patient with Alterations in Endocrine Health Adams, Michael, et al: Pharmacology for Nurses a Pathophysiological Approach, Ed. 5, New York, 2017, Pearson. Chapters 44 & 45. ATI: Practice Assessment Tests: Target Medical-Surgical 2019 Endocrine NOTE: this must be completed a minimum of 3 days prior to taking the Endocrine Unit Exam and you must bring your updated transcript with proof of completion of the practice test and the focused review when arriving for the unit exam. This exam can be taken multiple times.

See: Tutorials, Simulations and Quiz Bank Section: Pharmacology Made Easy: Module for Endocrine Skills Modules: Diabetes Management Jarvis: Physical Examination and Health Assessment, Ed. 8, St Louis, 2020, Elsevier. Pages, 248, 257-258. Lewis, et al: Medical Surgical Nursing Assessment and Management of Clinical Problems, Ed. 11, St Louis, 2020, Elsevier. Chapters 47, 48, 49 Potter, et al: Fundamentals of Nursing, Ed 9, St. Louis, 2017, Elsevier, pages 1054-1055, 1073 and 1081. Vallerand, A.H. & Sanoski, C.A.: Davis’ Drug Guide for Nurses (Book with CD-ROM), Ed 15, Philadelphia, 2016, F.A. Davis. AS NEEDED Van Leeuwen, et al: Davis’ Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications, Ed 6, Philadelphia, 2015, FA Davis. AS NEEDED

Unit Overview: Endocrine (regulatory mechanisms) health is influenced by many factors. While reading the student is asked to consider the factors which will put a patient at risk for problems associated with the Endocrine system. The learning in this unit will require that the student integrate the theoretical content presented in Foundations of Nursing. Exams will be comprised of information from the required readings and lecture content. It will be necessary to study these acute, chronic or life-threatening alterations in Endocrine (regulatory mechanisms) health by determining the populations that are at risk, the etiologies, associated signs and symptoms, the medical and nursing management and patient education. It will also require the student to determine priorities of care how and if a related care task can be

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delegated to other health care providers, including unlicensed personnel. It is highly recommended that an ATI system disorder template is completed for each disorder.

Section 1: Assessment Objectives The student will: Apply their knowledge of the anatomical structures and functions of the endocrine system to design evidence-based plans of care for patients having injuries and diseases which affect the endocrine system. Utilize the nursing process to develop strategies to enhance the normal functioning of the endocrine system. Identify the effects of aging, race, ethnicity and culture on endocrine health and apply the appropriate nursing strategies to meet these needs of patients which result from these changes. Develop strategies to meet the changing needs of the gerontological patient with changes in the endocrine system. Select appropriate NANDA approved nursing diagnoses as they relate to abnormalities of the endocrine system. Develop appropriate nursing interventions to meet the patient needs in response to abnormal findings of the following listed diagnostic studies. Be sure to identify those abnormal findings to which the nurse must respond and act immediately. Serum Studies Growth Hormone (Somatropin) GH Thyroid Stimulating Hormone Thyroxine (T4) Triiodothyronine (T3) Free T4 Parathyroid Hormone Serum Calcium Serum Phosphate Cortisol Aldosterone Adrenocorticotropic Hormone (ACTH) Fasting Blood Sugar Oral Glucose Tolerance Test (OGTT) Glycosylated Hemoglobin (A1C)

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Radiological Testing Thyroid Ultrasound Thyroid Scan Radioactive Iodine Uptake Utilize effective communication techniques in obtaining and endocrine history. Analyze factors which can influence endocrine health, or which are altered by changes in endocrine health. Current Medications Past Health History Past Surgical History Nutrition Elimination Sleep Patterns Activity Patterns Stress and Coping Apply knowledge of the holistic needs, growth and development in physical exam of the patient. Develop a systematic progression for physical assessment utilizing the following techniques: Inspection Palpation Auscultation Differentiate between normal and abnormal assessment findings in order to determine priorities when implementing care. Develop teaching plans to support endocrine health which include nutritional support.

Section 2: Management of Diabetes Mellitus Objectives The student will: Compare and contrast the characteristics of Diabetes Mellitus Types 1 and 2. Compare and contrast Macro-vascular and Micro-vascular complications of Diabetes Mellitus. Identify the effects of aging, race, ethnicity and culture on the occurrence of diabetes mellitus and apply the appropriate nursing strategies to meet these needs of patients which result from these changes. Select appropriate NANDA approved nursing diagnoses as they relate to Diabetes Mellitus. 4|Page

Develop a teaching plan to meet the nutritional needs of the patient with Diabetes Mellitus. Develop an exercise teaching plan for the patient with Diabetes Mellitus. Develop a teaching plan for patients performing self-monitoring of blood glucose. Compare the pathophysiology, clinical manifestations, complications and collaborative management of the following:    

The Pre-Diabetic Patient The patient with Diabetes Type 1 The patient with Diabetes Type 2 The patient with acute complications of Diabetes Mellitus Diabetic Ketoacidosis Hyperosmolar Hyperglycemic Syndrome  The patient with hyperglycemia  The patient with hypoglycemia  The patient with long term complications of Diabetes Mellitus Diabetic Retinopathy Nephropathy Neuropathy Integumentary Changes Infections https://professional.diabetes.org/content-page/practice-guidelines-resources Patient Teaching Information: http://www.diabetesforecast.org/2013/oct/20-tips-for-heart-healthy.html https://www.diabetes.org/diabetes/complications https://www.diabetes.org/diabetes-risk https://www.diabetes.org/diabetes Compare and contrast the different types of Insulin and administration methods associated with each type. It is highly recommended that an ATI medication template is completed for each class of medication. Identify the nursing implications, onset, peak and duration times, expected outcomes, side effects and complications of the following types of Insulin: Insulin, Rapid Acting lispro aspart glulisine Insulin, Short-acting regular 5|Page

Insulin, Intermediate-Acting NPH Insulin, Long-Acting glargine detemir Insulin, Combination NPH/Regular 70/30 50/50 lispro protamine/lispro aspart protamine/aspart Identify the side effects of Insulin and develop nursing interventions to prevent or respond to the following:  Hypoglycemia  Hyperglycemia  Lipodystrophy  Somogyi Effect  Dawn Phenomenon It is highly recommended that an ATI medication template is completed for each class of medication. Identify the nursing implications, expected outcomes and side effects of the following oral hypoglycemic medications: Sulfonylureas  glipizide  glyburide Non-Sulfonylureas Meglitinides  repaglinide  natglinide Biguandes  metformin Alpha Glucosidase Inhibitors  acarbose  miglitol Thiazolidinediones  pioglitazone  rosiglitazone https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drugsafety-communication-ongoing-review-avandia-rosiglitazone-and-cardiovascular-safety

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Dipeptidyl Peptidase-4 Inhibitor (DPP-4)  sitagliptin  vidagliptin  linagliptin  alogliptin It is highly recommended that an ATI medication template is completed for each class of medication. Identify the nursing implications, expected outcomes and side effects of the following injectable hypoglycemic medications: Amylin Analog  pramlintide Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (Incretin Mimetic)  exenatide  exenatide, extended release  liraglutide  albiglutide  dulaglutide  lixisenatide Glucagon

Section 3: Management of Endocrine Problems Pituitary: Objectives The student will: Compare the pathophysiology, clinical manifestations, complications and collaborative management of the following dysfunctions of the Anterior Pituitary:  Patients with Growth Hormone Excess (Acromegaly)  Patients with Hypofunction of the Pituitary (Hypopituitarism) Compare the pathophysiology, clinical manifestations, complications and collaborative management of the following dysfunctions of the Posterior Pituitary:  Patients with Syndrome of Inappropriate Antidiuretic Hormone  Patients with Diabetes Insipidus

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It is highly recommended that an ATI medication template is completed for each class of medication. Identify the nursing implications, expect outcomes and side effects of the following medication classifications or medications: Somatostatin analogs Growth Hormone Receptor Antagonists Dopamine Agonists Antidiuretic Hormone Replacement DDAVP Vasopressin Somatropin https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communicationongoing-safety-review-recombinant-human-growth-hormone-somatropin-and Loop Diuretics demeclocycline lithium chlorpropamide carbamazepine Thiazide Diuretics

Thyroid: Objectives The student will: Compare the pathophysiology, clinical manifestations, complications and collaborative management of the following:     

Patients with Goiter Patients with Thyroid Nodules Patients with Thyroiditis Patients with Hyperthyroidism Patients with Hypothyroidism

It is highly recommended that an ATI medication template is completed for each class of medication. Identify the nursing implications, expected outcomes and side effects of the following medication classifications or medications:

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Antithyroid Drugs propylthiouracil (PTU) https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drugsafety-communication-new-boxed-warning-severe-liver-injury-propylthiouracil methimazole Idodine Beta Adrenergic Blockers Radio-Active iodine levothroxine liotrix Patient Teaching Information: https://medlineplus.gov/thyroiddiseases.html http://www.thyroid.org/hypothyroidism/ http://www.thyroid.org/hyperthyroidism/

Parathyroids: Objectives The student will: Compare the pathophysiology, clinical manifestations, complications and collaborative management of the following:  Patients with Hyperparathyroidism  Patients with Hypoparathyroidism It is highly recommended that an ATI medication template is completed for each class of medication. Identify the nursing implications, expected outcomes and side effects of the following medication classifications or medications: Bisphosphonates Phosphorus Supplements Calcimimetic Agents Calcium Supplements Vitamin D Therapy Patient Teaching Information: https://www.niddk.nih.gov/health-information/endocrine-diseases/primary-hyperparathyroidism? dkrd=hispt0307 https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/symptoms-causes/syc20355375

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Adrenal Cortex Objectives The student will: Compare the pathophysiology, clinical manifestations, complications and collaborative management of the following Adrenal Cortex disorders:  Patients with Cushing Syndrome  Patients with Adrenocortical Insufficiency (Addison’s Disease)  Patients with Hyperaldosteronism Compare the pathophysiology, clinical manifestations, complications and collaborative management of the following Adrenal Medulla disorder:  Patients with Pheochromocytoma Develop a teaching plan for patients using corticosteroids. It is highly recommended that an ATI medication template is completed for each class of medication. Identifying the nursing implications, expected outcomes and side effects of the following medication classifications. Cortisol Inhibitors mitotane ketoconazole aminoglutethimide Corticosteroids Mineralocorticoids/ Aldosterone fludrocortisone fludrocortisone Glucocorticoids prednisone hydrocortisone dexamethasone Potassium Sparing Diuretics Selective Aldosterone Receptor Antagonists Calcium Channel Blockers Beta Adrenergic Blockers Patient Information: https://www.ucsfhealth.org/education/faq-prednisone https://medlineplus.gov/druginfo/meds/a601102.html

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