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 o’clock 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 loss
and irritability. She further reveals heat intolerance and increased swelling.
Physical examination reveals hand tremor, a pulse of 110, and a smoothly
enlarged 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's
problem?

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

4. What is thyroid storm? What are the clinical features? How would you treat
the 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 iodine
requirement temporarily, will he develop signs of iodine deficiency right away?
What other sources of organic iodine does the thyroid use to form additional
thyroid hormones?
8. Does the presence of goiter also signify the presence of hyperthyroidism? Is
goiter always associated with hyperthyroidism?
Case B
A 35 year old man has blood chemistries drawn at the time of a yearly physical
examination. His calcium was noted to be elevated and a parathyroid hormone level is
increased.

1. Compare and contrast between primary, secondary and tertiary

hyperparathyroidism in terms of the following:
 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 how
may 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 had
parathyroid surgery and why?
Case C
Juanito Haber, has ahd type 1 diabetes for 15 years. He has just been admitted
to the hospital with severe pyelonepritis, a kidney infection. He had infection for a
week and has developed mild ketoacidosis because of the infection. Analysis of
arterial blood gases indicates that his serum bicarbonate level is low and his
serum 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 Haber’s 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 encounter
because 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 sedentary
life. 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.
 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 promote
healing.
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 Nursing
responsibilities 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 at
this time?
11. Briefly review the effects of diabetes over time in this case.