Knowledge Check: Endocrine Disorders NURS 6501

Knowledge Check: Endocrine Disorders NURS 6501

Knowledge Check: Endocrine Disorders NURS 6501

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  • Question 1

    4 out of 4 points

    Correct

    Scenario 1: Syndrome of Antidiuretic Hormone (SIADH)

    A 77-year-old female was brought to the clinic by her daughter who stated that her mother had become slightly confused over the past several days. She had been stumbling at home and had fallen twice but was able to walk with some difficulty. She had no other obvious problems and had

    been eating and drinking. The daughter became concerned when she forgot her daughter’s name, so she thought she better bring her to the clinic.

    HPI: Type II diabetes mellitus (DM) with peripheral neuropathy x 30 years. Emphysema. Situational depression after death of spouse 6-months ago

    SHFH: – non contributary except for 40 pack/year history tobacco use.

    Meds: Metformin 1000 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago

    Labs-CBC WNL; Chem 7- Glucose-102 mg/dl, BUN 16 mg/dl, Creatinine 1.1 mg/dl, Na+116 mmol/L,

    K+4.2 mmol/L, CO237 m mol/L, Cl97 mmol/L.

    The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH).

    Question:

    Knowledge Check: Endocrine Disorders NURS 6501

    1.     Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH 

    Selected Answer:

    SIADH happens when increased ADH is produced in the body, causing water retention and electrolyte imbalance. Hypothalamus produces ADH, and the posterior pituitary secretes and stores ADH. ADH regulates water in the body through water retention, and it constricts blood vessels. It accomplishes this with kidneys. ADH causes renal tubules to retain water. An increased level of ADH causes extra water retention in the body, resulting in hyponatremia with hypo-osmolality and high urine osmolality.

    Causes of SIADH can be damage to the hypothalamus or posterior pituitary gland or ADH being produced somewhere else. The symptoms continue to become more severe if the SIADH goes untreated, including confusion, hallucinations, seizures, and even coma. Based on the patient history, this patient has emphysema and currently smokes 40 packs of tobacco a year. The current lab work shows that patient’s carbon dioxide level is elevated at 37. The normal range for serum carbon dioxide is 23-29. Also, their sodium level is abnormal at 116. The normal range of serum sodium ranges between 135-and 145. When the serum sodium level is too low, the syndrome of inappropriate antidiuretic hormone secretion (SIADH) diagnosis is possible

    Correct Answer:

    Correct 

    SIADH is a group of symptoms that occurs when antidiuretic hormone (ADH, arginine vasopressin) is secreted in the absence of osmotic or physiologic stimuli. These stimuli include: Increased serum osmolality, decreased plasma volume, and hypotension. A decrease in plasma osmolality normally inhibits ADH production and secretion. SIADH is characterized by fluid retention, dilutional hyponatremia, hypochloremia, concentrated urine, and lack of intravascular volume depletion. SIADH is characterized by normal to increased blood volume in normoproteinemia, nonedematous, and hyponatremic patients with normal renal and endocrine function.

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  • Question 2

    4 out of 4 points

    Correct

    Scenario 2: Type 1 Diabetes

    A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.

    PMH: noncontributory.

    Allergies-NKDA

    FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

    SH: denies alcohol, tobacco or illicit drug use. Not sexually active.

    Labs: random glucose 244 mg/dl.

    DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.

    Question

    1.     Explain the pathophysiology of the three P’s for (polyuria, polydipsia, polyphagia)” with the given diagnosis of Type I DM.

    Selected Answer:

    Diabetes type 1 is also known as juvenile diabetes and is dependent on insulin injections. Type 1 diabetes happens when the pancreas does not produce enough or any of the insulin hormones in the body, which are necessary to help regulate the glucose in the body. Common signs and symptoms of type 1 DM can appear relatively suddenly. These symptoms include; increased thirst(polydipsia), frequent urination (polyuria), bed-wetting in children who previously did not wet the bed during the night, extreme hunger (polyphagia), and unintended weight loss, irritability and other mood changes, fatigue, weakness, and blurred vision.

    Pathophysiology of Polyuria

    Polyuria is one of the diabetes symptoms which means urine excretion is more than usual. High amounts of solutes within the renal tubules cause a passive osmotic diuresis and increased urine volume. In Diabetic patients, high urinary glucose levels exceed tubular reabsorption capacity, leading to increased glucose levels in the renal tubules; water follows passively, resulting in glucosuria and increased urine volume.

    Pathophysiology of Polydipsia

    Polydipsia can be the first sign that blood glucose levels are too high. A high blood glucose level in diabetic patients causes the kidney to produce more urine in order to remove excess glucose from the body. Furthermore, high blood glucose levels cause intracellular dehydration, and hypothalamus activation sends the thirst signal (Christ-Crain et al., 2019, pp. 2-3). Because more urine is being produced to reduce the amount of glucose circulating in the bloodstream, the brain instructs the body to increase the amount of fluid consumed. According to Seladi-Schulman (2020), persistent thirst can be caused by dehydration, osmotic diuresis (an increase in urination caused by excess glucose entering the kidney tubules that cannot be reabsorbed, resulting in increased water in the tubules), and mental health issues such as psychogenic polydipsia.

    Pathophysiology of Polyphagia

    Polyphagia is an excessive hunger feeling. This hunger usually dissipates once the person satisfies the craving by eating. In diabetics, the sense of hunger does not dissipate following consuming food. in diabetes, glucose can’t enter cells to be used for energy due to either low insulin levels or insulin resistance. The issue occurs when the conversion from glucose to energy is impaired, leading to continued hunger. With this being said, when the person consumes food, the glucose from that food then leads to increased blood glucose levels.

    Correct Answer:

    Correct 

    (polyuria) Hyperglycemia acts as an osmotic diuretic. The amount of glucose filtered by the glomeruli of the kidneys exceeds the amount that can be reabsorbed by the renal tubules. Glycosuria results accompanied by large amounts of water lost in the urine. (polydipsia) Because elevated blood glucose levels, water is osmotically attracted from body cells which results in intracellular dehydration and hypothalamic stimulation of thirst. (polyphagia) Depletion of cellular stores of carbohydrates, fats, and proteins results in cellular starvation and a corresponding increase in hunger.

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  • Question 3

    4 out of 4 points

    Correct

    Scenario 2: Type 1 Diabetes

    A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.

    PMH: noncontributory.

    Allergies-NKDA

    FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

    SH: denies alcohol, tobacco or illicit drug use. Not sexually active.

    Labs: random glucose 244 mg/dl.

    DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.

    Question

    1.    Explain the genetics relationship and how this and the environment can contribute to Type I DM.

     

    Selected Answer:

     Type 1 diabetes can occur due to genetics, environmental, and or lifestyle influences. Type 1 diabetes (T1D) is a chronic autoimmune disorder that leads to progressive pancreatic ß-cell destruction and culminates in absolute insulin deficiency and stable hyperglycemia. Environmental factors likely play a role in triggering islet autoimmunity. Factors such as gluten, breastfeeding and cow’s milk, vitamin D intake, the composition of your gut microbiota, infections acquired, antibiotics, and other medications taken may all play a role and affect the patient, leading to type 1 diabetes.

    Genetic factors include: Islet autoantibodies found in serum – Interferon (IFN)-stimulated genes – Excess IFIH1 (MDA5) levels may contribute to inflammation and autoimmunity. – PTPN22 contains risk polymorphisms that almost double the risk for T1D – High expression of CTLA-4 leads to inhibition of T cell activation – IL10 has an anti-inflammatory effect and has been identified as a risk factor for T1D – TNFAIP3 exerts anti-inflammatory function by inhibiting NF-κB activation and is associated with T1D. – Interleukin-21 and IL-2.

    Correct Answer:

    Correct 

    Islet cell autoantibodies (ICAs) were detected in serum from patients with autoimmune polyendocrine deficiency. They have subsequently been identified in 85 percent of patients with newly diagnosed type 1 diabetes and in prediabetic people. Autoantigens form on insulin producing beta cells and circulate in the blood and lymphatics. This leads to processing and presentation of autoantigen by antigen presenting cells

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  • Question 4

    4 out of 4 points

    Correct

    Scenario 3: Type II DM

    A 55-year-old male presents with complaints of polyuria, polydipsia, polyphagia, and weight loss. He also noted that his feet on the bottom are feeling “strange” “like ants crawling on them” and noted his vision is blurry sometimes. He has increased an increased appetite, but still losing weight. He also complains of “swelling” and enlargement of his abdomen.

    PMH: HTN – well controlled with medications. He has mixed hyperlipidemia, and central abdominal obesity. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 333 mg/dl.

    Diagnosis: Type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching.

    Question:

    1.     How would you describe the pathophysiology of Type II DM?  

    Selected Answer:

    Type 2 diabetes is a chronic medical condition regarding how the body metabolizes glucose in the body. Two situations cause type 2 diabetes: the body develops insulin resistance, or the pancreas does not produce enough insulin. The cause of type 2 diabetes is unknown, although genetics and environmental factors, such as being overweight and inactive, seem to be contributing factors.

    Type 2 diabetes can be managed with diet and exercise in some cases. Once this therapy is unsuccessful, medications are added, changed, or increased.

    factors that put one at a higher risk for type ll DM include being overweight, high-fat content in the trunk, inactivity, family history, ethnicity/race, age, prediabetic, gestational diabetes, and polycystic ovarian syndrome.

    Correct Answer:

    Correct 

    There are very complex interactions that result in the development of Type II diabetes. The pathophysiology of type 2 diabetes mellitus is characterized by peripheral insulin resistance, impaired regulation of hepatic glucose production, and declining β-cell function, eventually leading toβ -cell failure. Type 2 diabetes mellitus consists of a constellation of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. It is often associated with obesity.

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  • Question 5

    4 out of 4 points

    Correct

    Scenario 4: Hypothyroidism

    A patient  walked into your  clinic today with the following complaints: Weight gain (15 pounds), however has a decreased appetite with extreme fatigue,  cold intolerance, dry skin, hair loss, and falls asleep watching television. The patient also tearfulness with depression, and with an unknown cause and has noted she is more forgetful.  She does have blurry vision.

    PMH: Non-contributory.

    Vitals: Temp 96.4˚F, pulse 58 and regular, BP 106/92,  12 respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted.

    Diagnosis: hypothyroidism.

    Question:

    What causes hypothyroidism?

    Selected Answer:

    Hypothyroidism is a hypometabolic state that results from a deficiency in T4 and T3. The most common cause of hypothyroidism is an autoimmune disorder called Hashimoto disease, in which the thyroid is destroyed by antibodies or lymphocytes that attack the gland. Other causes are thyroiditis, congenital hypothyroidism, thyroidectomy, radiation to the thyroid, medications, iodine deficiency, and pituitary disease. Hypothyroidism is an underactive thyroid that does not produce enough hormones.

    Correct Answer:

    Correct 

    Patients with primary hypothyroidism have elevated TSH levels and decreased free hormone levels. Patients with elevated TSH levels (usually 4.5- 10.0 mIU/L) but normal free hormone levels or estimates are considered to have mild or subclinical hypothyroidism. The most common cause of hypothyroidism is autoimmune thyroiditis known as Hashimoto’s disease. Primary hypothyroidism is essentially the only disease that is characterized by sustained rises in TSH levels. As the TSH level increases early in the disease, conversion of T4 to T3 increases, maintaining T3 levels. In early hypothyroidism, TSH levels are elevated, T4 levels are normal to low, and T3 levels are normal.

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