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Endocrine Disorders:
Comprehensive Assessment and
Management
Elaboration of the Given Text
Hypocalcemia Following Subtotal Thyroidectomy
After a subtotal thyroidectomy, a client may experience hypocalcemia, which can manifest as a tingling sensation in the hands, soles of the feet, and around the lips. To assess for this, the nurse should check for Chvostek's sign. Chvostek's sign is elicited by tapping the client's face just below and in front of the ear, and a positive response would be twitching of the ipsilateral facial muscles, indicating neuromuscular excitability due to hypocalcemia.
Treatment of Diabetic Ketoacidosis
When an adolescent client with a history of diabetes mellitus presents to the emergency department with confusion, flushing, and an acetone odor on the breath, indicating diabetic ketoacidosis, the nurse should anticipate using regular insulin to treat the condition. Regular insulin is a short-acting insulin that can be administered intravenously, with an onset of action of less than 30 minutes, making it the most appropriate choice for emergency situations of severe hyperglycemia or diabetic ketoacidosis.
Manifestations of Diabetes Insipidus
Diabetes insipidus is characterized by excessive excretion of dilute urine, resulting in dehydration. The nurse should expect to find the client experiencing dehydration, tachycardia, and a decrease in urine specific gravity. In contrast, findings such as polyphagia, hyperglycemia, and bradycardia are associated with diabetes mellitus, not diabetes insipidus.
Effectiveness of Vasopressin in Diabetes Insipidus
When a client with diabetes insipidus is receiving vasopressin, the nurse should identify a decrease in urine output and an increase in urine specific gravity as indications that the medication is effective. These changes reflect the desired response of vasopressin in controlling the frequent urination and water loss associated with diabetes insipidus.
Metabolic Acidosis
In a client suspected of having metabolic acidosis, the nurse should expect to see an arterial blood gas (ABG) result with a pH below 7.35, a
bicarbonate (HCO3) level below 21 mEq/L, and a normal or decreased partial pressure of carbon dioxide (PaCO2).
Positioning of the Client Following Subtotal Thyroidectomy
After a subtotal thyroidectomy, the nurse should keep the client in a semi- Fowler's position with the neck in a neutral position. This position supports the head and neck area without placing excessive tension on the operative area and sutures, which could occur with neck extension or flexion.
Interpretation of Blood Gas Findings
When reviewing a client's blood gas findings of HCO3 18 mEq/L and PaCO 28 mm Hg, the nurse should expect to find a decreased pH and the client experiencing metabolic acidosis. Other manifestations of metabolic acidosis may include diarrhea, circulatory shock, decreased level of consciousness, abdominal pain, cardiac dysrhythmia, and increased depth and rate of respirations.
Monitoring Priority for a Client Following Thyroidectomy
The priority for the nurse to monitor in a client following a thyroidectomy is airway patency. Nerve damage, hypocalcemia-induced tetany, and edema can all impair the airway, making this the most critical factor to assess.
Manifestations of Metabolic Alkalosis
In a client experiencing metabolic alkalosis, the nurse should monitor for clinical manifestations such as bicarbonate excess and circumoral paresthesia. Other signs, such as Kussmaul's respirations, flushing, and lethargy, are associated with metabolic acidosis or respiratory acidosis, not metabolic alkalosis.
Acid-Base Imbalance in a Client with Influenza
A client with influenza who is reporting numbness and tingling of the toes and fingers is experiencing metabolic alkalosis. This is due to the excessive vomiting associated with influenza, leading to a loss of hydrogen ions and a subsequent increase in pH and bicarbonate levels.
Interpretation of Arterial Blood Gas Results
When reviewing a client's arterial blood gas results with HCO3 18 mEq/L and PaCO2 28 mm Hg, the nurse recognizes that the client is experiencing metabolic acidosis. This is indicated by the decreased pH, decreased HCO3, and decreased PaCO2.
Diabetes Insipidus
When planning care for a client with a new diagnosis of diabetes insipidus, the nurse should include checking the client's urine specific gravity to monitor urine concentration, as a client with diabetes insipidus will have a urine specific gravity of less than 1.005.
Myxedema Coma
When caring for a client in a myxedema coma, the nurse should initiate warming measures, such as warm blankets, to reduce the risk of hypothermia. The nurse should also place the client on aspiration precautions due to the decreased mental status and risk of laryngeal edema and tongue thickening.
Postoperative Care after Thyroidectomy
When planning care for a client who is postoperative following a thyroidectomy, the nurse should include:
Instructing the client to deep breathe every 30 minutes to 1 hour to reduce the risk of atelectasis Assessing the client's voice every 2 hours to monitor for hoarseness, a manifestation of laryngeal nerve damage Elevating the head of the bed to reduce the risk of respiratory distress Supporting the client's neck with pillows and avoiding neck hyperextension to reduce the risk of bleeding and discomfort
Hypocalcemia after Total Thyroidectomy
A client who has had a total thyroidectomy and has a serum calcium level of 7.6 mg/dL is likely experiencing hypocalcemia. The nurse should expect the client to exhibit tingling of the extremities, hyperactive deep tendon reflexes, and lengthened QT intervals and prolonged ST segments due to the low calcium levels.
Uncontrolled Type 1 Diabetes Mellitus
For a client with uncontrolled type 1 diabetes mellitus, the nurse should expect to find weight loss and tachycardia, but not hypertension, hematuria, or bradycardia.
Hypoparathyroidism
When reviewing laboratory results, the nurse should recognize a client with a manifestation of hypoparathyroidism if they have an increased phosphate level of 5.7 mg/dL, as phosphorus levels are typically increased in hypoparathyroidism.
Hypercortisolism (Cushing's Syndrome)
When assessing clients, the nurse should identify a client exhibiting positive manifestations of hypercortisolism, such as a moon face and fat pads on the neck, back, and shoulders. Muscle atrophy is also a manifestation of hypercortisolism.
