NCLEX PREP: Endocrine disorders

[Music] hello climic review family it's Dr Sharon with climic reviews and I'm excited today to do an endocrine video with you I've had uh people asking me for endocrine videos in the past and so today I'm going to do basically I'm going to do Knowledge Questions with you and then I'm going to teach while I do the questions rather than just doing like a lecture on endocrine system because it's not the most exciting system to lecture on so the organs of the endocrine system not sure if I can remember them all but we've got the pituitary which is in the head um I think it's the thalamus and then we have the thyroid which is here in the neck the parathyroid which is right next to the thyroid the pancreas which secretes insulin um the adrenals which secret steroid hormones and then the ovaries and the testes and the kidneys actually also uh they're they're dual labeled as because they do release some hormones and they also uh release other and they also are obviously in the renal system as well so they're kind of dual labeled all right uh remember Clinic reviews also does enlex review so if you're getting ready to take your enlex and you feel like you need some help go ahead and sign up for a climic review at climic reviews.com okay let's get started a client with diabetes malius is admitted to the hospital with hyperglycemia the nurse should anticipate which hormone to be administered to lower the blood glucose level so I basically um put this here just to make sure you know insulin is considered a hormone anything that is secreted by an endocrine organ is considered a hormone other than the kidneys the kidneys do secrete some hormones that's why it's sort of part of the endocrine system but um for the most part the things that are secreted by the endocrine organs are considered hormones so just I just don't want you to be confused by that label of insulin as a hormone a client is diagnosed with hyper thyroidism which a assessment finding should the nurse anticipate so we're always most concerned about unexpected findings so you have to know what is expected so you know what not to be as concerned about so the thyroid like I said it's right here in the neck right behind the trachea you can sort of feel it if you palpate in your neck it's got two loes and it does release the thyroid hormone and you should think of it sort of as as an engine think of it as a fast running engine like you're in neutral or you're in park and you're like uh revving your engine like think of it like that and or if if you're in park and you're letting it idle just really slowly so that's hyperthyroidism and hypothyroidism so if you think of a fast revving engine it's going to get warm right so body temperature goes up it's going to run faster so heart rate goes up and blood pressure goes up and it also uses up a lot of gasoline that you don't need to be using because you're just sitting there so it uses up a lot of energy and it's going to require more gasoline so it's going to require more a person whose hyperthyroid is going to feel hungry and they're going to lose weight um so they're going to be slender and they have a lot of energy sometimes nervous energy so that's hyperthyroidism and then hypothyroidism is the OB opposite right so people don't have lot of energy they don't feel hungry but they still gain weight uh they have cold they feel cold all the time because they're their uh body temperature is lower their heart rate is lower their blood pressure is lower okay so those are that's hypothyroidism a slow running engine versus a fast running engine now the other thing uh that everyone sort of knows is a symptom of hyperthyroidism is EXO thalos so that's the fast running engine and I'm sure there's a pathological reason why this happens I just don't know it off the top of my head um that's the bulging of the eyes that's exop thalos so that that's associated with hyperthyroidism now they could have just as easily said the client is diagnosed with Graves disease Graves disease is hyperthyroidism and you would have to know Graves disease is hyperthyroidism the answer would have been the same so uh you should know that Graves disease is hyperthyroidism the nurse is providing discharge instructions to a client with Addison's disease which statement by the client indicates a need for further teaching further teaching means we're looking for the false statement so F goes with f further goes with false so we're looking for the false statement and Addison's disease is an disease of the adrenals the adrenal cortex these are there's two of them they're located just on top of the kidneys and they secrete stress hormones stress hormones are things like glucocorticoids mineral corticoids and they also can stimulate the the release of epinephrine and nor epinephrine so Addison's disease means it's not secreting enough stress hormones so stress hormones are not being secreted so people have a poor stress response okay so how do you think we would treat Addison's disease if they're not secreting stress hormones how would we treat it well we don't give epinephrine we give steroids okay so we give particularly glucocorticoids so that's what we give to treat Addison so we're looking for a false statement as it relates to discharge teaching in Addison's okay I will carry I will carry an emergency injection of hydrocortisone well hydrocortisone is a steroid and if they have a poor stress response they could actually pass out and and one of the things if people pass out like at a b a baseball game maybe you're in church uh maybe you're in the mall so somebody all of a sudden passes out um one of the things to consider is maybe they have Addison's disease and they that's why they have to carry an emergency injection of hydrocortisone because they may need to get that injection so that's a true statement I should monitor my weight daily and Report any sudden weight gain well why would that be a true statement because we're going to treat Addison's with steroids what is the side effect of steroids weight gain so it's we're not so much concerned about weight gain we know they could gain some weight but sudden weight gain is something to be concerned about so that's a true statement they would need to monitor their daily weight and Report any sudden weight gain I will increase my salt in to prevent dehydration no we don't ever tell people to increase their salt intake there's no reason for that plus um I do think um so no we don't ever tell anybody to increase their salt intake that's that's not a good enlex answer so false d I will wear a medical alert bracelet at all times well that's absolutely true because if they pass out and they need to get their emergency injection of hydrocortisone somebody needs to know that so they need to wear that medical alert bracelet so C is the false statement as it relates to Addison's disease which is under secretion of the adrenal cortex all right question four client with hypothyroidism is prescribed Lev thyroxine which is Synthroid so that would be if they're low thyroid then we need to give them thyroid which assessment finding should the nurse monitor for as a potential indication of medication Effectiveness well we talked about a fast revving engine right so they have a lot of energy well if we have a slow running engine they're going to have low levels of energy so an indication that the Synthroid is working would be increased energy levels now what about slowed heart rate well no if you have a slow running engine your heart rate is already slow so we actually would expect to see the heart rate start to go up when you start on Synthroid weight loss um when you start on Synthroid well I suppose it could be but that's not an indication of Effectiveness I mean they could lose weight but that that's not what we use to say it's effective it's really it's the energy levels that that tell us the medication is effective improve Vision that has nothing to do with it so the correct answer is increased energy levels as an indication of medication Effectiveness the nurse is assessing a client with Cushings syndrome which finding should the nurse expect so Cushing's syndrome is over secretion of the adrenal cortex and the adrenal cortex secretes steroids so if you think about what are the think about the same thing as the side effects steroids okay so let's let's just talk about this can steroids cause amena increased use of steroids cause amena yes it can can it cause hypotension no it actually causes hypertension does the use of steroids increase bone density no it decreases bone density does the use of steroids cause weight gain yes we just talked about that in the previous question can the use of steroids cause Moon shaped face yes can the use of steroids cause braic cardia no it causes is increased heart rate increased blood pressure can the use of steroids cause stria now this is a vocabulary word you should know what it means it it it means stretch marks stretch marks and yes it can use of steroid can cause stretch marks heroism hutis is facial hair on women can it cause facial hair on women yes it can so assessment findings that a nurse should look for with Cushing syndrome are the same as the side effects of someone who's taking Tak steroids so they're the same symptoms a client is admitted with syndrome of inappropriate antidiuretic hormone which intervention should the nurse Implement first so this is a first question so we may find more than one answer that we like but we want to know what we're going to do first all right so siadh syndrome of inappropriate antidiuretic hormone antidiuresis antidiuresis diuresis means losing fluid if it's antidiuresis we're retraining fluid so you can think of sadh as adding fluid okay we add fluid so they're fluid volume overloaded all right so let's think about this administer IV normal saline absolutely not they're fluid volume overloaded we're not going to do it monitor intake and output hourly um we don't usually monitor intake and output hourly we usually do it every shift and so it unless there's a specific reason that they tell me they're really unstable I wouldn't think that we would do that so I'm going to put a question mark next to it if I hate all the other answers I can pick it but I don't like it C place the client on fluid restriction well they're fluid volume overloaded so I like C that's a fast easy thing to do we know we're going to have to put them on a fluid restriction so absolutely administer vasopress and antagonist medication all right well I don't know if that's what I'm supposed to do since I don't know if I'm supposed to do that I you know I should do c absolutely so I'm going to pick C okay so if you're like I don't know well then pick the one you know remember I've told you many times pick the answer you know not the answer you don't know a client with diabetes inspius is prescribed desmopressin which instruction should the nurse include in the teaching plan so diabetes insipidus is dehydration so it's diuresis so think of diabetes Melius is an insulin problem right it's a it's an insulin problem whereas diabetes insipidus is a dehydration problem so the D and diabetes goes with diuresis and dehydration okay so we have um fluid volume loss and we're dehydrated they're probably already dehydrated so which instruction should the nurse include in the teaching plan increase dietary intake of sodium I never do that y'all I never pick that as the right answer so I'm not going to pick it here either monitor blood glucose levels regularly well it is diabetes so I'm going to put a question mark next to that and say that might be the right answer limit fluid intake during therapy well they're already dehydrated so I'm not going to limit fluid intake so that's off so a andc are off administer the medication intramuscularly actually I don't know how it's given so monitor blood glucose levels regularly let's go back to that one is there a reason why we would want to mon monitor blood glucose levels regularly well desmo pressent actually is acts like anti-diuretic hormone and uh anti-diuretic hormone can cause hyperglycemia so if we give desmopressin it can also cause hypoglycemia so which is part of the reason we call this diabetes insipidus so it's not diabetes Melius it's diabetes insipidus but since it's a diabetes I am going to pick that one that one makes the most sense to me and that is the correct answer eight a client is admitted to the hospital with a suspected FOC chromosoma which assessment finding should the nurse anticipate so I'm doing this one to teach you a vocabulary word foch chromosoma this is not a word that I can figure out what it means by breaking it down like if I okay what does fom mean Chromo Meine cyoa mean I don't know it doesn't help me at all so I'm going to tell you what it is it's actually a disease of the adrenals where it stimulates the release of epinephrine and norepinephrine okay epinephrine and norepinephrine are secreted foch chromosoma so unless you work on an endocrine floor or you work for an endocrinologist you're probably never going to see foch chromosoma so this is the kind of thing that you learn for the enlex so I do recommend learning it for the enlex okay so foch chromosoma stimulates is a a disease of the adrenals and it stimulates the release of epine and norepinephrine so we know epinephrine is a part of the sympathetic nervous system which is fight or flight so it should increase heart rate and blood pressure right so hypotension no bradicardia no epigastric pain not that I know of hypertension and tachicardia absolutely FOC chromosoma stimulates the release of epinephrine and norepinephrine which causes hypertension and tachicardia all right a client is admitted with hyper parathyroidism which of the following lab values will the nurse watch for so hyper parathyroidism the th parathyroid is right next to the the thyroid and one of the things they could ask you actually about hypo parathyroid is often when they do a thyroid ectomy when they remove the thyroid they accidentally remove the parathyroid along with it and the parathyroid controls calcium so if you do a th if they do a total thyroid ectomy and they accidentally remove the Para thyroid the person is going to be have low calcium low calcium so this is a question about hyper parathyroidism so we know if you lose the parathyroids you're going to have low calcium so if they're hyper parathyroid what do you think is going to happen to the calcium level well it's actually going to go high so what happens is the the the hormones that's released by the parathyroid stimulates the reabsorption of calcium somewhere in the I don't know proximal convoluted tubal I don't know where somewhere in the kidney right it stimulates the the reabsorption of calcium and it actually stimulates the the um excretion of phosphate so when you're hyper parathyroid hyper parathyroid they're going to have high calcium and low phosphate and it doesn't have any effect on sodium so that's just something you need to you need to remember and hypoparathyroid is going to be hypocalcemia okay hypocalcemia and it would be important to remember that calcium does the opposite of the prefix so hypocalcemia causes increased neuromuscular irritability increase neuromuscular irritability so if you get a question say about hypop parathyroidism and they say what symptom would you report to the healthcare provider what symptom SYM I would be looking if they're hypoparathyroid I would be looking for serious neuromuscular problems like tetany tetany is a is a serious now they they have a little bit of paresthesia hey paresthesia is a mild neuromuscular uh symptom very mild and I would expect paresthesia with hypoparathyroidism because the the calcium level is going to go down so I'm going to have some par athesia but I wouldn't expect tetany that's a very serious very serious neuromuscular symptom so I would need to report that to the healthcare provider all right well this was just kind of testing your knowledge I hope it was helpful and I hope you have a great rest of your day thanks bye

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Length: 17min 15sec (1035 seconds)

Published: Wed Jun 05 2024