Endocrine Disorders



Endocrine Disorders



Case Study 76


Name________________________Class/Group______________Date____________________


Group Members________________________________________________


INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will need to rewrite it.




Scenario


Y.L., a 34-year-old Asian woman, comes to the clinic with complaints of chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination. She tells you she has a vaginal yeast infection that she has treated numerous times with over-the-counter medication. She works full time as a clerk in a loan company and states she has difficulty reading numbers and reports, resulting in her making frequent mistakes. She says, “By the time I get home and make supper for my family, then put my child to bed, I am too tired to exercise.” She reports her feet hurt; they often “burn or feel like there are pins in them.” She has a history of gestational diabetes and reports that, after her delivery, she went back to her traditional eating pattern, which is high in carbohydrates.


In reviewing Y.L.’s chart, you notice she has not been seen since the delivery of her child 6 years ago. She has gained considerable weight; her current weight is 173 pounds. Today, her BP is 152/97 mm Hg, and a random plasma glucose is 291 mg/dL. The primary care provider suspects that Y.L. has developed type 2 diabetes mellitus (DM) and orders the following laboratory studies:



Chart View


Laboratory Test Results

























Fasting glucose 184 mg/dL
HbA1C 8.8%
Total cholesterol 256 mg/dL
Triglycerides 346 mg/dL
LDL 155 mg/dL
HDL 32 mg/dL
UA +glucose, −ketones





Case Study Progress


Y.L. comments, “I’ve heard many people with diabetes can lose their toes or even their feet.” You take this opportunity to teach her about neuropathy and foot care.



9. Which of the symptoms that Y.L. reported today led you to believe she has some form of neuropathy?


10. What findings in Y.L.’s history place her at increased risk for the development of other forms of neuropathy?


11. How would you educate Y.L. about neuropathy?


12. Because Y.L. already has symptoms of neuropathy, placing her at risk for foot complications, you realize you need to instruct her on proper foot care. Outline what you will include when teaching her about proper diabetic foot care.


13. What are some changes that Y.L. can make to reduce the risk or slow the progression of both macrovascular and microvascular disease?


14. Given all of the information in the foregoing scenario, what DM-related complication do you believe Y.L. is most at risk for, and why?


15. What monitoring will be needed for Y.L. in regards to nephropathy and retinopathy?



Case Study 77


Name________________________Class/Group__________________Date______________


Group Members________________________________________________


INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will need to rewrite it.



Scenario


You graduated 3 months ago and are working with a home care agency. Included in your caseload is J.S., a 60-year-old man suffering from chronic obstructive pulmonary disease (COPD) related to cigarette smoking. He has been on home oxygen, 2 L oxygen by nasal cannula (O2/NC), for several years. Approximately 10 months ago, he was started on chronic oral steroid therapy. His current medications include an ipratropium-albuterol (Combivent) inhaler, beclamethasone (Beclovent) inhaler, dexamethasone (Decadron), digoxin (Lanoxin), and furosemide (Lasix). On the way to J.S.’s home, you make a mental note to check him for signs and symptoms of infection and Cushing’s syndrome.



1. Differentiate between Cushing’s syndrome and Cushing’s disease.


2. Your assessment includes the following findings. Determine whether the findings are attributable to J.S.’s COPD or possible Cushing’s syndrome. Place an “L” beside the symptoms consistent with COPD and a “C” next to those consistent with Cushing’s syndrome.



3. You inform the physician of J.S.’s assessment. The physician believes J.S. has developed Cushing’s syndrome and decides to change his prescription from dexamethasone (Decadron) to prednisone (Deltasone) given on alternate days. Explain the rationale for this change.


4. Identify possible consequences of suddenly stopping the dexamethasone (Decadron) therapy.


5. Cushing’s syndrome can affect memory. Patients can easily forget what medications have been taken, especially when there are several different drugs and some are taken on alternating days. List at least three ways you can help J.S. remember to take his pills as prescribed.


6. J.S. states that his appetite has increased but he is losing weight. He reports trying to eat, but he gets short of breath and cannot eat any more. How would you address this problem?


7. You advise J.S. to take his prednisone (Deltasone) in the morning with food. You ask him a series of questions related to possible gastric discomfort, vision, and joint pain. Discuss the rationale for your line of questioning.


8. Differentiate between the glucocorticoid and mineralocorticoid effects of prednisone (Deltasone).


9. How would your assessment change if J.S. were taking a glucocorticoid that also has significant mineralocorticoid activity?


10. Review J.S.’s list of medications. Based on what you know about the side effects of loop diuretics and steroids, discuss the potential problem of administering these in combination with digoxin.


11. Realizing that patients like J.S. are susceptible to all types of infections, you write guidelines to reduce the risk of infection. Identify four major points that these guidelines will include.


12. Besides measures to reduce the risk of infection, what other information would you want to stress to J.S. at your visit? (Select all that apply.)




Case Study 78


Name________________________Class/Group__________________Date_________


Group Members________________________________________________


INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will need to rewrite it.

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  3. Pediatric Disorders
  4. Emergency Situations

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Jan 16, 2017 | Posted by in NURSING | Comments Off on Endocrine Disorders

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