Nursing Management: Endocrine Problems

Nursing Management

Endocrine Problems

Katherine A. Kelly

The worst thing that can happen to you may be the best thing for you, if you don’t let it get the best of you.

Will Rogers

Learning Outcomes

1. Explain the pathophysiology, clinical manifestations, collaborative care, and nursing management of the patient with an imbalance of hormones produced by the anterior pituitary gland.

2. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of the patient with an imbalance of hormones produced by the posterior pituitary gland.

3. Explain the pathophysiology, clinical manifestations, collaborative care, and nursing management of the patient with thyroid dysfunction.

4. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of the patient with an imbalance of the hormone produced by the parathyroid glands.

5. Identify the pathophysiology, clinical manifestations, collaborative care, and nursing management of the patient with an imbalance of hormones produced by the adrenal cortex.

6. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of the patient with an excess of hormones produced by the adrenal medulla.

7. List the side effects of corticosteroid therapy.

8. Describe common nursing assessments, interventions, rationales, and expected outcomes related to patient teaching for management of chronic endocrine problems.

acromegaly, p. 1190

Addison’s disease, p. 1211

Cushing syndrome, p. 1207

diabetes insipidus (DI), p. 1194

exophthalmos, p. 1197

goiter, p. 1195

Graves’ disease, p. 1196

hyperaldosteronism, p. 1214

hyperparathyroidism, p. 1205

hyperthyroidism, p. 1196

hypoparathyroidism, p. 1206

hypopituitarism, p. 1192

hypothyroidism, p. 1201

myxedema, p. 1202

pheochromocytoma, p. 1214

syndrome of inappropriate antidiuretic hormone (SIADH), p. 1193

thyroid cancer, p. 1204

thyroiditis, p. 1196

thyrotoxicosis, p. 1197

Reviewed by Dorothy (Dottie) M. Mathers, RN, DNP, CNE, Professor, School of Health Sciences, Pennsylvania College of Technology, Williamsport, Pennsylvania; Teresa J. Seright, RN, PhD, CCRN, Assistant Professor of Nursing, Montana State University, Bozeman, Montana; Daryle Wane, PhD, ARNP, FNP-BC, Professor of Nursing, Generic Program Track Coordinator, Pasco-Hernando Community College, New Port Richey, Florida; Saundra J. Hendricks, RN, MS, FNP, BC-ADM, Department of Medicine, Endocrine Division, The Methodist Hospital, Houston, Texas; Beth Lucasy, RN, MA, VP Marketing and Communications, TVAX Biomedical, Kansas City, Missouri; and Barbara Lukert, MD, Endocrinologist, University of Kansas Medical Center, Kansas City, Kansas.

eNursing Care Plan 50-1 Patient With Hyperthyroidism

Nursing Diagnosis* Activity intolerance related to fatigue, exhaustion, and heat intolerance secondary to hypermetabolism as evidenced by complaints of weakness, inability to perform usual activities, dyspnea, tachycardia, and/or irritability
Patient Goals 1. Achieves a program of activity that balances physical activity with energy-conserving activities 2. Reports increased tolerance to activity with less weakness and fatigue
Outcomes (NOC)	Interventions (NIC) and Rationales
Psychomotor Energy • Exhibits concentration _____ • Maintains personal grooming and hygiene _____ • Exhibits stable energy level _____ • Exhibits ability to accomplish daily tasks _____ Energy Conservation • Balances activity and rest _____ • Recognizes energy limitations _____ • Uses energy conservation techniques _____ • Reports adequate endurance for activity _____ Measurement Scale 1 = Never demonstrated 2 = Rarely demonstrated 3 = Sometimes demonstrated 4 = Often demonstrated 5 = Consistently demonstrated	Energy Management • Monitor patient for evidence of excess physical and emotional fatigue because hyperthyroidism results in protein catabolism, overactivity, and increased metabolism leading to exhaustion. • Monitor cardiorespiratory response to activity (e.g., tachycardia, other dysrhythmias, dyspnea, diaphoresis, pallor, blood pressure [BP], and respiratory rate) because decompensation of cardiopulmonary function can occur with hypermetabolism. • Assist with regular physical activities (e.g., ambulation, transfers, turning, and personal care) to make certain patient’s daily needs are met. • Assist the patient to understand energy conservation principles (e.g., the requirement for restricted activity or bed rest) to avoid fatiguing patient. • Assist the patient to schedule rest periods. • Avoid care activities during scheduled rest periods to promote adequate rest.
Nursing Diagnosis Imbalanced nutrition: less than body requirements related to hypermetabolism and inadequate food intake as evidenced by complaints of weight loss; less than optimal body weight
Patient Goals 1. Maintains weight appropriate for height (target weight ____ lb/kg) 2. Consumes food and fluid adequate to meet nutritional needs 3. Corrects nutritional deficiencies
Outcomes (NOC)	Interventions (NIC) and Rationales
Nutritional Status • Nutrient intake _____ • Food intake _____ • Fluid intake _____ • Energy _____ • Weight/height ratio _____ • Hydration _____ Measurement Scale 1 = Severe deviation from normal range 2 = Substantial deviation from normal range 3 = Moderate deviation from normal range 4 = Mild deviation from normal range 5 = No deviation from normal range	Nutrition Management • Determine, in collaboration with the dietitian, the number of calories and type of nutrients needed to meet nutrition requirements. • Ascertain patient’s food preferences to determine extent of the problem and plan appropriate interventions. • Provide patient with high-protein, high-calorie, nutritious finger foods and drinks that can be readily consumed because hyperthyroidism increases metabolic rate with resulting need to prevent muscle breakdown and weight loss. • Offer snacks (e.g., frequent drinks, fresh fruits/juice) to maintain adequate caloric intake. • Monitor recorded intake for nutritional content and calories to evaluate nutritional status. • Weigh patient at appropriate intervals to evaluate effectiveness of nutritional plan. • Provide appropriate information about nutritional needs and how to meet them to promote self-care. • Assist the patient in receiving help from appropriate community nutritional programs.

^*Nursing diagnoses listed in order of priority.

eNursing Care Plan 50-2 Patient With Hypothyroidism

Nursing Diagnosis* Imbalanced nutrition: more than body requirements related to calorie intake in excess of metabolic rate as evidenced by weight gain in presence of decreased appetite
Patient Goals 1. Attains weight appropriate for height (target weight _____ lb/kg) 2. Maintains caloric intake that meets nutritional needs
Outcomes (NOC)	Interventions (NIC) and Rationales
Weight Maintenance Behavior • Monitors body weight _____ • Maintains recommended eating pattern _____ • Balances exercise with caloric intake _____ • Maintains optimal daily caloric intake _____ • Maintains optimum weight _____ Measurement Scale 1 = Never demonstrated 2 = Rarely demonstrated 3 = Sometimes demonstrated 4 = Often demonstrated 5 = Consistently demonstrated	Weight Management • Discuss with individual the medical conditions that may affect weight to reassure patient that optimal weight can be maintained with treatment of hypothyroidism. • Discuss with individual the relationship between food intake, exercise, weight gain, and weight loss to promote understanding of weight management. • Determine the individual’s ideal body weight to plan weekly weight loss goals. • Assist in developing well-balanced meal plans consistent with level of energy expenditure. • Develop with the individual a method to keep a daily record of intake, exercise sessions, and/or changes in body weight to promote progress toward final goal. Nutrition Management • Determine, in collaboration with dietitian, number of calories and type of nutrients needed to meet nutrition requirements. • Provide appropriate information about nutritional needs and how to meet them so patient will be more agreeable to dietary restrictions. • Monitor recorded intake for nutritional content and calories to evaluate patient’s management of nutrition. • Weigh patient at appropriate intervals to monitor progress toward target weight.
Nursing Diagnosis Risk for constipation related to decreased motility of gastrointestinal tract
Patient Goal Experiences regular, soft formed stools that are easy to pass
Outcomes (NOC)	Interventions (NIC) and Rationales
Bowel Elimination • Elimination pattern _____ • Stool soft and formed _____ • Ease of stool passage _____ • Passage of stool without aids _____ Measurement Scale 1 = Severely compromised 2 = Substantially compromised 3 = Moderately compromised 4 = Mildly compromised 5 = Not compromised	Constipation/Impaction Management • Encourage increased fluid intake (e.g., 2-3 L of fluids per day) to maintain soft stool. • Instruct patient/family on high-fiber diet to increase knowledge of how to increase fecal mass. • Monitor bowel movements, including frequency, consistency, shape, volume, and color, to plan appropriate interventions. • Suggest use of laxatives/stool softeners to stimulate bowel evacuation. • Teach patient/caregivers about timeframe for resolution of constipation because elimination patterns will improve with treatment of hypothyroidism.
Nursing Diagnosis Impaired memory related to slowed mental processes as evidenced by forgetfulness, memory loss, somnolence, and/or personality changes
Patient Goal Demonstrates cognitive orientation with correction of hormone deficiency
Outcomes (NOC)	Interventions (NIC) and Rationales
Cognition • Comprehension of the meaning of situations _____ • Attentiveness _____ • Concentration _____ • Recent memory _____ • Cognitive orientation _____ Measurement Scale 1 = Severely compromised 2 = Substantially compromised 3 = Moderately compromised 4 = Mildly compromised 5 = Not compromised	Reality Orientation • Monitor for changes in orientation, cognitive and behavioral functioning, and quality of life to determine appropriate interventions. • Inform patient of person, place, and time to decrease confusion. • Provide a low-stimulation environment for patient in whom disorientation is increased by overstimulation. • Speak to patient in slow, distinct manner with appropriate volume to allow patient to understand. • Avoid requests that exceed the patient’s capacity (e.g., abstract thinking when patient can think only in concrete terms, decision making beyond preference or capacity) to decrease frustration and loss of self-esteem. • Use environmental cues (e.g., signs, pictures, clocks, calendars) to maintain orientation to time and day.
Nursing Diagnosis Fatigue related to decreased metabolic rate, anemia, decreased cardiac output, and neurologic changes as evidenced by compromised concentration, increase in rest requirements, lack of energy, lethargy, disinterest in surroundings, and verbalization of an overwhelming lack of energy
Patient Goals 1. Participates in self-care activities of daily living with minimal discomfort and fatigue 2. Reports increased energy and endurance
Outcomes (NOC)	Interventions (NIC) and Rationales
Fatigue Level • Exhaustion _____ • Lassitude _____ • Impaired concentration _____ • Decreased motivation _____ • Depressed mood _____ • Postexertional malaise _____ Measurement Scale 1 = Severe 2 = Substantial 3 = Moderate 4 = Mild 5 = None • Activities of daily living _____ • Rest quality _____ • Sleep quality _____ • Alertness _____ • Balance of activity and rest _____ • Activity _____ • Metabolism _____ Measurement Scale 1 = Severely compromised 2 = Substantially compromised 3 = Moderately compromised 4 = Mildly compromised 5 = Not compromised	Energy Management • Assess patient’s physiologic status for deficits resulting in fatigue to determine extent of problem and plan appropriate interventions. • Monitor patient for evidence of excess physical and emotional fatigue to evaluate effectiveness of treatment. • Monitor cardiorespiratory response to activity (e.g., pulse rate, cardiac rhythm, respiratory rate) to determine effect of activities and plan activity increases. • Encourage alternate rest and activity periods to prevent fatigue. • Teach activity organization and time-management techniques to prevent fatigue. • Promote bed rest/activity limitation (e.g., increase number of rest periods) to improve patient’s tolerance and comfort level. • Plan activities for periods when the patient has the most energy to allow maximum participation. • Monitor/record patient’s sleep pattern and number of sleep hours as sleep patterns are often altered in fatigue.

^*Nursing diagnoses listed in order of priority.

eNursing Care Plan 50-3 Patient With Cushing Syndrome

Nursing Diagnosis* Risk for infection related to lowered resistance to stress and suppression of immune system
Patient Goal Experiences no signs or symptoms of infection.
Outcomes (NOC)	Interventions (NIC) and Rationales
Infection Severity • Fever _____ • Sputum culture colonization _____ • Urine culture colonization _____ • Blood culture colonization _____ • Wound site culture colonization _____ • White blood count elevation _____ • Pain/tenderness _____ Measurement Scale 1 = Severe 2 = Substantial 3 = Moderate 4 = Mild 5 = None Risk Control • Modifies lifestyle to reduce risk _____ • Avoids exposure to health threats _____ Measurement Scale 1 = Never demonstrated 2 = Rarely compromised 3 = Sometimes demonstrated 4 = Often demonstrated 5 = Consistently demonstrated	Infection Protection • Monitor for systemic and localized signs and symptoms of infection so infection can be detected early and treatment initiated promptly. • Provide private room. • Maintain asepsis for patient at risk. • Screen all visitors for communicable diseases to reduce the risk of infection exposure. • Monitor absolute granulocyte count, WBC count, and differential results to detect infection and plan treatment. • Obtain cultures as indicated to identify and treat infectious organisms. • Inspect skin and mucous membranes for redness, extreme warmth, or drainage because other signs and symptoms of infection may be minimal or absent. • Teach patient and family members how to avoid infections (e.g., hand washing). • Teach the patient and family about signs and symptoms of infection and when to report them to the health care provider.
Nursing Diagnosis Imbalanced nutrition: more than body requirements related to increased appetite, high caloric intake, and inactivity as evidenced by statement of increased appetite; weight 10% or more than optimum for height
Patient Goals 1. Attains weight appropriate for height (target weight _____ lb/kg). 2. Maintains low-calorie diet that meets nutritional needs.
Outcomes (NOC)	Interventions (NIC) and Rationales
Nutritional Status • Nutrient intake _____ • Food intake _____ • Weight/height ratio _____ • Muscle tone _____ Measurement Scale 1 = Severe deviation from normal range 2 = Substantial deviation from normal range 3 = Moderate deviation from normal range 4 = Mild deviation from normal range 5 = No deviation from normal range Knowledge: Diet • Recommended diet _____ • Rationale for diet _____ • Relationship among diet, exercise, and weight _____ • Strategies to change dietary habits _____ Measurement Scale 1 = No knowledge 2 = Limited knowledge 3 = Moderate knowledge 4 = Substantial knowledge 5 = Extensive knowledge	Nutrition Management • Determine, in collaboration with dietitian, number of calories and type of nutrients needed to meet nutrition requirements (e.g., high protein, low fat, low carbohydrate, low sodium, high potassium, high calcium) to help correct the effects of excess corticosteroids. • Provide appropriate information about nutritional needs and how to meet them to promote self-care. • Monitor recorded intake for nutritional content and calories. • Weigh patient at appropriate intervals to evaluate progress toward goal. Nutritional Counseling • Discuss patient’s knowledge of the food groups, as well as perceptions of the needed diet modification. • Evaluate progress of dietary modification goals at regular intervals. • Provide referral/consultation with other members of the health care team (e.g., dietitian, physical therapist) to help address weight gain, muscle wasting, and altered mineral levels.
Nursing Diagnosis Situational low self-esteem related to altered body image, emotional lability, and diminished physical capabilities as evidenced by verbalization of negative feelings regarding personal appearance and inability to perform usual activities
Patient Goals 1. Reports increased acceptance of appearance. 2. Uses self-care methods to improve appearance.
Outcomes (NOC)	Interventions (NIC) and Rationales
Self-Esteem • Acceptance of self-limitations _____ • Description of self _____ • Maintenance of grooming/hygiene _____ • Acceptance of compliments from others _____ • Description of pride in self _____ • Feelings about self-worth _____ • Fulfillment of personally significant roles _____ Measurement Scale 1 = Never positive 2 = Rarely positive 3 = Sometimes positive 4 = Often positive 5 = Consistently positive	Self-Esteem Enhancement • Encourage patient to identify strengths to promote awareness of capabilities. • Reinforce the personal strengths that patient identifies. • Make positive statements about the patient to boost morale by providing positive feedback. • Encourage increased responsibility for self to improve patient’s appearance and self-esteem. Teaching: Disease Process • Provide reassurance about patient’s condition (e.g., explaining physical and emotional changes will resolve with hormonal balance) to increase their understanding and assist with coping.
Nursing Diagnosis Risk for impaired skin integrity related to thin fragile skin, edema, redistribution of fat, and impaired healing
Patient Goal Experiences no skin impairment, maintaining intact skin.
Outcomes (NOC)	Interventions (NIC) and Rationales
Tissue Integrity: Skin and Mucous Membranes • Skin integrity _____ • Thickness _____ • Texture _____ • Elasticity _____ Measurement Scale 1 = Severely compromised 2 = Substantially compromised 3 = Moderately compromised 4 = Mildly compromised 5 = Not compromised • Skin lesions _____ • Abnormal pigmentation _____ • Erythema _____ Measurement Scale 1 = Severe 2 = Substantial 3 = Moderate 4 = Mild 5 = None	Skin Surveillance • Observe extremities for color, warmth, swelling, pulses, texture, edema, and ulcerations for early detection of skin impairment. • Monitor for sources of pressure and friction to prevent injury to easily traumatized tissue. • Monitor skin for rashes and abrasions to promote early treatment. • Monitor skin and mucous membranes for areas of discoloration, bruising, and breakdown to provide early treatment. • Document skin or mucous membrane changes to provide early intervention. Skin Care: Topical Treatments • Provide support to edematous areas to promote circulation to edematous areas. • Use devices on the bed (e.g., sheepskin) that protect the patient. Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Introduction Nursing Management: Sexually Transmitted Infections Nursing Assessment: Cardiovascular System Nursing Management: Musculoskeletal Problems Stay updated, free articles. Join our Telegram channel Tags: Medical-Surgical Nursing Assessment and Management of Clinical P Nov 17, 2016 \| Posted by admin in NURSING \| Comments Off on Nursing Management: Endocrine Problems Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access