Chapter 7

Endocrine Diabetes Case Study Answers

1. What cultural considerations should be taken into account when developing Daisy’s care plan?

• Consider the importance of family in Daisy’s cultural context and involve them in discussions and decisions about her care.
• Utilize language-appropriate educational materials and ensure there is a translator available if needed.
• Recognize potential cultural barriers to adherence to treatment, such as traditional medicine beliefs or dietary preferences.
• Understand the importance of maintaining personal dignity and autonomy in care.

2. How would you assess Daisy’s understanding of her diagnosis and treatment plan given her primary language is Spanish?

• Utilize an interpreter proficient in medical terminology to ensure accurate communication.
• Use visual aids and written materials in Spanish to enhance comprehension.
• Encourage Daisy to ask questions and repeat information in her own words to confirm understanding.
• Assess Daisy’s level of health literacy and adjust education materials accordingly.

3. What lifestyle modifications would you suggest to Daisy, considering her socioeconomic background?

• Discuss low-cost dietary options, such as buying in-season fruits and vegetables or using frozen or canned options when fresh produce is expensive.
• Recommend physical activities that require little to no cost, like walking or gardening.
• Encourage portion control and balanced meals to maximize nutritional value.
• Advise on low-cost ways to monitor blood glucose levels, such as using a basic glucose meter.

4. What community resources could be utilized to support Daisy’s long-term management of diabetes?

• Identify local clinics that offer free or low-cost diabetes care and medication assistance programs.
• Connect Daisy with community-based diabetes support groups where she can receive guidance, education, and emotional support.
• Explore local food banks or government programs that provide nutritional assistance.

5. How might Daisy’s social and financial status impact her ability to access care and medications regularly?

• Recognize potential challenges in accessing care, such as transportation limitations or work schedule conflicts.
• Collaborate with Daisy to find solutions that accommodate her circumstances, such as flexible appointment times or telehealth options.
• Assist Daisy in identifying and applying for available financial aid programs or sliding scale clinics.

6. How would you involve Daisy’s family in her care plan to support her management of diabetes?

• Encourage family members to attend educational sessions and appointments to learn about diabetes management.
• Promote open communication within the family to address any concerns or misconceptions about Daisy’s condition and treatment.
• Explore the family’s support network and involve individuals who can provide practical or emotional support to Daisy.

Hyperthyroidism vs. Hypothyroidism Learning Activity Answers

1. When the thyroid stimulating hormone (TSH) is released, what two thyroid hormones are released by the thyroid? What element is needed for the body to use these hormones?

• The two thyroid hormones released by the thyroid are T3 and T4.
• Iodine is the needed element for T3 and T4.

2. Most common cause of hyperthyroidism is Graves’ disease.

3. Name two autoimmune diseases that affect thyroid function?

• Two autoimmune diseases that affect thyroid function are Graves’ disease (hyperthyroid) and Hashimoto’s (hypothyroid) disease.

4. Describe signs/symptoms of a thyroid storm (thyrotoxicosis)? What causes a thyroid storm?

• Signs and symptoms of a thyroid storm (thyrotoxicosis) are a high temperature (>105,), agitation, confusion (early sign), restlessness, and hypertension.
• A thyroid storm is caused by too much thyroid hormone.

5. The nurse is getting a new patient with an admitting diagnosis of possible (“rule-out”) myxedema coma.

• What equipment should they anticipate needing and why?
  • The following equipment would be needed because respiratory failure, low blood pressure, and low heart rate could occur: endotracheal intubation, trach kit, warm blankets (for cold intolerance), and a heart monitor.
• What are two risk factors for myxedema coma?
  • Two risk factors for myxedema coma are a thyroidectomy or abrupt stop of levothyroxine.

6. What are the signs/symptoms of hypothyroidism? What content should be included when teaching a patient with hypothyroidism about diet and activity?

• The signs and symptoms of hypothyroidism are the following: 
  • Low energy and weakness
  • Low metabolism (weight gain, edema)
  • Constipation
  • Losing hair (baldness)
  • Forgetfulness (low mood)
  • Low libido (sex drive)
  • Dry skin
  • No menstrual cycle (or missed) (amenorrhea)
• Patient teaching about hypothyroidism should include encouraging the client to take frequent rest periods and engage in a diet low in calories and low in cholesterol and saturated fats.

7. Levothyroxine

• What is the onset of action?
  • The onset of action for levothyroxine is typically about 3-4 weeks.
• When should levothyroxine be administered?
  • Levothyroxine should be taken on an empty stomach and 30-60 minutes before breakfast, once daily, and at the same time every day.

8. (True or False) Levothyroxine should not be taken during pregnancy.

• FALSE 

Thyroid Case Study 1

Ms. Hype had a thyroidectomy three months ago for thyroid cancer and has been taking levothyroxine for thyroid hormone replacement. She is having difficulty sleeping at night and is losing weight even though she says she is eating “…all the time.” She is wearing shorts and a t-shirt in January because she feels “so hot all the time.” She is restless and frequently asking how long this appointment will take.

VS: Temp – 101.2, Pulse – 112, Resp. – 18, BP – 162/94

9. What could be contributing to her symptoms?

• The levothyroxine dose may be too high for her and needs adjusting.

10. What is the action of PTU (propylthiouracil)? What two side effects should be reported?

• Propylthiouracil (PTU) stops thyroid from making thyroid hormones (T3 & T4).  A fever and/or a sore throat should be reported.

11. How does SSKI (potassium iodide) affect the thyroid?

• S – Shrinks the thyroid (before removal)
• S – Stains the teeth (drink through straw, mix with some juice)
• K – Keep one hour apart from other thyroid medications (don’t mix with other thyroid medications)

Thyroid Case Study 2

A patient with thyroid cancer needs to have their thyroid removed. They have just been administered the capsule containing RAIU (radioactive iodine uptake). Describe their needed education following their ingestion of this medication?

• Avoid people for 1-3 days because they are radioactive.
• Avoid crowds and pregnant individuals.
• Do not share eating utensils.
• Flush the toilet three times after using (excreted in waste products).
• Separate laundry. 
• No close contact with anyone.

12. Describe nursing care following a thyroidectomy and identify two specific rationales for these nursing interventions.

• Because of surgical manipulation, a load of thyroid hormones (T3 & T4) may be released into circulation.
• Airway—surgery is near the neck (edema following surgery, stridor, hoarseness)
  • Keep airway supplies at bedside (Trach set)
  • Breathing—Height of bed up (semi-Fowler’s). Keep neck aligned
  • Circulation (see above)  
  • Calcium—monitor calcium. Observe for numbness and tingling around mouth (circumoral) and fingers  
    • Trousseaus—BP cuff inflated x 3 minutes, and fingers will twitch
    • Chvostek—“Cheeky” smile when patient’s face is tapped on the cheek (due to facial numbness)

All of the answers to the interactive element are found within the element.