NUR 438 - Final Exam Questions and Complete Solutions
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Course
NUR 438
Institution
NUR 438
Neuroendocrine system interrelationship between the endocrine and autonomic nervous system
Pediatric endocrine: lack of homeostatic control - vulnerable to fluid and electrolyte imbalance - affects glucose and amino acid metabolism
Pediatric endocrine: immature feedback loop between acth and adre...
NUR 438 - Final Exam Questions and
Complete Solutions
Neuroendocrine system ✅interrelationship between the endocrine and autonomic
nervous system
Pediatric endocrine: lack of homeostatic control ✅- vulnerable to fluid and electrolyte
imbalance
- affects glucose and amino acid metabolism
Pediatric endocrine: immature feedback loop between acth and adrenal cortex ✅less
tolerance for stress and increased risk for acute insufficiency with cardiovascular
collapse
Testing for endocrine function ✅- family history
- child health: previous hx and presenting symptoms
- endocrine testing: water deprivation test (diabetes insipidus), glucose/ketones (dm),
cortisol (acute adrenal insufficiency)
- mri for tumor
Neurogenic (central) diabetes insipidus ✅posterior pituitary hypofunction →under
secretion of adh → body cannot balance fluid levels as they are lost in urine.
Neurogenic (central) diabetes insipidus s/sx ✅cardinal: polyuria/polydipsia (early)
→dehydration/ electrolyte imbalance, with irritability in infants.
This condition is entirely unrelated to diabetes mellitus confusion arises from the
polydipsia and polyuria (common to both)
Neurogenic (central) diabetes insipidus lab values ✅hypernatremia (na > 145 meq/l)
(water lost > salt loss) and high serum osmolality are 2 key tests
Neurogenic (central) diabetes insipidus diagnostic and medical management ✅+ water
deprivation test (water restrictions do not decrease urine output)
Long term hormone replacement using ddvap (route oral, intranasal, or parental) bid
Fluid replacement may be needed to correct dehydration
Neurogenic (central) diabetes insipidus priority nursing dx ✅fluid volume
deficit/electrolyte imbalance
Provide fluids, monitor weight, i/o, s/sx of dehydration, labs, and teach about disease.
Neurogenic (central) diabetes insipidus quality outcomes ✅early recognition of signs
and symptoms of di
Differentiation of di from other causes of polyuria and polydipsia (i.e., diabetes mellitus)
,Effective hormone replacement
Di vs siadh ✅di: high and dry
Siadh: soaked inside
Syndrome of inappropriate antidiuretic hormone (siadh) ✅posterior pituitary →over
production/secretion of antidiuretic hormone → kidney reabsorbs more water increases
circulating volume.
Siadh s/sx ✅low urine output (retention of free water), anorexia, vomiting, irritability,
progressive signs of stupor and seizures (most are signs due to cerebral edema
associate with na < 120 meq/l)
Siadh lab values ✅hyponatremia ( < 135 meq/l) (dilution effect) and low serum
osmolality are two key tests. Bun is normal to low
Siadh diagnostic and medical management ✅fluid restriction immediately
May require oral sodium replacement or hypertonic saline infusion (w/ severe
hyponatremia)
Consider diuretics
Seizure precautions
Siadh priority nursing diagnosis ✅fluid volume excess/electrolyte imbalance
Monitor weight, i/o, s/sx of hypervolemia, neuro status, labs, and teach about disease.
Siadh quality outcomes ✅early recognition of signs and symptoms of siadh
Fluid overload prevented
Seizures prevented
Cushing's syndrome clinical manifestations ✅hypertension from na+ & water retention)
Infection risk due to ¯ antibodies/halt of immune activities
Cushing's syndrome lab values ✅↑ cortisol, ↑ acth (due to overproduction/loss of
negative feedback loop), hyperglycemia (↑ gluconeogenesis), hypokalemia (d/t high
cortisol), & metabolic alkalosis (caused by loss of k+ and h+ ions)
Cushing's syndrome medical management ✅treatment depends on cause
Cushing's syndrome nursing care ✅• body image, risk for infection, and chronic pain
• when symptoms are from steroid therapy then a change in administration time to am
every other day helps with more even release.
Use analgesics for muscle and joint pain.
, Acute adrenal insufficiency ✅• adrenal gland fails to meet stress response usually
seen with infection
Exogenous steroids have not been abruptly withdrawn (r/t suppressed the
hypothalamic-pituitary-adrenal (hpa) axis)
Acute adrenal insufficiency cm ✅• early s/sx include weakness, headache, & n/v
Late s/sx → cardiovascular collapse (weak, rapid pulse, decrease bp, shallow
respirations, cold, clammy skin, and cyanosis)
Acute adrenal insufficiency lab values ✅↓cortisol, normal/ ↑ acth, hyponatremia (loss of
fluids), hypoglycemia (↓ gluconeogenesis) hyperkalemia (↓ loss of k in urine), &
metabolic acidosis (↑ bun/dehydration)
Acute adrenal insufficiency medical management ✅• iv dose of hydrocortisone to
replace cortisol
• ivfs to correct fluid/electrolyte imbalances and improve bp/circulation
• monitor ekg r/t hyperkalemia
Oxygen therapy for hypoxia
Acute adrenal insufficiency nursing care ✅• risk for decreased cardiac output if
collapse present otherwise consider fluid volume deficit with electrolyte imbalance.
Family coping as this is life-threatening
Acute adrenal insufficiency quality outcomes ✅• early recognition of signs & symptoms
of acute adrenal crisis
• hypokalemia or hyperkalemia prevented
• fluid balance maintained
Sufficient cortisol replacement
Diabetes mellitus type 1 ✅chronic disorder with destruction of pancreatic beta cells -
low blood insulin levels - hyperglycemia - osmotic gradient from glucose spilling into the
urine - increased water loss/urine output - volume deficit leads to polydipsia - cells are in
starvation state - hunger mechanism triggered - increased food intake - increase in
blood glucose which leads to dka
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