NURS 6501 Discussion Endocrine Disorders
Sample Answer for NURS 6501 Discussion Endocrine Disorders Included After Question
In this exercise, you will complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
- Diabetes
- Hyper- and hypothyroidism
- Adrenal disorders
- Parathyroidism (hyper and hypo)
- Checks & balances / negative feedback
- Syndrome of Inappropriate Antidiuretic Hormone
- Pheochromocytosis
- Diabetes insipidus
- Diabetic ketoacidosis
Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Midterm Exam.
NURS 6501 Discussion Endocrine Disorders
Resources
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Click the weekly resources link to access the resources.
By Day 5 of Week 6
Complete the Knowledge Check by Day 5 of Week 6.
A Sample Answer For the Assignment:NURS 6501 Discussion Endocrine Disorders
Title: NURS 6501 Discussion Endocrine Disorders
Scenario 1: Syndrome of Antidiuretic Hormone (SIADH)
A 77-year-old female was brought to the clinic by her daughter who stated that her mother had become slightly confused over the past several days. She had been stumbling at home and had fallen twice but was able to walk with some difficulty. She had no other obvious problems and had been eating and drinking. The daughter became concerned when she forgot her daughter’s name, so she thought she better bring her to the clinic.
HPI: Type II diabetes mellitus (DM) with peripheral neuropathy x 30 years. Emphysema. Situational depression after death of spouse 6-months ago
SHFH: - non contributary except for 40 pack/year history tobacco use.
Meds: Metformin 1000 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago
Labs-CBC WNL; Chem 7- Glucose-102 mg/dl, BUN 16 mg/dl, Creatinine 1.1 mg/dl, Na+116 mmol/L,
K+4.2 mmol/L, CO237 m mol/L, Cl–97 mmol/L.
The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH).
Question:
1. Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH
Your Answer:
This discussion question is about a 77-year-old female patient brought to the hospital by her daughter with complains that have led her being diagnosed with syndrome of inappropriate antidiuretic hormone. Syndrome of inappropriate antidiuretic hormone (SIADH) is a disorder characterized by the increased release of antidiuretic hormones. There is the inability to suppress the secretion of the ADH hormone leading to water toxicity. The kidneys cannot excrete excess water due to too much reabsorption, hence, hyponatremia. Patient factors contribute to the development of SIADH. One of them as seen in this case study is medications use. Some medications increase the patient’s risk of developing SIADH when used for a long time. They include drugs such as antidepressants, seizure medications, diabetes, cancer, and hypertension treatment drugs(Kim, 2022). The patient in the case study is currently using drugs such as metformin and escitalopram, which have an elevated risk of SIADH.
Respiratory conditions such as acute respiratory failure, tuberculosis, and pneumonia also predispose patients to developing the disorder. The patient in the case study has a history of emphysema, which could precipitate other respiratory complications associated with SIADH. Disorders of the nervous system have also been linked with the development of SIADH in some patients. Accordingly, conditions such as head injury, tumors, stroke, and meningitis carry an increased risk of SIADH because of the involvement of the brain. The patient in the case study has neuropathy due to diabetes mellitus. In addition, she is at a risk of developing diabetes-related complication such as stroke. The fact that she experienced slight confusion and stumbling at home could indicate stroke (Mentrasti et al., 2020). Therefore, additional investigations should be conducted to rule out SIADH secondary to neurological conditions such as stroke.
References
Kim, G.-H. (2022). Pathophysiology of Drug-Induced Hyponatremia. Journal of Clinical Medicine, 11(19), Article 19. https://doi.org/10.3390/jcm11195810
Mentrasti, G., Scortichini, L., Torniai, M., Giampieri, R., Morgese, F., Rinaldi, S., & Berardi, R. (2020). Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): Optimal Management. Therapeutics and Clinical Risk Management, 16, 663–672. https://doi.org/10.2147/TCRM.S206066
A Sample Answer 2 For the Assignment:NURS 6501 Discussion Endocrine Disorders
Title: NURS 6501 Discussion Endocrine Disorders
Scenario 2: Type 1 Diabetes
A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.
PMH: noncontributory.
Allergies-NKDA
FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process
SH: denies alcohol, tobacco or illicit drug use. Not sexually active.
Labs: random glucose 244 mg/dl.
DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.
Question
1. Explain the pathophysiology of the three P’s for (polyuria, polydipsia, polyphagia)” with the given diagnosis of Type I DM.
Your Answer:
This discussion question is about a 14-year-old girl that has been brought to the pediatrician’s office with complains of weight loss despite eating more, frequent urination, fatigue, and unquenchable thirst that has interfered with her school activities. The patient has been diagnosed with type 1 diabetes mellitus. Type 1 diabetes mellitus is a disorder characterized by the lack of insulin needed for the regulation of the normal blood glucose levels(Acharya et al., 2021). The patients present with symptoms that include polyuria, polydipsia, and polyphagia.
Polydipsia is an increase in thirst. Patients with type 1 diabetes mellitus often complain of an insatiable thirst. Patients with this disorder develop polydipsia because of the elevated blood glucose levels. The elevation results in the stimulation of the kidneys to excrete the excess glucose via the urine leading to glycosuria. On the other hand, the loss of fluids via the kidneys stimulates the brain to raise thirst level for the patient to take fluids to replace the loss (Del Chierico et al., 2022). Diabetes also causes osmotic diuresis, which is associated with dehydration and the increased need for body fluids.
Polyuria is the passage of urine more than normal. It is mostly more than 1-2 liters daily. As noted above an elevated blood glucose level results in the brain stimulating the kidneys to pass more urine, as a way of losing the excess glucose in it. The kidneys are stimulated to filter out more water, which increases the frequency, urgency, and volume of urine being passed. Polyphagia refers to excessive hunger. Patients with diabetes mellitus type I experience hunger because of glucose resistance. The glucose in the blood stream cannot enter the cells for metabolism due to the lack of insulin (Acharya et al., 2021). As a result, the cells continue being starved despite the high level of glucose, hence polyphagia.
References
Acharya, S., Shukla, S., & Vaswani, R. (2021). Pathophysiology of Complication in Diabetes Mellitus. Journal of Pharmaceutical Research International, 89–95. https://doi.org/10.9734/jpri/2021/v33i60A34459
Del Chierico, F., Rapini, N., Deodati, A., Matteoli, M. C., Cianfarani, S., &Putignani, L. (2022). Pathophysiology of Type 1 Diabetes and Gut Microbiota Role. International Journal of Molecular Sciences, 23(23), Article 23. https://doi.org/10.3390/ijms232314650
A Sample Answer 3 For the Assignment:NURS 6501 Discussion Endocrine Disorders
Title: NURS 6501 Discussion Endocrine Disorders
Scenario 2: Type 1 Diabetes
A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.
PMH: noncontributory.
Allergies-NKDA
FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process
SH: denies alcohol, tobacco or illicit drug use. Not sexually active.
Labs: random glucose 244 mg/dl.
DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.
Question
1. Explain the genetics relationship and how this and the environment can contribute to Type I DM.
Your Answer:
This discussion question is of a 14-year-old girl who has been brought to the pediatrician’s office by her parents with complains that have led to her diagnosis with type 1 diabetes mellitus. A significant relationship exists between genetics, environment and type 1 diabetes mellitus. Genetics play a crucial role in the development of type 1 diabetes. Accordingly, individuals born to families with a history of type 1 diabetes are highly at a risk of developing the disease (Ilonen et al., 2019). The risk can be seen from the inheritability of the genes that contribute to the development of type 1 diabetes. The genetic contribution of one’s risk of developing type 1 diabetes is estimated to be at least 50%. The variations in the major histocompatibility complex such as the human leukocyte antigen classes I and II contribute to more than half of the genetic risks in type 1 diabetes. Other genes such as the PTPN22, IL2RA, CTLA4, and INS also contribute to the disease. The patient’s maternal uncle has a history of diabetes (Norris et al., 2020). As a result, this may explain the basis for the child developing type 1 diabetes mellitus.
Environmental factors also contribute to the development of type 1 diabetes mellitus. Accordingly, exposure to some virus during pregnancy has been shown to increase the risk of type 1 diabetes mellitus. Exposure to some climatic conditions such as oceanic environments have also been linked to the disease (Ilonen et al., 2019). These environmental factors trigger autoimmune reactions that destroy the cells involved in the release of insulin.
References
Ilonen, J., Lempainen, J., &Veijola, R. (2019). The heterogeneous pathogenesis of type 1 diabetes mellitus. Nature Reviews Endocrinology, 15(11), Article 11. https://doi.org/10.1038/s41574-019-0254-y
Norris, J. M., Johnson, R. K., & Stene, L. C. (2020). Type 1 diabetes—Early life origins and changing epidemiology. The Lancet Diabetes & Endocrinology, 8(3), 226–238. https://doi.org/10.1016/S2213-8587(19)30412-7
A Sample Answer 4 For the Assignment:NURS 6501 Discussion Endocrine Disorders
Title: NURS 6501 Discussion Endocrine Disorders
Scenario 3: Type II DM
A 55-year-old male presents with complaints of polyuria, polydipsia, polyphagia, and weight loss. He also noted that his feet on the bottom are feeling “strange” “like ants crawling on them” and noted his vision is blurry sometimes. He has increased an increased appetite, but still losing weight. He also complains of “swelling” and enlargement of his abdomen.
PMH: HTN - well controlled with medications. He has mixed hyperlipidemia, and central abdominal obesity. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 333 mg/dl.
Diagnosis: Type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching.
Question:
1. How would you describe the pathophysiology of Type II DM?
Your Answer:
This discussion question is about a 55-year-old patient who has been diagnosed with type II diabetes mellitus. The patient came with complaints of polydipsia, polyuria, polyphagia, weight loss, blurred vision, and increased appetite, leading to a diagnosis of type II diabetes mellitus. Type 2 diabetes mellitus develops due to the inability of insulin-sensitive tissues to respond to insulin and defects in insulin secretion by the pancreatic betacells. Insulin is needed for glucose homeostasis and maintenance of optimum metabolic functioning in the body (Lima et al., 2022). Any imbalance in insulin secretion affects glucose homeostasis, hence, the development of the disorder.
Patients with type 2 diabetes mellitus have symptoms that include hyperglycemia. Hyperglycemia develops due to the high glucose levels in the cells. The lack of insulin implies that glucose entry into the cells will not be possible. As a result, cells starve despite the high glucose levels in the blood, leading to polyphagia. Patients also report polydipsia since the excess glucose is excreted through the kidneys via urine. The excretion causes dehydration, which increases the need for unquenched fluid intake by patients. Patients also develop weight loss due to inadequate nutrition needed to meet the metabolic needs of the patients. Type 2 diabetes mellitus is associated with complications such as diabetic nephropathy, retinopathy, and neuropathy. Excessive glucose cause micro and macrovascular damages, leading to the symptoms experienced by the client such as blurred vision and unusual sensations in the feet(Sanches et al., 2023). The associated risk factors for type 2 diabetes mellitus include family history, genetics, physical inactivity, obesity, and sedentary lifestyles.
References
Lima, J. E. B. F., Moreira, N. C. S., & Sakamoto-Hojo, E. T. (2022). Mechanisms underlying the pathophysiology of type 2 diabetes: From risk factors to oxidative stress, metabolic dysfunction, and hyperglycemia. Mutation Research/Genetic Toxicology and Environmental Mutagenesis, 874–875, 503437. https://doi.org/10.1016/j.mrgentox.2021.503437
Sanches, J. M., Zhao, L. N., Salehi, A., Wollheim, C. B., & Kaldis, P. (2023). Pathophysiology of type 2 diabetes and the impact of altered metabolic interorgan crosstalk. The FEBS Journal, 290(3), 620–648. https://doi.org/10.1111/febs.16306
A Sample Answer 5 For the Assignment:NURS 6501 Discussion Endocrine Disorders
Title: NURS 6501 Discussion Endocrine Disorders
Scenario 4: Hypothyroidism
A patient walked into your clinic today with the following complaints: Weight gain (15 pounds), however has a decreased appetite with extreme fatigue, cold intolerance, dry skin, hair loss, and falls asleep watching television. The patient also tearfulness with depression, and with an unknown cause and has noted she is more forgetful. She does have blurry vision.
PMH: Non-contributory.
Vitals: Temp 96.4˚F, pulse 58 and regular, BP 106/92, 12 respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted.
Diagnosis: hypothyroidism.
Question:
What causes hypothyroidism?
Your Answer:
This discussion essay focuses on a patient who has been diagnosed with hypothyroidism. The patient came with complaints that included weight gain, decreased appetite, fatigue, cold intolerance, hair loss, dry skin, falling asleep easily, and depression. Hypothyroidism is an endocrine disorder that is characterized by low levels of thyroid hormones. Hypothyroidism develops from several causes. One of them is congenital causes. Factors such as thyroid ectopy, hypoplasia, and aplasia cause hypothyroidism (Hegedüs et al., 2022). They cause defects in the synthesis of thyroid hormones.
Hypothyroidism can also develop from autoimmune disorders. Accordingly, conditions such as autoimmune thyroid disease cause hypothyroidism by impairing with the synthesis of thyroid hormones. Thyroid ablation is the other factor where a part or whole of the thyroid gland is removed surgically due to causes such as thyroid cancer and Graves’ disease. Radiation treatments for cancer may also cause hypothyroidism. The effects of radiotherapy such as immunosuppression may depress or impair with the normal production of thyroid hormones (Hegedüs et al., 2022).
Medications may also cause hypothyroidism. The effect is seen in patients prescribed medications such as interleukin-2, interferon alpha, amiodarone, and lithium. These drugs interfere with the normal physiological processes involved in the synthesis of thyroid hormones. In some cases, inadequate intake of dietary iodine also contributes to the development of hypothyroidism. Iodine is essential for the synthesis of thyroid hormones. A reduction in its supply is likely to lower the synthesis of thyroid hormones, hence, hypothyroidism. Patients may also report the hospital with secondary hypothyroidism. Secondary hypothyroidism develop from the damage to hypothalamus by causes such as surgery, radiation, or tumors. The damage impairs the control of thyroid hormone secretion(Chiovato et al., 2019). Therefore, accurate diagnosis is essential for the promotion of the patient’s optimum health and wellbeing.
References
Chiovato, L., Magri, F., &Carlé, A. (2019). Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Advances in Therapy, 36(2), 47–58. https://doi.org/10.1007/s12325-019-01080-8
Hegedüs, L., Bianco, A. C., Jonklaas, J., Pearce, S. H., Weetman, A. P., & Perros, P. (2022). Primary hypothyroidism and quality of life. Nature Reviews Endocrinology, 18(4), Article 4. https://doi.org/10.1038/s41574-021-00625-8