Page 54 nursing.elitecme.com Complete Your CE Test Online - Click Here Additional nursing considerations In addition to diet, exercise, and medication administration, nurses must teach patients how to monitor their blood glucose levels and to care for equipment used for such monitoring. Blood pressure control and smoking cessation reduces complication onset and progression [5,6,11] . Patients must be taught to take meticulous care of their skin and seeking prompt treatment for infection. Special attention should be paid to care of the feet. Teach patients to wash feet daily and dry them carefully, especially between the toes. Inspect the feet for corns, calluses, redness, bruising, and any breaks in the skin. Abnormalities should be reported to the physician promptly. Advise patients never to walk barefoot and to wear non-constricting shoes  . Stress the need to report and numbness or pain in the hands and feet and any changes in voiding patterns (e.g., incontinence), which may indicate diabetic neuropathy. All blisters, cuts, and scrapes should be carefully treated. Teach patients signs and symptoms of UTIs and to report these signs and symptoms to their HCPs promptly [5,11] . Explain the importance of keeping all scheduled medical appointments and encourage annual eye examinations. Caution patients to contact their HCPs in the event of illness, injury, and/or infection since they may necessitate a medication dose adjustment  . Teach patients and families the signs of acute complications of diabetic therapy, particularly the signs and symptoms of hypoglycemia. Signs and symptoms of hypoglycemia include anxiety, mental changes, dizziness, weakness, pallor, tachycardia, diaphoresis, seizures, confusion, and loss of consciousness that may progress to coma. Teach patients and families that if these signs and symptoms occur, patients should immediately be given carbohydrates such as glucose tablets, honey, or fruit juice. If patients are unconscious, they should be given glucagon or dextrose IV [5,6,11] . Patients and families must also be taught to recognize ketoacidosis. Signs and symptoms of ketoacidosis include acetone breath (fruity-smelling breath), weak, rapid pulse, polyuria, thirst, deep, rapid respirations (Kussmaul’s respirations), changes in level of consciousness, and stupor. Prompt treatment with IV fluids, insulin, and, often, potassium replacement is necessary  . Elder considerations Several important issues involve elderly patients. These include[5,6,11] : ● ● Cells become more resistant to insulin with aging. This decreases the older adult’s ability to metabolize glucose. Additionally, insulin release from the pancreas is delayed, and sudden concentrations of glucose occur. Such concentrations cause more prolonged hyperglycemia in elders. ● ● The thirst mechanism is less efficient in the elderly than in younger adults and children. Thus older adults may not experience the polydipsia that is characteristic of DM in younger adults. ● ● Healing is often slower in elders than in younger patients. DM compounds this delay in healing. CASE STUDY SCENARIOS AND STUDY QUESTIONS The endocrine system and its pathologies are complex topics. Compounding the complexity is the fact that many endocrine disorders are uncommon, and many HCPs have not had experience in working with patients who are dealing with endocrine pathologies. Recognition and treatment initiation, as well as providing appropriate nursing interventions, depend on a thorough knowledge of the glands of the endocrine system, hormonal production and actions, and clinical manifestations of pathologies. Education offerings must provide opportunities for review. Therefore, the following case study scenarios and study questions have been developed to reinforce the learner’s ability to recognize the various endocrine disorders and their management. The endocrine and nervous systems work together to regulate and integrate metabolic activities of the body. Differentiate the ways endocrine hormones and nerve impulses regulate such activities. The hormones that are secreted by the glands of the endocrine system are chemical messengers that transfer information from one set of cells to another to coordinate bodily functions . Hormones cause changes in the metabolic activities in specific cells while nerve impulses cause gland secretion and muscle contraction. Hormonal action is rather slow, but of prolonged duration. The action of nerve impulses, on the other hand, is rapid but of short duration . Andrea is preparing an oral presentation on the pituitary gland as part of her graduate work in nursing. When discussing this gland she must differentiate between the anterior and posterior regions of the pituitary. How can she do this? Recall that the pituitary is the “master gland.” It is divided into two regions: the anterior lobe or adenohypophysis and the posterior lobe or neurohypophysis[1,2,3] . The larger anterior lobe produces 6 hormones that are regulated by the hypothalamus: growth hormone (GH), thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL)[1,2,3] . The posterior pituitary is responsible for the secretion of antidiuretic hormone (ADH) and oxytocin[2,3] . Another important differentiation between the actions of the anterior and posterior pituitary is that the anterior pituitary actually produces 6 hormones. Production is regulated by the hypothalamus, which responds to negative and positive feedback mechanisms. The posterior pituitary stores ADH and oxytocin, which are actually produced by the hypothalamus[1,2,3] . Andrea (and other HCPs) must be aware of the pituitary’s role in endocrine functioning. They must know what hormones are secreted by the pituitary and how these hormones act on various body systems. Jennifer is a professor of nursing. She is developing an exam that deals with endocrine function. Several of the questions are designed to assess students’ knowledge of what glands produce specific hormones. Here are some samples of questions that Jennifer has written. Which gland is responsible for manufacturing a hormone that is the major metabolic hormone of the body? What is the hormone called? The correct answer would be the thyroid gland, which produces thyroid hormone, the major metabolite hormone of the body. Thyroid hormone increases metabolic rate, oxygen consumption, glucose absorption, and body temperature. It also affects growth and development and improves the effects of the sympathetic nervous system . What pancreatic cells produce glucagon? What pancreatic cells produce insulin? The alpha cells produce glucagon, which raises the blood glucose level by causing the breakdown of glycogen to glucose. The beta cells secrete insulin, which lowers blood glucose levels by facilitating movement of blood glucose across cells, converting glucose to glycogen[1,3] . Researchers are investigating the role of which gland in regulation of the sleep-wake cycle? The pineal gland, which is located in the middle of the brain, produces melatonin, which is believed to regulate circadian rhythms as part of the sleep-wake cycle[1,2] . What are the primary sources of sex hormones? The gonads are the primary source of sex hormones. In female, the ovaries produce eggs and the steroidal hormones estrogen and progesterone. In male, the testes, located in the scrotum, produce spermatozoa and the male sex hormone testosterone[1,2] . Give an example of a hormone that is controlled by positive feedback. What is the function of this hormone? Oxytocin is controlled by positive feedback. It targets the uterus and mammary glands, causing uterine contractions during childbirth and milk production for lactation. Oxytocin is produced by the hypothalamus and transported via nerves to the pituitary gland, where it is stored and then secreted when needed[1,2,3] .