Page 60 Complete Your CE Test Online - Click Here How is sexual assignment made in hermaphroditism? Sexual assignment is based on the anatomy of the external genitalia. Reconstructive surgery, during which inappropriate reproductive organs are removed, is performed as early as possible to prevent the development of incongruous secondary sex characteristics at puberty. Hormonal replacement may be needed[5] . Complete this sentence: Research indicates that about _______of patients newly diagnosed with hypertension have ______________. Research indicates that about 0.5% of patients newly diagnosed with hypertension have pheochromocytoma[5] . Pheochromocytoma causes episodes that are generally characterized by what four factors? Pheochromocytoma causes episodes typically characterized by[31] : ● ● Headaches. ● ● Palpitations. ● ● Diaphoresis. ● ● Severe, possibly life-threatening, hypertension. Urine collection of VMA (vanillylmadelic acid) is part of the diagnostic process for pheochromocytoma. What dietary instructions should the nurse provide prior to this test? Instruct patients to avoid food that are high in vanillin (such as coffee, nuts, chocolate, and bananas) for two days prior to collection of urine [5] . Treatment of choice for pheochromocytoma is surgical resection of the tumor, which usually cures the associated hypertension. It is important that specific measures be taken prior to surgery to control blood pressure and prevent intraoperative crisis. What measures should be taken preoperatively? Preoperative measures include[31] : ● ● Administration of an alpha-adrenergic blocker or metyrosine. ● ● Volume expansion with isotonic sodium chloride solution. ● ● Facilitation of liberal salt intake. ● ● Administration of a beta blocker only after sufficient alpha blockade to “avoid precipitating a hypertensive crisis from unopposed alpha stimulation[31, pg. 2] . ● ● Administration of the last doses of oral alpha and beta blockers on the morning of surgery. Frank is a registered nurse who is certified in critical care. His 45-year- old sister-in-law telephones him one evening in great distress. She has just been diagnosed with multiple endocrine neoplasia and has an appointment with an endocrinologist to discuss treatment options next week. She asks Frank to accompany her. She also tells Frank that “I have the kind that isn‘t cancer.” Frank agrees to go with her, but realizes that he must do some research on the disorder in order to be helpful. He is not familiar with multiple endocrine neoplasia and wonders what his sister- in-law meant by “the kind that isn’t cancer.”What is some information that would be helpful for Frank to know? There are two types of multiple endocrine neoplasia (MEN) that are well recorded. These are[5] : ● ● MEN I: MEN I, also called Werner’s syndrome, occurs because of a defect in a gene that carries the code for the protein menin [32] . This defect leads to hyperplasia and tumors of the pituitary and parathyroid glands, islet cells of the pancreas, and, rarely, the thyroid and adrenal glands. It is the more common form of MEN [5] . ● ● MEN II: MEN II, also called Sipple’s syndrome, is a rare familial malignancy caused by genetic mutation[33] . It usually involves medullary cancer of the thyroid and hyperplasia and tumor growth of the adrenal medulla and parathyroid glands[5,33] . Autosomal dominant inheritance is the usual cause of MEN. It affects twice as many females as males, can occur at any age from adolescence through old age, but is rare in children[5] . Clinical manifestations of MEN depend on the glands that are affected. Frank needs to find out what signs and symptoms have affected his sister- in-law and if her physician has talked about specific gland involvement. Treatment focuses on tumor removal and therapy to control any residual symptoms. Frank will need to discuss specific gland involvement, tumor size and location, postoperative therapy, and recommendations for surgeons who have experience in the type of surgery that will be needed. Differentiate among the different types of diabetes. There are three types of DM. ● ● Type 1: Type 1 diabetes occurs when the beta cells in the pancreas are destroyed or suppressed. Formerly referred to as juvenile diabetes or insulin dependent diabetes, type 1 diabetes is subdivided into idiopathic and immune-mediated types. In idiopathic diabetes there is permanent deficiency of insulin and no evidence of autoimmunity. In immune-mediated diabetes the body produces an autoimmune attack on pancreatic beta cells, and the pancreas becomes inflamed. By the time signs and symptoms appear, 80% of the beat cells are destroyed. Some experts, however, believe that beta cells are not destroyed but disabled and may later be reactivated [5,6,11] . ● ● Type 2: Type 2 diabetes, formerly referred to as adult-onset diabetes or non-insulin dependent diabetes, may be attributed to insulin resistance in target tissues, abnormal insulin secretion, or overproduction of glucose (inappropriate hepatic gluconeogenesis) [6,11] . ● ● Secondary diabetes: Secondary diabetes is so-called because this type occurs “secondarily” to another condition or event. The factors that trigger secondary diabetes include[11] : ○ ○ Physical or emotional stress that can cause prolonged elevation of cortisol, epinephrine, glucagon, and GH. Such elevations increase blood glucose levels and demands on the pancreas. ○ ○ Pregnancy, which causes weight gain, high levels of estrogen, and high levels of placental hormones[11] . This type of diabetes is referred to as gestational diabetes mellitus (GDM). Glucose levels usually return to normal after the women gives birth. However, women who have had GDM have a 40% to 60% chance of developing type 2 diabetes within five to 10 years [5] . ○ ○ Use of specific medications such as adrenal corticosteroids, hormonal contraceptives, and other drugs that oppose the desired effects of insulin[11] . Identify the diagnostic criteria for DM according to the American Diabetes Association (ADA) Guidelines. DM can be diagnosed if patients manifest any of the following[5] : ● ● Symptoms of DM plus a random, nonfasting blood glucose level equal to or greater than 200 mg/dl. ● ● Fasting blood glucose equal to or greater than 126 mg/dl. ● ● Oral glucose tolerance test (2-our sample) results equal to or greater than 200 mg/dl. How are blood glucose levels classified according to the American Diabetes Association? ● ● Normal: 126 mg/dl. What are the ADA recommended testing guidelines for DM? The ADA recommends the following testing guidelines[5] : ● ● Test people age 45 and older who have no symptoms every three years. ● ● People with characteristic signs and symptoms should be tested immediately. ● ● High risk groups should be tested “frequently.” There are several important issues regarding DM and elderly patients. What are they? Issues particular to elderly patients 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. Stacey is a busy high-school junior. She is a star on the girls’basketball team. She is also a diabetic. Stacey injected herself with her usual dose of insulin this morning. However, it is an especially stressful Friday for Stacey. Tonight is an important game. If her team wins this game they will progress to the district semi-finals. Stacey can barely eat her lunch and does not eat her usually snack prior to the game. “I’m just too