Page 61 Complete Your CE Test Online - Click Here nervous to eat.” Early in the game Stacey begins to feel anxious, weak, and dizzy. Her heart is pounding. She attributes this to anxiety until her coach calls for a time out and asks her if she ate lunch and her snack prior to game-time? Stacey admits that she did not eat much today? “Did you take your insulin today?” The coach suspects that Stacey might be developing a problem. What would you suspect that Stacey is developing? Stacey is most likely hypoglycemic as a result of taking her insulin without proper nutritional intake. 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. Stacey should immediately be given carbohydrates such as glucose tablets, honey, or fruit juice. If patients are unconscious, they should be given glucagon or dextrose I.V.[5,6,11] . Fortunately Stacey’s coach recognizes the signs and symptoms of hypoglycemia. Persons close to Stacey (and all persons who have DM) should be taught to recognize these signs and symptoms and what to do if they occur. Jeremy is a college sophomore who has had DM for several years. He hates injecting himself with insulin and often delays giving himself these injections. One Monday morning, after a late night of partying, Jeremy sleeps very late. His roommate awakens him excitedly. “What is wrong with you? We have a huge chemistry exam in 20 minutes!” Jeremy bolts out of bed, dresses quickly, and rushes to class. On the way he grabs a snack from the student union. He does not remember to take his insulin. Midway through the exam Jeremy begins to feel weak and is unable to concentrate. His heart is racing and he feels extremely thirsty. What is happening to Jeremy? Jeremy is experiencing 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 I.V. fluids, insulin, and, often, potassium replacement is necessary[5] . Jeremy’s friends should be taught to recognize signs of ketoacidosis and hypoglycemia. If Jeremy is unable to make rational decisions his friends may need to be able to not only recognize when he is in trouble but what to do if trouble occurs. Hypoglycemia is often quickly corrected, if recognized promptly, with simple measures such as providing glucose tablets, honey, or fruit juice. Ketoacidosis may be more problematic if not treated promptly. Implications for nursing continuing education Seldom does a day go by without media-grabbing headlines pertaining to health care. Whether it be about treatment breakthroughs, new means of prevention, or implications for safe and appropriate care, such news usually has significant implications for nurses. Those implications, in part, require that nurses acquire new knowledge and/or psychomotor skills. In other words, the necessity for new knowledge acquisition is a almost a daily task. To add to the plethora of new knowledge requirements is the need to become familiar with diseases and disorders that are not particularly common. Since many endocrine diseases and disorders are uncommon, and some are quite rare, how can nurses be expected to recognize the sometimes subtle signs and symptoms of what could be serious pathologies? Nursing professional development specialists are generally responsible for planning, developing, implementing, and evaluating the continuing education endeavors of the nursing department. It is a challenge just to keep up with accrediting organization mandates and education offerings that help nurses to provide care to nurses in various health care specialties. Issues surrounding the recognition of these diseases and provision of nursing care to persons affected by these and other pathologies increase the need for nursing continuing education. How can administrators and managers facilitate continuing education efforts? There is a need for creativity. Education is not solely delivered in a classroom setting. Various means of distance education can be used to offer brief “spurts” of education. E-mail, texts, and alerts can be sent to nurses’ iPhones, computers, and other devices. A disease that is uncommon can be highlighted on a weekly basis and important highlights pertaining to signs and symptoms, pathophysiology, risk factors, and treatment can be provided. Of course, nurses themselves are primarily responsible for their own education. They cannot rely exclusively on their employing organizations to provide all of the continuing education that is so critical to their professional endeavors. Nurses should suggest education topics for development by nursing professional development and for department-based and unit-based education. Here are some sources for nurses who are interesting in expanding their knowledge of endocrine disorders and other topics pertinent to the practice of nursing. ● ● Professional associations: Nurses should join and become active in professional organizations including those pertaining to their particular nursing specialty. These organizations often provide continuing education using various modalities. ● ● Professional journals: Most journals are offered in hard copy and via electronic media. Keeping abreast of new developments in health care in general and nursing in particular can be facilitated by reading reliable professional nursing journals. ● ● Companies that specialize in continuing education for HCPs: These companies offer continuing education on a wide variety of topics. Many companies offer a variety of ways to obtain continuing education including in-person seminars, hard copy catalogues, and online programming. These companies can usually be relied upon to offer education offerings that provide contact hours for licensure renewal. ● ● Professional books: Many nurses opt to purchase professional references that can be downloaded onto their various electronic devices, thus making resources readily accessible. ● ● Professional libraries: Most health care facilities have their own resource centers. Nurses should be encouraged to find out about the resources within their own organizations. ● ● Organizational committees and task forces: In this age of shared governance staff nurses are assuming more and more responsibility for managing their own practice. Part of this responsibility often includes serving on various committees and task forces. Meetings of these groups often provide opportunities for continuing education. ● ● Colleagues: Nurses need to be able to rely on each other for support and as education resources. An atmosphere of open communication should be part of every health care organization. This atmosphere should encourage nurses to not only share their knowledge with each other but to be able to ask questions without fear of embarrassment. ● ● Internet resources: Internet resources such as the Joint Commission, the Centers for Disease Control (CDC), and other organizations that are known to be reliable sources of accurate information also used for education. Many such organizations have downloadable apps that can be accessed quickly for frequent, even daily updates on issues of importance to nurses and other HCPs. These apps can also be used to search for information specific to particular signs and symptoms and diseases and disorders. Summary The endocrine system is quite complex and works in conjunction with the nervous system to maintain the delicate balance that ensures homeostasis. Even slight variations in its functioning can cause significant body disturbances. Several endocrine diseases and disorders are fairly common, such as thyroid disorder and diabetes mellitus. However, still more of them are uncommon and even rare, making recognition a challenge. To compound the complexity of caring for patients affected by endocrine pathologies, many of these diseases and disorders have insidious onsets, and initial signs and symptoms can be vague and mimic a variety of problems. It is essential that nurses pursue continuing education from a variety of sources to acquire knowledge about the endocrine system and nursing considerations when caring for patients with diseases and disorders of this body system.