Endocrine Seminar Part 2

*created by Meghan Conrad, Stephanie Nunes, and Lisa Banman with content from Developing Clinical Judgment
by Donna Ignatavicius (2021)

Instructions: Read the following case study and complete the associated
questions.
J.P., age 38, is a real estate agent who comes to the urgent care center after several days of experiencing
what she thinks is viral gastroenteritis with complaints of shortness of breath on exertion, insomnia,
nervousness, and fatigue. She has had diarrhea for the last 3 days, which is continuing. She recently
separated from her husband and she and her two school-age children have been living with her parents.
She reports that she had a total hysterectomy for fibroids 2 years ago, and she had similar symptoms at
that time, but they finally went away. She feels exhausted all the time but attributes her fatigue to her
demanding work schedule and the care of her children.

Assessment findings are as follows: blood pressure 148/92 mm Hg, heart rate 98 beats/min and
bounding, respiratory rate 22 breaths/min, and temperature 101.2° F (38.4° C); height 5 ft 4 in, weight
102 lb; S1 and S2 heart sounds loud with grade II systolic murmur noted; lungs clear in all fields; bowel
sounds hyperactive in all quadrants; skin is warm, smooth, and moist. Her general appearance is restless
and anxious with a fine tremor of her fingers. She has a mild protrusion of the eyeballs, but can close her
eyelids over her eyes. She denies any specific pain, but says she feels as if she is about to explode

1. Use a highlighter to mark any concerns you have with the above assessment findings.

2. You believe that J.P. is manifesting signs and symptoms of hyperthyroidism. Consider
other data that would be important to gather and differentiate from hypothyroidism
during an assessment. Match the signs and symptoms of either hyperthyroidism or
hypothyroidism.

Instructions: Select the correct answer for each statement

Signs and Symptom Hyperthyroidism Hypothyroidism
Constipation
Increased Systolic BP
Dry, Coarse Hair
Extreme fatigue
Splenomegaly
Hyperreflexia of tendon reflexes
Increased appetite
Easy bruising
Intolerance to heat
 Insomnia
Tremors
Muscular aches and pains
Weight gain
Muscle weakness and wasting
Thick, brittle nails
Weight loss

3. Which laboratory test results will support a diagnosis of hyperthyroidism (Grave’s disease)?
Select all that apply.

A) Increased calcium
B) Increased total thyroxine
C) Increased parathyroid hormone
D) Increased thyroid-stimulating hormone
E) Decreased phosphorus
F) Decreased vitamin
G) Increased potassium

4. What are some non-pharmacological interventions the nurse could implement for the
symptoms of hyperthyroidism in question #2?

J.P. is seen by an endocrinologist and they start her on methimazole.

5. What is the action of this medication and how will it help this patient to feel better?

After six months J.P. is not feeling better and her symptoms are not controlled. Her thyroid levels remain
elevated. A sub-total thyroidectomy is scheduled.

In planning for the client’s care, the nurse anticipates possible surgical complications.
 6. Indicate which nursing action listed in the far-left column is appropriate for each potential
postoperative thyroidectomy complication. Note that not all nursing actions will be used.

Nursing Action Potential Postoperative Appropriate Nursing Action for

Complication Each Postoperative
Complication
1. Increase IV fluids and Acute respiratory distress
call the HCP
2. Monitor the client q2h Bleeding
and reassure the client
that the problem is
temporary
3. Start oxygen therapy Parathyroid gland injury
immediately, suction if
needed, and notify the
HCP
4. Assess for signs of
calcium deficiency and Laryngeal nerve damage
give IV calcium
gluconate if needed.
5. Prepare the client for Thyroid storm
additional surgery
6. Administer propranolol
and corticosteroids and
apply a cooling blanket
7. Prepare to administer
an albumin transfusion.

8. Following surgery, when J.P. is returned to her room, your priority nursing intervention will be
to:
1. Assess her ability to speak and swallow –
2. Assess for signs of tracheal compression -
3. Place her in a semi-fowler’s position with a pillow under head
4. Monitor for tingling and numbness in her fingers and around her mouth

The next morning as you check J.P.'s vital signs, she states that the blood pressure cuff is too tight and is
hurting her arm.

Question: You note that she has a spasm in her hand and recognize this as a:

1. Positive Chvostek’s sign

2. Positive Trousseau’s sign
3. Symptom of thyrotoxic crisis