Assignment: NURS 6501 Endocrine Disorders

Assignment: NURS 6501 Endocrine Disorders

Assignment: NURS 6501 Endocrine Disorders

Scenario 1: Syndrome of Antidiuretic Hormone (SIADH)

Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH 

SIADH is an endocrine disorder characterized by excessive production of antidiuretic hormone, leading to retention of water in the body and reduction in the levels of certain electrolytes in the blood such as sodium (Jones, 2018). This condition is common among heart failure patients or those with defects in the hypothalamus. Other causes include substance use, brain disorders like trauma or infection, substance abuse, and certain medications such as seizure drugs and antidepressants. The 77-year-old female patient provided in the case study displays signs of SIADH. The development of this condition might have resulted from hyponatremia in diabetic peripheral neuropathy as seen in the patient’s history of presenting illness. The patient’s smoking habits, emphysema, and use of metformin and escitalopram also contributed to the development of SIADH.

Scenario 2: Type 1 Diabetes

2. Explain the pathophysiology of the three P’s for (polyuria, polydipsia, polyphagia)” with the given diagnosis of Type I DM.

Diabetes type 1 is an autoimmune disorder characterized by elevated blood glucose levels. The immune system attacks and destroys pancreatic beta cells, which are responsible for insulin production (Saberzadeh-Ardestani et al., 2018). This leads to complete insulin deficiency, hence unable to convert glucose to glycogen for storage. The patient will present with the 3P’s (polyuria, polydipsia, polyphagia) as the early signs and symptoms. Elevated blood glucose levels lead to increased blood osmolarity, as it makes it more concentrated, hence promoting excessive thirst (polydipsia) as a compensation mechanism. Excessive fluid intake, from thirst, in addition to glucose-induced urination, is responsible for increased urine frequency (Polyuria). Lastly, polyphagia/ increased hunger occurs because of excessive loss of glucose in the urine, which makes the body crave for more.

3. Explain the genetic relationship and how this and the environment can contribute to Type I DM.

Even though it’s still unclear on the actual triggers of β cell destruction in the development of type 1 DM, most studies have revealed the factors which regulate the risk of developing the disease. Previously reported evidence to suggest that T1DM is heritable with the HLA class II genes such as HLA-DR, DQ, DP strongly associated with the development of the disease (DiMeglio et al., 2018). While the genetic factors determine the likelihood of an individual to develop T1DM, environmental factors expose the individual to triggers that lead to the onset of the disease such as viruses.

Scenario 3: Type II DM

4. How would you describe the pathophysiology of Type II DM?

T2DM is a metabolic disorder characterized by elevated blood glucose levels because of a combination of two main primary factors, such as decreased sensitivity of insulin receptors to the ligand, and defective secretion of insulin by the pancreatic β cells (Padhi et al., 2020). Insulin is involved in maintaining the physiological levels of glucose in the blood. A defect in this mechanism can lead to increased production of glucose and decreased uptake of glucose both in the liver, muscles, and adipose tissue, leading to T2DM.

Scenario 4: Hypothyroidism

5. What causes hypothyroidism?

Hypothyroidism is an endocrine disorder characterized by the failure of the thyroid gland to produce enough amount of thyroid hormone to satisfy the body’s needs. Several factors have been associated with the cause of hypothyroidism, such as autoimmune disorders, radiation therapy, certain medications, and hyperthyroidism treatment (Chiovato et al., 2019). Some of the less common causes of hypothyroidism include pregnancy, iodine deficiency, pituitary disorder, and congenital disease.

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

DiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018). Type 1 diabetes. The Lancet, 391(10138), 2449-2462. https://doi.org/10.1016/S0140-6736(18)31320-5

Jones, D. P. (2018). Syndrome of inappropriate secretion of antidiuretic hormone and hyponatremia. Pediatrics in Review, 39(1), 27-35. https://doi.org/10.1542/pir.2016-0165

Padhi, S., Nayak, A. K., & Behera, A. (2020). Type II diabetes mellitus: A review on recent drug-based therapeutics. Biomedicine & Pharmacotherapy, 131, 110708. https://doi.org/10.1016/j.biopha.2020.110708

Saberzadeh-Ardestani, B., Karamzadeh, R., Basiri, M., Hajizadeh-Saffar, E., Farhadi, A., Shapiro, A. J., … & Baharvand, H. (2018). Type 1 diabetes mellitus: cellular and molecular pathophysiology at a glance. Cell Journal (Yakhteh), 20(3), 294. https://doi.org/10.22074/cellj.2018.5513

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Assignment: NURS 6501 Endocrine Disorders Knowledge Check: Endocrine Disorders

In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.

Possible topics covered in this Knowledge Check include:

Clinical Manifestation of Immune Thrombocytopenia Purpose (ITP)

Initially, ITP was perceived as a minor injury. However, the purpura and petechiae development occurred every several days, leading to an increase in bleeding from the mucosal site (McCance & Huether, 2019). Patients with ITP show signs like blood in the urine, bleeding gums, and increased bleeding. The main cause of accelerated platelet consumption is increased splenic sequestration or decreased bone marrow production (McCance & Huether, 2019). The lab test helps predict the diagnosis, evaluating the anti-glycoprotein erythrocyte and leukocyte count.

Genetic/Ethnic Considerations of Immune Thrombocytopenia Purpose (ITP)

ITP highly occurs in women (Kjaer et al., 2020). In comparison to acute, the chronic ITP is progressively worse. Acute ITP lasts for approximately one to two months and is common in children (Kjaer et al., 2020). It is not common for a patient to present the intracranial bleeding for the organs or any other sites.ITP is also likely to occur in the newborn as thrombocytopenia.

Conclusion

The patient presents ITP, which is associated with the previous diagnosis of Mononucleosis. It is important to review a patient platelet, which helps determine the anti-platelet antibodies when performing a diagnostic test. ITP highly occurs in women between 20 to 40 years.

References

Carter, C. M. (2018). Alterations in blood components. Comprehensive Toxicology, 249. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7152208/

Chen, D. P., Lin, W. T., Wen, Y. H., & Wang, W. T. (2022). Investigation of the correlation between immune thrombocytopenia and T cell activity-regulated gene polymorphism using functional study. Scientific Reports, 12(1), 1-8. https://www.nature.com/articles/s41598-022-10631-z

Grodzielski, M., Goette, N. P., Glembotsky, A. C., Constanza Baroni Pietto, M., Méndez-Huergo, S. P., Pierdominici, M. S., … & Marta, R. F. (2019). Multiple concomitant mechanisms contribute to low platelet count in patients with immune thrombocytopenia. Scientific Reports, 9(1), 1-10. https://www.nature.com/articles/s41598-018-38086-1

Kjær, M., Geisen, C., Akkök, Ç. A., Wikman, A., Sachs, U., Bussel, J. B., … & Skogen, B. (2020). Strategies to develop a prophylaxis for the prevention of HPA-1a immunization and fetal and neonatal alloimmune thrombocytopenia. Transfusion and Apheresis Science, 59(1), 102712. https://www.sciencedirect.com/science/article/pii/S147305021930285X

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier

Diabetes
Hyper- and hypothyroidism
Adrenal disorders
Parathyroidism (hyper and hypo)
Checks & balances / negative feedback
Syndrome of Inappropriate Antidiuretic Hormone
Pheochromocytosis
Diabetes insipidus
Diabetic ketoacidosis

Photo Credit: Getty Images/Science Photo Library RF

(Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Midterm Exam.)

Complete the Knowledge Check By Day 5 of Week 6

To complete this Knowledge Check:

Module 4 Knowledge Check

Midterm Exam

This 101-question exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.

This exam will be on topics covered in Weeks 1, 2, 3, 4, 5, and 6. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 2 hours for completion. When time is up, your exam will automatically submit.

(Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Midterm exam.)

Photo Credit: Getty Images

To prepare:

To help you review for your midterm exam, access the Midterm Exam Review document found in this week’s Learning Resources as well as any Knowledge Check feedback you might have received. (Note: You will also need to review all of your materials from each of these weeks to also help you better prepare for your midterm.)

By Day 7 of Week 6

Submit your Midterm Exam.

To complete your exam:

Midterm Exam

What’s Coming Up in Module 5?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 5, you will analyze processes related to neurological and musculoskeletal disorders through case study analysis. To do this, you will analyze alterations in the relevant systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, which may impact physiological functioning and altered physiology.

Week 7 Knowledge Check: Neurological and Musculoskeletal Disorders

In the Week 7 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 5. This Knowledge Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the Learning Resources in their entirety prior to taking the Knowledge Check, since the resources cover the topics addressed. Plan your time accordingly.

Next Module

To go to the next Module:

Module 5

Learning Objectives

Students will:

Analyze concepts and principles of pathophysiology across the lifespan

Learning Resources

Required Readings (click to expand/reduce)

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Chapter 21: Mechanisms of Hormonal Regulation, including Summary Review
Chapter 22: Alterations of Hormonal Regulation, including Summary Review
Chapter 23: Obesity and Disorders of Nutrition, including Summary Review

American Diabetes Association (2020). Standards of medical care of patients with diabetes mellitus. Diabetes Care, 26(suppl 1), pp. s33-s50. https://care.diabetesjournals.org/content/26/suppl_1/s33

Orlander, P. R. (2018). Hypothyroidism. Retrieved from https://emedicine.medscape.com/article/122393-overview

Hoorn, E. J., & Zietse, R. (2017). Diagnosis and treatment of hyponatremia: Compilation of the guidelines. Journal of the American Society of Nephrology, 28(5), 1340–1349

Document: NURS 6501 Midterm Exam Review (PDF document)

Note: Use this document to help you as you review for your Midterm Exam in Week 6.

Required Media (click to expand/reduce)

Module 4 Overview with Dr. Tara Harris

Dr. Tara Harris reviews the structure of Module 4 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and your Midterm. (3m)

Concepts of Endocrine Disorders – Week 6 (24m)

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 21 through 23 related to the endocrine system and disorders. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/

Optional Resources (click to expand/reduce)

The following source provides various tutorials related to maximizing your time management and managing stress. Feel free to access this resource to support you as you move through this course.

Walden University. (2019). ASC success strategies interactive tutorials. Retrieved from https://academicguides.waldenu.edu/academic-skills-center/skills/tutorials/success-strategies

Knowledge Check: Endocrine Disorders

Module 5

Question 1

1 out of 1 points

Correct

Low blood sugar during the night that may lead to morning-rebound hyperglycemia describes what effect?

Selected Answer:
Correct

Somogyi
Answers:
Correct

Somogyi

Myxedema

Hirsutism

Incretin
Question 2

1 out of 1 points

Correct

Calcitonin is secreted by what gland?

Selected Answer:
Correct

thyroid
Answers:

pancreas

pineal

pituitary

Correct

thyroid
Question 3

1 out of 1 points

Correct

Where are incretins released from?

Selected Answer:
Correct

gastrointestinal tract
Answers:

liver

pancreas

Correct

gastrointestinal tract

spleen
Question 4

1 out of 1 points

Correct

Lethargy, hyponatremia, perhaps seizure, decreased plasma osmolality, concentrated urine are symptoms of what condition?
Selected Answer:
Correct

SIADH
Answers:
Correct

SIADH

Pheochromocytoma

Primary hyperaldosteronism

Addison disease
Question 5

1 out of 1 points

Correct

Cytokines and hormones secreted by adipose tissue are known as _______________
Selected Answer:
Correct

adipokines
Answers:

MAT

Correct

adipokines

WAT

adipocyte
Question 6

1 out of 1 points

Correct

Nonpitting boggy edema caused by infiltration of mucopolysaccharides and proteins between connective tissue in the dermis describes what condition?

Selected Answer:
Correct

Myxedema
Answers:

Somogyi

Correct

Myxedema

Hirsutism

Incretin
Question 7

1 out of 1 points

Correct

Body fluid osmolality is regulated by what hormone?
Selected Answer:
Correct

Antidiuretic hormone (ADH)
Answers:
Correct

Antidiuretic hormone (ADH)

Parathyroid hormone (PTH)

Aldosterone

Insulin
Question 8

1 out of 1 points

Correct

Dysfunction of the thyroid gland can cause:
Selected Answer:
Correct

Primary hyperthyroidism and primary hypothyroidism
Answers:

SIADH and diabetes insipidus

Correct

Primary hyperthyroidism and primary hypothyroidism

Cushing disease, secondary hyperthyroidism and secondary hypothyroidism

Cushing disease, primary hyperthryoidism and secondary hypothyroidism
Question 9

0 out of 1 points

Incorrect

Type of adipose tissue, located viscerally and subcutaneously, with adipocytes that have one lipid droplet are called as:
Selected Answer:
Incorrect

MAT
Answers:

Adipokine

MAT

Correct

WAT

Adipocyte
Question 10

1 out of 1 points

Correct

Cell that stores fat are known as:
Selected Answer:
Correct

Adipocyte
Answers:

Adipokine

MAT

WAT

Correct

Adipocyte
Question 11

1 out of 1 points

Correct

Primary hyperparathyroidism can lead to the development of:
Selected Answer:
Correct

kidney stones
Answers:
Correct

kidney stones

bladder cancer

calcium depletion

acute kidney injury
Question 12

1 out of 1 points

Correct

Enlargement of the thyroid gland is a response to increased stimulation by ______________
Selected Answer:
Correct

TSH
Answers:
Correct

TSH

T4

T3

Thyroxine
Question 13

1 out of 1 points

Correct

Low hormone concentrations usually cause cells to _________________ receptors for that hormone.
Selected Answer:
Correct

up-regulate
Answers:

down regulate

Correct

up-regulate

permission regulate

bind
Question 14

1 out of 1 points

Correct

Dysfunction of the anterior pituitary can cause:
Selected Answer:
Correct

Cushing disease, secondary hyperthyroidism and secondary hypothyroidism

Answers:

SIADH and diabetes insipidus

Primary hyperthyroidism and primary hypothyroidism

Correct

Cushing disease, secondary hyperthyroidism and secondary hypothyroidism

Cushing disease, primary hyperthryoidism and secondary hypothyroidism
Question 15

1 out of 1 points

Correct

In autoimmune-mediated diabetes pancreatic beta cells are destroyed by autoreactive ______________________

Selected Answer:
Correct

cytotoxic T lymphocytes
Answers:

natural killer cells

Correct

cytotoxic T lymphocytes

B lymphocytes

monocytes
Question 16

1 out of 1 points

Correct

A person who has an iodine-deficient diet will have difficulty making enough of what hormone?

Selected Answer:
Correct

thyroid
Answers:

glucagon

insulin

Correct

thyroid

parathyroid
Question 17

1 out of 1 points

Correct

A chemical signal generated within a cell that mediates the action of a water- soluble hormone or other chemical is known as:
Selected Answer:
Correct

Second messenger
Answers:

Upregulation

First messenger

Correct

Second messenger

Downregulation
Question 18

1 out of 1 points

Correct

Dysfunction of the posterior pituitary can cause:
Selected Answer:
Correct

SIADH and diabetes insipidus
Answers:
Correct

SIADH and diabetes insipidus

Primary hyperthyroidism and primary hypothyroidism

Cushing disease, secondary hyperthyroidism and secondary hypothyroidism

Cushing disease, primary hyperthryoidism and secondary hypothyroidism
Question 19

1 out of 1 points

Correct

Weakness, fatigue, hypotension, hyperkalemia, hypoglycemia, elevated ACTH are symptoms of what condition?
Selected Answer:
Correct

Addison disease
Answers:

SIADH

Pheochromocytoma

Primary hyperaldosteronism

Correct

Addison disease
Question 20

1 out of 1 points

Correct

HIgh levels of what hormone is common in syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
Selected Answer:
Correct

ADH
Answers:
Correct

ADH

ACTH

FH

TSH

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:

Type 1 DM is a chronic metabolic condition characterized by autoimmune destruction of insulin-producing pancreatic islet beta cells in genetically predisposed persons. Yahaya & Salisu (2020) found more than 73 genes which were suspected in the pathogenesis of T1DM. The genes that accounted for most of the T1DM cases include the insulin gene, human leukocyte antigen (HLA), and cytotoxic T lymphocyte-associated antigen 4. The mutations in these genes, in addition to environmental factors, can result in a defective immune response in the pancreas, causing insulin deficiency, β-cell autoimmunity, and hyperglycemia. The mechanisms causing the cellular reactions are usually gene-specific and, if targeted in diabetic patients can result in improved treatment.

what are the environmental factors?

Question 4

4 / 4 pts

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:

Type 2 diabetes is a heterogeneous disorder where insulin resistance occurs, and the beta cells lack the ability to overcome this resistance. Galicia-Garcia et al. (2020)explain that Type 2 DM is caused by a combination of two factors: impaired insulin secretion by pancreatic β-cells and the inability of insulin-sensitive tissues to respond to insulin secretion. In the case of impaired β-cell function, the body experiences decreased insulin secretion, which limits its ability to maintain physiological glucose levels (Galicia-Garcia et al., 2020). On the other hand, an impairment of the feedback loops between insulin secretion and action causes abnormally elevated glucose levels in blood, resulting in hyperglycemia and eventually Type II DM.

Question 5

4 / 4 pts

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:

Hypothyroidism is caused by various factors including deficient hormone synthesis,

Congenital thyroid defects, Prenatal and postnatal iodine deficiency, and Autoimmune diseases like Hashimoto disease and sarcoidosis (Hegedüs et al. 2022). It is characterized by decreased levels of thyroid hormones (T3 and T4), which causes a slow basal metabolic rate (BMR). The decreased BMR affects lipid metabolism resulting in increased cholesterol and triglyceride levels.

Syndrome of inappropriate antidiuretic hormone release (SIADH) is a disorder that is characterized by the unregulated release of antidiuretic hormone (ADH). ADH is a hormone that is involved in the regulation of water reabsorption in the kidney tubules. The pituitary gland produces it. The 77-year-old female has been diagnosed with SIADH. Several patient characteristics may have contributed to her developing the disorder. One of them is the use of medications. Medications such as those utilized in the treatment of depression and diabetes increase the risk of SIAD. The patient in the case study is diabetic and currently uses metformin to manage her blood sugar levels(Bal et al., 2022). She also has depression and uses escitalopram, which is among the risk factors associated with SIADH.

            The other patient characteristic that may have contributed to the development of SIADH in the patient is neurological deficits. The patient currently suffers from peripheral neuropathy because of diabetes. Neurological disorders increase the risk of SIADH. The patient also has symptoms similar to those seen in patients suffering from stroke. Stroke is among the neurological disorders that increase the ris