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Endocrine

Endocrine System Review

Educational Use Only. This app is not intended to replace instructor guidance, institutional policies, clinical judgment, or professional medical training.

Overview

The endocrine system regulates hormones. NCLEX focuses on diabetes mellitus, thyroid disorders, adrenal insufficiency, and pituitary conditions. Blood glucose management and recognizing endocrine emergencies are essential.

Key Concepts

  • 1

    Diabetes Type 1: autoimmune, no insulin production, prone to DKA; Type 2: insulin resistance, prone to HHS

  • 2

    DKA: blood glucose >250, ketones, acidosis (pH <7.30, HCO3 <15), Kussmaul respirations, fruity breath

  • 3

    HHS: blood glucose >600, no ketones, severe dehydration, altered mental status; higher mortality than DKA

  • 4

    Hypoglycemia: glucose <70, sweating, tremors, tachycardia, confusion; treat with 15g fast carbs (rule of 15)

  • 5

    Hyperthyroidism: heat intolerance, weight loss, tachycardia, anxiety; Graves' disease most common cause

  • 6

    Hypothyroidism: cold intolerance, weight gain, bradycardia, fatigue, constipation; myxedema coma is life-threatening

  • 7

    Adrenal insufficiency (Addison's): hyponatremia, hyperkalemia, hypoglycemia, hypotension; crisis requires steroids

Nursing Interventions

  • Monitor blood glucose as ordered; sliding scale insulin per protocol

  • For DKA: IV fluids first, then regular insulin infusion, monitor potassium (insulin shifts K into cells)

  • Assess for signs of hypoglycemia every shift; keep glucose tabs or juice at bedside

  • Monitor for diabetic ketoacidosis: check urine ketones when glucose >240

  • For thyroid disorders: monitor vital signs, weight, and TSH levels; administer medications on time

  • For adrenal crisis: administer IV hydrocortisone immediately, monitor BP and electrolytes

  • Rotate insulin injection sites to prevent lipodystrophy; teach proper technique

Critical Red Flags

  • Blood glucose <50 with altered mental status — severe hypoglycemia

  • Fruity breath with Kussmaul respirations and altered mental status — DKA

  • Blood glucose >600 with severe dehydration and confusion — HHS

  • Hypotension with hyponatremia and hyperkalemia — adrenal crisis

  • Hypothermia, bradycardia, and decreased LOC — myxedema coma

  • Thyroid storm: high fever, tachycardia, agitation, heart failure signs

Key Lab Values

Fasting blood glucose: 70-99 mg/dL (normal)

HbA1c: <5.7% normal, 5.7-6.4% prediabetes, ≥6.5% diabetes (target <7% for diabetics)

TSH: 0.4-4.0 mIU/L (high = hypothyroid, low = hyperthyroid)

Free T4: 0.8-1.8 ng/dL

Cortisol (AM): 5-25 mcg/dL (low in Addison's)

Serum sodium: 135-145 mEq/L (low in adrenal insufficiency)

Serum potassium: 3.5-5.0 mEq/L (high in adrenal insufficiency)

Patient Teaching

  • Monitor blood glucose as prescribed; keep a log of readings

  • Recognize and treat hypoglycemia: 15g fast carbs, recheck in 15 min, repeat if needed

  • Administer insulin subcutaneously; rotate sites (abdomen, thigh, arm); store unopened in refrigerator

  • Wear medical alert identification; carry fast-acting glucose at all times

  • Inspect feet daily; wear properly fitting shoes; report any cuts or sores immediately

  • Follow diabetic diet; count carbohydrates; exercise regularly; do not skip meals

Educational Use Only — Not a substitute for professional training.