NCSBN – Lesson 8F: Endocrine System
NCSBN – Lesson 8F: Endocrine System Study Guide
Brittle hair, lanugo and amenorrhea are findings associated with anorexia
nervosa. The lanugo and amenorrhea are a result of the decreased levels of
estrogen and dehydroepiandrosterone (DHEA). Other physical findings include
reduced metabolic rate, constipation, dry skin, hypotension and bradycardia.
Dental erosion, due to vomiting, is seen in both bulimia nervosa and anorexia
nervosa; however, diarrhea is associated with laxative abuse and bulimina
nervosa.
The typical client with HHNS will have a plasma glucose level of 600 mg/dL (33.33
mmol/L) or greater, high serum osmolality, profound dehydration, a serum pH
greater than 7.3 and some alteration in consciousness. Unlike diabetic
ketoacidosis, however, there is little to no ketosis.
HHNS usually presents in older clients with type 2 diabetes mellitus who have
some concomitant illness (usually an infection) that leads to reduced fluid intake,
or who do not adhere to their diabetic medications and diet. All clients with HHNS
require hospitalization and rapid treatment to correct the profound hypovolemia
and hyperglycemia characteristic of this condition.
Immediate labs would include arterial blood gases, complete blood count with
differential, urinalysis, plasma glucose, BUN, electrolytes, chemistry profile and
creatinine levels. The client will be very dehydrated in this hyperosmolar
hyperglycemic state; therefore, rapid infusion of intravenous fluid will be needed
to correct the hypovolemia. IV infusion of regular insulin may be used to rapidly
correct the hyperglycemia, and glucose checks should be performed hourly until
blood sugar levels have reached a more normal level. At that point, a long-acting
insulin, such as glargine (Lantus), can be started to provide consistent baseline
insulin coverage, supplemented with rapid-acting insulin dosed according to a
sliding scale based on blood glucose readings.
Diaphoresis, shakiness, nervousness and irritability are signs of hypoglycemia and
warrant immediate attention. Hypoglycemia can rapidly reduce the level of
consciousness and progress to a hypoglycemic coma. Clients diagnosed with type
1 diabetes have a lack of insulin production and require blood glucose testing and
administration of insulin multiple times per day to control blood glucose levels.
You should recall that short-term problems in type 1 diabetes are hyperglycemia
and hypoglycemia,
