Endocrine System Disorders Q 45

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A 67-year-old female client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse would suspect which of the following disorders?

  

    A. Diabetes mellitus

    B. Diabetes insipidus

    C. Hypoparathyroidism

    D. Hyperparathyroidism

    

    

Correct Answer: D. Hyperparathyroidism

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Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercalciuria-causing polyuria. Patients should be asked about any history of kidney stones, bone pain, myalgias or muscle weakness, symptoms of depression, use of thiazide diuretics, calcium products, vitamin D supplements, or other symptoms associated with the multiple etiologies of hypercalcemia. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don’t have bone pain and increased sleeping.

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Option A: It often presents asymptomatically, but when symptoms develop, patients usually present with polyuria, polydipsia, and weight loss. On physical examination of someone with hyperglycemia, one may see poor skin turgor (from dehydration) and smell a distinctive fruity odor on their breath (in patients with ketosis).

Option B: The most common findings in patients with diabetes insipidus are polydipsia, polyuria, and nocturia. Polyuria is defined as a urine output of more than 3 L/day in adults or 2 L/m2 in children. In children, symptoms can be nonspecific, and they may present with severe dehydration, constipation, vomiting, fevers, irritability, failure to thrive, and growth retardation. In patients with central nervous system (CNS) tumors, headaches, and visual defects may present in addition to the classic symptoms.

Option C: Hypoparathyroidism is characterized by urinary frequency rather than polyuria. Significant hypocalcemia can cause numbness and paresthesias, muscle cramps, and carpopedal spasms. When severe it can be life-threatening with laryngospasm, tetany, and seizures.

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