i bc27f85be50b71b1 (216 page)

692

AClITE CARE HANDBOOK FOR PHYSICAL ntERAPISTS

ron ate, or intravenous pamidronare). Other bisphosphonates

currently under investigation include zoiedronare and ibandronate.52

Other interventions can include the foliowing47•S2:


Administration of calcitonin


Calcium supplementation (if necessary)


Promotion of mobility


Adequate hydration


Sympromatic relief with nonsteroidal anti-inflammatory agents

or acetaminophen

Management

Clinical management of endocrine dysfunction is discussed earlier in

specific endocrine gland and metabolic disorders sections. This section focuses on goals and guidelines for physical therapy intervention.

The following arc general physical therapy goals and guidelines for

working with patients who have endocrine or metabolic dysfunction.

These guidelines should be adapted ro a patient's specific needs. Clinical tips are provided earlier ro address specific situations in which the tips may be most helpful.

Coals

The primary physical therapy goals in this patient population are the

following: (1) ro optimize functional mobility, (2) ro maximize activity tolerance and endurance, (3) to prevent skin breakdown in the patient with altered sensation (e.g., diabetic neuropathy), (4) to

decrease pain (e.g., in patients with osteoporosis or hyperparathyroidism), and (5) to maximize safety for prevention of falls, especially in patients with altered sensation or muscle function.

Cuide/i1les

Patients with diabetes or osteoporosis represent the primary patient

population with which the physical therapist intervenes. Physical

ENDOCRINE SYSTEM

693

therapy considerations for these patients are discussed in the form of

clinical tips in earlier sections (Diabetes and Osteoporosis, respectively).

For other patients with endocrine or metabolic dysfunction, the

primary physical therapy treatment guidelines are the following:

l .

To improve activity tolerance, it may be necessary to decrease

exercise inrensiry when the patient's medication regimen is being

adjusted. For example, a patient with insufficient thyroid hormone

replacement will fatigue more quickly than will a patient with adequate thyroid hormone replacement. In this example, knowing the normal values of thyroid hormone and reviewing the laboratory tests

helps the therapist gauge the appropriate treatment intensity.

2.

Consult with the clinical nutritionist to help determine the

appropriate activity level based on the patient's caloric intake,

because caloric intake and metabolic processes are affected by endo·

crine and metabolic disorders.

References

I. Burch WM (cd). Endocrinology for the House Officer (2nd ed). Baltimore: Williams & Wilkins, 1988.

2. Bullock BL (cd). Pathophysiology: Adaptations and Alterations in Func·

tion (4th cd). Philadelphia: Lippincott, 1996.

3. Diagnostic Procedures. In JM T hompson, GK McFarland, JE Hirsch, er

al. (eds), Mosby's Manual of Clinical Nursing Practice (2nd ed). St.

Louis: Mosby, 1989;1594.

4. Corbett jV. Laboratory Tests and Diagnostic Procedures with Nursing

Diagnoses (5th ed). Upper Saddle River, NJ: Prentice Hall Health, 2000.

5. Malarkey LM, McMorrow ME (eds).

urse's Manual of Laboratory

Tesrs and Diagnostic Procedures. Philadelphia: Saunders, 2000j604-

612.

6. Sacher RA, McPherson RA, Campos JM (eds). Widman's Clinical lmer·

pretation of LaboralOry Tests ( I I th cd). Philadelphia: FA Davis, 2000;

741-823.

7. Lavin N (ed). Manual of Endocrinology and Metabolism (2nd cd). Bosron: Linle, Brown, 1994.

8. Allen MA, Boykin PC, Drass JA, et al. Endocrine and Metabolic Systems. In JM Thompson, GK McFarland, JE Hirsch, et al. (eds), Mosby's Manual of Clinical Nursing Practice (2nd cd). Sr. Louis: Mosby, 1989;

876.

9. Waeber KA. Updace on the management of hyperthyroidism and

hypothyroidism. Arch Intern Med 2000; 160(8):1067.

694 AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

1 0. EHim B. Diagnosing and Treating Hypmhyroidism. Nurse Pract

2000;25(3):92.

I I . Harrog M (ed). Endocrinology. Oxford, UK: Blackwell Scientific, 1 987.

1 2. Hershman JM (ed). Endocrine Pathophysiology: A Pa.ient-Oriented

Approach (3rd ed). Philadelphia: Lea & Febiger, 1 988;225.

1 3. Woolf N. Pathology, Basic and Systemic. London: Saunders, 1998;820-

873.

]4. Drug therapy usually secondary to surgery in the treatment of pituitary

adenomas. Drug T her Perspect 200 1 ; 1 7(3):5- 1 0.

1 5. Terpstra TL, Terpstra TL. Syndrome of inappropriate anridiuretic hormone secretion: recognition and management. Medsurg Nurs 2000; 9(2): 6 1 .

1 6. Beers MH, Berkow R (eds). Merck Manual of Diagnosis and Therapy

( 1 7th ed). Whitehouse S.ation, NJ: Merck, 1999.

17. Burch WM (ed). Endocrinology for the House Officer (3rd ed). Baltimore: Williams & Wilkins, 1 994;97.

18. Wand GS. Pituitary Disorders. In JD Stobo, DB Hellmann, PW Ladenson, et al. (eds), The Principles and Practice of Medicine (23rd ed).

S.amford CT: Appleton & Lange, 1 996;274-2 8 1 .

1 9. Heater OW. Diaberes insipidus. R N 1 999;62(7):44.

20. Malarkey LM, McMorrow ME (cds). Nurse's Manual of Laborarory

Tests and Diagnostic Procedures. Philadelphia: Saunders, 2000;6 1 9-

620.

2 1 . Malarkey LM, McMorrow ME (cds). Nurse's Manual of Laboratory

Tests and Diagnostic Procedures. Philadelphia: Saunders, 2000;564-

566, 570-57 1 .

22. Malarkey LM, McMorrow M E (eds). Nurse's Manual of Labora.ory

Tests and Diagnostic Procedures. Philadelphia: Saunders. 2000;555-

556.

23. Black JM, Matassarin-Jacobs E (eds). Luckmann and Sorensen's Medical Surgical Nursing: A Psychophysiologic Approach (4th ed). Philadelphia: Saunders, 1 993.

24. Baker JR Jr. Autoimmune endocrine disease. JAMA 1997;278(22):

193 1 -1937.

25. Wand GS, Cooper OS. Adrenal Disorders. In JD Stobo, DB Hellmann,

PW Ladenson, et al. (eds), The Principles and Practice of Medicine (23rd

ed). Stamford, CT: Appleton & Lange, 1 996;282-292.

26. Krasner AS. Glucoconicoid·jnduced adrenal insufficiency. JAMA 1 999;

282(7):67 1 .

27. Kizer JR, Koniaris jS, Edelman JD, et al. Pheochromocytoma crisis, cardiomyopathy, and hemodynamic collapse. Chest 2000; 118(4): 122 1 .

28. 0 ' Connell CB. A young woman with palpitations and diaphoresis. Physician Assistant 1999;23(4):94.

29. McCance KL, Huether SE (eds). Pathophysiology: The Biologic Basis for

Disease in Adults and Children (2nd ed). St. Louis: Mosby, 1 994;674.

30. Repon of the Expert Committee on the Diagnosis and Classification of

Diaberes Mellitus. Diabetes Care 200 I ;24( I ):S5.

3 1 . Olefsky JM. Prospects for research in diabetes mellitus. JAMA 200 1 ;

285(5):628.

ENDOCRINE SYSTEM

695

32. Lorenzi, M. Diabetes Mellitus. In PA Fitzgerald (cd), Handbook of Clin·

ical Endocrinology (2nd ed). East Norwalk, CT: Appleron & Lange,

1 992;463.

33. Saudek CD. Diabetes Mellitus. In JD Srobo, DB Hellmann, PW Ladenson, et al. (cds), The Principles and Practice of Medicine (23rd cd).

Stamford, CT: Appleron & Lange, 1996;32 1-3 3 1 .

34. Standards o f medical care for patients with diabetes mellitus. Diabetes

Care 2001;24(1 ):533.

35. Nutrition recommendarions and principles for people with diaberes mellitus. Diabetes Care 200 I ;24( I ):544.

36 Zinran B, Ruderman N, Phil O, er al. Diabetes mellitus and exercise.

Diaberes Care 200 I ;24( 1 ):551

37. Saudek CD, Duckworth \'(fC, Giobbie-Hurdcr A, et al. Implamable

insulin pump vs multiple·dose insulin for non·insulin dependent diabe·

tes mellitus: a randomized clinical trial. Deparrmem of Veterans

Affairs Implantable Insulin Pump Srudy Group. JAMA I 997;276( 1 6):

1 322-1 327.

38. Cefalu WT. Inhaled human insulin trearmeO[ in patiems with type 2 diabetes mellitus (Abstract). JAM A 200 I ;285(12): 1559.

39. Skyler J , Cefalu WT, Kourides lA, et al. Efficacy of inhaled human

insulin in type I diabetes mellitus: a randomised proof·of·concept study.

Other books

SEAL Forever by Anne Elizabeth
Monster Gauntlet by Paul Emil
My Fraternity Big Brother by Natasha Palmer
Past Midnight by Jasmine Haynes
Dirty Love by Lacey Savage
A Splash of Red by Antonia Fraser