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Gerotonlogy > Chronic Conditions Exam 2 > Flashcards

Chronic Conditions Exam 2 Flashcards

1
Q

What is Acute Illness ?

A
  • Occurs suddenly and often without warning
  • Stroke, myocardial infarction, hip fracture, infection
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2
Q

What is Chronic Illness ?

A
  • Managed rather than cured
  • Always present but not always visible
  • Most common chronic condition in persons over 65 is arthritis, followed by hypertension
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3
Q

What are the Chronic Conditions in Adults Over 65 ?

A
  • Heart Disease
  • HTN
  • Stroke
  • Asthma
  • Chronic Bronchi or Emphysema
  • Any Cancer
  • Diabetes
  • Arthritis
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4
Q

Preventive phase (pre-trajectory) ( Chronic Illness Trajectory )

A

No S/Sx

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5
Q

Definitive phase (trajectory onset) ( Chronic Illness Trajectory )

A

S/Sx & diagnosis PRESENT

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6
Q

Crisis phase ( Chronic Illness Trajectory)

A

Life-threatening situation

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7
Q

Acute phase ( Chronic Illness Trajectory)

A

Active illness requiring hospitalization

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8
Q

Stable phase

A

Controlled illness course/symptoms

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9
Q

Unstable phase

A

Not controlled but not requiring/desiring hospitalization

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10
Q

Downward phase

A

Progressive decline

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11
Q

Dying phase

A

Immediate weeks/days/hours before death

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12
Q

What is Frailty ?

A
  • Incidence increases with age
  • Normal age-related decreases in reserve capacity are depleted and not able to compensate
  • Combination of geriatric syndromes
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13
Q

How to Diagnose Frailty ? (5)

A
  • Unintentional weight loss
  • Self-reported exhaustion
  • Weak grip strength
  • Slow walking speed
  • Low activity
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14
Q

HTN ( Hypertension)

A

is a complex disease with a core defect of vascular dysfunction that leads to target organ damage.

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15
Q

Is the MOST COMMON chronic condition in people > 65 yo.

A

Hypertension

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16
Q

What are the Hypertension Interventions ?

A
  • Weight reduction (5-20 mmHg reduction)
  • DASH diet (8-14 mmHg reduction)
  • Lower sodium intake (2-8 mmHg reduction)
  • Increase physical activity (4-9 mmHg reduction)
  • EtOH in moderation (2-4 mmHg reduction)
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17
Q

Most common cause for hospitalization, re-hospitalization, and disability for those over 65 yo

A

Heart Failure

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18
Q

What is Heart Failure ?

A

Heart cannot keep up with workload

Results in insufficient oxygen delivery to body

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19
Q

What are the causes of Heart Failure ?

A
  • Results from damage from hypertension and CHD
  • Ventricles ENLARGE and DILATE

Results in weaker muscle

  • Also related to :
  • EtOH abuse
  • Drug abuse
  • Chronic hyperthyroidism

-Valvular disease

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20
Q

-What is Left sided Heart Failure ?

A

Pump Failure to lungs

  • Starling’s Law - Stretch
  • Systolic – decreased contractility – can’t squeeze
  • Diastolic – decreased filling – can’t relax
  • Think DYSPNEA
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21
Q

What is Right sided Heart Failure ?

A

Pump Failure to body

  • Results from Left-side failure
  • Think EDEMA – but also ascites
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22
Q

What is just Congestive Heart Failure (also Acute Decompensated) ?

A

Swelling, edema, fluid in lungs (pulmonary edema)

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23
Q

What are the S/S of Congestive Heart Failure ?(4)

A
  • Tachycardia
  • S3 or S4 gallop
  • Crackles - fluid in lungs
  • Dependent edema
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24
Q

What are Interventions for Heart failure ?(7)

A
  • Activity – Pace to tolerance
  • Exercise
  • Medications
  • CCB are usually contraindicated!!!
  • Sodium restriction
  • Supplemental Oxygen
  • Daily weights
  • Possible fluid restriction
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25
Q

What are the Cardiovascular Interventions ? (6)

A
  • Complete assessment of all risk factors and existing disease
  • Lifestyle changes
  • Medication regimen tailored to specific disease process and patient needs
  • Education
  • Referral for financial assistance with medications if needed
  • Focus on symptom management and prevention of exacerbations of disease
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26
Q

What are the CV Drugs ?

A
  • ACEI & ARB
  • Diuretics – Loop, Thiazide, & Potassium-Sparing
  • Beta Blockers
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27
Q

What Disease is considered Progressive and a Terminal Diagnosis ?

A
  • Over 10-20 yrs
  • Basal ganglia (corpus striatum) and involves the dopaminergic nigrostriatal pathway
  • Think DOPAMINE – Dopamine is lost or inhibited
  • Dopamine regulates nerve impulses for MOTOR function
  • More common (slightly) in men than women
  • Onset approximately 60 years
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28
Q

What the Patho for Parkinson Disease ?

A

Degeneration and death of neurons of substantia nigra (in midbrain – reward, addiction, & movement - also sleep-wake cycles & firing of action potentials)

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29
Q

What are PD Clinical Signs ?

A
  • Cogwheel Rigidity
  • Bradykinesia/Dyskinesia
  • Resting/Non-intention tremors
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30
Q

What is Cogwheel Rigidity ?

A
  • Arms, legs, neck affected
  • Small jerking movements when affected muscles stretched

Muscle rigidity

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31
Q

What is Bradykinesia/Dyskinesia?

A
  • All skeletal muscles affected
  • Difficulty starting, continuing, and or coordinating movements
  • Shuffling
  • May become frozen (Akinesia) - absence or poverty of movement
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32
Q

What are Resting/Non-intention tremors ?

A
  • Hands, feet, head, neck, face, lips, tongue, jaw most affected
  • Fine, rhythmic, purposeless tremors
  • Disappear with sleep and purposeful movements
  • Pills rolling, small handwriting, low monotone voice
  • Complications: falls, fractures, impaired communication, and social isolation
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33
Q

What is a Parkinsonian Crisis ?

A

Major complication

Precipitated by emotional stress or sudden withdrawal of meds

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34
Q

What are Manifestations Parkinsonian Crisis ?(5)

A
  • Severe exacerbation of tremors, rigidity, and bradykinesia
  • Anxiety
  • Sweating
  • Tachycardia

-Hyperpnea

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35
Q

What are Treatment and interventions Parkinsonian Crisis ? (4)

A
  • Respiratory/cardiac support prn
  • Non-stimulating environment
  • Psychological supports
  • Restarting medications
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36
Q

What are the teaching Exercises for PD ? (9)

A
  • Lift toes when walking
  • Widen legs while walking
  • Small steps while looking forward
  • Tight corner manipulation
  • Swing arms with walking to improve balance and ROM
  • Carry bag to counterbalance is necessary
  • Facial exercises
  • Read aloud
  • Speak slowly with purpose and concentrated articulation
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37
Q

What are the Nursing Interventions for PD ? (9)

A
  • Preservation of functional ability and quality of life
  • Increased independence and ADLs
  • Prevent complications and excess disability
  • Coping mechanisms
  • Increased socialization
  • Support groups for patient and family
  • Physical therapy and balance training
  • Increase strength and ROM
  • Occupational therapy with adaptive equipment
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38
Q

What are the Dopamine Precursors and Glutamine Antagonists ? ( First Line for PD ) (3)

A

Levodopa (Lardopa), carbidopa-levodopa (Sinemet), amantadine (Symmetrel)

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39
Q

What is the MOA of Dopamine Precursors and Glutamine Antagonists ?

A

Improves manifestations of motor dysfunction

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40
Q

Levodopa converted to dopamine…………

A

in brain by decarboxylase

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41
Q

Carbidopa prevents conversion of dopamine……..

A

in peripheral tissues

Synergistic effect

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42
Q

Amantadine increases what ????

A

CNS response to dopamine

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43
Q

What are the Side Effects for Levodopa (Lardopa), carbidopa-levodopa (Sinemet), Amantadine (Symmetrel) ?

A

N/V/D, arrhythmias, blurred vision, darkening of sweat and urine, dyskinesias, postural hypotension, hallucinations and vivid dreams

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44
Q

Who needs to Avoid Levodopa ?

A

Pts with TIA, angina, melanoma, NA glaucoma

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45
Q

What is Client Education for Levodopa (Lardopa), carbidopa-levodopa (Sinemet), Amantadine (Symmetrel) ?

A
  • Weeks to months to take effect
  • Decrease protein intake
  • High protein decreases function of meds
  • Avoid foods with pyridoxine

Pork, beef, avocado, beans, oatmeal

  • Antiemetics and PPIs/H2RA prn
  • Interventions to decrease postural hypotension
  • Teach to report increases symptoms and cardiac SEs
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46
Q

What are the Monoamine oxidase B inhibitors (MAOB inhibitors) ? (2)

A

Selegiline (Eldepryl), rasagiline (Azilect)

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47
Q

What is the MOA for Selegiline (Eldepryl), rasagiline (Azilect) ?

A
  • Inhibits enzymes that inhibit and/or breakdown dopamine
  • Often used synergistically with Levodopa
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48
Q

What are the Side Effects for Selegiline (Eldepryl), rasagiline (Azilect) ?

A

N/V, dizziness, insomnia, postural hypotension, HTN at high doses

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49
Q

What is the Client Education or Selegiline (Eldepryl), rasagiline (Azilect) ?

A
  • Take at same time each day
  • Report insomnia
  • Interventions to prevent postural hypotension
  • Skin exams – risk of melanoma
  • Avoid foods containing Tyramine
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50
Q

What is Contraindicated for Selegiline (Eldepryl), rasagiline (Azilect) ?

A

Prozac and Demerol

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51
Q

What are the Dopamine Agonists ? (3)

A

Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip)

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52
Q

What is the MOA for Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip) ?

A
  • Mimic effects of dopamine in brain
  • Often used synergistically with Levodopa
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53
Q

What are the SE for Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip ?

A

Similar to Levodopa

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54
Q

What is the Client Education for Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip) ?

A
  • Same teaching as Levodopa
  • Don’t stop abruptly
  • May cause compulsive behavior
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55
Q

What are the Catechol-O-Methyltransferase (COMT) Inhibitors ?

A

Tolcapone (Tasmar), entacapone (Comtan)

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56
Q

What is the MOA of Tolcapone (Tasmar), entacapone (Comtan) ?

A
  • Inhibit COMT, which breaks down dopamine
  • Used synergistically with Levodopa/Sinemet
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57
Q

What are the Nursing Considerations for Tolcapone (Tasmar), entacapone (Comtan) ?

A
  • Monitor LFTs
  • Interacts with warfarin, so monitor INR closely
  • Not to be used with MAOBIs
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58
Q

What is the Client Education for Tolcapone (Tasmar), entacapone (Comtan) ?

A
  • Take with food
  • No ETOH or sedatives
  • Interventions to prevent postural hypotension
  • Don’t stop abruptly
  • Report muscle control changes, jaundice, dark urine, hallucinations
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59
Q

What are the Anticholinergics in relation to PD ?

A

Benztropine (Cogentin), Trihexyphenidyl (Artane)

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60
Q

What is the MOA of Benztropine (Cogentin), Trihexyphenidyl (Artane) ?

A

Block the excitatory action of acetylcholine

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61
Q

What are the Nursing Considerations for Benztropine (Cogentin), Trihexyphenidyl ?

A
  • Used early in disease or when Levodopa not tolerated
  • Help prevent PD symptoms of drooling, tremors, rigidity
62
Q

What the Anticholinergic Side Effects ?

A
  • Can’t… SEE
  • Can’t… PEE
  • Can’t… SPIT
  • Can’t … POOP

Assess for glaucoma S/S and photophobia

63
Q

What is the Client Education for Benztropine (Cogentin), Trihexyphenidyl ?

A
  • Avoid activity which promotes fluid loss
  • Don’t stop abruptly
64
Q

What is GERD ?

A
  • Movement of gastric contents, especially gastric acid, into the esophagus
  • Lower esophageal spincter (LES) relaxes too much
65
Q

What the Older adult Symptoms for GERD ?

A
  • Persistent cough
  • Asthma exacerbations
  • Laryngitis
  • Intermittent chest pain
66
Q

Goal of therapy of GERD is to Prevent what ?

A

Exacerbation of Symptoms

67
Q

What is the Most serious Complication for GERD ?

A

Aspiration Pneumonia

68
Q

How do we prevent GERD Exacerbations ?

A

Lifestyle and diet changes ( Sit up after eating, Elevated HOB while sleeping and weight loss )

Medication management – PPI’s

69
Q

What are the Musculoskeletal Disorders ?

A

Osteoporosis

Osteoarthritis

Rheumatoid arthritis

70
Q

What are Osteoporosis Risk Factors ( Non- Modifiable ) ?

A
  • Female gender
  • Northern European ancestry
  • Advanced age
  • Family history of osteoporosis
71
Q

What are Osteoporosis Risk Factors ( Modifiable ) ?

A
  • Low body weight (underweight)
  • Low calcium intake
  • Estrogen deficiency
  • Low testosterone
  • Inadequate exercise or activity
  • Use of steroids or anticonvulsants
  • Excess coffee or alcohol intake
  • Current cigarette smoking
72
Q

For women, fastest overall loss of bone mineral density is 5 to 7 years immediately after what ?

73
Q

What are the complications of Osteoporosis ?

A
  • Most serious health consequence of osteoporosis is morbidity and mortality resulting from falls
  • 20-24% of adults with hip fractures die within one year
  • One in five will require long term care
  • Only 15% will be able to walk unassisted six months post fracture
  • Women with osteoporotic fractures have increased incidence of other major complications
  • Vertebral fractures often not recognized - Silent
  • Several new treatment options available – kyphoplasty/vertebroplasty
74
Q

When should women get screened for Osteoporosis ?

A

65 and Older

75
Q

What are the Interventions for Osteoporosis ?

A
  • Weight bearing and resistance training
  • Adequate calcium and vitamin D intake
  • Education about fall prevention
  • Pharmacological therapy to prevent bone loss
76
Q

What is the Safety Alert for Bisphosphonates ?

A

Oral Meds must be taken on an empty stomach ( when first awake ) with a full glass of water, and the person must remain in an upright position for at least 30 minutes and not eat or drink for at least 30 minutes.

77
Q

What is Osteoarthritis ( OA) ?

A
  • Normal soft and resilient cartilaginous lining in joint becomes thin and damaged
  • Joint space narrows and bones of joint rub together, causing joint destruction
  • Diagnosis is made clinically
78
Q

What is the Most common Symptom for OA ?

A
  • Stiffness with activity and pain with activity relieved by rest
79
Q

What are the Most common Locations for OA ?(7)

A

Neck – cervical spine

Lower back – lumbar spine

Hips

Hands

Fingers

Thumbs

Knees

80
Q

What are the OA Deformities ? ( If you see these you know for a fact this person has OA )

A
  • Heberden’s node – DIP – Distal Interphalangeal Joint
  • Bouchard’s node – PIP – Proximal Interphalangeal Joint
81
Q

What are the OA Interventions ? ( Non- pharmalogical therapy )

A
  • Weight loss can help – One pound of weight places four pounds of pressure on knees
  • Exercise - “Motion is the Lotion”

Strength and flexibility – support the joints

Water exercise

  • Physical therapy
  • Hot/Cold therapy – patient preference
  • Adaptive devices

Cane – Relieves hip pressure by 60%

Shoe lift for back pain

Knee brace for stability

82
Q

What are the OA Interventions ? ( Pharmalogical therapy )

A
  • Acetaminophen – 4 Gram MAX/day
  • NSAIDs - COX2 (selective NSAID)
  • Joint injections – Intra-articular

Steroids - Inflammation

Hyaluronic Acid - Lubrication

  • Acupuncture
  • Surgical intervention – Knee/Hip

Arthroscopy

Total Joint Replacement

83
Q

What is Rheumatoid Arthritis ( RA) ?

A

-Chronic, progressive, systemic inflammatory autoimmune disease

  • Primarily synovial joints
  • Inflammation destroys surrounding cartilage & eventually bone
84
Q

What is Systemic RA ?

A

can affect any organ system i.e. vasculitis, anemia, splenomegaly, pulmonary nodules, pericarditis

85
Q

The Focus of research for RA includes what ?

A
  • Genetic factors
  • Environmental triggers in genetically vulnerable population
  • Hormonal triggers
86
Q

What are Rheumatoid Arthritis interventions ? (4)

A
  • Complete physical and laboratory assessment
  • Exercise and physical therapy
  • Environmental modifications
  • Assistive devices
87
Q

What are Rheumatoid Arthritis interventions ? ( Pharmacological Therapy )

A

Pain management

DMARDs (disease-modifying anti-rheumatic drugs) - methotrexate

Biological response modifier - “-mab”

88
Q

Difference between is OA and RA ? ( Osteoarthritis )

A
  • Older adults
  • May be unilateral - Knee, hip, spine, hand
  • DIP & PIP
  • Usually NO MCP
  • Shorter period of morning stiffness
  • Pain with activity
89
Q

Difference between is OA and RA ? ( Rheumatoid Arthritis )

A
  • Women > Men
  • Symmetrical – hands & feet common
  • MCP & PIP
  • Usually NO DIP
  • Prolonged morning stiffness > 30 min
  • Pain > with inactivity
90
Q

What are the Endocrine Chronic Conditions ?

A
  • Diabetes Mellitus – altered presentation
  • Hyperthyroid
  • Hypothyroid
91
Q

What is Diabetes Mellitus ( DM) ?

A

Disorder of glucose metabolism

92
Q

What is Type 1 Diabetes ?

A

Absolute deficiency of insulin production due to autoimmune destruction of pancreatic β cells

92
Q

What is Type 2 Diabetes ?

A
  • Combination of relative insulin deficiency and insulin resistance
  • Genetics, lifestyle, and aging influence development of diabetes
93
Q

How does DM present in Older pts ?

A
  • Dehydration
  • Confusion, delirium
  • Decreased visual acuity
  • Incontinence
  • Weight loss & anorexia (polyphagia in younger)
  • Fatigue, nausea
  • Delayed wound healing
  • Paresthesias
94
Q

What is the risk for Amputation in DM pts ?

A
  • Peripheral neuropathy with loss of sensation
  • Evidence of increased pressure (redness, bony deformity)
  • Peripheral vascular disease (diminished or absent pedal pulses)
  • History of ulcers
  • History of amputation
  • Severe nail pathology
95
Q

What are the Interventions for DM ?

A
  • Screening and early identification of diabetes
  • Prevent complications
  • Assessment of end organ status
  • Assessment of self-care ability
  • Nutrition
  • Exercise
  • Close monitoring of residents in long-term care environment
95
Q

What are the Interventions for DM ?(7)

A
  • Screening and early identification of diabetes
  • Prevent complications
  • Assessment of end organ status
  • Assessment of self-care ability
  • Nutrition
  • Exercise
  • Close monitoring of residents in long-term care environment
96
Q

What are the Meds for DM ?

A
  • SGLT2 Inhibitors – Sodium Glucose Transport 2 Inhibitors
  • Biguanides
  • Sulfonylureas
97
Q

SGLT2 Inhibitors – Sodium Glucose Transport 2 Inhibitors

A

-glifozin

Prevents reabsorption of glucose ( and sodium)

“Pee out glucose”

98
Q

What are Biguanides ?

A
  • Metformin
  • Increases uptake of glucose by muscles (increases insulin sensitivity of body tissue) and reduces gluconeogenesis
99
Q

Nursing Considerations for Sulfonylureas ?

A
  • Don’t use in older adults!!
  • Long ½ life and risk for hypoglycemia
99
Q

Hypothalamic- Pituitary- Thyroid Axis( Whats the the order ? )

A

Negative Feedback System

Hypothalmus → Thyrotropin Releasing Hormone → Ant Pituitary to Increase Thyroid Stimulating Hormone →Thyroid Gland to produce T3 and T4

100
Q

What are the Diagnostic Studies of Thyroid Function ?

A
  • Serum levels of TSH, T3, T4 & Free T4
  • Thyrotropin-releasing hormone stimulation test (TRH)
  • Radioactive Iodine uptake (RAI)
  • Thyroid scan
101
Q

What is the Thyrotropin-releasing hormone stimulation test (TRH) ?

A

TRH injected and TSH measured to assess thyroid function

102
Q

What is the Radioactive Iodine uptake (RAI) ?

A
  • Direct test of thyroid function
  • Radioactive iodine absorbed by thyroid and thyroid can be visualized assessing for nodules
103
Q

What is a Thyroid Scan ?

A

Similar to RAI, but iodine not used. Radioactive isotopes given orally and taken up by thyroid and visualized on scan

104
Q

What does T4 Indicate ?

A
  • Generally bound to proteins
  • Free T4 measures T4 not bound to proteins therefore active
  • Released by thyroid gland
105
Q

What does T3 Indicate ?

A
  • Monitor the effectiveness of thyroid replacement therapy
106
Q

What should be Avoided for T3 and T4 testing ?

A

Hormones, steroids, ASA, foods containing iodine should be avoided for 7 days before testing.

107
Q

What is Hyperthyroidism ?

A
  • increased T3 and T4 hormones which increases the metabolic rate
  • Most severe form thyrotoxicosis
108
Q

What causes Hyperthyroidism ?

A
  • Autoimmune disorder (Grave’s disease) *most common
  • Multinodular goiter (Toxic goiter)
  • Women affected more often, 5-7:1
109
Q

What is the Pathophysiology of Hyperthyroidism ?

A
  • Increased circulating thyroid hormones (TH)
  • Metabolic rate increases
  • Heightened sympathetic nervous system
  • Heightened sensitivity to catecholamines
  • Manifestations of hyperthyroidism
110
Q

Hyperthyroidism In Relation to Older Adults ?

A
  • Onset often abrupt
  • Graves disease most common form in older adults
  • Also caused by toxic goiter, iodine ingestion or iodine-containing foods, contrast agents, & medications
111
Q

Thyroxine increases myocardial oxygen consumption which can cause what ? ( hyperthyroidism )

A
  • Increases risk for Afib and angina in person with CHD
  • Can cause heart failure
  • Most common complication – AFIB – 27% of older adults with hyperthyroidism
112
Q

How does Hyperthyroidism Present in the Older Population ?

A
  • Tachycardia
  • Tremors
  • Weight loss
  • Apathetic Thyrotoxicosis – slowed movement and depressed affect
113
Q

What is a Thyroidectomy ?

A
  • Surgical removal of part or all of thyroid
  • Reserved for severe case or large goiters
114
Q

What is the Pre- Op care for a Thyroidectomy ?

A
  • Give antithyroid medications
  • Lugol’s solution (potassium iodide and iodine) given 10 days before to decrease thyroid hormone production
  • Promote reduction of anxiety to reduce risk of thyroid storm
115
Q

What is the Post-Op care for a Thyroidectomy ?

A
  • HOB up Semi-Fowler’s
  • Check dressing – esp back of the neck
  • Assess resp status/distress due to risk of airway edema
  • Trach tray, oxygen and suction at bedside
  • Rest voice - hoarseness with nerve injury
  • Observe for tetany – Chvostek’s and Trousseau’s sign – indicator of damage or removal of parathyroid glands – resulting in hypocalcemia
116
Q

What is Chvostek’s sign?

A

Push the cheek and it spasms
(low calcium)

117
Q

What is Trousseau’s sign?

A

BP cuff inflated and causes a carpal spasm.

118
Q

What is Thyroid Storm ( thyrotoxicosis ) ?

A

Life-threatening condition

Exaggeration of hyperthyroid symptoms

Hyperthermia 102-106 F

Tachycardia (130+)

HTN

Abd pain, N/V/D, agitation, anxiety, psychosis, delirium, seizures, dehydration

119
Q

What are the S/S of a Thyroid Storm ?

A
  • Hyperthermia 102-106 F
  • Tachycardia (130+)
  • HTN
  • Abd pain, N/V/D, agitation, anxiety, psychosis, delirium, seizures, dehydration
120
Q

How do we treat a Thyroid Storm ?

A

Cooling with ice, reducing levels of TH, replacement of fluids and electrolytes, give oxygen, stabilize cardiac function. Avoid ASA (increases TH)

121
Q

What is hypothyroidism?

A
  • thyroid horome deficiency, low T3 and T4 levels which decreases the metabolic rate
  • AKA Myxedema in adults & Cretinism in infants

Women affected more often 5:1

  • Ages 30-60
122
Q

What are the Primary causes of Hypothyroidism ?

A

Genetic/congenital, tx for hyperthyroidism, thyroiditis, iodine deficiency, decrease TH produced

123
Q

What are the Secondary causes of Hypothyroidism ?

A

Pituitary TSH deficiency or peripheral resistance to thyroid hormones

124
Q

What the Meds for Hypothyroidism ?

A

Amiodarone, anabolic steroids, lithium, phenytoin, beta blockers

125
Q

What is Hashimoto’s Thyroiditis ?

A

Chronic autoimmune thyroiditis

Genetic link

126
Q

What is the Patho of Hashimoto’s Thyroiditis ?

A

Autoantibodies attack thyroid tissue>thyroid becomes fibrous>function of thyroid decreases>low T3 T4>goiter development>signs of hypothyroidism

127
Q

What are the S/S of Hashimoto’s Thyroiditis ?

A
  • Hypothyroidism
  • Sore throat, malaise
127
Q

How do we Treat Hashimoto’s Thyroiditis ?

A
  • Goal: decrease size of thyroid and prevent hypothyroidism
  • Thyroid hormone replacement

Giving Synthroid decreases size of gland by reducing its activity

128
Q

How to Diagnose Hashimoto’s Thyroiditis ?

A

With T3, T4, TSH, Antithyroid hormones

129
Q

Hypothyroidism In Relation to Older Adults ?

A
  • Most frequent cause chronic autoimmune thyroiditis
  • Also radioiodine treatment, surgery, medications (Amiodarone), pituitary/hypothalamic abnormality
130
Q

How does Hypothyroidism Present in Older Adults ? (5)

A
  • Slowed mentation
  • Gait disturbances
  • Fatigue
  • Weakness
  • Heat intolerance COLD intolerance
130
Q

How to Diagnose Hypothyroidism ?

A

TSH, T3, T4, FT4

PE( Pulmonary Embolism ) and hx; Cardiac studies to assess for complications

131
Q

How to Treat Hypothyroidism ?

A

Thyroid replacement therapy

Levothyroxine (Synthroid) ( Most Common )

132
Q

Levothyroxine (Synthroid) is the MOA ?

A

Synthetic T4 (converted to T3 in tissues)

133
Q

What are SE of Levothyroxine (Synthroid) ?

A
  • All those signs of HYPERTHYROIDISM
  • Dysrhythmias, CHF, HTN, angina, seizures
134
Q

What are the Nursing Considerations for Levothyroxine (Synthroid) ?

A
  • Assess for bleeding in pts on anticoagulants (potentiates action)
  • Hyperglycemia (need for increased DM treatments)
  • NOT used as a wt loss med
  • Long half-life
  • Give on empty stomach
135
Q

What is the myxedma coma?

A

Rare & Life-threatening complication with HIGH mortality rate

136
Q

What are the causes for myxedma coma ?

A
  • Untreated or uncontrolled hypothyroidism
  • External stressors including surgery, trauma, infection, excessive exposure to cold temps
137
Q

What are the Manifestations of Myexdema Coma ?

A

Hypothermia, Mental function ranges from depression to unconscious, Respiratory depression (hypoventilation), Hypotension, Bradycardia

138
Q

What are the treatments for Myxedema Coma ?

A
  • Supportive measures and stabilization of vitals
  • Treat underlying cause
  • Thyroid hormone replacement – must be slow r/t toxicity with rapid replacement
  • PO or IV
139
Q

What are the Brochodilators for Respiratory ?

A

Albuterol

Formoterol

Salmeterol

140
Q

What are the Inhaled corticosteroids (ICS) ?

A

Budesonide

Mometasone

Fluticasone

141
Q

What are the Oral Steroids ?

A

Prednisone

142
Q

What are the anticholinergics?

A

Short Acting Muscarinic Antagonists (SAMA)

  • Ipratropium

Long Acting Muscarinic Antagonists (LAMA)

  • Tiotropium
143
Q

A client has been diagnosed with hyperthyroidism. What lab result would the nurse least expect to be elevated?

A. T4

B. T3

C. Free T4

D. TSH

144
Q

A client with severe thyrotoxicosis has a temperature of 104 F. What medication or treatment is least appropriate to suppress the temperature?

A. Aspirin

B. Tylenol

C. Cooling blanket

D. Intravascular cooling system

A

A. Aspirin

145
Q

A client has been admitted to the ICU in myxedema coma. What client description does the nurse most expect?

A. Young man with abdominal pain

B. Middle-aged man with skeletal trauma

C. Middle-aged woman in summer

D. Elderly woman during winter

A

D. Elderly woman during winter

146
Q

The nurse evaluates that female client recently diagnosed with hypothyroidism understands the prescribed therapy with levothyroxine (Synthroid) when the client states

A. “I should be able to become pregnant in a couple of months.”

B. “This medications will help me lose all this extra weight.”

C. “I should call the doctor for nervousness or an increased pulse.”

D. “This medication should be taken with food, preferably dairy.”

A

C. “I should call the doctor for nervousness or an increased pulse.”

Gerotonlogy (2 decks)

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