Endo/neuro Flashcards
What are s/s of hypothyroidism?
Extreme fatigue Hair loss Brittle nails Dry skin Numbness and tingling Amenorrhea Intolerance to cold Bradycardia Weight gain Slow speech Tongue enlarges Constipation
What is myxedema coma?
Severe hypothyroidism. Pt becomes hypothermic and unconscious. May be precipitated by infection or by the use if sedatives
Pt May experience myxedema coma if they
Forget to take their thyroid replacement meds
In myxedema coma the pt may initially show signs of
Depression Diminished cognitive status Lethargy Somnolence Respiratory depression
Patient with myxedema coma may also exhibit
Hyponatremia Hypoglycemia Hypo ventilation Hypotension Bradycardia Hypothermia
Myxedema coma is treated with
IV T3 and T4
Oral levothyroxine
Nursing interventions for hypothyroidism
Keep room warm Give medication Apply moisturizer Give oxygen Cardiac monitor
What kind of diet should a pt with hypothyroidism be on
Low fat
High fiber
Low calories
Low carb
With the initial dose of hypothyroidism med a pt May experience
Chest pain or angina
There is a decrease in thyroid hormone absorption when pts are also taking
Magnesium containing antacids
Doses of anticoagulant meds need to be decreased in the beginning of thyroid replacement because
Of the increased risk of bleeding
Angina or dysrhythmias can occur when thyroid replacement is initiated because
Thyroid hormones enhance the cardio effects of catecholamines
Thyroid medication should be taken
First thing in the morning with a full glass of water
Hyperthyroidism is commonly caused by
Graves’ disease
Also by toxic adenoma, thyroiditis and excessive ingestion of thyroid hormone
In hyperthyroidism what are the T3,T4 and TSH levels
Increased T3 and T4
Decreased TSH
The presenting sx of hyperthyroidism is often
Nervousness
S/S of hyperthyroidism include
Weight loss Exophthalmos Amenorrhea Diarrhea Tachycardia Moist, flushed skin Increased sweating Heat intolerance Irritability Tremors
When assessing a thyroid for hyperthyroidism what can be pal payed and heard
Bruit and thrill
Nursing interventions for hyperthyroidism
Quiet, cold environment
High calorie diet
Increase fluid
Cardiac monitor
Anti thyroid meds for hyperthyroid are given to
Inhibit one or more stages of thyroid hormone synthesis or hormone release
The most common anithyroid meds given for hyperthyroidism are
PTU
Methimazole
Precautions taken when a pt is on radioactive iodine therapy
Keep door closed
Pt is isolated
Room is protected with lead
Methimazole is given 4-6wks prior to
Administration of radioactive iodine
For radioactive therapy what happens to the anithyroid meds
They are stopped 3 days before and restarted 3 days after administering radioactive iodine. And them tapered over 4-6 weeks
What are signs of thyroid storm
Cardiac dysrhythmias
Fever
Neuro impairment
What meds are given to treat sx of thyroid storm
Beta blockers
Patients who receive radioactive therapy should be informed that
They can contaminate their household thru saliva, urine and radiation emitting from their body. Avoid sexual contact, sleeping in the same bed as others, having close contact with children and pregnant women. Avoid sharing utensils and cups.
SIADH is
An excessive ADH secretion from the pituitary gland
SIADH cam be caused by
Head trauma
Lung cancer
Fluid retention in SIADH leads to
Concentrated urine Decreased urinary output Hyponatremia HTN that leads to HF Increased specific gravity At rush for fluid overload
Nursing interventions for SIADH
Give diuretics Treat the cause Limit fluids Monitor vital signs Monitor for signs HF Monitor urinary output Control HTN
Diabetes insipidus is
A deficiency of ADH
S/S of DI
Excessive thirst Large volumes of dilute urine Decreased specific gravity Low sodium in urine Hypotension Increased serum osmolarity Hypernatremia
DI can be caused by
Head trauma
Meningitis
Tumor
ADH is made and stored in
Made by the hypothalamus but stored in the posterior pituitary gland
Nursing interventions for DI
Increase IVF (isotonic)
Cardiac monitor
Desmopressin
What is the fluid deprivation test
Used to Dx DI. Withhold fluids for 8-12hrs or until 3-5% body weight is lost. Weigh pt frequently
The fluid deprivation test is stopped if the pt
Develops tachycardia, excessive weight loss, or hypotension
Desmopressin is administered
Intra nasally
If DI is renal in origin, what medication is used to treat it
Thiazide diuretics
Mild salt depletion
Prostaglandin inhibitors (ibuprofen, indomethacin and aspirin)
Vasopressin must be administered with caution in a pt with coronary disease because
Vasopressin causes vasoconstriction
Pheochromocytoma is a tumor that originates
In adrenal medulla and secretes large amounts of catecholamines (epinephrine and norepinephrine)
Triad of sx for pheochromocytoma
Headache
Diaphoresis
Palpitations
Other sx of pheochromocytoma include
Hypertension Tremor Flushing Anxiety Vertigo Blurring of vision
The five F’s of sympathetic nervous system over activity associated with high blood pressure
Hypertension Headache Hyperhidrosis Hyper metabolism Hyperglycemia
What is Hashimoto’s thyroiditis?
When the thyroid is invaded by WBC causing inflammation, which leads to a decrease secretion of T3 and T4 and an increase in TSH
Severe hypothyroidism is associated with
Elevated cholesterol levels, CAD and atherosclerosis
Patients with unrecognized hypothyroidism that are undergoing surgery are at risk for
Intraoperative hypotension, post op HF, and AMS
What are the three main treatments for hyperthyroidism?
Radioactive iodine therapy
Surgical removal
Thyroid medications
Nursing considerations for PTU
Monitor cardiac parameters
Observe for conversion to hypothyroidism
Must be given orally
What are s/e of PTU
Rash
N/V
Agranulocytosis
SLE
Prior to beginning PTU or methimazole what should be done?
Take baseline blood tests (complete CBC with differential)
Liver profile
Patient teaching for taking PTU and methimazole
Should be taken on empty stomach
30 min before eating
A thyroidectomy only removes ____ of the thyroid
five sixths
Before going into surgery a anithyroid medication is given until
Sx of hyperthyroidism have disappeared
Patients taking iodine medication must be monitored for
Iodinism (iodine toxicity)
S/S of iodinism
Swelling of the buccal mucosa
Excessive salivation
Cold sx
Skin eruptions
Nursing interventions for a pt that has undergone a thyroidectomy
Assess airway obstruction and swelling Trach kit needed Assess for s/s of hypocalcemia Check incision site Assess for excessive swallowing Ask pt to speak
What is used to treat hypocalcemia
Calcium gluconate
Hyperparathyroidism is characterized by
Bone decalcification and the development of renal calculi
A deficiency in the parathormone results in
Decreased calcium absorption and increased blood phosphate
Hyperparathyroidism can be caused by
Renal failure Bone disease Benign adenomas Tumor of parathyroid gland Vit D deficiency/malabsorption
S/S of Hyperparathyroidism
Apathy Fatigue Muscle weakness HTN Cardiac dysrhythmias
Treatment for Hyperparathyroidism
Increase fluid intake to prevent calculus Avoid thiazide diuretics Avoid dehydration Encourage mobility Oral phosphate Restrict Ca in diet
Hypoparathyroidism is chracterized by
Increased serum phosphate and decreased blood calcium and decreased resorption of calcium from bone
Hypoparathyroidism is caused by
the inadequate secretion of parathormone after the interruption of the blood supply or surgical removal of parathyroid tissue during thyroidectomy or radical neck dissection
Chief sx of Hypoparathyroidism
Tetany
Other sx of latent tetany include
Numbness, tingling, cramps in extremities and stiffness in the hands and feet
In overt tetany signs include
Bronchospams Laryngeal spasm Carpopedal spasm Dysphagia Photophobia Seizures Irritability, anxiety and depression
When tetany occurs, the immediate administration of what medication needs to be given
IV calcium gluconate
Nursing interventions for pts with Hypoparathyroidism
Environment that is free of noise, drafts and bright lights.
Diet high in calcium and low in phosphorus
Addisons disease is characterized by
Insufficient secretion of glucorticoid and mineralcorticoids
Therapeutic use of corticosteroids is the most common cause of
adrenocortical insufficiency
S/S of addisons disease
N/V Hyportension Muscle weakness Anorexia Dark pigmentation of the mucus membranes Depression Apathy
What are the electrolyte imbalances seen in Addison’s disease?
Hyponatremia
Hypoglycemia
Hyperkalemia
Addisons crisis is charactereized by
Hypotension Cyanosis Fever N/V HA Pallor Diarrhea
Immediate treatment for a pt with Addisons crisis includes
Administering fluids, corticosteroids Monitoring V/S Place pt in recumbant position with legs elevated Hydrocortisone IV D5W in NS
What kind of diet should a pt with Addison’s be on?
High Na
High carb
Low K
Cushings syndrome results from
An excessive secretion of glucocorticoids, particularly cortisol
Cushing’s is caused by
Use of cortocosteroid meds
S/S of Cushing syndrome
Central-type obesity Buffalo hump Thin extremities Thin, fragile skin Weakness Muscle wasting Osteoporosis HTN Moon face Slow wound healing
Electrolyte imbalances in Cushing syndrome
Hypernatremia
Hyperglycemia
Hypokalemia
What are the 3 tests used to diagnose Cushing
Serum cortisol
Urinary cortisol
Low dose dexamethasone
Serum cortisol levels are usually higher
In the morning (6-8am)
Diet for a pt with Cushing
High protein High K+ High Ca+/vit D Low Na Low calories
