Endocrine Flashcards
Thyroid does…
Regulates metabolism
Tip.
When you see THYROIDISM think METABOLISM
Hyperthyroidism = Hypermetabolism
S / S Everything (Goes Up / Goes Down)
What disease is this associated with
Everything goes up (except weight)
High HR, BP, irritation, heat intolerance, cold tolerance, Exophthalmos (bulging eyes)
Graves disease
Graves disease (Hyperthyroidism)
(3) treatments
Radioactive Iodine
PTU (propylthiouracil) Puts Thyroid Under - Cancer Drug
Thyroidectomy (most common)
Radioactive Iodine treatment for Graves disease (Hyperthyroidism)
Has (2) precautions
- No visitors for 24 hrs
- Flush urine 3x
If urine is spilled, call hazmat team
PTU for Graves Disease (Hyperthyroidism) which lab do you monitor
WBC- it’s an immune suppressant
Most important question to ask regarding Thyroidectomy
Is it Total (complete) or Subtotal (partial
Total Thyroidectomy
Risks
Subtotal
Risk
Life long hormone replacement
At risk Hypocalcemia
(Parathyroid controls Ca level -> Positive Trousseau & Chvostek)
Subtotal
Hormone replacement not needed
Risk for: Thyroid Storm / Crisis Thyroid storm
heart rate, blood pressure, and body temperature can soar to dangerously high levels.
Name the 4 S & S that correlate with a Thyroid Storm (SubTotal Thyroidectomy)
Super high Temps >105
Extremely High BP 210/ 180 (Stroke)
Severe Tachycardia 180 - 200
Psychotic Delirium- can cause brain damage while frying brain to death
Super high Temps >105
Extremely High BP 210/ 180 (Stroke)
Severe Tachycardia 180 - 200
Psychotic Delirium- can cause brain damage while frying brain to death
Thyroid Storm
What are the Interventions
Immediate intervention
(Reduce Temperature) how?
First way
Best way
Type of medication not to use
Oxygen at
When do you leave patient
Immediate; Temp down & Oxygen up
First way: Ice Packs
Best way: Cooling Blanket
Don’t use Tylenol- won’t work due to it affects the Hypothalamus
Oxygen @ 10L
Never, ever leave Patient
When treating a thyroid storm your priority is to Reduce Body Temp & Increase Oxygen
Put these interventions in order of which you do first
Ice pack
Oxygen
Cooling Blanket
Oxygen
Ice pack
Cooling Blanket
Post op risk: Thyroidectomy
1st 12 hours: priority =
Airway & hemorrhage
Post op Risk Thyroidectomy
12 - 48 hrs after Total & SUBTOTAL
Total: Tetany (muscular spasms in larynx, can cut off airway Due to Low Calcium)
Subtotal: Thyroid Storm
Releases large amount of Thyroid Hormone
Post op Risk Thyroidectomy
> 48 hours
Infection
Tip
Never choose Infection as a Priority in the first 72 hours for anything
Only chose it AFTER 72 HRS
Tetany vs Tinnitus
Tetany
symptom Involuntary muscle contractions and overstimulatedperipheral nerves
It’s usually caused bylow blood calciumlevels
Tinnitus = Ringing in the ears
Hypothyroidism / Hypometabolism
S/S
Skinny / fat
Cold / hot
BP / HR
Treatment
Fat
Cold
Low BP / HR = Myxedema
Treatment; Synthroid (levothyroxine)
Hypothyroidism / Hypometabolism
Sedation medication can have this affect on them.
Would you question am ambien HS before surgery?
If paitent is NPO what precaution would you take
Put them in a coma
Yes, this can put them in a coma
NPO, call Dr and confirm that they don’t need their Synthroid
Never hold what pill before surgery without Expressed orders to do so
Synthroid
Adrenocortex disease
Cushing, Conns, Addisons
All start with A / C
Addisons is (under / over) secretion of adrenal cortex
Under
S / S
Hyperpigmented (Tan)
No stress response (Get put into shock)
Addisons
Body responses to stress
Glucose & BP
Glucose Raises
BP Raises
Treatment for Addisons
Glucocortidicoids
Steroids; all end in “sone” ex: prednisone dexamethasone& hydrocortisone
TIP.
Addisons = ADD a SONE
Addisons disease is
(Over / Under) secretion of cortisol & sometimes aldostrone
Treatment (Add / Take Away) Cortisol/ Aldostrone
Under secretion of cortisol & sometimes aldostrone
Add
Crushings syndrome
( Depletion/ Excess) of cortical steroids production
S & S (Same as side effects of Steroid Medications)
S & S
Moon face (Puffy face & Neck)
Beard (Hirsutism)
Big Body (Certal Obesity)
Retains Sodium & Water (Loses K)
Straie (Stretch Marks)
HIGH GLUCOSE
Bruises
“IM Mad I have an Infection”
Cushings
Over production of Cortisol
Treatment
Adrenalectomy
Children’s Toy / Play Activy
- Is it safe (3)
- Age appropriate
- Feasible
1.
No small toys under 4
No metal (die-cast)toys if oxygen is in use
Beware of fomites
Which are safer (Teddy bears or GI joes) - Gi Joe’s, can be clean
Children’s Toy / Play Activy
Age appropriate
0 - 6 months:
Musical Mobile or Soft & Large
Age appropriate toy for
6 - 9 months:
Cover uncover toy/ Large Harder( Plastic, Wood, Metal)
Age appropriate
Object Perminamce (ability to know an object is there when they can’t see it. Ie. Object is hidden under a blanket)
6 - 9 months
Age Appropriate
9 - 12 Months
Vocalization
Talking Toys. See & Say, Pull String
Never pick answers with the following words in them in the child is under ___ months
(Build, Sort, Stack, Make, Construct)
9
(Build, Sort, Stack, Make, Construct)
9 months is when they start purposeful play
Age appropriate
1 - 3 year old
Push / Toys
Wagon, Stroller, Lawn Mower
Do Toddlers have finger dexterity ie. Use of scissors, color pencils, crayons
No
Parallel Play play along side but not with
Which age group
Toddlers
Preschoolers Work on these skills
Which type of play style
Fine motor / balance.
Characterized by Cooperative play. Pretend Play
School Age type of play
Creative: Allow them to create
Collective:
Competitive:
Adolescentes: Type of “Play”
Peer Group Association
LamenLaminectomy is
Why is it done?
Remove part or all of the vertebral bone (lamina).
Ease pressure on the spinal cord or the nerve roots
Caused by injury, herniated disk, narrowing of the canal (spinal stenosis), or tumors.
S & S of nerve route compression
(3)
Pain
Paresthesia
paresis
Most important part of any Neuro question
Location
Cervical Neck
Thoracic Upper Back
Lumbar Lower Back
What is the most important pre-op assessment for a Cervical Lamenectomy?
1.Breathing
2. Arm & Hand function
Cervical Intervates Diaphragm & Arms
What is the most important pre-op assessment for a Thoracic Lamenectomy?
- Assess Cough
- Bowel function
What is the most important pre-op assessment for a Lumbar Lamenectomy?
When was the last time they voided
Function of Legs
Intervates Bladder & Legs
1 post op answer after Lamenectomy is…
Log roll
3 rules for post op Spine Surgery
- Don’t dangle (Onside of bed) keep it minimal.
- Don’t sit for longer than 30 mins
- They may walk, stand, lay down without restrictions
Post op Complications for Cervical Lamenectomy
- Pneumonia
Post op Complications for Thoracic Lamenectomy
- Pneumonia
- Bowles don’t work
Post op Complications for Lumbar Lamenectomy
Urinary retention
Leg problems
Which Lamenectomy will have a chest tube
Anterior thoracic
Lamenectomy with Fusion taking a bone graft from ____
Illiac crest
Lamenectomy with Fusion will have 2 incision points which will
hurt more
Blood more
Reject more
The Illiac crest / Hip
Illiac crest
Spine
Discharge teaching Lamenectomy
4 Temp
3 Perm Restrictions
- No sitting longer 30 mins. (6 weeks)
- Lie flat and log roll for (6 weeks)
- No driving for (6 weeks)
- Don’t lift over 5 lbs (6 weeks)
Perm
1. Can’t lift by bend at waist. Lift with knee
2. Cervical lams cannot lift anything over head
3. No mountain biking, circus rides, cosas asi
