Endocrine Disorders, Pediatric Play, & Laminectomy Flashcards
Treatments for hyperthyroidism
Radioactive iodine, PTU, thyroidectomy
Radioactive iodine nursing considerations
- patient should be alone for 24 hours
- be careful with urine d/t radioactivity: instruct patient to flush three times, hazmat team must clean up spilled urine
PTU nursing consideration
Monitor WBCC (d/t immunosuppression)
Total thyroidectomy nursing considerations
- Monitor for hypocalcemia
- educate patient about the need for lifelong hormone replacement
Subtotal thyroidectomy nursing considerations
Monitor for S/S of thyroid storm (medical emergency): extreme temperature elevation, extreme hypertension, severe tachycardia, psychotic delirium
Thyroid storm treatment
Decrease temp, increase O2: Ice packs, cooling blankets, oxygen mask 10L
Post-op risks for both total and subtotal thyroidectomy within the first 12 hours
Airway and hemorrhage
Post-op risk for total thyroidectomy between 12-48 hours
Tetany (d/t hypocalcemia)
Post-op risk for subtotal thyroidectomy between 12-48 hours
Thyroid storm
Hypothyroidism nursing consideration
- Do NOT sedate (risk for myxedema coma)
- NEVER hold levothyroxine prior to surgery (NPO) unless given express orders to do so
Undersecretion of the adrenal cortex
Addison’s Disease
S/S of Addison’s Disease
Bronze/tan hyperpigmentation, inability to adapt to stress resulting in hypoglycemia and hypotension
The purpose of the body’s stress response is to perfume the brain with blood and raise _________ and _________
Glucose; Blood Pressure
Addison’s Disease treatment
Glucocorticoids (Addison’s = ADD SONes; Ex: prednisone)
Oversecretion of the adrenal cortex
Cushing’s Syndrome
S/S of Cushing’s Disease
Moon face, hirsutism, buffalo hump, gynecomastia, truncal obesity w/ skinny arms and legs, striae, retention of sodium and water, potassium loss, elevated glucose (hyperglycemia), easily bruised, immunosuppression — these are also all S/S of steroids
Cushing’s Syndrome treatment
Adrenalectomy
Nursing considerations for patient who is diabetic on a steroid
- higher doses of insulin needed (b/c steroid increases BG)
- Accuchekcs q6h
Toys for kids safety considerations
- no small toys for children under 4
- no metal (die-cast) toys if oxygen is in use
- beware of fomites (non-living object that harbors microorganisms)
What would be the best toy for a child who is immunosuppressed?
Hard-plastic action figure
Best toys for infants 0-6 months
Musical mobile (provides both sensory and motor stimulation), something soft and large to prevent choking
Best toys for infants 6-9 months
- Cover/uncover toys: jack in the box, pop up pals, books with little windows, peak-a-boo (these teach object permanence)
- something large but firm
Best toys for infants 9-12 months
- Speaking toys (this age group is learning to speak/vocalize)
- purposeful activity toys: building blocks/stacks
NOTE: never pick an answer with the following words in the kid is under 9 months — build, sort, stack, make, construct
Best toys for toddlers age 1-3
Push/pull toy (builds gross motor skills)
NOTE: if activities take finger dexterity, DO NOT choose for the toddler — colored pencils, scissors
Toddlers ages 1-3 engage in _________ play
Parallel
Best toys for preschoolers ages 4-5
Things that take finger dexterity and balance: tricycles, tumbling/dance class, ice skates (works on fine motor skills and balance)
Preschoolers ages 4-5 engage in _________ play
Cooperative
NOTE: this age group is highly imaginative! They like to play pretend
School-age children (age 6-13) characteristics
3 C’s: creative, collective, competitive
NOTE: best toys/activities include blank paper and colored pencils, legos, games where there is a winner/loser
Adolescent play
Peer group association/hang out with friends
Removal of the vertebral spinous processes
Laminectomy
Laminectomy indication
Relieve nerve root compression
Priority assessment pre-op for cervical Laminectomy
Breathing and arm and hand function
NOTE: cervical spine innervates diaphragm
Priority assessment pre-op thoracic Laminectomy
Cough mechanism and bowel sounds
NOTE: thoracic spine innervates abdominal muscles
Priority assessment pre-op lumbar Laminectomy
Bladder distention, function of arms and legs
NOTE: lumbar spine innervates bladder and legs
Post-op Laminectomy nursing considerations
- log roll patient
- do not dangle, no sitting longer than 30 min (meals only sitting time)
- patient can walk, stand, and lie down without restriction
NOTE: sitting is very bad for your back
Cervical Laminectomy post-op complications
Pneumonia
Thoracic Laminectomy post-op complication
Pneumonia and ileus
Lumbar Laminectomy post-op complication
Urinary retention, problem with legs
Laminectomy temporary restrictions discharge teaching
- do not sit longer than 30 min for 6 weeks
- lie flat and log roll for 6 weeks
- no driving for 6 weeks
- do NOT lift more than 5 lbs for 6 weeks (gallon of milk)
Laminectomy permanent restrictions discharge teaching
- do NOT lift object by bending at the waist, always with the knee
- cervical Laminectomy: do not lift anything over head (step stools needed)
- no off-trail biking, amusement park rides etc.
