Endocrine/toys/laminectomy

Question 1

hyperthyroidism is also known as

Answer 1

graves disease
- memory trick: your going to run yourself into the grave

Question 2

hyperthyroidism

Answer 2

• turn the word thyroid into metabolism= hyper metabolism

Question 3

hyperthyroidism s/s

Answer 3

• everything high and hot
• weight loss
• high HR
• goiter
• increased bp
• irritable/hyper
• heat intolerance ( always sweating so cant handle the heat)
• cold tolerance (always sweating so like the cold)
• exopthalamus
• confusion
• diarrhea

Question 4

treatment for hyperthyroidism

Answer 4

1. radioactive iodine
2. PTU
3. thyroidectomy

Question 5

radioactive iodine for tx of hyperthyroidism

Answer 5

• pt should be isolated for 24 hours after
• they have to be careful with their urine (flush 3 times)
• if they spill urine: call hospitalist hazmat team
• dangerous if pregnant

Question 6

PTU for hyperthyroidism

Answer 6

• puts thyroid under: decrease thyroid
• monitor: WBC since this is a cancer drug
• could be immunosupressed

Question 7

thyroidectomy for the tx of hyperthyroidism

Answer 7

• will need life long hormone replacement
• risk for hypocalcemia (watch for trousseus and chevestoks)
• if its a total: need life long tx
• if its su: risk for thyroid storm since you still have some thyroid- may need temporary thyroid reeplacment

Question 8

thyroid storm

Answer 8

• EMERGENCY and can be caused by anything that can stimulate body (stress, na+ in diet, soda, coffee, etc)
• very high temps ( even in 105 +)
• very high bp-stroke category (about 210/180)
• sever tachycardia
• delirious
• can cause brain damage

Question 9

tx for thyroid storm

Answer 9

• ice pack (first)
• cooling blanket (best)
• 02 per mask @ 10 L
• lower bp: beta blockers, ccb, dilators (nitro)
• 2 staff pt

Question 10

post op risks of thyroidectomy

Answer 10

1. in the first 12 hours: top priority is airway for total and sub since thyroid is in neck
2. 2nd is hemorrhage since the endocrine gland has alot of blood vessels
3. 12-48 hours for total is tetany due to hypocalcemia, 12-48 Hours for sub is storm

*NEVER PICK INFECTION IN FIRST 72 HOURS

Question 11

hypothyroidism is also known as

Answer 11

• myexedema or hashimotos

Question 12

hypothyroidism

Answer 12

• low metabolism
• low and slow
• hashimotos

Question 13

s/s of hypothyroidism

Answer 13

• everything low, slow, and cool
• obese
• decreased temp
• hair loss
• decreased mood and libido
• decreased RR
• confusion
• constipation
• low infertility
• boring
• dull
• heat tolerance (ALWAYS COLD SO LIKE HEAT)
• cold intolerance (always cold so dont like the cold)
• pulse and BP low

Question 14

tx of hypothyroidism

Answer 14

• thyroid hormone synthroid (levothyroxine)
• do not sedate these people because they will go into myexedema coma since already kinda sedated
• never hold thyroid meds the day of a surgery

Question 15

myexedema coma

Answer 15

• life threatning
• resp. failure
• help breathe, trach kit at bedside, et set up at bedside

Question 16

Addison disease

Answer 16

• under secretion of adrenal cortex
• low steroid (need to add them= addisons)

Question 17

s/s of addison

Answer 17

• hyperpigmentation
• cannot adapt to stress: any added stress can kill client
• stress = shock (glucose and bp will go down)
• skinny steve: skinny, weak, frail, no hair, hyperkalemia, decreased everything except k+ (energy, bp, sugar), salt craving and sodium loss (hyponatremia)

Question 18

tx of addisons `

Answer 18

• steroids (“sones”)
• increase steroids when something adds stress
• monitor bp closely when in stress

Question 19

Cushing syndrome

Answer 19

• over secretions of adrenal cortex
• cushy = more tushy
• high steroids

Question 20

s/s of cushing

Answer 20

• big hairy weightlifter
• increased everything
• moonface
• bruises
• muscle atrophy (skinny arms and legs)
• high glucose (needs increased insulin especially if diabetic)
• striae
• buffalo hump
• loses k+ and retains na+ and h20
• central or truncal obesity
• gynecomastia
• hirsutism (excess hair)
• irritable
• immunosuppressed

Question 21

tx of cushing

Answer 21

• bilateral adrenalectomy (which can lead to addisons which means they have to take steroids which makes them seem like they have cushings all over again

Question 22

safety when it comes to kids and toys

Answer 22

1. no small toys for kids under 4
2. no metal/die-cast toys if 02 in use (sparks)
3. beware of fomites (teddy bear) because these no living objects can harbor microorganisms

Question 23

0-6 months toy

Answer 23

• musical mobile
• soft and large things
• sensorimotor stage `

Question 24

6-9 months toys

Answer 24

• teach object permanence (looks for the toy when you hide it)
• best option is “cover/uncover toys”
• second best is large plastic/wood/metal
• worst toy is musical mobile
• never pick answers with the words: build, sort, stack, make, construct, for a child under 9 months

Question 25

9-12 months toys

Answer 25

- learning to speak - speaking toys - talking books - purposeful activities (build, sort, stack, make, construct)

Question 26

toddlers (1-3) toys

Answer 26

- push/pull toys (stroller, doggie, wagon) - working on gross motor skills (running, jumping, do not choose answers with finger dexterity like cutting or using pencils or coloring) *not including finger painting* - parallel play- play alongside other kids but not with them

Question 27

preschoolers (3-5 years) toys

Answer 27

- finger dexterity/working on balance - tricycles, tumbling, class/dance class, coloring - cooperative play= play together (they like to pretend play) : everyone wins and gets some prize - imaginative thinkers

Question 28

school aged kids

Answer 28

- create, collect, competitive - they like games where there is a winner - legos

Question 29

adolescence

Answer 29

- hang out with friends (unless pt is fresh out of post op (<12 hours), contagious disease, or immunosuppressed

Question 30

laminectomy

Answer 30

- removal of vertebral spinal processes (winged ends of vertebrae) - relieves nerve root compression - the most important thing to pay attention to is location

Question 31

s/s of nerve root compression

Answer 31

- 3 p's - pain - paresthesia - paresis (muscular weakness)

Question 32

cervical

Answer 32

- neck - innervates the diaphragm and arms - pre op: airway and arms (and hands) - complications: pneumonia

Question 33

thoracic

Answer 33

- upper back - innervates abd. and gut muscles - pre op: cough/bowels (coughing using abdominal muscles)- can still breathe but cant cough - complications: pneumonia and paralytic ilieus

Question 34

lumbar

Answer 34

- lower back - innervates bladder and legs - pre op: bladder (distended? voided?) and legs - complication : urinary retention and leg problems

Question 35

anterior thoracic

Answer 35

- from the front thru the chest to the spine- will have chest tube

Question 36

laminectomy with fusion

Answer 36

- bone graft from iliac crest - 2 incisions (hip-most bleeding, most pain, and most drainage and spine- increased chance of rejection) - both have 50/50 chance of infection

Question 37

post op spinal #1 answer

Answer 37

- log roll - dont dangle pt legs - dont sit for longer than 30 minutes - they may walk, stand, lay down w/o restriction

Question 38

dc teaching for spinal

Answer 38

- 4 temporary restrictions: 6 weeks 1. dont sit for longer than 30 minutes 2. lie flat and log roll 3. no driving 4. do not lift more than 5 lbs (gallon of milk) -3 permanent restrictions: 1. never lift objects by bending at the waist 2. cervical lams not allowed to lift anything over head 3. no jerking, horse back riding, 6 flags