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ACVN - SURGICAL NURSING > Endocrinology - surgical patient management > Flashcards

Endocrinology - surgical patient management Flashcards

(44 cards)

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1
Q

what is the thyroid made up of?

A

▪ Paired bilobed gland
▪ Larynx
▪ Trachea
▪ Blood vessels
▪ Nerves
▪ Ectopic tissue

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2
Q

what are benign surgical conditions of the thyroid?

A
  • Adenoma
  • Adenomatous Hyperplasia
  • Cysts
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3
Q

what is a functional surgical condition??

A

producing throid hormones

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4
Q

what type of mass are benign masses in cats?

A

functional

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5
Q

which masses are typically non-functional?

A

benign masses in dogs

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6
Q

what can functionalthyroid masses in cats cause?

A

hyperthyroidism

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7
Q

what malignant neoplasia can occur in the thyroid?

A
  • Carcinoma
  • Adenocarcinoma
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8
Q

what pre-operative thryoidectomy considerations are there of the cat?

A

*ASA status
* Systemic effects of hyperthyroidism
* Body condition score - weight loss, muscle loss
* Metastasis?
* Cardiovascular - tachycardia, hypertension
* Renal - pre-renal azotaemia
* Ocular - retinal detachment
* Co-morbidities unrelated to hyperthyroidism - CV, renal, increased anaesthetic risk, cachexia, arthritis
* Medical stabilisation
* Complications

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9
Q

what are the pre-operative considerations for thyroidectomy in the dog?

A
  • Far fewer systemic effects as non-functional
  • Body condition score: may be reduced due to effects of the cancer
  • Metastasis? Hopefully we’ve ruled this out pre-op
  • Up to 40% dogs have mets at presentation
  • Co-morbidities often present as typically older animals
    *Medical stabilisation
  • Pre-op not needed as non-functional
  • Post-op requirement will depend on surgery e.g. unilateral vs bilateral
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10
Q

how should you prep for a thyroidectomy?

A
  • Wide ventral neck clip and from level of jaw to thoracic inlet
  • Patient position in dorsal recumbency with sandbag etc under neck to elevate.
  • Keep neck straight
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11
Q

what are complications that can arise form a thyroidectomy?

A
  • Haemorrhage
  • Seroma formation
  • Laryngeal paralysis
  • Horners
  • Hypocalcaemia
  • Recurrence
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12
Q

what pre-emptive peri-operative support can you provide during thyroidectomy?

A

vpre-op vitamin d or post-op oral calcium

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13
Q

what does parathyroid hormone do?

A

increase blood calcium

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14
Q

how many parathyroid glands are there and what are they?

A

4
* Left extracapsular (cranial)
* Right extracapsular
* Left intracapsular (caudal)
* Right intracapsular

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15
Q

what medical treatment can be done for primary hyperthyroidism?

A

▪ Ethanol injection
▪ Heat ablation

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16
Q

what surgical treatment can you do for primary hyperthyroidism?

A

parathyroidectomy

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17
Q

what post-operative treatment can you do for primary hyperthyroidism?

A

monitor for hypoglycaemmia

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18
Q

what pre-operative considerations are there for parathyroidectomy?

Study These Flashcards
A

*Systemic effects
* Hypercalcaemia
* Affects renal function
* Co-morbidities as typically older animals
Medical stabilisation to improve ASA status
* Diuresis with high levels of IVFT to ‘dilute’ the calcium?
* Support renal function

19
Q

what are the complciations of parathyroidectomy?

Study These Flashcards
A
  • Haemorrhage
  • Seroma formation - depends on size of mass
  • Laryngeal paralysis
  • Horners
  • Hypocalcaemia
    *hypothyroidism
20
Q

what post-op care would you provide after a parathyroidectomy?

Study These Flashcards
A

*IVFT
* Standard care according to clinical appearance and losses
Analgesia
* Avoid NSAIDs
Monitor for complications
* Renal function
* Calcium => More shortly
Prognosis
* Usually good
* Hypocalcaemia can be transient (days) , or can take weeks / months to recover

21
Q

what are the clinical signs associated with iatrogenic hypoparathyroidisms?

Study These Flashcards
A
  • Initially
  • Inappetence
  • Weakness / Lethargy
  • Ptyalism
  • Pawing at face
  • More advanced
  • Tremors
  • Tetany
  • Seizures, coma and death
22
Q

how can you monitor for hypoglycaemia after parathyroidectomy?

Study These Flashcards
A
  • Vitamin D
  • Monitor blood calcium
  • Monitor clinical signs
  • Calcium administration
23
Q

how would you treat hypoglycaemia after parathyroidectomy?

Study These Flashcards
A
  • oral Vitamin D which takes 24-48hrs to effect
  • Oral calcium - home with patient
  • Intravenous 10% calcium gluconate
24
Q

what should you monitor after giving Intravenous 10% calcium gluconate slowly (10-20 mins)?

Study These Flashcards
A

*Monitor with an ECG for arrhythmia and bradycardia
* Initial bolus followed by constant rate intravenous infusion
* Avoid bicarbonate, lactate or phosphate containing fluids → precipitate calcium

25
what common pancreatic conditions are there?
diabetes and pancreatitis
26
what are more uncommon pancreatic conditions?
insulinoma, exocrine pancreatic neoplasia, pancreatic abscessation and pancreatic cysts
27
what are the clinical signs of insulinoma?
lethargy, tremors, seizures, collapse, peripheral neuropathy due to hypoglycaemia
28
what pre-oeprative management can you do for insulinoma?
- feed every 4-6hrs - diabetic diet - pre-op starvation? - gentle regular exercise - manage hypoglycaemia
29
what should you do if a aptient is having a hypoglycaemic crisis?
- give oral glucose or anything sugary - one off IV glucose 0.5-1mL/kg of 50% dextrose diluted - glucose infusion 2.5% solution
30
what post op management can you do for insulinoma?
- feeding +/- feeding tube - manage hypoglycaemia - exercise plan - drugs (analgesia, steroids, octreotide, chemo
31
what complications can arise after insulinoma surgery?
* Persistence of hypoglycaemia * Transient Hyperglycaemia * Pancreatitis * Can develop Diabetes Mellitus
32
what is internal adrenal anatomy?
outer cortex and inner medulla
33
what types of adrenal masses are there?
benign/malignant masses and primary or secondary tumours
34
what secondaryadrenal gland conditions are there?
adrenal enlargement (pituitary)
35
if there are no clinical signs with adrenal gland disease what is this?
incidentaloma
36
what functional clincial signs are there of adrenal gland disease?
- overproduction from cortex *Cushing's, conns syndrome, mineralcortoicoid, glucocorticoid, masculinising sydrome, androgen - overproduction from the medulla production from medulla * Phaeochromocytoma / Catecholamines e.g. Norepinephrine and/or Epinephrine => intermittent hypertension
37
what are benign adrenal glands enlargements usually?
adenomas
38
what are malignant adrenal gland enlargements?
adenocarcinoma
39
what can phaeochromactomas be?
malignant or benign
40
what systemic effects are there from adrenalectomy?
*Conns Syndrome => hypokalaemia * Cushings Syndrome => endogenous steroid => poor surgical candidate * Phaeochromocytoma => excess adrenaline/noradrenaline => unstable patient
41
what can you do to stabilise a patient to improve ASA status?
*Manage potassium => Potassium supplementation * Stabilise with medication e.g. Trilostane * Phaeo – stabilise with medication e.g. Phenoxybenzamine for 2-3 weeks pre-op (alpha adrenergic blocker)
42
how can you manage a patient post-operatively after adrenalectomy?
- cardiovascular function (ECGs and blood pressure) - electrolytes
43
what post op complications can occur after arenalectomy?
* Electrolyte abnormalities * Hypertension / Hypotension * Adrenal insufficiency requiring supplementation like an iatrogenic Addisons > mineralocorticoids and glucocorticoids * Delayed healing * Pulmonary thromboembolism
44
what intra-operative complications can occur during adrenalectomy?
*Tumour rupture * Haemorrhage * Tachycardia / cardiac arrhythmias * May need drugs to stabilise e.g. propranolol / lignocaine * Hypertension / Hypotension * May need supplementation of gluco- and mineralo-corticoids during surgery (Dexamethasone and Electrolytes (sodium and potassium))

ACVN - SURGICAL NURSING (17 decks)

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