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Med surg 2 > Exam 2 ch44 &45 > Flashcards

Exam 2 ch44 &45 Flashcards

1
Q

Know in acromegaly, what the purpose of the “glucose-tolerance test” is, what is measures. (pg 1000)

A

Growth Hormone concentration

-unchanged in acromegaly

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2
Q

What is acromegaly?

A

excessive growth (in width) b/c of excessive GH (hyper-pituitary)

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3
Q

Know what the post operative teaching is for a pt., scheduled for transphenoidal hypophysectomy. (pg. 1005)

A

Avoid strenuous things

-sneezing

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4
Q

What is transphenoidal hypophysectomy?

A

removal of pituitary gland

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5
Q

Know excess of what, causes the Large flattened features of the pt. with acromegaly. (pg. 998)

A

GH- Growth hormone

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6
Q

Know the classic s/s of diabetes insipidus (pg. 1008)

A

Massive diuresis, dehydration, thirst

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7
Q

Know why a pt. w/ “Addison Disease” must take hydrocortisone. (pg. 1017)

A

Regulate K+ and Na+ excretion

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8
Q

Know what nephrogenic DI is and how it differs from neurogenic DI (pg. 1007)

A

Nephro:
-Doesn’t respond to ADH, and is inherited

Neuro:
-defect in neither the production or secretion of ADH exisits

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9
Q

Know why a pt. w/ Addison disease would have disturbed body image related to the color of their skin. (pg. 1014 box 44-2)

A

Hyperpigmentation; Smokey/ bronze color

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10
Q

Know what a “cardinal indication: of pheochromocytoma is. (pg. 1023)

A

Diastolic B/P of 115 or higher

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11
Q

What is pheochromocytoma?

A

Tumor in adrenal glands

  • usually benign
  • excessive catecholamine’s = fight or flight
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12
Q

Know what the s/s of “Adrenal Crisis” are, when caring for a pt. w/ Addison’s disease. (Pg. 1014) ON BOARDS

A

“Addisonians Crisis” = life-threatening

  • decreased available adrenal hormones
  • mineralocorticoid & glucocorticoid
  • HTN, tachycardia, confusion, hyperkalemia, glycaemia
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13
Q

Know what the purpose of the lab test is, to measure the serum level of adrenocorticotropic hormone (ACTH.) is (pg.998)

A

Good indication that pituitary gland is sending the right signals to adrenal glands to release ACTH

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14
Q

Where does ACTH come from?

A

Adrenal glands

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15
Q

Know what would be included in the discharge plan for a pt. W/ Addison’s disease related to “ Risk for injury” (pg. 1019)

A

Call for help, rise slowly -dizziness

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16
Q

Know why a pt. In adrenal crisis, after receiving the initial dose of IV Solu Cortef, would need to continue IV Solu Cortef (pg. 1015)

A

To maintain level in blood

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17
Q

Know what a nurse would include in a teaching plan w/ a pt. Who has Addison’s Disease. (Pg. 1018)

A

Wear emergency ID

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18
Q

Know what medication would cause a long term asthma pt. To develop “Cushing Syndrome” (pg. 1019)

A

Corticosteroid agents

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19
Q

Know what the “hallmark findings” are expected when assessing a pt. W/ Cushing Syndrome (pg. 1020)

A

Moon face, truncal obesity, protein-wasting, purple striae

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20
Q

Know the instructions the nurse would give a pt. W/ Cushing syndrome for self care (pg 1021)

A

Avoid people W/ infections

-Decreased immune system

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21
Q

Know what a nurse would anticipate when assessing a pt. W/ Simmonds Cachexia, related to hypopituitarism (pg 1006)

A

Muscle & organ wasting

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22
Q

In documenting a care plan for a 10 year old boy w/ hyperpituitarism, what would the nurse tell the pt. Related to “disturbed self image”
(-giantinism)

A

He’s going to grow tall

-ask him what his concerns are

23
Q

Know what the nursing care for a pt. Is, who had a hypophysectomy, in which the whole pituitary was removed. (Post-op) (pg.1004)

A
  • hormone replacement for life
  • strict doc of I&Os
  • inspect nasal dressing for drainage
  • assess for infection
  • check for meningitis (bend head and foot toward trunk.
24
Q

Know what causes are for Addisonian crisis (pg 1014)

A

Stress, adrenal surgery, pituitary destruction, abrupt Interruption of steroid therapy, stressors (emotional, trama, psychiatric disturbances)

25
Q

Know what discharge planning for the pt. Who underwent a hypophysectomy if focused on (pg 1005)
(Self care)

A

Avoid straining (cough, sneeze, vomiting)
Heavy lifting,
Constipation,
Follow up care important

26
Q

Know what nursing responses would be best for the pts family and the pt., if the pt. Has giantism (pg 998)

A

Ask them about their concerns; try to get them to have acceptance
“What is it about his height that bothers you?”

27
Q

For a pt. W/ hypopituitarism who must take medications for the rest of their life, know what the teaching plan would include (pg 1007)

A

Continue prescribed drug therapy, keep Dr apts, have rest periods for fatigue, wear medical ID,
notify Dr if there’s an increase in urine output, thirst, weight, malaise, weakness

28
Q

Be familiar w/ the drug “Sandostatin” and what it is used for and how it works (pg1000)

A

Acromegaly

-surpresses GH (won’t reverse)

29
Q

If a pt. C/o headache and nuchal rigidity after a hypophysectomy, based on these assessments what should the nurse do? (Pg 1005)

A 
Menegial irritation (meningitis)
Report to physician or head nurse.
30
Q

If a physician orders a T3 and T4, what levels of these tests would indicate hypothyroidism? (Pg 1027)

A

Hypothyroid= decrease T3 & T4

31
Q

If a pt. Starts taking potassium iodide SSKI, know what the nurse should instruct the pt. To do. (Pg1030)

A

Drink through a straw to prevent staining teeth

32
Q

If a pt. W/ hyperthyroid, cannot get to sleep, know what the nurse should suggest (pg1031)

A

Encourage bed time rituals

33
Q

Know what significant instructions to give a pt. Who is post thyroid scan (pg1027,1231)

A

Wash hands w/ soap and water after voiding for 24hrs post scan BC of radioactive solution.

34
Q

If a pt. Had a lab test that showed a high level of thyroid stimulating hormone (TSH) and low level of T4, know what that would indicate (pg 1025/1035)

A

Hypothyroidism

35
Q

Know what “exophthaloms” is and when it goes away

A

Bulging eyes- will go away w/ medication treatment

36
Q

Know the pathophysiology (cause of Dx) of Graves Disease and how to explain that to a pt. (Pg1028)

A

?what’s going on abnormally increased synthesis and secretion of thyroid hormones

37
Q

If a pt. Was 1 day post op after subtotal thyroidectomy and noted the pts color was poor, pulse and respirations were rapid and the pt feels warm to the touch. Know what the nurses initial implementation would be. (Pg1028)

A

Call Dr or head nurse

38
Q

If a pt had been given the drug “propythiouracil” know what nursing implementations should be included (pg1030)

A

Monitor for bleeding, weight gain, fatigue, avoid use when pregnant

39
Q

Know what an appropriate nursing diagnosis is for a pt recently diagnosed w/ hyperthyroidism would be (pg1031)

A

Disturbed sleep pattern, etc

40
Q

If a newly diagnosed pt w/ hypothyroidism begins a drug regimen, know what the nurses instructions should be given relative to hormone replacement

A

Can flip to hyperthyroidism

41
Q

Know pre surgical teachings includes for a pt. Scheduled for subtotal thyroidectomy (pg1032)

A

how to avoid straining the neck, support the head/neck during position changes. Encourage cough and deep breathing.

42
Q

After a pt undergoes thyroidectomy know what explanation you would give the pt for the tracheostomy tray on the bed side

A

Airway can close= larengalspasm

43
Q

Know how a nurse should assess for hemorrhage in post thyroidectomy pt (pg1033)

A

Check back of neck for seeping (pt usually in high fowlers to prevent swelling)

44
Q

Know how foods such as soybeans, turnips, and rutabagas can have an effect on persons w/ a thyroid disorder (pg1035)

A

Suppress TH effect

45
Q

Know why an older persons daily dose of thyroid hormone taken for many years might need to be reduced

A

Metabolism rate slows down

46
Q

A pt who is 2 days pot op total thyroidectomy has a carpopedal spasm of the hand. Know why this would occur and what the spasm is called

A

Trousseaus sign (b/p cuff) hypocalcemia

47
Q

Know how the nurse would address the nursing diagnosis of “risk for impaired skin integrity, related to dry skin” In a pt w/ hypothyroidism. What intervention would the nurse provide

A

Lotion/creams, reduce frequency of bath

48
Q

Know how the nurse initiates “chvostek sign” and what it indicates

A

Tap on facial nerve. Watch for spasm

-hypocalcemia

49
Q

Know what a pt with hyperparathyroidism would exhibit in their history

A

Renal stones, impaired urinary elimination

50
Q

If a pt who has hyper parathyroid is and is to receive the drug Calcitonin (Calcimar) know what the pt should b tested for before receiving this drug

A

Sensitivity

51
Q

Know what an appropriate nursing diagnosis for a pt with hyper parathyroid is m would be HINT related to urinary elimination

A

Impaired urinary elimination related to renal calculi

52
Q

If a pt with hypo parathyroid I am c/o fatigue and lack of energy know what the nurse should be aware of

A

Hypocalcemia

-cardiac dysrythmia, decrease cardiac output

53
Q

Know nurse should recommend the use of salt that is iodized

A

To prevent goiter and cretinism ( infants)

54
Q

Know how a pt with hypothyroidism can live a full and normal life, related to the pts medication

A

Life long hormone replacements (synthroid/ levothyroxine/cytomel)

Med surg 2 (5 decks)

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