Exam 3 Flashcards
SIADH
Increased ADH, increased water
Fluid OVERLOAD
SIADH S/S
Weight gain w/o peripheral edema
Hypertensive, tachycardia
Change in loc, SEIZURE risk
Concentrated, amber urine
SIADH Labs
Hyponatremia
High urine specific gravity
SIADH nursing interventions
Daily weight, strict I/O’s, VS
Fluid restriction
Safety- Seizure and fall precautions
SIADH medical management
Demeclocycline
Diuretics (watch for low k)
Sodium replacement (PO or IV)
DI
Decreased ADH, decreased water
Fluid loss
DI S/S
Polydipsia, Polyuria
Dehydration
Hypotensive
Diluted, clear urine
DI labs
Hypernatremia
Low urine specific gravity
DI nursing interventions
Daily weights, strict I/O’s, VS
Restrict foods that DIURESE (watermelon, grapes, caffeine)
Safety - fall precautions, postural hypotension
DI medical management
DDAVP:
- synthetic vasopressin
- does NOT raise BP
- monitor i/o, vs, weight, electrolytes
- water intoxication
HYPERthyroid
Increased T3 and T4, decreased TSH
HYPERthyroid S/S
Increased metabolic rate
Increased HR, BP, temp
Weight loss, diarrhea
Restless, insomnia
Heat intolerance, diaphoresis
May have goiter, exophthalmos
HYPERthyroid nursing interventions
Avoid spicy, high fiber foods
Eat 4000-5000 cals a day
Avoid caffeine and nicotine
Eye protection for exophthalmos
Cool, calm environment
Thyrotoxicosis
THYROID STORM
HYPERthyroid
Thyrotoxicosis S/S
Elevated temp
Increased HR, systolic HTN
N/V/D
Agitation, tremors, confusion
Thyrotoxicosis medical management
Anti thyroid meds (PTU or meth)
Radioactive iodine therapy
Thyroidectomy
Thyrotoxicosis nursing interventions
BETA BLOCKER to stabilize CV fxn.
Oxygen, IVF
Anti thyroid meds
Treat hyperthermia
calm environment
HYPOthyroid
Decreased T3 and T4, increased TSH
HYPOthyroid S/S
Decreased metabolic rate
Decreased HR
Weight gain, constipation
Lethargy, fatigue
Cold intolerance
Dry skin/hair
May have goiter
HYPOthyroid nursing interventions
Take meds on empty stomach
Low cal, low fat diet
More fiber in diet
Avoid sedatives and opioids
Myxedema
HYPOthyroid, opposite of thyroid storm
Myxedema S/S
Decreased HR, BP, Temp
Hypoventilation
Hypoglycemia
Hyponatremia
Generalized edema
HYPOthyroid management
Thyroid hormone replacement (LEVOthyroxine)
Nutrition therapy to promote weight loss
Pt ed
Myxedema management
Respiratory and CV support
LEVOthyroxine IV
IVF, glucose
Keep pt warm
VS hourly, monitor for change in LOC
HYPERPARAthyroid
Increased Ca+ & PTH
Decreased phosphorus
HYPERPARAthyroid S/S
Increased BP, dysrhythmias
Bone pain, fractures, weakness
Kidney stones
Absent reflexes, poor coordination
N/V, constipation
Depression, irritability, psychosis
Mnemonic for HYPERPARAthyroid
WEAK
Weak muscles
EKG changes
Absent reflexes
Kidney stones
HYPERPARAthyroid nursing interventions
EKG for dysrhythmias
Exercise
Biphosphonates — sit upright for 30 mins and take 30 mins before breakfast
Post op — monitor for respiratory distress, hemorrhage; no straining, elevate HOB (ICP), hypocalcemic crisis
HYPERPARAthyroid medical management
MILD
- Increase fluids
- increase weight bearing exercise
SEVERE
- IVF, diuretics, biphosphonates, calcimimetics
- surgery — parathyroidectomy
HYPOPARAthyroid
Decreased Ca+ & PTH
increased phosphorus
HYPOPARAthyroid S/S
Decreased BP, dysrhythmias
Bronchospasm, laryngeal spasm
Abdominal cramps, Dysphagia
Hyperreflexia, muscle cramps
Tetany, seizures
+ chvostek and trousseaus
Mnemonic for HYPOPARAthyroid
CATS
Convulsions, chvostek
Arrhythmias
Tetany, trousseaus
Spasm + stridor
HYPOPARAthyroid nursing interventions
EKG for dysrhythmias
Seizure precautions
High calcium foods (dark green veggies, dairy, tofu)
Avoid oxalic acid foods (spinach, rhubarb)
HYPOPARAthyroid medical management
IV Ca gluconate
PO calcium supplements
Vitamin D
Cushings labs
Increased cortisol, glucose, sodium
Decreased potassium
Cushing S/S
Truncal obesity
Moon face and buffalo hump
HTN
Osteoporosis
Cushing nursing interventions
VS, daily weight, glucose checks
Emotional support
Risk of infection
Diet — decreased Na+ and increased K+, protein, Ca+
Cushings medical management
DECREASE steroid dose SLOW
Surgery — adrenalectomy
- requires lifelong glucocorticoid placement
-pre/post op teaching
Addisons labs
Decreased cortisol, aldosterone, glucose and sodium
Increased potassium
Addisons S/S
Hypotension
Hypovolemia
Hypoglycemic
Bronzed pigmentation
Anorexia
Addisons nursing interventions
VS, daily weight, I/O
Calm environment
Watch for s/s of Cushing’s and infection
Hormone replacement therapy — lifelong
Addisons medical management
Hydrocortisone
-gluco and mineralcorticoid
- 2/3 in morning and 1/3 in afternoon
Fludrocortisone
-mineral corticoid
-take w food in morning
-women need androgens
-stress dosing education
