Exam 6- Pain/ endocrine - LAST Flashcards
1
Q
pain
what expiernece
associated w
A
unpleasant expeirence
associated with actual or potential tissue damage
2
Q
Pain
whatever
what they
A
Whatever the experiencing person says it is, existing whenever he/she say it does
.
What they say is most reliable indicator of pain
3
Q
Is pain bad- yes and no-
also need to assess if
A
pain is body defense mechanism that tells you that something is wrong
Also need to assess if its expected or not- if not expected then it’s a problem
4
Q
Acute pain
chronic pain
can
A
Acute Pain -short term-decrease with normal healing –like surgery/scraping knee
Chronic Pain- result of medical condition-over long period of time
Can experience both at once
5
Q
Neuropathic pain
caused by
s/s
A
caused by abnormal processing of sensory input by nervous system (brain/spinal cord)
Burning, Sharp, Shooting
6
Q
Neuropathic pain- central
where is it/what types of pain
A
brain and spinal cord
like epilepsy , Parkinson’s, stroke
7
Q
Neuropathic pain- peripheral
what is it/ what types of pain
A
all other nerves
like diabetic neuropathy, carpal tunnel, phantom limb pain
8
Q
how do you treat neuropathic pain
central
peripheral
A
c- patches and opioids
p- adjuvant alnalgesics
9
Q
Nociceptive pain
damage
s/s
A
damage to tissues
aching, cramping, throbbing
10
Q
Nociceptive pain- somatic
where is it/ what types
A
skin
broken bones, arthritis, fractures
11
Q
Nociceptive pain- visceral
what is it/ what types
A
organ pain
like appendicitis, gall bladder and kidneys
12
Q
how do you treat nociceptive pain
somatic-
visceral-
A
s-acetaminophen, nsaids, opioids. ice/heat, topical, patches
v-opiods
13
Q
Mixed pain syndrome
x2
what is it
A
fibromyalgia, myofiscal pain-
both are going on and don’t know cuase
14
Q
A and p for nociceptive pain-
transduction
transmission
perception
modulation
A
1-damage to cells, releasing chemicals
2-action potential continues from site of injury into spinal cord into. brain
3- how brain expeiercnes pain
4-neurons will go back to spine inhibit nociceptive impulses
15
Q
neuropathic pain patho
has what
carries where
dermatomes-
A
Have nerve fibers that enter spinal cord-
carries it directly into central nervous system
Dermatomes- areas of skin that are innervated by a single spinal cord segment
16
Q
Assess pain first->
figures out
can tell
help figure out
A
Figures out what type of pain
Can tell if intervention worked or not
help Figure out what may be causing pain
17
Q
Other things to consider: pain
consider
evaluate
conduct
A
Consider patient condition or exposure to painful procedures
Evaluate psychological indicators-(anxiety /coping/ image issues)
Conduct an analgesic trial
18
Q
O
L
D
C
A
R
T
A
onset
location
duration
characteristics
aggravating factors
radiation
treatment
19
Q
P
Q
R
S
t
A
provoked
quality
region/ radiation
severity
timing
20
Q
objective assessment for pain
Behavior- why
VS- why
stability-why
lifestyle-what
A
Behavior- do they look in pain-facial expressions- change in adl/activity
Vital Signs-elevated w pain
Stability- can end up passing out if too much pain -loc
Lifestyle- what meds they use, smoking, alc use,
21
Q
when use Wong baker faces
A
children around school age
4 ish
22
Q
when use flacc
what is it
A
3 and under- infants or cannot identify smiles faces
Face
legs
activty
cry
consolability
23
Q
when use 0-10 numeric pain
A
pt needs to be able to comprehend the scale
24
Q
when give revised nonverbal pain scale
A
post op surgery before they are completely alert and orientated
25
pain thermometer
how does it work
The patient is asked to circle words next to the thermometeror to mark the area on the thermometer to indicate the intensity of pain.
26
Verbal manifestations of pain
telling
m
change
c
s
telling you they are in pain
moaning
change in mood
crying
screaming
27
nonverbal manifestations of pain- compare to baseline
G
r
diffculty
altered
elevated
s
what body
altered
eyes
t
c
teeth
t
Grimacing
Restlessness
Difficulty Sleeping
Altered Body Movement
Elevated Vital Signs
Sweating
Tense Body
Altered Gait
Squinting of eyes
Tears
Combative
Grinding Teeth
Thrashing
28
what is referred pain
pain felt at sight other then where cause is
29
lung and diaphragm
where is referred pain
base of neck
30
heart x2
where is referred pain
on mouth
down left arm
31
liver
x3
where is referred pain
right side of neck
sternum
right spot on middle back
32
gallbladder
where is referred pain
right shoulder
33
stomach
where is referred pain
middle of back(front and back)
34
ovaries
where is referred pain
by belly button on front and back
35
appendix
where is referred pain
RLQ pain
36
kidneys
where is referred pain
on back by kidneys
37
ureters
where is referred pain
whole groin region
38
bladder
where is referred pain
on butt crack
39
Battle between subjective and objective
do what
and also do what
Make sure to document difference between subjective and objective data if there is- (like 10/10 pain but is sleeping or 0/10 pain but elevated vs)
And provide interventions- doesn’t have to be meds- like calm music or speech
40
phantom pain-real
what type
may need to
neuropathic pain-
may have to treat w pain meds/psychosocial meds
41
Breakthrough pain
what is it
want to use what
exasperation of pain in a patient that has adequately controlled baseline pain
Want to use fast acting analegesic like morphine, oxycode, hydrmoprhone, fetnyal
42
Breakthrough pain
reassessment when
then when
Conduct pain reassessment 30 mins to hr after
then reassess as needed
43
Breakthrough pain Challenges
x2
make sure to
- cognitive level, cultural differnces,
Make sure to get whole assessment
44
Complications of unrelieved pain
Cardiovascular instability
Respiratory dysfunction
Gu disturbances
Decreased gi mobility
Metabolic imbalance
Developmental issues
Prolonged stress
Reduced immune system
45
Medical Plan of Care:
p
modalities
therapties
s
Collaborative Management
Pharmacological Interventions
Mind Body Based Modalities
Biologically Based Therapies
Surgery
46
Interdisciplinary:
p
a
s
p
Collaborative Management
Pharmacist
Anesthesia
Social Work
Physical Therapy
47
Nursing Interventions:
what is huge
use what
should not
Collaborative Management
Assessment is huge
Use multiple methods-
should not make pain worse
48
Mind based therapies
r
g I
m
m t
p
p t
a
other
Relaxation-
Guided imagery
Meditation
Music therapy
Prayer
Pet Therapy
Aromatherapy
Other distraction therapies
49
Massage-
what after
do not do what
Body based therapies
- fluids after dt protein release-
do not massage in area if suspected DVT or clots or bleeding
50
Positioning and body alignment-
do what
Body based therapies
get patient off of what hurts them-
51
Splinting
assess what
teach what
Body based therapies
- asses damage under splint-
teach about care of splint
52
Acupuncture
assess what after
Body based therapies
- asses for unexplained pain after
53
Hot/Cold –
what time
Body based therapies
timing- don’t leave on for too long-20 mins or less
54
Body based therapies
t p
e
Trigger Point
Exercise
55
pts needs what if using heat/ice
pts needs to be able to feel- dont use in neuropathy
56
dont use heat in
dont use heat in bleeding/ injury
57
dont use cold therapy in x2
open wounds
put on bare skins
58
Cognitive-Behavior Treatment-
do what
Psychological Therapies
thoughts create feelings
feelings create behavior
behavior reinforces thoughts
need to think better
59
Biofeedback
monitor for
connected to
how does it work
Psychological Therapies
- monitor for sweating, grimacing, dizziness-
connected to sensors-
will realize cell changes and relax certain muscles based on changes
60
Hypnosis
do what when its happening
Psychological Therapies
– make sure patient is safe and monitor during treatment
61
Tens
how does it work
what theory
Psychological Therapies
- provides little electrical pulses that control and lessen pain-
gate control theory
62
what types
waht interventions- provide/ check w
Biologically Based Interventions
herbs, vitamins, reiki, tai chi,
Nursing Interventions: provide resources
, check with pharmacy for drug compatibilities.
63
Spinal Cord Stimulators-
what is it
how does it work
Surgery- medical plan of care
implant with low electrical current-
will block sensation of pain
64
Rhizotomy
what does it do
Surgery- medical plan of care
-sever the nerve roots at spinal cord
65
Neurectomy
does what
Surgery- medical plan of care
- resect the nerves
66
Nerve Decompression-
does what
to do what
Surgery- medical plan of care
remove ligaments , Cartlidge or bone
give room for nerve
67
Joint Replacement/ Tissue, Muscle, Organ Removal -
why
Surgery- medical plan of care
- – if pain is too terrible
68
Nursing Interventions:
do
is
any
Surgery- medical plan of care
do they have pain,
is pain different then before
, any mobility or neurological complications
69
levels of spinal nerves- how many-
cervical
thoracic
lumbar
each controls where its located at
cervical-8
thoracic-12
lumbar-5
70
things to consider before med administration
se
sa
pain
se
t
with
Severity of pain
Safety- are they awake, bleeding, vs stable
Pain prior to admintration
Setting
Type
take With food or not
71
non opioid analgesics - meds
main one
acetaminophen
72
nonselective nsaids-
I
n
k
non opioid analgesics - meds
ibuprofen
, ketorolac,
naproxen
73
cox-2 selective nsaid-
non opioid analgesics - meds
celecoxib
74
Non opiod-
used why
nsaid cause what
acetaminophen works where
used for mild pain
Nsaids may cause bleeding
Acetminophen works on liver
75
opioid analgesics- meds
m
f
h
o
morphine
fentanyl
hydromorphone
oxycodone
76
opioid analgesics
are they
what type of pain
Are they safe respiratory or cardiac wise
Used for acute pain
77
local anesthetics
b
r
L
adjuvant analgesics
bupivacine
ropivacacine
lidocaine
78
anticonvulsants
g
p
adjuvant analgesics
gabapentin
pregabalin
79
antidepressants
d
n
d
adjuvant analgesics
desipramine
nortiplyline
duloxetine
80
opioids- storng pain
o
p
p
o
oxycodone
percadoen
Percocet
oxycontin
81
opioids mild to moderate
h
L
v
v
c
t /c
hydrocadone
lortab
Vicodin
vicoprofin
codeine
tylonel w codeine
82
aspirin
anti x4
,i
p
p
p a
anti inflammatory
anti pain
anti pyretic
anti platlet aggregation
83
NSAIDS
a
anti
anti
analgesic
anti inflammatory
antipyretic
84
NSAIDS
what distress
d
r
h
gi distress
dizziness
rash
heartburn
85
pasero opined induced sedation scale
s
1
2
3
4
s- sleep and easy to arouse
1-awake and alert
2- slightly drowsy
3- frequently drowsy
4- no response
86
DOs with transdermal meds
clean
remove
docuement
place
clean area of old patch
remove old patch
document place date adntime
place over dry skin
87
DONT with transdermal med admisntration
place over
do not
place
place over dense hair
do not shave hair
place heat over
88
PCA
basal rate
dose
lockout
Basal Rate- continuous amount that is given- no matter if patient hits button or not
Dose- amount when they hit button
Lockout- prevents them from getting a dose every time they hit the button
89
Nursing interventions for PCA
r-
what compatibility
how many
monitor x3
Respiratory-oxygen, carbon dioxide and rr
Iv compatibility
How many times are they hitting it
Monitor- Hypotension, dizziness, loc
90
Epidural
Cath where
binds to what
works where
Catheter placed in the epidural space
It binds to nerve roots where they enter and exit the spinal cord
Sympathetic nervous system
91
Epidural
low concentration-
high concetration-
Low concentration- sensory is blocked but motor is intact
High concentration -both are blocked
92
Epidural
monitor
lay
how position during insertion
Monitor client
Lay still during procedure
Hunched over, neck down position during insertion
93
Epidural after insertion
check for
what 2 vs
what's needed
make sure
checking for sensation(hot cold) and movement,
hypotensive and low rr
Bedrest is needed
Make sure dressing is intact and secure
94
Spinal epidural
Cath wehere
what blockage
Catheter placed in the cerebrospinal fluid
Autonomic, Sensory, and Motor Blockage
95
Nursing interventions- spinal epidural
know what
monitor
monitor for
Know level of spinal
Monitor headache
Monitor for cerebral spinal leak
96
spinal epidural
put on
what in place
dont place
Can be on fluids to decrease hypotension
May need cath in place
Do not place head down
97
If small hole happens during spinal epidural-blood patch-
draw from
pt lay where
iv where
draw how much
inject where
Will draw from patients blood
Patient will lay on side with legs flexed and knees drawn up to chest
Iv is placed in upper extremity
Draw 5-20 ml of blood
Inject the blood where they think spinal hole is located
98
injections
steroids why
nerve blocks why
monitor safety
steroids- nerve pain
nerve blocks-presurgery
monitor safety
99
opioid reversal
naloxone how- why need to constantly monitor
naltrexone how
naloxone iv- need to monitor because it has shorter half life and pt can reoverdose
naltrexone po
100
tolerance
need for what
rotate
Need for increased dose to maintain same degree of pain control
Rotate drug if tolerance develops, as increasing dose could contribute to hyperalgesia.
101
physical dependence
manifested by
to avoid withdrawal
manifested by withdrawals if you abruptly discontinue
to avoid withdrawal- taper down
102
Pseudo addiction
what behaviors
resolve when
when pt has behaviors that look like addiction
but resolve when treated pain
103
addiction
drive to
what is not indicator
use it despite
drive to take substances for other then therapeutic value
tolerance and dependance are not indicators of addiction
use it depsite risk of harm
104
s/s of opioid withdrawal
what pupils
L
what when coming off
pinpoint pupils
lethargic
jittery when coming off
105
opioid withdrawal s/s
cold
c
what symptoms
mood
pain
v
d
cold shakes
chills
fever like symptoms
mood swings
bone pain
vomiting
diarrhea
106
Pediatric- lifestyle considerations
limit
Limit pediatric pain as much as possible- limit anything that causes pain
107
School age-
involve
listen
might need
involve parent and child in plan of care-
listen to child needs-
might needs distraction
108
Adults
dealing w
- dealing with work, may not want to take off to get work
109
Geriatric
p
p
dont want
- polypharmacy-
pocketing of meds-
don’t want to kill organs
110
Hormones produced where
Hormones are produced and excreted by endocrine glands
111
what does water soluble hormones mean
what does lipid soluble hormones mean
Water soluble – travel in free form
Lipid soluble- need to bind to carriers to transport
112
Negative feedback-
does what
Maintaining Hormonal Balance
inhibit or secrete hormone- ability to stop buildup of too many hormones
113
Positive feedback-
Maintaining Hormonal Balance
increase levels
114
Biological rhythms-
like
Maintaining Hormonal Balance
like circadian rhythm
115
Central nervous system control
impacts what
Maintaining Hormonal Balance
- impact on our ongoing regulation
116
Primary Prevention-hormones
educate on:
d
e
manage
cycle
prevent
Diet
Exercise
Stress Management-huge
Sleep-Wake Cycle
Injury Prevention
117
Endorine- newborns are screen for x2
-routine congenital and thyroid
118
what are adults screened for endocrine
x2
Thyroid
Diabetes
119
Diagnostics in endocrine
x3
some scans need what
Ultrasound- of gland itself- see blood flow-
MRI
CT
Some scans may need radio isotopes
120
what labs in endocrine
what level
what testing
b
Hormone Level- (in blood urine or saliva)
Stimulation and suppression testing- (give a stim/supres targeted to release hormones)
Biopsy- (if cacner related or functionability)
121
subjective assessment endocrine
get a history of
f
I
d
Family- a lot are genetic
Injuries
Developmental- ?s, reproductive history, activity level, energy, nutrition, wt changes, appearance changes
122
endocrine assessment- objective
Vitals,
Height
Weight
General Inspection-any changes-skin color, facial characteristics , wounds, figures, etc
General Observation-moods, behavior changes, flat affect
,
Palpation-
Auscultation-over thyroid for bruit
123
consequences of impaired hormonal regulation
Alterations in growth and development
Alterations in cognition
Alterations in metabolism
Alterations in reproduction
Changes in growth
Altered adaptive responses
124
Surgical Interventions-endocrine
Hypophysectomy-what
Adrenalectomy-where
Thyroidectomy-where
Parathyroidectomy-where
Hypophysectomy-removal of pituitary
Adrenalectomy-on top of kidney
Thyroidectomy-on neck
Parathyroidectomy-on thyroid glands
125
ENDORCRINE Surgical Considerations
consider what
why
consider location-
if on neck then monitor airway
if on kidney then monitor kidney function
126
Hyperpitiutary- acromegaly
increase in what
increase in growth hormone
causes the patient to be really tall
127
Hyperpitiutary- acromegaly
s/s
slant
what jaw
enlarged
h
what problems
slanted forehead
protruding jaw
enlarged hands and feet
headache
vision problems
128
Hypopitiutary- dwarfism
caused by
what do they look like
caused by tumor
short in height, small feet, small features
129
Anterior Pituiatry (GH): Labs
x2
Thyroid Levels
Blood Sugar – dt insulin(elevated)
130
Hyperpitiutary- acromegaly meds
what Somatostatin Analogs
what GH Receptor Blockers
what dopamine agonists
Sandostatin- Somatostatin Analogs
Pegvisomant- GH Receptor Blockers
Bromocriptine/Cabergoline-Dopamine Agonists
131
Hyperpitiutary- acromegaly meds
give when
will not
just does what
give those prior to surgery-
will not reverse-
just will slow down further development
132
Hypopituitarism meds - dwarfism
what 3 somatropin
Omnitrope
Genotropin
Humatrope
133
Hypopituitarism meds -dwarfism
waht other 2
Testosterone
Estrogen
134
Hypopituitarism meds -dwarfism
watch for:
retention
m
pain
h
watch for for fluid retention
Malaysia,
joint pain
headache
135
Hyperpituitarism-acromegly
diet low in
monitor for
Medical Plan of Care: Diet
low in sugar
monitor for hyperglycemia
136
Hyperpituitarism-acromegly
increase in what
leads to what
Medical Plan of Care: Pain Management
increase in bone density
can lead to nerve pain
137
Hyperpituitarism- acromegly
Medical Plan of Care: Serial Photos
take what
to see
after
take pictures of different developmental stages in life
to se physical changes-
after surgery will not go back to normal size
138
Hypopituitarism- dwarfism
Medical Plan of Care: safety
Nursing Interventions: -
decrease in
watch for
what issues
decrease in bone density,
watch for falls
mobility issues
139
Hypopituitarism-dwarfism
Nursing Interventions: physical therapy
monitor what
help with
monitor therapy
help with device usage like crutches
140
Hypopituitarism-dwarfism
Medical Plan of Care: Diet
increase
increase Vit. D and Ca
141
SIADH-pituitary- (ADH)
does what w fluid
what to blood and electrolytes
what to urination
what changes
retains fluid
dilutes blood and electroltyes
decrease in urination
neurological changes
142
Diabetes Insipidus
what ADH
kidneys do what
what sodium
urine is what
decrease ADH
kindeys do not save water-waste
hypernatramia
urine is dilute
143
Pituitary (ADH): Labs
what level
what urine
sodium blood level
urine specific gravity
144
Hyper-SIADH meds
what ivf
waht antagonists
what diuretic
Hypertonic
vasopressin antagonsits- "vaptan"
furosemide
145
Hypo- DI meds
c
I
what iv fluid
Chlorpropamine-increases adh production
Indomethacin (NSAID)-increase renal resposivness
Isotonic then hypotonic iv fluid
146
Hypo- DI meds
replacement therapy
Desmopressin
Avasopressin
Vasopressin
147
SIADH
Medical Plan of Care: Diet
restrict what
I c
g
daily
fluid restrictions 800-1000 ml per day
ice chips
gums//
daily wt//
148
SIADH
Medical Plan of Care: Seizure precautions Nursing Interventions:
what on ned
what risk
check
pads on bed
fall risk
neuro checks
149
SIADH
no more then
Medical Plan of Care: HOB low
Nursing Interventions
no more then 10 degrees
150
DI
titrate
daily
Medical Plan of Care: Diet increase fluids
Nursing Interventions
: titrate fluid to urine output
daily wt
151
DI
what bed position
Medical Plan of Care: Trendelenburg
152
DI
also make sure to monitor what
appers what
Also monitor blood sugars-will appear high
153
Pituitary medical Plan of Care: Surgery
what surgery
what else
Hypophysectomy- best chance for cure
Stereotactic Radiosurgery- decrease size of tumor
154
Pituitary medical Plan of Care: Surgery
Pain
pain where
may mean what
check for what
headaches-
cerebrospinal fluid leak-
check for glucose
155
Pituitary medical Plan of Care: Surgery
bleeding where
epistasis -nose bleeding
156
Focused Area-
n
look for
how does It present
Pituitary medical Plan of Care: Surgery
neurological-
look for meningitis-
when look down pain goes down back
157
Pituitary medical Plan of Care: Surgery
Complications
h
changes
–hematoma- vision changes,
158
Potential Devices-
what dressing
e
Pituitary medical Plan of Care: Surgery
mustache dressing,
evd
159
Pituitary medical Plan of Care: Surgery
Main Nursing Care-
dont do what
avoid what
no what
HOB
do not blow nose for 24 hrs,
avoid straining coughing sneezing,
no vigourous toothbrushing for 10 days.
Hob elevated
160
what is purpose of thyroid
Purpose of thyroid is for metabolic consumption, energy
161
What causes thyroid problems
I
a
c
what dysfunction
inflammation,
autoimmune,
cancer,
gland dysfunction
162
Hyperthyroidism s/s
what inolerance
what bowels
what bp/vs
wt
e
t
what eyes
heat intolerance
hyperactive bowels
increase bp/vs
weight loss
edema
tremors
bulging eyes
163
Causes of Hyperthyroidism:
Graves’ Disease
most
what is it
Most common cause of hyperthyroidism
Autoimmune disorder-more common in women- causes thyroid to hyperfunction
164
Toxic Multinodular Goiter--Causes of hyperthyroidism
what is it
what is etiology
Thyroid tumor--small nodules that secrete excessive amounts of th
etiology-lack of iodine,
165
causes of hyperthyroidism
thyroidotis
what is it
causes
viral infection of thyroid glands
causing inflammaation and increased TH effects
166
Hypothyroidism s/s
what intolerance
e
what tongue
what bp/hr
what skin
what energy
what respiratory
what bowels
cold intolerance
edema
thick tongue
low bp/hr
dry skin
low energy
dyspnea/hoarnsess
constipation
167
what is goiter
what is exopthalamus
Goiter- enlarged tyroid gland- huge bulge in neck
Exopthalmus- bulging in eyes
168
Thyroid: Labs
x3
T3 Level
T4 Level - what we give when supplementing
TSH Level
169
Hyperthyroidism
Iodine-
only for what
how long before
not used
Thyroid Medical Plan of Care: Medications
only for surgery-
1-2 weeks before surgery-
not used to treat hyperthyroidism
170
Hyperthyroidism-Radioactive Iodine-
does what
how long does It take
can develop
Thyroid Medical Plan of Care: Medications
destroys thyroid tissue,
can take 3 months to work,
can develop hypothyroidism
171
Hyperthyroidism
what antithyroid meds x2
what heart med
Thyroid Medical Plan of Care: Medications
- main meds-blocks production
Propythiouracil (PTU)
Methimazole
Beta Blockers-cardio effects on heart
172
Hypothyroidism med-
Levothyroxine
is what
increase
monitor
take when
- synthetic hormone-
increase metabolism –
monitor for tachycardia- t
ake in morning
173
what surgery
Thyroid Medical Plan of Care: Surgery
Thyroidectomy- either total or partial
174
-Pain
make sure
thyroid and parathyroid surgery Medical Plan of Care: Surgery
- make sure its for surgery and not a non surgical pain
175
Bleeding
check where
thyroid and parathyroid surgery Medical Plan of Care: Surgery
- check behind neck
176
Focused Area-wheree
thyroid and parathyroid surgery Medical Plan of Care: Surgery
- airway
177
Complications– thyroid storm-
is what
what before
in emergency-> give
thyroid and parathyroid surgery Medical Plan of Care: Surgery
surge of hormones-
iodine ahead of surgery
emergency,// give iv fluids
178
complications- thyroid storm - s/s are
what vs
t
L
thyroid and parathyroid surgery Medical Plan of Care: Surgery
high hr,bp, temp,
tremors,
loc----
179
treatment of thyroid crisis
c
replacing
does what
cooling w/out aspirin ,
replacing fluids-checking glucose,electrolyes,
maintains vital organs
180
how does a thyroid crisis look on labs
elevated
decreased
increased
elevated t3/t4
decreased tsh
increased rai intake
181
thyroid and parathyroid surgery Medical Plan of Care: Surgery
complications- edema
position where
what as result
cannot
hear
- position w hob elevated-
can have laryngeal spasms as result
cannot exchange air,
will hear stridor
182
vocal cord paralysis-complications
inability
what a lot
change
potential
thyroid and parathyroid surgery Medical Plan of Care: Surgery
inability to hold airway open-
swallowing a lot,
change in voice,
potential to aspirate
183
tetany-
result of
can do what
how fix
thyroid and parathyroid surgery Medical Plan of Care: Surgery
as a result of low calcium from parathyroid
can close airway
fix w calcium
184
thyroid and parathyroid surgery Medical Plan of Care: Surgery
Potential Devices-
keep what
give
what med
hob
keep trach kit at bedside,
oxygen,
calcium glutamate,
hob elevated
185
Main Nursing Care-
monitor what
get
thyroid and parathyroid surgery Medical Plan of Care: Surgery
monitor calcium/ thyroid, and other electrolytes,
get pts moving
186
Hyperthyroidism- Diet:
high
hihg
what meals
daily
High Calorie,
High Protein
frequent meals,
daily weights
187
Hyperthyroidism
what environment
what eyes
Medical Plan of Care: Safety
Nursing Interventions
- calm cool environment,
protect eyes-may need to tape eyes
188
Hyperthyroidism
are
assess
Medical Plan of Care: Psychosocial Consult
are anxious,
assess coping
189
Hypothyroidism Medical Plan of Care Diet:
low
increase
avoid
Low Fat
increase iodize salt if have glands still,
avoid constipation
190
Hypothyroidism
caution w
place where
Medical Plan of Care: Safety
caution with sedatives and narcotics,
place close to nurse station dt myxedema coma
191
Hypothyroidism
assess
Medical Plan of Care: Psychosocial Consult
: asses coping,
192
myexedma coma
edema where
what face
what tongue
what voice
what labs
edema throughout body-
result of water retention-
puffy face
enlarged tongue
horse voice
decreased na, hypoglycema, acidosis
193
where is parathyroid gland
on thyroid gland
194
how does parathyroid regulate low calcium
seretes
does what
releases
secrete pth
increases reabsorption of bone
releases calcium into blood
195
how does parathyroid regulate high calcium
secrete
form
removes
secrete calcitonin
forms bones
removes calcium from blood
196
hyperparaythroidim means
hypoparaythroidim means
hyper- high blood calcium
hypo- low calcium
197
Parathyroid labs
what elvel
what electrolyte
PTH Level: Normal - 10-65 pg/mL or 10-65 ng/mL
Calcium Levels: 8.5-10.2 mg/dL,
198
Parathyroid: Medical Plan of Care Medications
Calcimimetic
increases
decreases
lower
Cinacalcet
- increase sensitivity of parathyroid gland
- decrease parathyroid secretion-
lower calcium levels
199
Bisphosphonates:-
Fosamax
Pamidronate (IV)
inhibits
what to calcium
improves
Parathyroid: Medical Plan of Care Medications
- inhibit bone reabsportion-
lower blood calcium-
improve bone mineral density
200
Loop Diuretics-
does what
Parathyroid: Medical Plan of Care Medications
increase secretion og calcium
Furosemide
201
Hypoparathyroidism
c
vit
what other electrolyte
Parathyroid: Medical Plan of Care Medications
Calcium – iv slowly or orally
Vitamin D
Magnesium Sulfate
202
Parathyroid: Medical plan of care Surgery
Parathyroidectomy-remove glands-
203
Hyperparathyroidism
large
iv fluids does what
what diuretic
Medical Plan of Care Diet: Increase Fluids
large glass w goal for fluids,
iv fluids to prevent renal calculi,
thiazide diretics
204
Hyperparathyroidism
risk
dt
Medical Plan of Care: Safety
risk for injury
dt fragile bones-
205
Hyperparathyroidism
put on
watch for
Medical Plan of Care: Cardiac Monitoring
tele-
watch for short qt intervals
206
Hyperparathyroidism
encourage
strain
what med
Medical Plan of Care: ADLs
encourage frequent ambulation,
strain urine for stones,
stool softener
207
Hypoparathyroidism
Medical Plan of Care Diet:
Increase Calcium
fruits, green leafy veggs, dairy- give vit d supllement
208
Hypoparathyroidism
monitor for
if see then what
Medical Plan of Care: Safety
monitory for tetany-
if see it give calcium iv
209
Hypoparathyroidism
see what
Medical Plan of Care: Cardiac Monitoring
prolonged qt interval-
210
where is adrenal gland
on top of kidneys
211
adrenal cortex releases x3
glucorticoids- cortisol
minerocorotcoids- aldosterone
sex hormones- testoterone
212
adrenal medula releases x2
epinephrine
norepipnehrien
213
3 s of adrenal gland hormones
salt-minercorticoids
sugar-glucostricoids
sex- androgens
214
Cushing syndrome- too much glucocorticoids-
see what
b h
face
bp
g
buffalo hump
moonfaced
high blood pressure
gynecomastia
215
Addisons disease
decreased
skin
bp
l
w
deceased loc
bronze skin
hypotension
lethargic
weakness
216
what sodium and potassium in
addisons
cushings
Low sodium, high potassium - in addisones
Hihg sodium and low potassium-Cush –
217
Cushings labs
midnight
low
24 hr
blood
Midnight salivary cortisol
Low Dose Dexamethasone Suppression Test
24hr Urine Cortisol
Blood ACTH Levels
218
Addisons lab
what tests
ACTH stimulation test
Corticotropin Releasing Hormone Stimulation test
219
cushings Medical Plan of Care:
Medications
Aminoglutethimide
Ketoconazole
Mitotane
Mifepristone
Metyrapone
Cyproheptadine
220
Addisons (insufficiency)
meds
Adrenal Medical Plan of Care: Medications
“ one “ meds
Cortisone and Prednisone–sugar- 2/3 morning 1/3 afternoon
Hydrocortisone and Fludrocortisone - salt-
Dehydroepiandrosterone –women only(DHEA)
221
cushings
removal
what else
medical plan of care
Removal of Pituitary Tumor
Adrenalectomy
222
cushings-Pain
where x2
medical plan of care
- back or kidneys
223
cushings-Bleeding
where x2
medical plan of care
- in core or at incision
224
cushings- Focused Area
replacing what x2
medical plan of care
- fluids and sugar
225
cushings- Complications
what bp
what imbalance
what risk
medical plan of care
– hypertension-
electryle imbalance-
fall risk
226
cushings
Main Nursing Care-
what care
what else
medical plan of care
skin care-
med alert braclet
227
Cushings
what bp
Medical Plan of Care: Monitor Blood Pressure
Nursing Interventions:
hypertension
228
Cushings
low
low
high
low
Medical Plan of Care Diet: Restrictions
low sugar intake
low carb
high protein
low sodium
229
Cushings
hand
skin
Medical Plan of Care: Infection Precautions
hand washing,
skin care,
230
Cushings
what
Medical Plan of Care: Cardiac Monitoring
Nursing Interventions -
hypokalemia
231
Cushings
conserve
elevate
Medical Plan of Care: ADLs
conserve muscle atrophy-
elevate hob 45
232
Addisons
what bp
Medical Plan of Care: Monitor Blood Pressure
hypotension
233
Addisons
increase
Medical Plan of Care Diet:
Increase Fluids
234
Addisons
avoid
what environment
what bed
provide
Medical Plan of Care: Safety
Nursing Interventions
- avoid stress,
calm enviroemnt,
low bed position,
provide assistance with ambulation
235
Addisons
limit:
e
foods
s
Limit exercise,
limit foods high in potassium,
limit sun exposure
236
pancreas
what does insulin do
promotes
high insulin levels means
insulin allows glucose to enter into cell
Promotes uptake of potassium into cell
High insulin levels can lower potassium
237
difference between type 1 and type 2
type 1- body doesn't make insulin
type 2- body doesn't respond to insulin
238
hypoglycemia symtpoms
s
p
h
lack
s
sweating
palor
hunger
lack of coordination
sleepiness
239
hyperglycemia symptoms
mouth
increased
w
h
vision
frequent
dry mouth
increased thirst
weakness
headache
blurred vision
frequent urination
240
pancreas labs
x2
blood sugar
a1c
241
what give when low blood sugar
what if still awake
low blood suagr= glucagon
if still awake start w juice or food
242
what do on diabetic sick days
prevent
r
frequent
continue
prevent dehydration
rest
frequent bs monitoring
continue insulin
243
DKA
body
produces
liver
body breaks down fat for energy
produces ketones
liver produces glucose that worsens hyperglycemia
244
DKA s/s
breath
excessive
frequent
/
resp
fruity breath
excessive thirst
frequent urination
n/v
kuessmal respiration(rapid)
245
DKA diagnostics
blood tests-why
urine tests-why
electrolye tests-why
Blood tests: To check for high blood glucose levels over 250, elevated ketones, and low blood pH (acidosis).
Urine tests: For the presence of ketones.
Electrolyte levels: DKA often leads to imbalances in electrolytes, particularly low potassium.
246
DKA interventions
r
e
I
how fast
rehydration
electrolyes
insulin
bring slowly down
247
Hyperosmolar Hyperglycemic Syndrome: Patho
h
d
h
no
Hyperglycemia,
dehydration
hyper osmaliry( high amount of concentrate in solutes in blood)
No ketone production
248
HHS manifestations
mouth
polys
bp
altered
Dry mouth
Polurua, polydipsia
Hypotension
Altered loc
249
HHS interventions
fluid-what
I
e
isotonic fluids
insulin
electrolytes
