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D-Third semester > Exam 6- Pain/ endocrine - LAST > Flashcards

Exam 6- Pain/ endocrine - LAST Flashcards

1
Q

pain

what expiernece
associated w

A

unpleasant expeirence

associated with actual or potential tissue damage

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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

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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

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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

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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

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6
Q

Neuropathic pain- central

where is it/what types of pain

A

brain and spinal cord

like epilepsy , Parkinson’s, stroke

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7
Q

Neuropathic pain- peripheral

what is it/ what types of pain

A

all other nerves

like diabetic neuropathy, carpal tunnel, phantom limb pain

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8
Q

how do you treat neuropathic pain

central
peripheral

A

c- patches and opioids

p- adjuvant alnalgesics

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9
Q

Nociceptive pain

damage
s/s

A

damage to tissues

aching, cramping, throbbing

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10
Q

Nociceptive pain- somatic

where is it/ what types

A

skin

broken bones, arthritis, fractures

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11
Q

Nociceptive pain- visceral

what is it/ what types

A

organ pain

like appendicitis, gall bladder and kidneys

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12
Q

how do you treat nociceptive pain

somatic-
visceral-

A

s-acetaminophen, nsaids, opioids. ice/heat, topical, patches

v-opiods

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13
Q

Mixed pain syndrome

x2
what is it

A

fibromyalgia, myofiscal pain-

both are going on and don’t know cuase

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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

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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

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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

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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

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18
Q

O
L
D
C
A
R
T

A

onset

location

duration

characteristics

aggravating factors

radiation

treatment

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19
Q

P
Q
R
S
t

A

provoked

quality

region/ radiation

severity

timing

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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,

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21
Q

when use Wong baker faces

A

children around school age

4 ish

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22
Q

when use flacc

what is it

A

3 and under- infants or cannot identify smiles faces

Face
legs
activty
cry
consolability

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23
Q

when use 0-10 numeric pain

A

pt needs to be able to comprehend the scale

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24
Q

when give revised nonverbal pain scale

A

post op surgery before they are completely alert and orientated

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25
Q

pain thermometer

how does it work

A

The patient is asked to circle words next to the thermometeror to mark the area on the thermometer to indicate the intensity of pain.

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26
Q

Verbal manifestations of pain

telling
m
change
c
s

A

telling you they are in pain

moaning

change in mood

crying

screaming

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27
Q

nonverbal manifestations of pain- compare to baseline

G
r
diffculty
altered
elevated
s
what body
altered
eyes
t
c
teeth
t

A

Grimacing
Restlessness
Difficulty Sleeping
Altered Body Movement
Elevated Vital Signs
Sweating
Tense Body
Altered Gait
Squinting of eyes
Tears
Combative
Grinding Teeth
Thrashing

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28
Q

what is referred pain

A

pain felt at sight other then where cause is

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29
Q

lung and diaphragm

where is referred pain

A

base of neck

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30
Q

heart x2

where is referred pain

A

on mouth

down left arm

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31
Q

liver
x3
where is referred pain

A

right side of neck

sternum

right spot on middle back

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32
Q

gallbladder

where is referred pain

A

right shoulder

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33
Q

stomach

where is referred pain

A

middle of back(front and back)

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34
Q

ovaries

where is referred pain

A

by belly button on front and back

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35
Q

appendix

where is referred pain

A

RLQ pain

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36
Q

kidneys

where is referred pain

A

on back by kidneys

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37
Q

ureters

where is referred pain

A

whole groin region

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38
Q

bladder

where is referred pain

A

on butt crack

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39
Q

Battle between subjective and objective

do what

and also do what

A

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

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40
Q

phantom pain-real

what type

may need to

A

neuropathic pain-

may have to treat w pain meds/psychosocial meds

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41
Q

Breakthrough pain

what is it
want to use what

A

exasperation of pain in a patient that has adequately controlled baseline pain

Want to use fast acting analegesic like morphine, oxycode, hydrmoprhone, fetnyal

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42
Q

Breakthrough pain

reassessment when
then when

A

Conduct pain reassessment 30 mins to hr after

then reassess as needed

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43
Q

Breakthrough pain Challenges

x2
make sure to

A
  • cognitive level, cultural differnces,

Make sure to get whole assessment

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44
Q

Complications of unrelieved pain

A

Cardiovascular instability

Respiratory dysfunction

Gu disturbances

Decreased gi mobility

Metabolic imbalance

Developmental issues

Prolonged stress

Reduced immune system

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45
Q

Medical Plan of Care:

p
modalities
therapties
s

Collaborative Management

A

Pharmacological Interventions

Mind Body Based Modalities

Biologically Based Therapies

Surgery

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46
Q

Interdisciplinary:
p
a
s
p

Collaborative Management

A

Pharmacist

Anesthesia

Social Work

Physical Therapy

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47
Q

Nursing Interventions:

what is huge
use what
should not

Collaborative Management

A

Assessment is huge

Use multiple methods-

should not make pain worse

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48
Q

Mind based therapies

r
g I
m
m t
p
p t
a
other

A

Relaxation-

Guided imagery

Meditation

Music therapy

Prayer

Pet Therapy

Aromatherapy

Other distraction therapies

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49
Q

Massage-
what after
do not do what

Body based therapies

A
  • fluids after dt protein release-

do not massage in area if suspected DVT or clots or bleeding

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50
Q

Positioning and body alignment-
do what

Body based therapies

A

get patient off of what hurts them-

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51
Q

Splinting

assess what
teach what

Body based therapies

A
  • asses damage under splint-

teach about care of splint

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52
Q

Acupuncture

assess what after

Body based therapies

A
  • asses for unexplained pain after
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53
Q

Hot/Cold –

what time

Body based therapies

A

timing- don’t leave on for too long-20 mins or less

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54
Q

Body based therapies

t p
e

A

Trigger Point

Exercise
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55
Q

pts needs what if using heat/ice

A

pts needs to be able to feel- dont use in neuropathy

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56
Q

dont use heat in

A

dont use heat in bleeding/ injury

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57
Q

dont use cold therapy in x2

A

open wounds

put on bare skins

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58
Q

Cognitive-Behavior Treatment-

do what

Psychological Therapies

A

thoughts create feelings

feelings create behavior

behavior reinforces thoughts

need to think better

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59
Q

Biofeedback

monitor for
connected to
how does it work

Psychological Therapies

A
  • monitor for sweating, grimacing, dizziness-

connected to sensors-

will realize cell changes and relax certain muscles based on changes

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60
Q

Hypnosis

do what when its happening

Psychological Therapies

A

– make sure patient is safe and monitor during treatment

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61
Q

Tens

how does it work

what theory

Psychological Therapies

A
  • provides little electrical pulses that control and lessen pain-

gate control theory

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62
Q

what types

waht interventions- provide/ check w

Biologically Based Interventions

A

herbs, vitamins, reiki, tai chi,

Nursing Interventions: provide resources

, check with pharmacy for drug compatibilities.

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63
Q

Spinal Cord Stimulators-
what is it
how does it work

Surgery- medical plan of care

A

implant with low electrical current-

will block sensation of pain

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64
Q

Rhizotomy

what does it do

Surgery- medical plan of care

A

-sever the nerve roots at spinal cord

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65
Q

Neurectomy
does what

Surgery- medical plan of care

A
  • resect the nerves
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66
Q

Nerve Decompression-
does what
to do what

Surgery- medical plan of care

A

remove ligaments , Cartlidge or bone

give room for nerve

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67
Q

Joint Replacement/ Tissue, Muscle, Organ Removal -

why

Surgery- medical plan of care

A
  • – if pain is too terrible
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68
Q

Nursing Interventions:

do
is
any

Surgery- medical plan of care

A

do they have pain,

is pain different then before

, any mobility or neurological complications

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69
Q

levels of spinal nerves- how many-

cervical

thoracic

lumbar

each controls where its located at

A

cervical-8

thoracic-12

lumbar-5

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70
Q

things to consider before med administration

se
sa
pain
se
t
with

A

Severity of pain

Safety- are they awake, bleeding, vs stable

Pain prior to admintration

Setting

Type

take With food or not

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71
Q

non opioid analgesics - meds

main one

A

acetaminophen

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72
Q

nonselective nsaids-

I
n
k

non opioid analgesics - meds

A

ibuprofen

, ketorolac,

naproxen

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73
Q

cox-2 selective nsaid-

non opioid analgesics - meds

A

celecoxib

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74
Q

Non opiod-

used why

nsaid cause what

acetaminophen works where

A

used for mild pain

Nsaids may cause bleeding

Acetminophen works on liver

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75
Q

opioid analgesics- meds

m
f
h
o

A

morphine

fentanyl

hydromorphone

oxycodone

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76
Q

opioid analgesics

are they
what type of pain

A

Are they safe respiratory or cardiac wise

Used for acute pain

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77
Q

local anesthetics

b
r
L

adjuvant analgesics

A

bupivacine

ropivacacine

lidocaine

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78
Q

anticonvulsants

g
p

adjuvant analgesics

A

gabapentin

pregabalin

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79
Q

antidepressants

d
n
d

adjuvant analgesics

A

desipramine

nortiplyline

duloxetine

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80
Q

opioids- storng pain

o
p
p
o

A

oxycodone

percadoen

Percocet

oxycontin

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81
Q

opioids mild to moderate

h
L
v
v
c
t /c

A

hydrocadone

lortab

Vicodin

vicoprofin

codeine

tylonel w codeine

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82
Q

aspirin

anti x4
,i
p
p
p a

A

anti inflammatory

anti pain

anti pyretic

anti platlet aggregation

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83
Q

NSAIDS

a
anti
anti

A

analgesic

anti inflammatory

antipyretic

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84
Q

NSAIDS

what distress
d
r
h

A

gi distress

dizziness

rash

heartburn

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85
Q

pasero opined induced sedation scale

s
1
2
3
4

A

s- sleep and easy to arouse

1-awake and alert
2- slightly drowsy
3- frequently drowsy
4- no response

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86
Q

DOs with transdermal meds

clean
remove
docuement
place

A

clean area of old patch

remove old patch

document place date adntime

place over dry skin

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87
Q

DONT with transdermal med admisntration

place over
do not
place

A

place over dense hair

do not shave hair

place heat over

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88
Q

PCA

basal rate
dose
lockout

A

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

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89
Q

Nursing interventions for PCA

r-
what compatibility
how many
monitor x3

A

Respiratory-oxygen, carbon dioxide and rr

Iv compatibility

How many times are they hitting it

Monitor- Hypotension, dizziness, loc

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90
Q

Epidural

Cath where

binds to what

works where

A

Catheter placed in the epidural space

It binds to nerve roots where they enter and exit the spinal cord

Sympathetic nervous system

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91
Q

Epidural

low concentration-

high concetration-

A

Low concentration- sensory is blocked but motor is intact

High concentration -both are blocked

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92
Q

Epidural

monitor
lay

how position during insertion

A

Monitor client

Lay still during procedure

Hunched over, neck down position during insertion

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93
Q

Epidural after insertion

check for
what 2 vs
what’s needed
make sure

A

checking for sensation(hot cold) and movement,

hypotensive and low rr

Bedrest is needed

Make sure dressing is intact and secure

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94
Q

Spinal epidural

Cath wehere

what blockage

A

Catheter placed in the cerebrospinal fluid

Autonomic, Sensory, and Motor Blockage

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95
Q

Nursing interventions- spinal epidural

know what
monitor
monitor for

A

Know level of spinal

Monitor headache

Monitor for cerebral spinal leak

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96
Q

spinal epidural

put on
what in place
dont place

A

Can be on fluids to decrease hypotension

May need cath in place

Do not place head down

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97
Q

If small hole happens during spinal epidural-blood patch-

draw from
pt lay where
iv where
draw how much
inject where

A

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

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98
Q

injections

steroids why
nerve blocks why

monitor safety

A

steroids- nerve pain

nerve blocks-presurgery

monitor safety

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99
Q

opioid reversal

naloxone how- why need to constantly monitor

naltrexone how

A

naloxone iv- need to monitor because it has shorter half life and pt can reoverdose

naltrexone po

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100
Q

tolerance

need for what

rotate

A

Need for increased dose to maintain same degree of pain control

Rotate drug if tolerance develops, as increasing dose could contribute to hyperalgesia.

101
Q

physical dependence

manifested by

to avoid withdrawal

A

manifested by withdrawals if you abruptly discontinue

to avoid withdrawal- taper down

102
Q

Pseudo addiction

what behaviors

resolve when

A

when pt has behaviors that look like addiction

but resolve when treated pain

103
Q

addiction

drive to
what is not indicator
use it despite

A

drive to take substances for other then therapeutic value

tolerance and dependance are not indicators of addiction

use it depsite risk of harm

104
Q

s/s of opioid withdrawal

what pupils
L
what when coming off

A

pinpoint pupils

lethargic

jittery when coming off

105
Q

opioid withdrawal s/s

cold
c
what symptoms
mood
pain
v
d

A

cold shakes

chills

fever like symptoms

mood swings

bone pain

vomiting

diarrhea

106
Q

Pediatric- lifestyle considerations

limit

A

Limit pediatric pain as much as possible- limit anything that causes pain

107
Q

School age-

involve
listen
might need

A

involve parent and child in plan of care-

listen to child needs-

might needs distraction

108
Q

Adults

dealing w

A
  • dealing with work, may not want to take off to get work
109
Q

Geriatric
p
p
dont want

A
  • polypharmacy-

pocketing of meds-

don’t want to kill organs

110
Q

Hormones produced where

A

Hormones are produced and excreted by endocrine glands

111
Q

what does water soluble hormones mean

what does lipid soluble hormones mean

A

Water soluble – travel in free form

Lipid soluble- need to bind to carriers to transport

112
Q

Negative feedback-

does what

Maintaining Hormonal Balance

A

inhibit or secrete hormone- ability to stop buildup of too many hormones

113
Q

Positive feedback-

Maintaining Hormonal Balance

A

increase levels

114
Q

Biological rhythms-

like

Maintaining Hormonal Balance

A

like circadian rhythm

115
Q

Central nervous system control

impacts what

Maintaining Hormonal Balance

A
  • impact on our ongoing regulation
116
Q

Primary Prevention-hormones
educate on:

d
e
manage
cycle
prevent

A

Diet

Exercise

Stress Management-huge

Sleep-Wake Cycle

Injury Prevention

117
Q

Endorine- newborns are screen for x2

A

-routine congenital and thyroid

118
Q

what are adults screened for endocrine

x2

A

Thyroid

Diabetes

119
Q

Diagnostics in endocrine

x3

some scans need what

A

Ultrasound- of gland itself- see blood flow-

MRI

CT

Some scans may need radio isotopes

120
Q

what labs in endocrine

what level
what testing
b

A

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
Q

subjective assessment endocrine

get a history of

f
I
d

A

Family- a lot are genetic

Injuries

Developmental- ?s, reproductive history, activity level, energy, nutrition, wt changes, appearance changes

122
Q

endocrine assessment- objective

A

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
Q

consequences of impaired hormonal regulation

A

Alterations in growth and development

Alterations in cognition

Alterations in metabolism

Alterations in reproduction

Changes in growth

Altered adaptive responses

124
Q

Surgical Interventions-endocrine

Hypophysectomy-what

Adrenalectomy-where

Thyroidectomy-where

Parathyroidectomy-where

A

Hypophysectomy-removal of pituitary

Adrenalectomy-on top of kidney

Thyroidectomy-on neck

Parathyroidectomy-on thyroid glands

125
Q

ENDORCRINE Surgical Considerations

consider what

why

A

consider location-

if on neck then monitor airway

if on kidney then monitor kidney function

126
Q

Hyperpitiutary- acromegaly

increase in what

A

increase in growth hormone

causes the patient to be really tall

127
Q

Hyperpitiutary- acromegaly

s/s

slant
what jaw
enlarged
h
what problems

A

slanted forehead

protruding jaw

enlarged hands and feet

headache

vision problems

128
Q

Hypopitiutary- dwarfism

caused by

what do they look like

A

caused by tumor

short in height, small feet, small features

129
Q

Anterior Pituiatry (GH): Labs

x2

A

Thyroid Levels

Blood Sugar – dt insulin(elevated)

130
Q

Hyperpitiutary- acromegaly meds

what Somatostatin Analogs

what GH Receptor Blockers

what dopamine agonists

A

Sandostatin- Somatostatin Analogs

Pegvisomant- GH Receptor Blockers

Bromocriptine/Cabergoline-Dopamine Agonists

131
Q

Hyperpitiutary- acromegaly meds

give when

will not
just does what

A

give those prior to surgery-

will not reverse-

just will slow down further development

132
Q

Hypopituitarism meds - dwarfism

what 3 somatropin

A

Omnitrope
Genotropin
Humatrope

133
Q

Hypopituitarism meds -dwarfism

waht other 2

A

Testosterone

Estrogen

134
Q

Hypopituitarism meds -dwarfism

watch for:
retention
m
pain
h

A

watch for for fluid retention

Malaysia,

joint pain

headache

135
Q

Hyperpituitarism-acromegly

diet low in
monitor for

Medical Plan of Care: Diet

A

low in sugar

monitor for hyperglycemia

136
Q

Hyperpituitarism-acromegly

increase in what
leads to what

Medical Plan of Care: Pain Management

A

increase in bone density

can lead to nerve pain

137
Q

Hyperpituitarism- acromegly
Medical Plan of Care: Serial Photos

take what
to see
after

A

take pictures of different developmental stages in life

to se physical changes-

after surgery will not go back to normal size

138
Q

Hypopituitarism- dwarfism
Medical Plan of Care: safety
Nursing Interventions: -

decrease in
watch for
what issues

A

decrease in bone density,

watch for falls

mobility issues

139
Q

Hypopituitarism-dwarfism
Nursing Interventions: physical therapy

monitor what
help with

A

monitor therapy

help with device usage like crutches

140
Q

Hypopituitarism-dwarfism
Medical Plan of Care: Diet

increase

A

increase Vit. D and Ca

141
Q

SIADH-pituitary- (ADH)

does what w fluid

what to blood and electrolytes

what to urination

what changes

A

retains fluid

dilutes blood and electroltyes

decrease in urination

neurological changes

142
Q

Diabetes Insipidus

what ADH

kidneys do what

what sodium

urine is what

A

decrease ADH

kindeys do not save water-waste

hypernatramia

urine is dilute

143
Q

Pituitary (ADH): Labs

what level

what urine

A

sodium blood level

urine specific gravity

144
Q

Hyper-SIADH meds

what ivf

waht antagonists

what diuretic

A

Hypertonic

vasopressin antagonsits- “vaptan”

furosemide

145
Q

Hypo- DI meds

c
I
what iv fluid

A

Chlorpropamine-increases adh production

Indomethacin (NSAID)-increase renal resposivness

Isotonic then hypotonic iv fluid

146
Q

Hypo- DI meds

replacement therapy

A

Desmopressin
Avasopressin
Vasopressin

147
Q

SIADH
Medical Plan of Care: Diet

restrict what
I c
g
daily

A

fluid restrictions 800-1000 ml per day

ice chips

gums//

daily wt//

148
Q

SIADH
Medical Plan of Care: Seizure precautions Nursing Interventions:

what on ned
what risk
check

A

pads on bed

fall risk

neuro checks

149
Q

SIADH

no more then

Medical Plan of Care: HOB low
Nursing Interventions

A

no more then 10 degrees

150
Q

DI

titrate
daily

Medical Plan of Care: Diet increase fluids
Nursing Interventions

A

: titrate fluid to urine output

daily wt

151
Q

DI

what bed position

A

Medical Plan of Care: Trendelenburg

152
Q

DI

also make sure to monitor what

appers what

A

Also monitor blood sugars-will appear high

153
Q

Pituitary medical Plan of Care: Surgery

what surgery
what else

A

Hypophysectomy- best chance for cure

Stereotactic Radiosurgery- decrease size of tumor

154
Q

Pituitary medical Plan of Care: Surgery
Pain

pain where
may mean what
check for what

A

headaches-

cerebrospinal fluid leak-

check for glucose

155
Q

Pituitary medical Plan of Care: Surgery
bleeding where

A

epistasis -nose bleeding

156
Q

Focused Area-

n
look for
how does It present

Pituitary medical Plan of Care: Surgery

A

neurological-

look for meningitis-

when look down pain goes down back

157
Q

Pituitary medical Plan of Care: Surgery
Complications

h
changes

A

–hematoma- vision changes,

158
Q

Potential Devices-

what dressing

e

Pituitary medical Plan of Care: Surgery

A

mustache dressing,

evd

159
Q

Pituitary medical Plan of Care: Surgery

Main Nursing Care-

dont do what
avoid what
no what
HOB

A

do not blow nose for 24 hrs,

avoid straining coughing sneezing,

no vigourous toothbrushing for 10 days.

Hob elevated

160
Q

what is purpose of thyroid

A

Purpose of thyroid is for metabolic consumption, energy

161
Q

What causes thyroid problems

I
a
c
what dysfunction

A

inflammation,

autoimmune,

cancer,

gland dysfunction

162
Q

Hyperthyroidism s/s

what inolerance
what bowels
what bp/vs
wt
e
t
what eyes

A

heat intolerance

hyperactive bowels

increase bp/vs

weight loss

edema

tremors

bulging eyes

163
Q

Causes of Hyperthyroidism:
Graves’ Disease

most
what is it

A

Most common cause of hyperthyroidism

Autoimmune disorder-more common in women- causes thyroid to hyperfunction

164
Q

Toxic Multinodular Goiter–Causes of hyperthyroidism

what is it

what is etiology

A

Thyroid tumor–small nodules that secrete excessive amounts of th

etiology-lack of iodine,

165
Q

causes of hyperthyroidism
thyroidotis

what is it
causes

A

viral infection of thyroid glands

causing inflammaation and increased TH effects

166
Q

Hypothyroidism s/s

what intolerance
e
what tongue
what bp/hr
what skin
what energy
what respiratory
what bowels

A

cold intolerance

edema

thick tongue

low bp/hr

dry skin

low energy

dyspnea/hoarnsess

constipation

167
Q

what is goiter

what is exopthalamus

A

Goiter- enlarged tyroid gland- huge bulge in neck

Exopthalmus- bulging in eyes

168
Q

Thyroid: Labs

x3

A

T3 Level

T4 Level - what we give when supplementing

TSH Level

169
Q

Hyperthyroidism
Iodine-

only for what
how long before
not used

Thyroid Medical Plan of Care: Medications

A

only for surgery-

1-2 weeks before surgery-

not used to treat hyperthyroidism

170
Q

Hyperthyroidism-Radioactive Iodine-

does what
how long does It take
can develop

Thyroid Medical Plan of Care: Medications

A

destroys thyroid tissue,

can take 3 months to work,

can develop hypothyroidism

171
Q

Hyperthyroidism
what antithyroid meds x2

what heart med

Thyroid Medical Plan of Care: Medications

A
  • main meds-blocks production
    Propythiouracil (PTU)
    Methimazole

Beta Blockers-cardio effects on heart

172
Q

Hypothyroidism med-
Levothyroxine

is what
increase
monitor
take when

A
  • synthetic hormone-

increase metabolism –

monitor for tachycardia- t

ake in morning

173
Q

what surgery

Thyroid Medical Plan of Care: Surgery

A

Thyroidectomy- either total or partial

174
Q

-Pain
make sure

thyroid and parathyroid surgery Medical Plan of Care: Surgery

A
  • make sure its for surgery and not a non surgical pain
175
Q

Bleeding
check where

thyroid and parathyroid surgery Medical Plan of Care: Surgery

A
  • check behind neck
176
Q

Focused Area-wheree

thyroid and parathyroid surgery Medical Plan of Care: Surgery

177
Q

Complications– thyroid storm-

is what
what before

in emergency-> give

thyroid and parathyroid surgery Medical Plan of Care: Surgery

A

surge of hormones-

iodine ahead of surgery

emergency,// give iv fluids

178
Q

complications- thyroid storm - s/s are

what vs
t
L

thyroid and parathyroid surgery Medical Plan of Care: Surgery

A

high hr,bp, temp,

tremors,

loc—-

179
Q

treatment of thyroid crisis

c
replacing
does what

A

cooling w/out aspirin ,

replacing fluids-checking glucose,electrolyes,

maintains vital organs

180
Q

how does a thyroid crisis look on labs

elevated
decreased
increased

A

elevated t3/t4

decreased tsh

increased rai intake

181
Q

thyroid and parathyroid surgery Medical Plan of Care: Surgery
complications- edema

position where
what as result
cannot
hear

A
  • position w hob elevated-

can have laryngeal spasms as result

cannot exchange air,

will hear stridor

182
Q

vocal cord paralysis-complications

inability
what a lot
change
potential

thyroid and parathyroid surgery Medical Plan of Care: Surgery

A

inability to hold airway open-

swallowing a lot,

change in voice,

potential to aspirate

183
Q

tetany-

result of
can do what
how fix

thyroid and parathyroid surgery Medical Plan of Care: Surgery

A

as a result of low calcium from parathyroid

can close airway

fix w calcium

184
Q

thyroid and parathyroid surgery Medical Plan of Care: Surgery
Potential Devices-

keep what
give
what med
hob

A

keep trach kit at bedside,

oxygen,

calcium glutamate,

hob elevated

185
Q

Main Nursing Care-

monitor what
get

thyroid and parathyroid surgery Medical Plan of Care: Surgery

A

monitor calcium/ thyroid, and other electrolytes,

get pts moving

186
Q

Hyperthyroidism- Diet:

high
hihg
what meals
daily

A

High Calorie,

High Protein

frequent meals,

daily weights

187
Q

Hyperthyroidism

what environment
what eyes

Medical Plan of Care: Safety
Nursing Interventions

A
  • calm cool environment,

protect eyes-may need to tape eyes

188
Q

Hyperthyroidism

are
assess

Medical Plan of Care: Psychosocial Consult

A

are anxious,

assess coping

189
Q

Hypothyroidism Medical Plan of Care Diet:

low
increase
avoid

A

Low Fat

increase iodize salt if have glands still,

avoid constipation

190
Q

Hypothyroidism

caution w
place where

Medical Plan of Care: Safety

A

caution with sedatives and narcotics,

place close to nurse station dt myxedema coma

191
Q

Hypothyroidism

assess

Medical Plan of Care: Psychosocial Consult

A

: asses coping,

192
Q

myexedma coma

edema where
what face
what tongue
what voice

what labs

A

edema throughout body-
result of water retention-

puffy face

enlarged tongue

horse voice

decreased na, hypoglycema, acidosis

193
Q

where is parathyroid gland

A

on thyroid gland

194
Q

how does parathyroid regulate low calcium

seretes
does what
releases

A

secrete pth

increases reabsorption of bone

releases calcium into blood

195
Q

how does parathyroid regulate high calcium

secrete
form
removes

A

secrete calcitonin

forms bones

removes calcium from blood

196
Q

hyperparaythroidim means

hypoparaythroidim means

A

hyper- high blood calcium

hypo- low calcium

197
Q

Parathyroid labs

what elvel
what electrolyte

A

PTH Level: Normal - 10-65 pg/mLor 10-65 ng/mL

Calcium Levels: 8.5-10.2 mg/dL,

198
Q

Parathyroid: Medical Plan of Care Medications
Calcimimetic

increases
decreases
lower

A

Cinacalcet

  • increase sensitivity of parathyroid gland
  • decrease parathyroid secretion-

lower calcium levels

199
Q

Bisphosphonates:-
Fosamax
Pamidronate (IV)

inhibits
what to calcium
improves

Parathyroid: Medical Plan of Care Medications

A
  • inhibit bone reabsportion-

lower blood calcium-

improve bone mineral density

200
Q

Loop Diuretics-

does what

Parathyroid: Medical Plan of Care Medications

A

increase secretion og calcium
Furosemide

201
Q

Hypoparathyroidism

c
vit
what other electrolyte

Parathyroid: Medical Plan of Care Medications

A

Calcium – iv slowly or orally

Vitamin D

Magnesium Sulfate

202
Q

Parathyroid: Medical plan of care Surgery

A

Parathyroidectomy-remove glands-

203
Q

Hyperparathyroidism

large

iv fluids does what

what diuretic

Medical Plan of Care Diet: Increase Fluids

A

large glass w goal for fluids,

iv fluids to prevent renal calculi,

thiazide diretics

204
Q

Hyperparathyroidism

risk
dt

Medical Plan of Care: Safety

A

risk for injury

dt fragile bones-

205
Q

Hyperparathyroidism

put on
watch for

Medical Plan of Care: Cardiac Monitoring

A

tele-

watch for short qt intervals

206
Q

Hyperparathyroidism

encourage
strain
what med

Medical Plan of Care: ADLs

A

encourage frequent ambulation,

strain urine for stones,

stool softener

207
Q

Hypoparathyroidism

Medical Plan of Care Diet:

A

Increase Calcium

fruits, green leafy veggs, dairy- give vit d supllement

208
Q

Hypoparathyroidism

monitor for
if see then what

Medical Plan of Care: Safety

A

monitory for tetany-

if see it give calcium iv

209
Q

Hypoparathyroidism

see what

Medical Plan of Care: Cardiac Monitoring

A

prolonged qt interval-

210
Q

where is adrenal gland

A

on top of kidneys

211
Q

adrenal cortex releases x3

A

glucorticoids- cortisol

minerocorotcoids- aldosterone

sex hormones- testoterone

212
Q

adrenal medula releases x2

A

epinephrine

norepipnehrien

213
Q

3 s of adrenal gland hormones

A

salt-minercorticoids

sugar-glucostricoids

sex- androgens

214
Q

Cushing syndrome- too much glucocorticoids-

see what

b h
face
bp
g

A

buffalo hump

moonfaced

high blood pressure

gynecomastia

215
Q

Addisons disease

decreased
skin
bp
l
w

A

deceased loc

bronze skin

hypotension

lethargic

weakness

216
Q

what sodium and potassium in

addisons
cushings

A

Low sodium, high potassium - in addisones

Hihg sodium and low potassium-Cush –

217
Q

Cushings labs

midnight

low

24 hr

blood

A

Midnight salivary cortisol

Low Dose Dexamethasone Suppression Test

24hr Urine Cortisol

Blood ACTH Levels

218
Q

Addisons lab

what tests

A

ACTH stimulation test

Corticotropin Releasing Hormone Stimulation test

219
Q

cushings Medical Plan of Care:

Medications

A

Aminoglutethimide

Ketoconazole

Mitotane

Mifepristone

Metyrapone

Cyproheptadine

220
Q

Addisons (insufficiency)

meds

Adrenal Medical Plan of Care: Medications

A

“ one “ meds

Cortisone and Prednisone–sugar- 2/3 morning 1/3 afternoon

Hydrocortisone and Fludrocortisone - salt-

Dehydroepiandrosterone –women only(DHEA)

221
Q

cushings

removal
what else

medical plan of care

A

Removal of Pituitary Tumor
Adrenalectomy

222
Q

cushings-Pain

where x2

medical plan of care

A
  • back or kidneys
223
Q

cushings-Bleeding

where x2

medical plan of care

A
  • in core or at incision
224
Q

cushings- Focused Area

replacing what x2

medical plan of care

A
  • fluids and sugar
225
Q

cushings- Complications

what bp
what imbalance
what risk

medical plan of care

A

– hypertension-

electryle imbalance-

fall risk

226
Q

cushings

Main Nursing Care-
what care
what else

medical plan of care

A

skin care-

med alert braclet

227
Q

Cushings

what bp

Medical Plan of Care: Monitor Blood Pressure
Nursing Interventions:

A

hypertension

228
Q

Cushings

low
low
high
low

Medical Plan of Care Diet: Restrictions

A

low sugar intake

low carb

high protein

low sodium

229
Q

Cushings

hand
skin

Medical Plan of Care: Infection Precautions

A

hand washing,

skin care,

230
Q

Cushings

what

Medical Plan of Care: Cardiac Monitoring
Nursing Interventions -

A

hypokalemia

231
Q

Cushings

conserve
elevate

Medical Plan of Care: ADLs

A

conserve muscle atrophy-

elevate hob 45

232
Q

Addisons

what bp

Medical Plan of Care: Monitor Blood Pressure

A

hypotension

233
Q

Addisons
increase

Medical Plan of Care Diet:

A

Increase Fluids

234
Q

Addisons

avoid
what environment
what bed
provide

Medical Plan of Care: Safety
Nursing Interventions

A
  • avoid stress,

calm enviroemnt,

low bed position,

provide assistance with ambulation

235
Q

Addisons

limit:

e
foods
s

A

Limit exercise,

limit foods high in potassium,

limit sun exposure

236
Q

pancreas

what does insulin do

promotes

high insulin levels means

A

insulin allows glucose to enter into cell

Promotes uptake of potassium into cell

High insulin levels can lower potassium

237
Q

difference between type 1 and type 2

A

type 1- body doesn’t make insulin

type 2- body doesn’t respond to insulin

238
Q

hypoglycemia symtpoms

s
p
h
lack
s

A

sweating

palor

hunger

lack of coordination

sleepiness

239
Q

hyperglycemia symptoms

mouth
increased
w
h
vision
frequent

A

dry mouth

increased thirst

weakness
headache

blurred vision

frequent urination

240
Q

pancreas labs

x2

A

blood sugar

a1c

241
Q

what give when low blood sugar

what if still awake

A

low blood suagr= glucagon

if still awake start w juice or food

242
Q

what do on diabetic sick days

prevent
r
frequent

continue

A

prevent dehydration

rest

frequent bs monitoring

continue insulin

243
Q

DKA

body
produces
liver

A

body breaks down fat for energy

produces ketones

liver produces glucose that worsens hyperglycemia

244
Q

DKA s/s

breath
excessive
frequent
/
resp

A

fruity breath

excessive thirst

frequent urination

n/v

kuessmal respiration(rapid)

245
Q

DKA diagnostics

blood tests-why
urine tests-why
electrolye tests-why

A

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
Q

DKA interventions

r
e
I

how fast

A

rehydration

electrolyes

insulin

bring slowly down

247
Q

Hyperosmolar Hyperglycemic Syndrome: Patho

h
d
h
no

A

Hyperglycemia,

dehydration

hyper osmaliry( high amount of concentrate in solutes in blood)

No ketone production

248
Q

HHS manifestations

mouth
polys
bp
altered

A

Dry mouth

Polurua, polydipsia

Hypotension

Altered loc

249
Q

HHS interventions

fluid-what
I
e

A

isotonic fluids

insulin

electrolytes

D-Third semester (19 decks)

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