Mark K Lectures 7-9 Flashcards
Treatments for hyperthyroidism and what to remember for each one
- Radioactive iodine (private room for 1st 24 hrs, be very careful with urine)
- PTU (puts thyroid under) (*watch WBC count)
- Thyroidectomy (total or subtotal/partial) (*needs lifelong hormonal replacement, *At risk for thyroid storm, *emergency)
S/s of thyroid storm
Temp >105
Stroke level BP
Severe tachycardia
Psychotic delirium
Treatment for thyroid storm
Get O2 up (O2 mast at 10L/min)
Get temp down (ice, cooling blanket)
Pt will come out of it on their own (self-limiting)
Biggest concerns for 1st 12hrs post op partial and full thyroidectomy
1: airway
#2: hemorrhage
Biggest concerns for 12-48 hrs post op partial and full thyroidectomy
Total: tetany (low Calcium)
Partial: thyroid storm
Risk for 72 hrs after partial or full thyroidectomy
Infection
Another name for hypothyroidism
Myxedema
Treatment for hypothyroidism
Give thyroid hormone
Do not sedate (risk of myxedema coma)
Question NPO orders before surgery (*must give thyroid meds)
What is Addison’s disease?
Under secretion of adrenal cortex
S/s of addison’s disease
Hyperpigmented
Cannot adapt to stress (makes glucose and BP go down = risk of shock)
Treatment of addison’s disease
Glucocorticoids (ending in -sone)
What is Cushing’s syndrome?
Over secretion of Adrenal Cortex
S/s of Cushing’s syndrome
(Think of cushman)
Moon face
Hirsutism (hair growth)
Gynecomastia
Truncal obesity
Striae
Bruise easily
Losing potassium
Full of water
Buffalo hump
Too much glucose
Treatment for Cushing’s syndrome
Adrenalectomy
(Bilateral adrenalectomy = addison’s)
Key safety rules for children’s toys
No small parts for < 4
No metal toys if O2 in use
Beware of fomites (non-living object that harbors microorganisms)
Stage of 0-6 month old and best toy
Sensory motor
Musical mobile, soft and large toys
Stage and best toy for 6-9 months
Working on object permanence
Cover-uncover toy, hard and large toys
Stage and best toy for 9-12 mo old
Learning to speak, purposeful movements
Talking toys/books, build, sort, stack, make
Stage, type of play, and best toy for toddler (1-3 yrs)
Working on gross motor skills
Parallel play
Push/pull toys
Stage, type of play, and best toy for preschool (3-6 yrs)
Working on fine motor skills and balance
Cooperative play, pretend play
Tricycles, tumbling class
Stage, type of play, and best toy for school age (6-12)
Creative
Collective
Competitive
Enjoys collecting things
What is a laminectomy?
Removal of vertebral spinous processes to relieve nerve root compression
What should you assess after a pt has cervical spine surgery?
Diaphragm and arms (breathing and arm/hand function)
What should you assess after a pt has thoracic spine surgery?
Cough and bowels
What should you assess after a pt has lumbar spine surgery?
Bladder and legs
Mobilization of patients after spinal surgery
Must logroll
Do not dangle
Do not sit for more than 30 min
May walk, stand, and lie down without restriction
Main post op complication of concern after cervical spine surgery
Pneumonia (b/c not breathing well)
Main post op complication of concern for a pt after thoracic spine surgery
Pneumonia (b/c can’t cough)
Ileus (b/c trouble with bowel)
Main post op complication of concern for a pt after lumbar spine surgery
Urinary retention
Problems with legs
Discharge teaching for a pt post spinal surgery
For first 6 weeks:
Do not sit for more than 30 min
Lie flat and log roll
No driving
No lifting more than 5 lbs
Permanent:
Do not lift by bending at waist
Cervical: no lifting above head
No jerky movements (horseback riding, amusement park rides, etc.)
List of lab values what are the highest priorities
Potassium >6
PH in 6’s
CO2 > or = 60
O2 < or = 60
Platelets <40,000
Treatment for potassium >6
Hold potassium
Assess heart
Prepare to administer sodium polystyrene sulfonate (kayexalate)
Call provider
Treatment for pH in 6’s
Assess vitals (will be going way down)
Call provider ASAP
Treatment for CO2 > or = 60
Assess respiratory status
Prepare to intubate and ventilate
Call respiratory therapy
Call provider
Treatment of O2 < or = 60s
Assess respiratory status
Prepare to intubate and ventilate
Call respiratory therapy
Call provider
List of next highest priorities
INR >4
Potassium <3.5
Hemoglobin <8
CO2 in 50’s
SaO2 < or = 92
Abnormal sodium with change in LOC
Total WBCs < 5,000
ANC <500
CD4 count <200 (AIDS)
Treatment for INR >4
Hold Coumadin
Assess for bleeding
Prepare to give vit k
Call provider
Treatment for potassium <3.5
Assess heart
Prepare to give potassium
Call provider
Treatment for potassium between 5.4-5.9
Hold potassium
Assess heart
Prepare to give sodium polystyrene sulfonate and D5W and regular insulin
Call provider
Treatment for hemoglobin <8
Assess for bleeding
Prepare to administer blood
Call provider
Treatment for CO2 in 50s
Assess respiratory status
Have pt do pursed lip breathing (usually solves problem)
Treatment for SaO2 < or = 92
Assess respiratory status
Give O2 (usually corrects problem)
Treatment for low WBC counts
Assess for s/s of infection
Initiate neutropenic precautions
Main side effects of all psych drugs
Low BP
Weight changes (usually weight gain)
What are phenothyazines?
1st gen antipsychotics
Ending for phenothyazines
All end in -zine
Actions of meds ending in -zine
(-zines for the Zaney)
Major tranquilizers (Do not cure, just reduce symptoms)
Large dose treats psychosis, small dose treats nausea
Side effects for -zine drugs
(A-G)
A: anticholinergic (dry mouth)
B: blurred vision
C: constipation
D: drowsiness
E: EPS (extra pyramidal syndrome)
F: photosensitivity
G: aGranulocytosis (low WBC count)
Biggest nursing diagnosis for pt taking a -zine
Risk for injury b/c of side effects
Action of tricyclic antidepressants (NSSRIs)
Mood elevators to treat depression
Ways to remember tricyclic antidepressants and a couple of examples
Ending in -triptyline, -ine or -line
Amitriptyline
Imipramine
Side effects of tricyclic antidepressants
Tricycles have 5 things that make them go (3 wheels and 2 pedals) = 5 symptoms (A-E)
A: anticholinergic (dry mouth)
B: blurred vision
C: constipation
D: drowsiness
E: Euphoria
Pt teaching for tricyclic antidepressants
Takes 2-4 weeks to start working
Actions of benzodiazepines
Anti-anxiety
Minor tranquilizers (at Led Zeppelin, minors are on tranquilizers & Zefs and zines are tranquilizers)
*Cannot take for >2-4 weeks
Side effects of benzodiazepines
(A-D)
A: anticholinergic (dry mouth)
B: blurred vision
C: constipation
D: drowsiness
Action of MAOIs
Antidepressants
Pt teaching for MAOIs
*Pt must avoid all foods with Tyramine
Examples of foods with tyramine in them
Fruits and veggies EXCEPT (salad BAR): bananas, avocados, raisins (or other dried fruit)
No organ meat or processed meat
No preserved meat
No aged cheese or yogurt
No alcohol
No caffeine (chocolate, soy sauce)
No OTC meds
Action of lithium
(Is an electrolyte)
Decreases mania (bipolar)
Stabilizes nerve cell actions (which changes its SE)
Side effects of lithium
(3 Ps)
Peeing
Pooping
Paresthesia
Toxic effects of lithium
Tremors
Metallic taste
Severe diarrhea
Number 1 nursing intervention for lithium toxicity
Ample IV fluids
Watch sodium level and for s/s of dehydration
(Low sodium = lithium more toxic)
(High sodium = lithium ineffective)
Example of SSRIs
Fluoxetine
Side effects of SSRIs
(A-E) (similar to NSSRIs)
A: anticholinergic (dry mouth)
B: blurred vision
C: constipation
D: drowsiness
E: euphoria
Nursing considerations for SSRIs
Causes insomnia so give before noon
Watch for suicidal ideation in adolescents and young adults only and only when dose is changed
What type of drug is haloperidol?
1st gen antipsychotic
Very similar to Thorazine
Side effects of haloperidol
(A-G)
A: anticholinergic (dry mouth)
B: blurred vision
C: constipation
D: drowsiness
E: EPS
F: photosensitivity
G: aGranulocytosis (low WBC count)
What is NMS?
Neuroleptic malignant syndrome
From overdose
Occurs in elderly and young white pts with schitz
How should you determine the difference between EPS and NMS?
Take pt’s temperature
EPS is ok but NMS is deadly
What type of drug is Clozapine?
2nd gen atypical antipsychotic
Action of clozapine
Treats zaney
Tranquilizer
Side effects of clozapine
Agranulocytosis
Nursing priority for pt taking clozapine
Monitor WBC
What is ziprasidone used for?
Schizophrenia
Bipolar disorder
Side effect of ziprasidone
Prolongs QT interval
Can cause sudden cardiac arrest
What type of drug is sertraline?
SSRI
Patient teaching for sertraline
Causes insomnia, but can give at bedtime
Taking with certain other drugs increases toxicities (St. John’s wort causes serotonin syndrome, warfarin/Coumadin dose must be lowered - watch for increased bleeding)
S/s of serotonin syndrome
(SAD HEAD)
Sweating
Apprehension (impending sense of doom)
Dizziness
Headache
