MED/SURG EXAM #4

Question 1

Thyrotoxicosis manifestations

Answer 1

Bulging eyes
Skinny

Question 2

Myxedema coma manifestations

Answer 2

– Puffy
– Slow metabolism
– Fatigue

Question 3

Foods to take when diabetic glucose is low

Answer 3

– 8oz SKIM milk
– 3 graham crackers
– 4oz orange juice
– 1 TBS honey
– 4 tsp sugar

Question 4

Healthy snacks for person with Addison’s disease

Answer 4

– Turkey and cheese sandwich –

NOTE: want diet with low K and high Na, carbs, and protein

Question 5

Foods HIGH in Potassium (K+)

Answer 5

– Bananas
– Baked potatoes
– Plain yogurt w/ peaches

Question 6

Grave’s disease

Answer 6

– Most common of hyperthyroid
– T3, T4 = high; TSH = low
–

Question 7

Hashimoto’s disease

Answer 7

– Excessive hypothyroidism

Question 8

Metabolic Syndrome

Answer 8

– RF for diabetes
– hypercholesteralemia
– enlarged waist size
–

Question 9

Which of the following clients are at risk for developing Cushing’s Syndrome?
a. A client w/ a tumor on the pituitary gland, which is causing too much ACTH to be secreted
b. A client taking glucocorticoids for several weeks
c. A client with a tuberculosis infection
d. A client who is post-op from an adrenalectomy

Answer 9

B. A client taking glucocorticoids for several weeks
– DO NOT stop abruptly b/c may cause

Question 10

Addison’s Disease

Answer 10

A decreased secretion of aldosterone and cortisol
– HYPONa+, HYPERK+, decreased weight, HYPOglycemia, HYPERCa2+

Question 11

Primary vs Secondary etiology of Adrenocortical Insufficiency

Answer 11

1~: Addison’s disease; reduction of glucocorticoids, mineralocorticoids, and androgens

2~: lack or pituitary ACTH; lack of glucocorticoids and androgens

Question 12

Clinical Manifestations: Graves Disease

Answer 12

Watch out for cardiac concerns

Question 13

Addison’s FIVE S’s

Answer 13

1. Sudden pain in back, legs, stomach
2. Syncope
3. Shock
4. Super low BP
5. Severe diarrhea, H/A, vomiting

NOTE: Think “tan, skinny, betch!*

Question 14

Causes of Addison’s

Answer 14

– autoimmune (adrenalitis)
– idiopathic
– surgery
– infection (TB)

Question 15

Acute Thyrotoxicosis

Answer 15

Thyroid storm
– Severe tachy, heart failure
– Shock
– Hyperthermia (up to 106.8F)
– Agitation
– Seizures
– Abdominal pain
– Delirium, coma

Question 16

Diagnostic tests for acute thyrotoxicosis

Answer 16

Decreased TSH (less than 0.4 mU/L)
 Increased free thyroxine (free T4)
 Total T3 and T4 (not definitive)
 Radioactive iodine uptake (RAIU)
 Distinguishes Graves’ disease from other forms of thyroiditis

Question 17

Medication treatment for Addison’s Crisis

Answer 17

IV Solu-Cortef – cortison needed NOW
– IV + glucocorticoid to make patient stable
1. NS w/ D5 = increase Na+ and K+
2. Hydrocortisone sodium (100-300mg) OR Dexamethasone (4-12mg IV bolus)
3. 100mg Solu-Cortef by continuous IV infusion over next 8hrs
4. Hydrocortisone (80mg) IM w/ H2O q12hr
5. IV H2 histamine blocker to reduce ulcer irritation (e.g. Ranitidine)

Question 18

Client has elevated temp +tachy w/ palpitations + HYPERthyroidism. What to do?

Answer 18

Thyroid storm
– Necessitates aggressive treatment
 Give medications that block thyroid hormone production
and SNS
 Monitor for dysrhythmias
 Ensure adequate oxygenation
 Fluid and electrolyte replacement

Question 19

RN Implementation for Acute Thyrotoxicosis

Answer 19

– Ensure adequate rest
– Cool, quiet room
– Light bed coverings (switch frequently b/c of they’re hot)
– Encourage and assist w/ exercise

Question 20

Postoperative Care for HYPERthyroidism

Answer 20

Hypothyroidism
 Hypocalcemia
 Hemorrhage
 Laryngeal nerve damage
 Thyrotoxicosis
 Infection

Have IV Calcium ready

Question 21

Treatment for HYPOthyroidism

Answer 21

Synthroid Levothyroxine
Complication that would cause a concern: Tachycardia, high temp, insomnia –> S/Sx of HYPERthyroidism

Question 22

HIGH Ca2+ manifestations vs. LOW

Answer 22

HIGH: Tingling of mouth and extremities; at risk for tetany (oral paresthesia)
LOW:

Question 23

Levothyroxine to Tx HYPOthyroidism, TSH levels?

Answer 23

TSH = will reduce/slow down (b/c thyroid being stimulated b/c not enough in body)
T3, T4 = increased

Question 24

True or False: You aspirate insulin shots into the subcutaneous fat.

Answer 24

False, not EBP anymore.

Question 25

Difference between subclinical HYPOthyroidism vs. Nonthyroidal illness syndrome (NTIS)

Answer 25

Subclinical hypothyroidism  TSH is greater than 4.5 mIU/L  T4 levels normal  Affects up to 10% of women over 60  Nonthyroidal illness syndrome (NTIS)  Critically ill patients  Low T3, T4, and TSH levels

Question 26

Primary vs Secondary HYPOthyroidism

Answer 26

Primary hypothyroidism -- Caused by destruction of thyroid tissue or defective hormone synthesis Secondary hypothyroidism -- Caused by pituitary disease (decreased TSH) or hypothalamic dysfunction or (decreased TRH)

Question 27

Diagnostic studies for HYPOtyroidsim

Answer 27

-- History and physical examination TSH and free T4: -- TSH increases with primary hypothyroidism -- TSH decreases with secondary hypothyroidism Thyroid antibodies: autoimmune origin LABS -- Elevated: cholesterol, triglycerides, creatine kinase -- Low: RBCs (anemia)

Question 28

Cushing's Manifestations

Answer 28

**S**kin fragile **T**runcal obesity **R**ound face ("moon face") **E**cchymosis w/ increased BP **S**triae on extremity (purple stretchmarks) **S**ugars increased **E**xcessive body hair **D**orsal cervical fat pad **D**epression LABS: HYPERNa+, HYPERglycemia, increased carbohydrates, HYPOK+

Question 29

Difference b/w Addison's vs. Cushing's

Answer 29

_Cushing's:_ increased secretions of cortisol (stress hormone) _Addison's:_ decreased secretion of cortisol

Question 30

Positive sign for Trosseau and Chvostek are indicated in which laboratory values?

Answer 30

Decreased Mg2+ Decreased Vitamin D Decreased Ca2+ NOTE: Trosseau is for *head* & Chvostek is for *face*

Question 31

What type of insulin do we use to treat DKA?

Question 32

List examples of 15 g of carbohydrates to treat hypoglycemia.

Question 33

What is the onset of action for regular insulin?

Question 34

List ways to prevent complications of diabetes.

Question 35

Criteria to diagnose diabetes.

Question 36

Locations for insulin injections.

Question 37

Criteria to diagnose Diabetes Insipidus (what about specific gravity?)

Question 38

Considerations for metformin.

Question 39

Risk factors for diabetes.

Question 40

When a client is sick and has diabetes, how often should they check their blood glucose?

Question 41

Manifestations of Cushing’s.

Question 42

Diet considerations for Cushing’s.

Answer 42

HIGH Na+ and LOW K+

Question 43

Nursing considerations to manage Addison’s Disease & Addison’s Crisis.

Question 44

Manifestations of hypoparathyroidism.

Question 45

What happens to magnesium level in a client with primary HYPERparathyroidism?

Answer 45

Mg2+ level is increased Ca2+ level is increased P3+ level is decreased

Question 46

Nursing considerations for client with hyperparathyroidism.

Question 47

Manifestations of hypothyroidism.

Answer 47

Mg2+ level is decreased Ca2+ level is decreased P3+ level is increased

Question 48

Post-op care & considerations following thyroidectomy.

Answer 48

Watch out for: hypothyroidism, airway compromising (ending in tracheostomy), check Ca2+ (parathyroid which controls might be nicked), assess for Chvosteks and Trousseau

Question 49

What is the test to determine if the thyroid is overactive, appropriately active or underactive?

Question 50

Why would a client need to add whole grains to their diet if they have hypothyroidism?

Question 51

Risk factors for SIADH?

Question 52

Manifestations of hypercortisolism.

Question 53

Lab Values

Answer 53

Phosphate: 3-4.5 Calcium: 8.5-10.5 Ca & Phosphate = inversely related

Question 54

What happens to phosphorous in a client who has hypoparathyroidism?

Answer 54

Increases in the blood (Phospohorous), but will decrease calcium levels

Question 55

We encourage clients to taper steroids and not suddenly stop because of what possible syndrome?

Question 56

Drugs to know: metformin, glipizide, prednisone, levothyroxine, vasopressin, regular insulin, NPH, glargine, hydrocortisone, hydromorphone