MED/SURG EXAM #4 Flashcards
Thyrotoxicosis manifestations
Bulging eyes
Skinny
Myxedema coma manifestations
– Puffy
– Slow metabolism
– Fatigue
Foods to take when diabetic glucose is low
– 8oz SKIM milk
– 3 graham crackers
– 4oz orange juice
– 1 TBS honey
– 4 tsp sugar
Healthy snacks for person with Addison’s disease
– Turkey and cheese sandwich –
NOTE: want diet with low K and high Na, carbs, and protein
Foods HIGH in Potassium (K+)
– Bananas
– Baked potatoes
– Plain yogurt w/ peaches
Grave’s disease
– Most common of hyperthyroid
– T3, T4 = high; TSH = low
–
Hashimoto’s disease
– Excessive hypothyroidism
Metabolic Syndrome
– RF for diabetes
– hypercholesteralemia
– enlarged waist size
–
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
B. A client taking glucocorticoids for several weeks
– DO NOT stop abruptly b/c may cause
Addison’s Disease
A decreased secretion of aldosterone and cortisol
– HYPONa+, HYPERK+, decreased weight, HYPOglycemia, HYPERCa2+
Primary vs Secondary etiology of Adrenocortical Insufficiency
1~: Addison’s disease; reduction of glucocorticoids, mineralocorticoids, and androgens
2~: lack or pituitary ACTH; lack of glucocorticoids and androgens
Clinical Manifestations: Graves Disease
Watch out for cardiac concerns
Addison’s FIVE S’s
- Sudden pain in back, legs, stomach
- Syncope
- Shock
- Super low BP
- Severe diarrhea, H/A, vomiting
NOTE: Think “tan, skinny, betch!*
Causes of Addison’s
– autoimmune (adrenalitis)
– idiopathic
– surgery
– infection (TB)
Acute Thyrotoxicosis
Thyroid storm
– Severe tachy, heart failure
– Shock
– Hyperthermia (up to 106.8F)
– Agitation
– Seizures
– Abdominal pain
– Delirium, coma
Diagnostic tests for acute thyrotoxicosis
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
Medication treatment for Addison’s Crisis
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)
Client has elevated temp +tachy w/ palpitations + HYPERthyroidism. What to do?
Thyroid storm
– Necessitates aggressive treatment
Give medications that block thyroid hormone production
and SNS
Monitor for dysrhythmias
Ensure adequate oxygenation
Fluid and electrolyte replacement
RN Implementation for Acute Thyrotoxicosis
– Ensure adequate rest
– Cool, quiet room
– Light bed coverings (switch frequently b/c of they’re hot)
– Encourage and assist w/ exercise
Postoperative Care for HYPERthyroidism
Hypothyroidism
Hypocalcemia
Hemorrhage
Laryngeal nerve damage
Thyrotoxicosis
Infection
Have IV Calcium ready
Treatment for HYPOthyroidism
Synthroid Levothyroxine
Complication that would cause a concern: Tachycardia, high temp, insomnia –> S/Sx of HYPERthyroidism
HIGH Ca2+ manifestations vs. LOW
HIGH: Tingling of mouth and extremities; at risk for tetany (oral paresthesia)
LOW:
Levothyroxine to Tx HYPOthyroidism, TSH levels?
TSH = will reduce/slow down (b/c thyroid being stimulated b/c not enough in body)
T3, T4 = increased
True or False: You aspirate insulin shots into the subcutaneous fat.
False, not EBP anymore.
Difference between subclinical HYPOthyroidism vs. Nonthyroidal illness syndrome (NTIS)
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
Primary vs Secondary HYPOthyroidism
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)
Diagnostic studies for HYPOtyroidsim
– 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)
Cushing’s Manifestations
Skin fragile
Truncal obesity
Round face (“moon face”)
Ecchymosis w/ increased BP
Striae on extremity (purple stretchmarks)
Sugars increased
Excessive body hair
Dorsal cervical fat pad
Depression
LABS: HYPERNa+, HYPERglycemia, increased carbohydrates, HYPOK+
Difference b/w Addison’s vs. Cushing’s
Cushing’s: increased secretions of cortisol (stress hormone)
Addison’s: decreased secretion of cortisol
Positive sign for Trosseau and Chvostek are indicated in which laboratory values?
Decreased Mg2+
Decreased Vitamin D
Decreased Ca2+
NOTE: Trosseau is for head & Chvostek is for face
What type of insulin do we use to treat DKA?
List examples of 15 g of carbohydrates to treat hypoglycemia.
What is the onset of action for regular insulin?
List ways to prevent complications of diabetes.
Criteria to diagnose diabetes.
Locations for insulin injections.
Criteria to diagnose Diabetes Insipidus (what about specific gravity?)
Considerations for metformin.
Risk factors for diabetes.
When a client is sick and has diabetes, how often should they check their blood glucose?
Manifestations of Cushing’s.
Diet considerations for Cushing’s.
HIGH Na+ and LOW K+
Nursing considerations to manage Addison’s Disease & Addison’s Crisis.
Manifestations of hypoparathyroidism.
What happens to magnesium level in a client with primary HYPERparathyroidism?
Mg2+ level is increased
Ca2+ level is increased
P3+ level is decreased
Nursing considerations for client with hyperparathyroidism.
Manifestations of hypothyroidism.
Mg2+ level is decreased
Ca2+ level is decreased
P3+ level is increased
Post-op care & considerations following thyroidectomy.
Watch out for: hypothyroidism, airway compromising (ending in tracheostomy), check Ca2+ (parathyroid which controls might be nicked), assess for Chvosteks and Trousseau
What is the test to determine if the thyroid is overactive, appropriately active or underactive?
Why would a client need to add whole grains to their diet if they have hypothyroidism?
Risk factors for SIADH?
Manifestations of hypercortisolism.
Lab Values
Phosphate: 3-4.5
Calcium: 8.5-10.5
Ca & Phosphate = inversely related
What happens to phosphorous in a client who has hypoparathyroidism?
Increases in the blood (Phospohorous), but will decrease calcium levels
We encourage clients to taper steroids and not suddenly stop because of what possible syndrome?
Drugs to know: metformin, glipizide, prednisone, levothyroxine, vasopressin, regular insulin, NPH, glargine, hydrocortisone, hydromorphone
