MED/SURG EXAM #4 Flashcards

1
Q

Thyrotoxicosis manifestations

A

Bulging eyes
Skinny

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2
Q

Myxedema coma manifestations

A

– Puffy
– Slow metabolism
– Fatigue

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3
Q

Foods to take when diabetic glucose is low

A

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

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4
Q

Healthy snacks for person with Addison’s disease

A

– Turkey and cheese sandwich –

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

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5
Q

Foods HIGH in Potassium (K+)

A

– Bananas
– Baked potatoes
– Plain yogurt w/ peaches

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6
Q

Grave’s disease

A

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

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7
Q

Hashimoto’s disease

A

– Excessive hypothyroidism

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8
Q

Metabolic Syndrome

A

– RF for diabetes
– hypercholesteralemia
– enlarged waist size

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9
Q

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

A

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

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10
Q

Addison’s Disease

A

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

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11
Q

Primary vs Secondary etiology of Adrenocortical Insufficiency

A

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

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

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12
Q

Clinical Manifestations: Graves Disease

A

Watch out for cardiac concerns

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13
Q

Addison’s FIVE S’s

A
  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!*

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14
Q

Causes of Addison’s

A

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

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15
Q

Acute Thyrotoxicosis

A

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

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16
Q

Diagnostic tests for acute thyrotoxicosis

A

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

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17
Q

Medication treatment for Addison’s Crisis

A

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)

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18
Q

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

A

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

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19
Q

RN Implementation for Acute Thyrotoxicosis

A

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

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20
Q

Postoperative Care for HYPERthyroidism

A

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

Have IV Calcium ready

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21
Q

Treatment for HYPOthyroidism

A

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

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22
Q

HIGH Ca2+ manifestations vs. LOW

A

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

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23
Q

Levothyroxine to Tx HYPOthyroidism, TSH levels?

A

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

24
Q

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

A

False, not EBP anymore.

25
Q

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

A

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

26
Q

Primary vs Secondary HYPOthyroidism

A

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)

27
Q

Diagnostic studies for HYPOtyroidsim

A

– 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)

28
Q

Cushing’s Manifestations

A

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+

29
Q

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

A

Cushing’s: increased secretions of cortisol (stress hormone)

Addison’s: decreased secretion of cortisol

30
Q

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

A

Decreased Mg2+
Decreased Vitamin D
Decreased Ca2+

NOTE: Trosseau is for head & Chvostek is for face

31
Q

What type of insulin do we use to treat DKA?

A
32
Q

List examples of 15 g of carbohydrates to treat hypoglycemia.

A
33
Q

What is the onset of action for regular insulin?

A
34
Q

List ways to prevent complications of diabetes.

A
35
Q

Criteria to diagnose diabetes.

A
36
Q

Locations for insulin injections.

A
37
Q

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

A
38
Q

Considerations for metformin.

A
39
Q

Risk factors for diabetes.

A
40
Q

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

A
41
Q

Manifestations of Cushing’s.

A
42
Q

Diet considerations for Cushing’s.

A

HIGH Na+ and LOW K+

43
Q

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

A
44
Q

Manifestations of hypoparathyroidism.

A
45
Q

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

A

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

46
Q

Nursing considerations for client with hyperparathyroidism.

A
47
Q

Manifestations of hypothyroidism.

A

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

48
Q

Post-op care & considerations following thyroidectomy.

A

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

49
Q

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

A
50
Q

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

A
51
Q

Risk factors for SIADH?

A
52
Q

Manifestations of hypercortisolism.

A
53
Q

Lab Values

A

Phosphate: 3-4.5
Calcium: 8.5-10.5

Ca & Phosphate = inversely related

54
Q

What happens to phosphorous in a client who has hypoparathyroidism?

A

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

55
Q

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

A
56
Q

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

A