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: