N212 - Health across the lifespan 2 Flashcards
Psychiatric Nursing,
DSM-IV
(Diagnostic and Statistical Manual of Mental Illness)
tool to Dx of mental illness
5 Axes of DSM
- Clinical disorder that is the focus of tx (i.e. bipolar)
- personality disorder/mental retardation
- Medical condition (i.e COPD, Cancer)
- Psychosocial/Envt probs (death of parent)
- Global Assessment of Functioning (GAF) Scale
Therapeutic Interaction
facts only, no opinions, no reassurance, no advice
Forbidden Phrases when dealing with Mentally Ill
.avoid social interactions, cliches and saying too much.
.DON”T change subjects (they think you are ignoring them)
.avoid GOOD, BAD, RIGHT, WRONG, NICE
Coping: Fantasy
unrealistic, excessive day dream, watch tv for hours,
Coping: Identification
person unconsciously adopts personality of someone else. to relieve anxiety.
Coping: Intellectualization
aka isolation. hiding emotional responses under facade of words.
Coping: Introjection
begins to follow vegan diet for no reason like others?
the unconscious adoption of the ideas or attitudes of others
Coping: Projection
project anger on others. student failed test and blames parents for tv too loud.
Coping: Rationalization
substitute acceptable reason for real and actual reason
Coping: Reaction Formation
person behaves opposite of how they feel
Coping: Regression
return to childhood behaviour
Coping: Undoing
tries to undo harm he has done to others. When others are rude to some one, he will apologize or try to make person feel comfortable.
Coping: Repression
block out events. but experience unesasy feels when near triggers. sometimes uncounsious
Coping: Sublimation
unacceptable into acceptable : chanel sex drive into sports
UNIT 1: Grief
Shock, Denial, Guilt/Anger, Bargaining, Depression, Acceptance.
4 Levels of Anxiety
general
Mild
Moderate
severe
Mild Anxiety
.Individual is ALERT
.attention i possible
. allows person to take risks, interview for new job etc.
Moderate Anxiety
. decreased perceptual field .difficulty concentrating .lose site of details in envt. . perception narrows. .Pacing .PRN Meds
Severe Anxiety
trouble thinking, reasoning, muscle tighten, can not learn, brain freeze
.individual needs direction to focus
Panic
not panic disorder
feeling of impending doom. monitor for suicide, safety, stay w patient.
ss angry, aggressive, withdraw, clingy, crying need intervention
Psychoanalytical Theory
.psychic conflict
.Freud, stages of psychosexual, ID, EGO, SUPERGO
poor personal skills, difficulty w relationships
Interpersonal Theory
Sullivan, Pavlov
human development results from interpersonal relationships.
Cognitive/Behavioural Theory
Skinner, Piaget, Erikkson, Pavlov
learn through experisnce.
Biological Theory
Genetics
brain abnormalities
neurochemical theorists
GABA, 5Ht, NE
TX:
combo med/therapy
Cognitive Behaviourl Therapy:
.Assertiveness Trining (behaviral, use pos reinforcement, shaping, remodlig to reduce anxiety)
.Positive Reframing (build on principals. attempt to gradually instil pos attitude towards phobia)
.Decatastrophizing (desensitizing, tx of choice for phobias)
.Biofeedback
.Narcotherapy
.Electroconversive (ECT) last resort. severe mental state
Anxiety Disortders
.GAD (Generalized Anxiety Disorder) .PD (Panic Disorders) .OCD .Phobic disorders (agorophobia etc) .ASD (acute distress disorder) and PTSD
General Anxiety Disorder (GAD)
more common WOMEN
.free floating anxiety .slow forming .chronic .mild - sever - debilitating .can lead to self medication
Cause: Idiopathic
SS: .nervousness, irritability, apprehension, agitation, tension, tachy, diaphoresis, SOB, diff sleeping, overlap w panic/depressive, insomnia, cold clammy hands, poor concentration, worry over minor matters, fear of grave misfortune, procrastination, avoidance, poor problem solving skills
TX: non rx first (relaxation, bio feedback …
Panic Disorder
more common MEN
.anxiety in most severe form.
.recurrent panic attacks
.late adolescents- mid adult. rarely after age 50
. diff from fear. No warning, just comes on.
.duration 15-20min. can reoccur for hours.
50% develop phobia
self medicate
Panic Attack SS
miimc heart atack
SOB, rapid shallow breath, chest pain, pressure, nause, dizzy, chills, exagerated speech, startled
TX: therapy, cognitive behaveoral
Phobias
irrational
.Agoraphobia: fair of marketplace
.Social Phobia
.Specific Phobia (natural evnt, blood inj, situational, animal, others
Mgmt: assertivenes training, social skill group, behavior therapy (systematic desensitization, flooding, self exposure)
TX: NO critizism
ASD (Acute Stress Disorder)
Develops after exposure to clearly identifiable traumatic event.
ASD
onset: within 4 wks after event
duration: 2 days - wks
SS: start during or shortly after trauma, numbness, impair fx, hurt relationships. may begin as soon as 2 days after trauma. Resolves in 4 wks could re dx to PTSD
TX: discuss and validate event. ID feeling of survival guilt, tch relaxation, prn meds
? PTSD
onset: acute within 6 mos after event. delayed, over 6mos after event
duration: 1-3months / 3 or more months
SS:
Tx:
** Personality Disorders Clusters **
Cluster A: (odd/eccentric)
PSS (Paranoid, Schizoid, Schitotypical personalities)
Cluster B: (Dramatic, emotional, erratic)
BHAN (borderline, hystrionic and narcisistic)
CLUSTER C: (anxios/fearful)
ADO avoidant, dependant, OCD
CLUSTER A (SUSPECT)
SUSPECT
.Spouse fidelity, suspected .Unforgiving (grudges) .Suspicious .Perceives attacks, react quickly .Enemy or Friend .Confiding in others feared .Threats perceived in benign events
humorless, envious, bad temper, lack of social support, don’t seek help unless there is a problem.
CLUSTER A:
Psycotherpeutic Mgmt
trust, formal, business like manner. don’t ask too many personal questions. don’t challenge their paranoid beliefs
CLUSTER A: Schizoid DISTANT
.Detached/flat affect .Indifferent to criticism or praise .Sexual little interest .Tasks solitary .Absence of close friends .Neither desire or enjoy close relations Take pleasure in few activities
CUSTER A:
Schizotypal Personality
ME PECULIAR
ME PECULIAR
.Magical thinking/odd beleifs
.Experiences unusual perceptions
.Paranoid ideation .Eccentric behaviour or appearance .Constricted (or innapropriate) affect .Unusual (odd) thinkingg and spech .Lack close freind .Ideas or reference .Anxiety in social situations .Rule out psychotic disorder and pervasive develpoem disorder.
easily overwhelmed by stress, be patient,
CLUSTER B B H A N
.Borderline
.Histrionic
.Antisocial Personality
.Narcisist
Antisocial Personality Disorder TYPE B, CORRUPT
MEN, 50% prison population
CORRUPT
.Conform to law, LACK .Obligations ignored .Reckless disregard for safetly or self/others .Remorse lacking .Underhanded .Planning insufficient (Impulsive) .Temper
charming, manipulative, arrogant, irritable, aggressive, maintain close personal/sexual relationship
TX: pt making connections betwn feeling and bahaviour
PEAK 20yrs
under age 15 = conduct disorder
Limit Setting
3 steps
.state behavioral limit
.id consequences
.id expected behaviour
be consistent, apply consequences, avoid power struggles, avoid arguing, not personal., all business
Borderline Personality Disorder: TYPE B
AM SUICIDE
AM SUICIDE
.Abandonment
.Mood instability
.Suicidal/self mutilating behavious .Unstable/intense relationships .Impulsive without thinking consequence .Control of anger .Id disturbane .Dissociative or paranoid, stress related .Emptiness, chronic feelings of
20s. Suicidal,
TX: mylutherapy?
dont be sympathetic, promote trust, may idolize staff and not like others, will play you against others,
lithium, valproic acid, benzodiazapine
Hystrionic
PRAISE ME
PRAISE ME
.Provocative behaviour .Relationships .Attention seeking .Influenced easily .Style of speech .Emotions shallow .Made up appearance to draw attention .Emotions exagerated, theatrical
infidelity, egocentric, lack of consideration for others
TX: Meds
NI: choices in care options. incorporate care options into care plan. increases their sense of control.
Narcissistic : TYPE B
NI: acknowlendge pt sense of self importance
focus on positive. non judgemental, no aruing or defensivenes.s gain trust, teach social skills, reinforce appropriate behavior
CLUSTER C (anxious, fearful)
CRINGES
Avoidance
Dependent
Obsessive
CRINGES
AVOIDANCE
.Cretaintay or
.Rejection
.Intimate relationshi
SLIDE ?
SS: shyness, timid, low selfesteem, reluctance to speak, overtalkative, weariness w others, test sincerity, diff starting and maintain relationship rejeions of people who don’t meet thier high standards, self counscious, loner, don’t take personal risks, frequent escape to fantasy
NI: persistent, consitent and flexible care. gain trust, give lots of advanced notice, accountable for actions, teach relaxation to manage anxiety, coping skills
Dependent RELIANCE
SLIDE
RELIANCE
.R .E .L .I .A .N .C .E
Obsessive Compulsive
LAW FIRMS
SLIDE
LAW FIRMS
.L
.A
.W
.F .I .R .M .S
perfectionist, hoarder, miserly, cheap, rigid
SCHIZOPHRENIA
MEN/WOMEN equal
more common than alzheimers
group of severe disabling psychiatric disturbances in thought, senseory, emotions, mvmnts, behaviour.
Types: Catatonic, Paranoid, Disorganized, Residual, Undifferentiated
hard to maintain job, relationship, school, personal hygiene. Life expectancy 10yrs shorte. 10% commit suidide in first 10yrs of illness.
ONSET:
Men 15-25
Women 25-35
worse prognosis each episiode. most suffer lifeong. 30% not resonsive to meds.
Schizo Speech Abnormalities
.clang associations (rhyming) .echolalia (meaningless repetition) .Loose association and flight of ideas .word salad .neologisms made up words w meaning only for patient
Schizo Thought Distortion
.Overly concrete thinking, delusions
.hallucinations, .thought blocking
.magical thinking
Schizo POSITIVE SS
TEMPORAL LOBE, indicates lost touch w reality
.abnormal thought form .agitation, tension .association disturbances .bizaare behaviour .conceptual disorganization .delusions .excitement .feeling of persecution .grandiosity .hallucinatinos .hostility .ideas of reference .illusions .insomia .suspicious
UNIT 2
UNIT 2
who coined the term ‘Schizophrenia’?
E. Bleuler
affective disorder
Schizophrenia Positive SS
linked to brain abnormatlities
and Temporal lobe abnormalite
Schizophrenia Negative SS
linked to brain abnormatlities
.ventricles and frontal cortex?
.Alogia .Apathy, lack of intereest in anything. flat affect. no expression .anhedonia asocial ebhaviour attntion efecit avolition .blunt affect .commun difficulties, diff w abstractions, passive sical weithdrawal, poor grroming//hygiene, poverty of speech
Schizophrenia Disorganized SS
relects abnormal thinking
confused thinking, mild to incoherent rambling
Speech Abnormalities
Catatonic, Paranoid
Schiz Etiology
brain abnormality
Phases
1. Prodromal (1 yr before obvious ss, wdraw from friends, school performance suffers, etc)
2. Active: acute psychotic ss. delusions, catatonic, d/t trauma (get worse after every episode)
3. Residual
Psychological (disability levels stabilized, ss similar to prodromal)
Paranoid Schitzp[hrenia
decline. all ss
plateau at 5 years
w have several relaps by 45 d/t non compliance with meds.
Schiz Tx:
.neuroleptic rx (prevent relapse of acute ss)
Side Effects: .Parkinsonian ss .akathisia .constipation .urinary retention *.photosensitive .drowsy .pruritus *.tardive dyskinesia .neuroleptic malignant ss
ss present up to 24mos before tx usually starts.
therapy
Extrapyramidal Syndrome
Parkinsonism
Tardive Dyskenesnia
Typical Rx
antipyschotic drugs. ONLY address POSITIVE ss
clorazine (first drug ever used on schitz)
Haldol
Atypical
relieve Positive AND Negative ss
lowers neutrophils
Ability
Cloanzapine
4-8wk to assess if working
Lithium
Depakote
Tegrol
Types of Schizophrenia
Paranoid
Catatonic
Disorganized
Paranoid Schiz
one or more delusions or prequen auditory hallcinations
.grandiose delustions.
less disabled than other types
respond to meds
don’t touch. don’t laugh or whisper. keep distance. serve sealed food, don’t tease, joke or argue
Disorganized SS
disorganized speech, loose association, blunt, silly, superficial, grmimace, can withdraw socially.
Intervention: quit envt, information boards, simple schedule
Catatonic
rare
waxy, stupor
rapid swing between stupor and excitement
.extreme negativism or mutisim
NI: immobility to minimize circulatory problems and loss or muscle tone
.adequate diet, exercise and rest
Depression
Mood Disorder
Mood Disorder
.Bipolar
.Major Depressive Disorder
.Cycloclothymic
Major Depressive Disorder
5 of ss for 2 wks .depressed mood .anhedonia .change weight .insomnia .change psychomotor .fatigue .guilt .lo concentratoin .suicidal
Major Depressive Disorder
5 of ss for 2 wks .depressed mood .anhedonia .change weight .insomnia .change psychomotor .fatigue .guilt .lo concentratoin .suicidal
NI:
Major Depressive Disorder
5 of ss for 2 wks .depressed mood .anhedonia .change weight .insomnia .change psychomotor .fatigue .guilt .lo concentration .suicidal
NI:
Major Depressive NI:
.safety
.increase self esteem, give praise
.punching bag/foam bats
Mood Disorder: Bipolar
aka Manic, Mood Disorders
.1wk
.at least 3 of ss
inflated self esteem, grandiosit, lo need for sleep, talkative, flight of ideas, distractibility, psychomotor agiation, excessive involvemnt in pleasurable activity
.extreme HI w extreme LO
ONSET 20-30
hypomanic
4 days
not sever enoght o result in signifiatnt impairment.
BiPolar 1 and !!
most severe
sever mania
Bipolar !!
hypo mania w alternate depressive episodes
Cyclothymic Disorder
2 yrs, hx of hypomanic anddepressed mood
grandiosity rapid speech distracted imparire judgement rapid response to external stimuli .manic, depressed
NI: safety, reduce stimuli, safe envt, no competition, realistic limit behavior, hi cla diet, rest, sleep, hypnotic/sedative
Lithium Therapy
main tx for Bipolar
affects cellular mechanism,
Anti Inflammatory increase Lithium toxiciy
monitor * blood levels (narow therapeutic margins) check 8 -12 hrs after first dose, then 2/3 times weekly, then weekly to monthly
not for people who cant have regular blood testing. not for renal impairment.
0.6 - 1.2 mEq/L (.5 -
NI:
.6-8 glasses water (3k ml).
.replace sodium, not too much or it they will lose lithium and ss return
SIDE EFFECTS: dry mouth tremors ataxia thirst weight gain soft stool/diarhea meds w food or after meals. muscle weaknes fatigue hair loss increase urinatino tremors
no driving on meds. monitor for suicide
take missed does within 2 hours. don’t adjust or double up.
therapeutic response 2-4wks
Delerium
sundown, like prison
Reversible. Acute, comes on fast.
fearfulness, disorientation, agitation, confustion, delusion, sometimes hallucination. withdrawal from etoh, drugs
watch se’s. control envt.
NO benzodiazapines, unless caused by etoh. phyical or cemical restrains
Dementia
Chronic, not normal aging process.
.not reversible .r/t alzheimer's or TIA's .Alzhiemers .most common cause of disabiity in elderyl .6th cause deat 85 and older .
Alheimers
plaques in brain. kills neurons.
Dx: through autopsy, view amaloid plaque
Demential SS
Early:
.Agnosia (don’t recognize objects)
.Ataxia (
.
Mild: forgetfulness, can’t find words
Moderate: confusion w progressive mem loss, no complex tasks, oriented to person, place, thing. need caregiver
.Severe: personality changes, delusional, wandering, help w adl’s, in nursing facility
Delerium vs Dementia
Delerium: acute, fluid intervals, hours to weeks
awareness reduces, mistake familiar places, immediate mem loss, incoherent speech, interupted sleep
Demential: insidious, no change, month to years, awareness clear, orientation impaired, fragment sleep
Reversible Dementia
Non Reversible Dementia
Reversible: lupus, up lo thyroid, UTI, etc
non-reersible: alzheimers
65 yrs or older
5 Stages of Alzheimerg
Mild: diff balancing checkbook
Moderate
Severe
Mild Alzheimers
.trouble balancing check book .preparing complex= meals .med schedule probs .poor concentration .try to cover up ss .deter personal apperance .bad short term mem .sleep disturb .no new memories .clumbsy
Moderate Alzheimers: Stage 2
,diff simple food prep .no clean up, yard work .help w =adls .tantrum .incontinence .make up things to hide memory loss .apraxia, agnosia, aphasia .don't remember person, plate, thing, fam members
Severe Alxhimers
.need assistance w personal care, toileting
Profound
obvlivious to sorrounding
terminal
bed bound, non respnosive. brain eating away at itself. no appetite.
Alz Tx
no cure
look for side effects
aricept
cognix
ravistifmine
galantamine
ginko nsaids vite estrogen ccb's prevent influx
2:37 Class 2
2:37, class 2
Parkinson’s
hypokenetic disorder. degenerative, progressive,chronic. EPS area of brain. Idiopathic. imbalance of acetalcholine and dopamine.
caused: viral, head trauma, intoxication,
LO dopamine, affect coordination.
SS: pill rolling tremors, shuffling gate, mask like facial, drooling, fatigue, general weakness, constipation, orth hypotension, hallucinations
Dx: PET, PEG, CAT scans
NI: DIET, hi residue, hi calorie, soft food
Rx: antocholernergi
cogentin, sinemet, carbidopa
LOTS of diff meds.
NI: maintain diet, assess neuro vascular, reposition to prevent contracture, vs, daily ambulation, maintai patent airway, oral hygiene, emoti=onal support.
Diffuse Lewy Body Disease
similar to Alzheimers. rapid, no slow like Alzheimers
YOUTUBE
Huntington’s Disease
disturbanec in gait, slurred speech, neuro - intellectual deterioratoin, lose muscle controld, tongue, breathing
hereditary
Pick’s Disease
simiar to Alz
associaed w aging.
duration, 5-7yrs.
shrinkage of frontal lobe.
Creutzfeldt Jakob Disease
aka Prion Disease
non inflam dementia.
visiaon, hearing loss, muscle wastering, tremors, hallucinations,
Vascular or Multi Infarction Dementia
leading cause of vascular probs to brain 85 and older pop
Alcoholic Dem
15-20yrs continuous drinking
SS:
.Toxic to neurons (wetbrain)
.disruptive neutritional defincit
.CNS defecit
Transient Ischemic Attacks
micro embolisms to brain through sclerotic plaque
Psychotherapeutic Mgmt.
Delerium: Safety, Optimal level of fxing. praise, touch, affection when possible, use title and last name, learn background and lifestyle
3 Miliem Relate=d Issues
Stress
Safety
Wandering
Don’t change envt
No new skills
Clock/Calendar
3 stages
.Forgetfulness
.Wandering
Rx; Serox, Ativan
Substance Abuse
.Alchohol,
Alchoholism
primary drug prob. cns depressent,. rapidly into bloodstream.
SS
Biological dependence
loss of control
maladaptive consequenses
Etiology: learner behaviour, inhertitted, oral fixation (freud)
Effects: relaxation,
SS: slurred speeech, unsteady gait, lack coordination, impared attention, concentration, memory, judgement diarrhe,a ulcers, cirrosis, delerium,
korsakoff psyvchosis
thiamine, niacin deficient
wernicke’s encephalopathy
thiamine deficiency
Alcholholi RX
Benzodiazepines
.Lorazepam (ativan)
.Diasepam (valium)
Diulfiram (antabuse)
avoid products w ETOH
Odansetron (Zofran)
Tx for methampetamine
Stimulant Abuse
uppers, speed, crank
cocain: snorted
detox
by 10% per day
Intoxicatoin
develops rrapidly
OD
arythmia, respiratory collapse
death rare
TX
induce vomiting, forced diuresis
Rx: Zofran,
Cannabis Sat
2 Cannabinoids
Marinol (Dronabinol)
Cesamet (Nabilone)
Endocrien
Adrenal: aldosterone
Renal Cortex: Cortisol (cushings, addison’s , stress hormone anti infla,
Medula: works with ANS, ephinepherine and norepinepherien, broncho dilater, stress hormone.
UNIT 3 - Endocrine
UNIT 3 - Endocrine
Thyroid controlled by
Pit - Anterior
T3/T4 metabolic rate
Calcitonin keeps Ca in bones.
Parathyroid
regulates itself. Ca levels LO, para releases hormone to decrease bone decalcification
Parathyroid PULLS Ca out of bone
Pancreas
Endocrine/Exocrine
Beta - secretes insulin, allows liver and body to take in glucose to store as glycogen
Low Blood Glucose, Alpha releases glucogon. liver breaks down and inc blood glucose levels
Ovaries/Testes
Pit - Ant
FSH and Leutenizing hormone
Hormone Regulation
.neg feedback mech
.change blood levels of Ca and Glucose
.
Pos Feedback Syst
body already producing the hormone. Body produces more for incident, then reduces to normal again.
Endocrine Sys controlled by
Hypothalmus
Hyperpituitariasm
hypermeglia, hypercretion of growht hormone
SS:
visual defects
.large nose/jaw, teeth separated/missing
.spade shaped hands/feet, arthrosis, peripheral neuropathy, sex dysf, cardiomegaly hypertension, hypertrophy of sweat/sebaceous glasds.
Hyperpituitarism SS
aka Simmon’s Disease
hypo fx of anterior pit gland.
NI .meds per rx .express feelings .skin care, repositiosn .monitor for infection .post op care
hypopituitarism
hypo- thermia, glycemia, tension
low growth hormone
DECREASED:
GH from Ant Pit
.poor muscle mass
.no strength
ACTH from Ant Pit
.fatigue
.diminish tolerance for stress
ADH from Post Pit
.Diabetes insipidus
TX: Sx to remove tumor, radiation to shrink, hormone replacement therapy
Trans-sphenoidal hypopysectomy
A transsphenoidal hypophysectomy is a surgical procedure most commonly used to remove a tumour of the pituitary gland. Transsphenoidal means through the sphenoid sinus. This is the air sinus (cavity) at the back of your nose.
Post Pit Complications
ADH (works on collecting tubules of kidney)
.Diabetes Insipidus
.AIDH
Diabetes Insipidus (DI) - PIT Disorder
Deficiency of ADH
disorder of water balance regulation
Etiology: .neuro conditions .sx .tumors .head injury .inflamm probs
Cause: .Trauma .Tumor .Head injury .failure of kidney to respond .congenital malformation
SS:
polyuria
NI: .hormonal replacement (vasopressin) .non hormonal therapy .UP fluid .monitor I&O / weight
SIADH (syndrome of inappropriate adh) - PIT disorder
UP ADH levels
SS: .concentrated urine .lo urine output .up weight .mental confusion (food building up in brain) .cerebral edema (sz, unconsiosness) .n/v .fluid overload
NI: .water intake restriction .diuretics .elevate bed head (up to 5%) .Tetracycline (interfreres w action of adh) .mouth care
Dx Tests:
1. serum Na. - pos greater than 134. SG up 1.005
ID, SUPERGO, EGO
ID: Instincts (devil on shoulder)
EGO: Reality (you, conscious)
SUPER EGO: Morality (angel on shoulder)
Freud’s 5 Stages of Psychosexual Developments
- Oral stage: birth to 2; breastfeeding, putting objects in mouth
- Anal stage: 18 months to 3 years; toilet training
- Phallic stage: 3 to 6 years; genitalia primary erogenous zone; become aware of bodies
- Latency stage: 6 years to puberty; external activities
- Genital stage: puberty to adult life; independence from parents; consensual adult sexuality
O 0-2mos A 18mos - 3 P 3-6 L 6-pube G pube - adult
Erikson’s Developmental Tasks
Trust vs. mistrust: birth to 18 months
Autonomy vs. shame and doubt: ~18 months to 3 years
Initiative vs. guilt: ~3 to 5 years
Industry vs. inferiority: ~5 to 13 years
Identity vs. role confusion: ~13 to 21 years
Intimacy vs. isolation: ~21 to 35 years
Generativity vs. stagnation: ~35 to 60 years
Integrity vs. despair: ~60 to death
Eriksons 8 stages Numonic
- BUN, rust, mistrust
- SHOE
- TREE
- DINOSAUR
- DIVE
- STICKS
- HEAVEN
- PLATE
1:04
thyroid disorder
DI contd
Polyuriea Greater then 5L per day
Polydyspsis 4-40L p day
olorless urine, tahy, hypotension, constant ha.
SG les than 1.010
urine dilute, pt always thirsty. can not make concentrated urine.
Mgmt:
Dx adn Tx IV therapy hyration, electrolyte up anticonvulsive (tegretol) adh replacement, diuretics, antiinflam
monitor i/O, weight, fluid electrolyte balance.
Thyroid Disorders
gland stimulates cell metab
hormones: t3(bound to T4, regulate respiratory rate / T4 (throxin, main hormone)
TSH
UP T3/T4 raisesmet rate.
Hypothroidism
underactive. lo secreation of thyroid hormone
causes:
mid age women, peole w hashimotos. thyrodectomy, any pit malfunction, use of radiaocactive iodine, preg toxemia.
low T3/T4
up TSH, Cholesterol
LO oxidation of nutrients, met rate, heat production
SS:
Edema, weight gain, clammy cold skin, coarse hair, alopecia, thick tongue, swolen lip, mental sluggsh constipation, muscle weakness, aches, hypersentist to opioids, anorexia, lo diaphoresis, brittle nails/hair, dull blank expresion, eyelid edema, reced hairline, menstrual distrubances
NI:
1:!2
Hurtuism
Hypo Complications
.cretinism
.myxedema/ myexedema coma (med emergency)
Myexedema Coma
severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. It is a medical emergency with a high mortality rate.
NI: .maintain airway patency .maintain circulation (iv replacement) .cardiac monitor .monitor arterials (ABGs) .ensure wrmth. NOT warming blanket, will cause shock. .replacement thyroid hormones .synthroid .i&O, daily weight .replace fluids, glucose .corticosteroids .monitor for infection. .lo calorie, lo cholesterol diet
MEDS:
Levothyroxine (Synthroid): diuresis, lo puffiness, improved reflexes and muscle tone, UP PR
Hyperthyroidism
over secretion of Thyroid gland (thyrotoxicosis)
Cause: emotional stress mid age women autoimmune graves disease adenoma, goiter, viral inflammation, DKA, pregnancy,
Dx: look for up blood chem
Up T3/T4
protein bound Iodine
lo TSH and cholesterol
intake goitrogenic food. (cabage, string beans)
Simple Goiter
enlarged thyroid d/t iodine def, intake of goitrogenic foods (cabbage, turnips, soybeans), heriditary
Thyroid Storm
complication of Graves Disease
med emergency .up temp, tachy, dysrhythmias .tremors, restlessness .delirious, psychotic state/coma .up BP and RR
Cause:
.infection`
.trauma or sx
.inadequate tx
Thyroid Storm MM:
.PTU - antythyroid drug .Tapazole .Iodine Preps (Lugal's solution with straw) or K Iodide. .Inderal .radioactive iodine .Sx
Thyroid Storm
NI .monitor VS .no stimulants (drugs/food w caffeine) .emotional support .cool envt. . small frequent feedings (up calories, protein 4-5k calories daily) .daily wt. .eye care .elevate HOB
Thyroidectomy Post Op
removal of thyroid gland.
.O2 therapy, suction secretions
.HOB 30degrees
.head/neck support (no tension on sutures)
.assess for resp distress, hoarsness, apasia, larangeal damage.
.emergency trach set in room
.white board to communicate.
Throidectomy Post Op Comlications
.Tetany d/t hypocalcemina r/t accidental removement of parathyroid gland
. 1:38:15
Grave’s Disease/Hyper
Go Getter Gertrude
.hi anxiety .flush smooth skin .rapid mood swings .diaphoresis .dyspnea .up systolic bp .hand tremors .bulging eyes . Everything running except period.
Complicatios:
.hpn, angina, chf
.exophthalmos - eyeball protrusion
.thyroid storm (excessive adrenergic response)
Thyroid Storm
complication of Graves Disease
med emergency .up temp, tachy, dysrhythmias .tremors, restlessness .delirious, psychotic state/coma .up BP and RR
Cause:
.infection
.trauma or sx
.inadequate tx
Thyroid Storm MM:
.PTU(antythyroid, block TH prod)
.Tapazole (bloks TH prod)
.Iodine Preps (Lugal’s solution with straw) or K Iodide.
Thyroidectomy Post Op
removal of thyroid gland.
.O2 therapy, suction secretions
.HOB 30degrees
.head/neck support (no tension on sutures)
.assess for resp distress, hoarsness, apasia, larangeal damage.
.emergency trach set in room
.white board to communicate.
Throidectomy Post Op Complications
.Tetany d/t hypocalcemina r/t accidental removement of parathyroid gland
.Hemorrhage
BOWTIE
assess for
Bleeding Open airway Whisper Trache set Incision Emergency
Tetany NI
.assess for numbness, tingling, twiching
.chvosterk’s sign, Trousseau’s sign
.Ca+ gluconate IV
Homorrhage NI
Watch For: hypotension, tachy, hypovolemia, irreg breathing swelling choke, clearing of throat, difff swallowing
Trousseau
muscle spacsms of hands and wrist
Chvostek’s sign
facial twitch when tap on nerve
Thyroid Storm
life threatening
.sudden UP of TH
.fever, tachy, restless (w/in 10min of sx), agitation, delierium
Parathyroid Gland Disorders
embedded w/in tyroid gland
4 pt glands. respond to serum calcium levels.
8.5 - 10.5 normal Ca
affects kidney adjusts rate at which mag and phosperous, ca removed from urine
.idiopathic
.
Dx;sserium phoserpherous, alkaline phosphate, calcium
Calcium/Phosperos
inverse relationship
Parathyroid gland
pulls Ca out of bone ,UP serum CA levels.
Calcitonin, secreted from thyroid gland, keeps ca in bone.
Parathyroid hormone
.mobilization of Ca and Phospherous from bone
.resorption of Ca from bone to maintain serum levels.
.Renal, UP Ca resbsorption and phosphate excrtion
.UP abosorbion in GI tract by stim kidneys to convert VIT D to its active form.
Calcium Fx
.maintain N muscle and neuromuscular responses.
.blood coag mechanisms
Hypoparathyroidism
Xray, up bone density
Mgmt: .Ca supplement (Calcium Gluconate IV?) .Vit D .seizure precaution .listen fr stridor/hoarseness .trach set@ bedside
Normal Lab Levels
??
Ca
Ph
K
????
Normal Lab Levels
??
Ca Ph K chloride Mg
Hyperthyroidism
.Ca relaased into blood leads to bone damage
.hypercalcemia, lack of resorption of Ca into bone (bone cyst/path fx)
.kidney stones
.anorexia, n/v, constipation, peptic ulcer
Hyperthyroidism MM
.Tx of choice: Diet or Sx removal .IV PNSS 5L/d w diuretics .cranberry juice .low ca .strain urine for stones .
Disorders of the Pancreas
DM I and II
learn drugs
converts food to glucose. Pancrease creates insulin which alows glucoase to enter body
DM1
Absolute Insulin insufficency. Body does not make any insulin,
inability to produce insulin. any age. usually under 15.
DM2
Insulin resistance.
defecit in insulin release.
over 4o. alarming how many kids getting it.
DM
predisposing factors:
.idiopathic
.I, genetic, inherited, virus, pancreatitis, pancreatic tumor, autoimmune, obesity
2:54:46
DM SS
.chronic tiredness .crave drink .frequent urination .numbness/tingle feet .hungry .weight loss .blurred vision .sex dyfx
DM Dx
Fasting Blood Sugar
.npo 12hr
.normal value 80-120mg/dl
.140 UP Dx of DM
Postprandial Blood Sugar
.blood drawn 2hrs post meal
.N = < 120 mg/dl
.200 mg/dl UP dx DM.
Oral Glucose Tolerance Test
NPO 12 hrs, no smoking, cofee or tea. lo activity, lo stress
.obtain FS, admin 100gm glucose po diluted in juice. obtain urine after 1, 2 and 3hrs.
.n value = blood glucose rise to 140 in 1st hr adn returns to normal by 2, 3 hrs.
.Abnormal = glucose does not return to normal by 2, 3 hrs. urine pos for glucose.
Glycosylated hemoglobin
.A1C, info re blood glucose for 3 months. glucose stays attached for 120 d life span of RBC.
DM Diet
DIABETES
Diet:
CHO 50-60%
FAT 20-30%
CHON 10=20%
Hypoglycemia Mgmt
.simple sugar orally (oj, candy glucose tab, sugar)
.glucagon (sq, im0 IF UNCONSIOUS OR NPO
.if no response, 50ml of 50% glucose IV or 1000ml 5-10% gluose IV.
Oral Antidiabetic Agents
.sulfonylureas
.biguanides
.alpha glucosidase inhibitors
.thiazolidineldiones
See pic of above
blue
Biguanides
Metformin (glucophage)
UP sensitivity to insulin, UP glucose uptake, LO glucose prod by lilver
Alpha-Glucosidase Inhiio
Acarbose (Precose)
Migliol (Glyset)
delay absorption of glucose in intestines
Thiazolidenediones
Rosiglitazone (Avandia)
Pioglitazone (Actos)
enhance insulin action at receptor sites
Insulin: Ultra RAPID acting
Humalog
Onset: 15min
Peak: 2-4hrs
Duration: 6-8hrs
Insulin: Rapid acting
Semilente
Onset: 1/2 - 1hr
Peak: 2-4hrs
Duration: 6-8hrs
Insulin: Int NPH
Lente
Onset: 1-2 hrs
Peak: 7-12 hrs
Duration: 24-30 hrs
Insulin: Long Acting
Protamine Zinc
Ultralente
Lantus
DO NOT MIX
Onset: 4-6 hrs
Peak: 18+ hrs
Duration: 30-36 hrs
DM Teaching
carry rapid acting during escerzice
Exercises: .enhances action of insulin .LO BG levels .LO need for insulin .UP fxing receptor sites
DM complications
.DKA
.Insulin Shock
.Hyperglycemin, .hyerosmolar
DKA and HNNA
hyperglycemic crises.
can result in coma/death.
3:42:21
DKA
Hyperglycemic, Hyperosmolar, Non-Ketotic Coma (HHNC)
.when action of insulin severyl inhibited
.seen in pts w NIDDM, elderly
Cause:
infection, renal failure, MI, CVA, GI hemorrhaeg, pancreatitits, CHF, TPN, Sx, Dialysis, steroids
SS: Polyuria - to oliguria lethargy UP temp, UP PR, LO BP, fluid deficit confusion ,seizure, coma BG OVER 600mg/100ml
DM Complicatoins
see pic
- Vascular Changes
a) Macroangiopathy
b) Microangiopathy - Neuropathy
DM Complicatoins
see pic
- Vascular Changes
a) Macroangiopathy
b) Microangiopathy - Neuropathy
Trioangle of DM mgmt
Diet
Exercise
Medication
DM NI:
see pic
foot care (dont cut nails)
monitor infections
no cream betwen tooes. keep feet dry
.
Simogy Phenomenon
rebound hyperglycermia following episode of hypoglycemia r/t reduction in insulin dose.
Shogrin Phenomemnon
INreased lacrimal and salivary secreteion. dry eyes and mouth
Dawn Phene
marked increase in insulin requirements
Delirium SS
Hyperactive Delirium: agitated incoherent speech delusions disorganized thoughts hallucinations disorientation
Hypoactive Delirium:
sudden sluggish
withdrawn
less reactive/sullen
Mixed Stated Delirium:
hyper active and hypo active simultaneously.
Delerium vs Demential
see google doc
Anti -Anxiety Meds
Benzodiazepine and Barbituates (Benzos and Barbs)
Benzos
fast acting
suffix: pam, lam , Ativan, Lorazepam (sedates brain, and leaves body quickly)
Barbs (gabba alpha receptors)
for Seizures
long acting, lasts in body longer. habit forming
.Barbitol, 3-5 days to leave system.
Gaba in brain controls thoughts. ETOH relaxes the gaba and sedates you, similar to Barbs. Benzos act on different receptor sites of gaba itself. both are CNS depressents
hr, resp rate,
