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Med Surg 2 > Quiz 5 > Flashcards

Quiz 5 Flashcards

1
Q

What is acromegaly?

A

Excessive growth hormone

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2
Q

What are the clinical manifestations of acromegaly?

A

HE’S TALL

H - Hypertension & Height
E - Enlarged Organs (cardiac issues/fractures)
S - Sweating & oily skin

T - Too much pain in joints
A - Arthritis
L - Long hands & feet
L - Long protruding jaw

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3
Q

What is the surgical treatment for acromegaly? What are the post op considerations?

A

Transphenoidal Hypophysectomy
- surgical removal of pituitary gland

Post op: important to decrease ICP
- no coughing/bending over
- HOB 30 degrees
- stool softener
- assess nasal drainage (CSF leak)

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4
Q

What are the medications used for acromegaly? What do they do?

A

Octreotide (helps to slow GI bleeds)
Bromocriptine
Pergolide (long acting)

Stop the release of growth hormone

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5
Q

What are the nursing interventions for acromegaly?

A

Provide emotional support
Provide post op or radiation care
Teach medication f/u adherence

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6
Q

What is hyperthyroidism?

A

HIGH thyroid hormones (T3 and T4)

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7
Q

What are the risk factors of hyperthyroidism?

A

Graves’ disease (GAINS)
Thyroiditis (hashimotos)
Goiter
Excessive iodine intake
Pituitary tumor
Thyroid cancer

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8
Q

What are the clinical manifestations of hyperthyroidism?

A

HIGH & HOT

Grape eye (exophthalmos)
Goiter
High BP (HTN crisis 180/100+)
High HR (Tachycardia)
Heart palpitations
High temp (hot & sweaty)
Diarrhea
Bruit over thyroid
Pretibial myxedema

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9
Q

What therapeutic procedure is done for hyperthyroidism?

A

thyroidectomy
preop: administer SSKI and antithyroid meds
postop: semi flowers, resp status, hypocalcemia, note any hoarseness, hypothyroidism

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10
Q

What medications are given for hyperthyroidism?

A

propylthiouracil (PTU)
methimazole
potassium iodine (SSKI)
Lugol’s solution
atenolol
propranolol

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11
Q

What nursing interventions are done for hyperthyroidism?

A

encourage rest
monitor VS, dysrhythmias, I&O, weight
report increase in temp
eye protection for exophthalmos
high caloric-diet, avoid high fiber and stims

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12
Q

What is a complication of hyperthyroidism? What are the clinical manifestations?

A

thyroid storm/crisis (thyrotoxicosis)

manifestations:
high and hot
agitation/confusion

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13
Q

How is a thyroid storm managed?

A

antithyroid meds
acetaminophen
cool IV fluids to keep temp down

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14
Q

What is hypothyroidism?

A

LOW & SLOW
primary: thyroid gland dysfunction (postop trach placement)
secondary: anterior pituitary gland dysfunction (can’t produce TSH)
tertiary: hypothalamus dysfunction (can’t produce TRH)

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15
Q

What are the risk factors of hypothyroidism?

A

female 30-60
inadequate iodine intake
radiation therapy to head/neck
meds (lithium or amiodarone)

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16
Q

What are the clinical manifestations of hypothyroidism?

A

LOW & SLOW

low energy
low metabolism
constipation
low mood (depression)
dry skin

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17
Q

What medication is given for hypothyroidism?

A

LEVOthyroxine

Life long and long slow onset (3-4 weeks til relief)
Early morning or Empty stomach (NOT @ NIGHT)
Very active (high HR/BP) report agitations/confusion
Oh the baby is fine (pregnancy dafe)

do not stop abruptly

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18
Q

What drugs interact with levothyroxine?

A

increases effects of warfarin
increases insulin requirements
increases excretion of digoxin
decreases absorption w/ calcium, iron, and sucralfate

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19
Q

What are the nursing interventions for hypothyroidism?

A

safe warm environment
avoid sedatives
monitor weight
increase activity

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20
Q

What is a complication of hypothyroidism? How is it managed?

A

myxedema coma (non pitting edema)

very low and slow: breathing airway, low BP = death
hoarseness

tx: IV hormone therapy

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21
Q

What do the parathyroid glands do?

A

regulate serum calcium

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22
Q

What is hyperparathyroidism?

A

increased PTH (parathyroid hormone) = high calcium

hypercalcemia (over 10.5)

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23
Q

What are the risk factors of hyperparathyroidism?

A

parathyroid disease
renal disease
tumor (adenoma [not cancer]/ malignant [cancer])

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24
Q

What are the clinical manifestations of hyperparathyroidism?

A

weak bones
kidney stones (nephrolithiasis)
constipation
dysrhythmias
N/V
polyuria

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25
Q

What therapeutic procedure is done for hyperparathyroidism?

A

parathyroidectomy

preop: mithramycin to decrease Ca (SE: bleeding and increased clotting times)
postop: similar to thyroidectomy

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26
Q

What medications are given for hyperparathyroidism?

A

calcitonin
loop diuretic
bisphosphonate - alendronate
calcimimetic - cinacalcet
calcium chelator - mithramycin

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27
Q

What nursing interventions are done for hyperparathyroidism?

A

initiate fall precautions
weight bearing exercises
low-calcium, low-vitamin D diet
strain urine
hydrations
monitor for hypercalcemic crisis (hyperreflexia >15mg/dL tx: mithramycin)

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28
Q

What is hypoparathyroidism?

A

decreased PTH = low calcium (under 9)

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29
Q

What are the risk factors of hypoparathyroidism?

A

iatrogenic (due to medical tx)
idiopathic (no known cause)
hypomagnesemia

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30
Q

What are the clinical manifestations of hypoparathyroidism?

A

Trousseau’s sign: twerk w/ BP cuff
Chvostek’s sign: cheeky smile when stroking face
diarrhea
paresthesia
muscle cramps
tetany (hyperreflexia)
bradydysrhythmias

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31
Q

What medications are given for hypoparathyroidism?

A

acute: IV calcium chloride or gluconate
chronic: calcium carbonate, phosphate binder, vitamin D

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32
Q

What are the nursing interventions for hypoparathyroidism?

A

seizure precautions
assess s/s for neuromuscular irritability
monitor ECG
high calcium, low phosphorus diet

33
Q

What is Cushing’s Syndrome?

A

high cortisol levels
cushion of steroids HIGH (big round hairy)

34
Q

What are the risk factors of Cushing’s syndrome?

A

pituitary adenoma
adrenal hyperplasia
adrenal adenoma or carcinoma
malignancies (GI, lung cancer)
exogenous glucocorticoids

35
Q

What are the clinical manifestations of Cushing’s syndrome?

A

BIG bp, infections, weight, hair, belly, brittle bones

CUSH
Cushion - truncal obesity, moon face, hump
Unusual hair growth - hairy suit
Skin - purple striae, butterfly mark
High - sugar, BP, weight

36
Q

What therapeutic procedures are done for Cushing’s syndrome?

A

chemotherapy (mitotane)
hypophysectomy
adrenalectomy

37
Q

What medications are used for Cushing’s syndrome?

A

ketoconazole (manages)
metyrapone (temporarily decreases cortisol)
antacid, H2RB, PPI to prevent GI bleed

38
Q

What interventions are done for Cushing’s syndrome?

A

assess for hyperglycemia
taper steroids down

39
Q

What is Addison’s disease?

A

adrenal insufficiency

40
Q

What are the clinical manifestations of Addison’s disease?

A

AADDSS
Added tan (hyperpigmentations)
Added potassium (over 5.0)
Decreased weight
Decreased BP, hair, sugar, energy, hydration
Sodium loss (<135)
Salt craving

41
Q

What medications are given for Addison’s disease?

A

hydrocortisone (main tx-increase dose during illness)
prednisone
fludrocortisone
vasopressors for hypotension crisis
antibiotics for infection

42
Q

What nursing interventions are done for Addison’s disease?

A

ADDDI
Add steroids
Diet high in protein, carbs, sodium
Don’t abruptly stop
Don’t believe meds will cure
Indefinitely (life long)

43
Q

What is a complication of Addison’s disease?

A

Addisonian crisis:
decreased BP, HR, sodium
increased RR, potassium

tx: IV fluid replacement and IV steroids

44
Q

What is pheochromocytoma?

A

tumor on adrenal gland

45
Q

What are the clinical manifestations of pheochromocytoma?

A

hypertension
hyperhidrosis
hyperglycemia
hypermetabolism
headache

46
Q

What medications are given for pheochromocytoma?

A

phentolamine and propanolol (decreases BP)
sodium nitroprusside (@ risk for hemorrhagic stroke / decreases BP)
calcium channel blockers

47
Q

What is the therapeutic procedure for pheochromocytoma?

A

surgical removal of tumor

48
Q

What are the nursing interventions for pheochromocytoma?

A

monitor BP
provide a quiet environment and frequent rest
provide a high calorie nutritious diet

49
Q

What does the liver do?

A

nutrient metabolism
hematologic function
detoxification and storage
bile production (bilirubin)

50
Q

What does it mean if there in an increase in liver enzymes?

A

liver damage

51
Q

What does it mean if there is an increase in bilirubin?

A

jaundice

52
Q

What does it mean if there is an increase in PT?

A

liver disease
bleeding disorder
vitamin K deficiency
blood thinners

53
Q

What does it mean if there is a decrease in albumin?

A

edema in abdomen (ascites)
liver disease
malabsorption
low protein

54
Q

What is the most common method of transmission of HCV?

A

needle sharing

55
Q

What is cirrhosis?

A

progressive liver disease characterized by extensive irreversible scarring

56
Q

What are the risk factors of cirrhosis?

A

alcohol use (most common)
hepatitis
chemicals
biliary disease
R heart failure

57
Q

What are the clinical manifestations of cirrhosis?

A

fatigue
pruritus
clay-colored stool
tea-colored urine
weight loss
emotional lability

58
Q

What are the complications of cirrhosis?

A

peripheral edema (ankle and presacral edema)
ascites (abdominal distention with weight fain, everted umbilicus, abdominal striae)
portal hypertension (increased portal venous pressure, large collateral veins, esophageal and gastric varices)
splenomegaly
hepatic encephalopathy

59
Q

Describe esophageal varices

A

varicose veins in esophagus
s/s of rupture: hematemesis - hypovolemic shock
tx for ruptured: stop bleeding w/blakemore tube (most common)

60
Q

What should be in the room if an esophageal varice ruptures?

A

scissors
cuts all the part to get air out asap for pt to breath

61
Q

What are the risk factors of hepatic encephalopathy?

A

cerebral depressants
GI bleed
constipation
metabolic alkalosis
uremia
infection
dehydration
hypokalemia
increased metabolism
paracentesis

62
Q

What are the clinical manifestations of hepatic encephalopathy?

A

neurologic changs
asterixis (flapping hand tremor seen)
fector hepaticus (sweet must odor, can be smelled in breath and urine, results from accumulations of digestive products)
inappropriate behavior
sleep disturbances

63
Q

What is hepatorenal syndrome?

A

azotemia (too much BUN in blood)
oliguria
intractable ascites

64
Q

What are the therapeutic procedures for cirrhosis?

A

paracentesis to relieve ascites
transjugular intrahepatic portosystemic shunt
surgical bypass shunting procedure (portacaval shunt/distal splenorenal shunt)
EGD
liver bx
liver transplantation

65
Q

What medications are used for cirrhosis?

A

1st - albumin IV
2nd - diuretics (furosemide)
neomycin and metronidazole (rifaximin - targets bacteria in blood stream to get rid of ammonia)
lactulose
supp. vitamins
PPIs or H2RBs (help precent GI bleed)
beta blockers

66
Q

What are the nursing interventions for cirrhosis?

A

measure abdominal girth and weigh client daily

67
Q

What are nursing interventions for esophageal and gastric varices?

A

prevent bleeding
- avoid alc, ASA, NSAIDs, irritating foods
- screen for bleeding

68
Q

What are the nursing interventions for ascites? What medications are given?

A

restrict sodium
measure abdominal girth
weigh client daily
cleanse abdomen gently

meds: albumin, diuretics, tolvaptan

69
Q

What medication reduce ammonia formation?

A

lactulose
rifaximin

70
Q

What is the most common method of transmission of HBV?

A

healthcare related blood or fluid exposure w/o protection

71
Q

What is acute liver failure?

A

fulminant hepatic failure

72
Q

What are the clinical manifestations of acute liver failure?

A

jaundice
coagulation problems
encephalopathy
renal failure
hypoglycemia
metabolic acidosis
sepsis
multiorgan failure

73
Q

What are the risk factors of liver cancer?

A

cirrhosis
hepatitis c
chronic alcoholism

74
Q

What are the clinical manifestations of liver cancer?

A

early (absent or subtle)
- fatigue
- hepatosplenomegaly
- complications from portal hypertension

late
- fever, chills
- jaundice, anorexia, weight loss
- palpable mass, RUQ pain

75
Q

What is the evaluation process for a liver transplantation?

A

assessment for comorbid conditions
physical assessment
lab tests and diagnostic tests
psychological evaluation

76
Q

What are postoperative complications of liver transplantations?

A

graft rejection
infection (fever)
bleeding
renal failure

77
Q

What are the types of graft rejection?

A

hyperacute rejection (rare): occurs within 24 hours after transplantation tx: removal of organ

acute rejection: occurs in first 6 months after transplantation tx: immunosuppressive therapy, but pt at higher risk of infection /neoplastic changes

chronic rejection: occurs sporadically over months or years tx: similar to acute rejection but long term success is poor

78
Q

What is the clinical manifestations of graft rejection?

A

liver failure

79
Q

What are the nursing interventions of liver transplantation?

A

prevent infection
assess neurologic status
assess for bleeding
monitor fluid and electrolyte levels
monitor urinary output
monitor for signs of rejection (increased BP/HR)
provide emotional support

Med Surg 2 (7 decks)

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