review Flashcards
What is Endocrine made up of?
Ovaries/testies/thyroid/parathyroid/pancreas/hypothalamus/pituitary/epithilial gland
What is a catecholamine?
Norepi, Epi
What secretes chatecholamine?
Adrenal gland
Where is the adrenal gland?
On top of the kidneys
What is another hormone the kidney secretes?
Erythropoietin
What does Erythropoietin do?
Stimulates RBC = causes more blood
What hormone does pancreas secrete?
Insulin
If the brain has low perfusion what are the s&s?
restlessness, anxiety, take close off put leg on bed rail, LOC goes down, SYNCOPY = passing out
If your periphery has low blood perfusion what are the s&s?
pcc= pale, cool, clammy vs normal = pink, warm, dry
What happens when there is low perfusion of kidney?
URINE OUTPUT LESS THAN 0.5mL/kg/hr !!!
Long term complication with diabetes (5)
- Retinopathy (blindness)
- Neuropathy can lead to loosing ability of limbs —> diabetic foot ulcers —> Non traumatic wound amputation
- Kidney failure (ESRD) end stage renal disease
- Heart disease #1 reason why end stage renal disease dies
- Stroke
How to managing diabetes?
- Manage diet, exercise, medications
Type 2 diabetic risk factors?
- Obesity
- Poor diet
- Sedentary lifestyle
- Increased age
- Genetics
Diagnosis of diabetes?
- Hemoglobin A1C of 6.5 or higher
-A1C taken over 3 months, takes the average blood glucose over 3 months
-High = diabetic
What can hyperglycemia lead to?
DKA, HHS
Normal glucose range?
74-106
What 2 things does the brain require to function?
- Oxygen
- Blood glucose
Change of mental status what is the first things you do for a patient?
- check blood sugar
- O2 stat
Hypoglycemia protocol
- Give 15 g carbs then recheck in 15 min KNOW
-Have pt eat 15 grams of QUICK ACTING carbohydrates - juice, glucagon/dextrose product, 4-6 oz soda, 5-8 lifesavers, tablespoon of maple syrup/honey, 4 teaspoons of jelly- Check blood glucose again, if its still under 70, repeat the treatment of 15 g
- Once glucose is stable give additional food of carbs plus protein (orange juice, crackers with cheese, peanut butter)
- Unconscious patient —> give Dextrose (D50) IV or glucagon IM/IV turn pt on their side
How can a client be hypoglycemia
- Too much medication
- Too much exercise
- Not enough food
- Alcohol use without food intake
What symptom should you alert a nurse for thyroidectomy?
if you start to feel tingling
then nurse will administer IV calcium salts (IV calcium gluconate)
Hemmorage s&s?
Difficulty speaking in the beginning, vocal cord paralysis, airway obstruction
Hemmorage interventions
- Support pt head with pillows
- Can have fluids as soon as they can tolerate
- Looking for hypocalcium
Hypothyroidism would present as
hypocalcemia
Before surgery of hypothyroidism what do you do?
Give antithyroid drugs-carbimazole, methimazole.
beta blockers bc iodine decreases vascularization of the thyroid gland, so it reduces the risk of hemorrhage
Best indicator of fluid volume status
Daily weights
Fluid volume labs (3)
- Sodium 135-145
- BUN 6-20 high = dry, low = wet
- Hematocrit M: 40-50, W: 36-41 high = hypovolemia, low = hypervolemia
Signs of fluid volume deficit or hypovolemia?
- Confusion
- N/V
- Chest pain
- Weakness
- Pale cool clammy
- High BUN, high sodium, high hematocrit
How do you administer potassium?
NEVER give potassium faster than 10meq
CANNOT give potassium IV push can cause DEATH
Why would a client be hypokalemic?
- vomitting —> loosing potassium
- urine loss —> potassium sparing diuretic (spironolactone)
What acid base state is a client in Hyperkalemia
Respiratory acidosis bc potassium shifts out of the cells bc H+ goes into the cell and bullies the potassium out
What acid base state can DKA or end stage renal failure result in
Metabolic acidosis
Hyperkalemic clients are at risk for?
Cardiac death
Hyperkalemia protocol
- Give client 10 U of regular insulin (even if not diabetic) –> to lower blood glucose
- Follow insulin immediately with IV D50
- Give calcium gluconate –> stabilize cardiac membrane
- Give kexolate orally or rectally –> binds to potassium and poops it out (lots of diarrhea) = will bring potassium down
What are crackles?
Fluid in the intersitial spaces in the lung
Interventions for fluid?
Diuretics
What acid base disturbance is expected with COPD?
Respiratory acidosis
How do you promote ventilation in COPD patient?
Pursed lip breathing
how? 2 in 4 (co2=bad) out
What do you use incentive spirometer for?
Atelectasis
Atelectasis can lead to?
Pnuemonia
How do you use a incentive spirometer
- Pick up spirometer in non dominant hand
- First fully breathe out first
- Put hose in mouth
- Breathe in deep, slow
- Cough
What acid base disturbance do you expect with NG tube?
Metabolic alkalosis getting acid out of stomach (vomiting)
What acid base do you expect with respiratory distress
Respiratory alkalosis
What acid base do you expect with DKA?
Metabolic acidosis
Compensates by breathing out more co2 with RAPID, DEEP BREATHS = KUUSMAL RESPIRATIONS
Most important monitoring for a client with JVD?
Fluid volume excess
-Crackles in lungs pulmonary edema
EKG finding with client with hyperkalemia?
Tall, peaked T waves
Wide, flat P wave
Primary purpose of respiratory system
Gas exchange
How do we monitor or elevate the respiratory system?
- Respirations
- O2 stats
- ABG
- Chest x ray —> can see infiltration = pneumonia or fluid = pulmonary edema
Who do you call for ABG?
Respiratory therapist
Only do ABG on
clients going into respiratory distress or respiratory failure cuz costly, invasive, painful
What do we do for wheezes?
Bronchodilator, call respiratory therapy will put on nebulizer treatment
How to achieve asthma control?
minimize symptoms throughout day and night, acceptable activity levels, exercise levels
TB drugs complications
Hepatotoxic —> call provider when yellow eyes or skin
Pneumonia signs and symptoms
- Tired
- Lethargic
- Struggling to breathe
- Fever
- Might have crackles or bronchi
- May have cyanosis if really ill
Labs for Pneumonia
- Chest x ray
- Sputum culture
- WBC
Main symptom of Acute Bronchitis
- Cough lasts up to 3 weeks
Treatment for acute bronchitis
- Take cough suppressants
- Increase oral fluid intake
- Humidifier
COPD interventions
- Nebulizers
- IV steroids —> too much steroid can get Cushings
Low grade temp (98-101) alerts you to what?
Atelectasis
Interventions for Atelectasis
- Coughing
- deep breathing
- Ambulation
- Incentive spirometry
2 big intraoperative complications
- Malignant hyperthermia
Ask: Has anyone in your fam ever died from surgery?
Causes: Genetic gene called millie & anesthesia
S&S: rigid muscles, HOT temp,
Treatment: dantrolene - Anaphylaxis
Causes: Antibiotics, latex,
S&S: Wheezing, pulmonary edema
Treatment: Epinephrine
Nutritional therapy for diabetes
- Carbs: fruits, veggies, grains, legumes, low fat milk
Fiber intake 25-30 g - High protein is not recommended for weight loss
- Minimize transfat, cholesterol <200 mg/day
- Limit alcohol / moderate alcohol consumption has no effect on glucose and insulin concentrations
Light activities that affect caloric expenditures (100-200 kcal/hr)
Fishing, light housework, secretarial work, teaching, walking casually
Moderate activities that affect caloric expenditures (200-350 kcal/hr)
Active housework, bicycling (light), bowling, dancing, gardening, golf, roller skating, walking briskly
Vigorous activities that affect caloric expenditures (400-900 kcal/hr)
Aerobic exercise, bicycling, hard labor, ice skating, outdoor sports, running, soccer, tennis, wood chopping
Thyroidectomy is done for? (3)
- Those who have a large goiter causing trachael compression
- A lack of response to antithyroid therapy
- Thyroid cancer
Advantage of thyroidectomy over radio active iodine therapy (RAI)?
More rapid reduction in T3 and T4 levels
what is a bronchoscopy?
- Procedure where the bronchi is visualized through a fiberoptic tube inserted through the nose or mouth
- Achieves patency of an airway that has been partially or nearly fully obstructed by tumors
What is a bronchoscopy used to treat?
persistent cough
what is peak expiratory flow?
Maintain greater than 80% of their personal best PEF –> what we use to decide on treatment regimen
Low peak expiratory flow = asthma is not controlled well so will have to check them again
normal wbc range
4500-11000 (4.5-11)
bronchoscopy finding to report to provider
Bronchospasms
Blood tinged sputum, dry nonproductive cough, sore throat = normal
Thoracentesis complications
- Mediastinal shift: shift of thoracic structures to one side of the body
-Monitor: Auscultate lungs for decrease in breath sounds - Pneumothorax
-Monitor: diminished breath sounds, distended neck veins, asym. Chest wall, cyanosis, reps. Distress
-Can develop during first 24 hrs following thoracentesis - Bleeding
-Monitor: coughing, hypotension, reduced Hgb - Infection from needle
-Monitor: temp and ensure sterile technique
EKG finding of hypokalemia?
Prominent U wave
Shallow T wave
Peaked P wave
Rapid acting insulin
Onset: 15 min
Peak: 30 min
Duration: 3-5 hrs
Don’t give before surgery
Short acting insulin (regular)
Onset: 30-60 min
Peak: 2-4 hrs
Duration: 5-8 hrs
Intermediate acting insulin
Onset: 1-3 hrs
Peak: 8 hrs
Duration: 12-16 hrs
When do you give NPH?
give at night because it is long acting and peaks in 8-10 hrs
Etiologies of postop hypotension
Fluid and Blood Loss –> hypovolemic shock
Effects of anesthesia that didn’t wear off yet
Pt at greatest risk of postop hypotension
- Cardiovascular disease
- Altered respiratory fx
- Older adults
- Debilitated
- Critically ill
S&S of hypoglycemia
-cold clammy
-tachycardia
-hunger
-emotional changes
-numbness on toes/fingers
-nervousness/tremors
-unsteady gait
-slurred speech
-vision changes
-seizure/coma
Patient teaching of newly diagnosed type 1 diabetic
- Exercise does not have to be vigorous to be effective
- Choose exercises that are enjoyable to foster regularity
- Use proper fitting footwear to avoid rubbing or injury
- Start the exercise program gradually and increase slowly
- Exercise is best done AFTER meals —> when blood glucose level is rising
- Monitor blood glucose levels before, during, and after exercise to determine the effect exercise has on blood glucose levels at specific times of the day
- Before exercise, if blood glucose LESS than or equal to 100 mg/dL do 15 rule, if it is still less than 100 = delay exercise
- Before exercise, if blood glucose is greater than or equal to 250 in a type 1 diabetic and ketones are present, delay vigorous activity until KETONES ARE GONE. Drink fluids
- Exercise-induced hypoglycemia may occur several hours after the completion of exercise
- Planned or spontaneous exercise can still occur when taking a glucose-lowering medication
S&S of hyperglycemia
Increased in urination
Increased in appetite
Weakness & fatigue
Blurred vision
Headache
Glycosuria
N/V
Abdominal cramps
Mood swings
Metabolic Syndrome diagnosis factors
Diagnosed if an individual has 3 or more of the following conditions:
1. Obesity
2. HTN (130 or higher)
3. Abnormal lipid levels (200 or below= normal)
4. High blood glucose
Metabolic Syndrome increases risk for
Developing CVD, stroke, and diabetes.
Underlying risk factor for metabolic syndrome is insulin resistance related to excess visceral fat
What is laryngeal stridor a sign of?
Hypocalcemia
Monitor calcium levels and give IV calcium gluconate if hypocalcemic
Priority assessment for postop thyroidectomy
Monitor airway and respiratory status
Assess patient every 2hrs for 24hrs for signs of hemorrhage or tracheal compression
Monitor for calcium
Hoarseness expected 3-4 days following
Priority assessment for postop thyroidectomy
Monitor vitals every 15 min
Assist with deep breathing every 30-60 min
Provide oral or tracheal suction if needed
Check dressing
Monitor respiratory distress that can occur 24 hrs postop signs of hemorrhage or tracheal compression
Monitor for hypocalcium s&s: positive Chvosteks/Trousseaus, muscle twitching, tingling –> give IV calcium gluconate
Hoarseness expected 3-4 days following
What is sub total thyroidectomy?
to treat hyperthyroidism when medicine did not work, remaining thyroid supplies enough thyroid hormone
What is the highest priority intervention for a client following adrenalectomy in the intermediate postop period?
Hemorrhage
-Critical period for circulatory instability is 24-48hrs post-op
-Monitor high BP from increase amounts of corticosteroids
