Sep 1 Flashcards
Hyperthyroid tx: total thyroidectomy
Risk for hypocalcemia, because you probably took part of the parathyroid
Hyperthyroid tx: partial thyroidectomy
Risk for thyroid storm
Thyroid storm symptoms
Temp 105
Extreme htn
Extreme tachy
Delirium
Thyroid storm tx
Lower their temp and give oxygen at 10 liters
Thyroidectomy post op first 12 hours
For both partial and total, top priority is airway and bleeding
Thyroidectomy post op 12 to 48 hours
Partial- watch for storm
Total- watch for tetany (t for t)
Myxedema tx
Give thyroid hormone
Do NOT sedate
Never hold thyroid pills for myxedema patient even before surgery because they’d be way too susceptible to over sedation
Adrenal cortex disease hint
They all start with A or C
Addisons …three things about what it is
Adrenal cortex undersecretion
These people can’t adapt to stress, they can’t respond and they’re blood sugar and BP drop, leading to shock
Their skin is hyper pigmented
Addisons tx
Steroids (things that end in sone)
Think- in addisons you add a sone
Cushings
Over secretion of adrenal cortex
Signs and symptoms of cushings is the same as
Steroids
Cushings tx
adrenalectomy
Kids toys: nothing with small parts for age
4 or less
Kids toys: If O2 is in use
nothing metal/dycast
Kids toys: If immunosuppressed
must be plastic, metal or something else you can sterilze
Best toy: 0 to 6 months
musical mobile or something soft
Best toy: 6 to 9 months
They’re learning object permanence, so use a cover-uncover toy like jack in the box.
The WORST toy for this age is the mobile
Best toy: 9 to 12 months
Speaking toys because they’re working on talking
Best toy: They can’t do anything purposeful until 9 months. So if the kid is under 9, do NOT pick answers with words like
build, sort, stack
Best toy: 1 to 3 years
Push-Pull toy
Finger painting
NO finger dexterity games
Best toy: Preschool
Finger dexterity
Balance (tricycle, dance)
Best toy: School age
The 3 Cs
- Creative: Instead of coloring books, give them blank paper
- Collecting stuff
- Competitive
Laminectomy
- Removing vertebral spines
- Purpose is to remove nerve root compression
When you get a laminectomy (or any neuro) question look at
the location (cervical, thoracic, lumbar)
Laminectomy: Most important pre op check for Cervical
Breathing
Arm/hand function
Laminectomy: Most important pre op check for Thoracic
Cough mechanism
bowels
Laminectomy: Most important pre op check for Lumbar
Bladder
Legs
Laminectomy: Best answer for Post Op, no matter what the location is
Log Roll
Laminectomy: Dangling
-Don’t do it for longer than a couple seconds (unlike with other operations)
Laminectomy: They can sit for
30 minutes (for meals)
Laminectomy: Ambulating
they can walk, stand, lay down without restriction
Laminectomy: Cervical complications
pneumonia
Laminectomy: Thoracic complications
Pneumonia
Illeus
Laminectomy: Lumbar complications
Urinary retention
Leg problems
Anterior thoracic laminectomy needs
chest tubes
Laminectomy with fusion
takes bone graft from illiac crest
The hip incision causes more complications than the spine incision
Laminectomy Discharge teaching: Temporary things
- Don’t sit longer than 30 minutes for 6 weeks
- Lay flat and log roll for
- No driving
- No lifting over 5 lbs
In general, if you don’t know how long to restrict something choose
6 weeks
Laminectomy Discharge teaching: Permanent things
- Lift with knees
- Never lift something over your head (cervical)
- No horseback riding, off road biking etc
Creatinine range
0.6 to 1.2
INR range
2s - 3s
Creatinine changes
low priority. Only report if they’re having a dye procedure
INR over 4
category C (means you have to do something)
Hold warfarin
Assess
Prepare vitamin K
Call
For any situation that’s a category C, the 4 generic steps
Hold
Assess
Prepare
Call
K range
3.5 to 5.3
K 5.4 to 5.9 category
category C
K 6 and over category
D
K less than 3.5 category
C
Hold nothing
Assess heart
Prepare K
Call
what do you do about pH in the 6s
Do vitals
Call
BUN range
10 to 20
BUN out of range, what do you do
assess for dehydration
Hemoglobin range
12 to 18
Hemoglobin Category C
less than 7
Assess for bleeding
Prepare for transfusion
CO2 range
35 to 45 (same as pH minus the 7)
CO2 Category C
in the 50s
Assess respiratory
Use pursed lip
CO2 Category D
in the 60s
- this is criteria for resp failure
- Stay with them
- Assess resp
- Prepare to intubate
- Call for help
Hematocrit range
36 to 54 (it’s 3 times the hemoglobin levels)
Hematocrit elevated, what category
just a B, just assess dehydration
PO2 (not POX) range
80 to 100
PO2 category C
Low 70s
Give O2
PO2 category D
Low 60s
- Give O2
- Assess
- Prepare to intubate
- Call
Anemia and POX reading
Anemia falsely elevates POX, so you need to check O2 in another way. Same is true with dye procedures
BNP that indicates HF
under 100
Change in Na category
C
WBC range
5000 to 11000
ANC (Neutrophil) range
500 +
WBC below 5000 category
C
ANC (Neutrophil) below 500 category
C
Highest, most serious priority lab values
pH/K…….6s
CO2/PO2……..60s
Platelet…..less than 40
Psyc drugs all have these SE
decrease BP
Weight change
1st gen anti psyc drugs all end in
zine (we use zines for the zany)
1st gen anti psyc drugs: in small doses are used as
antiemetics
1st gen anti psyc drugs: are some of the major
tranquilizers
1st gen anti psyc drugs: SE: A, B, C, D, E, F, G
Anticholingeric Blurred Vision Constipation Drowsy EPS (like parkinsons) Fotosynthesis (sun burn) aGranulocytosis
1st gen anti psyc drugs: SE: A
Anticholingeric
1st gen anti psyc drugs: SE: B
Blurred Vision
1st gen anti psyc drugs: SE: C
Constipation
1st gen anti psyc drugs: SE: D
Drowsy
1st gen anti psyc drugs: SE: E
EPS (like parkinsons)
1st gen anti psyc drugs: SE: F
Fotosynthesis (sun burn)
1st gen anti psyc drugs: SE: G
aGranulocytosis
consideration for SE vs TE
you don’t have to report SE, they’re expected
Decanate
a drug that’s long acting and given IM; it’s used for non-compliant patients by court order
