Thyroid, Adrenal Cortex, Kids Toys, Laminectomy

Question 1

Is Graves Disease Hypothyroidism or Hyperthyroidism?

Answer 1

Hyperthyroidism
“you are going to RUN yourself INTO the GRAVE”

Question 2

S/S of Hyperthyroidism
& Labs

Answer 2

-Graves Disease
Everything is sped up
-Appearance: Wt. Loss, Exophthalmos (Bulge eyes)
-Irritability, Hyper
-Vitals: Tachy, HTN
-Heat Intolerance (cold tolerant)
Labs: High T3 & T4

Question 3

Medications for Hyperthyroidism

Answer 3

1. Radioactive Iodine
   –24hr Isolation, Flush 3x careful w/ urine
2. PTU (Put Thyroid Under)
   –Cancer drug, Must monitor WBC

Question 4

What are 2 surgery’s for Hyperthyroidism?

Answer 4

Total thyroidectomy or subtotal thyroidectomy

Question 5

What is pt. at risk of and needs with Total Thyroidectomy

Answer 5

Needs Lifelong hormone replacement
Risk of Hypocalcemia
–Ensure calcium gluconate is available

Question 6

S/S of Hypocalcemia

Answer 6

Everything goes UP
Paresthesia 1st s/s
-Tetany, irritability, Seizures, tachy, HTN
Chvostek’s sign (Cheek)
Trousseaus sign (arm/hand spasm)

Question 7

What is pt. at risk of and doesn’t need with Subtotal thyroidectomy

Answer 7

Pt does NOT need Lifelong hormone replacement
Risk for THYROID STORM or THYROTOCISIS a emergency

Question 8

S/S of Thyroid Storm

Answer 8

Emergency
Pt. feels Anxious
Super HIGH TEMP (105+)
Extreme HTN (210/180)
SEVERE TACHY (180bpm)
Psychosis & Delirium

Question 9

Tx. for Thyroid storm

Answer 9

**Decrease temp **
–ice packs (1st) & Cooling blanket
O2 via Face mask 10L/min
Must stay w/ pt.

Question 10

What are POST OP risks for Thyroidectomy

Answer 10

0-12hr (for BOTH total & subtotal)
–Airway & Hemorrhage
-Monitor for stridor’s
-Keep suction+O2+Tracheostomy tray @ bedside
12-48hr
–Total thryroidectomy= Tetany
–Subtotal thryoidectomy= Thyroid Storm

Question 11

NEVER pick Infection in first 72hr for anything

Answer 11

Only pick infection AFTER 72hr

Question 12

S/S of Hypothyroidism

Answer 12

everything slowed
-Appearance: dry+thick skin, brittle nails, hair loss, facial edema, obese, pallor/anemia
-Vitals: Brady & HToN
-Fatigue, dull personality, depression
-Cold Intolerance (heat tolerance)
Labs: HIGH TSH & LOW T3 T4

Question 13

Medications for Hypothyroidism

Answer 13

Levothyroxine–> Do Not Sedate Them can lead to MYEDEMA COMA
–Preop med question Ambien (sedative)
NEVER HOLD A THYROID MED

Question 14

S/S of Myxedema Coma

Answer 14

Severe Hypothyroidism
Hypothermia (95F)
**Hypoventilation) (RR10/min)
Bradycardia
Decreased mental status, face & hand edema, hyponatremia, hypoglycemia

Question 15

Tx. for Myxedema Coma

Answer 15

1. Airway (bag-valve mask)
2. IV levothyroxine (after Resp. status secured)
3. Warming Blanket

Question 16

What is causes Addison’s Disease

Answer 16

Under secretion of the adrenal cortex
tx. w/ steroid =sone

Question 17

S/S of Addison’s Disease

Answer 17

-Hyperpigmented (Tan Skin)
-Wt. Loss, weakness, Hypoglycemia (everything low)
-Do NOT adapt to stress well (can go into Shock)
—Shock state raises Blood sugar and BP

Question 18

S/S of Adrenal Crisis (Addison Crisis)

Answer 18

HToN
Tachy
Dehydration
Hyponatremia
Hyperkalemia
Hypoglycemia

Question 19

Tx for Addison’s

Answer 19

Steroids
-sone
ADD steriods for “ADD-i-sone disease”

Question 20

Tx for Addison’s

Answer 20

Steroids
-sone
ADD steroids for “ADD-i-sone disease”

Question 21

S/S of Cushing’s

Answer 21

Over secretion of adrenal cortex (and steroid SE)
Moon Face, Hirsutism (high body hair), buffalo hump. central obesity, Gynecomastia (man boobs), Retain Sodium & Water, Loses Potassium
Think CUSH MAN

Question 22

Tx of Cushing’s

Answer 22

Adrenalectomy–> replacement therapy–> need steroids

Question 23

0-6 month age appropriate toys

Answer 23

1. Musical mobile
2. Soft & Large toys

Question 24

6-9 months age appropriate toys

Answer 24

-working on object permanence
1. Cover/uncover toys (jack inthe box)
2. Hard & Large toys
Never pick musical mobile for this age

Question 25

9-12 months age appropriate toys

Answer 25

-working on vocalization 1. Speaking/vocalizing toys *@9 months old child will do anything purposeful **Never pick an answer w/ infants less then 9 months: Build, Sort, Stack, Make, Construct** these are all purpose words

Question 26

1-3 yr old age appropriate toys

Answer 26

-working on gross motor skills 1. push-pull toys **Never pick finger dexterity for toddlers (colored pencils, scissors)** -Finger painting is fine Engaged in Parallel play

Question 27

3-5 yr old age appropriate toys

Answer 27

-work on fine motor skills/balance Colored pencils, tricycles, tumbling, drawing -Engaging in cooperative play & Imaginative play

Question 28

6-12 yr old age appropriate toys

Answer 28

Creative Collective Competitive

Question 29

Safety Considerations 1. No small toys for less then ____ yr old? 2. No ___ toys if O2 uses present 3. What toys are best to prevent Fomites?

Answer 29

1. Less then 4 yr no small toys 2. Metal toys if O2 used 3. Best toys: Plastic toys Worst: Stuffed animals -Immunosuppressed pt. best toy is plastic

Question 30

Where is the Cervical part of spine located?

Answer 30

Neck

Question 31

Where is the Thoracic part of spine located?

Answer 31

Upper Back

Question 32

Where is the Lumbar part of spine located?

Answer 32

Lower Back

Question 33

What does the Cervical part of spine innervates?

Answer 33

Diaphragm Arms Hands

Question 34

What is the most important Preop Assessment for Cervical location for laminectomy?

Answer 34

**Breathing** Hand/arm function

Question 35

What are post-op complication to cervical spine from a laminectomy?

Answer 35

Pneumonia--> Breathing is effected -No lifting over head at all for rest of life

Question 36

What does the Thoracic part of spine innervates?

Answer 36

Coughing ability Bowel (gut muscles)

Question 37

What does the Lumbar part of spine innervates?

Answer 37

Bladder Legs

Question 38

What is the most important Preop Assessment for Thoracic location for laminectomy?

Answer 38

Coughing ability Bowel Sounds

Question 39

What is the most important Preop Assessment for Lumbar location for laminectomy?

Answer 39

Last void/bladder distention Leg & foot function

Question 40

What are post-op complication to Thoracic spine from a laminectomy?

Answer 40

**Pneumonia** ( coughing ability is affected) Paralytic ileus

Question 41

What are post-op complication to Lumbar spine from a laminectomy?

Answer 41

Urinary Retention

Question 42

How do you move any laminectomy or spinal cord injury pt.

Answer 42

LOG ROLL

Question 43

Post OP Laminectomy nursing care pt. education

Answer 43

**DO NOT DANGLE/SIT** on edge of bed --Pt. transition straight from supine to ambulation **Avoid Sitting** --may sit for 30 min MAX Cannot lift things above the head