Thyroid, Adrenal Cortex, Kids Toys, Laminectomy Flashcards
Is Graves Disease Hypothyroidism or Hyperthyroidism?
Hyperthyroidism
“you are going to RUN yourself INTO the GRAVE”
S/S of Hyperthyroidism
& Labs
-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
Medications for Hyperthyroidism
- Radioactive Iodine
–24hr Isolation, Flush 3x careful w/ urine -
PTU (Put Thyroid Under)
–Cancer drug, Must monitor WBC
What are 2 surgery’s for Hyperthyroidism?
Total thyroidectomy or subtotal thyroidectomy
What is pt. at risk of and needs with Total Thyroidectomy
Needs Lifelong hormone replacement
Risk of Hypocalcemia
–Ensure calcium gluconate is available
S/S of Hypocalcemia
Everything goes UP
Paresthesia 1st s/s
-Tetany, irritability, Seizures, tachy, HTN
Chvostek’s sign (Cheek)
Trousseaus sign (arm/hand spasm)
What is pt. at risk of and doesn’t need with Subtotal thyroidectomy
Pt does NOT need Lifelong hormone replacement
Risk for THYROID STORM or THYROTOCISIS a emergency
S/S of Thyroid Storm
Emergency
Pt. feels Anxious
Super HIGH TEMP (105+)
Extreme HTN (210/180)
SEVERE TACHY (180bpm)
Psychosis & Delirium
Tx. for Thyroid storm
**Decrease temp **
–ice packs (1st) & Cooling blanket
O2 via Face mask 10L/min
Must stay w/ pt.
What are POST OP risks for Thyroidectomy
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
NEVER pick Infection in first 72hr for anything
Only pick infection AFTER 72hr
S/S of Hypothyroidism
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
Medications for Hypothyroidism
Levothyroxine–> Do Not Sedate Them can lead to MYEDEMA COMA
–Preop med question Ambien (sedative)
NEVER HOLD A THYROID MED
S/S of Myxedema Coma
Severe Hypothyroidism
Hypothermia (95F)
**Hypoventilation) (RR10/min)
Bradycardia
Decreased mental status, face & hand edema, hyponatremia, hypoglycemia
Tx. for Myxedema Coma
- Airway (bag-valve mask)
- IV levothyroxine (after Resp. status secured)
- Warming Blanket
What is causes Addison’s Disease
Under secretion of the adrenal cortex
tx. w/ steroid =sone
S/S of Addison’s Disease
-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
S/S of Adrenal Crisis (Addison Crisis)
HToN
Tachy
Dehydration
Hyponatremia
Hyperkalemia
Hypoglycemia
Tx for Addison’s
Steroids
-sone
ADD steriods for “ADD-i-sone disease”
Tx for Addison’s
Steroids
-sone
ADD steroids for “ADD-i-sone disease”
S/S of Cushing’s
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
Tx of Cushing’s
Adrenalectomy–> replacement therapy–> need steroids
0-6 month age appropriate toys
- Musical mobile
- Soft & Large toys
6-9 months age appropriate toys
-working on object permanence
1. Cover/uncover toys (jack inthe box)
2. Hard & Large toys
Never pick musical mobile for this age
9-12 months age appropriate toys
-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
1-3 yr old age appropriate toys
-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
3-5 yr old age appropriate toys
-work on fine motor skills/balance
Colored pencils, tricycles, tumbling, drawing
-Engaging in cooperative play & Imaginative play
6-12 yr old age appropriate toys
Creative
Collective
Competitive
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?
- Less then 4 yr no small toys
- Metal toys if O2 used
- Best toys: Plastic toys
Worst: Stuffed animals
-Immunosuppressed pt. best toy is plastic
Where is the Cervical part of spine located?
Neck
Where is the Thoracic part of spine located?
Upper Back
Where is the Lumbar part of spine located?
Lower Back
What does the Cervical part of spine innervates?
Diaphragm
Arms
Hands
What is the most important Preop Assessment for Cervical location for laminectomy?
Breathing
Hand/arm function
What are post-op complication to cervical spine from a laminectomy?
Pneumonia–> Breathing is effected
-No lifting over head at all for rest of life
What does the Thoracic part of spine innervates?
Coughing ability
Bowel (gut muscles)
What does the Lumbar part of spine innervates?
Bladder
Legs
What is the most important Preop Assessment for Thoracic location for laminectomy?
Coughing ability
Bowel Sounds
What is the most important Preop Assessment for Lumbar location for laminectomy?
Last void/bladder distention
Leg & foot function
What are post-op complication to Thoracic spine from a laminectomy?
Pneumonia ( coughing ability is affected)
Paralytic ileus
What are post-op complication to Lumbar spine from a laminectomy?
Urinary Retention
How do you move any laminectomy or spinal cord injury pt.
LOG ROLL
Post OP Laminectomy nursing care pt. education
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
