Thyroid/Adrenals, kids, spinal Flashcards
What are the s/s of hyperthyroidism?
HYPERMETABOLISM
Weight loss
HR increase
BP increased
Hyperpersonality
Heat intolerance b/c body is a furnace
Exopthalmos
What is another word for hyperthyroidism?
Graves disease
You are going to run yourself into the grave
What are 3 ways to treat hyperthyroidism?
Nuke it with radioactive iodine
PTU (propylthiouracil) - Puts Thyroid Under
Thyroidectomy
What is a consideration if you nuke the thyroid with radioactive iodine
Need a private room for the first 24 hours
Visitor restriction for first 24 hours
Flush 3 times after urinating
Call hazmat if urine is spilled
What is a consideration if using PTU for hyperthyroidism?
Monitor WBC because patient is immunosuppressed
If a patient has a total thyroidectomy they will need ______ and it is important to watch for ______
They will need lifelong hormone replacement
Watch for hypothyroidism because it can be difficult to spare the parathyroid gland when doing a total thyroidectomy
Does a subthyroidectomy need replacement? What are they at risk for?
No, but they many need some at first
At risk for thyroid storm
What are the s/s of a thyroid storm?
Temp 105 or above
High BP (stroke level)
Severe tachycardia
Psychotically delirious
How do you treat thyroid storm?
Get the temp down and bring oxygen up
Body temp down with ice packs and cooling blanket
Oxygen mark at 10L
Stay with patient - usually 2:1 ratio
These patients do not get medication, it is self limiting and they either come out of it or they don’t
After a total or subtotal thyroidectomy what are the risks in the first 12 hours? The next 12-48 hours? After 48 hours?
First 12: airway d/t edema and hemorrhage because endocrine glands are very vascular
Next 12-48:
Total: tetany d/t hypocalcemia (could close off the airway d/t irreversible spasm)
Subtotal: thyroid ström
After 48: infection
What are the s/s for hypothyroidism?
Hypometabolism
Obesity
HR decreased
BP decreased
Personality is flat, boring, dull
Intolerant to the cold b/c always cold
Academically challenged
What is a myxedema coma?
Severe hypothyroidism that leads to decreased mental status, hypothermia, and other S/S r/t slowing of function in multiple organs
What is the treatment of hypothyroidism?
Levothyroxine
Take in the morning 30 minutes to and hour before breakfast
What 2 orders should you question for your patient with hypothyroidism
Any sedative - they are already super slow so a sedative could put them into a coma
NPO prior to surgery including their thyroid replacement. They are already super slow so their condition without the replacement can potentiate the anesthesia during surgery. DO NOT hold thyroid meds unless it is specifically stated and if it is call around
How do you know if a disease is caused by the Adrenal Cortex?
The disease will either start with an A or a C
What is Addisons disease? S/S
Under secretion of steroids
VERY tan
Does not adapt well to stress
What is the purpose of a stress response?
To maintain normal BP to perfuse the brain and other organs
Ensure an adequate level of glucose to feed to body
If a patient with Addisons can’t adapt to stress what happens to them under stress?
Addisonian crisis
Shock
Hypoglycemic crisis
What is the treatment for Addisons disease?
Steroids (glucocorticoids - end in -SONE)
In Addison you ADD-a-SONE
What is Cushing syndrome?
Over secretion of the adrenal cortex
If you have a cushy tushy… you got more
What are the S/S of Cushing/steriod med SE?
Moon face
Hirsutism (lot of hair)
Truncal/central obesity
Muscle atrophy (skinny arms/legs)
Gynecomastia
Buffalo hump
Retaining Na+ and water
Stretch marks
High glucose
Easy bruising
Grouchy (“roid rage”
Immunosuppressed
Because patients with Cushings has hyperglycemia what should we do?
Accu-checks every 6 hours
What is the treatment for cushings? What does this result in?
Adrenalectomy
Now pt has Addisons and will be given a steroid to treat (SONE)
Pt will start looking like cushion
Takes about a year of titration for pt to start looking normal
What do you think about before giving a toy to a child?
Size (no small toys under 4)
NO metal/dye cast if oxygen is in use
Beware of fomites - non living things that harbor microorganisms like stuffed animals
If a patent is immunocompromised what kind of toy would you give them?
Hard plastic toy because can be disinfected
What are the considerations for an infant 0-6 months? Best toy? 2nd choice?
Sensorimotor
Best choice: musical mobile
Second choice: Large but soft toy
What are the considerations for an infant 6-9 months? Best toy? 2nd choice? Worst toy?
Object permanence
Best toy: cover/uncover toy such as jack in the box, peaks boo, window books
Second best: large but firm
Worst: Musical mobile d/t strangulation
What are the considerations for an infant 9-12 months? Best toy? 2nd choice?
Vocalization
Best: speaking or verbal toys such as tickle me Elmo, woody cowboy talking books
If a question has the words that indicate purposeful play, only pick for ages _____ and older
Build, sort, stack, make, construct
9 months and older
What are toddlers (1-3) working on? Best toy? What kind of play do they do?
Gross motor skills such as running and jumping
Best toy: push/pull toy like lawn mower, wagon.
CAN finger paint
Parallel play - alongside each other
If an activity/toy takes finger dexterity, which age group is this NOT for?
NOT for toddlers and younger
What are preschoolers (3-6) working on? Good toys/activities? Type of play?
Fine motor skills
Finger dexterity - write, draw, use pencils/scissors
Balance - dance, ice skate, tricycles, tumbling
Cooperative play - play with others. They are highly imaginative (you be the cop ill be the robber)
What are school age (7-11) working on? What 3 things do they like?
Concrete
- Creative - they like to get involved. Don’t give them a coloring book, give them a black paper to draw
- Collective - baseball cards, stickers
- Competitive - WANT winner/loser. DONT want to hear EVERYONE WINS
What are adolescents (12-18) working on? Activities? What 3 scenarios would not allow these activities to occur?
Peer group association
Allow them to be in each other rooms UNLESS
- <12 hours post-op
- immunosuppressed
- Contagious
Why preform a laminectomy? What is the MOST important question to ask about a laminectomy?
To relieve nerve root compression. Cuts away bony prominences to give the nerve more room
LOCATION, LOCATION, LOCATION
What are the s/s of nerve root compression?
Pain
Parethesia (tingly)
Paresis (muscle weakness)
With a cervical laminectomy, what you you assess pre-op first and second? What do you watch for post-op?
Pre-op - cervical innervates diaphragm and arms
First: assess for breathing
Second: assess function of arms/hands
Post-op: pneumonia b/c trouble breathing deeply
With a thoracic laminectomy, what you you assess pre-op first and second? What do you watch for post-op?
Pre-op: innervates gut/abd muscles
First: cough (need to use abd muscles to cough)
Second: bowels
Post-op: pneumonia (b/c cant cough) and paralytic ileus
With a lumbar laminectomy, what you you assess pre-op first and second? What do you watch for post-op?
Pre-op: Innervates bladder and legs
First: assess urinary retention/last time pt voided
Second: leg function
Post-op: Urinary retention and leg issues
How do you move a patient after a laminectomy?
log roll
DO NOT dangle/have these pts. sit on edge of bed. Only long enough to overcome othrostatic
Supine to walking ASAP
DO NOT allow them to sit for more than 30 minutes
Walk, stand, lie down without restrictions
What type of laminectomy will require a chest tube?
Anterior thoracic b/c have to go through the front/chest/spine so pneumothorax
What is a laminectomy with fusion? Where is the bone taken from?
When removing a disc, then you need to fuse so no bone on bone
Taken form the hip –> two incisions
Which incision has more pain in a laminectomy with fusion? Which has the most bleeding? Infection? High risk for rejection?
Hip
Hip (hemovac/JP will be here)
Both have same risk
Spine
What are the 4 temporary restrictions for a laminectomy?
Do not sit for >30 minutes for 6 weeks
Lie flat and log roll for 6 weeks
Don’t drive for 6 weeks
Don’t life more than 5 pounds for 6 weeks
What are the 3 permanent restrictions for a laminectomy?
Never be allowed to lift by bending at the waist (must bend at the knees)
Cervical should never be allowed to lift anything of their head
No horseback right, off trail biking, jerky amusement park rides
