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Mark K > Thyroid/Adrenals, kids, spinal > Flashcards

Thyroid/Adrenals, kids, spinal Flashcards

1
Q

What are the s/s of hyperthyroidism?

A

HYPERMETABOLISM

Weight loss
HR increase
BP increased
Hyperpersonality
Heat intolerance b/c body is a furnace
Exopthalmos

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2
Q

What is another word for hyperthyroidism?

A

Graves disease

You are going to run yourself into the grave

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3
Q

What are 3 ways to treat hyperthyroidism?

A

Nuke it with radioactive iodine
PTU (propylthiouracil) - Puts Thyroid Under
Thyroidectomy

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4
Q

What is a consideration if you nuke the thyroid with radioactive iodine

A

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

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5
Q

What is a consideration if using PTU for hyperthyroidism?

A

Monitor WBC because patient is immunosuppressed

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6
Q

If a patient has a total thyroidectomy they will need ______ and it is important to watch for ______

A

They will need lifelong hormone replacement

Watch for hypothyroidism because it can be difficult to spare the parathyroid gland when doing a total thyroidectomy

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7
Q

Does a subthyroidectomy need replacement? What are they at risk for?

A

No, but they many need some at first

At risk for thyroid storm

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8
Q

What are the s/s of a thyroid storm?

A

Temp 105 or above
High BP (stroke level)
Severe tachycardia
Psychotically delirious

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9
Q

How do you treat thyroid storm?

A

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

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10
Q

After a total or subtotal thyroidectomy what are the risks in the first 12 hours? The next 12-48 hours? After 48 hours?

A

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

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11
Q

What are the s/s for hypothyroidism?

A

Hypometabolism

Obesity
HR decreased
BP decreased
Personality is flat, boring, dull
Intolerant to the cold b/c always cold
Academically challenged

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12
Q

What is a myxedema coma?

A

Severe hypothyroidism that leads to decreased mental status, hypothermia, and other S/S r/t slowing of function in multiple organs

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13
Q

What is the treatment of hypothyroidism?

A

Levothyroxine

Take in the morning 30 minutes to and hour before breakfast

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14
Q

What 2 orders should you question for your patient with hypothyroidism

A

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

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15
Q

How do you know if a disease is caused by the Adrenal Cortex?

A

The disease will either start with an A or a C

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16
Q

What is Addisons disease? S/S

A

Under secretion of steroids

VERY tan
Does not adapt well to stress

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17
Q

What is the purpose of a stress response?

A

To maintain normal BP to perfuse the brain and other organs

Ensure an adequate level of glucose to feed to body

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18
Q

If a patient with Addisons can’t adapt to stress what happens to them under stress?

A

Addisonian crisis

Shock
Hypoglycemic crisis

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19
Q

What is the treatment for Addisons disease?

A

Steroids (glucocorticoids - end in -SONE)

In Addison you ADD-a-SONE

20
Q

What is Cushing syndrome?

A

Over secretion of the adrenal cortex

If you have a cushy tushy… you got more

21
Q

What are the S/S of Cushing/steriod med SE?

A

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

22
Q

Because patients with Cushings has hyperglycemia what should we do?

A

Accu-checks every 6 hours

23
Q

What is the treatment for cushings? What does this result in?

A

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

24
Q

What do you think about before giving a toy to a child?

A

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

25
Q

If a patent is immunocompromised what kind of toy would you give them?

A

Hard plastic toy because can be disinfected

26
Q

What are the considerations for an infant 0-6 months? Best toy? 2nd choice?

A

Sensorimotor

Best choice: musical mobile

Second choice: Large but soft toy

27
Q

What are the considerations for an infant 6-9 months? Best toy? 2nd choice? Worst toy?

A

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

28
Q

What are the considerations for an infant 9-12 months? Best toy? 2nd choice?

A

Vocalization

Best: speaking or verbal toys such as tickle me Elmo, woody cowboy talking books

29
Q

If a question has the words that indicate purposeful play, only pick for ages _____ and older

A

Build, sort, stack, make, construct

9 months and older

30
Q

What are toddlers (1-3) working on? Best toy? What kind of play do they do?

A

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

31
Q

If an activity/toy takes finger dexterity, which age group is this NOT for?

A

NOT for toddlers and younger

32
Q

What are preschoolers (3-6) working on? Good toys/activities? Type of play?

A

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)

33
Q

What are school age (7-11) working on? What 3 things do they like?

A

Concrete

  1. Creative - they like to get involved. Don’t give them a coloring book, give them a black paper to draw
  2. Collective - baseball cards, stickers
  3. Competitive - WANT winner/loser. DONT want to hear EVERYONE WINS
34
Q

What are adolescents (12-18) working on? Activities? What 3 scenarios would not allow these activities to occur?

A

Peer group association

Allow them to be in each other rooms UNLESS

  1. <12 hours post-op
  2. immunosuppressed
  3. Contagious
35
Q

Why preform a laminectomy? What is the MOST important question to ask about a laminectomy?

A

To relieve nerve root compression. Cuts away bony prominences to give the nerve more room

LOCATION, LOCATION, LOCATION

36
Q

What are the s/s of nerve root compression?

A

Pain
Parethesia (tingly)
Paresis (muscle weakness)

37
Q

With a cervical laminectomy, what you you assess pre-op first and second? What do you watch for post-op?

A

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

38
Q

With a thoracic laminectomy, what you you assess pre-op first and second? What do you watch for post-op?

A

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

39
Q

With a lumbar laminectomy, what you you assess pre-op first and second? What do you watch for post-op?

A

Pre-op: Innervates bladder and legs
First: assess urinary retention/last time pt voided
Second: leg function

Post-op: Urinary retention and leg issues

40
Q

How do you move a patient after a laminectomy?

A

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

41
Q

What type of laminectomy will require a chest tube?

A

Anterior thoracic b/c have to go through the front/chest/spine so pneumothorax

42
Q

What is a laminectomy with fusion? Where is the bone taken from?

A

When removing a disc, then you need to fuse so no bone on bone

Taken form the hip –> two incisions

43
Q

Which incision has more pain in a laminectomy with fusion? Which has the most bleeding? Infection? High risk for rejection?

A

Hip
Hip (hemovac/JP will be here)
Both have same risk
Spine

44
Q

What are the 4 temporary restrictions for a laminectomy?

A

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

45
Q

What are the 3 permanent restrictions for a laminectomy?

A

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

Mark K (12 decks)

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