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NCLEX Review (by M.K.) > Thyroid And Adrenals, Laminectomy > Flashcards

Thyroid And Adrenals, Laminectomy Flashcards

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1
Q

Wheneber you see th word thyroid, think “_____________”

A

Metabolism

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2
Q

What are the signs and symptoms of Hypertheyroidism

A

Weight loss
HR up, BP up
Hyperpersonality
Heat intolerance… they can tolerate the cold because the body is like a urnace
Exophthalmos (bulging eyes)

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3
Q

What are the 3 Treatment Modalities of Hyperthyroidism

A
  1. Nuke it with radioactive iodine
  2. PTU (Proylthiouracil)
  3. Thyroidectomy
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4
Q

What are precautyions for radioactive iodine (used for hyperthyroidism)?

A

Pt must flush three times after urinating
Call hazmat team if urine id spilled on the floor
Pt needs a private room in the first 24 hours
Visitors restriction and in hospital and at home in first 24 hours

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5
Q

What do we watch out for when a pt is on PTU/Propylthiouracil/“Puts Thyroid Under”

A

Monitor WBC because pt is immunosuppressed by PTU

***PTU’s primary use if for cancer

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6
Q

What is the most common treatment of hyperthyroidism?

A

Thyroidectomy

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7
Q

What are the two types of Thyroidectomy?

What does pts that has gone in _____ thyroidectomy need? What do we watch out for in pts that has done this treatment?

A

Total and Sub (Partial)

Total thyroidectomy needs lifelong
hormone replacement, and pt is risk
for hypocalcemia due to difficulty to
spare the parathyroid glands

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8
Q

What are the symptoms of hypocalcemia?

A

Calcium = everything opposite
Low Ca = everything up

Paresthesia
Tenany
Twitching
Spasm
Clonus
Seizure
Jitteriness
Tremor (all UP!)
Also…. Chvostek and Trosseau signs

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9
Q

What do we do for patients that has done SUBthyroidectomy?

What are they at risk for?

A

May need supplement of hormone replacement at first?

They are at risk for THYROID STORM (thyroid toxicity, never happens in total thyroid)

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10
Q

What are the S/Sx of Thyroid Storm

What are nursing actions?

A

It is a medical emergency because it can lead to brain damage due to hypoxia
*Temp of 105 or above
High BP, stroke level — about 210/180
Severe tachycardia 180 as high as 200
Psychotically delirius

Treatment: Temp down, O2 up
1. Put O2 mack on
2. Icepack
3. Cooling blanket

Firts step is ice pack
Best step is cooling blanket

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11
Q

What are the postop risks in the first 12 hours of total thyroidectomy and subtotal thyroidectomy

A
  1. Top priority is airway, due to edema (thyroid is right on airway)
  2. Next is hemorrhage because it is an endocrine gland— very vascular
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12
Q

What are the post of risks of thyroidectomy and subtotal thyroidectomy in the next 12 to 48 hours???

A
  1. Total: big danger is tetany due to low calciul
    TOTAL = TETANY *T=T …can slose off airway due to irreversible spasm (the larynx can go into spasm and cut off airway)
  2. Subtotal: big danger is thyroid storm
    SUBTOTAL = STORM(severe) *S=S
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13
Q

What is the post of risk of thyroidectomy and subtotal thyroidectomy
AFTER 48 hours

A

Risk is infection

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14
Q

What is the postop risk 48 hours after thyroidectomy and subtotal thyroidectomy

A

Infection

Note: For any type of procedure, the risk of infection significantly increases after 72 hours

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15
Q

What are the S/Sx of hypothyroidism?

A

/hypometabolism

Obesity
HR down, BP down
Personality: Flat, boring, dull
They have cold intolerance… can tolerate heat
Academically challenged (brain lethargy —> cant process fast enough)

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16
Q

This is when a pt with severe hypothyroidism presents with skin involvement

A

Myxedema

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17
Q

• Severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs
• Medical emergency

A

Myxedema Coma

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18
Q

What is the treatment of hypothyroidism?

A

• Levothyroxine (Synthroid)
• Taken in the morning 30 minutes to 1 hour before breakfast
• Taken alone on an empty stomach with water

**DO NOT sedate these pts, they can go into a coma

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19
Q

What is the treatment of hypothyroidism

A

• Levothyroxine (Synthroid)
• Taken in the morning 30 minutes to 1 hour before breakfast
• Taken alone on an empty stomach with water

*DO NOT sedate these pts, they can go into a coma because they’re already super low

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20
Q

What pre-op order for hypothyroid pts from the physician would you question?

A

• Ambien (zolpidem) at hs
• (at hs = at bedtime)

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21
Q

A pt dx with hypothyroidism will be undergoing surgery the next morning. The physician ordered the pt NPO at 12:00 am. Pt is on Synthroid and multivitamin pills. What should the nurse question?

A

Clarify the NPO order for the Synthroid … Why?
o The pt needs the Syntroid medication to get through surgery. Otherwise, the condition may potentiate the suppressing effects of the anesthesia during surgery
o Therefore, don’t hold thyroid pills unless explicitly orders

22
Q

Name Adrenal Cortex diseases

A

Interestingly, all adrenal cortex diseases either start with an “A” or a “C”
• Addison Disease (a.k.a. hypoadrenalism or adrenal insufficiency), Cushing’s

23
Q

What are adrenal Hormones?

A

Epinephrine
Cortisol (high BG)
Aldosterone * high Na, low K)

24
Q

• Under secretion of steroids/stress hromones (they are a time bomb!)
• S/Sx: pts are Hyperpigmented (very tan)
• They do NOT adapt to stress → r/t to low Perfusion in brain

A

Addison Disease

25
Q

What is the purpose of stress response in an individual?

A

To maintain
— a normal BP to perfuse the brain and other organs
— an adequate level of glucose to feed the body

26
Q

What happens when a pt with Addison Disease can’t adapt to stress?

A

Under stress, pts with Addison disease will go into shock (low Aldosterone = love BP) and have an hypoglycemic episode (Addisonian crisis)

27
Q

What is the treatment of Addison Disease

A

• Give steroids
• Glucocorticoids drugs that end in -SONE
o Prednisone o Methylprednisone
• “In Addison, you ADD-a-SONE”

28
Q

• If you have a cushy touchie … You got more
• Oversecretion of adrenal cortex (steroids)

A

Cushings Syndrome

29
Q

S/Sx of Cushings

A

*S/Sx are S/E of Steroid medications!!

Moon Face
Hirsutism (a beard)
Truncal or Central Obesity
Muscle atrophy — arms and legs are skinny
Gynecomastia (big breast)
BUffalo bump (hump on back)
Striae (stretch marks)
Easy bruising
Grouchy (“Roid rage”)
Immunosupressed

Retaining Na+ and water
High serum glucose

30
Q

How to remember the S/Sx of Cushings (based on S/E of steroid medications)

A

Draw picture of a little man
Give man a MOON FACE
Give him a beard—hirsutism
Draw a big body—truncal or central obesity
Arms and legs are skinny—muscle atrophy
Bump on front—gynecomastia (big breast)
Bump on back—buffalo hump
Fill him full of water (he is retaining Na+ and water)
He is losing K+ out the back
Give him some striae-stretch marks
Most important of all—high serum glucose
— Do Acce-Checks q6h. They look like diabetics
Easy bruising—put buruises all over him
Make him say something in a speech balloon… “I’m mad because I have an infection”
Grouchy “”Roid rage”)_
Immunosuppressed

31
Q

A pt comes in with an acute exacerbation of COPD. The pt is being treated with Solu-Medrol (methylprednilosone) IV push q8 hours to reduce the inflammation in the airway. What nursing action needs to be taken while the pt is on the medication?

A

• Do an Accu-Checks q6 hours
• Since pt is on steroid, his condition is similar to diabetes even though he is not diabetics
• The complications are worse if pt is diabetic

32
Q

What is the treatment for Cushings?

A
  1. Adrenalectomy
33
Q

What happens with a bilateral adrenalectomy?

A

Now pt has Addison disease
Now give steroids *=(ending in SONE) to treat
Pt will start looking like Cushman (Cushin-like)
It takes about a year or so—after a lot of tirtration—for the pt to start looking normal

34
Q

What is the other name for Hypethyroidism?

A

Grave’s disease

35
Q
  • a cancer drug
  • supressess thyroid
  • what to watch out for when pt is on this medication?
A

PTU (Propylthiouracil)

36
Q

It is the removal of the vertebral spinous process

A

Laminetomy

37
Q

Why do we perform laminectomy?

A

To relieve NERVE ROOT COMPRESSION… In other words, cutting away the bony prominence gives the nerve more room

38
Q

What are the S/Sx of nerve root compression?

A

The 3 “Ps”
1. Pain
2. Paresthesia (tingly)
3. Paresis (muscle weakness

39
Q

What are the 3 different locations where laminectomy is performed

A
  1. Cervical
  2. Thoracic
  3. Lumbar
40
Q

What is the most important pre-op for cervical (neck) laminectomy?

It’s post-op complication?

A

Cervical innervates the diaphgram and the arms
First, assess for breathing
Next, check functions of arms/hands

Post-op complication: pneumonia

41
Q

What is the most important pre-op for thoracic (upper back) laminectomy?

It’s post-op complication

A

Thoracic innervates gut/abdominal muscles… Assess cough and bowels (cannot cough when you cannot contract abs)

Post-op complication: pneumonia and paralytic ileus

42
Q

What is the most important pre-op for lumbar laminectomy>

A

Lumbar innervates Bladder and legs… Assess for urinary retention or last time pt voided or is the bladder empty
Next best answer if to evaluate leg functions

Post-op complication: Urinary retention, and leg problems

Lumbar = Legs, Urinary retention

43
Q

Postop laminectomy care

A

Number 1 answer for postop laminectomy, including spinal surgery, is log roll

44
Q

Mobilizing pt after laminectomy or spinal surgery

A

• Do not dangle these pts—have them seat at the edge of the bed
• They should go from supine to walking as soon as possible
• Can they sit on bed long enough to overcome orthostatic hypotension?
o Yes, but not for 10 to 15 minutes
• Do not allow pt to sit for more than 30 minutes
• So, what post-op order would you question for a laminectomy?
o Up in chair for 1 hour TID
• These pts may
o Walk, stand, lie down without restriction
o Sitting is bad

45
Q

You are caring for a pt with a lumbar oligodendrogliocytoma. What is the #1 problem?
a. Airway
b. Ileus
c. Cardiac arrhythmia
d. Urinary retention

A

D

46
Q

Anterior thoracic laminectomy would require a _______ post-op

A

Chest-tube

47
Q

What is a laminectomy with fusion?

A

• This involves taking a bone graft from (1) the iliac crest and (2) the spine
• Bone from your hip is taken and put it in place so no bone-to-bone

48
Q

Hip or Spine? (Laminectomy with fusion)

  1. Of the two incisions, which site has the most Pain?
  2. Of the 2, which one will have/need the most Bleeding/Drainage?
  3. Of the 2, which one has the higher risk of infection?
  4. Of the 2, which one has the higher risk for rejection?
A
  1. THE HIP
  2. THE HIP, This is where the HEMOVAC, JP will be
  3. They are equal
  4. The spine
49
Q

What are 4 temporary restrictions and 3 permanent of LAMINECTOMY

A

• Temporary restrictions … (6 weeks)
1. Do not sit for >30 minutes
2. Lie flat, log roll for 6 weeks
3. Don’t drive for 6 weeks
4. Don’t lift more than 5 lbs for 6 weeks (gallon of milk)

Permanent restrictions
1. Laminectomy patients will never be allowed to lift by bending at waist (use knees)
2. Cervical laminectomy should never be allowed to lift anything over the head
3. No horseback riding, off trail biking, jerky amusement park rides, etc. …

50
Q

1.___________is an antithyroid medication commonly rpescribed for hyperthyroidism. A concern that this medication may cause serious 2._________. Baseline 3._______________ tests should be obtained and monitored throughout the duratin of a client taking it,.

A
  1. PTU
  2. Serious hepatic injury
  3. Baseline liver function tests
51
Q

Which lab data is essential prior to the initiation of ((Isotretinoin)) ???

A

Isotretinoin is indicated in the treatment of moderate to severe acne vulgaris. This medication may raise triglyceride levels; thus, a baseline lipid panel is necessary, along with epriodic monitoring

NCLEX Review (by M.K.) (21 decks)

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