monitor response to treatment : surgery for example : hyperthyroidism post-op what undergoes this

Monitor for complications Vital Signs per policy (ex q15 until stable, then q30) Pain control Positioning DB+C q1h/ oral and tracheal suction PRN

Week 1: endocrine ( altered hormone regulation ) Flashcards by mary doe

afib for digoxin afib for digoxin mjust a refresh what is this describing ? :

the physiological mechanism that regulate the secretion and action of hormones associated with the endocrine system.

hormone regulation

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True or false. Hormone regulation : variations and context : hormone imbalance can lead to many problems/symptoms

true

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concept extension : hormone regulation two major issues are hormone insufficiency and excess . true or false.

true

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concept extension : hormone regulation : variations and context

what are some causes ?

trauma, congenital, genetic, inflammatory, tumors

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endocrine glands are not working properly when hormone are not regulated.

true

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what are the five cues of clinical judgement model

recognize cues
analyze cues
plan/prioritize
take action
evaluate

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what do you do first when you see a patient ( clinical judgement model ) ?

visualize ( recognize cues )

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what is this describing : on going assessments : gathering data what is the clinical judgement is this describing ?

analyze cues

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recognize cues : what are some disorders and match it with the hormones

posterior pituitary disorders

Thyroid disorders

Adrenal Gland disorders

diabetes

ADH
Thyroid hormone
Corticosteroids
Insulin

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does concentrated mean diluted or not diluted

it means that it is diluted

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analyze data : what question are you asking?

what are the different things you’re looking for ?

what does it mean ?

assessment :
vital signs
inspection
palpation

diagnostic tests
- hormone levels
-stimulation/suppression
-testing
-imaging
-biopsy

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plan and prioritize
what description are we thinking in this case ?

consider all possibilities and determine urgency

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what undergoes the plan & prioritize

( consider all possibilities and determine urgency )

What happens with extreme highs/lows of this hormone? (DM, Thyroid, Adrenal Glands, Post Pituitary)
ABCs/vital signs stable?
Neurological status affected?
Are you concerned about electrolyte imbalances?
Impact of patient’s past medical history?

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is this true or false. this is the stuff we should recognize in planning and prioritize

consider all possibilities and determine urgency :
* What happens with extreme highs/lows of this hormone? (DM, Thyroid, Adrenal Glands, Post Pituitary)
* ABCs/vital signs stable?
* Neurological status affected?
* Are you concerned about electrolyte imbalances?
* Impact of patient’s past medical history?

true

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what can detect changes ?

vital signs

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take action :
nursing intervention for hormone imbalance

what undergoes this ?

Nutrition therapy
Fluid and electrolyte
management
Monitoring response to treatments*

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what else is a part of taking actions as a nursing interventions for hormone imbalance

preventing complications
patient education
psychosocial support

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ADH, adrenal glands, corticosteroids have big impact there what else is important ?

blood work is important

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what type of treatment of taking action is included in the slides

meds
surgery radiation

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what is meds used for when talking abt endocrine

may replace or suppress glands to produce too much

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what is surgery used for

removing hyper active glands

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monitor response to treatment : surgery

for example : hyperthyrodism

what are we doing during pre-op

optimize hormone levels ( meds )
optimize weight

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monitor response to treatment : surgery

for example : hyperthyroidism

post-op what undergoes this

Monitor for complications*
Vital Signs per policy (ex q15 until stable, then q30)
Pain control
Positioning
DB+C q1h/ oral and tracheal suction PRN

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sending somone with sky high thyroid for surgery - what is currently the state of the patient ?

** where is this occurring post or pre op **

state of hypermetabollic, their heart is working very heart
blood pressure is also high ( want to control as much as possible )
normalize their thyroid levels

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what is one thing we need to leave behind when it comes to surgery in a hormone imbalance

parathyroid gland ( we do not want to get rid of this )

what does DB + C stand for when talking about post op surgery treatment ?

deep breathing and coughing

what did the prof mentioned in class about parathyrpid hormone and it's contribution?

parathyroid has a big role in managing calciumia and a pt may experience hypocal

what is a thyroidectomy ?

removal of thyroid

what are the different complications of surgery as a treatment

hemorrhage ( high risk in 1st 24 hours ) swelling injury/loss of function to surronding thyroid storm

true or false. when someone had a surgery ( throidectomy ) you should keep an eye on the nutrional status ?

true

explain swelling further as a complication in surgery

trauma or surgery to the throat even if its in the tranchea ior esopahgus ( swelling can impact another)

true or false. surgery : Calcium is low and as a result muscle cramping may occur, additionally what is this called?

true , this is called tetani

recall that thyroid storm serves as a complications in surgery , what else are the signs and symptoms ?

high blood pressure. high temp, and tatchy

sodium associates with part of the body ?

the brain

not a question but just read : in this section we are evaluating Evaluate Did your intervention help? * Re-assess your patient’s condition * Have symptoms improved or resolved? * Is there any evidence of the opposite problem occurring? (ex: low hormone levels becoming too high or vice versa) * Is there a need for changes to current treatment plan?

yessss sir

typically in a hypothyroidism patient what do we see ?

weight gain, mixed edema ( geenralized pitting edema over the body ) or in the face, cooling ( bundled up usually ), thyroid is low = cold intolerance , neurologically tired , slower

below are lab values what do u think this will be ( increased, decreased or normal ) provide the answers ( this is a patient with hypothyroidism )

TSH ↑ T4 ↓ TPO ↑ Serum Osmol N Urine Osmol N ACTH N Cortisol N

what other blood work should be checked for someone who has hypothyrodism ?

hemoglobin cholesterol

increased in tsh - refers to what scientific term /

haishomoto issue in teh brain - tsh produced in the brain ( injury in the brain )

what is the worst state that can happen with hypothyrodism ?

myxedema coma ( hypothyroid crisis)

given that the worst state that can happen with hypothyrodism is myxedema coma ( hypothyroid crisis ) what are the characteristics ( name 3 (

serious complications of untreated or poorly treated hypothyroidism characterized by reduced cardiopulmonary and neurological functioning pt ca experience decrease in LOC , decrease temp, and even decrease in BP/HR, RR

true or false. Myxedema coma ( hypothyroid crisis) is often precipitated by infection, medication, exposure to cold, and trauma

true

what can we do for hypothyrodism ?

nutrition therapy monitoring response to treatments ( med/surgery) ( any special considerations in cardiac cardiac pts

hypothyrodism : what can we do ? preventing complications patient education psychosocial support are apart of what we could do to keep a hypothyrodism patient in danger.

true

what type of diet should a hypothyrodism be on?

high fiber for the constipation, low fat = healthy diet in essence, healthy diet and controlled carbs and salt

true or false. Levothyroxine is a lifelong management ( once the thyroid is destroyed by autoimmune, it doesn't get better, have to take medication for the rest of their life )

true

someone who has hypothyrodism has a complication of what ? ( name what she mentioned in class )

increased risk for cvd ( astrovastatin )

hypothyrodism : what can we do for myxedema coma ? this is a med emergency, in which is often precipitated by what?

infection, exposure to cold, or trauma

hypothyrodism : what can we do for myxedema coma ? complications :

lethargy progresses to coma hypotension hypothermia hypoventilation

true or false. hypothyrodism : can lose conciousness.

true

someone with hypothyroidism may need critical care what undergoes this

oxygen IV fluid BP medication cardiac monitoring IV thyroid replacement

Diabetes : what is the worst state that can happen with this condition? ( what is the first one ) there is two that could happen

hypoglycemia BS<4 autonomic nervous sytem activated neuroglycopenic signs occur if BS conitnues to fall ( brain not getting enough glucose ) hypoglycemic unawareness can occur in pts with neuropathy, older patients, those taking beta blockers

diabetes: what is the worst state that can happen with this condition recall we already know hypoglycemia is one

hyperglycemia in DM1 hyperglycemia in DM2

diabetes: what is the worst state that can happen with this condition recall we already know hypoglycemia is one what undergoes Hyperglycemia in DM1

diabetic ketoacidosis lack of insulin leads to hyperglycemia ( BS>14 ) fat is used for fuel leading to ketones S&S of metabolic acidosis and dehydration

diabetes: what is the worst state that can happen with this condition recall we already know hypoglycemia is one what undergoes Hyperglycemia in DM2

hyperosmolar hypeglycemia low insulin but enough to prevent ketoacidosis BS can climb over 34 mmol/L S&S of severe dehydration

true or false. the sugar is not going into the cells , starting to use fats as a resource in hyperglycemia in DM1

true

type 1 diabetes is more seen in older adults. True or false.

false seen in younger children

what is the major symptom of hyperglycemia in DM2

dehydration

recall that severe dehydration udnergoes hyperglycemia in DM2, which means what?

causing vs changes along with being unstable

diabetes ( taking action ) nutrition therapy what do we control here?

controlled carbohydrate diet timing of food & insulin N&V or NPO

it is a must the pt blood sugar and be careful with insulin : eating their food: wait until they actual do. true or false.

true

recall that nutrition therapy is important in a pt who has diabetes when it comes to taking action what else? include the description in the class

fluid and electrolyte management angiogram very disturbed: osmotic diuresis - so much sugar in urine causing a lot of urine production and loss of fluid

diabetes: monitoring response to treatments which one is the most effective? med surgery or radiation?

med

diabetes taking action what undegoes this ? recall we already know nutrition therapy fluid and electrolyte management monitoring response to treatments what else?

preventing complications pt education psychosocial support

what should we check when we are trying to prevent complications in someone who has diabetes?

blood sugar control monitor bp skin, sensation, vision, kidney hypertension( peripheral vascular disease, check skin, and vision )

what udnergoes pt education when are talking abt someone who has diabetes

teach importance of BS control signs of abnormal blood sugar

what undergoes pyschosocial support when we are talking abt diabetes

empower pt toward self management

when monitoring repsonse to treatment what should we be careful of hypoglycemia

insulins and insulin secretagenous

when someone is having hypoglycemia what should we do ?

follow hypoglycemia treatment protocol

recall we follow hypoglycemic treatment protocol , when talking about diabetes name what undergoes this

BS<4 give 15 gm oral CHO ( glucose tabs ) BS<4 with altered LOC give 1 amp d50 IV push or if no IV access give 1 mg glucagon re-check blood sugar after 15 minutes

true or false. vein is better than the gut, because vein is faster.

false, gut is better although vein is faster.

DKA and HHS goal is to restore blood glucose to a normal to rehydrate, and to reverse any electrolyte and acid/base imbalances. what might be the signs and symptoms of metabolic acidosis

kausmal repsirations- deep breathing, nausea, vomitting and diarrhea, neurological: drowsy and confused hydrogen ( too much acid ) intracellular potassium comes out and leaves with that urine getting lose depleted of potassium = which can lead to dysrhmia

diabetes : DKA and HHS patients are usually cared for on a medical ward will require frequent assessment of ? continuous administration of ?

1) blood glucose levels vital signs mental status 2) IV fluids and IV insulins ( is an infusion, rehydrating before insulin)

true or false. Potassium goes down with insulin as well so you need to watch closely.

true

which electrolyte should you monitor closely once the pt begins the insulin infusion?

potassium

review: what is Addisons and what gland does it link to?

Addisons disease is where there is an insufficient amount of cortisol and aldosterone and this involves the adrenal gland

what re the signs and symptoms of Addisons?

hypoglycemia, weight loss, postural hypotension, weakness, gi disturbances, change in distribution of body hair, bronze pigmentation of skin

what are the risk factors of Addisons?

adrenal crisis can happen without warning, stress, sudden corticosteroid withdrawal, sudden pituitary gland destruction

what are some potential complications with SIADH?

hyponatremia - GI disturbances, loss of appetite, N/V neuro symptoms

what are the assessment findings with SIADH?

low serum sodium, high urine osmolality, low urine volume, signs of fluid overload

what are the assessment findings for Diabetes insipidius?

high serum sodium, low urine osmolality, high urine volume, monitor for sings of dehydration

what are the potential complications of DI?

dehydration

what are some nursing interventions for SIADH?

fluid restrictions, measure I/o daily weights, drug therapy with vasopressin receptor antagonists (vaptans) ex. tolvaptan, hypertonic saline (ex. 3% NaCl) bc of low sodium levels, monitor response to treatment - prevent fluid overload (PE and HF) look for neuro worsening (sodium not improving)

what are some nursing interventions for DI?

assess for signs of dehydration, - drug therapy with desmopressin, I/O - check urine specific gravity, recording the patient’s weight daily encourage fluid intake The patient with permanent DI requires lifelong drug therapy, dose adjusted based on symptoms Teach that polyuria and polydipsia indicate the need for another dose. Drug therapy for DI induces water retention and can cause fluid overload (teach pt to weight themselves OD)