week 1 :endrocrine review Flashcards
Cushing syndrome : alterations for diagnosis
risk of infections
alterations of nutrition
disturbed body image
risk of skin integrity
cushing syndrome : what is it ?
excess glucocorticoids –> corticosteroids
how do we prevent/inteventions for cushing syndrome
reduce corticosteroids:
find underlying issues : tumour = remove
too much - suppress - medication = ketoconodazole
risk factors for cushing syndrome :
prednisone users
adrenal tumours
women 20-40 years olds
expected findings for cushing syndrome :
centripenal fat - buffalo hump , purple striae, htn/moon face
what are the diagnoses we use for cushing syndrome :
what do we teach out patient in terms of education :
ct/mri
patient education : avoid extreme temperatures, infection/being too stress
cushing syndrome : nursing care
VS/glucose/daily wt
assess for any infection
monitor for thromboembolic events/pulmonary embolic
assess for any pain/loss of function
what are the complications of cushing syndrome
hyperglycemia
loss of collagin
muscle wasting
loss of bone matrix- osteoporosis and back pain
what are the signs of infection for cushing syndrome that we should look out for ?
drainage/extreme warmth
what are the nutrition management for cushing syndrome
high protein, high potassium , high calcium
low carbs , low fat, low sodium
these help correct the effect of excess corticosteroids
it is important to attain wt appropriate for the ht of the patient when it comes down to nutrition management of a Cushing syndrome patient.
yes this is true
true or false. it is important to maintain a low calorie diet that meets nutritional needs
yes this is true
what type of device do we use for a Cushing syndrome patient ?
use device of the bed ( sheep skin to protect the patient )
what is hypothyrodism ?
inadequate amount of circulating t3/t4 hormones. decrease in metabollic rate.
what are the alterations in diagnosis when it comes down to hypothyrodism
1: thyroid gland dysfunction
2 : anterior pituary, target cell dysfunction
3: hypothalamus not producting tr factor ( tertiary ( rare ) not enough tsh )
health promotion/disease prevention
long drug therapy should not be stopped abrupt
diet should include iodine/selenium/zinc
what are the risk factors for hypothyrodsim
female- older than 60 years , exposure to radiation in the neck prior to surgery
- inadequate iodine intake/autoimmune disease
what is the expected findings for hypothyrodism
early findings vs. late findings
anemic- iron deficiency
early findings - irritability/fatigue.cold intolerance/constipation/wt gain/depression
late fings : low heart rate,rr,bp,dysrythmias,dry skin,peural effusion
what is pleural effusion
too much fluid between the layers of your pleura
what are the hormone levels for hypothyrodism
high tsh
low t4
high TPO
serum urine/acth/cotisol - normal
true or false. monitor cardiac changes
- take meds on empty stomach when it comes to hypothyrodism
true
what are the diagnostic tool for hypothyrodism
xray/ct scan/mri
what are the safety consideration for hypothyroidism
fall risk
altered metabolism
mental changes
loss of conciousness
immobility due to depression
what are the lab test for hypothyrodism
t3
t4
thyroid deficiencies
cholesterol
hgb
hct
rbc
suddenly stopping levothyroxine can lead to what?
can lead to decrease hr, bp, rr , co, coma, hypoxia
what is the worst thing that could happen with hypothyrodism
myxedema coma - life threathening , impacted by stress
recall that constipation is one of the things that could occur with hypothyrodism , why is that
decrease in gastrointestinal motility
what is hyperthyroidism :
hyperactivity of the thyroid gland , with sustained increase in synthesis and release of thyroid hormones
what is the alterations in diagnosis of hyperthyrodism :
activity intolerance
impaired nutrional status
risk of impaired electrolyte balance
what is the health promotion/disease prevention
avoiding caffeine
reducing stress
smoking cessation
what is the risk factors for hyperthyrodism
women>men
20-40 years old
family history of thyroid
disease of autoimmune disease
what is the expected findings for hyperthyrodism
goitre
bruits
exopthlamus ( protusion of eyeballs from orbits, usually bilateral)
what could happen after thyroidectomy ?
airway obstruction, after thyroid surgery is an emergency, keep 02, suction/tracheostomy
what is exophathalmus
potential corneal injury related to dryness + irritation
nursing care for hyperthyrodism
monitor for dysrthimias
ensure 02
give iv fluids - replace fluid and electrolyte losses from n and v
calm and quiet
assisting exercise involving muscle groups
what is the diet we should give hyperthyrodism
high protein, high calorie
hypermetabolism
tatchy , dyspnea, dysarthmias, diaphoresis, pallor, high bp
what are the laboratory test we should look upon when it comes down to hyperthyrodism
tsh levels
t3 and t4 levels
thyroid antibody levels
what is the diagnostic procedures
raiu test
thyroid scan
thyroid ultrasound
what are some interventions we could do with hyperthyroidism
surgical therpahy subtotal
( thyroidectomy )
nutritional diet ( high calorie )
radioactie iodine therpahy
complications for hyperthyrodism
acute thyrotoxicosis
( life emergency ) released into the circulation
-afib
-osteoporosis
what should the position for a hyperthyroidism patient be ?
what should u do before surgery ( thyroidectomy )?
what should u encourage the pt ?
have a pt sit upright as much as possible to promote fluid drainage from periorbital area
before surgery - show pt how to support head manually while turning in bed to minimize stress on suture line
encourage regular exercise
what is diabetes mellitus
partial or complete metabolic deficiency of insulin by destruction of pancreatic beta- type 1
arises when body fails to use insulin theraphy - type 2
alterations in heath when it comes down to diabetes mellitus
ineffective health management
readiness to enhance nutrition –> hyperglycemia
( 3 Ps, weakness lethargy, malaise, blurring of vision, H/A )
risk of injury
risk of peripheral injury ( neurovascular dysfunction )
what are the risk factors for dm
genetics can predispose type 1
toxins and viruses can predispose an individual to diabetes leading to type 1
obesity/ physical inactivity/ triglycerides>250/ htn - insulin resistance
when do we restrict exercise for dm
more than 14 mmol ( especially ketones present )
– bodys requirement or 128 hz tuning fork for baseline findings – comprehensive findings foot assesment
what is the health promotion and disease prevention
bg levels/exercise regimen/diet pattern
what is the laboratory test for diabetes mellitus
8 hr fasting blood glucose 126 mg/ml
randome glucose of 200 mg/ml
hb a1c > glycosated hgb
oral glucose tolerance test
true or false. it is good self monitored blood glucose, before meals and bedtime
true it is good
nursing care for dm :
monitor vs/bg/in and out/skin integrity/healing wounds/sensory alterations/dietary patterns/exercise patterns
what is the complications when it comes down to dm
dka ( diabetic ketoacidosis )
this is life threatening ( ketones )
what is addison’s disease?
decrease production of adrenal hormones, decrease in cortisol production initially followed by aldosterone
recall that addison’s disease : decrease production of adrenal hormones, decrease in cortisol production initially followed by aldosterone
both of which will what ?
increase acth and msh hormones due to the loss of negative feedback inhibition
true or false. addison disease can be prevented
false it cannot be prevented
risk factors for addison’s disease
type 1 diabetes
pernicious anemia
testicular dysfunction
graves disease
mysastenia gravis
what is the expected findings for addisions
fatigue
extreme weakness
unexplained wt loss
muscle aches
dizziness
fainting
changes in bp or hr
abdominal pain
n and v
what are the laboratory test for Addison disease
cortisol
acth
aldosterone
renin
electrolytes
renin
bun
creatine
glucose
crh
what is the diagnostic tests for addison’s disease
abdominal ct
xray
what is the safety consdierations for addison’s disease
risk infection
risk fluid imbalance
risk for electrolyte imbalance
what is the nursing care for addison’s disease
monitor i and o
administer iv
monitor electrolytes
administer meds
what should we teach the patient for addison’s
high sodium
high caloric
low potassium
monitor fluids/med compliance
what are the complications for addison’s disease
severe dehydration
severe hypotension
shock
vomitting
diarrhea
extreme muscle weakness
h/a
extreme sleepiness
coma
death
