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57 Cards in this Set

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Thyroid Gland:

*Which hormones does it produce? (3)
*What do you need to make these hormones?
*Thyroid hormones give us what?
*T3, T4, Calcitonin

*Iodine (dietary)

*Energy
Thyroid Gland:

*Hyperthyroid-Gives us what?
*Which Condition is this associated with?
*TOO MUCH ENERGY

*Graves Disease
Thyroid Gland:

*Hyperthyroid- What are the S/S?
~nervousness
~decreased weight
~sweaty/hot
~exophthalmus (bulging eyes)-fluid builds up behind the eye pushing the eye forward, this is irreversible
~decreased attention span
~increased appetite
~increased BP
~irritable
~Increased GI (hyperactive)
~increased metabolism
~thyroid is enlarged-nurse may be able to palpate
Thyroid Gland:

*Dx
~Thyroid Scan- pt must d/c any iodine containing medication one week prior to the scan
Thyroid Gland:

*Tx
~Antithyroids
~Iodine Compounds
~Beta Blockers
~Radioactive iodine
~Surgery
~Antithyroids:Propacil/PTU, Tapazole-stops thyroid from making thyroid hormones, pt has to be weaned off this med or they will become hypothyroid

~Iodine Compunds: (SSKI, Lugol's Solution) these will decrease the size and vascularity of the gland Give in milk or juice and have pt drink with a straw it will stain the teeth

~Beta-Blockers (Inderal), blocks epi and norepi (fight/flight), decreases BP and HR, BETA BLOCKERS MASK THE S/S OF HYPOGLYCEMIA DO NOT GIVE BETA BLOCKERS TO ASTHMATICS (they can have an asthma attack) OR DIABETICS!

~Radioactive Iodine: destroys thyroid cells they will become hypothyroid, don't to pregnant pt and after dose have pt stay away from babies and don't kiss anyone for 24hrs the pt is considered radioactive, watch for thyroid storm (emergency)

~Surgery: thyroidectomy (partial/complete), post-op pt may become hypocalcemic b/c part of the parathyroid may get taken out as well, remember with hypocalcemic muscles may become rigid including airway
Thyroid Gland:

*Hypothyroid-associated with what condition?
~Myxedema
*What are S/S of Myxedema?
S/S:

~no energy
~If a baby is born with it it is called cretinism this is dangerous and can lead to slowed mental/physical development, if baby is sleeping too much and not eating but gaining wt it could be this.

~Slow GI

~fatigue

~Increased wt, but pt not eating more

~Cold

~Slurred speech

~no expression
Thyroid Gland:

Hypothyroid

*Tx
~Synthroid, proloid, Cytomel- watch for heart complaints (SOB, chest pain etc) everything is going to start to increase again so more workload on the heart

~pt with hypothyroidism tend to have Coronary Artery Disease (CAD)
Parathyroid Gland:

~How does it work?
~Which electrolyte should you think of?
parathyroid secretes PTH which make you pull Calcium from bones and out it into the blood and Calcium level will increase

When you think of PTH think of Calcium!

They have the same relationship when PTH is increased so is Calicum, when PTH is low so it Calcium

BUT it has an inverse relationship with phosphorous, when PTH is high Phos is low and vice versa
Parathyroid Gland:

Hyperparathyroidism =(Hypercalemia, Hypophophatemia)

*S/S
S/S:

they are sedated from from head to toe

*remember earlier in note Ca and Mg act like sedatives~ *
Parathyroid Gland:

Hyperparathyroidism

*Tx
Partial parathyroidectomy~

Post-Op:
~WATCH for hypocalcemia because there's a decrease in PTH

~pt could have seizures, laryngospasms, arrhythmias
Hypoparathyroidism=Hypocalcemia=Hyperphosphatemia

*S/S
*Tx
S/S:

pt not sedated

Tx:

give pt Calcium
Adrenal Gland:

What are the 2 parts?
*Adrenal Medulla

*Adrenal Cortex
Adrenal Gland:

Adrenal Medulla Problems
-Medulla think Epi and norepi

-Problems: Pheocromocytoma (major problem) and benign tumors that secrete epi/norepi in blouses
Adrenal Gland:

Adrenal Medulla: S/S
Increased BP

Increased Pulse

Flushing/Diaphoretic/Headache
Adrenal Gland:

Adrenal Medulla: Dx
VMA (vanylmandelic acid) test: a 24hr urine specimen is done and you're looking for increased levels of epi/nrepi also called catecholamines. with a 24hr urine you should discard the first voiding & save the last voiding.

TEACH pt: not to have any food with vanilla in it, tell pt to be calm/peaceful
Adrenal Gland:

Adrenal Medulla: Tx
~Surgery-removal of tumors

Post-Op: WATCH BP!
Adrenal Gland:

Adrenal Cortex Steroids:Glucocorticoids

~What are their 4 major actions?
~Change your mood (mean, depressed, angry, etc.)

~Alter defense mechanism-suppresses the immune system

~Breakdown protein/fat

~Inhibits Insulin-causes blood sugar increase
Adrenal Gland:

Adrenal Cortex Steroids:Mineralcorticoids...THINK Aldosterone!

~What do they do and what happens if you have too much and then not enough?
Make you retain Sodium and Water, but makes you lose Potassium

Too Much Aldosterone:
Fluid Volume Excess and Hypokalemia

Not enough Aldosterona:
Fluid Volume Defecit and hyperkalemia
Adrenal Gland:

Adrenal Cortex Problems- Name the 2.
~Addison's Disease

~Cushing's Syndrome
Adrenal Gland:

Adrenal Cortex Problem: Addison's Disease~pathophysiology
THINK ADD steroids they don't have enough!

Focus on Aldosterone these pt don't have enough so they aren't retaining Sodium and Water and their Potassium is increased so think of hyperkalemia!
Adrenal Gland:

Adrenal Cortex Problem: Addison's Disease~S/S
S/S: Think hyperkalemia first:

~twitching muscles
~weak muscles
~flaccid/paralysis muscles
~Anorexia/nausea
~hyperpigmentation-bronzing color of the skin
~decreased bowel sounds
~hypoglycemia
~white patchy areas of depigmented skin (vitiligo)
~hypotension
~pt blood/urine would have decreased/absent cortisol
Adrenal Gland:

Adrenal Cortex Problem: Addison's Disease~Tx
TX:

~Combat Shock (b/c losing Na and Water)
~Give the processed fruit juice/broth- has lots of Na
~I&O, daily wt
~since they're losing na their BP will be decreased
~they will most likely be losing wt
~Nsg Dx: Fluid Volume Defecit
~Weight is important with adjusting their meds *if they gain or lose 2 lbs it's usually okay to keep med does the smae but any more in either direction their med dose will most likely increase/decrease)
Addisonian Crisis
severe hypotension and vascular collapse
Adrenal problems:

~Cushing's (in general what's wrong with this pt?)
Too Many Steroids
Cushing's:

What is the difference between:

~Cushing's Syndrome and Cushing's Disease?
Cushing's Syndrome: Exogenous Administration-->someone who is taking steroids for tx and may receive too many steroids as part of the tx.

Cushing's Disease: Endongenous...Comes from Within the body ex. bilaterally adrenal hyperplasia, pituitary adenoma increases secretion of ACTH, malignancies.
Cushing's:

S/S Total of 15!
-growth arrest
-thin extremities/skin
~increased risk for infection
-hyperglycemia
-psychoses to depression (mood changes)
-moon face
-truncal obesity
-buffalo hump
-oily skin/acne
-women with male traits (deep voice, beard)
-poor sex drive
-high BP
-CHF
-Wt Gain
-Fluid Volume Excess
Since this pt has a high level of aldosterone what will happen to the Potassium, Sodium and Water?
Potassium= decreased

Sodium= Increased

Water= increased
Cushing's:

*Treatment
~Adrenalectomy (unilateral or bilateral)
*If both are removed there will be a lifetime replacements of the steroids we can't live without them

~Quiet Environment (Stress Free)

~Avoid Infection
Cushing's:

~Treatment: Dietary Requirements
~Dietary Requirements:

Increased Potassium
Decreased Sodium
Increased Protein
Increased Calcium

Steroids decrease serum Ca making you excrete it through the GI tract
Cushing's:

~Treatment: What might appear in their urine?
Glucose and ketones

Glucose because of the hyperglycemia the glucose goes into their urine

Ketones because steroids breakdown fat
Steroids Cause What?
Brittle Bones

(ex. person sneezes and they break 3 ribs)
Diabetes:

~Type 1 (IDDM)- What is the pathophysiology?
~they have little or no insulin
~usually starts in childhood
~1st sign might be DKA
~Diabetes:

~Type 1 (IDDM): S/S
S/S:

~polyuria (pee alot)
~polydispsia (thirsty)
~Polyphagia (excess eating, the brain cells are starving for glucose)
Diabetes:

~Type 1 (IDDM): Tx
Tx:

~Insulin
~Oral hypoglycemia agents such as Glipzide and Glyburide will NOT work in this pt
Explain what the Somogyi Phenomonom is...
rebound phenomenon that occurs in Type 1 diabetics, pt has normal or increased Blood Glucose levels at bedtime and blood glucose drops in the early morning hours (2-3am)

Tx: give the pt a bedtime snack to hold them through the night
Explain what the Dawn Phenomenon is...
Resulting from a decrease in the tissue sensitivity to insulin that occurs between 5-8am (pre-breakfast hyperglycemia)

Tx: give intermediate-acting insulin (NPH, Lente) at 10PM
Diabetes:

~Type II (NIDDM)-Patho

*Sneaky One*
The pt's don't have enough insulin or the insulin they do have is no good

These pt are usually overweight, they can't make enough insulin to keep up with the glucose load the pt is taking in

This type of diabetes is not as abrupt as Type 1

It's usually found by accident, the pt keeps coming to the doctor for things like wounds that won't heal or recurrent vaginal infections
Diabetes:

~Type II (NIDDM)-Tx
Start with diet and exercise, then add oral agents, then add insulin
Diabetes:

~General Treatment for Type I and II

*Diet
Diet:

~Majority of the calories should come from complex carbohydrates, then fats, then Protein(being the lowest) low protein because many diabetics have renal problems

Exercise:

~wait until blood sugar normalizes to begin exercise, to prevent hypoglycemia the pt should eat or drink before (ex milk or fruit), exercise when blood sugar is at it's highest, exercise the same time/amount each day
~General Treatment for Type I and II

~Exercise
Exercise:

~wait until blood sugar normalizes to begin exercise, to prevent hypoglycemia the pt should eat or drink before (ex milk or fruit), exercise when blood sugar is at it's highest, exercise the same time/amount each day
~General Treatment for Type I and II

*Medications-how do oral hypoglycemics work?

what is the only type of insulin you can give IV?
they stimulate the pancreas to make insulin

~Regular
Pt should eat when insulin is at it's ____?
Peak (working the hardest and blood sugar it at it's lowest)
Describe the Hemoglobin A1C...
this is a blood test that tells the average blood sugar reading for the past 3 months
What happens to blood sugar when you are stressed or sick?
it goes up (a normal pancreas can handle these increases it is our bodies normal response to help fight the illness/stressor)
Insulin Injection Rules
Rotate sites (within an area first) to give tissue time to heal

Don't aspirate (maybe on a thin person but usually don't aspirate)
Hypoglycemic Episodes:

*What are the S/S of hypoglycemia? (7)
~Shaky
~Nervous
~Jittery
~Nausea
~H/A
~Increased HR
~confusion
what should a person do if they are hypoglycemic?

After they get the blood sugar up what should they do?
~eat simple sugars (ex. piece of candy) to get the BS up

~eat a complex-carb & protein to substitute the BS
Complications of Diabetes:

~Diabetic Ketoacidosis (DKA)--> Patho
~anything that increases the BS (infection, illness, skipping insuling, etc.) can throw a pt into DKA

~this may be the 1st sign of Diabetes

~have the same s/s as type 1 (IDDM)
Complications of Diabetes:

~Diabetic Ketoacidosis (DKA)--> Tx
Find the cause

Hourly Blood Sugar and potassium (b/c we're giving IV insulin)

IV Insulin (drives the glucose and potassium) out of the vascular space and into the cell

We are watching for hypoglycemia and hypokalemia

ECG (continuous)

ABG's-pt is in metabolic acidosis


IVF's start with an Normal Saline when the blood sugar gets down to about 300 switch to D5W to prevent hypoglycemia
Complications of Diabetes:

Hyperosmolar hyperglycemic nonketosis (HHNK) or sometimes called HHNC (C is for coma)--> patho
~looks like DKA but no ketones (acid)

~they are making just enough insulin so they are not breaking down fat...no fat breakdown = no ketones....no ketones = no acidosis
Will the pt with HHNK/HHNC have Kussmaul Respirations?
No because they are not acidotic
In the NCLEX world which match out of the 4....

Type 1, Type 2, HHNK, DKA?
Type 1----> DKA

Type 2---> HHNK/HHNC
Diabetes:

Vascular Problems (Major Comlpications)-->patho
will develop poor circulation everywhere due to vessel damage (sugar irritates the vessel lining, accumulation of sugar will decrease the size of the vessel lumen therefore decreasing blood flow)
Diabetes:

Vascular Problems: List 2 complications
1. Diabetic Retinopathy: can lead to blindness-they need to take care of their eyes

2. Nephropathy: kidney damage- this is a biggie!
Nephropathy--> S/S
S/S:

1. sexual problems- impotence/decreased sensation

2. Foot/Leg Problems: pain/paresthesias/numbness

3. Neurogenic Bladder-bladder doesn't empty properly and may lead to incontinence or retention

4. Gastroparesis: stomach emptying is delayed so there is an increase risk of aspiration
Diabetic Foot Care
~cut the toenails straight across and not too short

~where good shoes all of the time

~dry well between toes because bacteris

~don't soak feet for long periods of time

~inspect feet everyday

~no harsh chemicals on the feet

~do not soak feet for long periods of time