Med-Surg Question

Front 1

Hyperthyroidism

Back 1

hyperactivity of the thyroid gland with sustained increased in synthesis and release of thyroid hormones; occurs in women more than men, with the highest frequency in persons 20 to 40 years old; most common type of is Graves’ disease; other causes include toxic nodular goiter, thyroiditis, exogenous iodine excess, pituitary tumors, and thyroid cancer

Front 2

Hypothyroidism

Back 2

-results from insufficient circulating thyroid hormone as a result of a variety of abnormalities; can be primary (related to destruction of thyroid tissue or defective hormone synthesis) or secondary (related to pituitary disease with decreased TSH secretion or hypothalmic dysfunction with decreased thyrotropin-releasing hormone (TRH) secretion); it may also be transient, related to thyroiditis or discontinuance of thyroid hormone therapy; iodine deficiency is the most common cause of hypothyroidism worldwide and is most prevalent in iodine-deficient areas of the world. Hypothyroidism also may develop due to treatment for hyperthyroidism, specifically the surgical removal of the thyroid glands or radioactive iodine therapy

Front 3

What’s a goiter and what are the possible nursing interventions when caring for a patient with a goiter?

Back 3

Goiter is hypertrophy and enlargement of the thyroid gland caused by excess TSH stimulation, which in turn can be caused by inadequate circulating thyroid hormones; may also be caused by growth-stimulating immunoglobulins and other growth factors. Goitrogens (foods or drugs that contain thyroid-inhibiting substances) can cause goiter but usually only in the individual who lives in an iodine-deficient area (endemic goiter). A goiter is also commonly found in patients with Graves’ disease.

Interventions-Monitor patient for evidence of excess physical and emotional fatigue, monitor cardiorespiratory response to activity (tachycardia, other dysrhythmia, dyspnea, pallor, blood pressure, respiratory rate), Assist the patient to schedule rest periods, monitor laboratory values, ascertain patient’s food preferences to determine extent of the problem and plan appropriate interventions, and weigh patient

Front 4

What lab values are used to determine hypothyroidism and differentiate from an anterior pituitary problem?

Back 4

The most common and reliable laboratory tests used to evaluate thyroid function are those that measure TSH and free T4. Serum TSH levels help to determine the cause of hypothyroidism. Serum TSH is high when the defect is in the thyroid and low when it is in the pituitary or hypothalamus. An increase in TSH (thyroid-stimulating hormone) after TRH (thyrotropin-releasing hormone) injection suggests anterior pituitary dysfunction.

Front 5

How is that insulin works on our body? How would you explain this to a patient?

Back 5

Insulin is a hormone produced by the B cells in the islets of Langerhans of the pancreas. Under normal conditions, insulin is continuously released into the bloodstream in small pulsatile increments (a basal rate), with increased release (bolus) when food is ingested. The action of released insulin lowers blood glucose and facilitates a stable, normal glucose range approx 70-120. Insulin and these counter-regulatory hormones provide a sustained but regulated release of glucose for energy during food intake and periods of fasting and usually maintain blood glucose levels within the normal range. Insulin is released from the pancreatic B cells as its precursor, pro-insulin, and is then routed through the liver.

Front 6

What is the difference between Type 1 and Type 2 diabetes mellitus?

Back 6

Type 1 diabetes mellitus formerly known as “juvenile onset” of “insulin-dependent” diabetes, most often occurs in people who are under 30 years of age, with a peak onset between 11 and 13, but it can occur at any age. It is the end result of a long-standing process in which the body’s own T cells attack and destroy pancreatic beta cells, which are the source of the body’s insulin. Manifestations of type 1 diabetes develop when the person’s pancreas can no longer produce insulin; requires a supply of insulin from an outside source (exogenous insulin), such as an injection, in order to sustain life.

Front 7

What is the difference between Type 1 and Type 2 diabetes mellitus?

Back 7

Type 2 diabetes mellitus is by far the most prevalent type of diabetes, accounting for over 90% of patients. It usually occurs in people over 35 years of age, and 80% to 90% of patients are overweight at the time of diagnosis. The pancreas usually continues to produce some endogenous (self-made) insulin. However, the insulin that is produced is either insufficient for the needs of the body and/or is poorly utilized by the tissues. The presence of endogenous insulin is the major pathophysiologic distinction between type 1 and type 2 diabetes

Front 8

What lab tests are used in testing and assessing diabetes mellitus? What’s the particular function of each and when is each test used?

Back 8

Fasting plasma glucose level >126mg/dl-fasting defined as no caloric intake for at lease 8 hours
Random, or casual, plasma glucose measurement>200 mg/dl, plus manifestations of diabetes such as polyuria, polydipsia, and unexplained weight loss. Casual is defined as any time of day without regard to the time of the last meal.
Two-hour OGTT level >200 mg/dl, using a glucose load of 75g. When this is used the accuracy of test results depends on adequate patient preparation and attention to the many factors that may influence the outcome of such tests.
The fasting plasma glucose (FPG) test, confirmed by repeat testing on another day, is the preferred method of diagnosis. When overt symptoms of hyperglycemia (polyuria, polydipsia, and polyphagia) coexist with FPG levels of 126 mg/dl or greater, further testing using the OGTT may not be necessary to make a diagnosis.

Front 9

What’s the effect of exercise for patient who has diabetes? What teaching on exercise and its effects would you do for the patient? Are there some specific things you would teach a patient who is on insulin?

Back 9

Exercise increases insulin receptor sites in the tissue and can have a direct effect on lowering the blood glucose levels. It also contributes to weight loss, which also decreases insulin resistance. The therapeutic benefits of regular physical activity may result in a decreased need for diabetes medications in order to reach target blood glucose goals.

Any new exercise program in the diabetic patient should be started only after medical clearance and should be started slowly with gradual progression toward the desired goal.

Exercise does not have to be vigorous to be effective, it can be attained with brisk walking, it should be enjoyable, should have a warm-up and cool-down period, best done after meals when levels are rising, self-monitor, before, during, and after exercise to determine effect

Patients who use insulin are at increased risk for hypoglycemia when there is an increase in physical activity, especially if the patient exercises at the time of peak drug action or if food intake has not been sufficient to maintain adequate blood glucose levels. Some patients may have to inject a small bolus of rapid-acting or regular insulin if the blood glucose level is elevated before exercising to prevent progressive hyperglycemia.

Front 10

Principles of insulin administration-think about how you would teach this to a patient.

Back 10

Wash hands thoroughly, always inspect insulin bottle before using it, if the solution is NPH it is cloudy, the insulin bottle should be rolled between the palms of hands to mix the solution, select proper injection site, wipe area with alcohol pad, inject at 90-degree angle, after injection leave in place for 5 seconds to ensure all insulin has been injected, hold alcohol pad n place for a few seconds but do not massage, destroy and dispose of single-use syringe safely!

Front 11

What is the Somogyi effect? How is this evaluated/assessed?

Back 11

It is a rebound effect in which an overdose of insulin induces hypoglycemia; it usually occurs during the hours of sleep, it produces a decline in blood glucose level in response to too much insulin; The danger of this effect is that when blood glucose levels are measured in the morning, hyperglycemia is apparent and the patient may increase the insulin dose; if this is suspected as a cause for early morning high blood glucose, the patient may be advised to check blood glucose levels between 2:00 and 4:00 am to determine if hypoglycemia is present at that time, if it is the insulin dosage affecting the early morning blood glucose is reduced. The assessment must include insulin dose, injection sites, and variability in the time of meals or insulin administration. In addition, the patient is asked to measure and document bedtime, nighttime (between 2:00 and 4:00 am), and morning fasting blood glucose levels on several occasions.

Front 12

When might a person who is taking insulin in combination have a reaction?

Back 12

local reactions may be self-limiting within 1 to 3 months or may improve with a low dose of antihistamine; a true insulin allergy is rare; lipodystrophy may occur if the same injection sites are used frequently, and the somogyi effect and dawn phenomenon may also occur.

Front 13

Oral agents-how do they work and what’s the difference between classes?

Back 13

oral agents work to improve the mechanism by which insulin and glucose are produced and used by the body; OAs work on the three defects of type 2 diabetes: 1) insulin resistance, 2) decreased insulin production, 3) increased hepatic glucose production

Front 14

Teach a patient how to self-monitor his blood glucose-principles and steps

Back 14

By providing a current blood glucose reading, self-monitoring of blood glucose enables the patient to make self-management decisions regarding diet, exercise and medication; SMBG is also important for detecting episodic hyperglycemia and hypoglycemia. It provides patients with a tool for achieving and maintaining specific glycemic goals

Front 15

Emergency management of DKA.

Back 15

Ensure patent airway
administer oxygen via nasal cannula or non-rebreather mask
Establish IV access with large-bore catheter
Begin fluid resuscitation with 0.9% NaCl solution 1L/hr until BP stabilized and urine output 30-60 ml/hr
begin continuous regular insulin drip
Identify history of diabetes, time of last food, and time/amount of last insulin injection
Ongoing:

Monitor vital signs, LOC, cardiac rhythm, oxygen saturation, and urine output
Assess breath sounds for fluid overload
Monitor serum glucose and serum potassium
Administer potassium to correct hypokalemia
Administer sodium bicarbonate if severe acidosis (ph <7.0)

Front 16

What is happening physiologically in DKA?

Back 16

Patients exhibits dry mouth, thirst abdominal, nausea & vomiting, confusion, lethargy, flushed, dry skin, eyes appear sunken, breath odor of ketones, rapid, weak pulse, labored breathing (Kussmaul respiration's), fever, urinary frequency, serum glucose >300.

Front 17

Managing diabetes at home when ill-principles and guidelines

Back 17

When the person with diabetes is ill, the blood glucose should be tested at 4-hour intervals to determine the effects of this stressor on the blood glucose level’ they should also continue with the regular meal plan while increasing the intake of noncaloric fluids, such as broth, water, diet gelatin, and other decaffeinated beverages; they should also continue taking oral agents and insulin as prescribed. When the illness causes the patient to eat less than normal, she or he should continue to take oral hypoglycemic medications and/or insulin as prescribed while supplementing food intake with carbohydrate-containing fluids; the health care provider should be notified promptly if the patient is unable to keep any fluids or food down. Patient should understand that medication for diabetes, including insulin, should not be withheld during times of illness because counter-regulatory mechanisms often increase the blood glucose level dramatically; food intake is also important during this time because the body requires extra energy to deal with the stress of the illness, and extra insulin may be necessary to meet this demand and to prevent the onset of DKA in the patient with type 1 diabetes.

Front 18

Hypoglycemia

Back 18

to treat first check blood glucose if possible if below 70, should began giving 15 to 20g of a simple (fast acting) carbohydrate, such as 4 to 6 oz if fruit juice or regular soft drink or 8oz of low-fat milk; treatment with sweet foods that also contain fat, such as candy bars, cookies, and ice cream, should be avoided because the fat in them will slow down the absorption of the sugar and delay the response to treatment; over-treatment with large quantities of quick-acting carbohydrates should also be avoided so that a rapid fluctuation to hyperglycemia does not occur; blood glucose should be checked 15 minutes following the initial treatment, and treatment should be repeated if the blood glucose remains below 70. If there is no significant improvement in the patient’s condition after 2 to 3 doses of 15g of simple carbohydrate, or if the patient is not alert enough to swallow, 1 mg of glucagon may be administered by IM or SubQ injection.

Front 19

Hyperglycemia

Back 19

treatment physician’s attention, continuance of diabetes medication as ordered, check blood glucose frequently, check urine for ketones and record results, and hourly drinking of fluids

Front 20

What’s glucagon? Principles for use and follow-up.

Back 20

Is synthesized and released from pancreatic alpha cells in response to low levels of blood glucose, protein ingestion, and exercise; it increases blood glucose by stimulating glycogenolysis, gluconeogenesis, and ketogenesis. glucagon and insulin function in a reciprocal manner to maintain normal blood glucose levels; also used in hypoglycemia to increase blood glucose levels

Front 21

What is diabetes insipidus (DI)? How does the nurse assess? What signs and symptoms are of concern

Back 21

It is associated with a deficiency of production or secretion of ADH or a decreased renal response to ADH; the decrease in ADH results in fluid and electrolyte imbalances caused by increased urinary output and increased plasma osmolality; characterized by increased thirst and increased urination, but the primary characteristic of DI is the excretion of large quantities of urine (5 to 20 L per day) with a very low specific gravity;
The nurse management of the patient with DI includes early detection, maintenance of adequate hydration, and patient teaching for long-term management; assessment of weight gain, headache, restlessness, and signs of hyponatremia and water intoxication because indicate overdosage.

Front 22

Graves’ disease-how is it managed?

Back 22

Is a autoimmune disease of unknown etiology marked by diffuse thyroid enlargement and excessive thyroid hormone secretion; precipitating factors such as insufficient iodine supply, infection, and stressful life events may interact with genetic factors to cause Graves’ disease. It is managed the same as hyperthyroidism.

Front 23

Thyroidectomy post-op care.

Back 23

Assess the patient ever 2 hours for 24 hours for signs of hemorrhage or tracheal compression such as irregular breathing, neck swelling, frequent swallowing, sensations of fullness at the incision site, choking, and blood on the anterior or posterior dressing
Place patient in a semi-Fowler position and support the patient’s head with pillows, and avoid flexion of the neck and any tension on the suture lines.
Monitor VS. Complete initial assessment by checking for signs of tetany secondary to hypoparathyroidism (tingling in toes, fingers, or around the mouth; muscular twitching; apprehension) and by evaluating difficulty in speaking and hoarseness; Trousseau’s sign and Chvostek’s (light tap over facial nerve)sign should be monitored for 72 hours. Some hoarseness is to be expected for 3 to 4 days after surgery because of edema
Control postoperative pain by giving medication.
If postoperative recovery is uneventful, the patient is ambulated within hours after surgery, is permitted to take fluid as soon as tolerated, and eats a soft diet the day after surgery

Front 24

Managing exophthalmos in a patient.

Back 24

A protrusion of the eye-balls from the orbits; it is a type of infiltrative ophthalmopathy that is due to impaired venous drainage from the orbit, which causes increased fat deposits and fluid (edema) in the retro-orbital tissues, and due to the increased pressure, the eyeballs are forced outward and protrude; to relieve eye discomfort and prevent corneal ulceration include applying artificial tears to soothe and moisten conjunctival membranes and salt restriction may help reduce periorbital edema, elevation of the patient’s head promotes fluid drainage from the periorbital area, the patient should sit upright as much as possible, dark glasses reduce glare and prevent irritation from smoke, air currents, dust and dirt; of the eyelids cannot be closed, they should be lightly taped shut for sleep; to maintain flexibility, the patient should be taught to exercise the intraocular muscles several times a day by turning the eyes in the complete rang of motion; good grooming can be helpful in reducing the loss of self-esteem that can result from an altered body image.

Front 25

Cushing syndrome-signs & symptoms, management; How it differs from Addison’s?

Back 25

is a spectrum of clinical abnormalities caused by an excess of corticosteroids, particularly glucocorticoids.
In Addison’s disease, all three classes of adrenal corticosteroids (glucocorticoids, mineralocorticoids, and adrogens) are reduced; the most common cause is autoimmune response; adrenal tissue is destroyed by antibodies against the patient’s own adrenal cortex.

Front 26

Adrenalectomy care.

Back 26

Careful assessment for signs of fluid and electrolyte imbalance (especially potassium) can cardiovascular status. BP should be monitored frequently before and after surgery b/c unilateral adrenalectomy is sucessful in controlling hypertension in only 80% of patients with adenoma. The need for continued health supervision should be stressed

Front 27

Prednisone/corticosteroid therapy principles and guidelines

Back 27

Anti-inflammatory action
Immunosuppression
Maintenance of normal BP
Carbohydrate and protein metabolism
Drug alert-Instruct patient not to discontinue abruptly, monitor for signs of infection, instruct diabetes to closely monitor blood glucose