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79 Cards in this Set
- Front
- Back
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A 60-year-old woman is diagnosed with Hypothyroidism. Signs and symptoms of Hypothyroidism include:
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A. Tachycardia
B. Weight gain C. Diarrhea D. Anorexia |
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ｰ
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LEVOTHYROXINE (SYNTHROID)
patient instructions |
take empty stomach-1 hour ac/2 hours pc
Do not stop without consulting MD Report... Chest pain, SOB, palpitations Pulse > 100 Food and Drug interactions Do not substitute |
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What should you teach concerning prevention of Myxedema coma?
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Take medication as directed
Avoid stressful events Wear ID bracelet |
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WHAT IS MYXEDEMA COMA?
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Extreme form of hypothyroidism
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MYXEDEMA COMA
s/s |
Hypotension
Bradycardia Hypothermia Coma Respiratory depression Hypoglycemia |
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NURSING RESPONSES for hypothyroidism
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ABC’s
Administer IV Levothyroxine Administer IV fluids Glucose, sodium EKG monitoring Administer IV Steroids Treat underlying cause Keep warm Avoid sedation Continue to monitor very closely |
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A Client is admitted to the emergency department and a diagnosis of myxedema coma is made. What nursing actions does the nurse prepare to carry out initially?
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Maintain an airway
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HYPERTHYROIDISM
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Graves’ Disease
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What are the signs and symptoms of Hyperthyroidism?
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Nervousness and weight loss
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WHICH FINDINGS INDICATE HYPERMETABOLISM?
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Anxiety, restlessness, insomnia
Increased SBP Palpitations, dysarrhythmias, tachycardia Dyspnea Elevated temperature Low weight/height ration |
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CALLS FOR NURSING
hyperthyroidism |
Decreased Cardiac Output
Disturbed Sensory perception: Visual Imbalanced Nutrition: Less than Body Requirements Disturbed Body Image Anxiety |
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Medications to treat hyperthyroidism
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Antithyroid drugs
Propanolol (Inderal) |
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ACTIVITY for hyperthyroidism
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Encourage rest
Quiet, cool environment Cool baths |
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NUTRITIONAL NEEDS for hyperthyroidism
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High calorie, high protein, high carbohydrate meals
6 meals day Assess bowel elimination & adjust diet accordingly Monitor weight Monitor nutritional status |
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INSTRUCT PATIENT TO REPORT these s/s of hyperthyroidism
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Palpitations
Dyspnea Vertigo Chest pain |
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The nurse should teach the client to prevent corneal irritation from mild exophthalmos by:
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Wearing dark covered glasses
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MEDICAL THERAPY for hyperthyroidism
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Antithyroid Agents
PTU (propylthiouracil) Adjunct Therapy SSKI or Lugol’s solution Beta Blockers Inderal |
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THYROID STORM NURSING RESPONSES
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Maintain patent airway.
Monitor for and promote reduction of hypermetabolic state-Administer: Antithyroid drugs Steroids Beta blockers Promote reduction of temperature Monitor fluid volume deficit/overload |
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TREATMENT OPTIONS for hyperthyroidism
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Radioactive iodine (RAI)- I 131
Surgery-Subtotal Thyroidectomy |
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A client with Grave’s Disease is treated with radioactive iodine (RAI). Which of the following statements by the nurse will explain to the client how the drug works?
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The RAI destroys thyroid tissue so that thyroid hormones are no longer produced.”
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SURGICAL MANAGEMENT for hyperthyroidism
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Pre-op teaching
Post-op management Airway Activity Nutrition Emotional support Assess for complications Hemorrhage Respiratory Distress Laryngeal nerve damage Tetany Discharge instructions |
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The nurse is performing an assessment on the client following a thyroidectomy. The nurse notes that the client has developed hoarseness and a weak voice. Which of the following nursing actions is appropriate?
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Notify the physician immediately.
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CUSHING’S SYNDROME
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CORTISOL EXCESS
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Cushing’s is manifested by the excessive secretion of corticosteroids. The hormones involved are:
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Glucocorticoids, Aldosterone and Androgens
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adrenal gland hormones
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S Sugar (glucocorticoids)
S Salt (mineralcorticoids) S Sex (androgens) |
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Cause of Cushing’s Syndrome
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Long-term steroid use
Adrenal tumor |
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Cause of Cushing’s Disease
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Pituitary tumor
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WHICH INDICATE CUSHING’S SYNDROME?
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Truncal obesity
Moon face Weakness & fatigue BP 180/94 Frequent colds Thin arms & legs thin fragile skin Bruising on both arms Hyperglycemia GI disturbance |
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CALLS FOR NURSING for Cushing's syndrome
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Fluid volume excess
Risk for injury Risk for infection Disturbed body image |
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Nursing Responses
Fluid Volume Excess |
Daily Weight
Assess for… Fluid Restriction |
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Nursing Responses
Risk for Injury |
Safety measures
Balance activity with rest |
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Nursing Responses
Risk for Infection |
Prevent infection
Monitor vitals Increase protein and vitamins |
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Nursing Responses
Disturbed Body Image |
Express feelings
Coping strategies |
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Bone resorption is a possible complication of Cushing’s syndrome. To counter the damage done by the disease, the nurse should encourage the client to:
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Maintain a regular program of weight-bearing exercise.
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MEDICATION TEACHING FOR STEROIDS
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Take with food
Diet Teaching Report weight gain/edema Skin care Gradually increase activity Protect from injury Report any illness Emotional support Wear ID Don’t stop abruptly |
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A nurse is doing discharge teaching with a client who has Cushing’s syndrome. Which of the following statements is correct?
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I will limit the amount of salt in my diet
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ADDISON’S DISEASE
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ADRENOCORTICOL INSUFFICIENCY
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Explain what happens when you take long-term steroids.
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“If you don’t use it, you lose it.”
adrenal gland shrinks |
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How can I tell if my dose is too low?
(corticosteroid) |
Extreme weakness
Lethargy Nausea Dizziness (when standing) |
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CAUSES OF ADDISON’S DISEASE
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Autoimmune or Idiopathic
Surgical Secondary |
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Cortisol Deficiency
s/s |
Hypoglycemia
Anxiety, restlessness, irritability, confusion Lethargy, weakness, nausea, vomiting & diarrhea |
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Aldosterone Deficiency
s/s |
Hyponatremia
Dizziness, confusion & neuromuscular irritability Postural hypotension, syncope Hyperkalemia Cardiac Dysarrhythmias |
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CALLS FOR NURSING
ADDISON’S DISEASE |
Deficient Fluid Volume
Anxiety Risk for Ineffective Therapeutic regimen |
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The nurse would expect the client with Addison’s disease to exhibit which of the following signs and symptoms?
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Lethargy
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NURSING RESPONSES
ADDISON’S DISEASE |
Administer Medications
Hydrocortisone (Cortef) Prednisone Take with meals Never skip a dose Weigh daily Florinef Restore Fluid Volume IV 0.9 NS |
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MONITOR FLUID BALANCE
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Why?
Assess vital signs Lying, sitting and standing BP’s Daily weights Monitor I/O Assess signs dehydration Encourage fluid intake 3000 ml/day Liberal use of salt Increased salt in hot weather Teach safety measures |
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TEACH ACTIVITY GUIDELINES
ADDISON’S DISEASE |
Avoid unnecessary activity that could precipitate crisis
Minimize all stress |
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After stabilization of Addison’s disease, a client attends a stress management class. Which of the following actions taught by the nurse in the class is based on principles of stress management?
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Use relaxation techniques such as music
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CLIENT EDUCATION: TO AVOID A CRISIS
Addisons disease |
Close follow-up
Dosage increased in times of stress, illness Know s/s crisis Emergency measures if can’t take oral med Diet with increased fluids, high sodium low potassium Medic-Alert bracelet |
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The nurse is teaching an adult client who has Addison’s disease about drug therapy for his condition. In evaluating the effectiveness of teaching regarding drug therapy, the nurse should expect him to be able to verbalize the need:
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For lifelong therapy
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s/s ADDISON’S CRISIS
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Life threatening…Develops Rapidly
S/S shock/Severe Dehydration rapid, weak pulse; hypotension, circulatory collapse, shock and coma High Fever Weakness Severe pain in abdomen, back and legs Severe vomiting and diarrhea |
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NURSING RESPONSES TO Addisons CRISIS
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Restore blood volume
IV fluids-D5/NS Vasopressors Administer Cortisol IV Frequent assessments & monitoring Treat underlying problem |
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Mr. B is admitted to the hospital with Addison’s disease. He has a respiratory infection. When his vitals are assessed, his blood pressure is 86/40. The nurse should notify the physician immediately because:
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Shock may be developing
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REVIEW the ANTERIOR PITUITARY
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Growth hormone
Prolactin Adrenocorticotropin hormone Thyroid stimulating hormone Gonadotropins |
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CALLS FOR NURSING
transsphenoidal hypophysectomy |
Anxiety
Pain Risk for disturbed self-esteem Sexual dysfunction Risk for activity intolerance |
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PRE-OP TEACHING
transsphenoidal hypophysectomy |
Clarify knowledge about disease and anticipated effects
Emotional support Further explain surgical approach Dura patch Nasal packing |
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POST-OPERATIVE CARE
transsphenoidal hypophysectomy |
Identify major teaching needs
Prevent increased intracranial pressure Semi-fowlers Do not cough, sneeze , blow nose, vomit or bend over Prevent infection Gentle mouth rinsing-no brushing for 2 weeks Encourage fluids Immediately report runny nose, post-nasal drip, increased swallowing, halo ring, stiff neck, persistent headache |
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POST-OPERATIVE CARE
trans sphenoidal hypophysectomy |
Prevent Atelectasis
Turn q 2 hr Teach deep breathing, sighing and mouth breathing Adequate fluid intake |
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A patient is admitted for surgery to treat a pituitary adenoma. To help minimize the risk of postoperative respiratory complications, the nurse would focus the client’s preoperative teaching on the importance of:
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Deep breathing
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SURGERY WAS SUCCESSFUL (transsphenoidal hypophysectomy)
Ten hrs post-op c/o post-nasal drip & frequent swallowing What 5 actions do you need to take? |
Assess drainage in throat with light.
Check external nasal pack for “halo ring” Take Vitals Keep on BR & HOB Assess for early s/s infection-fever, headache, etc.. Save drainage to show MD |
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transsphenoidal hypophysectomyVS 100/66, 98, 16
c/o thirst, skin flushed urine output 300ml/h with specific gravity 1.003 flaccid What additional information do you need before calling the physician? |
Check temperature
Assess neurologic status s/s dehydration-restless & irritability Assess other signs of hypovolemia dry skin, turgor, I/O, weight, mucous membranes |
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After Pituitary surgery the nurse should assess the client for which of the following?
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Urine specific gravity less than 1.010
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PHYSICIAN ORDERS
After Pituitary surgery |
Serum & urine osmolality & electrolytes
Urine osmolality 95 Serum osmolality 315 Sodium 146 Replacement therapy IV’s-2500-3000ml/day Desmopressin PO, IV, IM & SQ. |
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EVALUATE NURSING RESPONSES
After Pituitary surgery |
Weight stable
Urine output decreased Stable VS Balanced I/O Electrolytes WNL Moist mucous membranes Good skin turgor No c/o thirst Alert & oriented Remissions? |
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DISCHARGE TEACHING
After Pituitary surgery |
Replacement therapy for life
Glucocorticoid & Mineralcorticoid May need Vasopressin (DDAVP) May need Thyroid or Sex hormones Medication Teaching |
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EYE DISORDERS-CATARACTS
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Clouding or opacity of .
Painless blurring of vision. Eventual loss of sight. |
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RISK FACTORS FOR CATARACTS
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AGE (senile)
Ocular Conditions Physical Factors Trauma Sunlight Systematic Disease Diabetes Lifestyle Factors Smoking ETOH |
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IS THERE ANY PREVENTION FOR CATARACTS ?
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PRIMARY PREVENTION: Eye Protection, Lifestyle factors
SECONDARY PREVENTION: Routine Screening TERTIARY PREVENTION: Diabetic Control |
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Interdisciplinary Care FOR CATARACTS
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Surgery is only treatment
Done when interferes with vision or ADL’s Phacoemulsification IOL-Intraocular lens implant |
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CALLS FOR NURSING FOR CATARACTS
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Decisional Conflict: Cataract Removal
Risk for Ineffective Therapeutic Regimen Management |
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NURSING INTERVENTIONS FOR CATARACTS
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Help explain the condition to the client
Providing pre-operative care Anticoagulant therapy discontinued prior Aspirin-5-7 days NSAIDS-3-5 days Coumadin 3-5 days or until INR 1.5 Dilating drops prior Pre-op teaching |
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POST-OP CLIENT EDUCATION FOR CATARACTS
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Providing post-operative care
Teach Measures to prevent Eye Injury Avoid vomiting, straining, coughing, sneezing, lifting > 5`# and bending over at the waist. Assess for Potential Complications Pain, hemorrhage, flashers of light, floaters or sensation of curtain being drawn over eye Teach Eye Care Use of medications Gentle cleansing with warm water Eye Shield Safety Education |
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COMMUNITY-BASED CARE
FOR CATARACTS |
Self-care deficit
Follow-up Care |
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After a client has undergone outpatient surgery for a right eye cataract removal, the nurse teaches the client to avoid which of the following when the client goes home
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Lying on the right side
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Outpatient cataract surgery has been performed and the client is being prepared for discharge. To evaluate whether the client understands the postoperative home care teaching regimen, the nurse asks the client to do which of the following?
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Demonstrate proper instillation of eye drops
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