Endo 2

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Endo 2
2012-01-21 22:48:20

Hyperthyroid thru Pheochromocytoma
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  1. Hyprethyroidism
    • Autoimmune disorder
    • Increase in T3 and T4.
    • Increase metabolism and growth.
  2. Hyperthyroidism Data Collection
    Goiter, Exopthalmos (excess fliud behind eyeball causeing them to bulge), Increase metabolic rate, heat intollerance, wt loss, increase appitite, tachycardia, hypertension, hyperthermia, gynomastia, vitiligo, restlessness, tremmors, fatigue
  3. Hyperthyroidism Interventions
    Restfull enviornment, avoid stimulants that increase metabolic rate, no asprin, daily wt, I&O, safety, diet high cal 4000-5000, teach S/S of hypothyroidism, surgery
  4. Thyroidectomy
    • Removal of the thyroid gland
    • Position in high fowlers
    • Support incision when moving
    • S/S of infection, vocal striderr
    • Monitor for tetany (tx- Calcium Glutimate)
    • harsh voice will go away
    • monitor for low Ca (muscle cramps, twitching)
    • Complications- airway, heart failure, death, MI, tachycardia
  5. Thyroid Storm
    • over secreation of Epi or Norepi, thyrotoxicosis, severe hypermetabolism
    • Medical emergency
    • can cause cardiac, hepatic and renal failure
    • causes- stressful situations (surgery, infection, HA, stroke, abrupt stop of meds
  6. Thyroid storm Data Collection
    Increase HR, BP, Temp, tremmors, seizures, diabetic ketoacidosis
  7. Thyroid Storm Interventions
    Nothing to increase metabolic rate, quiet restful environment, beta blockers, No Aspirin, Call Dr. immediately
  8. PTU propyithouracil
    • Decrease production of thyroid hormone
    • PO
    • SE- agranulcytosis, drug induced hepatitis, headache, decreased taste sensation, arthralgia, N, V, anorexia, diarrhea, hypothyroidism, drowsiness, joint pain
    • Interventions- safety, give with food, monitor for infection, S/S of liver toxicity (clay colored stool, amber urine, jaundice), avoid foods with iodine
  9. SSKI potassium iodide
    • Decrease production of thyroid hormone
    • IV, PO
    • SE- diarrhea, ache, hypothyroidism, iodism (metallic taste, stomatitis, skin lesions, severe GI upset
    • Interventions- mix with fruit juice or milk, give around meals, drink with straw (med can stain teeth, lips, and skin), avoid foods with iodine
  10. Hypothyroidism
    • Cretinism in children- congenital defficet
    • defective physical development and mental retardation
    • Thick protuding tounge, large heads, short limbs, puffy eyes, excessivly dry skin
    • untreated- dwarfism, sterility, MRDD
    • Myxedema in adults
  11. Myxedema
    • Presistantly low thyroid hormone
    • Decreases T3 and T4
  12. Myxedema Data Collection
    Cold intolerance, decreased metabolic rate, enlarged heart, GI problems, deafness, menstral disturbances, hypotension, bradycardia, hypothermia, constipation, forgetfull, decreased BS, Na, iscemic heart disease, poor circulation, wt gain
  13. Myxedema Interventions
    Low cal diet, decrease cholesterol and fats, monitor BS, avoid iodine foods, vitals, neuro checks, safety, rest, daily wt, monitor heart, increase roughage and water, teach S/S of hypo and hyperthyroidism
  14. Myxedema Coma
    • Medical emergency
    • hypothyroid crisis
    • due to abrupt withdraw of meds
    • care for coma pt
    • keep warm
    • cardiovascular collapse
  15. Synthroid levothyroxine
    • Hormone thyroid preparation
    • PO, IM, IV
    • SE- insomnia, nervousness, headache, increased sweating, increase or decrease BP
    • Interventions- give in morning before breakfast, monitor BP and P (adult over 100, child over 120 hold med, call dr.). life long therapy, dont switch between trade and generic,monitor for wt loss, Anticolagulant, digitalis, hyperglycemics enhance effects of med
  16. Thyroid Disorders
    • Hashimotos Thyroiditis
    • autoimmune hypothyroid
    • antibodies kill enzymes needed to produce T3 and T4
    • more common in females
    • increase chance with heredity
    • life long hormone replacement
    • usually have down's or turner's syndrome
    • Thyroid tumors
    • painless lump
    • thyroid scan tells if cancer or not (cold = cancer, hot= benign)
    • biopsy confirms cancer
    • radiation to shrink chemo if wide spread
    • surgery to remove thyroid
    • dyspasia, hoarseness, vocal strider, mass in neck
  17. hyperpapathyroidism
    • overactive parathyroid
    • increased PTH
    • Calcium leaves the bones and accumulates in blood
    • kidneys cant keep up excretion of Ca starts to seep into surrounding tissue
  18. Hyperparathyrodism Complications
    kidney stones, spongy swollen kidneys, UTI, renal failure, stone formation in bile duct and gallbladder
  19. Hyperparathyroidism Data Collection
    polyuria, wt loss, HTN, bradycardia, back pain, bbone tenderness, tetany, renal calculi, neuro changes, skeletal deformities, anorexia, constipation, N, V, stooper
  20. Hyperparathyroidism Diagnostics
    • serum PTH and Ca increased, Phosporus decreased
    • X-Ray of long bones
  21. Hyperparathyroidism Interventions
    Diet with Mag and Vita D, monitor cardiac, surgery, trach, O2 and suction by bed side, screen urine for stones, hormone replacement
  22. Calcimar calcitonin
    • Hormone that causes Ca to be excreated by kidneys
    • IM, SubQ, Intranasal
    • SE- urinary frequency, epitaxis, N, V, diarrhea, headache, flushing, hypocalcemia
    • Interventions- teach intranasal technique, S/S hypocalcemia (muscle twitching, seizure, nervousness, paresthesia, muscle cramping/pain)
  23. Hypoparathyroidism
    • autoimmune congenital
    • seen mostly because of removal
    • Ca leaves blood is reabsorbed into bones
    • long term decreased Ca = decreased contractility of heart
  24. Hypoparathyroidism Complications
    CHF, increased ICP, bone deformities, resp distress, severe tetany
  25. Hypoparathyroidism Data Collection
    Chvostek's and Trousseau's sign, urinary retention, frequent dry skin, alopecia, teeth crack or stain
  26. Hypoparathyroidism Diagnostics
    • Serum Ca increased
    • Ca in urine
  27. Hypoparathyroidism Interventions
    diet with increased Ca, monitor airway, neuro checks, monitor for seizures
  28. Kalcinate calcium gluconate
    • electrolyte replacement, maintain cell permeability
    • PO, IV
    • SE- tingling, bradycardia, N, V, constipation, renal calculi
    • Interventions- S/S of hypocalcemia, no enteric coated med within 1 hr of med, no high oxalate foods, increase fluids, Vita D, no antacids with Mag
  29. Vitamin D
    • Supplament
    • PO, IM, IV
    • SE- headache, dizzyness, bradycardia, hypertension, anorexia, nausea, diarrhea, dry mouth, metallic taste, bone pain, fever, chills, increased BP
    • Interventions- vitals, oral care, drinks, hard candy, foods high in calcium, S/S hypocalcemia, no antacids with Mag
  30. Cushing's Disease
    • increase ACTH
    • pituitary causes adrenal gland to increase production of corticosteroids and glucocorticoids
  31. Cushing's Disease Complications
    insulin resistance, slow wound healing, decreased inflammatory response, decreased ability to handle stress, early puberty, easy brusing, fatigue,
  32. Cushing's Disease Data Collection
    wt gain, water retention, buffalo hump, moon shaped face, hyperglycemia, hypertension, hypokalemia, hirsuitism
  33. Cushing's Disease Interventions
    restore balance if tumor remove it, monitor for bleeding, I&O, increased protein, potassium, decreased Na, carbs, cal
  34. Cushing's Disease Meds
    • Cytadren, Nizoral, Mitotane
    • Steroids before and after surgery, give with food, steroids interact with birth control, monitor BS, do not stop abruptly tapper off
  35. Cytadren aminoglutethimide
    • antineoplastic, inhibits adrenal steroids
    • PO
    • SE- dizziness, drowsiness, N, V, wt loss, alopecia, decreased immune system
    • Interventions- S/S of infection, daily wt, I&O, s,all frequent meals, eat whatever sounds good to them
  36. Nizoral ketoconazole
    • antifungal, inhibits steroid genisis at cell level
    • Topical
    • SE- localized burning, redness, stinging
    • Interventions- monitor skin, wash area before applying, rotate sites, no dressing over med, can stain skin, clothes, hair
  37. Mitotane lysodren
    • antiparkinson agent, decreases activity of adrenal cortex
    • PO
    • SE- orthostatic hypotension, N, V, depression, dizziness, change position slowly, give with meals, limit protein intake, limit activity, monitor BS, birth control is less effective
    • usually given for inoperable adrenal tumor
  38. Addison's Disease
    • decreased function of adrenal gland
    • 10% functioning 90% dysfunction
    • usually from abrupt withdraw from meds
  39. Addison's Disease Data Collection
    Bronze skin, weakness, hypotension, hyponatremia, hyperkalemia, hypoglycemia, wt loss, vitiligo, faigue, light headed, crave salt, decreased stress tolerance, irregular P, BP, GI upset
  40. Addison's Disease Interventions
    Restore electrolyte balance, increase Na, decrease potassium, small frequent meals, lifetime steroid replacement
  41. Hydrocortisone hydocortone
    • steroid
    • PO, IM, IV SubQ, Topical
    • SE- anaphalactic reaction, mask infection, wt gain, hypocalcemia, hypokalemia, thrombocytopenia, osteoporosis, headache, insomnia, vertigo, delayed wound healing
    • Interventions- vitals, daily wt, I&O, S/S of infection, monitor BS
  42. Addisonian Crisis
    • acute form of addisons disease
    • trauma, surgery, stress, abrupt withdraw of steriods
  43. Addisonian Crisis Data Collection
    • same as addison's disease
    • severe symptoms
    • rapid onset
  44. Addisonian Crisis Interventions
    • immediate steroids
    • promptly restore fluid and electrolyte balance, I&O, skin turger, urine charactersitics, IV hydrocortisone
  45. Pheochromocytoma
    • Increase in Epi or Norepi
    • hypertensive crisis
    • adrenal medulla tumor
    • paroxysmal or sustained HTN
    • 5% hereditary
  46. Pheochromocytoma Data Collection
    increased HR, BP, pa;pitations, increased metabolism, wt loss, renal failure in late stage, headache, sweating, N, Vm visual disturbances, Triad increased diastolic BP 115 or above, unrelenting headache, profuse sweating
  47. Pheochromocytoma Interventions
    radiation, surgery, chemo, monitor BP, increase protein, avoid caffeine, alcohol, yogurt, aged cheese, wine, monitor for anxiety, avoid stimulating foods
  48. Pheochromocytoma Meds
    • Regitine Dibenzyline- given if surgery is counterdicted, avoid OTC for colds, avoid alcohol, orthostatic hypotension
    • Nipride- potent antihypertensive
    • Metyrosine (Desmer)- blocks catacholamine, for inop tumor, on for rest of life
    • Inderal- dont stop abruptly, no smoking
    • Atenolol- beta blocker, increased cold sensitivity
    • Minipress- take on empty stomach
    • Normadyne- lay for 3 hours after taking, usually given at bedtime
    • Procardia- protect from light, monitor BP for effectivness