med-surg test #3 ch 44 & 45

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med-surg test #3 ch 44 & 45
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med-surg test #3 ch 44 & 45
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  1. Acromegaly
    Disease of middle-age adults resulting fromoverproduction of growth hormone by the anterior pituitar
  2. Addison Disease
    Deviation resulting from a deficiency of adrenocorticotropic hormone cause by a destruction or dysfunction of the adrenal glands
  3. Adrenalin
    Epinephrine; a powerful vasoactive substanceproduced by the adrenal medulla in times of stress or dancer
  4. Androgens
    Hormones produced by the adrenal cortex, testes,and ovaries that stimulate the development of male characteristics
  5. Catecholamine’s
    Chemicals released by sympathetic nerve endingsin response to stress
  6. Cushing Disease
    Caused by the hypersecretion of glucocorticoidsas a result of the excessive release of adrenocorticotropic hormone by thepituitary
  7. Cushing Syndrome
    Resulting from excessive Glucocorticoids in thebody as a result of a tumor or the hypersecretion of the pituitary gland or bythe prolonged administration of large doses of exogenous steroids
  8. Diabetes Insipidus
    Disease caused by the inadequate secretion ofthe antidiuretic hormone by the posterior portion of the pituitary gland
  9. Dwarfism
    attainment of a maximum height that is 40 below normal.  occurs when inadequate secretion of growth hormone occurs during pre-adolescence
  10. Endocrine Glands
    Gland that secretes a substance directly intothe blood
  11. Estrogens
    Hormone produced by the ovaries, adrenal glands,and fetoplacental unit in women; it is responsible for the sexual developmentand maturation of women
  12. Gigantism
    Disease caused by excessive growth hormone inchildren and young adolescents resulting in excessive proportional growth
  13. Glucocorticoid
    Class of adrenocortical hormones that affectprotein and carbohydrate metabolism and help protect the body against stress
  14. Hypophysectomy
    – Surgical removal of all or part of thepituitary gland
  15. Mineralcorticoids
    Type of hormone secreted by the adrenal cortexand involved in the regulation of fluid and electrolyte levels in the body
  16. Syndrome of inappropriate antidiuretic hormone(SIADH)
    Disorder caused by excess antidiuretic hormoneproduction; symptoms include decreased urination, edema, and fluid overload
  17. Chvostek sign
    Spasm of the facialmuscles when the facial nerve is tapped. It is indicative of hypocalcemia
  18. Cretinism
    Permanent mental andphysical retardation caused by congenital deficiency of thyroid hormones
  19. Exophthalmos
    Protrusion of theeyeballs; is associated with hyperthyroidism
  20. Goiter
    Enlargement of thethyroid gland
  21. Goitrogen
    Substances thatsuppresses thyroid function
  22. Laryngospasm
    Spasmodic closure ofthe larynx
  23. Myxedema
    Facial edema thatdevelops with severe, long-term hypothyroidism; sometimes used as a synonym forhypothyroidism
  24. Nodule
    Small mass of tissuethat can be palpated
  25. Parotiditis
    Inflammation of theparotid (salivary) gland; most commonly called parotitis
  26. Tetany
    Steady musclecontraction caused by hypocalcemia
  27. Thyroiditis
    Inflammation of thethyroid gland
  28. Thyrotoxicosis
    Excessive metabolicstimulation caused by an elevated level of the thyroid hormone
  29. Trousseau sign
    Carpopedal spasmafter compression of the nerves in the upper arm; is a sign of hypocalcemia
  30. Know what Cushing’s syndrome is what causes it and the signs and symptoms of it
    • cushing's syndrome is a condition that results from excess cortisol - hypersecretion of adrenal cortex which results in excess amounts of corictosteroids especially glucocorticoid - may result from endogenous and exogenous causes
    • endogenous causes include corticotropin-secreting pituitary tumors
    • exogenous causes are prolonged administration of high doses of corticosteroid agents  - most common cause
    • S/S: obesity, facial redness, hirsutism (excess hiar), menstrual disorders, hypertension of varying degrees, muscle wasting of the extremities, delayed wound healing, insomnia, irrational behavior, mood disturbances such as anxiety and mood swings
    • halmark s/s: truncal obesity, protein wasting, facial fullness or moon face, purple striae on abnomen, breast, buttocks or thighs, osteoporosis, hypocalemia of uncertain causes
  31. Know what Addison’s disease is, what causes it and the signs and symptoms of it
    • primary adrenal insufficiency also called addison's disease
    • frequently result of distructive disease process affecting the adrenal glands causeing difficiencies of cortisol and aldosterone
    • the most common cause is idiopathic atrophy which is an autoimmune disease in which adrenal tissue is destroyed by antibodies of the patients own immune system.  other causes are TB, hemorrhage related to anti-coagulant therapy, fungal infections, AIDS, metabolic cancer, gram-negatic sepsis, adrenalectomy, adrenal toxins, abrupt withdrawal of exogenous steroid agents
    • S/S: decreased loss of body, axillary and pubic hairs, in pre-pubescent people; facial, pubic and axillary hair may fail to grow entirely, lack of secondary sex characteristics, symptoms present during acute adrenal crisis or addisonian crisis
  32. what is an addisonian crisis?
    • a life threatening emergency which results from a sudden marked decrease in available adrenal hormones.
    • sometimes happens after adrenal surgery or pituitary distruciton or an abrupt withdrawal of steroid therapy and stress
    • s/s: hypotension, tachycardia, dehydration, confusion, hyponatremia, hyperkalemia, hypercalcemia, hypoglycemia, if left unbalanced the elecgtrolyte imbalance can lead to circulatory collapse, d
  33. Know what is happening with the electrolytes in Addison’sdisease
    Addison's disease isthe destruction of the adrenal glands, preventing their response to ACTH. Lackof response to ACTH means reduced production of glucocorticoids and Mineralcorticoids.In Addison's disease there is high ACTH, low sodium and high potassium in theblood. Low blood sodium also means that a person with Addison's disease willhave a low blood pressure; when sodium is absorbed in the kidney, water isabsorbed as well and therefore sodium absorption is important for maintainingblood pressure. Treatment for Addison's disease is intravenous administrationof hydrocortisone and is authorized by a physician
  34. Know nursing interventions for treatments ofAddison’s disease
    • a.       Ineffective Tissue Perfusion - administer prescribed IV normal saline, plasma expanders and vasopresorts to maintain blood volume. Monitor serum electrolytes and assess for weakness, paresthesia, dizziness, and electrocardiogram changes.
    • b.      Risk for Injury - instruct the patient who has dizziness to call for help when getting out of bed and to rise slowly to prevent falls. Exercise legs before standing promotes venous return and may minimized the drop in B/P. Administer fluid replacement and hormones as ordered to treat addisonian crisis.
    • c.       Imbalanced Nutrition Less Than Body Requirements - monitor weight changes, salt is not restricted. Respect the patient's food preferences as much as possible. Encourage frequent rest periods to avoid depletion of glycogen stores. Meals should be taken regularly. Monitor for hypoglycemia (headache, tachycardia, trembling and sweating).
    • d.      Fatigue - plan specific rest periods to conserve energy and provide assistance with ADLs as needed.
    • e.       Disturbed Body Image - encourage patient to do their own grooming and compliment the patient's efforts. Discuss strategies to cope with changes
    • .f.       Ineffective Self-Health Management - It is critical for the patient to understand Addison disease and to know how to recognize the effects of the disease. Teach the patient to learn to make adjustments in replacement hormones depending on various stressors.
  35. Know why Imbalanced Nutrition is a Nursingintervention for Addison’s disease
    Hypoglycemia may develop as a result ofdecreased cortisol secreting. Encourage frequent rest periods to avoiddepletion of glycogen stores. Meals should be taken regularly, and between-mealsnacks may be needed to maintain blood glucose. Monitor for ( and teach) thepatient symptoms of hypoglycemia: headache, tachycardia, trembling, andsweating. Periodic laboratory studies are done to assess nitrogen balance,liver function, as well as serum albumin, glucose, electrolytes, BUN, and creatinine
  36. Know what Addisonian Crisis is, what causes it?And the signs and symptoms
    • a.       Patients with either primary or secondary adrenal insufficiency are at risk for episodes of acute adrenal crisis, also called addisonian crisis, which is a life-threatening emergency. This usually results from a sudden marked decrease in available adrenal hormones. Precipitating factors are adrenal surgery, pituitary destruction, abrupt withdrawal of steroid therapy (often a result of a patient unwittingly stopping medications), and stress. Any factor that causes stress in the person can initiate a crisis. Examples of stressors include infection, illness, trauma, and emotional or psychiatric disturbances.
    • Manifestations include symptoms of mineral corticoid and glucocorticoid deficiency but are more severe: hypotension, tachycardia, dehydration, confusion, hyponatremia, hyperkalemia, hypercalcemia, and hypoglycemia. If left untreated, then fluid and electrolyte imbalances can lead to circulatory collapse, cardiac dysrhythmias, cardiac arrest, coma, and death. Page 1015 has a table of interventions for addisonian crisis.
  37. Know each of the endocrine glands
    • Pituitary gland
    • Thyroid gland
    • Pancreas
    • Ovaries
    • Testes
    • Adrenals
    • Parathyroid
  38. Pituitary gland
    anterior pituitary secretes growth hormone (GH),adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH),follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin,melanocyte-stimulating hormone (MSH). Posterior pituitary secretes antidiuretichormone (ADH), oxytocin
  39. Thyroid gland
    thyroid hormone, triiodothyronine, andcalcitonin
  40. Pancreas
    insulin, glucagon
  41. Ovaries
    progesterone and estrogen
  42. Testes
    testosterone and estrogen
  43. Adrenals
    aldosterone, androgen, epinephrine,norepinephrine
  44. Parathyroid
    parathyroid hormone (PTH)
  45. Know the anatomy of the pituitary gland and thedifference between the anterior and posterior lobes)
    a.       The pituitary gland, also called the hypophysis, is a structure that weighs approximately 0.6 g and is located in the sella turcica, a small indentation in the sphenoid bone at the base of the brain.  It is connected to the hypothalamus by the infundibular (hypophyseal) stalk.  The pituitary gland is small and oval and has a diameter of approximately 1 cm.  It consists of two parts, or lobes.  The larger of the two lobes, which accounts for 70 % to 80 % of the glands weight, is the anterior lobe.  The anterior lobe is called the adenohypophysis.  The smaller lobe of the pituitary is known as the posterior pituitary because of it    location in the sella turcica behind the anterior lobe.  It is sometimes referred to as the neurohypophysis
  46. what are the anterior pituitary hormones
    • Growth hormone (GH) or somatotropic hormone
    • Adrenocorticotropic hormone (ACTH)
    • Thyroid-stimulating hormone (TSH) or thyrotrophichormone
    • Follicle-stimulating hormone (FSH)
    • Luteinizing hormone (LH)
    • Prolactin or lactogenic hormone
    • Melanocyte-stimulating hormone (MSH)
  47. what are the posterior pituitary hormones
    • Antidiuretic hormone (ADH) or vasopressin
    • Oxytocin
  48. Growth hormone (GH) or somatotropic hormone
    • stimulates the growth and development of bonesmuscles, and organs
    •  Anterior pituitaryhormones
  49. Adrenocorticotropic hormone (ACTH)
    • controls the growth, development, and function ofthe cortex of the adrenal glands; controls release of glucocorticoids andadrenal androgens; necessary for secretion of aldosterone but does not controlrate of aldosterone secretion
    •  Anterior pituitaryhormones
  50. Thyroid-stimulating hormone (TSH) or thyrotrophichormone
    • controls the secretory activities of the thyroid gland
    •  Anterior pituitaryhormones
  51. Follicle-stimulating hormone (FSH)
    • stimulates the development of the eggs in theovary of the woman and sperm production in the man
    •  Anterior pituitaryhormones
  52. Luteinizing hormone (LH)
    • controls ovulation of egg release in the womanand testosterone production in the man
    •  Anterior pituitaryhormones
  53. Prolactin or lactogenic hormone
    • stimulates breast milk production in the woman
    •  Anterior pituitaryhormones
  54. Melanocyte-stimulating hormone (MSH)
    • promotes pigmentation
    •  Anterior pituitaryhormones
  55. Antidiuretic hormone (ADH) or vasopressin
    • causes the reabsorption of water from the renaltubules of the kidney.  By doing so,water excretion from the body in the form of urine is decreased
    • Posterior pituitary hormones
  56. Oxytocin
    • causes contractions of the uterus in labor andthe release of breast milk
    • Posterior pituitary hormones
  57. Know the age related changes that occur with theendocrine system
    • a.       In older adults the response to ADH is diminished so that the older people is less able to compensate for inadequate fluid intake or excessive fluid loss and is at risk for dehydration.
    • Under normal circumstances, adrenal function remains adequate in the older person. Some patients have a decline in cortisol secretion but that is balanced by a decrease in cortisol metabolism such that blood levels remain normal. Secretion of aldosterone and plasma rennin activity decline with age, and thus the abilities to conserve sodium and adapt to position changes become less efficient
  58. Know the cause of diabetes insipidus and thesigns and symptoms
    • a.       Diabetes insipidus is classified as nephorogenic, neurogenic (central or hypothalamic), or dysgenic (primary polydipsia). Nephrogenic DI is an inherited defect in which the renal tubules of the kidney do not respond to ADH, resulting in inadequate water reabsorption by the kidneys. In neurogenic DI, a defect in either the production or secretion of ADH exists. Dipsogenic DI is a disorder of thirst stimulation.
    • b.      Common s/s are massive diuresis, dehydration, and thirst. Dehydration is characterized by hypotension, tachycardia, dizziness, decreased skin turgor, weakness, and possible fainting episodes. Additional findings include malaise, lethargy, and irritability. An irregular heartbeat may also be detected.
  59. Know how diabetes insipidus is diagnosis andtreated + Meds
    • a.       DI is diagnosed  by a 24-hour urine output of greater than 4 L, without food or fluid restrictions. Patients with DI can excrete up to 30 L/day, depending on the severity of the ADH deficiency or relative deficiency. For the water deprivation test, water is withheld for 8 to 16 hours during which time B/P, weight, and urine osmolality are measured each hour. The test is stopped when the osmolalities stabilize, the patients loses 5% of his or her body weight, or the patient develops orthostatic hypotension. A dose of ADH is then given and the urine osmolality measured 1 hour later. If the patient has neurogenic DI, then the urine osmolality should increase. I suggest reading the pages to get a full understanding of the diagnosis and treatment
    • .b.      Medications that can be used are chlorporpamide (Diabinese), clofibrate (Atromid-S), carbamazepine (Tegretol), indomethacin (Indocin).
  60. Know the nursing care of a surgical patient thatwould have their pituitary gland removed
    • a.       Education and emotional support of a person receiving a hypophysectomy are vital components in their nursing care.
    • b.      Patients need to know that many body changes may occur. Surgical treatment is aimed primarily at preventing further symptoms and complications
    • .c.       Assessment:
    • §  Neurologic status and vision must be monitored closely, with particular attention to level of consciousness, pupil size and equality, and vital signs.
    • §  Strict documentation of intake and output and measurement specific gravity is important.
    • §  Inspections of the nasal dressing for drainage are important because CSF leaks may sometimes occur. Document clear, colorless drainage and notify the surgeon.  To confirm that it is CSF a culture must be taken.
    • §  Monitoring a patient for signs and symptoms of infection is also important. Watch for and elevated WBC count, sudden rise in temperature, headache or nuchal rigidity may be indications of meningitis.
    • §  A pt who has had a gamma knife surgery will return from the procedure with a stereotactic frame in place. Because it is secured to the skull with pins, pin care may need to be done. If pt has a history of seizures, they are at increased risk for the first 24 hours.
    • d.      Interventions:
    • §  Anxiety: orient pt to environment and explain all procedures. Give drugs and teach how pt gives self drugs.
    • §  Disturbed sensory perception: be aware of visual disturbances and collect info about new disturbances that could indicate intracranial pressure.
    • §  Acute pain and impaired oral mucous membrane: administer analgesics and follow up to see if med was effective. Perform frequent mouth care
    • §  Risk for injury:
    • §  Excess or deficit fluid volume: provide IV fluid as ordered and monitor pulse, BP, and I&O.
    • §  Risk for infection: administer antibiotics as ordered.
  61. Know what syndrome of inappropriate antidiuretichormone is, what causes it and what a nurse should watch for
    • a.       Cause: Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is characterized by a water imbalance related to an increase in ADH synthesis, ADH secretion, or both. Factors that may cause or contribute to the development of SIADH include brain trauma, surgery, tumors, and infection; some drugs, including vasopressin, general anesthetic agents, oral hypoglycemic agents, and Tricyclic antidepressant agents' some pulmonary diseases; hypothyroidism; lupus erythematosus; and some types of cancer, including small cell lung cancer, duodenal cancer, and pancreatic cancer.
    • b. Pathophysiology:  When ADH is elevated despite normal or low serum osmolality, the kidneys retain excessive water. Plasma volume expands, causing BP to rise. Body sodium is diluted (hyponatremia), and water intoxication develops. Several types of SIADH exist, with various patterns of abnormal ADH secretions.
    • c.       Signs and Symptoms:   The main symptoms of SIADH initially reflect the effects of delusional hyponatremia and water retention: weakness, muscle cramps or twitching, anorexia, nausea, diarrhea, irritability, headache, and weight gain without edema. When the CNS is affected by water intoxication, the level of consciousness deteriorates. The patient may have seizures or lapse into a coma.
    • d.      Medical Diagnosis: Diagnosis is confirmed by laboratory tests of serum and urine electrolytes and osmolality. Simultaneous measurements of urine and serum osmolality are especially useful. When measured simultaneously, urine osmolality much higher than that of the serum indicates SIADH. The serum is very dilute and the urine is very concentrated. Major characteristics include hyponatremia, hypochloremia, hypouricemia, reduced BUN and creatinine clearance, increased urine sodium, and fluid volume excess without edema. Urine osmolality may be high, or it may be extremely dilute.
    • e.       Nursing Care: Check history for the presence of anorexia, nausea, vomiting, diarrhea, headache, irritability, and muscle cramps and weakness. Document a history of cancer, pulmonary disease, nervous system disorders, hypothyroidism, or lupus erythematosus. Note any prescription drugs the patient is taking. Measure the patient's vital signs, weight, intake and output, and urine specific gravity. Palpate the skin for moisture and edema. Test muscle strength by having the patient grip your hands and push and pull against resistance. Document seizures and muscle weakness, twitching or cramps. Describe mental LOC every 4 hours in the alert, oriented patient and hourly if there is evidence of impairment.
    • f.       Nursing Diagnosis: Risk for Injury, Excess Fluid Volume, Ineffective Self-Health Management
  62. know tests used to diagnosis different disorders
    • CerebralCT Scan:  Uses radiographs to create images   of internal structures; detects tumors, edema, and structural abnormalities.
    • MRI scan with gadolinium infusion:  Gadolinium is a contrast medium   that is used with MRI to enhance brain imaging.
    • Cerebralangiogram:  Radiographs are taken to study   cerebral blood flow and blood vessels.
    • Glucosetolerance test: Evaluatesresponse to glucose dose to detect diabetes mellitus and hyperpituitarism
    • Dexamethasonesuppression test: Measurecortisol, which increases with adrenal hyperplasia, Cushing's syndrome, oatcell carcinoma; decreases with hystoplasmosis and tuberculosis
    • Pituitaryhormone levels (luteinizing hormone, follicle-stimulating hormone, growthhormone, adrenocorticotropic hormone, thyroid-stimulating hormone, prolactin): Serumlevels are measured to detect elevations or deficiencies of pituitary hormones
    • HypertonicSaline Test: ANinfusion of hypertonic saline is given to stimulate release of ADH; used todetect DI
    • Fluid deprivation: Detectschanges in specific gravity and osmolality after aqueous vasopressin is givensubcutaneously. Specific gravity and osmolality decrease with primary andsecondary DI. No response with nephorogenic DI
  63. Know what pheochromocytoma and the signs andsymptoms
    • Pheochromocytomais a tumor, usually benign, of the adrenal medulla that causes secretion ofexcessive catecholamine’s (epinephrine, norepinephrine). Patients exhibitepisodes of hypertension, hypermetabolism, and hyperglycemia. The classicalfindings are hypertension, severe pounding headache, and diaphoresis. Other signs and symptoms include
    • pallor, dilated pupils, orthostatic hypotension, and blurred vision. Episodes
    • may be triggered by emotional distress, exercise, manipulation of the tumor,
    • postural changes, and major trauma, including surgery
  64. know what nursing interventions should be done (pheochromocytoma)
    • a.       Nursing Interventions are similar to those of Cushing's Syndrome
    •   i.      Risk for Infection: watch for low-grade fever, sore throat, or aches. Any symptoms indicative of a cold should be brought the attention of the physician.                                                           
    • ii.      Disturbed Thought Processes: help family understand that mood swings are part of the disorder, particularly depression.                                                         
    • iii.      Risk for Impaired Skin Integrity: keep bed linens clean and dry. Be careful when rotating a patient every 2 hours to avoid friction.                                                         
    • iv.      Risk for Injury: Keep bed in low position and call light within reach. Keep side rails up and instruct patient to call for assistance when getting in and out of bed.                                                           
    • v.      Disturbed Body Image: encourage and assist patients to be well groomed. Reassure the patient that physical changes will gradually improve after surgery.
    • vi.     Ineffective Self-Health Management: the patient must understand the condition, complications, treatment and self-care. Provide information to teach patient about drugs, schedules, and adverse effects.
  65. Know the special instructions you must teach apatient who has had a parathyroidectomy i.e. when oral calcium supplements should be taken
    Hypocalcemia is apotential surgical complication after having a parathyroidectomy. It can causeairway obstruction caused from tetany due to low calcium. Early symptoms oftetany include a tingling sensation around the mouth and in the fingers, whichmay progress to severe muscle spasms/cramps and to laryngospasm. The healthcare team will closely monitor calcium and other electrolytes during thepostoperative period. Immediately inform the nurse if symptoms of tetany begin.Tetany is treated with oral or IV calcium supplements
  66. Know the anatomy of the thyroid gland
    • Thyroid gland: Located in the lower portion in the anterior neck. It consists of two lobes, one on each side of the trachea. The lobes are connected in front of the trachea by a narrow bridge of tissue called the isthmus.
    •  Major role: Regulating the body’s rate of metabolism and growth and development. When the metabolic rate falls, they hypothalamus stimulates the pituitary gland to secrete THS thyroid-stimulation hormone. This hormone in turn stimulates the thyroid gland to secrete hormones that affect the production and use of energy
  67. Know hormones produced by thyroid gland
    • Hormones produced thyroid gland: Thyroid hormone (also called, thyroxine, tetraiodothyronine, or T4), triiodothyronine T3), and calcitonin. 
    • Both T4 and T3 increase the body’s metabolic rate.
    • Calcitonin, or thyrocalcitonin, plays a role in regulating the serum calcium level. It is secreted when serum calcium levels are high, limiting the shift of calcium from the bones into the blood
  68. know the anatomy of the parathyroid
    Parathyroid glad: Small glands usually locatedon the back of the thyroid gland. Occasionally, some glands are found in themediastinum as well. Most people have four parathyroids, but some people havemore. Even though they typically embedded in the thyroid, they functionindependently
  69. know the hormones produced by the parathyroid gland
    Parathyroids secrete only one hormone. PTH (parathormone), which plays acritical role in regulation the serum calcium level. Calcium is an essentialcomponent of strong bones and plays a vital role in the functions of nerve andmuscle cells. When the serum calcium level falls,PTH is secreted. PTH increases theabsorption of calcium from the intestines, transfers calcium from the bones to the blood, and signals thekidneys to conserve calcium
  70. Hyperthyroidism
    Often referred to“overactive thyroid” is characterized by abnormally increased and secretion of thyroid hormones
  71. Hypothyroidism
    Is the result of inadequate secretion of thyroid hormones. It is seen in infants,children, and adults. The rate ofmetabolism slows causing mental and physical sluggishness
  72. Know hyperthyroidism and the different typesalso know the signs and symptoms
    • a.       Hyperthyroidism is characterized by abnormally increased synthesis and secretion of thyroid hormones.
    • b.      Several forms exist. The most common are:
    •  Graves disease – also called toxic diffuse goiter. is thought to be an auto immune disorder. Antibodies activate TSH receptors, which in turn stimulate thyroid enlargement and hormone secretion. Graves disease develops most often in young women. 
    •  Multinodular goiter – also called toxic nodular goiter. Most often occurs in women in their 60’s and 70’s. It is most likely to develop in people who have had goiter for a number of years. Hyperthyroidism in this case is caused by small thyroid nodules that secrete excess thyroid hormone. Unlike Graves disease, the increased hormone production is independent of TSH. The nodules can be benign or malignant.
    • c.       S/S: Increased metabolic rate can range from mild to severe. Weight loss and nervousness may be the only symptom in some cases. In more severe cases, the patient’s history may reveal restlessness, irritable behavior, sleep disturbances, emotional lability, personality changes, hair loss and fatigue. May patients report poor tolerance of heat and excessive perspiration. Changes in menstrual and bowel patterns may occur. Examination findings may include warm, moist, velvety skin; fine tremors of the hands; swelling of the neck; and ophthalmopathy including Exophthalmos. Exophthalmos is most apparent effect of hyperthyroidism on the eyes. Tearing, light sensitivity, decreased visual acuity and swelling around the orbit of the eye. Other symptoms may include tachycardia, increased systolic BP and sometimes atrial fibrillation. Heart rate may be 160 beats per min. During sleep 80 bpm
  73. Know the complications that occur ifhyperthyroidism is untreated. Know the signs and symptoms of this
    Hyperthyroidism may lead to Thyrotoxicosis(thyroid storm or crisis). Thyrotoxicosis is excessive stimulation caused byelevated thyroid hormone levels that produce dangerous tachycardia andhyperthermia. A risk for HF exists. The patient is restless and agitated andmay lapse into a coma. Thyrotoxicosis is a medical emergency. Fortunately,modern treatment of hyperthyroidism makes this complication rare
  74. know what drugs are commonly used to treathyperthyroidism
    • a.       Hyperthyroidism may be treated with Thionamide agents and Iodide agents. Initially it is treated with antithyroid drugs. These drugs are effective in treating hyperthyroidism by blocking the syntheses, release, or activity of thyroid hormones.
    • b.      Thionamide agents : Examples: propylthiouracil (PTU) and methimazole (tapazole). Usually takes several weeks before the effects of these agents are noticeable
    • .c.       Iodide Agents : Iodide agents are useful because iodine inhibits the synthesis of thyroid hormones. They are used most often after a course of propylthiouracil to suppress hormone secretion before thyroidectomy. The agents also may be used to treat Thyrotoxicosis. Potassium iodide (SSKI) can be given to people who have been exposed to radiation.  
  75.  Know about Iodides used to treat hyperthyroidism
    a.       Iodide agents are useful because iodine inhibits the synthesis of thyroid hormones. They are used most often after a course of propylthiouracil to suppress hormone secretion before thyroidectomy. The agents also may be used to treat Thyrotoxicosis. Potassium iodide (SSKI) can be given to people who have been exposed to radiation
  76. Know how Graves’ disease is treated
    Graves disease is often treated by removing mostof the thyroid gland. This procedure is called a subtotal thyroidectomy.Procedure may be done endoscopically or through a larger incision across thetop of the clavicles. Pts are commonly given antithyroid drug therapy forseveral weeks before surgery
  77. Know about thyroid storm
    A thyroid storm (Thyrotoxicosis) ishyperthyroidism left untreated. Thyrotoxicosis is excessive stimulation causedby elevated thyroid hormone levels that produce dangerous tachycardia andhyperthermia. Heart Failure is a big risk. The patient will be restless and agitated and may lapse into acoma.  Thyrotoxicosis is a medicalemergency.  This is rare
  78. Know the nursing diagnosis for a hyperthyroidismpatient
    • a.       Decreased cardiac output r/t excessive thyroid hormone stimulation: Monitor the patient’s pulse and blood pressure at intervals; give beta-adrenergic blockers as ordered to counteract the stimulant effects of the elevated thyroid hormones.
    • b.      Disturbed Sleep pattern r/t metabolic disturbance: Encourage the patient to arrange the day to allow periods of rest. Caffeine should be avoided because of its stimulating effects. Encourage bedtime rituals, which may be helpful in preparing for sleep. For the hospitalized patient, provide a restful environment and a soothing back rub to promote relaxation. Give sedatives as ordered to promote sleep.
    • c.       Hyperthermia r/t increased metabolic energy production: Patient feels too warm even when others are comfortable. Light clothing may be needed, adjust the temperature as much as possible for comfort; frequent bathing and clothing changes help promote comfort.
    • d.      Imbalanced Nutrition: Less than body requirements r/t increased metabolic requirements: A diet high in calories, vitamins, and minerals is recommended. Some patients require 4000-5000 calories daily to maintain body weight.
    • e.       Risk for injury r/t Exophthalmos: The condition which deposits of fat and fluid behind the eyeballs make them bulge outward then, the eyelids do not cover the eyeballs. The eyeballs are not kept moist and are susceptible to injury.  The eyelids can be taped shut, lubricated eye pads or artificial tears may be used. Raising the head of the bed at night and limiting salt intake may be helpful.
    • f.       Disturbed body image r/t Exophthalmos
    • g.      Disturbed sensory perception r/t ophthalmopathy: this patient’s eye symptoms may include double vision, periorbital edema, tearing, photosensitivity, and a feeling of “sand” in the eyes. Elevate the head of the bed, reduce bright lighting, and advise use of tinted glasses. Severe inflammation is treated with a 2-4-week course of prednisone.
    • h.      Diarrhea r/t excessive thyroid hormone stimulation: electrolyte imbalances and skin irritation may result. Give antidiarrheal medications as ordered, and monitor the effect. Thorough perianal cleansing after each stool reduces the risk of skin breakdown.
  79. Know the care that must be done for athyroidectomy postoperative patient
    • Ineffective airway clearance:
    • A.    Turning and deep breathing are recommended to prevent respiratory complications. Coughing may not be recommended due to possible stress on the suture line.
    • B.     Monitor and Document the rate and ease of respirations after thyroidectomy.  Respiratory distress can result from laryngospasms that close the airway. Emergency tracheotomy is needed to restore the airway.
    • C.     Laryngeal nerve damage are hoarseness and inability to speak.
    • D.    Elevate the head of the bed to decrease edema. Use pillows to prop and support the head to avoid stress on the suture line
    • E.     Tetany is caused when the serum calcium level falls (hypocalcemia) from no PTH. Muscle contractions begin as twitches around the mouth and eyes. The face, fingers, and toes begin to tingle.  The patient may have painful “cramps.” 
    • F.      Hypocalcemia is spasm of the larynx and as the larynx closes, the patient has difficulty breathing and can suffocate. Cardiac dysrhythmias and seizures also can occur.
    • G.     Tetany is treated with calcium salts given IV or PO
    • Decreased cardiac output
    • a.       Frequently inspect the dressing to detect bleeding and take the vital signs. Blood may flow under the dressing to the back of the neck.  Therefore be sure to check behind the patient’s neck and upper back to detect this.
    • b.      Thyroid crisis (thyroid storm) can develop when large amounts of thyroid hormone enter the blood-stream during surgery.
    • c.       Approx. 12 hours after surgery, the patient in thyroid crisis shows signs of severe hyperthyroidism (e.g., tachycardia, cardiac dysrhythmias, vomiting, fever, confusion).
    • Disturbed Body Image
    • Acute Pain
    • a.       Frequently inquire about the postoperative patient’s comfort level. 
    • b.      Promptly administer prescribed analgesics, and evaluate and document effects.
    • Risk for Infection
    • A.    Practice good hand-washing and use aseptic technique whenever handling dressings.
    • B.     Tell pt to keep hands away from incision and to report any s/s of infection (i.e., fever, increasing wound redness and swelling, foul drainage). 
    • C.     Protect the incision from strain and possible dehiscence by supporting the neck when arising and reclining.                                                                                                                           
  80. Complications that can occur postoperative
    thyroidectomy
    • 1.      Complications are airway obstruction, recurrent laryngeal nerve damage, hemorrhage, and tetany.
    • 2.      Thyroid crisis, thyroid storm, or Thyrotoxicosis can happen but is usually prevented by preoperative treatment with antithyroid drugs.
    • 3.      It is especially important to ASSESS and DOCUMENT respiratory status, voice quality, comfort, and neuromuscular irritability.
  81. Know what Hyperparathyroidism is what causes itand symptoms
    • a.       Hyperparathyroidism is the secretion of excess PTH.  It is caused most often by a tumor called an adenoma.  The tumors can be benign or malignant.   The most notable effect of hyperparathyroidism is elevation of serum calcium (hypercalcemia).
    • b.      S/S  are very vague at first.  They may report weakness, lethargy, depression, anorexia, and constipation, mental and personality changes, cardiac dysrhythmias, weight lox and urinary calculi.
  82. Know what hypothyroidism is and the signs andsymptoms
    • a.       Hypothyroidism is the result of inadequate secretion of thyroid hormones.  If not treated during infancy causes permanent retardation of physical and mental development. (creatism)  Myxedema sometimes is called hypothyroidism as well. 
    • b.      S/S are gradual.  The metabolic rate slows, weight gain with decreased food intake, lethargy, forgetfulness, and irritability, frequent headaches, constipation, menstrual disorders, numbness and tingling in the arms and legs, cold intolerance, pulse is slow and dyspnea may be present.
  83. Know the difference between goiters and nodules
    • a.       Goiter is in enlargement of the thyroid gland.
    • b.      Nodule is a small mass of tissue that can be palpated. 
  84. Know about pheochromocytoma
    • a.       Is a tumor, usually benign, of the adrenal medulla that causes secretion of excessive catecholamine’s (i.e. epinephrine, norepinephrine). Pts with a pheochromocytoma exhibit episodes of hypertension, hypermetabolism and hyperglycemia. The classic clinical finding are hypertension with a diastolic pressure of 115 mm Hg or higher; severe pounding headache; and diaphoresis. Other signs and symptoms include pallor, dilated pupils, orthostatic hypotension, and blurred vision. Episodes may be triggered by emotional distress, exercise, manipulation of the tumor, postural changes and major trauma, including surgery
    • b.      Can be treated by surgical removal of the tumor.
  85. .Know different test to assess for hypocalcemiaand the signs and symptoms of hypocalcemia
    • a.       Chvostek sign – a spasm in the facial muscle when the face is tapped over the facial nerve
    • b.      Trousseau sign – a carpopedal spasm that occurs when a BP cuff is inflated above a patients systolic BP and left in place for 2 – 3 minutes
    • c.      Hypocalcemia is the abnormally increased level of calcium in the serum. Causes include, high calcium or vitamin d intake, Hyperparathyroidism, and  immobility that causes stores of calcium in the blood streem to enter the blood. It can also be a complication of scertain kinds of cancer.
  86. know what Tetany is, what causes it and signs andsymptoms
    • a.       Tetany is steady muscle contractions.
    • b.      It is caused when the serum calcium levels fall or hypocalcemia.
    • c.       S/S include: muscle contractions begin as twitches around the mouth and eyes. The face, fingers, and toes begin to tingle. The pt may have painful cramps.
  87. Know what hypoparathyroidism is and what causesit
    • a.       Hypoparathyroidism is a deficiency of PTH.
    • b.      It is an uncommon condition, usually caused by accidental removal of or damage to parathyroid glands during surgery.
    • c.       Primary hypotension can be caused by autoimmune process and by several conditions, including Wilson disease.  
  88. Know what happens if hypercalcemia is untreated
    Inadequate secretion of PTH leads tohypocalcemia. Severe hypocalcemia can progress to convulsions and respiratoryobstruction because of spasms of the larynx. Laryngospasm can be fatal
  89. Know the complications that can occur in apostoperative parathyroidectomy patient
    • a.       Airway obstruction  - When the patient has a neck incision, accumulated fluid and blood in the surgical site can compress the trachea, thus causing airway obstruction. Monitor and document the respiratory rate the effort  and the pulse rate. Increasing pulse and respiratory rates, especially accompanied by restlessness, suggest inadequate oxygenation. Notify the physician of any indications of respiratory distress. Keep an emergency tracheotomy tray at the bedside in the event of acute obstruction. 
    • b.      Hypocalcemia - Be alert for tetany – a tingling sensation around the mouth and in the fingers is an early symptom of tetany. It may progress to severe muscle spasms or cramps and even to laryngospasm. Closely monitor calcium and other electrolytes

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