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Hyperpituitaryism
too much GH
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Hypopituitaryism
Low GH, ATCH, TSH, FSH, LH
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Diabetes Insipidus
- Low ADH
- watch for after surgeries and trauma
causes hypotension and electrolyte imbalance
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Person with Diabetes Insipidus will have
too much NA
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SIADH
too much ADH causing dilutional hyponatremia...
seizure precautions
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Hyperthyroidism causes....
- Graves Disease
- Thyroid Storm
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Hypothyroidism causes....
Mixedema coma....heart issues
Brady, hypotension, hypothermia, hypodynamic
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Hyperparathyroidism causes ......
hypercalcemia and hypophosphatemia
osteoporosis, nephrolithiasis, muscle weakness
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Hypoparathyroidism causes...
hypocalcemia and hyperphasphatemia
prevent tetany, watch for dysrhythmias and decreased CO
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Cushings
Hypercortisolism....and lots of aldosterone
think high everything....but low K
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Addison's Disease
loss of adrenal hormones
think low everything but high K
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Pre Op for Cushings
- correct F&E imbalance (K, Na and glucose)
- WBC's need to be WNL
- Give IV glucocorticoids
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Post op for Cushings
- watch for s/s of cardiovascular collapse
- hypotension, rapid and weak pulse, decreased UO
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Addison's persons need to be watched for....
Addisons crisis from a stressful event
- Give IV hydrocortisone #1
- replace what is missing...cortisol/sugar/salts
- teach s/e of life long steroid treatments
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Hypopituitaryism can cause...
- growth retardation
- metabolic abnormalities
- sexual immaturity
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Care for hypopituitaryism
- probably from a tumor on anterior pituitary
- surgery/radiation
- life long hormone replacement
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Hyperpituitaryism can cause.....
- gigantism(before growth plates sealed)
- or
- acromegaly (after growth plates sealed)
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Surgery for Hyperpituitaryism....post op management
Hypophysectomy
- monitor neuro status
- monitor fluid balance and watch for DI
- teach pt. dont sneeze/cough
- floss and oral mouth rinse....no brushing teeth
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S/S of hypothyroidism
- fatigue/lethargy
- impaired memory
- depression
- decreased CO
- constipation
- cold intolerance
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Management of hypothyroidism
Synthroid to replace TH
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S/S of hyperthyroidism
- tachy
- systolic htn
- agitation
- tremors
- mood swings
- confusion
- seizures
- fever
- coma
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Management of hyperthyroidism
- PTU-impairs TH synth
- Methimazole-blocks TH action on body
- Iodine therapy
- Thyroidectomy
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Pre thyroidectomy surgery
- control cardiac problems
- prepare for possible airway complications post op
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Post Op thyroidectomy surgery
- assess for respiratory compromise
- monitor VS closely
- assess for tetany
- teach about need to follow up with labs and daily thyroid replacement
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Tests for hypoparathyroidism
Chvostek and Trousseaus
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Management of hypoparathyroidism
- treat tetany-IV calcium gluconate
- correct hypocalcemia
teach long term diet considerations with calcium and V. D supplements
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Management of hyperparathyroidism
surgery-remove 3 of the 4 glands and resect the 4th...lets body keep making some calcium on its own
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Post op potential complications with hyperparathyroidism
hemorrhage from vascular area around the glands
AND
respiratory distress....and tetany and hypocalcemia ...
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How do I prevent post op complications when the parathyroid has been removed
- monitor for tetany....chovtek and trousseaus
- admin. calcium gluconate prn
- monitor I&O
- teach importance of exercise and dietary need for CA
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Addison's crisis....s/s and interventions
life threatening event with the major problem being profound hypotension and shock
- promote F&E balance
- monitor and replace glucocorticoids and mineralcorticoids
- teach pt. side effects of life long steriod trtmnt
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What can cause Cushings
- prolonged admin of steroids
- tumors
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S/S of Cushings Disease
- weight gain
- thin fragile skin
- hypervolemia/hypertension/edema
- inhibited immune response
- sodium and water retention
- HYPOKALEMIA
- Hyperpigmentation of skin
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Treatment for Cushings Disease
Transphenoidal surgery...hypophysectomy or adrenalectomy
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Pre op care before hypophysectomy for Cushings
- correct F&E imbalances
- monitor dysrhythmias from hypokalemia
- control hyperglycemia
- prevent infection
- glucocorticoid therapy
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Post op care after hypophysectomy for Cushings
watch for s/s of cardio collapse from insufficient replacement of glucocorticoids
lifelong corticoisteroid treatment
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