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What is the definition of Nursing?
The diagnosis and treatment of human response to health and illness.
A state of complete physical, mental and social well being and not merely the absence of disease and infirmity.
What are some factors significant to health care delivery system?
- -Elderly population increasing
- -increased cultural diveristy
- -changes in disease patterens(obiesity epidemic, HIV, Cancer)
- -Advances in technology
- -Demand for quality improvement(Evidence based practice)
What are the different Nursing care delivery roles?
- -Case managment( manages clients with similar needs)
- - Primary nursing/Total pt care(Total care on small number of pts)
- -Team leading( RN supervises and delegates)
- -Functional Nursing (Task and activity oriented)
- -collaborative practice( RN delefates but must retain accountability)
What does the home health nurse provide for the pt?
- -pt advocate
- -cooridnates care
What is cultural competance?
being able to understand different cultural backgrounds.
What is Implementing?
Carrying out the proposed plan
- Collect pt data and ask your self:
- was it accurate?
- did the pt achieve the expected goals?
- -Include pt family or s/o in plan of care
- -identify alterations.
- Continue all steps in nursing process (ADPIE)
What are the 5 major endocrine glands?
- -pancreas( islest of langerhans)
- -pituitary( controlled by the hypothalmus)
What are the functions of the endocrine system?
- -Maintian and regulate cital functions
- -growth and development
- -metabolism of energy
- -muscle and adipose tissue distribution
- -sexual development
- -fluid and electrolyte balance
What do hormones do?
regulate and integrate body functions
What is the difference between endocrine and exocrine glands?
endocrine secrete into blood
exocrine secrete into another organ
What is Negative feedback?
sensors detect changes in hormone levels and respond to regulate the level. Example would be if gulcose is to high insulin is released.
What are some common causes of hormonal disorders?
- -autoimmune diseases
- - genetics
- -target cells are resistant to hormone(insulin)
- -side effects from treatments(steroids)
What are some abnormal pyshical findings for hormonal disorders?
- -abnromal growth or skin
- -increase or decrease in appetite
- -increased thirst
- -urine output
- -mental status
Thyroid gland produces three hormones what are they?
- -T3 (Triiodothyronine)
- -T4 (Thyroxine)
What are some diagnostic tests for thyroid disoders?
- -lab(blood levels)
- -24 Hour urine
- -biopsy and ultrasound
- Also palpation of the thyroid gland
What is hypothyroid?
- Low levels of thryroid homone also known as :
- -myxedema/myxedema coma
- -autoimmune disorder (hashimotos disease)
What is hyperthyroid?
- High levels of thyroid hormone
- also known as
- -graves disease
- -thyroid storm
- -thyrotoxic crisis
What are the clinical manifestations of hypothyroidism?
- -extreme fatigue
- -hair loss
- -brittle nails, dry skin
- -numbness or tingling in fingers
- -hoarseness/husky voice
- -menstrual changes
- -low body temp & heart rate
- -weight gain/low appetite
- -personality changes
What are some personality changes that you may see with hypothyroidism?
- -weakened emotional respsonse
What are some medical treatments for hypothyroidism?
- -Synthroid or levothroid
- -monitor for med interactions(no calcium and vitamins at the same time of med)
- -prevent complications
Who does hypothyroidism most commonly affect?
occurs most frequently in older woman
What is Creatnism?
deficiency of thyroid hormones (congenital hypothyroidism) due to maternal nutritional deficiency of iodine.
What is the 2nd most common endocrine disorder?
Hyperthyroidism is 2nd after(DM)
What is hyperthyroidism?
- -excessive levels of thyroid hormone
- -affects women 8 times more often than men
- -graves disease is the most commone type.
What are the causes of hyperthyroidism?
- -excessive ingestion of thyroid hormone
- -emotional shock or stress
What is some pt teaching regarding HYPOthyroidism?
- -continue taking meds FOREVER
- -take calcium (just not at the same time as thyroid meds)
- -when to seek medical attention
- -diet and nutrition
- -prevention of bone loss and osteoporosis
What are some clinical manifestations of hyperthyroidism?
- -hot and sweaty
- -dry, itchy skin
- -Exopthalmos(bulging eyes)
- -Weight loss/ increased appetite
- -bowel and menstrual changes
What are post op concerns for a thyroidectomy?
- -hypocalcium(check calcium levels post op)
- * reasoning- parathyroid can be damaged or removed resulting in low calcium
What are some medical treatments for HYPERthyroidism?
- -PTU ana ntithyroid agent that inhibits the release of thyroid hormone. It is used until Euthyroid is reached, and the pt is weaned off of it.
- -131 I or thyroid storm is a radioactive iodine the destroys overreactive thyroid cells. given in 1 dose by a radiologist.closely monitor cardiac for dysrthmea, and fever, and neuro impairment
What is the function of the parathyroid?
What does parathormone do?
regulates calcium and phosphorus balance.
Insulin glargine can be mixed with regular insulin,
True or False
False. Glargine insulin is not compatable with normal insulin such a s Humulin R or Novolin
Cool and Clammy give them ????
- Candy !
- (Hypoglyciemia) they need sugar.
Hot and Dry .....
Sugar is TOO High ! Pt needs insulin.
Low parathormone causes what?
Increase in serum phosphate, and decrease in serum calcium
What is hypoparathyroidism?
- Low parathormone production,
- -can be caused from surgery, trauma or the atrophy of the gland.
Increase in phosphate and decrease in calcium can cause what?
What is TETANY? (test question)
Low levels of serum calcium which causes muscle tremors, twitching, uncoordinated movement, numbness and tingling in extremities and face, can lead to bronchospasms, and death.
What is a considered a normal level of serum calcium?
What is a pheochromocytoma?
a tumor of the adrenal medulla
What does at pheochromocytoma do ?
- -increases production of catecholamines
- -causes acute unpredictable attacks such as:HA, diaphoresis, palpations, blurred vision, dyspnesa, vertigo, etc
What is Addisonian Crisis?
A severe untreated form of Addisons disease.
What are S/Sx of Addisonian Crisis?
Circulatory shock, weakness, abdominal pain, confusion and death if not treated !
What is treatment for Addisonian crisis?
Rapid Iv replacement of fluids and glucocortocoids
What is Cushings Syndrome?
- Excessive adrenocortical activity commonly caused by corticosteroid use.(can also be caused by a pituitary tumor)
- More common in Women!
What is some teaching regarding Cushings syndrome ? (*test question*)
SAFETY !!! (muscle weakness is common and disturbed sleep, so safety is the first priority, after ABC's of course)
What is Diabetes Mellitus?
A metabloic disorder where glucose is high in the blood stream but low in the individual cells. (Type 1 & 2)
What is the biggest risk factor for type 1 diabetes?
Genetice predisposition combined with immunologic enviromental factors.
Type 1 pathophysiology?
- -inability of beta cells to produce insulin.
- -glucose cannot be stored
- -kidnesy cannot reabsorb the glucose so it is in urine
Type 2 Pathophysiology?
- -insulin resistance (decreased tissue sensitivity to insulin)
- -cellular membrane resistance