Thyroid
Symptoms of hypothyroid.
What is "cold and slow"?
Thick brittle nails, hypoventilation, hypotension, enlarged heart, bradycardia, cold intolerance, weight gain, constipation?
Key Features box pg 1271 9th ed./pg 1252 10th ed.
If Cushing's syndrome is suspected, this should be obtained.
What is a good medical history and medication history?
9th 1256
Signs and symptoms of pheochromocytoma.
What are severe HTN, severe HA, palpitations, diaphoresis, flushing, apprehension, sense of impending doom, pain in chest or abdomen, nausea or vomiting?
9th 1261
Complications of HHS.
What are severe dehydration with electrolyte losses, cerebral edema, seizures, shock?
pg 1315 9th ed.
Critical Rescue Box
Priority interventions for those in DI.
What are monitor labs, monitor LOC, monitor I/Os, monitor VS, monitor daily weight, intervene early for symptoms of dehydration, administer desmopression?
pg 1250 9th ed.
Symptoms of hyperthyroid.
What is "hot and fast"?
Diaphoresis, palpitations, chest pain, heat intolerance, weight loss, tachycardia, hypertension, weight loss, tremors.
Key Features box pg 1265 9th ed./ pg 1255 10th ed.
Cushing's diet teaching.
What is low sodium and possibly a fluid restriction?
pg 1258 9th edition
Complications from thyroidectomy
What are hemorrhage, respiratory distress with reduced gas exchange, hypocalcemia with tetany, damage to laryngeal nerves, and thyroid storm?
pg 1269 9th edition/1258-1259 10th
HHS priority interventions
What are replace fluids while monitoring for fluid overload and performing neuro checks q1h, then once adequate hydration achieved start insulin gtt, then monitor and replace electrolytes?
pg 1315 9th ed.
True or false: DI is a sugar problem.
What is false?
DI is a diuresis (polyuria) problem. Those with DI need to be educated that DI and DM are not the same and the only common symptom is diuresis.
Non-invasive treatment and interventions for Graves disease/hyperthyroid.
What are beta blockers, PTU, methimazole, radioactive iodine, reducing stimulus, promote comfort?
Know nursing implications for the medications PTU and methimazole. Box on page 1268 9th/1257 10th
Know Education Box for Unsealed Radioisotopes, 9th pg 1269/10th pg 1258
Those at most risk for developing Cushing's syndrome.
What are those on chronic long term steroids?
9th pg 1256
Transphenoidal hypophysectomy teaching points.
What are avoid coughing, deep breathing exercises only (hourly while awake), no nose blowing or coughing, rinse mouth frequently, avoid bending from the waist , avoid toothbrushing, floss and rinse only?
pg 1249 9th ed
HHS is resolved when this is noticed.
What is improvement in level of consciousness and neuro status?
pg 1315 9th ed
Secondary reasons a patient can go in to DI.
What are head trauma, brain surgery, metastatic tumors, and medications (ie lithium)?
pg 1250 9th ed.
Recognize this symptom for a thyroid storm and then provide priority interventions.
What is increase in temp of 1 degree or more and then maintain patent airway, give oral medications as prescribed, give beta blocker and glucocorticoid as prescribed, etc?
Know Best Practice Box pg 1270 9th ed./pg 1259 10th ed.
Priority intervention for an Addison's patient that is experiencing hyperkalemia.
What is insulin and dextrose to shift the potassium in to the cell? Also ensure continuous monitoring is in place?
Best Practice Box 62-6 pg 1253 9th edition
Do not do this when assessing the patient with a pheochromocytoma.
Palpate the abdomen/tumor.
Expected blood gas for DKA
What is metabolic acidosis?
pg 1312 9th edition
Drug therapy for SIADH
What are hypertonic saline (cautiously), tolvaptan or conivaptan, possibly diuretics on a limited basis, demeclocycline?
pg 1252 9th ed.
Frequency of assessment for the hypothyroid patient to recognize this complication.
What is every 8 hours for changes in mental status or in respiratory pattern to recognize myxedema coma?
Action Alert Box pg 1273 9th ed./pg 1253 10th ed.
Priority interventions for the Acute Adrenal Insufficiency patient
What are replace volume with NS or D5NS; give steroids by IV push, then a drip and then IM; monitor glucose levels hourly?
Best Practice Box pg 1253 9th edition
Have these supplies at the bedside of a patient who experienced a thyroidectomy.
What are calcium gluconate or calcium chloride; oxygen; a trach kit; suction?
pg 1269 9th ed
DKA priority interventions
What are fluid therapy, then insulin therapy, monitor electrolytes and cardiac monitor, replace potassium once UOP becomes greater than 30ml/hr?
pg 1313 9th ed
Priority interventions for low sodium in SIADH.
What are a safe environment and seizure precautions; full neuro assessment; fluid restriction?
pg 1252 9th ed.