Thyroid
What are the Symptoms of hypothyroid.
&
Symptoms of hyperthyroid.
What is "cold and slow"? Thick brittle nails, hypoventilation, hypotension, enlarged heart, bradycardia, cold intolerance, weight gain, constipation?
What is "hot and fast"?
Diaphoresis, palpitations, chest pain, heat intolerance, weight loss, tachycardia, hypertension, weight loss, tremors.
This condition can happen when corticosteroids are stopped abruptly.
What is adrenal crisis (Addisonian crisis?)
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?
Symptom of hyperglycemia
What is blood glucose >200
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?
This medication would be ordered for a patient who has a urine specific gravity of 1.04.
What is vasopressin?
(Treatment for DI) Urine specific gravity inidcates urine that is close to the specific gravity of water. This occurs in Diabetes Insipidus (Lack of ADH) and must be treated by replacing ADH which is known as the treatment vasopressin.
A physician ordered T3 and T4 tests for a young woman. Which laboratory test results will confirm the diagnosis of hypothyroidism?
A. Both tests show increases.
B. The T3 test elevates, and the T4 test decreases.
C. Both tests show decreases.
D. The level of thyroxin rises and then falls back to subnormal levels.
C
Both tests show decreases.
Cushing's diet teaching.
What is low sodium and possibly a fluid restriction?
Complications from thyroidectomy
What are hemorrhage, respiratory distress with reduced gas exchange, hypocalcemia with tetany, damage to laryngeal nerves, and thyroid storm?
Position patient Semi Fowlers with head and neck supported by pillows to prevent muscle strain.
Symptoms of DKA
What is blood glucose between 300 - 1000, polydipsia, hypotension, acetone smelling breath, rapid respirations.
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.
This medication treatment plan is the major component for hypothyroidism.
What is levothyroxine?
Should be taken 30 to 60 minutes before breakfast and two hours after a meal.
Causes insomnia.
Non-invasive treatment and interventions for Graves disease/hyperthyroid.
What are beta blockers, PTU, methimazole, radioactive iodine, reducing stimulus, promote comfort?
Those at most risk for developing Cushing's syndrome.
What are those on chronic long term steroids?
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?
Symptoms of hypoglycemia
What are diaphoresis, tachycardia, light-headed, feeling shakey?
Reasons a patient can go in to DI.
What are head trauma, brain surgery, metastatic tumors, and medications (ie lithium)?
The therapuetic indication for this medication is to inhibit the synthesis of thyroid.
What is Propylthiouracil? (PTU)
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?
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?
Do not do this when assessing the patient with a pheochromocytoma.
Palpate the abdomen/tumor.
Expected blood gas for DKA
What is metabolic acidosis?
Treatment for SIADH
What are identify underlying cause, fluid restriction, diuretics, hypertonic saline (cautiously), demeclocycline?
The treatment of a person with Addison's disease includes which of the following medications?
A. Hydrocortisone
B. Insulin
C. Calcitonin
D. Growth hormone
Hydrocortisone
A laboratory test for a patient, which showed a high level of thyroid-stimulating hormone (TSH) and a low level of T4. What is the nurses most accurate explanation to the patient?
A.“I am sorry. You will have to ask your physician about your laboratory results. We are not allowed to discuss them.”
B.“It means that you have an inconsistency in your thyroid tests, and you will need more testing.”
C.“ That means that you will have to go on hormone therapy for the rest of your life.”
D.“ The TSH is sending a message to your thyroid gland to increase production, but your thyroid isn’t producing enough hormone.”
D
“The TSH is sending a message to your thyroid gland to increase production, but your thyroid isn’t producing enough hormone.”
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?
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?
DKA priority interventions
What are fluid therapy, then insulin therapy, monitor electrolytes and cardiac monitor?
Priority interventions for low sodium in SIADH.
What are a safe environment and seizure precautions; full neuro assessment; fluid restriction?
If NPH insulin is given before breakfast, a hypoglycemic reaction is most likely to occur.
What is between midafternoon and dinnertime. Peak affect is 4-12 hours.
(NPH, Humulin N, Novolin N)
LIST Complications from thyroidectomy!
What are hemorrhage, respiratory distress with reduced gas exchange, hypocalcemia with tetany, damage to laryngeal nerves, and thyroid storm?
Have these supplies at the bedside of a patient who experienced a thyroidectomy.
MAKE SURE READY calcium gluconate or calcium chloride; oxygen; a trach kit; suction?
Name the principal action of Aldosterone.
A. To ensure sodium is removed from the blood.
B. To conserve sodium in the kidneys.
C. Aldosterone causes magnesium to be retained.
D. To conserve sodium in the large intestines.
D
To conserve sodium in the kidneys.
Transsphenoidal 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?
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?
Do not Palpate the abdomen/tumor when assessing the patient with a pheochromocytoma.
Diabetes insipidus is caused by a lack of what pituitary hormone:
A. Mineralocorticoids
B. Glucocorticoids
C. Antidiuretic Hormone (ADH)
D. Insulin
C. Antidiuretic Hormone (ADH)
You need to give a patient 20 units of NPH and 4 units of Regular insulin, What medication would you draw up first?
What is Regular insulin (clear to cloudy)
Nancy Regan Registered Nurse
NR RN
Air Insulin
This endocrine disorder will cause a positive Trousseau’s and Chvostek’s sign.
What is hypoparathyroidism
This is the most important treatment for patients who are experiencing and endocrine driven crisis with symptoms that include:
Confusion, Severe dehydration, Severe Hypotension, Low body temperature, and Severe fatigue
S/S of Addisonian Crisis
Most important treatment is the replacement of steroids.
Other treatment includes IV fluid volume restoration and monitoring BP
Nursing caring for a patient after transsphenoidal hypophysectomy should watch for these possible complications (total of 5). Name at least 3.
What are:
1. CSF leakage (Clear nasal drainage? - Check for glucose >30mgdL = CSF)
2. Headache
3. Infection – abscess, meningitis
4. Bleeding
5. Nasal septal perforation
These are three signs or symptoms of under-production of ADH.
What are polyuria, dehydration, increased serum osmolality, and decreased urine osmolality?
What are the classic symptoms of diabetes insipidus (DI)?
A. Dizziness, hypertension, and excitability
B. Bradycardia, insomnia, and muscle cramps
C. Diuresis, tachycardia, and weakness
D. Stress incontinence, vomiting, and edema
C. Diuresis, tachycardia, and weakness