Thyroid
Symptoms of hypothyroidism
What is "cold and slow"?
Thick brittle nails, hypoventilation, hypotension, enlarged heart, bradycardia, cold intolerance, weight gain, constipation
If Cushing's syndrome is suspected, this should be obtained.
What is a good medical history and medication history?
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?
Complications of HHS.
What are severe dehydration with electrolyte losses, cerebral edema, seizures, shock?
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?
Symptoms of hyperthyroidism
What is "hot and fast"?
Diaphoresis, palpitations, chest pain, heat intolerance, weight loss, tachycardia, hypertension, weight loss, tremors.
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?
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?
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/hyperthyroidism
What are beta blockers, 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?
HHS is resolved when this is noticed.
What is improvement in level of consciousness and neuro status?
Secondary reasons a patient can go in to DI.
What are head trauma, brain surgery, metastatic tumors, and medications (ie lithium)?
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?
Drug therapy for SIADH
What are hypertonic saline (cautiously), tolvaptan or conivaptan, possibly diuretics on a limited basis.
When do you want to give levothyroxine?
In the morning before food (30-60 minutes before meals)
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, replace potassium once UOP becomes greater than 30ml/hr?
Priority interventions for low sodium in SIADH.
What are a safe environment and seizure precautions; full neuro assessment; fluid restriction?