My THYROID tells me I'd rather be napping right now
What are the different types of thyroiditis and what are the treatments for each of the different types of thyroiditis?
Subacute (viral)
Acute (bacterial or fungal)
Chronic autoimmune thyroiditis
Hashimoto’s thyroiditis
What hormone does the parathyroid gland secrete? Which electrolytes does this gland help regulate?
PTH (Parathyroid Hormone)
Regulates calcium and phosphate levels
What are the symptoms of a patient with SIADH?
anorexia
nausea and vomiting
Weight gain without edema
Thirst
Neurological changes
Tachycardia
Hyponatremia
Muscle weakness and cramping
What are the assessment findings and interventions for a client who has hypoglycemia?
Hunger
Fatigue
Shaking
Sweating
Pale Skin
Headache
Dizziness
Confusion
Slurred Speech
Blurred Visual
Altered LOC
Seizures
Coma
What symptoms are seen in someone with Cushing's?
Altered fat distribution – truncal obesity
Buffalo hump
“Moon Face”
Muscle wasting – thin extremities
Hyperglycemia
Purplish red striae- breasts, buttocks, abdomen
HTN
Unexplained hypokalemia
Menstrual disorders in women
Hirsutism in women
Osteoporosis
What is the treatment for a patient in myxedema coma?
IV thyroid replacement
Support vital functions
What are symptoms of hypoparathyroidism?
*Think manifestations of hypocalcemia*
-Positive Chvostek sign (contraction of facial muscle)
-Positive Trousseau's sign (induction of carpal pedal spasm)
-Parasthesias
-Prolonged QT interval
What are the symptoms in a patient with DI?
polyuria
Extreme thirst
Nocturia
Weight loss
Hypotension
tachycardia
Severe dehydration
Hypernatremia
restlessness/agitation
decreased reflexes
seizures
coma
What is taught to patients who are diabetic regarding diet? What about exercise?
Diet Education:
Maintain consistent carbohydrate intake at each meal and over the course of the day
Plan serving size:
15 gms carbohydrates per food portion
Typical meal 45-60 gm carbs
Watch protein and fats
Eliminate alcohol
Exercise: exercise encouraged, monitor BG, take insulins/meds as scheduled
What are symptoms seen in someone with Addison's?
-Hypoglycemia
- Hyperpigmentation
- Aldosterone Deficiency
- Hyponatremia and volume depletion
- Decreased cardiac output, hypotension
-Hyperkalemia
- Weakness, fatigue, and weight loss
What is the treatment for a patient who presents in thyroid storm?
-Antithyroid meds- Propylthiouracil (PTI) and Methimazole (Tapazole)- inhibit thyroid hormone synthesis
-Fluid Replacement
-Manage respiratory distress
- fever reduction
- reduce or remove stressors
What are symptoms of hyperparathyroidism?
GI: loss of appetite, N/V, constipation
Bone: muscle weakness/aches
KIDNEY: renal calculi/stones (r/t increased CA)
NEURO: Fatigue/emotional disorders, Shortened attention span
What is the difference between Gigantism and Acromegaly?
gigantism- children
acromegaly- adults
How would the nurse focus the teachings about diabetes for a child?
Role playing/demonstration
What abnormal labs and vital signs would the nurse expect to find in a patient with hyperaldosteronism?
A. Na 145, K 3.8, BP 160/80
B. Na 129, K 5.9, BP 144/76
C. Na 148, K 3.3, BP: 156/74
D. Na 146, K 5.8, BP 90/50
C. Na 148, K 3.3, BP: 156/74
Remember:
-Sodium Retention → Hypernatremia & Hypertension
- Potassium Wasting → Hypokalemia
What signs and symptoms would be consistent with a person who would have the diagnosis of Grave’s Disease? What would labs shows?
S/S- Clubbed fingers, tremors, diarrhea, bulging eyes, intolerance to heat, facing flushing, enlarged thyroid, tachycardia, elevated systolic BP, breast enlargement, fine-thin hair, muscle wasting, localized edema
LABS- decreased TSH levels, elevated free throxine levels (t4), Radioactive iodine uptake (RAIU)- to differentiate Graves Disease from Thyroiditis.
What is treatment for someone with hyperparathyoidism?
Surgical
parathyroidectomy
Nonsurgical
Conservative management (diet, exercise, meds, labs)
Which of the following labs would be consistent with a diagnosis of DI?
A. serum osmo 305, serum sodium 152, specific gravity 1.000
B. serum osmo 305, serum sodium 152, specific gravity 1.040
C. serum osmo 280, serum sodium 130, specific gravity 1.000
D. serum osmo 280, serum sodium 130, specific gravity 1.040
A: serum osmo 305, serum sodium 152, specific gravity 1.000
Increased serum osmolalilty >295
Increased serum sodium >145
Decreased urine specific gravity <1.005
Decreased urine osmolality <500
Decreased urine sodium <20 meQ in a random sample
What is the the priority implementation of interventions for a client who presents in DKA?
Hospitalization
Fluid and electrolyte replacement - monitor potassium levels- EKG?
IV insulin- IV infusion: Bolus and Gtt
Monitor BG, ketones BP, I and O, Neuro status
What should the nurse include in a teaching plan for or someone with Cushing's?
- When to call MD
Wear a medical bracelet
Avoid extremes of temperature, infections, emotional distress
Taught to adjust corticosteroid dosage during times of stress
Corticosteroids- lifelong or taper?
Do not stop abruptly- taper off
Watch for hyperglycemia
Watch for signs of infection
What are the assessments that are completed post thyroidectomy?
Airway monitoring
Thyrotoxicosis.
Head support
Evaluate for bleeding
Deep breathing and leg exercises
Monitor voice
Monitor for hypocalcemia
What is treatment for someone with hypoparathyoidism?
Vitamin D to enhance absorption of Calcium
Mg supplement
Diet- avoid foods with oxalic acid, ingest foods high in calcium
Which set of labs would be a consistent finding in a patient with SIADH?
Which of the following labs would be consistent with a diagnosis of DI?
A. serum osmo 305, serum sodium 152, specific gravity 1.000
B. serum osmo 305, serum sodium 152, specific gravity 1.040
C. serum osmo 280, serum sodium 130, specific gravity 1.000
D. serum osmo 280, serum sodium 130, specific gravity 1.040
D. serum osmo 280, serum sodium 130, specific gravity 1.040
Elevated ADH level > 5
Decreased serum osmolality <285
Decreased serum sodium <135
Decreased BUN, Creatinine, and H &H
Increased urine specific gravity > 1.035
Increased urine osmolality >850
Increased urine sodium >20 in a random sample
What are key teachings for each of the following classes of medications: Biguanides (Metformin/Glucophage)? Sulfonylurease (Glypizide/glyburide)? Meglitinides (Prandin)?
Biguanides- Metformin-1st CHOICE
Stop 2 days before using iodine contrast, surgery
Do not use liver disease, heart disease
Sulfonyluresas-glipizide or glyburide
Take before meals
Watch for hypoglycemia
Meglitinides- Prandin
Take just before meal
DO NOT TAKE if meal not eaten
Watch for Hypoglycemia
Which set of labs would be consistent with a patient in Addisonian Crisis?
A. Na 145, K 3.8, Cortisol 18
B. Na 129, K 5.9, Cortisol 4
C. Na 148, K 3.3, Cortisol 26
D. Na 146, K 5.8, Cortisol 30
B. Na 129, K 5.9, Cortisol 4
Remember- low sodium, high potassium, low cortisol