Cushing and Thyroid
why are Cushing's clients more prone to fractures?
what is hypocalcemia loss of bone density
what do you teach your client
safety features, rubber soled shoes, prevention of falls, calcium and vit D intake
client with Myxedma suffer from what endocrine issue
what is hypothyroidism,
1) what is the priority assessment in this client
2) dietary recommendations?
3) Complications from Myxedema
1) airway management
2) high fiber, fluids, and low calorie
3) heart failure/MI, depression, fecal impaction, mood instability, cold intolerance
Assessments for the post operative thyroidectomy
What is Temp, numbness/tingling sensations, tetany, Monitor for increasing hoarseness, assess for neck drainage, Assess for any facial twitching
Patient Positioning Post operative
neutral neck position, semi fowlers,
Patient with SIADH requests water/juice during your shfit, what must you keep in mind?
what is fluid restrictions due to SIADH, client is retaining
Can a UAP tell a patient to report any new onset of pain (pain in general)
What is YES,
What is the MOST important teaching to provide a newly diagnosed (or poorly managed) cushing's client
what is medication management/administration
Life long!
Discharge teaching for a client with Addison's disease
what is get a med alert bracelet, Dental work/surgery w/medication, report mood changes, avoid STESS, MEDICATION COMPLIANCE
Electrolyte Abnormality seen in post operative thyroidectomy
what is hypocalcemia
how do you assess for this
how do we treat this
numbness tingling in giners, nose, lips, chvostek's sign and Trousseau's sign tetany
treat with calcium gluconate IV
Most Important complication to assess for post adreanlectomy
what is adreanal crisis
Can a UAP be delegated by an RN to give Meds?
what is NO
Can an LPN?
What CANT an LPN do?
Yes, LPNs can give meds
LPNS cant give IV drugs or Blood administration and nothing in a Central line
Radioactive iodine is used to treat what?
what is Hyperthyroidism, goiter, thyroid cancer
1) What do you need to teach/educate ?
2) What can a goiter be caused by?
1) cant get pregnant for 6 months, back up birth control, use separate toilet or flush 2x.
2) lack of iodine (endemic)
Why should the RN teach relaxation techniques to the client with Addison's disease ?
what is due to stress being a contributing factor, increase in cortisol in the blood.
Common communication complication associated with postoperative thyroidectomy
what is laryngeal nerve damage
What can the client expect to experience post adreanalectomy due to lack of adrenal hormones
what is mood instability
what do you educate them on
this will be temporary and pass once medications get adjusted
Can a UAP measure intake/output and obtain/record daily weights
what is yes
Signs and Symptoms of worsening Cushing's syndrome would include what?
what is tachycardia and/or irregular HR, ecchymosis (upper extremities) large pitting edema in the legs, and hyperglycemia
What do you do?
Call the MD! you need help
EMERGENT complication with Addison's disease (life threatening)
what is SHOCK, irreversible shock
What focused assessment should be done frequently for post operative thyroidectomy
what is respiratory
Why
due to edema, inflammation, bleeding, nerve damage, have a tracheostomy tray/kit next to bedside
hyperaldosteronism is commonly seen in what adrenal disorder
what is adrenal tumor
UAP asks if the DI patient in bed 3 can have an extra glass of water, the RN response is
what is YES do NOT restrict fluids on a DI client
Cushing's Syndrome Electrolyte Abnormalities
What is increased cortisol, glucose, sodium levels, Decreased serum potassium and calcium levels
Dietary recommendations
lean meat, brown rice, sliced bananas/melons (potassium enriched)
Addison's Disease Electrolyte Abnormalities
What is Decreased sodium, increased potassium
Dietary recommendations?
fluids with lots of electrolytes such as broths and juices,
As an RN caring for a postoperative thyroidectomy what do you need to have at the bedside?
what is tracheostomy tray/kit
why
EMERGENT concern postoperatively to monitor for?
respiratory distress
Patient positioning for exophthalmos
what is supine,
Prevention of eye damage?
Why can't they be prone?
lay supine, not prone
eye ulcers
what drug (also the hormone released from the pituitary gland) would be given as treatment for DI
what is vasopressin