Hypothyroid
Name for autoimmune hypothyroid.
What is Hashimoto's disease or Hashimoto's thyroiditis?
Interventions for a patient with exophthalmos.
What are eye drops to maintain moisture, safety precautions at home and at work (risk for injury r/t blurred vision), eye patches while asleep?
MS book pg. 1465
Risk factors for developing Type 2 diabetes.
What are
•Age >30 years for type 2
•High-density lipoprotein (HDL) cholesterol level ≤35 mg/dL (0.90 mmol/L) and/or triglyceride level ≥250 mg/dL (2.8 mmol/L)
•History of gestational diabetes or delivery of a baby over 9 lb
•Hypertension
•Family history of diabetes (e.g., parents or siblings with diabetes)
•Obesity (i.e., ≥20% over desired body weight or body mass index ≥30 kg/m2)
•Previously identified impaired fasting glucose or impaired glucose tolerance
•Race/ethnicity (e.g., African Americans, Hispanic Americans, Native Americans, Asian Americans, Pacific Islanders)
MS book pg. 1488
First priority for HHS and DKA.
What is IV hydration with isotonic fluid?
This treatment for hyperthyroidism causes the patient receiving it to be a danger to those around them.
What is radioactive iodine (RAI)?
Abnormal labs for hypothyroid.
What are TSH being high, T3 and T4 being low?
Symptoms of hyperthyroid.
Diaphoresis, palpitations, chest pain, heat intolerance, weight loss, tachycardia, hypertension, weight loss, tremors.
Risk factors for developing gestational diabetes.
What are physical inactivity, first-degree relative with diabetes, hypertension, high-risk race/ethnicity, obesity, polycystic ovary syndrome, hypercholesterolemia, previous large infant >9 lb; and smoker?
Maternal book pg. 705
Because of an insulin drip, these labs must be monitored closely.
What are BMP (K+, Glucose, kidney function, anion gap)? Accucheck Q1h? VBG?
MS book pg. 1515
These oral medication for type 2 DM cause the beta cells of the pancreas to release more insulin and should be taken before a meal.
What are sulfonylureas (glipizide, glyburide, glimepiride)?
Bruner and Suddarth pg. 1505
Symptoms of hypothyroid.
What is "cold and slow"?
Thick brittle nails, hypoventilation, hypotension, enlarged heart, bradycardia, cold intolerance, weight gain, constipation?
Abnormal labs for hyperthyroid.
What are high T3 and T4, low TSH?
Acute Complication for Type 2 DM ONLY.
What is hyperosmolar hyperglycemic state (HHS)?
Priority interventions for a hypothyroid patient who has became lethargic with shallow respirations and hypothermia.
What is administer levothyroxine IV, warm blankets or an air warmer, maintain airway?
This medication for hypothyroidism is started on a low dose and increased slowly based on response.
What is levothyroxine?
Why?
MS book pg. 1457
Symptoms of the medical emergency associated with hypothyroidism.
What is hypothermia, obtunded or somnolent leading to coma, decreased respiratory effort and alveolar hypoventilation with respiratory acidosis, hyponatremia, hypoglycemia, hypoventilation, hypotension, bradycardia?
MS book pg. 1456
Symptoms of a thyroid storm.
What are
•Hyperpyrexia (high fever), >38.5°C (>101.3°F)
•Extreme tachycardia (>130 bpm)
•Exaggerated symptoms of hyperthyroidism with disturbances of a major system—for example, gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations)
•Altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma
MS book pg. 1463
List at least 5 Sick day rules.
What are
•Take insulin or oral antidiabetic agents as usual.
•Test blood glucose and urine ketones every 3 to 4 hours.
•Report elevated glucose levels as specified or urine ketones to your primary provider.
•Take supplemental doses of regular insulin every 3 to 4 hours, if needed, if you take insulin.
•Substitute soft foods (e.g., 1/3 cup regular gelatin, 1 cup cream soup, ½ cup custard, 3 squares graham crackers) six to eight times a day if you cannot follow your usual meal plan.
•Take liquids (e.g., ½ cup regular cola or orange juice, ½ cup broth, 1 cup sports drink [Gatorade]) every ½ to 1 hour to prevent dehydration and to provide calories, if vomiting, diarrhea, or fever persists.
•Report nausea, vomiting, and diarrhea to your primary provider, because extreme fluid loss may be dangerous.
•Be aware that if you are unable to retain oral fluids, you may require hospitalization to avoid diabetic ketoacidosis and possibly coma.
MS book pg. 1515
Complications to monitor for after surgical treatment for hyperthyroidism.
What are hemorrhage, thyroid storm, hypocalcemia, laryngeal edema and stridor (compromised airway)?
MS book pg. 1469
A patient taking this medication for hyperthyroidism should have frequent blood checks to monitor for bone marrow suppression.
What is methimazole?
Karch, Amy M. Karch's Focus on Nursing Pharmacology. (8th Edition). 2019. pg. 619
Interventions for constipation from hypothyroidism.
What are
Encourage increased fluid intake within limits of fluid restriction.
Provide foods high in fiber.
Instruct patient about foods with high water content.
Monitor bowel function.
Encourage increased mobility within patient’s exercise tolerance.
Encourage patient to use laxatives and enemas sparingly.
MS book pg. 701
5 Priority interventions for hyperthyroidism.
What are maintain cardiac output, improve nutrition, maintain normal body temp, enhance coping measures, improve self-esteem, and monitor for potential complications?
How will you do these things? What will you assess, monitor, administer, and teach?
MS book pg. 1465
Education for a diabetic diet.
What is evaluate diet history to identify eating habits and lifestyle and cultural eating pattern, decrease overall caloric intake to lower the BMI, do not skip meals, pace meals throughout the day to put less demand on the pancreas, consistency between meals to reduce the risk of hypoglycemia, how to read food labels and what the labels mean in regards to calories and nutrition, for caloric intake- 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein; total calories only 10% should be saturated fat; limit total cholesterol intake to less than 300mg day; increasing fiber can decrease blood sugar but consume at least 28g of fiber a day; count carbs or measure serving sizes or use MyPlate as tools to keep track of your meal and energy intake; alcohol in moderation as it converts to sugar?
MS book pg. 1495-1496
Priority intervention for a type 1 diabetic who is sweating, tachycardic, and confused.
What is check blood sugar then provide glucose replacement (glucagon, D50, oral carbohydrates)?
MS book pg. 1513
If a patient's blood sugar drops below 250 on an insulin drip, this should be added to their fluids if they're still acidotic.
What is dextrose 5%?
MS book pg. 1516