Endocrine Notes February 16, 2009 Lecturer: Allie Brown Additions to the powerpoint Questions: The nurse understands that after a radioactive iodine is administered to a client with Graves? disease, the client is? Not radioactive and be handled as any other individual Highly radioactive and should be isolated as much as possible Mildly radioactive and should be treated with routine safety precautions Not radioactive but may still transmit some dangerous radiations and must be treated with precautions Understanding the need to decrease the size and vascularity of the thyroid gland before a thyroidectomy which medication can the nurse expect the physician to order? Potassium iodide Pitressin Propylthiouracil Potassium permanganate The nurse is assessing a client for possible laryngeal nerve injury following a thyroidectomy. Which action should the nurse implement on an hourly basis Ask the client to speak Ask the client to swallow Have the client hum a familiar tune Swab the client?s throat to test the gag reflex A client with hyperthyroidism asks the nurse about the tests the physician will be ordering. Which diagnostic tests should the nurse plan to include in a teaching plan for this client? T4 and x-ray films (T4 is a good answer, but x-ray isn?t. The whole answer must be right) TSH assay and T3 Thryoglobiulin level and PO2 Protein-bound iodine and something else On the first post-op day following a thyroidectomy, a client tolerates a full-fluid diet. This is changed to a soft diet on the second post-op day. The client complains of a sore throat when swallowing. What should the nurse do? Give analgesics as needed before meals A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia. Check all that apply. Use tinted glasses Use warm, moist compresses HOB 45 degrees Tape eyelids shuts at night if they do not close Apply a petroleum-based jelly to lower lid Organs and Hormones - Just memorize the slide in the ppt Pituitary gland See visual in new ppt Over production of growth hormone ( giantism Treatment of Acromegaly Transphenoidal surgery goes through nose to remove tumor Hypophysectomy might not be in book Radiotherapy to reduce size of tumor Acromegaly Most appropriate nursing interventions ? providing emotional support, history, assessment, medications, dx tests, monitoring vital signs, decreasing stress, I&O, Wt qg, minimizing risks for infection Maybe cardiac arrhythmias too Anterior pituitary gland hypofunction May have to take growth hormone shots SIADH ? too much ADH Opposite is Diabetes insipidus due to ADH inisuff Too much ADH ? FVE, BP increased Too little ADH ? FVD BP decreased (Diabetes insipidus) Thyroid gland Tests Thyroid antibodies (TA) ? looking to see if there are any antibodies in bloodstresam TSH ? increase or decrease in thyroid stimulating hormone T4 is checking the serum thyroxine, checking for an increase in thyroid hormone (hyperthyroidism and thyroiditis) T3 is checking for an increase in thyroid hormone (hyperthyroidism and thyroiditis) RAI ? checking for hyperthyroidism, Graves disease; the radioactive iodine will have more of an uptake because the body wants to take it in very quickly. They scan to see to what degree the radioactive iodine is being taken up. See page 523-526 in book. Don?t need to know values, but look over this in Ch. 18 How would hyperthyroidism affect Integumentary ? flushed, diaphoretic CV ? heart rate increased (tachycardic) Respiratory ? breathing faster Weight ? report a loss Mood ? expect to see anxiety, irritability, restlessness Muscle weakness also Pre-tibial myxedema looks nasty Different from a myxedema coma ? name alert This is something we see with hyperthyroidism Exophthalamos does not necessarily go away with treatment ? skin changes cause them to never gain their normal appearance again Thyroid storm Very serious Think death Hashimoto?s Thyroiditis Read about this in book Antibodies created ? immune system attacks and destroys thyroid gland Get blood levels drawn to see what thyroid is doing Weird hot and cold sensations See page 538 about meds for thyroid activity Subtotal thyroidectomy Respiratory distress because the thyroid is so close to the trachea Assess laryngeal nerve damage by asking them to talk to use every hour Need a trach tray at bedside in case of emergency Looking for arrhythmias ? on tetany Hyperthyroidism Might need to take in about 4000 calories/day Body image ? things we?ve already talked about, but also the scar from the surgery Most important nursing diagnoses ? history, assessment, meds, dx test before teaching, monitoring vital signs, decreasing stress, monitoring the environment, schedule rest periods, protection of skin, I&O, wt qg, nutritional monitoring, providing emotional support, eye care, post-op care, monitoring for cardiac arrhythmias, monitoring electrolytes, minimizing risks for injury, minimizing risks for infection, monitoring for fluid volume deficit Hypothyroidism Look at this on p. 543 Parathyroid Primary hyperparathyroidism Where can the parathyroid gland be re-implanted after it is removed? Into the brachioradialis muscle Hypocalcemia Serum calcium needs to be monitored Positive Chvostek?s sign ? run your finger down someone?s cheek and he/she has muscle twitching Positive Trousseau?s sign ? inflate BP cuff above systolic pressure for several minutes, and he/she has muscle contraction in arm Both are indicative of calcium deficiency Adrenal gland Make sure you know the difference between Cushing?s syndrome and Cushing?s sign Hyperfunction Can have excessive hair growth or balding Addison?s Disease Polar opposite of Cushing?s Too little cortisol Not something wrong with the gland itself, but something has happened to make the gland not function properly Adrenal Medulla Look at p. 538 about drugs ? especially drugs used to shrink the thyroid vs. drugs used to bring down the thyroid level
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