Cloned from: HESI Med/Surg I



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Excessive activity of thyroid gland, resulting in an elevated level of circulating thyroid hormone.
Hyperthyroidism
Graves disease, Goiter
T/F
Graves' Disease is a Autoimmune disorder.
True
A patient having weight loss, exophthalmos, T3 & T4 elevation, heat intolerence and tachycardia would lead the nurse to believe the patient may have which endocrine disorder?
Hyperthroidism
After treatments for hyperthyroidism, the resulting _____ will require daily hormone replacement
Hypothyroidism
Patient presents with fever, tachycardia, agitation, anxiety and hypertension the nurse believes the patient is experiencing _____
Thyroid Storm
Sudden over secreation of thyroid hormone
Thyroid Storm
Postoperative thyroidectomy should have hat at the bedside?
Tracheostomy set, oxygen and suction machine. Calcium Gluconate should be easliy accessible.
Monitoring a patient after a thyroidectomy the nurse should monitor for what?
Laryngeal edema damage (watch for hoarsness or inability to speak clearly)
Do not hyperextend the nect when moving patient.
What is the best indication of parathyroid problems s/p surgery?
A decrease in the serum calcium level compared to preoperative value. Normal Ca level is 9.0-10.5
If 2 or more parathyroid glands have been removed the nurse should monitor for what?
Tetany
How to monitor for Tetany
Serum Ca+  (9.0-10.5)
Tingling of toes/fingers/mouth
Check Chvosteks sign (twitching of lip after tap over parotid gland
check trousseau's sign-carpopedal  spasm after BP cuff inflated
Myxedema Coma
-precipitated by acute illness
-withdrawl from thyroid meds
-anasthesia
-use of sedatives

Respiratory
System
Ethambutal
Vision check before starting and monthly, may have to take 1-2 years
Isoniazid
Increases Dilantin Level
Rifampin
reduces oral contraceptives
gives body fluids oranges tinge
stains soft contact lenses
Teaching is very important for TB Pt.
Drug therapy usually long term, 9mos or longer.  Must take entire course for effective results.
Adult


PH


7.35-7.45


Pco2


35-45mmHg


     Po2


80-100 mmHg


HCO3  


21-28 mEq/l

Pink Puffer
-Barrel chested
-emphysema
-using accessory muscles to  breathe/working hard 2 breath
-O2 adequate


Blue Bloater
-Insufficient 02
-Chronic bronchitis
-cyanosis and often cor pulmonale 
                   (right sided Heart Fail)

Why be careful with 02 delivery on COPD pt?
stimulus to breathe is hypoxia not hypercapnia.


Hypercapnia


excessive carbon dioxide
Clubbing of fingers/ fingernails
inadequate arteriole oxygenation, early and late signs
toungue/mouth appears white, gray , dark brown, black or may appear patchy
Cancer of the Larynx
Laryngectomy tube is different how from tracheostomy tube
Shorter with larger lumen
Fear of Choking
Laryngetomy pts cannot cough as before due to excision of glottis
High risk for PNA
-Altered LOC
-depressed/absent GAG reflex
-suseptible to aspirating secretions
-brain injury
-stroke victims
Cleaning of inner cannula, suctioning, applying clean dressing
Tracheostomy care
-Natural humidifying pathway is gone
-secretions become thick and crusty
laryngectomy pt.
Glottal Stop technique
deep breath, cover trach tube w/ finger, cough simultaniously remove finger from tube
Leading cancer in USA
Lung Cancer
whats responsible for 80-90% of lung cancers
Cigarrette smoking
fever w/ night sweats
Anorexia/weight loss
Malaise/fatigue
Cough/hematopysis
dyspnea/pain w/ inspiration
Tuberculosis symtoms
If Chest tube disconnects from end/container
Place tube in water for a temporary seal
Inability of air sacs to fill and empty properly
emphysema and C.F.
Obstruction of Air Passages
Carcinoma, Asthma, Chronich Bronchitits
Accumulation of fluid in Air sacs
PNA
Respiratory Muscle Fatigue
COPD, PNA
4 comon symtoms of PNA
Tachypnea, Fever w/ chills, productive cough, bronchial breath sounds
4 nursing interventions assisting PT. to cough productively
deep breathing, increase fluid intake to 3 L/day, use of humidity, Suction airway to stimulate cough
Symptoms Of PNA in older client
confusion, lethargy, anorexia, rapid resp rate
O2 flow of pt. with COPD?
1-2 liters NC, too much O2 may reduce pts stimulus to breathe
How to reduce hypoxia during suctioning
Hyperinflate 100% O2, before and after
3 Major nursing interventions with mechanical ventilation
  • secure connections
  • way to comunicate w/ pt
  • airway clear w/ coughing suctioning techniques
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