Exam Unit

Exam Unit
Thyroid Disorders
Hypothyroidism/Graves disease
Definition
too much thyroid hormone
increased metabolic rate
increased beta receptors
Primary hypothyroidtoo much TH
Secondarytoo much TSH
Causes
autoimmune
goiter
infection
stress
pituitary tumorsecondary
synthroid overdose
Diagnostic Tests
Signs/Symptoms
heat intolerance
hypermetabolic state
incr. appetite w/ wt loss
frequent stools
nervousness
tachycardia
HF
warm smooth skin
exopthalmus
lub. eye drops
Complications
thyrotoxic crisis
hypothyroidism after thyroid
removal or treatment
Treatment
subtotal thyroidectomy
antithyroid meds
radioactive iodine
PTU
Lugal's (iodine preparation)
Methimizole
Nursing Care
hyperthermia
diarrhea
disturbed sleep pattern
Anxiety
Risk for injury
Hyperthyroidism
Diabetes Mel...
Type 1
Insullin needed to carry sugar into
cells and sugar remains in the blood
stream
Type 2
Not insulin dependant
controlled by diet changes,
exercise, and/or oral agent
Adrenal Disorders
Addison's disease
glucocorticoids
Definition
PrimaryACTH to stimulate
cortex into producing
Autoimmune
Adrenalectomy
small, misshapen, atrophied glands
Secondarydecreased ACTH does not
encourage adrenals to produce
enough
Pituitary or hypothalmus problem (low ACTH)
ABRUPT STEROID DISCONTINUATION!!!
Signs/Symptoms
Decreased aldosterone
hypotension
Na and H2O loss
K+retention
Bronze skin
N/V/D
Decreased Cortisol
Hypoglycemia
weakness, fatigue
weight loss
confusion, psychosis
Diagnostic Tests
Serum and urine cortisol levels decreased
Blood sugardecreased
ElectrolytesNalow, K+high
BUN/HCTelevated due to dehydration
Treatment
Glucocorticoidshydrocortisone
mineralocorticoidsfludrocortisone
2/3 in am;1/3 pm mimic natural secretion
lifelong replacement
need double or triple dose in times of strees
HIGH Na diet (only disorder
that requires increase in salt)
Complications
Adrenal Crisisin times of extreme stress
Profound dehydration,
hypotension, hypoglycemia
Nursing Care
monitor daily wt., I & O, glucose, electrolytes
Cushing's disease
Definition
increased adrenal cortex hormones
without regart to time of day or
stress
too much of the 3 S's
salt
Sugar
Sex
cushings syndrome is a group of disease like S/S that
mimic the disease but are caused by excess
cortisol/glucocorticoid therapy (Moon face caused by
prednisone therapy)
Cushing's disease is caused by
too much ACTH in the pituitary
Signs/Symptpms
Weight gein/truncal obesity
thin arms and legs/muscle wasting
purple striaecatabolic effect on tissue
Buffalo hump
moon face
secondary DM
osteoporosis
fractures
mental status changessteroid psychosis
Naand H2O retentionincreased aldosterone
hypokalemia
Diagnostic tests
appearance
increased plasma and urine cortisol
increased ACTH
dexamethasone supression test
ElectrolyteslowK, high na and glucose
Treatment
Surgeryremove pituitary tumor ***Admin
steroid hormone first to prevent adrenal
crisis
remove adrenal gland or radiate it
if caused by steroid
therapydecrease dose or admin
qod
symptom controllasix to
decrease fluid retention**must
give K+
Nursing Care
Hi K+, Low Na diet
Monitor blood sugar
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