Exam 2 COA

Hyperthyroidism

Too much thyroid hormone

Hyperthyroidism signs/symptoms

Nervousness, insomnia, high energy, tired, diarrhea, tachycardia

Hyperthyroidism labs

Decreased TSH and increased free T4

Hyperthyroidism cardiac effects

A-fib and tachycardia

Hypothyroidism

Not enough thyroid hormone

Hypothyroidism signs/symptoms

Constipation, bradycardia, drowsy, hypoactive

Hypothyroidism labs

Elevated TSH and decreased free T4

Hypothyroidism medication

Levothyroxine

Levothyroxine nursing consideration for CAD pts\

Monitor for cardiac arrhythmias in patients with CAD

Levothyroxine and glycemic control

Levothyroxine can worsen glycemic control

Levothyroxine and insulin

Patients may need increased insulin dosages

Levothyroxine and bone density

Monitor bone density in postmenopausal women

Levothyroxine effect

Decreases [listed in notes; specific effect not provided]

Adrenal insufficiency

Not enough cortisol is produced

Adrenal insufficiency causes

Autoimmune destruction, infections, pituitary dysfunction, and abrupt steroid withdrawal

Adrenal insufficiency infections

TB, AIDS, and histoplasmosis

Pituitary dysfunction and adrenal insufficiency

Insufficient production and release of ACTH

Abrupt steroid withdrawal

Can cause adrenal insufficiency

Adrenal insufficiency signs/symptoms

Weakness, fatigue, poor activity tolerance, stress, anorexia, vomiting, salt cravings, cold intolerance, infertility issues, dehydration, postural hypotension, hyperpigmentation, loss of axillary/pubic hair, decreased LOC, and tachycardia

Adrenal insufficiency labs

Decreased cortisol, hyponatremia, hyperkalemia, hypoglycemia, and elevated ACTH

Adrenal insufficiency treatment

Glucocorticoid therapy and mineralocorticoid therapy

Florinef

Fludrocortisone; a mineralocorticoid used to treat adrenal insufficiency

Addison's disease

Caused by autoimmune destruction

Hyperkalemia

Too much potassium

Hyperkalemia medications/treatments

Florinef (fludrocortisone), IV regular insulin with dextrose, and sodium polystyrene sulfonate (Kayexalate)

Hypercortisolism

Prolonged exposure to excess cortisol

Hypercortisolism clinical manifestations

Weight gain, mood changes, sleep problems, anorexia, truncal obesity with thin extremities, edema, thin/fragile skin with reddish stretch marks, hypertension, testicular atrophy, and hypokalemia

Hypercortisolism diagnostic test

24-hour urine test for free cortisol

Thyroidectomy

Removal of part or all of the thyroid gland

Thyroidectomy treatment after surgery

Levothyroxine for thyroid hormone replacement

Parathyroid gland location

Behind the thyroid gland

Parathyroid gland responsibility

Secretes parathyroid hormone and maintains calcium and phosphate homeostasis

Parathyroid hormone organs affected

Bones, kidneys, and GI tract

Diabetes treatment assessment

HbA1c monitoring, self finger sticks, and continuous glucose monitoring (CGM)

HbA1c

Average serum blood glucose level over the last 2-3 months

Goal HbA1c

Less than 7%

Self-monitoring of diabetes

Self finger sticks and CGM

Rapid-acting insulin

Lispro and Novolog

Short-acting insulin

Regular insulin

Intermediate-acting insulin

NPH

Long-acting insulin

Lantus and Levemir

Premixed insulin

NPH/Regular

Diabetes complications

DKA, retinopathy, nephropathy, and neuropathy

Diabetic ketoacidosis (DKA)

Serious diabetes complication caused by a buildup of ketones and metabolic acidosis

DKA signs/symptoms

Polyuria, polydipsia, dehydration, Kussmaul respirations, and fruity/acetone breath

DKA glucose

Glucose greater than 250

Kussmaul respirations

Rapid, deep respirations associated with DKA

DKA treatment

Isotonic fluid replacement, IV regular insulin, and electrolyte management

Retinopathy

Diabetes complication affecting the eyes

Nephropathy

Diabetes complication affecting the kidneys

Neuropathy

Diabetes complication affecting the nerves

Fasting blood sugar normal range

70-100

Chest tube collection chamber

Collects fluid and blood from the pleural space

Chest tube water seal chamber

Acts as a one-way valve allowing air to escape from the chest

Chest tube suction control chamber

Regulates the amount of suction applied to the pleural space

Chest tube bubbling

Bubbling is normal when exhaling; continuous bubbling is bad

Chest tube positioning

Keep the chest tube system upright and below chest level

Chest tube clamping

Never clamp a chest tube because it can trap air in the pleural space

Chest tube air leak signs

Continuous bubbling, respiratory distress, hypoxia, and tachypnea

Chest tube removal requirements

Lung re-expansion confirmed by x-ray, no air leak for 24 hours, drainage less than 100 mL/day, and equal bilateral breath sounds

Pneumothorax

A collapsed lung caused by air leaking into the pleural space

Pneumothorax risks

Rupture of a congenital bleb, bullous emphysema, chest trauma, blast injury, and iatrogenic causes

Congenital bleb

A small air-filled space on the lung surface that can rupture and cause a pneumothorax

Bullous emphysema

Enlarged air spaces in the lung that can rupture and cause a pneumothorax

Blast injury

Sudden atmospheric pressure impact that can cause pneumothorax

Iatrogenic pneumothorax

Caused by invasion during medical procedures

Pneumothorax signs/symptoms

Dyspnea, sudden pleuritic chest pain, and decreased/absent breath sounds

Pneumothorax pathophysiology

Loss of negative intrapleural pressure

Open pneumothorax

Caused by an unsealed wound in the chest wall

Closed pneumothorax

Caused by an opening in lung tissue while the chest wall remains intact

Tension pneumothorax

Air leaks into the pleural space and becomes trapped during expiration, putting pressure on the lungs and heart

Tension pneumothorax

Life-threatening type of pneumothorax

Pneumonia diagnosis

Chest x-ray, elevated WBC, and sputum cultures

Pneumonia treatment

Macrolides, fluoroquinolones, penicillins, cephalosporins, and albuterol

Pneumonia nursing diagnoses

Impaired gas exchange, ineffective airway clearance, ineffective breathing pattern, and acute pain

Tuberculosis (TB) signs/symptoms

Night sweats, low-grade fever, weight loss, fatigue, persistent cough with rust-colored sputum, pleuritic chest pain, dyspnea, crackles, pleural effusion, and lymphadenopathy

Latent TB medications

Isoniazid and rifampin

Active TB treatment

Multi-drug therapy

TB compliance problem

Noncompliance or stopping medications early can result in secondary drug resistance and multidrug-resistant TB

Directly Observed Therapy (DOT)

Watching the patient swallow every dose of TB medication

TB confirmation tests

Sputum for AFB, tuberculin skin test, interferon gamma release assays (IGRAs), and chest x-ray

TB sputum test

Sputum for acid-fast bacilli (AFB)

Tuberculin skin test

Used to help identify TB infection

IGRA

Interferon Gamma Release Assay; blood test used to help identify TB infection

TB skin test induration ≥5 mm

Positive for high-risk/immunocompromised groups

TB skin test induration ≥10 mm

Positive for moderate-risk/high-prevalence groups

TB skin test induration ≥15 mm

Positive in all persons

Pulmonary embolism (PE)

Blockage in a pulmonary artery

Pulmonary embolism risks

Recent surgery, immobilization, active cancer, estrogen therapy, history of VTE, and infectious triggers

Pulmonary embolism first symptom

Pleuritic chest pain

Pulmonary embolism signs/symptoms

Pleuritic chest pain, dyspnea, hemoptysis, crackles, tachycardia, hypotension, JVD, and low oxygen

Hemoptysis

Coughing up blood

PE confirmation tests

CT pulmonary angiography, pulmonary angiography, V/Q scan, D-dimer, and TEE

V/Q scan

Assesses ventilation and perfusion

PE medications/treatment

Heparin, Eliquis, Xarelto, warfarin, and tPA

PE surgical treatments

Embolectomy and inferior vena cava filter placement/replacement

COPD

Chronic obstructive pulmonary disease

COPD types

Chronic bronchitis and pulmonary emphysema

Chronic bronchitis

Chronic airway inflammation

Pulmonary emphysema

Breakdown of elastin in alveolar walls