PME chapter 14: medical conditions involving glaucoma, kidneys, and thyroid disorders

glaucoma

-increased pressure in the eye

-increased pressure when fluid can’t flow through the canal of schlemm at the junction between the iris and cornea

risk factors for glaucoma

-Age

-Family history

-History of cataracts

-when left Untreated it can lead to partial or complete blindness

types of glaucoma

-open angle

-narrow angle

open angle glaucoma

-95%

-Gradual onset

-Little pain

-Treated with eye-drops

-considered chronic glaucoma

narrow angle glaucoma

-Sudden onset

-Severe pain

-Surgery required

-considered acute glaucoma

symptoms of open angle glaucoma

-Halo around lights

-Loss of peripheral vision

-Blurred vision

-Difficulty adapting to bright/dark changes

-Meds can cause constriction of pupils

• Carry ID so others know its glaucoma and not heroin overdose

treatment implications of glaucoma

-Adapt oral care for limited sight

-Provide safety glasses

applications to practice for narrow angle glaucoma

-Avoid anticholinergics/↓salivary flow/ ↑ intraocular pressure = acute painful attack

-Antihistamines, Benadryl, Tylenol/Advil PM, Unisom

management of acute attack of glaucoma

-Call 911

-Hospital setting

• Ophthalmic Surgery

function of kidneys

-Filter wastes from blood

-Eliminate wastes in urine

-Manage water balance

range of disorders involving kidneys

-Infection

-Uremia (waste in blood)

-Glomerulonephritis

-End-stage renal disease (ESRD)

end-stage renal disease (ESRD)

deterioration of nephrons

complications of ESRD

-Fluid overload

-BP ↑

-Waste build up in body tissues

-↓ RBC → Anemia

causes of ESRD

-Diabetes

-Hypertension

-Glomerulonephritis

treatment of ESRD

-Hemodialysis

-Peritoneal dialysis

oral manifestations of chronic renal failure

-Bad odor from mouth

-Metallic taste in mouth

-Dry mouth

-Candidiasis

-Enlarged parotid gland

-Mucosal pallor

-Stomatitis

-Painful ulcerations

-Osteolytic lesions in bone

-Risk of fracture

-Petechial hemorrhages

-Gingival bleeding

treatment implications for ESRD

-Schedule appointment on day after dialysis

• ↓ Bleeding with ↓ heparin amounts

-Consult with nephrologist about potential complications

• Asked if prophylactic antibiotics are needed

-Review blood test results (risk for increased bleeding)

-Monitor clotting

• Heparin; effects last for a few hours

-Monitor blood pressure (arm opposite of shunt)

-Take panoramic radiographs (stability/bone abnormalities)

-Avoid aspirin & NSAIDs

• Acetaminophen, nitrous oxide, lidocaine = ok/controlled amounts

-Set frequent maintenance schedule

• Identify infections early / treat with proper medications

phases of renal transplant

-immediate period

-stable period

-chronic rejection period

immediate period

-6 months after transplant

-Antirejection medication adjusted

-May be taken for life

-Monitoring for rejection

-No routine oral care

stable period

-Consult with physician

-Emphasize oral hygiene

-Appts. 3-6 months

-Identify infection early

• Antirejection meds → ↓ immune system

• Treat early with aggressive antibiotics

-Avoid oral care trauma

-Monitor blood pressure

chronic rejection period

Consult physician before providing any oral care

potential emergencies with kidney disorders

-No medical emergency situations specific to kidney disease

-Cardiovascular emergencies increase

-Cardiovascular disease is the number one cause of death in people with chronic kidney disease

-50% of people with ESRD die of cardiovascular complications

-Be prepared to handle a cardiovascular emergency

thyroid disorders

-thyroid cancer

-hypothyroidism

-hyperthyroidism

-goiter

-autoimmune conditions involving thyroid

myxedema

hypothyroidism of an adult

cretinism

hypothyroidism in a child

autoimmune conditions of thyroid disorders

-graves disease

-hashimoto thyroiditis

graves disease

-↑ women

-Leads to hyper

-Functional goiter

hashimoto thyroiditis

-Leads to hypo

-Non-functional goiter

thyroid hormones

-Thyroxine (T4)

-Triiodothyronine (T3)

-Calcitonin

-all Regulated by pituitary gland

function of thyroid hormones

-Maintain body temperature

-Metabolism

-Growth

-Regulation of body functions

signs of hypothyroidism

-Hypotension to normal BP

-Bradycardia

-Intolerance to cold

-Sensitive to CNS depressant drugs

-Edema of face, tongue

-Goiter

• Enlarged thyroid (↓ or non)

-Fatigue

-Dry skin

signs of hyperthyroidism

-Hypertension

-Tachycardia

-Elevated body temperature

-Heat intolerance

-Overly responsive to epinephrine

• Controlled still small amounts

-Bulging eyes

-Goiter

• Enlarged thyroid

• Functional

-Nervousness, trembling

-Sweating

application to practice for thyroid problems

-Ongoing measures

• Make sure thyroid condition is controlled

• Medication is working correctly

-Both ↑ CVD

• Take blood pressure, pulse

• Assess functional capacity

• Assess for facial edema

• Assess for goiter

• EOIO → neck, tongue, thyroid

-If client is symptomatic

• Refer for medical evaluation

• Delay elective treatment

emergency state of thyroid problems

-Uncontrolled

-Can be reaction to stress

potential emergencies of thyroid problems

-Myxedemic coma (hypo)

-Thyroid storm (hyper)

myxedemic coma

-Severe hypotension

-Hypothermia

-Edema

-Hypoventilation

thyroid storm

-Restlessness

-Fever

-Tachycardia

-Pulmonary edema

-Tremors

-Stupor

-Coma

-Death

what is he most likely emergency situation involving thyroid problems

thyroid storm

management of emergencies involving thyroid disorders

-Recognize signs

• Activate 911 / will need hospital care

• Provide cold towels to Bring down body temperature

• Monitor and record vital

-Provide CPR

• Cardiac arrest occurs

  • Airway

  • Breathing

  • Circulation