NUR 185 Exam 1 - Endocrine and Shock Review

Flashcards covering medications, laboratory values, nursing interventions, and clinical manifestations for endocrine disorders and types of shock as discussed in the lecture notes.

Propranolol (Inderal)

A Beta blocker used to treat hypertension, angina, and thyroid storm; nursing assessment requires checking Heart Rate and Blood Pressure.

Hydrocortisone (Solucortef)

A steroid used to restore glucocorticoid and mineralocorticoid levels in patients with Addison's disease; effectiveness is indicated by normal Blood Pressure and $K$ levels.

Levothyroxine (Synthroid)

A synthetic hormone used to treat hypothyroidism by increasing thyroid hormone production; must be taken on an empty stomach for the rest of a patient's life.

PTU (Propylthiouracil)

A medication that treats hyperthyroidism and thyroid storm by blocking thyroid replacement and decreasing hormone levels; requires hepatic level monitoring and is safe for pregnant women.

Mitotane

A cytotoxic chemotherapy medication used for treating tumors of the adrenal gland.

Tapazole (methimazole)

An antithyroid medication used in the treatment of hyperthyroidism.

Florinef

A medication for Addison's disease that requires monitoring for hemoptysis, seizures, and hypokalemia.

Epinephrine

An IM injection used to treat anaphylactic reactions; common side effects include nausea, vomiting, and tachycardia.

Meropenem (Merrem)

An antibiotic/anti-infective medication administered via IVPB to treat sepsis.

Zosyn (piperacillin/tazobactam)

An antibiotic that requires checking for penicillin allergies and monitoring of BUN, creatinine, and potassium levels.

Metyrapone (Metopirone)

An adrenal corticoid inhibitor used for Cushing's disease; effective when cortisol levels decrease to $6-23$, blood pressure is stable, and fatigue decreases.

Hypothyroidism Lab Findings

Characterized by decreased $T3$ (triiodothyronine) and decreased $T4$ (thyroxine) levels.

Signs and Symptoms of Hypothyroidism

Include constipation, cold intolerance (hypothermia), weight gain, anorexia, lethargy, bradycardia, hypotension, and thin hair/dry skin.

Myxedema

A severe long-term form of hypothyroidism characterized by non-pitting periorbital edema and edema to hands and feet, which can lead to coma.

Hypothyroidism Interventions

Include providing a warm room with extra blankets, a low-calorie diet, stool softeners, rest periods, and applying lotion to dry skin.

Signs and Symptoms of Hyperthyroidism

Include diaphoresis, heat intolerance, exophthalmos (bulging eyes), pretibial myxedema, weight loss with increased appetite, and tachycardia.

Hyperthyroidism Interventions

Include increasing caloric and protein intake ($6$ high-calorie meals), keeping the patient cool, and decreasing caffeine and iodine.

Postoperative Thyroidectomy Care

Requires HOB in semi fowlers, keeping a Trach kit at the bedside, and monitoring for neuromuscular irritability and voice changes.

Hypocalcemia in Post-Op Thyroidectomy

A calcium level below $8.5$ indicated by a positive Chvostek's sign, Trousseau sign, or laryngeal spasms/stridor.

Chvostek's sign

A twitch of the facial muscles occurring when gently tapping the individual's cheek in front of the ear, indicating hypocalcemia.

Trousseau sign

A hand and wrist muscle spasm occurring when pressure is applied to the upper arm, indicating hypocalcemia.

Thyroid Storm Signs

A severe state of hyperthyroidism marked by elevated blood pressure, elevated temperature, agitation, delirium, and cardiac arrhythmias or tachycardia.

Thyroid Storm Treatment

Involves administering Tylenol, beta-blockers like Inderal/propranolol, PTU, and IV fluids while monitoring vitals.

Cushing Disease Symptoms

Facial fullness (moon face), truncal obesity, slender extremities, fragile skin with risk for infection, hypertension, and hypokalemia.

Pheochromocytoma

A rare adrenal tumor characterized by severe hypertension, hyperglycemia, and hypermetabolism.

Bilateral Adrenalectomy Nursing Care

Requires life-long steroid replacement, aseptic technique to prevent infection, and monitoring for low Blood Pressure, low urine output, and hypothermia.

Transsphenoidal Microsurgery Patient Teaching

Instruct the patient not to blow their nose, avoid heavy lifting or bending at the waist, and report clear nasal drainage (check for glucose).

Addison's Disease Signs

Hyperpigmentation (darkened skin), hypoglycemia, weight loss, salt cravings, and postural hypotension.

Addison’s Crisis Signs

Tachycardia, vasomotor collapse, hyperkalemia (paresthesia), fever, and confusion; notably, IV $KCl$ is contraindicated.

Addison's Crisis Treatment

Includes Electrolyte replacement (No IV potassium), Hydrocortisone (Solucortef) IV, and IV fluids such as Dextrose 50 ext{%} and $D5NS$.

Sepsis Indications

Hypotension (even with IV fluids), elevated temperature, tachycardia, tachypnea, altered mental status, and positive blood cultures.

Lactic Acid and Shock

Shock forces the body into anaerobic metabolism, producing lactic acid which leading to cellular decline, organ failure, and irreversible damage.

Hypovolemic Shock

Caused by excessive vomiting, diarrhea, burns, or blood loss; characterized by low Blood Pressure, oliguria, and increased heart and respiratory rates.

Septic Shock

Caused by toxins causing vasodilation; symptoms include diaphoresis, chills, and elevated serum lactate (normal is $0.5-2.2$).

Anaphylactic Shock

Caused by severe allergic reaction leading to vasodilation, angioedema, SOB, hypotension, and tachycardia.

Neurogenic Shock

Caused by spinal injury or anesthesia; characterized by vasodilation, hypotension, bradycardia, and cyanosis of fingertips.

Cardiogenic Shock

Involves pump failure and decreased myocardial contractility, primarily caused by acute MI (myocardial infarction).

Obstructive Shock

Inadequate blood flow caused by physical impairment, such as tension pneumothorax, cardiac tamponade, or pulmonary embolisms.