Final NR 235

hypothyroidism

unable to produce T3 or T4

myxedema coma (hypothyroidism)

resp depression, lethargy progressing to stupor (due to untreated hypothyroid, or infection)

s/s of hyperthyroidism

nervousness, rapid pulse, exophthalmos, heat intolerance

medications for hyperthyroidism

methimazole, dexamethasone, beta blockers

management of hyperthyroidism

radioactive iodine therapy, thyroidectomy

thyroid storm (hyperthyroidism)

metabolic rate inc. rapidly (due to uncontrolled hyperthyroid or infections)

hypoparathyroidism

PTH deficiency caused by surgery (thyroidectomy)

s/s of hypoparathyroidism

tetany, numbness, tingling, stiffness, anxiety/depression

(hypocalcemia, hyperphosphatemia)

hypoparathyroidism has a positive:

Chovestek's and Trousseau's sign

management of hypoparathyroidism

long term oral Ca+ supplements, Ca+ gluconate (diet low in P+)

s/s of hyperparathyroidism

inc. Ca+, bone decalcification, renal calculi, fatigue, n/v, HTN

management of hyperparathyroidism

parathyroidectomy, hydration, restrict Ca+

adrenal crisis

adrenal suppression by chronic steroid use that is abruptly stopped (adrenal gland damage)

Addison's disease

ACTH not being released (due to autoimmune or tremors)

s/s of Addisons's disease

muscle weakness, anorexia, GI s/s, fatigue, dark pigmentation

management of Addison's disease

monitor F/E status, vitals, weight changes

s/s of hypothyroidism

extreme fatigue, weight gain, low HR, hair loss, dry skin

management of hypothyroidism

T4 (levothyroxine) replacement therapy

hyperthyroidism

excessive activity of the thyroid gland (TSH)

parathyroid hormone regualtes:

calcium and phosphorus

Cushing syndrome

excessive adrenocortical activity or corticosteroid meds

s/s of Cushing syndrome

hyperglycemia, buffalo hump, heavy trunk, thin extremities, fragile thin skin, weakness

nursing considerations for Cushing syndrome

activity level, skin assessment, mental function, emotional status

primary Aldosteronism

excess production of aldosterone by the adrenal glands resulting in low renin levels

s/s of primary Aldosteronism

HTN, low K+, headache, fatigue, muscle cramps/weakness

management of primary Aldosteronism

surgical removal of gland, aldosterone-blocking drugs

diagnostic tests for diabetes

blood glucose, fasting BS, Hgb A1C, glucose tolerance test

DKA

absence or inadequate amount of insulin resulting in abnormal metabolism (carbs, proteins, and fats)

s/s of DKA

3Ps, hyperglycemia, dehydration, inc. K+

treatment of DKA

continuous infusion of regular insulin, F/E balance, monitor blood glucose

HHS

lack of sufficient insulin (ketosis is absent)

s/s of HHS

hypotension, dehydration, tachycardia, variable neuro

treatment of HHS

rehydration, insulin admin, monitor F/E

causes of hypoglycemia

too much insulin, oral hypoglycemic agents, not enough food

s/s of hypoglycemia

sweating, tremors, slurred speech, palpations (tachy), nervousness, hunger, headache

management of hypoglycemia

glucose tablets, OJ, snack w/ protein & carbs

breast cancer risk factors

age, family history, BRCA gene, obesity

mammography screening occurs annually after the age of:

40

post-op considerations mastectomy

pain management, coping, avoid high-impact activities, monitor drainage (infection)

management of breast cancer

mastectomy, biopsy, chemo/radiation, hormone therapy

s/s of breast cancer

non-tender, fixed hard lesion w/ irregular borders

(orange peel)

risk factors for prostate cancer

age, family history, African American

s/s of prostate cancer

urinary obstruction, blood in urine

treatment of prostate cancer

prostatectomy, chemo/radiation, hormone therapy

potential complications of prostatectomy

UTI, hemorrhage, catheter obstruction

management of prostatectomy

monitor urinary drainage, keep catheter patent and irrigate

acute myeloid leukemia (AML)

hematopoietic stem cells that differentiate into all myeloid cells (monocytes, erythrocytes, platelets)

treatment of AML

chemo, supportive care

chronic myeloid leukemia (CML)

mutation in myeloid stem cells (inc. blast cells)

s/s of CML

Philadelphia chromosome, uncontrolled proliferation extends to the cavities of bones and cells in liver and spleen (painful)

acute lymphoid leukemia (ALL)

uncontrolled proliferation of immature cells from the lymphoid stem cells

s/s of ALL

liver, spleen, bone pain, cranial nerve palsies (CNS)

treatment of ALL

chemo, corticosteroids, pontential lumbar puncture

complications of CLL

hemolytic anemia

chronic lymphoid leukemia (CLL)

malignant clone of the B lymphocyte

s/s of CLL

inc. lymphocyte, splenomegaly, inc. infections

treatment of CLL

antibiotics

Hodgkin's lymphoma

reed-sternberg cells

s/s of Hodgkin's and non-Hodgkin's lymphoma

painless firm lymph nodes (one side of neck), fever w/out infection, night sweats, weight loss

treatment of Hodgkin's lymphoma

chemo/radiation, transplantation

non-Hodgkin's lymphoma

neoplastic growth of lymphoid tissue throughout body

diagnosis of non-Hodgkin's lymphoma

w/out reed-sternberg cells, CT, PET scan

treatment of non-Hodgkin's lymphoma

agressive chemo w/ monoclonal antibody

multiple myeloma

malignant disease of the plasma cell (M proteins) > non-functional immunoglobulins

s/s of multiple myeloma

bone pain, osteoporosis, fractures, inc. Ca+, anemia, infections

(CRAB)

what is necessary to diagnose multiple myeloma

bone marrow biopsy

CRAB (multiple myeloma)

Ca+ inc., renal insufficiency (kidney failure), anemia, bone lesions/pain

treatment of multiple myeloma

HSCT (extends remission), steroids, chemo/radiation

living will

outlines conditions under which you want to be kept alive or allowed to die (vegetative state, CPR, how to distribute belongings)

DNR

spells out conditions under which you prefer not to have your life saved by CPR

POA does not have to follow:

living will or DNR

palliative vs. hospice care

hospice is prognosis of 6 months or less and is non-curative (comfort care)

needs of the terminally ill

physical, psychological, spiritual, pain and s/s management

meeting hospice criteria

any diagnosis in which the pt. will die from (ES heart, renal, lung disease, dementia, AIDS, ALS/Parkinson's)

OSA 3S's (s/s)

sleepiness, snoring, significant other reports stopped breathing

empyema

fluid due to infection around the lung

s/s of empyema

cyanosis, fever, tachycardia, cough, pleural pain

s/s of pneumothorax

asymmetric movement, SOB, inc. RR, low pulse O2

tension pneumothorax

too much air (sucking chest wound)

COPD

post infection, lung tissue turns into scar tissue

s/s of COPD

coughing, SOB, wheezing, edema, excess mucus production

medications for COPD

SABA, anticholinergics, corticosteroids, fluticasone (dries drainage)

asthma

narrowing of airway > impaired O2

s/s of asthma exacerbation

airway constriction, SOB, difficulty breathing, mucus production

treatment for asthma

SABA, anticholinergics, corticosteroids, fluticasone

s/s of TB

night sweats, fever, bloody sputum

treatment for TB

antibiotics (9 months), breathing treatments

pulmonary embolism (PE)

starts as DVT > clot gets thrown into lungs > obstruction

s/s of PE

pain on deep breath

treatment for PE

heparin drip, anticoag, O2

diagnostics for PE

CT chest w/ contrast, positive d-dimer (+.50) and VQ scan

atelectasis

caused by lack of motion post surgically (partial collapse)

diagnostics for pneumonia

chest x-ray, sputum culture

medications for pneumonia

albuterol, mucolytic, antibiotics, antipyretic

s/s of COVID-19

chills, body aches, SOB, cough, runny nose

diagnostic for COVID-19

ground glass opacity

acute coronary syndrome (ACS)

unstable angina, NSTEMI, STEMI (MI)

coronary artery disease (CAD)

characterized by atherosclerosis (plaque)

stable angina

stable plaque, vessel is unable to dilate

(inadequate blood flow)

unstable angina/NSTEMI

plaque ruptures and thrombus forms around the rupture plaque
(partial occlusion of the vessel)