Term
| What are the priority nursing diagnoses for patients with alterations in metabolic functioning? |
|
Definition
Infection, risk for
Fluid volume, risk for (excess or deficit)
Injury, risk for
Nutrition, imbalanced
Pain, acute or chronic
Fatigue
Activity intolerance
Body image disturbance
Body image disturbance
Sexual dysfunction |
|
|
Term
| What is the goal of the care for all patients with endocrine hormone anomalies? |
|
Definition
| to stabilize the hormonal levels to near normal and avoid complication of the abnormal hormone levels |
|
|
Term
| What is the nurse's primary role in health promotion? |
|
Definition
Provide education
Support and empower the individual to make informed decisions
Promote self management education
Identify potential problems
Take appropriate proactive actions that promote metabolic homeostasis |
|
|
Term
| What is the focus of the plan of health promotion? |
|
Definition
Good hygiene
Maintain hydration status
Work toward exercise goals
Appropriate community referrals
Recommend medical alert identification |
|
|
Term
| What would you teach to a patient going home? |
|
Definition
Knowledge of complications
Self medication administration
Importance of home safety
Regular contact with health care team |
|
|
Term
| What is the effect of tight glycemic control on the hospital course and on the prevention of long term vascular complications in a patient with diabetes mellitus? |
|
Definition
| ebp showed that there were no changes in the prevention of long term vascular complication in a patient with DM. It did show, however, that there were more hypoglycemic events in the patients. |
|
|
Term
| What are the standard targets for glycemic control for fasting blood glucose levels? |
|
Definition
|
|
Term
| what does maintaining glycemic control do? |
|
Definition
prevents development of vascular complications
results in fewer hospitalized days and decreases mortality |
|
|
Term
| What patients require special consideration by the nurse? |
|
Definition
high risk patients with multiple risk factors
patients with cardiac disease |
|
|
Term
|
Definition
Insulin is a hormone and a protein. Insulin was first introduced in the 1920's
It was initially made from beef or pork pancreas
Since the 1980's, insulin has been genetically engineered to mimic human insulin
This "human" or humulin insulin is absorbed faster with fewer allergic reactions
Insulin is the drug of choice to control gestational diabetes and Type 1 diabetes mellitus |
|
|
Term
| what are the actions of insulin? |
|
Definition
Insulin administration is replacement therapy for insufficient or absent insulin secretion
Promotes the use of glucose by cells in the body
Insulin can be administered IV or sub Q
Cannot be given orally
GI secretions destroy insulin |
|
|
Term
| what are the side effects of insulin? |
|
Definition
allergic reactions (rare)
lipodystrophy: hypertrophy of subQ tissue due to repeated injection, must teach patients to rotate sites
hypoglycemic reaction (insulin shock) |
|
|
Term
| what are the signs and symptoms of hypoglycemia? |
|
Definition
Nervousness
Headache
Dizziness,
Confusion
Seizures
Tremor
Lack of coordination
Combative
Slurred speech
Diaphoresis
Tachycardia |
|
|
Term
| What are the nursing considerations with insulin? |
|
Definition
Insulin storage: refrigerate insulin until opened then store at room temperature for 1 month then disguard
Insulin administration
Correct type of insulin
Correct dosage
Correct syringe
Correct sub Q technique
Correct IV administration
Patient teaching for insulin injections: Reverse demonstration
Insulin injection site rotation essential to avoid lipodystrophy |
|
|
Term
|
Definition
| rapid acting, short acting, intermediate acting, long acting, combination |
|
|
Term
| Types of Insulin: rapid acting |
|
Definition
humalog(Lispro), novolog(Aspart), glulisine(Aprida)
onset: 5-15 min
peak: 30-60 min
duration: 2-4 hrs
route: subq only
indications: used immediately prior to meals to correct hyperglycemia |
|
|
Term
| Types of Insulin: short acting (regular insulin) |
|
Definition
humulin R, Novolin R
onset: 30-60 min
peak: 2-3 hours
duration: 4-6 hours
route: sub Q or IV
indications: clear liquid; used in sliding scale dosages and for emergency |
|
|
Term
| Types of Insulin: intermediate acting (NPH insulin) |
|
Definition
humulin N, Ilentin NPH, Lente NPH, Lente insulin, (look for N or NPH on label)
onset: 2-4 hrs
peak: 4-12 hrs
duration: 16-20 hrs
route: sub Q
indications: contains protein derivative that prolongs insulin activity; cloudy liquid; must be gently rotated to mix |
|
|
Term
| Types of Insulin: Long acting (basal insulin) |
|
Definition
ultra Lente; Lantus (glargine); Detremir (levemir)
onset: 1 hr
peak: no peak, continuous
duration: 24+ hrs
route: sub Q only
indications: clear liquid, cannot be mixed, usually given HS |
|
|
Term
| Types of Insulin: Combination Insulin |
|
Definition
Humulin 70/30 (70 NPH, 30 reg)or 75/25; Humulin 50/50 (50 NPH, 50 reg)
peak, onset, duration: same as separate insulin types
indications: 2 different insulins pre-mixed in same vial |
|
|
Term
| Why would you mix insulins and what are the most common mixtures? |
|
Definition
allows administration of 2 types of insulin in 1 injection
most common are rapid or short plus intermediate |
|
|
Term
| How soon after mixing should the insulin be given to patient? |
|
Definition
| five minutes to maintain action times |
|
|
Term
| What is the order of preparation with mixing insulins? |
|
Definition
Inject air into intermediate acting insulin first
Then inject air into rapid or short acting insulin vial cloudy to clear)
Then draw up rapid / short acting insulin
Next draw up intermediate acting dose (clear to cloudy) or (R-rapid to N-NPH)
Hint: cloudy, clear, clear, cloudy (you can mix clear to cloudy but not cloudy to clear) |
|
|
Term
| What do you need to know about insulin pens? |
|
Definition
Resembles a fountain pen
Consists of a disposable needle and a disposable insulin filled cartridge
Cartridge is usually pre filled in US
More accurate than syringe
Number of units of insulin desired is dialed onto pen
Increases patient compliance
More expensive |
|
|
Term
| What do you need to know about insulin pumps? |
|
Definition
Worn externally
Connect to an indwelling sub Q needle
Infusion set (changed every 2-3 days) with a sub Q needle and insulin cartridge
Delivers a continuous infusion of insulin
Usually uses rapid acting insulin (humalog, Novolog)
Basal continuous rate is set
Patients can give bolus doses associated with meals and carbohydrates
Advantage over injections is a continuous insulin infusion provides more stable blood glucose |
|
|
Term
| What types of research are being done for insulin therapy |
|
Definition
Implantable insulin pumps
Pump is surgically implanted under the skin
Insulin given either intraperitoneally or IV
Long term use under study
Inhalant insulin delivery
Insulin has rapid onset and short duration of action
Used for meal time bolus dosages
Only 10% of inhaled insulin is absorbed so doses are 10x greater than subQ
Limitations: very expensive, dosages not consistent
Still under study to obtain more exact dosages |
|
|
Term
| When can oral medications be used? |
|
Definition
| only when the pancreas is still producing insulin; depends on the physical status of patient, the drug's site of action, and the pt's response to therapy |
|
|
Term
| What are the 6 classes of oral anti-diabetic meds? |
|
Definition
Sulfonylureas
Biguanides
Alpha-glucosidase inhibitors
Thiazolidinediones
Meglitinides
Incretin mimetics |
|
|
Term
| Sulfonylureas: 2nd generation |
|
Definition
action: stimulate beta cells to secrete more insulin
drugs: Glucotrol (glipizide):
Onset 1 - 1.5 hrs
Peak 1 - 3hrs
Duration 12 - 24 hrs
Diabeta, Micronase (glyburide)
Onset 2 - 4 hrs
Peak 4 hrs
Duration 24 hrs
Amaryl (glimepiride)
Onset 1 hr
Peak 2 - 3 hr
Duration 24 hr |
|
|
Term
| What are the side effects for sulfonylureas? |
|
Definition
Hypoglycemia
GI disturbances: N / V / D, anorexia, weight gain, constipation, flatus
Neuro disturbances:
headache, dizziness,skin rash
implications: |
|
|
Term
| What are the implications for sulfonylureas? |
|
Definition
give 30 min prior to meals
teach pt to recognize & treat low Bg
weight gain meal plan modifications
Contraindicated in pregnancy, renal & liver dysfunction
CAUTION with sulfa allergies
interactions with NSAIDs, warfarin, sulfanomides
Monitor liver enzymes |
|
|
Term
|
Definition
Action: Diminishes the increase in BG following meals & limits postprandial hyperglycemia;
Reduces hepatic glucose production;
Increases peripheral tissue sensitivity to insulin;
Lowers fasting BG;
Decreases glucose absorbed from intestines:
Lowers cholesterol;
Does NOT affect beta cells &
Does NOT cause low BG
Drugs: Glucophage, glucophage XL, glucophase, fortament (metformin) |
|
|
Term
| what are the side effects of biguanides? |
|
Definition
GI: anorexia, N?V, flatus
Neuro: headache
Lactic acidosis |
|
|
Term
| What are the implications of biguanides? |
|
Definition
Contraindicated in : impaired liver & renal fx, alcohol abuse, resp insufficiency (resp acidosis)
severe infections--S/S= lactic acidosis, weak, fatigue, GI discomfort, muscle pain
Hold prior to procedures using dyes & 48 hrs after |
|
|
Term
| Alpha-glucosidase inhibitors |
|
Definition
Delays the digestion and absorption of carbohydrates in the small intestine
Slows entry of glucose into the circulation
Smaller rise in blood glucose levels after meals
Does not increase insulin production – no hypoglycemia, no weight gain
Meds: Precose(acarbose) and Glycet (miglitol) |
|
|
Term
| What are the side effects of alpha-glucosidase inhibitors? |
|
Definition
GI disturbances: abdominal distention or discomfort, diarrhea, flatulence (gas)
Skin rash |
|
|
Term
| What are the nursing implications for alpha-glucosidase inhibitors |
|
Definition
Peak effectiveness in 3 hours
Not absorbed by the intestines
Contraindicated in GI dysfunction |
|
|
Term
Thiazolidinedione
(glitazones) |
|
Definition
Action: Lowers insulin resistance and re-sensitizes the body to its own insulin
Decreases insulin resistance
Increases sensitivity to insulin in fat & muscle
Stimulates insulin receptor sites
Some evidence that this class may regenerate B cells
Meds: Actos (pioglitazone) onset 30 min, peak 2 hrs
Avandia (rosiglitatazone) reaches peak in 1 hr
****recent reports indicated increased heart attacks and CV deaths with Avandia; FDA added warning label & emphasizes CV risks (ie: don't take it!) |
|
|
Term
| What are the side effects of Thiazolidinediones? |
|
Definition
Hypoglycemia
Anemia
Impaired platelet function
Weight gain
Edema
Hyperlipidemia
Possible liver toxicity |
|
|
Term
| What are the nursing implications of thiazolidinediones? |
|
Definition
Monitor liver fx (every 3 months)
Monitor for low BG
Teach pt to prevent and treat low BG
hypoglycemia risk is increased with other insulin or meds
weight gain, meal plan modifications
ADA recommends that CV patients avoid Avandia |
|
|
Term
Meglitinides
(Non-Sulfonylurea Insulin Secretagogues) |
|
Definition
Action: Stimulates beta cells of pancreas to produce insulin
Improves insulin reaction at binding sites
Shorter action time than Sulfonylureas
Peaks in 3 hours
Meds: Prandin (repaglinide) and Starlix (neteglide) |
|
|
Term
| What are the side effects for meglitinides? |
|
Definition
Similar to Sulfonylureas:
Hypoglycemia
Less weight gain
Mild GI disturbances
CV adverse effects: HTN, MI |
|
|
Term
| What are the nursing implications for meglitinides? |
|
Definition
Monitor blood glucose to limit hypoglycemic reactions
Teach patients to prevent, recognize & treat low BG
Take within 15 minutes of meal, if NPO omit dose |
|
|
Term
|
Definition
Action: manufactured synthetically & given Sub Q
Used in patients with Type 2 diabetes
Enhances insulin secretion in hyperglycemia
Reduces glucose released from liver
Prevents hyperglycemic spikes after meals
Adjunctive therapy used with sulfonylureas (metformin) to improve glycemic control
Meds: Byetta (exenatidine) |
|
|
Term
| What are the side effects with incretin mimetics? |
|
Definition
GI disturbances:
N / V, decreased appetite, weight loss, slowed GI emptying |
|
|
Term
| What are the nursing implications for incretin Mimetics? |
|
Definition
Must be kept refrigerated
Given only subQ
Should be taken before meals
Injected 2x/day within 1 hour before breakfast and dinner
Not an insulin substitute |
|
|
Term
|
Definition
Action: Synthetic human amylin hormone analog
Prevents postprandial increase in glucagon
Lower BG after meals
Adjunctive therapy used in addition to insulin
Meds: Symlin(pramlintide) |
|
|
Term
| What are the side effects of amylin hormone analog? |
|
Definition
GI disturbances:
N/V, anorexia, weight loss
decreased appetite
Neuro:
headache, dizziness
Hypoglycemia |
|
|
Term
| What are the nursing implications of amylin hormone analog? |
|
Definition
Must be given subQ
Must be injected separately from insulin
Must be injected in abdomen or thigh not arm due to variable absorption rates
Monitor blood glucose to limit hypoglycemic reactions
Teach patients to prevent, recognize and treat low blood glucose
Pre-meal insulin dose should be decreased by 50% when staring Symiln
Give immediately before meals, if NPO omit dose |
|
|
Term
Incretin Modifier
(Dipetidyl Peptidase-4 Inhibitor) (DDP-4 |
|
Definition
Action: Slows inactivation of incretin hormones
Additional insulin secretion by beta cells after food
Glucose dependant insulin synthesis improved
Reduces glucose (glucagon) secretion from liver
Meds: Januvia (sitagliptin) and Galvus (vildagliptin) |
|
|
Term
| What are the side effects of incretin modifiers? |
|
Definition
GI disturbances: N / V
Slows gastric emptying time
Neuro: Headache
Hypoglycemia
Respiratory:
Upper resp infection, sore throat, stuffy nose |
|
|
Term
| What are the nursing implications of incretin modifiers? |
|
Definition
Monitor blood glucose to limit hypoglycemic reactions
Teach patients to prevent, recognize and treat low blood glucose
Oral medication
Used as monotherapy or with other antidiabetes medications |
|
|
Term
| What are the combination anti diabetic drugs and what are the advantages? |
|
Definition
Glucovance (metformin with glyburide)
Metaglip (glipizide with metformin)
Avandamet (rosiglitazone with metformin)
Advantages:Increases compliance - Patient only has to take one pill
Cost less
Multiple actions of the agents are being done at the same time
Drug companies prefer – increases charges for generic medications |
|
|
Term
| What is glucagon and what is its action? |
|
Definition
a hormone secreted by the alpha cells in the pancreatic islets
Actions: Increases blood sugar by stimulating glycogen breakdown in the liver
Protects cells, especially the brain, by providing energy
Used to treat insulin induced hypoglycemia when other methods are not available
Blood glucose level begins to increase 5 to 20 minutes after administration |
|
|
Term
| What are the side effects of glucagon? |
|
Definition
N /V
Hypotension
Allergic reaction |
|
|
Term
| What should you consider with glucagon? |
|
Definition
Administered parenterally (Sub Q, IM, IV)
Used in severe hypoglycemic reactions (insulin shock)
Patients prone to these reactions should have glucagon emergency kit in the home
Family members should be taught how to administer subQ or IM injections in an emergency
Monitor blood glucose to limit hypoglycemic reactions
Teach patients to prevent, recognize and treat low blood glucose |
|
|
Term
| What are corticosteroids? |
|
Definition
hormones that affect metabolism
produced in the adrenal cortex
glucocorticoids (cortisol) and Mineralocorticoids (aldosterone) |
|
|
Term
| What do corticosteroids do? |
|
Definition
Glucocorticoids regulate metabolism and increase blood glucose
Mineralcorticoids regulate potassium and sodium balance |
|
|
Term
| What happens when you have too much corticosteroids? |
|
Definition
| can cause Cushing's syndrome |
|
|
Term
| What happens when you have too little corticosteroids? |
|
Definition
can cause adrenal insufficiency or Addison's disease
lifelong steroid replacement therapy is essential |
|
|
Term
| Adrenal Hormone: Glucocorticoid |
|
Definition
Used for corticosteroid therapy in adrenal insufficiency or hypofunction of the adrenal gland. Also used to suppress inflammation, control allergic reactions, and to control transplant rejections.
hydrocortisone (Cortisol, Solu-Cortef)
dexamethasone (Decadron)
prednisone ( Deltasone)
methylprednisolone (Solu-Medrol, Medrol)
Adrenal Hormone: Mineralocorticoid |
|
|
Term
| This type of corticosteroid facilitates secretion of aldosterone which is involved in the fluid and electrolyte balance? |
|
Definition
| Fludrocortisones (Florinef) |
|
|
Term
| Anti-Thyroid Medication: Thiomides |
|
Definition
Action: Drug of choice for hyperthyroidism
Used for hyperthyroidism, thyroid storm & in preparation for thyroidectomy
Thioamides interfere with incorporation of iodide into T3 & T4
Meds: PTU, Propyl-Thracil (propylthiouracil)
Tapazole (methimazole) |
|
|
Term
| What are the side effects of thioamides? |
|
Definition
Weight gain
Decreased BP & HR
Signs of hypothyroidism: requires adjustments in meds
Signs of thyroid crisis (thyroid storm): can result from sudden withdrawal of anti thyroid meds administration of excess thyroid hormone or failure to give thyroid hormone after thyroidectomy |
|
|
Term
| What are the nursing implications of thioamides? |
|
Definition
monitor VS
Monitor serum T3, T4, & TSH |
|
|
Term
| Anti-Thyroid Medication: Beta Adrenergic Blockers (adjunctive therapy) |
|
Definition
Action: Used as adjunctive therapy for hyperthyroidism because of the cardiac symptoms from increased metabolism
Relieves symptoms from increased sympathetic nervous system stimulation
Meds: Propranolol |
|
|
Term
| What are the side effects and implications for a beta blockers with regards to metabolism? |
|
Definition
s/s: decreased BP & HR
Monitor VS |
|
|
Term
| Anti-Thyroid Medication: Iodine or iodine compounds |
|
Definition
Action: Iodine or iodine compounds once only treatment for hyperthyroidism
Increased levels of iodine suppressed release of thyroid hormones
Adjunctive therapy- no longer used as only treatment
Decreases release of thyroid hormones
Reduces size & vascularity of gland
Used prior to thyroidectomy
Increases effect of other anti thyroid drugs
Meds: Iodine solution (Lugol's solution) and Potassium iodide solution |
|
|
Term
| What are the implications for iodine compounds? |
|
Definition
Dilute & give after meals
sip with straw--discolors teeth |
|
|
Term
| Anti-Thyroid Medications: Radioactive iodine (RAI) |
|
Definition
Action: Thyroid gland absorbs iodine in any form
When radioactive iodine administered it is concentrated in thyroid gland
Damages or destroys thyroid tissue so less thyroid hormone produced
Meds: sodium iodide 131-oral administration |
|
|
Term
| What are the side effects and implications for RAI? |
|
Definition
often causes hypothyroidism & requires thyroid hormone replacement
No radiation precautions needed
Contraidicated during pregnancy
used for pt that are not surgical candidates for thyroid removal |
|
|
Term
| What do thyroid replacement medications do? |
|
Definition
| increase blood levels of thyroid hormone and restore the pts metabolic rate to normal |
|
|
Term
| What are the thyroid hormones? |
|
Definition
levothyroxine sodium (T4) (Levoxyl, Levothyroid, Synthroid) – drug of choice for replacement therapy
liothyronine sodium (T3) (Cytomel) – synthetic T3, initial therapy for myxedema, not for long term treatment
liotrix (Euthroid, Thyrolar) – combination drug, composed of levothyroxine sodium and liothyronine sodium in 4:1 ratio |
|
|
Term
| What should you assess with pts on thyroid hormones? |
|
Definition
| Monitor vital signs, report abnormal results (especially pulse over 100) Monitor cardiac function – cardiovascular response to hormone therapy determines medication dosage Monitor changes in weight, edema, and fluid intake / output Monitor serum T3, T4 and thyroid stimulating hormone, report abnormal results |
|
|
Term
|
Definition
it is essential for hormone production.
Most common source is iodized salt
patients on low sodium diets may be at increased risk of hypothyroidism |
|
|
Term
| What happens when you take echinacea and corticosteroids? |
|
Definition
| may significantly decrease the effectiveness of corticosteroids |
|
|
Term
| What happens when you take ginseng and corticosteroids? |
|
Definition
| patient may experience central nervous system stimulation and insomnia |
|
|
Term
| What happens when you take herbal laxatives, herbal diuretics and corticosteroids? |
|
Definition
| the laxatives and diuretics can decrease serum potassium levels. when they are mixed with corticosteroids, severe hypokalemia can occur |
|
|
Term
| What happens when you mix licorice and corticosteroids? |
|
Definition
| licorice potentiates the effects of corticosteroids which can cause significant decreases in serum potassium levels |
|
|
Term
| What happens to blood glucose levels when you take cinnamon? |
|
Definition
| cinnamon can help control blood glucose by promoting insulin synthesis |
|
|
Term
| What happens to blood glucose levels when you take ginseng? |
|
Definition
| can lower bg when taken before or during a meal. can cause hypoglycemia reaction if taken with insulin or oral anti-diabetic meds |
|
|
Term
| What happens to blood glucose levels when you take chromium? |
|
Definition
| may decrease insulin requirements |
|
|
Term
| What happens to blood glucose levels when you take black cohosh? |
|
Definition
| may increase the effects of insulin and oral anti-diabetic meds |
|
|
Term
| What happens to blood glucose levels when you take garlic, aloe, bitter melon, and gymnema? |
|
Definition
| can increase insulin levels. As a result, they cause hypoglycemia when used with insulin or oral anti-diabetic meds |
|
|
Term
| What happens to blood glucose levels when you take bilberry? |
|
Definition
| may increase hypoglycemia when taken with insulin or oral anti-diabetic meds |
|
|
Term
| What happens to blood glucose levels when you take coco, rosemary or stinging nettle? |
|
Definition
| the therapeutic effect of oral anti-diabetic meds and insulin is decreased. can create a hyperglycemic effect |
|
|
Term
| How does taking multivitamins and mineral supplements affect diabetes? |
|
Definition
| pts with type 2 diabetes that take multivitamins may have a reduced incidence of infections |
|
|
Term
| What is a hypophysectomy? |
|
Definition
| removal of the pituitary gland |
|
|
Term
| What are the indications for a hypophysectomy? |
|
Definition
Performed to treat primary pituitary tumors
Most common treatment for hyperpituitarism
Majority of the surgeries done to remove pituitary tumors
Associated with acromegaly
Usually use the transsphenoid approach
Goal of surgery is to only remove tumor that is causing secretion of excess growth hormone |
|
|
Term
| What are the pre-op interventions for a hypophysectomy? |
|
Definition
Patient education before surgery:
Nasal packing in place for 2-3 days
Will not be able to cough, sneeze or blow their nose
They cannot bend over or brush their teeth initially because these activities increase intracranial pressure (ICP)
Patient's cooperation will
Protect the muscle graft over the surgical site
Improve the wound healing and avoid complications. |
|
|
Term
| What are the post-op interventions for a hypophysectomy? |
|
Definition
Desired outcomes for a patient after a hypophysectomy focus on:
Monitoring neurologic status
Initiating hormone replacement
Maintaining fluid balance
Avoiding post operative complications.
Postoperative Complications:
Possibility of a CSF leak from the surgical site
Development of diabetes insipidus |
|
|
Term
| What are the nursing interventions for a hypophysectomy? |
|
Definition
Prevent adrenal insufficiency
Monitor for hormonal insufficiencies
Monitor for increased intracranial pressure
Monitor for CSF drainage
Monitor for meningitis
Provide oral hygiene; gentle rinse, do not brush teeth
Bowel regime; avoid constipation, straining increases ICP |
|
|
Term
| What would you teach a pt with a hypophysectomy? |
|
Definition
Re-enforce pre op instructions
Advise the patient to not to cough, sneeze or blow their nose
Do not bend over
Leave nasal packing in place |
|
|
Term
| What discharge teaching would you do for a pt who has had a hypophysectomy? |
|
Definition
Follow-up monitoring; regular monitoring of hormone balance is required, follow-up medical care is essential
Medications
Lifelong hormone replacement therapy is required,
Vasopressin may be needed to treat diabetes insipidus and maintain fluid balance
Bowel regime
Mouth care at home
Do not brush teeth for about 2 weeks after surgery until oral incision line is healed
Gentle rinse every 4-6 hours
Sense of smell is decreased; usually lasts 3-4 months after surgery
Monitor for signs of
Infection
Cerebral edema (neuro status changes)
Signs of hyperpituitarism (could indicate tumor recurrence) |
|
|
Term
|
Definition
| partial or total removal of the thyroid gland |
|
|
Term
| What patients would have a thyroidectomy? |
|
Definition
| pts that have: very large goiters, thyroid cancer, unresponsive to antithyroid therapy for hyperthyroidism, pts who are not good candidates for radioactive iodine therapy |
|
|
Term
| What is the advantage of a thyroidectomy? |
|
Definition
| it results in more rapid reduction in T3 and T4 levels |
|
|
Term
| What is a total thyroidectomy? |
|
Definition
Complete removal of the thyroid gland
Usually performed to treat thyroid cancer
Must take thyroid replacement hormones for the rest of their lives |
|
|
Term
| What is a subtotal thyroidectomy? |
|
Definition
Involves the partial removal of the thyroid gland
Approximately 90% of the gland must be removed
If too much is removed then the gland will not regenerate after surgery |
|
|
Term
| What is an endoscopic thyroidectomy? |
|
Definition
Minimally invasive procedure that is appropriate for individuals with small nodules (less than 3 cm) and no malignancy
Endoscopic thyroidectomy involves less pain, less scaring and faster recovery |
|
|
Term
| what is the pre-op care for a thyroidectomy? |
|
Definition
Must be euthyroid before the procedure
Antithyroid medications, iodine and beta-adrenergic blockers may be given several weeks before surgery to attain a more normal thyroid state and control symptoms
Preoperative iodine reduces the size and vascularization of the thyroid gland and decreases post operative hemorrhage |
|
|
Term
| What is the post-op care for a thyroidectomy? |
|
Definition
Desired outcomes of postoperative care for a patient after a thyroidectomy include
Maintain airway
Minimize strain on the incision line
Relieve pain
Manage respiratory secretions
Prevent complications
Patient's hospital room should be prepared with oxygen and suctions equipment, and a tracheostomy tray |
|
|
Term
| What are the post op complications of a thyroidectomy? |
|
Definition
Respiratory difficulty caused by edema of the glottis, hemorrhage or laryngeal nerve damage
Weak or hoarse voice due to damage to one laryngeal nerve
Hypocalcemia or tetany due to accidental removal of one or more parathyroid glands
Thyroid crisis / Thyroid storm |
|
|
Term
| What is laryngeal stridor? |
|
Definition
| a harsh vibratory sound during respirations, emergency situation, indicates impending respiratory distress and requires immediate action |
|
|
Term
| What would you do for laryngeal stridor? |
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Definition
Assess for signs and symptoms of hemorrhage
Initially, place in semi-Fowler's position with the head supported by sand bags or pillows to limit movement.
Monitor VS, control pain and cough & deep breath |
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Term
| what would you teach a pt who has had a thyroidectomy? |
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Definition
Avoid tension on the suture line by limiting abrupt head movements and by supporting the neck when they move
The nurse should reassure the patient that the hoarseness is temporary and usually improves in several days
Monitor and treat hypocalcemia:
The manifestations of hypocalcemia develop 1 to 7 days after surgery
Call a physician if the signs are present.
Keep calcium gluconate ampules available
Make certain the patient has a patent IV line |
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Term
| Do you remember the signs/symptoms of hypocalcemia??? |
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Definition
Monitor the patient for:
Chvostek's sign (facial nerve irritability)
Trousseau's sign (carpal spasm)
Numbness or tingling around the mouth, finger tips, or toes
Muscle spasms or twitching. |
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Term
| what would you teach a pt that is going home following a thyroidectomy? |
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Definition
Follow-up monitoring:
Regular monitoring of thyroid balance is required
Follow-up medical care is essential
Appropriate thyroid replacement medications should be prescribed
T3 / T4 levels monitored
Medications:
Teaching about lifelong thyroid replacement medications following total thyroidectomy is essential to patient success.
Promote wound healing:
Teach the patient how to care for their incision
The surgical wound should heal without infection in approximately 6 weeks |
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Term
| What would indicate a unilateral or bilateral removal of adrenal glands? |
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Definition
When hyper function (Cushing Syndrome) of the adrenal glands is caused by an adrenal tumor, an adrenalectomy may be performed to remove the tumor
Only one adrenal gland is usually involved
However, if an ACTH producing ectopic tumor is involved then a bilateral adrenalectomy is required
Lifelong adrenal hormone replacement therapy is necessary when both glands are removed. |
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Term
| What are the pre-op interventions for an adrenalectomy? |
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Definition
Prior to surgery, the patient is brought to optimal physical condition
Electrolyte and glucose imbalances are corrected before the procedure
Dysrhythmias can develop from potassium imbalances and cardiac monitoring is needed
Patient with adrenal hyperfunction is at risk for infection and fractures
Strict aseptic technique and frequent handwashing can prevent infections
Nurse must promote safety
Decrease the risk of falls
Putting side rails up
Assisting the patient with transfers
An increased calorie diet with high protein content is prescribed before surgery to increase strength |
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Term
| What are the post-op interventions of an adrenalectomy? |
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Definition
After an adrenalectomy, the patient is usually sent to the critical care unit
These glands are highly vascular and the risk of hemorrhage is significant
Also, after surgery the BP, fluid balance, and electrolyte balances are unstable due to hormone fluctuations
In the postoperative period (for both the laparoscopic and the open approach) the patient will probably have
NG tube
Urinary catheter
IV fluids
Central venous pressure monitoring
Sequential leg compression devices to promote circulation
High doses of corticosteroids are administered during and after surgery
Doses are titrated based on the patient's cardiovascular response (BP and heart rate) and fluid and electrolyte balance |
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Term
| What are the post-op complications of a adrenalectomy? |
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Definition
critical period for circulatory instability is 24 – 48 hours after surgery
Postoperative infection
Hemorrhage
Acute adrenal insufficiency (Addisonian crisis)
Results from the sudden reduction in adrenal hormones is essential and requires careful monitoring
Also at risk for injury as a result of
Possible skin breakdown
Pathological fractures
GI bleeding due to previous hypercortisolism
Preventing these complications should be a major focus of nursing care |
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Term
| What would you focus on when teaching about an adrenalectomy? |
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Definition
*avoid infection--teach the patient to cough and deep breathe to prevent post op resp infections. Also advise the pt to protect the wound and maintain the dressing as prescribed
*Corticosteroid imbalance--pts must be able to identify s/s of hypocortisolism or decreased cortisol including N/V, weakness, dehydration and decreased BP. If there are excessive corticosteroids, the pt may experience Cushing-like symptoms (hypercortisolism) including emotional disturbances, joint pain, itching and peeling skin |
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Term
| What are the discharge instructions for a pt with an adrenrolectomy? |
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Definition
Follow-up monitoring:
Ongoing medical follow up is needed to monitor the corticosteroid levels and adjust medications
The patient and family must be taught to be alert for signs and symptoms of corticosteroid imbalance
Patients should be advised to avoid extremes in temperature, infections, and emotional disturbances as much as possible
Medications:
Life time hormone replacement therapy is required for patients following a bilateral adrenalectomy
It can take several months to adjust the hormone levels appropriately
If only one adrenal gland was removed them hormone replacement is continued until the remaining gland increases function (usually 6-12 months)
Medication adjustments:
Patient may need to increase the dose of corticosteroids during periods of physical or emotional stress
Medical identification:
Patient should be advised to wear a medic alert bracelet at all times
Always carry medical identification and instructions |
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Term
| What should nurses in the community stress about adrenalectomies? |
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Definition
pts on long-term steroid therapy are at high risk for developing Cushing's syndrome
very important to stress dangers of abruptly stopping medication-gradual tapering of dosage levels is essential |
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Term
| Explain pancreatic islet cell transplants |
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Definition
Instead of transplanting the entire pancreas, only the insulin producing islet cells are transplanted
They can be harvested from human cadaver donors or from pigs
It requires two human pancreases to obtain enough islet cells for one transplant |
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Term
| Who can get islet cell transplants? |
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Definition
mostly in pts with type 1 diabetes
used instead of traditional pancreatic transplants because it is a minor surgical procedure, less expensive, safer and has fewer complications |
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Term
| What are the pre-op interventions of pancreatic islet cell transplants? |
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Definition
Prior to the procedure, the patient's glucose level must be controlled to near normal levels
The surgery takes less than one hour and is performed under local anesthesia
After the cells are harvested, they must be utilized with 12 hours
The islet cells are injected, through the abdominal wall, into either the peritoneal space or into the liver (Edmonton Protocol) |
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Term
| What is the post-op care for pancreatic islet cell transplants? |
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Definition
After the islet cells are transplanted, they begin producing insulin
Many of these diabetic patients can be free from insulin injections for several months or for as long a year after the transplant
The patient requires anti rejection medications to protect the islet cells from attack by the body's immune system |
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Term
| What are the post-op complications of pancreatic islet cell transplants? |
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Definition
After the procedure, the patient is at risk for bleeding at the surgical site and hemorrhage in the area of the cell implantation
Steroid drugs, although they are usually part of the anti rejection medication routine, are avoided in these protocols because they cause hyperglycemia
They are also damaging to the islet cells |
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Term
| What are the nursing interventions for pt with a pancreatic islet cell transplant? |
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Definition
Monitor VS
Monitor blood glucose
Assess for signs and symptoms of hemorrhage
Administration of anti rejection medications – doses adjusted to patient response
Protect immunosuppressed patient from infections – key safety intervention
Monitor for signs and symptoms of infections – increased WBC, temperature and wound drainage. |
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Term
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Definition
| an elevated fasting blood glucose greater than 110 mg/dl or a BG of 140 mg/dl two hours after a meal |
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Term
| What factors predispose a pt to hyperglycemia? |
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Definition
Inadequate insulin production (diabetes mellitus)
Changes in glucose metabolism (Cushing's syndrome or glucocorticoid medications)
Excessive food intake, infection, acute illness, stress, decreased activity. |
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Term
| What are the signs/symptoms of hyperglycemia? |
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Definition
Polyuria (increased UO)
Polydipsia (increased thirst)
Fatigue, weakness
Dry mouth
Poor wound healing, infection
Neuro: Headache, blurred vision
GI: N/V, abdominal cramping |
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Term
| What are the outcomes of treatment of hyperglycemia? |
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Definition
Stabilize blood glucose
Give insulin or oral antidiabetic medication
Treat the factors that caused increased BG
Prevent complications of hyperglycemia |
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Term
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Definition
low blood glucose (less than 70)
Mild low BG < 50 -70 mg / dL
Moderate low BG < 30-50 mg / dL
Severe low BG < less than 30 mg / dL |
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Term
| What factors predispose a patient to hypoglycemia? |
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Definition
Too much insulin
Sudden increase in activity
Failure to eat on time
Alcohol ingestion
Some medications |
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Term
| What are the signs/symptoms of hypoglycemia? |
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Definition
Tremors
Hunger
Pallor
Diaphoresis
Increased pulse
Neuro: irritable, nervous, headache, confusion, slurred speech, blurred vision, lethary, loss of consciousness
Coma, death |
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Term
| What are the treatments for hypoglycemia? |
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Definition
Mild low BG – give 15 grams of fast acting carbohydrate; fruit juice followed by a complex carbohydrate such as cheese and crackers
Moderate low BG – give 20-30 grams of carbohydrate or glucagon 1 mg SubQ or IM or Dextrose 50% 50ml IV
Severe low BG – administer 50% dextrose IV |
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Term
| What is a thyroid crisis? (also called thyroid storm) |
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Definition
acute rare condition where there is extreme excessive hyperthyroidism
This is a life threatening emergency but mortality is rare when treatment is aggressively initiated early
The causes of thyroid crisis are stressors in a patient with previous hyperthyroidism
These stressors include infection, trauma, surgery |
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Term
| What are the signs/symptoms of a thyroid crisis? |
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Definition
Hyper metabolic hypertension
Severe tachycardia
Heart failure
Diaphoresis
Hyperthermia (fever up to 105F)
Restlessness, agitation |
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Term
| What are the outcomes of treatments for thyroid crisis? |
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Definition
Reduce circulating thyroid hormone
Manage cardiac symptoms
Manage respiratory distress
Decrease fever
Fluid replacement
Manage stressors that precipitated crisis |
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Term
| What is an adrenal crisis? |
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Definition
a sudden decrease in the production of adrenocortical hormones caused by acute stress outside the adrenal glands
It is a life threatening condition
Adrenal crisis usually occurs with a chronic condition such as Addison's Disease (adrenal hypofunction) |
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Term
| What are the signs/symptoms of an adrenal crisis? |
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Definition
Severe sudden electrolyte and fluid imbalance
N / V
Tachycardia
Dysrythmias
Progresses to seizures, coma, and death |
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Term
| What are the outcomes of treatment for adrenal crisis? |
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Definition
Rapid intervention required
Supply needed hormones
Restore fluid and electrolyte balance |
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Term
| How are metabolic changes related to homeostasis? |
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Definition
| Homeostasis is disrupted when changes in metabolic functioning cause alterations in fluid, electrolyte and glucose balance as in Cushing's disease, Addison's disease and diabetes mellitus. |
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Term
| How are metabolic changes related to nutrition? |
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Definition
| Alterations in Nutrition occur when the metabolism of nutrients, such as glucose and protein are disrupted as in diabetes mellitus |
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Term
| How are metabolic changes related to elimination? |
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Definition
| Changes in the functioning of Elimination develop when the metabolism of waste products in the body is altered as in the complication of renal failure or changes in GI functioning such as constipation or diarrhea. |
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Term
| How are metabolic changes related to infection? |
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Definition
| The incidence of Infection can be increased by changes in the immune system functioning of the patients due to alterations in metabolism as a result of diseases such as diabetes mellitus and Cushing's syndrome. |
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Term
| How are metabolic changes related to mobility? |
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Definition
| Changes in a patient's Mobility can result from metabolic changes that cause peripheral disease such as diabetic neuropathy, peripheral vascular disease, and amputations. |
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Term
| How are metabolic changes related to sensory perception? |
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Definition
| Alterations in a patient's Sensory Perception develop when disruptions in metabolism cause neurological damage. This damage can facilitate the development of pathology such as retinopathy, resulting in changes in visual acuity, and peripheral neuropathy, resulting in changes in sensation. |
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