Hyperthyroidism is also called
Grave’s disease or hypermetabolism
Tip to remember Grave’s disease s/s’s
“Run yourself into the Grave” – everything is up … diarrhea, thin, hot, high BP, high HR, cold tolerance, hot intolerance
Treatment for Grave’s disease
Radioactive Iodine, PTU (put thyroid under), surgically remove
Total thyroidectomy … totals get
tetany, need lifelong hormone replacement
After thyroidectomy patients are at risk for
hypocalcemia, remember hypocalcemia is opposite of the prefix and anything to BP so tetany, parasthesia
parathesia
numbness and tingling, first sign of electrolyte imbalance
Subtotal thyroidectomy … subs get
storm
S/S of thyroid storm
Extremely high vital signs, hyperpyrexia, psychotic delerium
How to treat thyroid storm
give o2, lower temp to spare brain
Risks post op for total thyroidectomy
airway, hemorrhage for 1st 12 hours then for 12-48 hours hypocalcemia leading to tetany
Risks post op for sub total thyroidectomy
airway, hemorrage for 1st 12 hours then for 12-48 hours thyroid storm
Hypothyroidism is also called
Myxedema or hypometabolism
S/S of mydexema
everything is down, constipation, heat tolerance, cold intolerance
Treatment for mydexema
give thyroid medications
Where to put the 5 ice packs to cool a thyroid storm patient
neck pits groin
If you cool a patient too fast what might happen?
Heart arrythmias
Never hold the hormone for what patient?
patient who is NPO with mydexema
Addison’s disease easy way to remember
Add a Sone (sone = steroid)
Adrenal Cortex diseases easy way to remember
A in Adrenal stands for Addison’s
C in Cortex stands for Cushing’s
Addison’s disease is
undersecretion of adrenal cortex, not enough hormone, BRONZE/tan, go into shock very easily. STRESS can trigger.
Addison’s disease treatment
give a steroid, chronic steroid therapy
Cushing’s syndrome
Over secretion of adrenal cortex, too much hormone, too much steroid.
S/S of Cushing’s syndrome
same as steroid use … moon face, think cushman “I’m mad I have an infection”, high blood sugar, losing Potassium,
Treatment for Cushing’s syndrome
Surgery, bi or uni lateral adrenalectomy (bilateral is worse)
Donning PPE’s order
Gown, Mask, Goggles, Gloves
Removing PPE’s order
alphabetically inside the room
For airborne precautions the mask is removed where?
outside of the room
Avoid answers with what words for children 9 mths and younger?
build, sort, stack, construct, make
Toddlers (1-3) work on
their gross motor skills (jump, hop, throw), NO fine motor, parallel play
Preschoolers (3-6) work on
fine motor, balance (tumbling, dance, tricycle), cooperative play, pretend
School age (7-11) work on
creative, collect, competitive
Best default order for click and drag order questions?
Hold ….. med
Assess ….. what med does
Prepare …… the correction
Call ….. or notify
Rarely if ever answer …
call Doctor, NCLEX wants you to think critically
Creatinine lab values
same as lithium 0.6-1.2 Not a huge worry, not a dangerous lab to worry about
INR lab values
2-3, critical value if off, potential for patient to bleed. Use default order for order ?’s (hold all coumadin, assess for bleeding, prepare Vit K (antidote for Coumadin), Call or notify
Potassium lab values
3.5-5.3 If low it is a critical lab to worry about assess the heart and then prepare to give K
if high, hold all K, assess heart (EKG), give D5W and reg insulin, call
if really high, hold, assess, prepare, call STAT Get someone else involved! Dangerous!!
pH lab values
7.35-7.45 if pH is in the 6;s VERY dangerous remember as the patient’s pH goes so goes the patient
If bad vitals, call rapid response team
BUN lab values
8-30 check for dehydration if elevated not a big deal, just be concerned
If a deadly or dangerous lab value is discovered AND they have symptoms call the
rapid response team!
HgB lab values
12-18 check for bleeding if low or high, if low prepare for tranfussion
HCO3 lab values
22-26 if it is abnormal so what!
CO2 lab values
35-45 if in the 50’s assess respiratory status and have patient do pursed lip breathing, if in 60’s considered deadly and respiratory failure, need intubated
Hct lab values
36-54 thickness of blood if abnormal not too big of a deal, assess for dehydration
PO2 lab values
78-100 this is only obtained from an ABG if low give O2 but if really low it is respiratory failure give O2, prepare for intubation, call resp therapy and call Dr
O2 sat lab values
93-100 pulse ox, if under 93 assess resp status and give O2
BNP lab value
less than 100 is normal, good indicator of CHF, edema, if elevated assess s/s of CHF
NA lab values
135-145, if a change in LOC then evaluate for fall/safety risk
WBC lab values
5000-11000 if low assess for infection
CD4 count less than 200 equals
AIDS
Neutropenic precautions (low WBC)
strict handwashing, avoid crowds, private room, low bacteria diet (no raw or undercooked), no water that has been standing longer than 15 min, vital signs Q4H
Platelets lab value
150000-400000 if lower than 90000 bad if lower than 40000 REALLY bad, if they sneeze they could die. Called thrombocytopenia
Bleeding precautions
no venipuncture, injection or IV, if necessary use small guage, handle patient gently, use drawsheet, no razor, no toothbrush, blow nose gently, no aspriin, no rectal temp, no hard foods
RBC lab values
4-6 million abnormal doesn’t really matter
Reason for laminectomy
treat nerve root compression
S/S of nerve root compression
Pain
Parasthesia (numbness & tingling)
Paresis (muscle weakness)
Cervical
Diaphram and Arms affected, breathing, respiratory pattern