Exam 3

Question 1

SIADH

Answer 1

Increased ADH, increased water
Fluid OVERLOAD

Question 2

SIADH S/S

Answer 2

Weight gain w/o peripheral edema
Hypertensive, tachycardia
Change in loc, SEIZURE risk
Concentrated, amber urine

Question 3

SIADH Labs

Answer 3

Hyponatremia
High urine specific gravity

Question 4

SIADH nursing interventions

Answer 4

Daily weight, strict I/O’s, VS
Fluid restriction
Safety- Seizure and fall precautions

Question 5

SIADH medical management

Answer 5

Demeclocycline
Diuretics (watch for low k)
Sodium replacement (PO or IV)

Question 6

DI

Answer 6

Decreased ADH, decreased water
Fluid loss

Question 7

DI S/S

Answer 7

Polydipsia, Polyuria
Dehydration
Hypotensive
Diluted, clear urine

Question 8

DI labs

Answer 8

Hypernatremia
Low urine specific gravity

Question 9

DI nursing interventions

Answer 9

Daily weights, strict I/O’s, VS
Restrict foods that DIURESE (watermelon, grapes, caffeine)
Safety - fall precautions, postural hypotension

Question 10

DI medical management

Answer 10

DDAVP:
- synthetic vasopressin
- does NOT raise BP
- monitor i/o, vs, weight, electrolytes
- water intoxication

Question 11

HYPERthyroid

Answer 11

Increased T3 and T4, decreased TSH

Question 12

HYPERthyroid S/S

Answer 12

Increased metabolic rate
Increased HR, BP, temp
Weight loss, diarrhea
Restless, insomnia
Heat intolerance, diaphoresis
May have goiter, exophthalmos

Question 13

HYPERthyroid nursing interventions

Answer 13

Avoid spicy, high fiber foods
Eat 4000-5000 cals a day
Avoid caffeine and nicotine
Eye protection for exophthalmos
Cool, calm environment

Question 14

Thyrotoxicosis

Answer 14

THYROID STORM
HYPERthyroid

Question 15

Thyrotoxicosis S/S

Answer 15

Elevated temp
Increased HR, systolic HTN
N/V/D
Agitation, tremors, confusion

Question 16

Thyrotoxicosis medical management

Answer 16

Anti thyroid meds (PTU or meth)
Radioactive iodine therapy
Thyroidectomy

Question 17

Thyrotoxicosis nursing interventions

Answer 17

BETA BLOCKER to stabilize CV fxn.
Oxygen, IVF
Anti thyroid meds
Treat hyperthermia
calm environment

Question 18

HYPOthyroid

Answer 18

Decreased T3 and T4, increased TSH

Question 19

HYPOthyroid S/S

Answer 19

Decreased metabolic rate
Decreased HR
Weight gain, constipation
Lethargy, fatigue
Cold intolerance
Dry skin/hair
May have goiter

Question 20

HYPOthyroid nursing interventions

Answer 20

Take meds on empty stomach
Low cal, low fat diet
More fiber in diet
Avoid sedatives and opioids

Question 21

Myxedema

Answer 21

HYPOthyroid, opposite of thyroid storm

Question 22

Myxedema S/S

Answer 22

Decreased HR, BP, Temp
Hypoventilation
Hypoglycemia
Hyponatremia
Generalized edema

Question 23

HYPOthyroid management

Answer 23

Thyroid hormone replacement (LEVOthyroxine)
Nutrition therapy to promote weight loss
Pt ed

Question 24

Myxedema management

Answer 24

Respiratory and CV support
LEVOthyroxine IV
IVF, glucose
Keep pt warm
VS hourly, monitor for change in LOC

Question 25

HYPERPARAthyroid

Answer 25

Increased Ca+ & PTH Decreased phosphorus

Question 26

HYPERPARAthyroid S/S

Answer 26

Increased BP, dysrhythmias Bone pain, fractures, weakness Kidney stones Absent reflexes, poor coordination N/V, constipation Depression, irritability, psychosis

Question 27

Mnemonic for HYPERPARAthyroid

Answer 27

WEAK Weak muscles EKG changes Absent reflexes Kidney stones

Question 28

HYPERPARAthyroid nursing interventions

Answer 28

EKG for dysrhythmias Exercise Biphosphonates — sit upright for 30 mins and take 30 mins before breakfast Post op — monitor for respiratory distress, hemorrhage; no straining, elevate HOB (ICP), hypocalcemic crisis

Question 29

HYPERPARAthyroid medical management

Answer 29

MILD - Increase fluids - increase weight bearing exercise SEVERE - IVF, diuretics, biphosphonates, calcimimetics - surgery — parathyroidectomy

Question 30

HYPOPARAthyroid

Answer 30

Decreased Ca+ & PTH increased phosphorus

Question 31

HYPOPARAthyroid S/S

Answer 31

Decreased BP, dysrhythmias Bronchospasm, laryngeal spasm Abdominal cramps, Dysphagia Hyperreflexia, muscle cramps Tetany, seizures + chvostek and trousseaus

Question 32

Mnemonic for HYPOPARAthyroid

Answer 32

CATS Convulsions, chvostek Arrhythmias Tetany, trousseaus Spasm + stridor

Question 33

HYPOPARAthyroid nursing interventions

Answer 33

EKG for dysrhythmias Seizure precautions High calcium foods (dark green veggies, dairy, tofu) Avoid oxalic acid foods (spinach, rhubarb)

Question 34

HYPOPARAthyroid medical management

Answer 34

IV Ca gluconate PO calcium supplements Vitamin D

Question 35

Cushings labs

Answer 35

Increased cortisol, glucose, sodium Decreased potassium

Question 36

Cushing S/S

Answer 36

Truncal obesity Moon face and buffalo hump HTN Osteoporosis

Question 37

Cushing nursing interventions

Answer 37

VS, daily weight, glucose checks Emotional support Risk of infection Diet — decreased Na+ and increased K+, protein, Ca+

Question 38

Cushings medical management

Answer 38

DECREASE steroid dose SLOW Surgery — adrenalectomy - requires lifelong glucocorticoid placement -pre/post op teaching

Question 39

Addisons labs

Answer 39

Decreased cortisol, aldosterone, glucose and sodium Increased potassium

Question 40

Addisons S/S

Answer 40

Hypotension Hypovolemia Hypoglycemic Bronzed pigmentation Anorexia

Question 41

Addisons nursing interventions

Answer 41

VS, daily weight, I/O Calm environment Watch for s/s of Cushing’s and infection Hormone replacement therapy — lifelong

Question 42

Addisons medical management

Answer 42

Hydrocortisone -gluco and mineralcorticoid - 2/3 in morning and 1/3 in afternoon Fludrocortisone -mineral corticoid -take w food in morning -women need androgens -stress dosing education