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Med Surg 2 > Quiz 5 > Flashcards

Quiz 5 Flashcards

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1
Q

What is acromegaly?

A

Excessive growth hormone

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2
Q

What are the clinical manifestations of acromegaly?

A

HE’S TALL

H - Hypertension & Height
E - Enlarged Organs (cardiac issues/fractures)
S - Sweating & oily skin

T - Too much pain in joints
A - Arthritis
L - Long hands & feet
L - Long protruding jaw

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3
Q

What is the surgical treatment for acromegaly? What are the post op considerations?

A

Transphenoidal Hypophysectomy
- surgical removal of pituitary gland

Post op: important to decrease ICP
- no coughing/bending over
- HOB 30 degrees
- stool softener
- assess nasal drainage (CSF leak)

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4
Q

What are the medications used for acromegaly? What do they do?

A

Octreotide (helps to slow GI bleeds)
Bromocriptine
Pergolide (long acting)

Stop the release of growth hormone

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5
Q

What are the nursing interventions for acromegaly?

A

Provide emotional support
Provide post op or radiation care
Teach medication f/u adherence

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6
Q

What is hyperthyroidism?

A

HIGH thyroid hormones (T3 and T4)

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7
Q

What are the risk factors of hyperthyroidism?

A

Graves’ disease (GAINS)
Thyroiditis (hashimotos)
Goiter
Excessive iodine intake
Pituitary tumor
Thyroid cancer

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8
Q

What are the clinical manifestations of hyperthyroidism?

A

HIGH & HOT

Grape eye (exophthalmos)
Goiter
High BP (HTN crisis 180/100+)
High HR (Tachycardia)
Heart palpitations
High temp (hot & sweaty)
Diarrhea
Bruit over thyroid
Pretibial myxedema

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9
Q

What therapeutic procedure is done for hyperthyroidism?

A

thyroidectomy
preop: administer SSKI and antithyroid meds
postop: semi flowers, resp status, hypocalcemia, note any hoarseness, hypothyroidism

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10
Q

What medications are given for hyperthyroidism?

A

propylthiouracil (PTU)
methimazole
potassium iodine (SSKI)
Lugol’s solution
atenolol
propranolol

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11
Q

What nursing interventions are done for hyperthyroidism?

A

encourage rest
monitor VS, dysrhythmias, I&O, weight
report increase in temp
eye protection for exophthalmos
high caloric-diet, avoid high fiber and stims

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12
Q

What is a complication of hyperthyroidism? What are the clinical manifestations?

A

thyroid storm/crisis (thyrotoxicosis)

manifestations:
high and hot
agitation/confusion

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13
Q

How is a thyroid storm managed?

A

antithyroid meds
acetaminophen
cool IV fluids to keep temp down

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14
Q

What is hypothyroidism?

A

LOW & SLOW
primary: thyroid gland dysfunction (postop trach placement)
secondary: anterior pituitary gland dysfunction (can’t produce TSH)
tertiary: hypothalamus dysfunction (can’t produce TRH)

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15
Q

What are the risk factors of hypothyroidism?

A

female 30-60
inadequate iodine intake
radiation therapy to head/neck
meds (lithium or amiodarone)

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16
Q

What are the clinical manifestations of hypothyroidism?

A

LOW & SLOW

low energy
low metabolism
constipation
low mood (depression)
dry skin

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17
Q

What medication is given for hypothyroidism?

A

LEVOthyroxine

Life long and long slow onset (3-4 weeks til relief)
Early morning or Empty stomach (NOT @ NIGHT)
Very active (high HR/BP) report agitations/confusion
Oh the baby is fine (pregnancy dafe)

do not stop abruptly

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18
Q

What drugs interact with levothyroxine?

A

increases effects of warfarin
increases insulin requirements
increases excretion of digoxin
decreases absorption w/ calcium, iron, and sucralfate

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19
Q

What are the nursing interventions for hypothyroidism?

A

safe warm environment
avoid sedatives
monitor weight
increase activity

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20
Q

What is a complication of hypothyroidism? How is it managed?

A

myxedema coma (non pitting edema)

very low and slow: breathing airway, low BP = death
hoarseness

tx: IV hormone therapy

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21
Q

What do the parathyroid glands do?

A

regulate serum calcium

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22
Q

What is hyperparathyroidism?

A

increased PTH (parathyroid hormone) = high calcium

hypercalcemia (over 10.5)

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23
Q

What are the risk factors of hyperparathyroidism?

A

parathyroid disease
renal disease
tumor (adenoma [not cancer]/ malignant [cancer])

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24
Q

What are the clinical manifestations of hyperparathyroidism?

A

weak bones
kidney stones (nephrolithiasis)
constipation
dysrhythmias
N/V
polyuria

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25
What therapeutic procedure is done for hyperparathyroidism?
parathyroidectomy preop: mithramycin to decrease Ca (SE: bleeding and increased clotting times) postop: similar to thyroidectomy
26
What medications are given for hyperparathyroidism?
calcitonin loop diuretic bisphosphonate - alendronate calcimimetic - cinacalcet calcium chelator - mithramycin
27
What nursing interventions are done for hyperparathyroidism?
initiate fall precautions weight bearing exercises low-calcium, low-vitamin D diet strain urine hydrations monitor for hypercalcemic crisis (hyperreflexia >15mg/dL tx: mithramycin)
28
What is hypoparathyroidism?
decreased PTH = low calcium (under 9)
29
What are the risk factors of hypoparathyroidism?
iatrogenic (due to medical tx) idiopathic (no known cause) hypomagnesemia
30
What are the clinical manifestations of hypoparathyroidism?
Trousseau's sign: twerk w/ BP cuff Chvostek's sign: cheeky smile when stroking face diarrhea paresthesia muscle cramps tetany (hyperreflexia) bradydysrhythmias
31
What medications are given for hypoparathyroidism?
acute: IV calcium chloride or gluconate chronic: calcium carbonate, phosphate binder, vitamin D
32
What are the nursing interventions for hypoparathyroidism?
seizure precautions assess s/s for neuromuscular irritability monitor ECG high calcium, low phosphorus diet
33
What is Cushing's Syndrome?
high cortisol levels cushion of steroids HIGH (big round hairy)
34
What are the risk factors of Cushing's syndrome?
pituitary adenoma adrenal hyperplasia adrenal adenoma or carcinoma malignancies (GI, lung cancer) exogenous glucocorticoids
35
What are the clinical manifestations of Cushing's syndrome?
BIG bp, infections, weight, hair, belly, brittle bones CUSH Cushion - truncal obesity, moon face, hump Unusual hair growth - hairy suit Skin - purple striae, butterfly mark High - sugar, BP, weight
36
What therapeutic procedures are done for Cushing's syndrome?
chemotherapy (mitotane) hypophysectomy adrenalectomy
37
What medications are used for Cushing's syndrome?
ketoconazole (manages) metyrapone (temporarily decreases cortisol) antacid, H2RB, PPI to prevent GI bleed
38
What interventions are done for Cushing's syndrome?
assess for hyperglycemia taper steroids down
39
What is Addison's disease?
adrenal insufficiency
40
What are the clinical manifestations of Addison's disease?
AADDSS Added tan (hyperpigmentations) Added potassium (over 5.0) Decreased weight Decreased BP, hair, sugar, energy, hydration Sodium loss (<135) Salt craving
41
What medications are given for Addison's disease?
hydrocortisone (main tx-increase dose during illness) prednisone fludrocortisone vasopressors for hypotension crisis antibiotics for infection
42
What nursing interventions are done for Addison's disease?
ADDDI Add steroids Diet high in protein, carbs, sodium Don't abruptly stop Don't believe meds will cure Indefinitely (life long)
43
What is a complication of Addison's disease?
Addisonian crisis: decreased BP, HR, sodium increased RR, potassium tx: IV fluid replacement and IV steroids
44
What is pheochromocytoma?
tumor on adrenal gland
45
What are the clinical manifestations of pheochromocytoma?
hypertension hyperhidrosis hyperglycemia hypermetabolism headache
46
What medications are given for pheochromocytoma?
phentolamine and propanolol (decreases BP) sodium nitroprusside (@ risk for hemorrhagic stroke / decreases BP) calcium channel blockers
47
What is the therapeutic procedure for pheochromocytoma?
surgical removal of tumor
48
What are the nursing interventions for pheochromocytoma?
monitor BP provide a quiet environment and frequent rest provide a high calorie nutritious diet
49
What does the liver do?
nutrient metabolism hematologic function detoxification and storage bile production (bilirubin)
50
What does it mean if there in an increase in liver enzymes?
liver damage
51
What does it mean if there is an increase in bilirubin?
jaundice
52
What does it mean if there is an increase in PT?
liver disease bleeding disorder vitamin K deficiency blood thinners
53
What does it mean if there is a decrease in albumin?
edema in abdomen (ascites) liver disease malabsorption low protein
54
What is the most common method of transmission of HCV?
needle sharing
55
What is cirrhosis?
progressive liver disease characterized by extensive irreversible scarring
56
What are the risk factors of cirrhosis?
alcohol use (most common) hepatitis chemicals biliary disease R heart failure
57
What are the clinical manifestations of cirrhosis?
fatigue pruritus clay-colored stool tea-colored urine weight loss emotional lability
58
What are the complications of cirrhosis?
peripheral edema (ankle and presacral edema) ascites (abdominal distention with weight fain, everted umbilicus, abdominal striae) portal hypertension (increased portal venous pressure, large collateral veins, esophageal and gastric varices) splenomegaly hepatic encephalopathy
59
Describe esophageal varices
varicose veins in esophagus s/s of rupture: hematemesis - hypovolemic shock tx for ruptured: stop bleeding w/blakemore tube (most common)
60
What should be in the room if an esophageal varice ruptures?
scissors cuts all the part to get air out asap for pt to breath
61
What are the risk factors of hepatic encephalopathy?
cerebral depressants GI bleed constipation metabolic alkalosis uremia infection dehydration hypokalemia increased metabolism paracentesis
62
What are the clinical manifestations of hepatic encephalopathy?
neurologic changs asterixis (flapping hand tremor seen) fector hepaticus (sweet must odor, can be smelled in breath and urine, results from accumulations of digestive products) inappropriate behavior sleep disturbances
63
What is hepatorenal syndrome?
azotemia (too much BUN in blood) oliguria intractable ascites
64
What are the therapeutic procedures for cirrhosis?
paracentesis to relieve ascites transjugular intrahepatic portosystemic shunt surgical bypass shunting procedure (portacaval shunt/distal splenorenal shunt) EGD liver bx liver transplantation
65
What medications are used for cirrhosis?
1st - albumin IV 2nd - diuretics (furosemide) neomycin and metronidazole (rifaximin - targets bacteria in blood stream to get rid of ammonia) lactulose supp. vitamins PPIs or H2RBs (help precent GI bleed) beta blockers
66
What are the nursing interventions for cirrhosis?
measure abdominal girth and weigh client daily
67
What are nursing interventions for esophageal and gastric varices?
prevent bleeding - avoid alc, ASA, NSAIDs, irritating foods - screen for bleeding
68
What are the nursing interventions for ascites? What medications are given?
restrict sodium measure abdominal girth weigh client daily cleanse abdomen gently meds: albumin, diuretics, tolvaptan
69
What medication reduce ammonia formation?
lactulose rifaximin
70
What is the most common method of transmission of HBV?
healthcare related blood or fluid exposure w/o protection
71
What is acute liver failure?
fulminant hepatic failure
72
What are the clinical manifestations of acute liver failure?
jaundice coagulation problems encephalopathy renal failure hypoglycemia metabolic acidosis sepsis multiorgan failure
73
What are the risk factors of liver cancer?
cirrhosis hepatitis c chronic alcoholism
74
What are the clinical manifestations of liver cancer?
early (absent or subtle) - fatigue - hepatosplenomegaly - complications from portal hypertension late - fever, chills - jaundice, anorexia, weight loss - palpable mass, RUQ pain
75
What is the evaluation process for a liver transplantation?
assessment for comorbid conditions physical assessment lab tests and diagnostic tests psychological evaluation
76
What are postoperative complications of liver transplantations?
graft rejection infection (fever) bleeding renal failure
77
What are the types of graft rejection?
hyperacute rejection (rare): occurs within 24 hours after transplantation tx: removal of organ acute rejection: occurs in first 6 months after transplantation tx: immunosuppressive therapy, but pt at higher risk of infection /neoplastic changes chronic rejection: occurs sporadically over months or years tx: similar to acute rejection but long term success is poor
78
What is the clinical manifestations of graft rejection?
liver failure
79
What are the nursing interventions of liver transplantation?
prevent infection assess neurologic status assess for bleeding monitor fluid and electrolyte levels monitor urinary output monitor for signs of rejection (increased BP/HR) provide emotional support

Med Surg 2 (7 decks)

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