Thyroid/Adrenals Flashcards
(23 cards)
What are the s/s of hyperthyroidism?
HYPERMETABOLISM
Weight loss
HR increase
BP increased
Hyperpersonality
Heat intolerance b/c body is a furnace
Exopthalmos
What is another word for hyperthyroidism?
Graves disease
You are going to run yourself into the grave
What are 3 ways to treat hyperthyroidism?
Nuke it with radioactive iodine
PTU (propylthiouracil) - Puts Thyroid Under
Thyroidectomy
What is a consideration if you nuke the thyroid with radioactive iodine
Need a private room for the first 24 hours
Visitor restriction for first 24 hours
Flush 3 times after urinating
Call hazmat if urine is spilled
What is a consideration if using PTU for hyperthyroidism?
Monitor WBC because patient is immunosuppressed
If a patient has a total thyroidectomy they will need ______ and it is important to watch for ______
They will need lifelong hormone replacement
Watch for hypothyroidism because it can be difficult to spare the parathyroid gland when doing a total thyroidectomy
Does a subthyroidectomy need replacement? What are they at risk for?
No, but they many need some at first
At risk for thyroid storm
What are the s/s of a thyroid storm?
Temp 105 or above
High BP (stroke level)
Severe tachycardia
Psychotically delirious
How do you treat thyroid storm?
Get the temp down and bring oxygen up
Body temp down with ice packs and cooling blanket
Oxygen mark at 10L
Stay with patient - usually 2:1 ratio
These patients do not get medication, it is self limiting and they either come out of it or they don’t
After a total or subtotal thyroidectomy what are the risks in the first 12 hours? The next 12-48 hours? After 48 hours?
First 12: airway d/t edema and hemorrhage because endocrine glands are very vascular
Next 12-48:
Total: tetany d/t hypocalcemia (could close off the airway d/t irreversible spasm)
Subtotal: thyroid ström
After 48: infection
What are the s/s for hypothyroidism?
Hypometabolism
Obesity
HR decreased
BP decreased
Personality is flat, boring, dull
Intolerant to the cold b/c always cold
Academically challenged
What is a myxedema coma?
Severe hypothyroidism that leads to decreased mental status, hypothermia, and other S/S r/t slowing of function in multiple organs
What is the treatment of hypothyroidism?
Levothyroxine
Take in the morning 30 minutes to and hour before breakfast
What 2 orders should you question for your patient with hypothyroidism
Any sedative - they are already super slow so a sedative could put them into a coma
NPO prior to surgery including their thyroid replacement. They are already super slow so their condition without the replacement can potentiate the anesthesia during surgery. DO NOT hold thyroid meds unless it is specifically stated and if it is call around
How do you know if a disease is caused by the Adrenal Cortex?
The disease will either start with an A or a C
What is Addisons disease? S/S
Under secretion of steroids
VERY tan
Does not adapt well to stress
What is the purpose of a stress response?
To maintain normal BP to perfuse the brain and other organs
Ensure an adequate level of glucose to feed to body
If a patient with Addisons can’t adapt to stress what happens to them under stress?
Addisonian crisis
Shock
Hypoglycemic crisis
What is the treatment for Addisons disease?
Steroids (glucocorticoids - end in -SONE)
In Addison you ADD-a-SONE
What is Cushing syndrome?
Over secretion of the adrenal cortex
If you have a cushy tushy… you got more
What are the S/S of Cushing/steriod med SE?
Moon face
Hirsutism (lot of hair)
Truncal/central obesity
Muscle atrophy (skinny arms/legs)
Gynecomastia
Buffalo hump
Retaining Na+ and water
Stretch marks
High glucose
Easy bruising
Grouchy (“roid rage”
Immunosuppressed
Because patients with Cushings has hyperglycemia what should we do?
Accu-checks every 6 hours
What is the treatment for cushings? What does this result in?
Adrenalectomy
Now pt has Addisons and will be given a steroid to treat (SONE)
Pt will start looking like cushion
Takes about a year of titration for pt to start looking normal
