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โ REMEMBER this is live/ever changing and I will continue to add to it in every section as necessary. So use this to make sure you're not forgetting anything that should be on your study guide.
Exam 4 Cheat Sheet
Endocrine
Pituitary
Diabetes Insipidus- ( Hyposecretion of ADH) -
- S/S: Excessive urination and thirst, s/s of dehydration, hypotention
- DI treatment โ **vasopressin tannate, desmopressin acetate
- Nursing Interventions:** Monitor input and output (I&O) and neurological status cardiovascular status, fluid and electrolyte levels 4.
SIADH- ( Hypersecretion of ADH)
- S/S- Low Sodium/ Water retention/intoxication
- SIADH treatment โ **Fluid restriction, normal or increased salt diet
- Nursing Interventions:** Monitor input and output (I&O) and neurological status cardiovascular status, fluid and electrolyte levels
Urine specific gravity- 1.005- 1.
Diluted urine- <1.
Concentrated urine- >1.
- Gigantism caused by โ Excess growth hormone
- Acromegaly symptom โ Enlarged hands/feet
Thyroid Gland
Hypothyroidism
- S/S: Symptoms of slowed down basal metabolic rate: lethargy, fatigue, bradycardia, intolerance to cold, weight gain, dry skin and hair,constipation, myxedema, forgetful, menstrual disturbance
- Lab expected in hypothyroidism โ **High TSH, Low T3, T
- Treatment-** a. Levothyroxine (Synthroid)- will decrease the level of TSH, increase T3,T4 and reverse alleviate s/s of hypothyroidism. - Should be taken in am with no food / cause insomnia b. Monitor Thyroid levels
- Hypothyroidism severe complication โ Myxedema coma
S/S: Hypotension, bradycardia, Hypothermia, Hyponatremia,
Hypoglycemia, Generalized edema, Respiratory failure, Coma
Treatment- Hormone therapy ( Priority tx for Myxedema coma)
Hyperthyroidism
1. S/S: tachycardia, weight loss, intolerance to heat, cardiac dysrhythmias, HTN,
diaphoresis, anxiety, palpitations, exophthalmos, goiter
- Lab expected in hyperthyroidism โ Low TSH, High T3, T
- Graves disease โ Autoimmune antibodies. Causes Hyperthyroidism
- Hyperthyroidism medication โ propylthiouracil (causes Agranulocytosis -) i. **Methimazole
- Intervention:** Provide adequate rest, cool, quiet environment, sedation
- Complication : Thyroid Storm
- s/s: fever, tachycardia, systolic hypertension, confusion, seizures, delirium, coma
- Priority treatment for thyroid storm โ Beta blockers
- Surgical Procedure: Thyroidectome (which will also result in parathyroidectomy)
Parathyroid
Hypoparathyroidism
- Labs- Best test for diabetes control โ HbA1insulinc (average glucose for 120 day) 4-6.5 ok for diabetics (Goal less 6.5% or less. ) 4. Diabetes foot care โ Daily inspection 5. Exercise lowers the blood glucose level
6 Instruct client about relationship between blood glucose levels and dietary
Adjustments
- Peak action time of insulin important because of relationship to development of
hypoglycemic reactions (reg and nph)
- Only short-duration insulin ( lispro, aspart, glulisine, and regular insulin) can be
administered intravenously or in a pump
Chronic Problems:
Neuropathy- pain and decreased sensation
Retinopathy-blurred vision
Nephropathy- kidney damage
Hypoglycemia -Sign of hypoglycemia โ Diaphoresis,blurred vision, tachycardia
- Treatment-Sugar (candy, Orange Juice)
- Treatment IV Glucagon if canโt swallow
Hyperglycemia
1. Treatment- Insulin ( monitor K+)
DM Type 1
- Treatment - Insulin
- Emergency complication of diabetes โ DKA ( Met acidosis/Ketones) โ DKA sign โ Kussmaul respirations i. IV insulin/Monitor K+
ii. Monitor for quick decrease of blood sugar can cause Hypoglycemia and cerebral edema iii. IV fluids 0.9% sodium chloride to treat dehydration
DM Type 2
- Treatment- Oral Hypogycemic Medications and Insulin (if needed) โ Glipizide
- Emergency complication of diabetes โHHNS ( No Met acidosis/ No Ketones) โ IV insulin/Monitor K+ โ Monitor for quick decrease of blood sugar can cause Hypoglycemia and cerebral edema โ IV fluids to treat dehydration
Insulin
- Insulin lowers blood glucose
-Contraindicated in hypoglycemia
-prevent exposure to sunlight
-Do not shake insulin
-Keep at room temp x 1 month
-refrigerate insulin that is not in use to maintain potency
-Administered SQ and IV ( on the unit- regular insulin only- can cause hypokalemia), sq pump
Pump- change needle every 3 days ( cannot use long acting insulin with pump)
Insulin Types
-NPH- cloudy, peaks in 6 โ14 hr
NPH insulin is an intermediate-acting insulin. cloudy, Its onset of action is 1 to 2 hr, peaking at 6 to 14. Can be mixed with regular insulin
-Regular- is short acting. Clear (discard if it is cloudy) Onset in 30 min. Peak in 2-4 hrs. Must eat in 30 minutes or hold. Can be given IV
-Glargine is a long-acting insulin- If patient NPO- call MD for order donโt just HOLD
(-if patient able to have CT with contrast increased hydration is required)
-restrict dietary sodium potassium phosphorus and magnesium
-control protein intake based on level of disease and type of dialysis
Renal Calculi/Urolithiasis
Caused mostly by calcium but also other substances like (Uric Acid Gout)
s/s: sever sharp pain (depending on where it is ), dysuria, hematuria, fever, Increase in VS d/t pain
-Flank pain when the stones are in the Kidney pelvis
- Pain radiates to the groin and the Testiscals or labia when stones are in the ureters
- Suprapubic pain when stones are in the bladder
Tx: Abx, pain meds, Lithotripsy
Nursing Intervention: Pian management, Increase fluids, Strain Urine
Lifestyle changes: Drink a lot of water for prevent
Adhere to diet restrictions (based on cause)
Complications : Urosepsis, Obstruction, Hydronephrosis
Pyelonephritis : Pyelonephritis is a bacterial infection of the renal pelvis
-Cause: ascending UTIs (usually with E coli)
-Risk Factors- Female young adult, pregnancy, DM (see pg. 443)
-s/s Flank or costovertebral angle, Fever, Chills, malaise, tachycardia, tachypnea
-Treatment: Antibiotics
-Complication: Septic Shock, Chronic Kidney Disease, Hypertension
Patient education focus on UTI prevention
- Urinate frequently
- Drink adequate fluids to flush out bacteria
- Urinate after sex to flush out bacteria
- Vaginal douching or feminine hygiene rinses which can destroy norma flora
- Wear cotton underwear and avoiding tight-fitting clothing
Glomerulonephritis : Immune complex Disease that causes inflammation
- usually following a streptococcal infection
s/s-Edema (including face and eyes), Hypertension, weight gain, anorexia, Nausea (see pg
Treatment
Meds: Antihypertensives, Antibiotics
Dietary changes: Fluid restriction, Sodium restriction, Protein restriction
Nursing: Conserve energy, monitor I/Oโs, BP, Resp, Electrolytes
Nephrotic Syndrome: Immunological disorder that causes increase glomerular permeability
-s/s: Facial and periorbital edema, Massive Proteinuria
-Treatment
- Meds: Diuretics, Ace inhibitors, anticoagulants (see slides)
-Diet Change-Low Sodium, High Protein
-Dx: Labs, Biopsy
-Common cause of bilateral hydronephrosis
- Not a high risk for cancer
-Treatment : Meds, TURP
Procedures:
TURP: Surgical option for BPH
Post procedure expectations
-Indwelling 3 way catheter with continuous CBI ( Can be discharged with it)
- Pink-tinged urine for the first 24-48hrs is normal
-Urge to urinate dur bladder spasm is normal and will result unless pt has retention
Monitor: Bleeding, I/Oโs, Infection
Complication: Oliguria, Urinary retention, Suprapubic pain from blood clots causing obstructions
Assess for: Distended bladder, suprapubic pain, oliguria
Interventions: bladder scan and irrigation
Cystoscopy : Visualization of the bladder
-NPO after midnight, Monitor VS, patient placed in the Lithotomy position.
-Post procedure monitor: Urine output ( Pink urine expected), Monitor for pain and infection, encourage oral fluid
Renal biopsy
-Risk factor- bleeding
Monitor or bleeding, pt lays supine position for 4โ6 hours post-biopsy
Transplant
-Monitor to s/s of rejection: Fever, Hypertension, Pain, increase in BUN/Creatin
Peritoneal Dialysis โ Kidney replacement therapy
- Can be done at home continues or intermittent ( less effective than hemodialysis)
- Dialysate is instilled into the peritoneal cavity
- Dialysate has electrolyte and the glucose can cause hyperglycemia
-Use gravity to drain (more removed should equal or be more than amount inserted)
-Drainage bag should be lower than abdomen
- for drainage issues check for kicks and reposition
-Practice safe sex
-Get tested yearly
-No sex during outbreak or infection (even if on meds)
- Some can be transmitted even when no asymptomatic
-Partner must be tested
Genital Herpes: Blister/painful genital ulcers, fever, malaise (virus stays dormant)
Tx: Acyclovir
Gonorrhea: Yellow or green drainage (can be asymptomatic especially in women)
Similar to Chlamydia and Cause infection in the reproductive system. Risk for PID
Dx: Culture swab- rectal, urethral, cervical, or oropharyngeal
Tx: Ceftriaxone -single dose
Chlamydia: Yellow or green drainage, dysuria, pelvic pain, vaginal spotting/bleeding (can be asymptomatic especially in women), Risk for PID
Tx: Doxycycline, Levofloxacin, Azithromycin (single dose)
Syphilis: Primary is inoculation- chancre/point of entry
Secondary: Flu Like symptoms (Low garde fever, malaise headache, Sore throat), red rash or gray/white rashes on the hands, feet, Mucous membranes that are highly contagious.
can have neurologic or cardiovascular complications if untreated,
TX: Penicillin
Pelvic Inflammatory Disease
Cancer Screening (Prostate, Breast, Cervix)
Procedures:
Testicular Self-Exam
- monthly on the same day
- done during or after a warm bath or shower
- use both hands to examine each testis separately
- a slight difference in testicle size is normal
-**** report any hard masses, lumps, or areas of firmness
Breast Self-Exam
-Monthly a few days after your menses
- The same day every month for post-menopausal women
-Know your breast and report ANY changes to your provider
Pap smear/: To test for Cervical cancer (HPV also done)
Guidelines:
-None needed for women under age 21
- women ages 21-65- should have a Pap test every 3 years (HPV every 5 years) - : Women who have had a total hysterectomy non-cancer related - Women over age 65 may discontinue cervical cancer screening if they have had 3 consecutive negative Pap tests
Teaching:
-No vaginal medication, Abstain from sex, douching, and tampons 24hr prior
-Potential for bleeding after
