NCLEX: Mark Klimek - Lecture 7 (Thyroids, Adrenals, Kid Toys, & Laminectomy)
All adrenal cortex diseases start with...
"A" or "C"
What is Cushing's Syndrome?
"If you've got a cushy, you've got more tushy." - Oversecretion of adrenal cortex (steroids)
What is/are the treatment(s) for Addison's Disease?
"In Addison, you ADD-a-SONE." - Give steroids - Glucocorticoid drugs that end in - SONE
Whenever you see the word "thyroid," change it to...
"metabolism."
What are the rules of mobilization for patients after a laminectomy or spinal surgery?
- Do NOT dangle patients - If needed, do it less than 10-15 mins. - Do NOT allow patients to sit for more than 30 minutes
What are the treatments of a SUBthyroidectomy?
- Do not need lifelong hormone replacement - May need to supplement at first - AT RISK for thyroid storm
What are the 3 treatments for hyperthyroidism?
- Nuke it (Radioactive iodine) - PTU (Propylthiouracil) or "Put thyroid under" - Thyroidectomy (surgical removal)
What are the s/s of hypocalcemia?
- Paresthesia - Tetany - Twitching - Spasm - Clonus - Seizure - Jitteriness, - Tremor (all UP!) - Chvostek - Trousseau signs
What is a laminectomy with fusion?
- Taking a bone graft from the (1) iliac crest and/or (2) spine - Bone from the hip is taken and put in place so there's no bone-to-bone friction
What are the s/s of thyroid storm?
- Temperature of >105 - High BP - Severe tachycardia 180-200+ - Psychotically delirious
What are post-op risks of thyroidectomy in the first 12 hours?
-Airway due to edema - Hemorrhage: vascular gland
What are the three things to consider when selecting toys and play activities for children?
1. Is it safe? 2. Is it age appropriate? 3. Is it feasible (Doable)?
What are the discharge teachings for a laminectomy?
4 temporary restrictions (6 weeks): - Do NOT sit for >30 min - Lie flat, log roll for 6 weeks - Don't drive for 6 weeks - Don't lift more than 5lbs for 6 weeks, like a gallon of milk 3 permanent restrictions: - Do not lift by bending at waist (use knees) - Cervical laminectomy should never be allowed to lift anything over the head - NO horseback riding, off-trail biking, jerky amusement rides, etc.
What age are small toys okay for children?
<4 NO small toys. >4 Small toys okay.
What is a fomite?
A non-living object that harbors microorganisms, such as stuffed animals
A pt comes in with an acute exacerbation of COPD. The pt is being treated with Solu-Medrol (methylprednilosone) IV push q8 hours to reduce the inflammation in the airway. What nursing action needs to be taken while the pt is on the medication?
Accu-checks q6h Patients on a steroid is like diabetes even though they aren't diabetic. So complications are even WORSE if the patient is actually diabetic.
What is/are the treatment(s) for Cushing's Syndrome?
Adrenalectomy
What are the s/s of Cushing's Syndrome?
All side effects of steroid medications DRAW THE MOON MAN!! - Moon face - Has a beard (Hirsutism) - Truncal or central obesity - Weak arms/legs (Muscle atrophy) - Gynecomastia - Buffalo hump - Retaining Na+ and H2O - Losing K+ out the back - Stretch marks - HIGH SERUM GLUCOSE!! Do accu-checks q6h. - "I'm mad I have an infection" Roid rage - Immunosuppressed
What is the location and most important pre-op assessment for lumbar laminectomy?
BLADDER AND LEGS Assess for urinary retention or last time patient voided or emptied Evaluate leg functions
What are the best toys for ages 7-11 years?
CONCRETE The 3 "Cs:" Creative: Blank paper to draw, Legos, Transformers Collective: Baseball cards, Barbies, Beanie babies Competitive: Winner/losers
What are the 3 different locations where laminectomy is performed?
Cervical Thoracic Lumbar
A patient with hypothyroidism will be undergoing surgery the next morning. The physician ordered the pt NPO at 12:00 am. Pt is on Synthroid and multivitamin pills. What should the nurse question?
Clarify the NPO order for Synthroid. The patient needs the med to get through surgery. Otherwise, the condition may potentiate the suppressing effects of the anesthesia during surgery.
What is the location and most important pre-op assessment for cervical laminectomy?
DIAPHRAGM and ARMS Assess breathing Check function of arms/legs
What are the best toys for ages 3-6 years?
FINE MOTOR SKILLS Finger dexterity: Draw, write, colored pencils, scissors Work on balace: Dance, ice skate, tricycles, tumbling Cooperative Play HIGHLY imaginative
What are the 2 steps to lowering body temperature in a thyroid storm?
FIRST: Ice packs BEST: Cooling blanket
What does anterior thoracic mean?
Front though the chest to the spine
What are the best toys for ages 1-3 years?
GROSS MOTOR SKILLS Push/pull toys Paint Parallel Play
What is the location and most important pre-op assessment for thoracic laminectomy?
GUT AND ABDOMINAL MUSCLES Assess cough and bowels
What toys are good to prevent fomites?
Hard plastic toys -- they can easily be disinfected
What are the s/s of hyperthyroidism?
Hypermetabolism: - Weight loss - Increased HR - Increased BP - Hyper-personality - Heat intolerance - Exophthalmos - Seen in Graves' Disease - "Run yourself in the Graves Disease."
What is Addison's Disease?
Hypoadrenalism (Adrenal insufficiency) - Under secretion of steroids (They're a time bomb) - Hyperpigmented (Very tan) - They do NOT adapt to stress
What are the s/s of hypothyroidism?
Hypometabolism: - Obesity - Low HR - Low BP - Flat, boring, dull - Cold intolerant - Academically challenged
What are post-op risks of thyroidectomy after 72 hours?
Infection
What is the #1 nursing intervention for post-op laminectomy?
LOG ROLL!!
What is the treatment for hypothyroidism?
Levothyroxine (Synthroid) Take alone on an empty stomach with water... in the morning 30min-1hr before breakfast
What is a myxedema coma?
MEDICAL EMERGENCY! Severe hypothermia leading to decreased mental status, hypothermia, and other symptoms that slow function in multiple organs
If oxygen is in use, what toys should children avoid?
NO metal or dye-cast
What are the best toys for ages 6-9 months?
OBJECT PERMANENCE Best toy is to teach them cover/uncover: Jack-in-the-box Peek-a-boo Something large and firm
What are the best toys for ages 12-18 years?
PEER GROUP ASSOCIATION Hangout with kids unless recent post-op <12 hrs, immunosuppressed, contagious
What is the post-op assessment for thoracic laminectomy?
Pneumonia and paralytic ileus
Why would you perform a laminectomy?
Relieves nerve root compression
What happens with a bilateral adrenalectomy?
Removal of both adrenal glands means the patient now has Addison's Disease, so we have to give ADD-a-SONE to treat it. Patient will start to look like Cushman with steroids. It will take like a year or so to look back to normal.
What are the best toys for ages 0-6 months?
SENSORIMOTOR Best toy is a musical mobile (1st) or something large and soft (2nd)
What is myxedema?
Severe hypothyroidism presented with skin involvement
What is a laminectomy?
Surgical removal of one or more vertebrae from the spine.
Which type of thyroidectomy requires lifelong hormone replacement?
TOTAL thyroidectomy
Which thyroidectomy is the patient at risk for hypocalcemia? Why?
TOTAL thyroidectomy due to difficulty to spare the thyroids
What are post-op risks of thyroidectomy in the next 12-48 hours?
TOTAL: Tetany due to low calcium SUB: Thyroid storm
What are the s/s of nerve root compression?
The 3 "Ps" Pain Paresthesia Paresis
What could happen if patients with Addison's Disease cannot adapt to stress?
They will go into shock and have a hypoglycemic episode called "Addisonian crisis"
What is the purpose of the stress response in an individual?
To maintain: - A normal blood pressure to perfuse the brain and other organs - An adequate level of glucose to feed the body
What post-op order would you question for a laminectomy?
Up in chair for 1 hour TID
You are caring for a pt with a lumbar oligodendrogliocytoma. What is the #1 problem? a. Airway b. Ileus c. Cardiac arrhythmia d. Urinary retention
Urinary retention
What is the post-op assessment for lumbar laminectomy?
Urinary retention and leg problems
What are the best toys for ages 9-12 months?
VOCALIZATION Best toys are speaking or verbal: Tickle Me Elmo, Woody Cowboy
What is the post-op assessment for cervical laminectomy?
Watch for pneumonia
