Edocrine - Lecture

Hypercalcemia S/S

*Increased heart rate and blood pressure* *Bounding pulse* Bradycardia (late stage) *Shortened QT interval and widened T wave* Muscle weakness (hypotonicity) Diminished deep tendon reflexes *Nausea and vomiting* *Constipation* *Abdominal distention* Confusion, lethargy, and *coma* -GI problems (peptic ulcer), urinary calculi, bone fractures

cortisol levels

-10-20 mcg/dL -Addison's disease cortisol level of less than 3mcg/dL

adrenal hypofunction

-Addisons disease -impaired secretion of glucocorticoids (cortsol) and mineralocorticoids (aldosterone)

Antiadrenergic Drugs

-BLOCK receptors that stimulate sympathetic activity -treatment of thyroid storm

Hypocalcemia S/S

-Diarrhea, Numbness, Tingling of extremities and around mouth, Convulsions, Positive Chvostek sign, Positive Trousseau sign, *Pt at risk for tetany. -decreased Ca+ -treatment: monitor for tetany, educate about food high in calcium, implement seizure precautions -meds: Ca+ supplements

Smallpox (Variola)

-First signs are high fever and general weakness, soon followed by tell-tale pink-red spots (macules). -These become papules, then fluid-filled vesicles which develop into deep pustules. When pustules break open, they emit infectious pus, and leave scars or pocks -no treatment -is viral so we treat the symptoms

Pheochromacytoma (neuroendocrine tumor) S/S

-HTN, severe HA, palpitations, apprehension -treatment: do not palpate abdomen, teach do not smoke or ingest caffeine, monitro BP frequently, Adrenalectomy

NPH insulin

-Humulin N/Novolin N -Intermediate Acting Insulin -onset 4 hours -peak 8 hours -duration 12 hours

Aldosterone function

-Increases resorption of sodium from DCT, leading to increased water retention and incrased plasma volume -excrete potassium, reduce urine

secondary dysfunction

-Medications, trauma, hormone therapy -Temporary or permanent

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

-N/V, HA, change in LOC, JVD, crackles, hyponatremia -fluid rentention -treatment: fluid restrictions, I/O, seisure precautions, monitor, safe environment

Mineralocorticoids

-One of the major groups of steroid hormones produced by the adrenal cortex. It regulates water and electrolyte balance in extracellular fluid, mainly by regulatind sodium reabsorption by the kidney tubules. --Chiefly aldosterone.

Thionamides

-PTU, methimazole -used in the treatment of thyroid storm

Regular insulin

-Short acting insulin -Humulin R, Novolin R -Peaks in 2-4 hours -Pt teaching s/s: Monitor for hypoglycemia.

IV hydrocortisone

-What is the treatment for adrenal crisis? -Treatment of acute adrenal insufficiency

plague

-aerosolized plague organisms -abrupt onset of pneumonia with bloody sputum -disseminated intravascular coagulation (DIC), multiorgan failure, and death -Gentamicin (Garamycin) -Person to person, respiratory droplet precautions, and Standard Precautions

Methimozole (Tapazole)

-another med used to help with hyperthyroidism

Corticosteroids

-anti-inflammatory agents that treat skin inflammation -A group of hormones, including cortisol, released by the adrenal glands at times of stress -the steroid hormones produced by the adrenal cortex

What is the initial treatment for wounds from animal bites

-antibacterial soap and water for 15 to 20 minutes

Ciprofloxacin (Cipro)

-antibiotic -used for anthrax

diabetes insipidus

-antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect -decrased BP, increased heart rate, incrased thirst, poor skin turgor, decreased cognition (confusion), decreased urine specific gravity (dehydration)

A patient in a long-term care facility frequently becomes combative with the assistive personnel. What are some strategies that the nurse can teach the assistive personnel when approaching a combative patient

-calm and don't come in real quickly -establish eye contact -call them by their name -reorient the patient -talk to them and listen -express concern and redirect that patient to safety

Cushing's syndrome

-caused by prolonged exposure to high levels of cortisol, pituitary tumors, cortisol secreting tumor -s/s increased weight, moonface, buffalo hump, hirsutism, thin skin, increased Na+, increased blood glucose -treatment: monitor fluid overload, prevent skin breadown, i/o, daily weights, response to therapy, pituitary removal (vasopressin), plasma cortisol, leucocytosis -decrease steroid therapy

Predinosine

-class of medication called corticosteroids -works to treat patients with low levels of corticosteroids -teach s/s fo Cushing's

Hypothyroidism

-condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity -lethargic, decrased RR, increase weight, constipation, cold intolerance dyspnea, hyopventilation -treat the sign and symptoms

Addison treatment

-cortisol and/or aldosterone replacement

Glucorticoids

-hormones produced by the adrenal cortex that reduce edema and the release of histamines in the respiratory system by interrupting the inflammatory process -used in the treatment of a thyroid storm -controlling how your cells use sugar and fat -decreased glucocorticoid / hypoglycemia

primary dysfunction

-hyposecretion and hypersecreation -tumors and inflammation -infection, mechanical damage, or autoimmune response

Type I Diabetes Mellitus

-insulin dependent -caused by autoimmune destruction of the beta cells of the pancreas leading to little or no production of insulin -require regular injections of insulin to permit entry of glucose into cells -s/s polyuria, polyphagia, poydipsia -pH 6.8-7.3, decreased BP, decreased Na+ and K+ -confusion, fruity breath, Kussmauls (rapid, deep breathing at a consistenr pace) -treatment: monitor hydration, I/O, decreased glucose, monitor response to therapy, assess airway, teach sick days -meds: IVF (NS), IV insulin

What do you do in the event of chemical splash in an eye

-irrigate the eye with normal saline -from the inside to the outside

Thyroid storm

-is a medical emergency -increased temp, heart rate, blood pressure and resperations -HOT (hyperthermia)

Myedema coma

-is a medical emergency -s/s: decreased temp, mental status change, dyspnea, edema -treatment: ICU, ventilator support, IV administration fo thyroid hormone, correction of hypvolemia and electrolyte abnormalities

Addisonian crisis s/s

-life threatening emergency - sudden decrease in adrenal hormone -hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, confusion -treatment: IVF (NS or D5NS), monitor for dysrhythmias, monitor blood glucose hourly, electrolyte replacement

What do you do in the event of an injury with possible glass in an eye

-lightly cover both eyes with gauze

Lantus (insulin glargine)

-long-acting insulin with no peak used to provide basal insulin

Tolvaptan (Vasopressin Antagonist)

-medication for SIADH -3% normal saline

coritsone, prednisolone hydrocortisone, Fludrocortisone

-medication for addison's disease

Addison's disease

-occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone -Impaired secretion of glucocorticoids (cortisol) and mineralocorticoids (aldosterone) -decrease in lower and muscle glycogen=decrease available glucose=hypoglycemia -decrease in GFR and gastric acid production -can be caused by: autoimmune (80%), TB, adrenalectomy, abrupt withdraw of steroids -s/s: lethargic, muscle weakness, GI problems, hyperpigmentation -treatment: fluid balance, vital signs, weights, i/o, life long medication for the rest of their lives

What do you do in event of a suspected insect inside an ear

-oil in the ear then irrigate it

Iodine preparations

-short-term therapy before surgery -decrease blood flow through the thyroid gland, reducing the production and release of thyroid hormones -treatment for thyroid storm

Vesticular breathing sounds

-soft sounds of air filling alveoli -regular breath sounds

psychological responses to disaster

-stage I: impact stage -stage II: Recoil stage -stage III: Post-trauma stage

Cortisol

-stress hormone released by the adrenal cortex -increases blood glucose -increase protein metabolism -anti-inflammatory

Type II Diabetes (Hyperosmolar Hyperglycemic State, HHS)

-type of diabetes in which the body produces insulin but the insulin cannot be used by body cells -polyuria, polypagia, polydipsia, decreased Na+ and K+, decreased BP -pH >7.4 -glucose 600 or more, confusion (Dehydration) -Treatment: monitor hydration, decrease glucose, monitor response to therapy, I/O, teach sick days, airway -Meds: IVF (1/2 NS), IV insulin (blood glucose levels should decrease by 50-70mg/dL/hr)

When educating individuals regarding disaster preparedness, instructions should include a minimum of a 3 day supply of items such as:

-water -medications -non perishable foods -first aid kits -battery operated radio,

clinical signs of shock

-weak pulse, tachycardia, hypotension, pale mucous membranes, hypothermia, hyperventilation, and cool extremities

During a routine physical examination appointment, a patient tells you that he is going on a cross-county skiing trip with some friends. Discuss hypothermia suggestions the nurse should give the patient that would prevent hypothermia

-wear layers -move around -high protein foods/high carb foods -cover your head -get shelter

In the event of a disaster, perishable foods should not be held at temperatures greater than 40 degrees F for longer than: 1. 2 hours 2. 4 hours 3. 6 hours 4. 8 hours

1. 2 hours

When teaching individuals about preparing safe water for drinking after a disaster, the nurse knows that one way is by boiling water for: 1. 3 to 5 minutes 2. 10 to 12 minutes 3. 15 to 20 minutes 4. 20 to 25 minutes

1. 3 to 5 minutes

When responding to an accident, spinal injury would be most suspected in which of the following accidents? 1. Sledding 2. Swimming 3. Jogging 4. Golfing

1. Sledding

The patient's wife indirectly suggests that her husband has a substance abuse 1. What substances (alcohol, tobacco, or illicit substances) are you currently using 2. How often do you drink or use illicit substances 3. When did yo last drink or use drugs of any kind 4. How do you feel about people who use abuse substances 5. Why does your wife think you have a substance abuse problem 6. Is there a family history of alcoholism or substance abuse

1. What substances (alcohol, tobacco, or illicit substances) are you currently using 2. How often do you drink or use illicit substances 3. When did yo last drink or use drugs of any kind 6. Is there a family history of alcoholism or substance abuse

The nurse is discussing the implementation of emergency nursing measures with a nursing student. Which initial action does the nurse tell the student to perform in the event of carbon monoxide poisoning? 1. get the client to fresh air 2. wrap he client in blankets 3. keep the client as quiet as possible 4. Initiate cardiopulmonary resuscitation

1. get the client to fresh air

An incidence is considered a disaster when the number of casualties exceeds: 1. the resource capabilities of the area 2. the number of injuries 3. the number of deaths 4. the number of emergency responders

1. the resource capabilities of the area

To control bleeding in an emergency situation, direct pressure should be applied to a wound for: 1. 1 to 2 minutes 2. 5 to 10 minutes 3. 15 to 20 minutes 4. 25 to 30 minutes

2. 5 to 10 minutes

People living in hurricane-prone areas should prepare a disaster kit an keep it refreshed every: 1. 3 months 2. 6 months 3. 12 months 4. 18 months

2. 6 months

The nurse is educating a new nurse about mass casualty events (disasters). Which statement by the new nurse indicates a need for further teaching? Select all that apply 1. An event is termed a mass casualty when it overwhelms local medical capabilities 2. Mass casualty events do not require an increase in the number of staff that are needed 3. A mass casualty event occurs only within the health care facility and could endanger staff 4. A mass casualty event occurs if a fight between visitors occurs in the emergency department 5. Mass casualty events may require the collaboration of many local agencies to handle the situation

2. Mass casualty events do not require an increase in the number of staff that are needed 3. A mass casualty event occurs only within the health care facility and could endanger staff 4. A mass casualty event occurs if a fight between visitors occurs in the emergency department

A client who has been admitted to the hospital has developed delirium tremens (DDT's). Which of the following actions should the nurse take? 1. Assess the client's nutritional status 2. Provide padding to the side rails of the bed 3. Perform range-of-motion activities 4. institute universal precautions

2. Provide padding to the side rails of the bed

A client has sustained a laceration that will not stop bleeding. Direct pressure and elevation have been carried out by the nurse. Which of the following actions should the nurse perform next 1. Continue to provide direct pressure 2. Provide pressure to the supply artery 3. Place ice packs to the laceration 4. Apply warm, moist compresses to the area

2. Provide pressure to the supply artery

After several days of hunting in the cold, a hunter is brought to the emergency department with feet that are pale and slightly cyanotic. he client reports stiffness and loss of sensation in both feet. The nurse anticipates the need for which nursing action? 1. Vigorous rubbing of the feet 2. Slowly rewarming the feet in cool water that is progressively warmed 3. Immersing the feet in a whirlpool with possible debridement of the cyanotic tissue 4. Rapid rewarming of the feet in hot water for 10 minutes

2. Slowly rewarming the feet in cool water that is progressively warmed

The emergency department nurse receives a telephone call and is informed that a tornado has hit a local residential area and numerous casualties have occurred. The victims will be brought to the emergency department. Which should be the initial nursing action 1. prepare the triage rooms 2. activate the agency emergency response plan 3. obtain additional supplies from the central supply department 4. obtain additional nursing staff to assist with treating the casualties

2. activate the agency emergency response plan

Following surgery, the nurse notes that the patient may be exhibiting signs and symptoms of shock if assessment reveals: 1. diaphoresis, decrease pulse and respirations, decreased blood pressure 2. diaphoresis, increased pulse and respirations, decreased blood pressure 3. cyanosis, restlessness and anxiety increased urine output 4. cyanosis, decreased respiratory rate, cold and clammy skin

2. diaphoresis, increased pulse and respirations, decreased blood pressure

Signs and symptoms a patient would exhibit if he or she contracted smallpox in a biologic disaster include: 1. symmetrical descending flaccid paralysis 2. fever, rash with deep-seated vesicles or pustules, a flu-like symptoms 3. abrupt onset of pneumonia with bloody sputum 4. flu-like symptoms rapidly progressing to respiratory failure, shock, and possibly death

2. fever, rash with deep-seated vesicles or pustules, a flu-like symptoms

A nurse assisting during a disaster knows that "care of special populations" refers to additional support and assistance needed for certain population groups, which includes infants, elderly, disabled, and: 1. victims who have a history of cardiac problems 2. victims who are immunocompromised 3. victims who are in stage III psychological response 4. victims who are triage class IV

2. victims who are immunocompromised

When a chemical disaster occurs in a neighborhood, which of the following instructions should be given to individuals if evacuation is not necessary? 1. open all windows and doors to the dwelling to allow for air flow 2. turn on all fans and heating or air conditioning systems 3. Wet towels and jam them in any cracks under doors 4. Open fireplace dampers

3. Wet towels and jam them in any cracks under doors

According to triage guidelines, which patient would the nurse classify as a class II victim after a disaster? 1. a victim suffering from injuries that allow for very little chance of survival 2. a victim who has an immediate threat to his or her life, such as a compromised airway 3. a victim with a major injury that would require treatment with 2 hours 4. a victim with minor injuries that would requires treatment within 24 hours

3. a victim with a major injury that would require treatment with 2 hours

A client who sustained a inhalation injury arrives in the emergency department. The nurse notes that the client is very confused and combative. The nurse determines that the client is experiencing which of the following? 1. fear 2. pain 3. hypoxia 4. anxiety

3. hypoxia

The incubation period before clinical manifestations occur after exposure to inhalation anthrax is 1. 3 to 6 months 2. 5 to 17 days 3. 12 to 72 hours 4. 1 day to 6 weeks

4. 1 day to 6 weeks

Which of the following would be a preferred method of cooling a person who has suffered a heatstroke? 1. administration of chlorpromazine (Thorazine) to control seizures and shivering 2. Ice water enemas 3. Ice water Lavage 4. Application of ice packs to the groin and axillae

4. Application of ice packs to the groin and axillae

The nurse responds to an external disaster (a mass casualty event) that occurred in a large city when a building collapsed. There are numerous victims that require treatment. Which victim should the nurse attend to first 1. an alert victim who has numerous bruises on the arms and legs 2. a victim who received a head injury and is crying hysterically 3. a victim who sustained multiple serious injuries and is deceased 4. a victim with a partial amputation of a leg who is bleeding profusely

4. a victim with a partial amputation of a leg who is bleeding profusely

A disaster victim in stage 1 psychological will most likely exhibit: 1. compliance with directions and willingness to help other 2. elation and gratefulness for still being alive 3. guilt for no suffering as much as friends and neighbors 4. difficulty following directions for several hours after the event

4. difficulty following directions for several hours after the event

A client presents to the urgent care center with a chemical burn to the right eye. Which of the following actions should the nurse prepare to take 1. application of cold compress to the right eye 2. application of warm compress to the right eye 3. minimizing movement of the right eye with a light bandage 4. flushing the right eye with copious amounts of sterile solution

4. flushing the right eye with copious amounts of sterile solution

Glucocorticoids (cortisol)

Adrenal cortex stimulates gluconeogenesis anti-inflammatory immunosuppression

Lasix (furosemide)

Classification: Loop Diuretic Therapeutic Effects: Diuresis. Lowering of blood pressure Adverse Reactions & side effects: Dehydration, hypochloremia, hypokalemia, hypomagnesaemia, hyponatremia, hypovolemia, metabolic alkalosis Nursing Implications & teaching: Monitor for thirst, dry mouth, lethargy, weakness, hypotension, oliguria and notify physician. Monitor K+, Ca++, Mg. Can increase BUN, glucose and creatinine, TAKE WITH FOOD -medication for hypercalcemia

Synthroid (levothyroxine)

Classification: Thyroid preparation Therapeutic Effects: Restoration of hormonal balance, suppression of cancer Adverse Reactions & side effects: Insomnia, arrhythmias, tachycardia, wt. loss. Avoid use in thyrotoxicity Nursing Implications & teaching: Assess apical pulse and BP prior to admin & during therapy, & for chest pain, tachyarrhythmia. Give prior to breakfast. Monitor T3 and TSH. Important drug interactions -medication for hypothyroidsim -take at the same time every day without food

Compensatory stage of shock

Confusion Decreased urinary output BP systolic < 100

Triage Guidelines

Not needing Emergency care; Greatest chance of survival with medical care; Medical intervention will aid survival; Survival would not increase with medical intervention;

DDAVP (desmopressin)

Prevents or controls thirst and frequent urination caused by diabetes insipidus and certain brain injuries. Works on posterior pituitary....Treatment for: diabetes insipidus, bedwetting(nocturia), brain injuries, hemophilia A w/ some factor VIII production nasally, IV, oral/subling tab up to 20 hours

Contact precautions have what 5 things?

Private room - door can be open Gloves Gown- if giving direct care Handwashing Disposable supplies Dedicated equipment

Lispro, Aspart, Glulisine

Rapid-acting insulin (bolus) onset: 10-30min peak: 30min - 3h duration: 3-5h Client should eat within 5-15 minutes after injection

Hypercalcemia causes

S.H.A.M.P.O.O. D.I.R.T. S - Sarcoidosis H - Hyperparathypoidism, Hyperthyroidism A - Alkali-milk syndrome M - Metastases, myeloma P - Paget disease O - Osteogenesis imperfecta O - Osteoporosis D - Vitamin intoxication I - Immobility R - RTA T - Thiazides

Epinephrine (adrenaline)

Secreted by the adrenal medulla; increases heart rate and blood pressure and dilates airways (sympathomimetic). It is part of the body's "fight or flight" reaction.

ACTH (adrenocorticotropic hormone)

Stimulates adrenal cortex to release glucocorticoids (cortisol)

Smallpox

a disease that causes a high fever and often death

Antidote for Acetaminophen

acetylcysteine

bronchiol breath sounds

loud and high pitched with a hollow quality that are created by air moving through the trachea close to the chest wall

adrenal cortex

outer section of each adrenal gland; secretes cortisol, aldosterone, and sex hormones

Hyperthyroidsim (*Grave's disease)

s/s: exophtalmos, increased RR, weight loss, loose stools, heat intolerance, chest pain, palpitations treatment: treat the s/s, falls precautions, radiation, surgery (subtotal or total)

Gluconeogenesis

the making of glucose from a noncarbohydrate source such as amino acids or glycerol

PTU (propylthiouracil)

thyroid hormone antagonist. Given to those with hyperthyroidism. Potassium iodide may decrease effectiveness. Effective when TSH is within normal range. Warn pt. to avoid foods with iodine and cough medicines with iodine.