PN Exam-Unit 4

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PN Exam-Unit 4 by Mind Map: PN Exam-Unit 4

1. Adrenal Disorders

1.1. Addison's disease

1.1.1. glucocorticoids

1.1.2. Definition Primary-ACTH to stimulate cortex into producing Autoimmune Adrenalectomy small, misshapen, atrophied glands Secondary-decreased ACTH does not encourage adrenals to produce enough Pituitary or hypothalmus problem (low ACTH) ABRUPT STEROID DISCONTINUATION!!!

1.1.3. Signs/Symptoms Decreased aldosterone hypotension Na and H2O loss K+retention Bronze skin N/V/D Decreased Cortisol Hypoglycemia weakness, fatigue weight loss confusion, psychosis

1.1.4. Diagnostic Tests Serum and urine cortisol levels decreased Blood sugar-decreased Electrolytes-Na-low, K+high BUN/HCT-elevated due to dehydration ACTH stimulation test-see if adrenals can be "tricked" into functioning

1.1.5. Treatment Glucocorticoids-hydrocortisone mineralocorticoids-fludrocortisone 2/3 in am;1/3 pm mimic natural secretion lifelong replacement need double or triple dose in times of strees HIGH Na- diet (only disorder that requires increase in salt)

1.1.6. Complications Adrenal Crisis-in times of extreme stress Profound dehydration, hypotension, hypoglycemia

1.1.7. Nursing Care monitor daily wt., I & O, glucose, electrolytes

1.2. Cushing's disease

1.2.1. Definition increased adrenal cortex hormones without regart to time of day or stress too much of the 3 S's cushings syndrome is a group of disease like S/S that mimic the disease but are caused by excess cortisol/glucocorticoid therapy (Moon face caused by prednisone therapy) Cushing's disease is caused by too much ACTH in the pituitary

1.2.2. Signs/Symptpms Weight gein/truncal obesity thin arms and legs/muscle wasting purple striae-catabolic effect on tissue Buffalo hump moon face secondary DM osteoporosis fractures mental status changes-steroid psychosis increased risk of infection-immunosupressed-delayed wound healing Na-and H2O retention-increased aldosterone hypokalemia

1.2.3. Diagnostic tests appearance increased plasma and urine cortisol increased ACTH dexamethasone supression test Electrolytes-lowK, high na and glucose

1.2.4. Treatment Surgery-remove pituitary tumor ***Admin steroid hormone first to prevent adrenal crisis remove adrenal gland or radiate it if caused by steroid therapy-decrease dose or admin qod symptom control-lasix to decrease fluid retention**must give K+

1.2.5. Nursing Care Hi K+, Low Na- diet Monitor blood sugar

2. Thyroid Disorders

2.1. Hypothyroidism/Graves disease

2.1.1. Definition too much thyroid hormone increased metabolic rate increased beta receptors Primary hypothyroid-too much TH Secondary-too much TSH

2.1.2. Causes autoimmune goiter infection stress pituitary tumor-secondary synthroid overdose

2.1.3. Diagnostic Tests

2.1.4. Signs/Symptoms heat intolerance hypermetabolic state incr. appetite w/ wt loss frequent stools nervousness tachycardia HF warm smooth skin exopthalmus lub. eye drops acceptance of appearance corticosteroids orbital decompression surgery eye muscle surgery Prism glasses orbital radiotherapy

2.1.5. Complications thyrotoxic crisis hypothyroidism after thyroid removal or treatment

2.1.6. Treatment subtotal thyroidectomy antithyroid meds radioactive iodine PTU Lugal's (iodine preparation) Methimizole

2.1.7. Nursing Care hyperthermia diarrhea disturbed sleep pattern Anxiety Risk for injury imbalanced nutrition:less than body requirements

2.2. Hyperthyroidism

2.2.1. Definition

3. Diabetes Mellitis

3.1. Type 1

3.1.1. Insullin needed to carry sugar into cells and sugar remains in the blood stream

3.2. Type 2

3.2.1. Not insulin dependant

3.2.2. controlled by diet changes, exercise, and/or oral agent