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

1.1.2.1. Primary-ACTH to stimulate cortex into producing

1.1.2.1.1. Autoimmune

1.1.2.1.2. Adrenalectomy

1.1.2.1.3. small, misshapen, atrophied glands

1.1.2.2. Secondary-decreased ACTH does not encourage adrenals to produce enough

1.1.2.2.1. Pituitary or hypothalmus problem (low ACTH)

1.1.2.2.2. ABRUPT STEROID DISCONTINUATION!!!

1.1.3. Signs/Symptoms

1.1.3.1. Decreased aldosterone

1.1.3.1.1. hypotension

1.1.3.1.2. Na and H2O loss

1.1.3.1.3. K+retention

1.1.3.1.4. Bronze skin

1.1.3.1.5. N/V/D

1.1.3.2. Decreased Cortisol

1.1.3.2.1. Hypoglycemia

1.1.3.2.2. weakness, fatigue

1.1.3.2.3. weight loss

1.1.3.2.4. confusion, psychosis

1.1.4. Diagnostic Tests

1.1.4.1. Serum and urine cortisol levels decreased

1.1.4.2. Blood sugar-decreased

1.1.4.3. Electrolytes-Na-low, K+high

1.1.4.4. BUN/HCT-elevated due to dehydration

1.1.4.5. ACTH stimulation test-see if adrenals can be "tricked" into functioning

1.1.5. Treatment

1.1.5.1. Glucocorticoids-hydrocortisone

1.1.5.2. mineralocorticoids-fludrocortisone

1.1.5.2.1. 2/3 in am;1/3 pm mimic natural secretion

1.1.5.2.2. lifelong replacement

1.1.5.2.3. need double or triple dose in times of strees

1.1.5.2.4. HIGH Na- diet (only disorder that requires increase in salt)

1.1.6. Complications

1.1.6.1. Adrenal Crisis-in times of extreme stress

1.1.6.1.1. Profound dehydration, hypotension, hypoglycemia

1.1.7. Nursing Care

1.1.7.1. monitor daily wt., I & O, glucose, electrolytes

1.2. Cushing's disease

1.2.1. Definition

1.2.1.1. increased adrenal cortex hormones without regart to time of day or stress

1.2.1.1.1. too much of the 3 S's

1.2.1.2. 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)

1.2.1.3. Cushing's disease is caused by too much ACTH in the pituitary

1.2.2. Signs/Symptpms

1.2.2.1. Weight gein/truncal obesity

1.2.2.2. thin arms and legs/muscle wasting

1.2.2.3. purple striae-catabolic effect on tissue

1.2.2.4. Buffalo hump

1.2.2.5. moon face

1.2.2.6. secondary DM

1.2.2.7. osteoporosis

1.2.2.8. fractures

1.2.2.9. mental status changes-steroid psychosis

1.2.2.10. increased risk of infection-immunosupressed-delayed wound healing

1.2.2.11. Na-and H2O retention-increased aldosterone

1.2.2.12. hypokalemia

1.2.3. Diagnostic tests

1.2.3.1. appearance

1.2.3.2. increased plasma and urine cortisol

1.2.3.3. increased ACTH

1.2.3.4. dexamethasone supression test

1.2.3.5. Electrolytes-lowK, high na and glucose

1.2.4. Treatment

1.2.4.1. Surgery-remove pituitary tumor ***Admin steroid hormone first to prevent adrenal crisis

1.2.4.2. remove adrenal gland or radiate it

1.2.4.3. if caused by steroid therapy-decrease dose or admin qod

1.2.4.4. symptom control-lasix to decrease fluid retention**must give K+

1.2.5. Nursing Care

1.2.5.1. Hi K+, Low Na- diet

1.2.5.2. Monitor blood sugar

2. Thyroid Disorders

2.1. Hypothyroidism/Graves disease

2.1.1. Definition

2.1.1.1. too much thyroid hormone

2.1.1.2. increased metabolic rate

2.1.1.3. increased beta receptors

2.1.1.4. Primary hypothyroid-too much TH

2.1.1.5. Secondary-too much TSH

2.1.2. Causes

2.1.2.1. autoimmune

2.1.2.2. goiter

2.1.2.2.1. infection

2.1.2.2.2. stress

2.1.2.3. pituitary tumor-secondary

2.1.2.4. synthroid overdose

2.1.3. Diagnostic Tests

2.1.4. Signs/Symptoms

2.1.4.1. heat intolerance

2.1.4.2. hypermetabolic state

2.1.4.3. incr. appetite w/ wt loss

2.1.4.4. frequent stools

2.1.4.5. nervousness

2.1.4.6. tachycardia

2.1.4.7. HF

2.1.4.8. warm smooth skin

2.1.4.9. exopthalmus

2.1.4.9.1. lub. eye drops

2.1.4.9.2. acceptance of appearance

2.1.4.9.3. corticosteroids

2.1.4.9.4. orbital decompression surgery

2.1.4.9.5. eye muscle surgery

2.1.4.9.6. Prism glasses

2.1.4.9.7. orbital radiotherapy

2.1.5. Complications

2.1.5.1. thyrotoxic crisis

2.1.5.2. hypothyroidism after thyroid removal or treatment

2.1.6. Treatment

2.1.6.1. subtotal thyroidectomy

2.1.6.2. antithyroid meds

2.1.6.2.1. radioactive iodine

2.1.6.2.2. PTU

2.1.6.2.3. Lugal's (iodine preparation)

2.1.6.2.4. Methimizole

2.1.7. Nursing Care

2.1.7.1. hyperthermia

2.1.7.2. diarrhea

2.1.7.3. disturbed sleep pattern

2.1.7.4. Anxiety

2.1.7.5. Risk for injury

2.1.7.6. 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