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Med Surg Exam 3 Notes Primary Concepts of Adult Nursing (Nova Southeastern University) Hypothyroidism *Hyposecretion of thyroid hormone?slowed metabolic rate* • Thyroid deficiency can aff ect all body functions and can range from mild, subclinical forms to • Clinical manifestations o Extreme fatigue (makes it difficult for person to • Medical management o Objectives: restore a normal metabolic state by replacing the missing hormone, as well as prevention of disease progression and complications • Nursing management o Medications are administered to the patient with extreme caution because of the potential for altered metabolism and excretion, depressed metabolic rate and respiratory status Med Surg Exam 3 Hyperthyroidism *form of thyrotoxicosis resulting from excessive synthesis and secretion of thyroid hormone by the thyroid* • Clinical manifestations o Nervousness; emotionally hyper excitable, irritable, apprehensive, cannot sit quietly, o T4 • Medical management o Appropriate treatment depends on underlying cause • Nursing management o Nutritional status: appetite is increased but may be satisfied by several well balanced meals of small size. Avoid highly seasoned foods to reduce diarrhea. Weight and dietary intake are 2 Med Surg Exam 3 Thyroid Cancer/Thyroidectomy • Diagnostics • Medical management o Treatment of choice?surgical removal (thyroidectomy) ? Attempts are made to spare parathyroid tissue to reduce risk of post op hypocalcemia • Nursing management o Important pre-op goals: prepare patient for surgery and reduce anxiety ? Quiet and relaxing activities are encouraged o Post-op care ? Periodically assess surgical dressings ? Rest, relaxation, adequate nutrition and avoid putting strain on incision 3 Med Surg Exam 3 Pituitary Hypersecretion/Hyposecretion *anterior pituitary: FSH, LH, ACTH, TSH, GH* • Hypersecretion ACTH TSH • Hyposecretion o Can result from disease of pituitary gland itself or disease of hypothalamus o Result is extreme weight loss, emaciation, atrophy of all endocrine glands and organs, 4 Med Surg Exam 3 Hyperparathyroidism *caused by overproduction of parathormone by parathyroid glands and is characterized by bone decalcification and development of renal calculi containing calcium* • Diagnostics o Elevation of serum calcium levels and an elevated concentration of parathormone • Medical • Nursing • Complication: hypercalcemic crisis o Acute hypercalcemic crisis can occur with extreme elevation of serum calcium levels 5 Med Surg Exam 3 Hypoparathyroidism *caused by abnormal parathyroid development, destruction of glands, and vitamin D deficiency* • Most • Diagnostics o Positive Chvostek’s sign ? Sharp tapping over facial nerve causes spasm or twitching of mouth, nose & eye o Positive Trousseau’s sign ? XRAY shows increased bone density • Medical o Goal: increase serum calcium level to 9 or 10 mg/dL (2.2 to 2.5 mmol/L) and to eliminate ? egg yolk are restricted due to high phosphate • Nursing o Care of post op patient directed toward detecting early signs of hypocalcemia and anticipating signs of tetany, seizures, and respiratory difficulties 6 Med Surg Exam 3 Pheochromocytoma *tumor that is usually benign and originates from chromaffin cells of the adrenal medulla* • Clinical manifestations o Typical triad: headache, diaphoresis, and palpitations in patients with hypertension • Diagnostic o 5 Hs ? Hypertension, headache, hyperhidrosis (excessive sweating), hypermetabolism, and hyperglycemia • Medical o During an attack of hypertension, tachycardia, anxiety, and the other symptoms of pheochromocytoma, bed rest with head of the bed elevated is prescribed to promote an • Nursing 7 Med Surg Exam 3 Adrenal Insufficiency (Addison’s Disease) *occurs when adrenal cortex function is inadequate to meet the patient’s need for cortical hormones* • Autoimmune or idiopathic atrophy of the adrenal glands is responsible for the vast majority of cases • Clinical manifestations o Muscle weakness, anorexia, GI symptoms fatigue, o of ? untreated • Diagnostics o Confirmed by lab tests (hypoglycemia, hyponatremia, hyperkalemia, leukocytosis) • Medical o Immediate treatment is directed toward combating circulatory shock ? Restore blood circulation, administer fluids and corticosteroids, monitor vital signs, • Nursing o Assessing the patient ? Presence of symptoms of fluid imbalance and patient’s level of stress 8 Med Surg Exam 3 Cushing Syndrome *excessive adrenocortical activity* • Commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex • Clinical manifestations o Central type obesity (buffalo hump in the neck, a heavy trunk, relatively thin extremities) o Skin is thin, fragile, and easily traumatized (ecchymosis and striae develop) • Diagnostics o Serum cortisol, urinary cortisol, and low dose dexamethasone • Medical o Surgical removal of tumor is treatment of choice; radiation has Nursing 9 Med Surg Exam 3 Hepatitis • Systemic viral infection that causes necrosis and inflammation of liver cells • Hepatitis A: fecal oral transmitted o No jaundice, many asymptomatic, mild flu Hepatitis B: blood, saliva, semen, vaginal secretions o Major cause of cirrhosis and liver cancer Hepatitis C: blood, sexual contact o Not curable, no benefit from rest or diet o No vaccine Portal Hypertension • Increased pressure throughout portal venous system that results from obstruction of blood flow 10 Med Surg Exam 3 Ascites *increased abdominal girth and rapid weight gain, fluid in peritoneal cavity* • Failure of liver to metabolize aldosterone results in increased sodium and water retention by kidneys • Clinical manifestations • Diagnostics o • Medical o Dietary modifications ? Goal: negative sodium balance to reduce fluid retention ? Added salts, butters, canned foods, should be avoided • Signed consent, empty bladder, upright position, monitor for hypovolemia, report increase in temperature, check site for leakage • Nursing o Monitor I&O, abdominal girth, and daily weight 11 Med Surg Exam 3 Hepatic Cirrhosis *replacement of normal liver tissue with , coug 

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