MED SURG II HESI (Elsevier) COMPLETE SOLUTION ( A+ GRADED 100% VERIFIED

1. Respiratory System 2. Renal System 3. Cardiovascular System 4. Gastrointestinal System (intestinal obstruction) 5. Endocrine System 6. Musculoskeletal System 7. Neurosensory System 8. Neurologic System 9. Hem ...

1. Respiratory System 2. Renal System 3. Cardiovascular System 4. Gastrointestinal System (intestinal obstruction) 5. Endocrine System 6. Musculoskeletal System 7. Neurosensory System 8. Neurologic System 9. Hematology and Oncology 10. Reproductive System 11. Burns Downloaded by GEOFREY NGUGI ([email protected]) lOMoARcPSD|14331017 Endocrine System Hyperthyroidism (Graves’ Disease, Goiter) [Description]  Excessive activity of thyroid gland  Elevated T3 & T4  Increased rate of body metabolism  Autoimmune process  Etiologies: o Primary disease state o Use of replacement hormone therapy o Excessive TSH production  Diagnostic: o Low TSH o High T3/T4 o Thyroid scan – goiter  Treatment: o Medication:  Propylthiouracil (PTU)  Methimazole (Tapazole) o Thyroid ablation by medication o Radioactive iodine therapy o Thyroidectomy o Adenectomy – portion of the anterior pituitary where TSH is made is taken out o NOTE: all treatments cause hypothyroid = lifelong hormone replacement [Assessment]  Enlarged thyroid gland (goiter)  Acceleration of body processes: o Weight loss o Increased appetite o Diarrhea o Heat intolerance o Tachycardia, palpitations, high HP o Diaphoretic, wet, moist skin o Nervousness, insomnia  Exophthalmos [Intervention]  Observe for Thyroid Storm  Teach: o After treatment, hormone replacement necessary o Diet: high calorie, high protein, low caffeine, low fiber diet Downloaded by GEOFREY NGUGI ([email protected]) lOMoARcPSD|14331017 o Perform eye care for exophthalmos  Artificial tears to maintain moisture  Sunglasses when bright light  Annual eye exams  Thyroidectomy o Check frequently for bleeding, irregular breathing, neck swelling o Support neck when moving client o Check for laryngeal edema (hoarsness) o Monitor Trousseau and Chvostek sign – removal of parathyroids [HESI Hint]  Thyroid Storm o Uncontrolled hyperthyroidism 2/2 Grave’s disease o Life threatening o S/S: tachycardia, HTN, agitation, anxiety, fever o Priority = MAINTAIN AIRWAY  PTU and Tapazole are treatment for thyroid storm  Propranolol can be given to decrease sympathetic stimulation (BB)  After thyroidectomy – possibility of laryngeal edema o Tracheostomy, O2, suction at bedside o Calcium gluconate – if parathyroid gland accidently removed  Normal serum calcium: o 8.5-10.5 o Watch for decrease in calcium level – compare to pre-op value  IF two or more parathyroid glands have been removed, chance of tetany increases o Monitor serum calcium levels o Check for tingling in toes/fingers/around mouth o Chvostek sign  Twitching of lip after tap over facial nerve o Trousseau sign  Carpopedal spasm after BP cuff is inflated above systolic pressure and held for 3 min Hypothyroidism (Hashimoto Disease, Myxedema) [Description]  Hypofunction of the thyroid gland  Low T3/T4  High TSH  Treatment = thyroid hormone replacement (Levothyroxine) [HESI Hint] Downloaded by GEOFREY NGUGI ([email protected]) lOMoARcPSD|14331017  Myxedema coma o Decreased metabolism 2/2 lack of T3/T4 – causes heart muscles to become weak and the chamber size to increase -> low CO -> bradycardia -> shock state o Precipitated by:  Illness, abrupt withdrawal of thyroid medication, anesthesia, use of sedatives, or hypoventilation o Airway patent & ventilator support as needed [Assessment]  Fatigue  Thin, dry hair, dry skin  Thick, brittle nails  Constipation  Bradycardia  Hypotension  Goiter  Periorbital edema, facial puffiness  Cold intolerance  Weight gain  Slow speech  Husky voice [Interventions]  Teach: o Medication regimen o Take meds in morning before meals & no taking with other meds o Avoid food/products containing iodine o s/s of myxedema coma:  hypotension  Bradycardia  Hypoventilation  Hypothermia  Hyponatremia  Hypoglycemia  Lactic acidosis  Respiratory failure  Develop bowel elimination plan – prevent constipation  3L/day of fluid intake  High fiber diet – fruits, veggies  Increased activity  Little/no use of enemas and laxatives  NO SEDATION – can lead to respiratory difficulties