Lecture 7 Endocrine overview, children’s/play activities, Laminectomy Thyroid GlandMark Klimek Audio Lectures

Lecture 7 Endocrine overview, children’s/play activities, Laminectomy Thyroid GlandMark Klimek Audio Lectures Lecture 7 Endocrine overview, children’s/play activities, Laminectomy Thyroid Gland - Thyroid Gland: - The thy ...

Lecture 7 Endocrine overview, children’s/play activities, Laminectomy Thyroid GlandMark Klimek Audio Lectures Lecture 7 Endocrine overview, children’s/play activities, Laminectomy Thyroid Gland - Thyroid Gland: - The thyroid gland controls the body’s metabolism. - When you see thyroid, think metabolism - Hyperthyroidism = Hypermetabolism - Hypothyroidism = Hypometabolism Hyperthyroidism (Graves disease) - Hyperthyroidism: - Think high (“hyper”) metabolism. - Having a high metabolic rate causes all body systems to work at an increased rate. - Graves disease: - Another name for hyperthyroidism is Graves disease. - Think, “your going to run yourself into the grave” - Signs and symptoms of hyperthyroidism: - Weight loss (increased metabolic rate) - Increased heart rate and blood pressure - Hyperactive - Heat intolerance (already have increased temp, cant stand extra heat) - Cold tolerance (since they are run an increased temp, can tolerate cold) - Exophthalmos (bulging eyes) - Treatment of hyperthyroidism: - Radioactive Iodine treatment: - For the next 24 hours after Radioactive Iodine treatment the patient needs to be in a private room, by themselves. No visitation - After the 24-hour mark the patient’s urine is still radioactive. They should flush three times after urination. If their urine is spilled the HAZMAT team need clean the entire room. - PTU (Propylthiuracil) - PTU, think “Puts Thyroid Under” - Primarily used in cancer. All cancer drugs are immunosuppressant’s. - Thyroidectomy is the most common treatment of hyperthyroidism: - Removing part of the thyroid, called Partial/subtotal Thyroidectomy - Subtotal thyroidectomy patients may be on thyroid hormone replacement for a little while until the remaining thyroid resumes normal function. - Parathyroids are left in tact so there is no risk of calcium imbalances. - Risk for thyroid storm. - Priorities after subtotal thyroidectomy: - First 12 hours first priority is the patient’s airway and hemorrhaging - 12-48 hours after the second biggest risk is thyroid storm - 48 hours after they are at risk of infection. (first, after 72 hr) - Removing the complete thyroid, called Complete/total Thyroidectomy - Total thyroidectomy’s need life long hormone replacement therapy (thyroxin, synthroid) - Because the total thyroid is removed the parathyroids are also removed and the patient is at risk of calcium imbalances (lecture 6). - No risk of thyroid storm. - Priorities after total thyroidectomy: - Within 12 hours first priority is the patient’s airway and hemorrhaging - 12-48 hours after the second biggest risk is tetany from low calcium levels - 48 hours after they are at risk of infection (first, after 72 hr) - Thyroid storm: A life-threatening condition that is caused by a hyper-release of thyroid hormones, which causes 4 serious complications: - Extremely high temperatures: 40oC and above - Extremely high blood pressure: 210/180 (ballpark) - Extreme tachycardia: 180 (ballpark) - Psychotic delirium - This is a medical emergency. Patients are at risk of brain damage and death from frying their brain due to increased temp, and brain hypoxia. - Treatment of Thyroid storm: - Treatment of thyroid storm is aimed at getting the temperature down and getting the oxygen levels up. - Surround them with ice (second) - Getting them under a cooling blanket (third, and best) - Give oxygen by mask at 10 liters (first) - Two nurses monitoring patient continuously - This is a self-limiting condition. No medications are given. The goal of the treatment is to spare the patients brain until the thyroid hormones are out of the patients system. Hypothyroidism (Myxedema) - Hypothyroidism: - Think high (“hypo”) metabolism. - Having a low metabolic rate causes all body systems to work at an decreased rate. - Myxedema: - Another name for severe hypothyroidism is myxedema - Signs and symptoms of hypothyroidism: - Weight gain (Metabolize at a slower rate) - Hypoactive - Flat affect - Heat tolerance (Usually run cold so heat is tolerated well) - Cold intolerance (Usually run cold so can tolerate addition coldness) - Low heart rate and blood pressure - Treatment of myxedema: - Thyroid hormone replacement therapy (thyroxin, synthroid) - Do not sedate these patients. They already have low metabolism and bodily functioning. Sedating them may cause them to enter a coma, called a myxedemic coma. - Patients with myxedema need to have their thyroid hormone replacement medication before any surgery, regardless of NPO orders. The Adrenal Cortex - Adrenal Cortex: - Disorders of the adrenal cortex begin with either the letter “A” or “C”. - Addison’s disease - Cushing’s disease - Conn’s disease - Cortical insufficiency - Adrenal insufficiency