20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
MEDICAL SURGICAL NURSING 1
Man → TOTALITY
• Suprasystem
o Individual, family, community, society ADRENAL CORTEX
• Subsystem Glucocorticoids/Steroids
• Gluconeogenesis (formation of new glucose from fats and
Stress Response/SMR (Sympatho-medullary Response/ SAMR proteins) → increased CHON catabolism (breakdown) → (-)
(Sympatho-adreno-medullary response)/GAS (General Adaptation nitrogen balance (catabolism>anabolism)
Response) o Positive nitrogen balance (more protein
✓ Diaphoresis anabolism)
✓ Increased B Mineralocorticoid/Aldosterone
✓ Increased PR • Fluid and sodium retention
✓ Increased rate/depth resp. o Oliguria <400 ml /24 hrs.
✓ Pallor o Anuria <100 ml /24 hrs.
✓ Cold clammy • Potassium excretion
✓ Weight loss
✓ Weakness NEUROHYPOPHYSEAL (Hypophysis Cerebri/Sella Turcica)
✓ Anorexia Anterior (Adenohypophysis)
✓ Diarrhea • TSH
✓ Constipation • ACTH
✓ Urinary frequency • FSH
✓ Oiguria • LH
✓ Anuria • MSH (Melanocyte-Stimulating Hormone)
✓ Transient hyperglycemia • SH (Somatotrophic Hormone)
✓ Increased in visual acuity
• GH
Posterior (Neurohypophysis)
• Hypothalamus
• ADH
o Sympatho-adrenal medullary
• Oxytocin
o Adreno-cortical
o Neurohypophyseal
ENDOCRINE
Hypoactivity
Adrenal glands
• Congenital absence of glands
• On top of kidneys
• Surgical removal of gland
• Adrenal medulla
o Inner portion • Idiopathic atrophy of glands
o Secretes catecholamines: Hyperactivity
EPINEPHRINE/ADRENALINE • Tumor within or outside the gland
▪ Vasodilator (coronary artery, cerebral • Failure of kidneys to secrete hormones
artery, peripheral blood vessels) • Failure of liver to deactivate of hormones
▪ Vasoconstrictor (peripheral arterioles)
▪ Glycogenolysis (breakdown of DECREASED APG ACTIVITY
glycogen in liver) Pituitary dwarfism
NOREPINEPHRINE/NORADRENALINE • Dwarf (doubled size of infant)
▪ Vasoconstrictor Frohlicks Syndrome
• Dwarf, obese, mentally retarded, genital atrophy
ADRENAL MEDULLA Simmonds disease/ Pituitary Cachexia
Epi/Norepi (Sympathetic/Adrenergic) • Wizened old man, mental lethargy, teeth start to fall,
• Dilated coronary arteries → increased myocardial amenorrhea, absence of spermatogenesis
perfusion → increased myocardial contraction →
increased PR INCREASED APG ACTIVITY
• Dilated peripheral blood vessels Gigantism
• Relaxation of smooth muscular bronchioles • Before closure of epiphyseal line
→bronchodilation → increased rate/depth respiration • Rapid growth of long bones
• Constricted peripheral arterioles → increased o Prolongation/elongation of long bones
peripheral resistance → increased BP Acromegaly
• Constricted arteries of skin → decreased blood supply • After closure of epiphyseal line
→ pallor • Increased in bone thickness and hypertrophy of soft tissues
• Increased glycogenolysis → transient hyperglycemia o Enlargement of cartilages
• Sweat glands → stimulation ▪ Nose
• GIT → decreased gastric secretion → decreased ▪ Ears
gastric motility o Enlargement of larynx
• No urine ▪ Deepened voice
o Urinary bladder muscles →relaxes o Progmathism/protrusion of jaw
o Urinary sphincter → close ▪ Separation of teeth
• Pupils → dilation → increased visual acuity o Thickening of lips and oral mucous membrane
o Lengthening of chin
o Broad hands/spade-like fingers
o Enlargement of visceral organs
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
,20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
MEDICAL SURGICAL NURSING 2
o Calcium preparations (after meals)
▪ Calcium carbonate
▪ Calcium Lactate
• Management ▪ Calcium Chloride 10%
o Cobalt therapy ▪ Calcium gluconate
▪ Radiation
o Surgical removal o Given with vit. D (tachysterol)
▪ Hypophysectomy ▪ Dihydrotachysterol
o Inhibit production of growth hormone ▪ Hytakerol
(subcutaneously) ▪ Calciferol
o Somatostatin ▪ Calcifediol
▪ Sandostatin ▪ Calcidiol
▪ Octreotide/actreotide ADRENAL CORTEX
1. Glucocorticoid/steroid – gluconeogenesis
DIABETES INSIPIDUS • Fat → increased lipolysis → abnormal fat distribution
• Disorder in water metabolism → decreased ADH → prevent • CHON → increased CHON catabolism → tissue
renal tubules reabsorption of water → polyuria = 5-29 L/24 starvation & muscle wasting
hrs. → Polydipsia → diluted (decreased specific gravity = 2. Mineralocorticoid/aldosterone
1.010-1.025) → increased Na (135-145 mEq/L) 3. Androgen
✓ All electrolyte testing do not require NPO
Cushing’s
• ADH • Increased GMA
o Oily preparations (Deep IM) → lipodystrophy (rotate • Increased 3S
route of administration) o Sugar
▪ Pitressin Tannate ▪ Hyperglycemia
▪ Vasopressin – vasoconstrictor → HPN ▪ Moon facies
o Nasal sprays (clear nasal passages) ▪ Buffalo hump
▪ Desmopressin Acetate ▪ Truncal obesity
▪ Lypressin o Salt
• Anti-lipidemic ▪ Fluid retention → Increased BP
o Clofibrate/Atromid S/Clo 5 ▪ Hypernatremia
▪ Hypokalemia
SIADH o Sex
• Increased ADH ▪ Virilism
• Fluid retention ▪ Masculinization
o Increased IV volume (hypervolemia) ▪ Hirsutism
▪ Increased BP • Management
▪ Increased renal perfusion → o Cobalt therapy
enhance/increased GFR/ increased o Adrenalectomy
UO → no leg edema o Cortisol inhibitors
o Electrolyte dilution → Dilutional hyponatremia → ▪ Aminogluthetemide
fluid move into the cell ▪ Trilostane
▪ Cerebral edema → Increased ICP ▪ Metyrapone
▪ Cellular overhydration ▪ Metotane
• Management Addison’s
o Hypophysectomy • Decreased GMA
o Inhibit production of ADH • Decreased 3S
▪ Demeclocyline/Declomycin PO o Sugar
▪ Hypoglycemia
Parathormone ▪ Stimulate anterior pituitary gland →
• Promote reabsorption of Ca in the renal tubules and increased ACTH → MSH → tan
excretion of P, essential for blood coagulation, regulate complexion → bronze-skinned
cardiac rhythmicity o Salt
Hypoparathyroidism ▪ Decreased IV volume → hypotension
• Hypocalcemia = hyperphosphatemia ▪ Hyponatremia
o 4.5-5.5 mEq/L ▪ Hyperkalemia → myocardial irritability
o 8-11 mg/dL → altered electrical conduction →
o High calcium diet dysrhythmias → heart arrest
• Tetany o Sex
o (+) Chvostek – tap the Facial nerve (below the • Management
temporals) → muscle twitching of face o Steroids
o Trousseau – occlude blood flow of an extremity
for 1-2 minutes → carpopedal spasm Conns/Primary aldosteronism
• Management • Adenoma of adrenal cortex (benign)
o Can be given sea foods but not milk, dairy • Hyperactivity
products and egg (rich in phosphorus) so check Pheochromocytoma
levels of phosphorus if among the choices, all is • Adenoma of adrenal medulla (benign)
with calcium • Hyperactivity
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
,20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
MEDICAL SURGICAL NURSING 3
• 5H o Evaluate amount of radioactive iodine 131
o Hypertension accumulated by the thyroid gland and excreted
o Headache by the kidneys
o Hyperglycemia o No intake of iodine
o Hypermetabolism o Uptake = 15-40%
o Hyperhidrosis o Urine = 40-80%
• Management o PO RAI 131 cocktail (with brassy taste) → 24 hr.
o Cobalt therapy urine → 2-4 hr. scanner
o Surgical removal of adrenal medullary o E.g. 11am PO RAI 131 6 millicuries → 24 hr.
• Assessment urine → 1pm scanner
o VMA (Vanillylmandellic Acid) ▪ N: 0.9%-2.4 millicuries
▪ Level of catecholamine ▪ Low: 0.67
• Blood 0.2-0.9 mg% ▪ High: 3.6
• Urine 0.2-7 mg/24 hrs. o Directly proportional to uptake
o Inversely proportional to urine
Thyroid glands • Thyroid Scan
• Isthmus – connects the two lobes of the thyroid glands o Evaluate RAI 131 stored by thyroid gland to
• Thyroid hormones determine size, shape, location of thyroid gland
o T3 – tri-iodothyronine
o T4 – Thyroxine HYPOTHYROIDISM
o Thyrocalcitonin • Onset of symptoms
• Plasma iodide + tyrosine (amino acid) = thyroglobulin o Cretinism - childhood
(storage form) → T3, T4 o Myxedema - adulthood
o Level of hormones are related to feedback • Cause
mechanism o Primary – failure of thyroid gland to secrete T3 T4
o Secondary – failure of anterior pituitary gland to
Anterior pituitary gland → trophic hormone → target organ secrete TSH
• TSH → thyroid gland → T3 T4 • S/sx
• ACTH → Adrenal cortex → SSS o Stunted growth
o Delayed onset of puberty
Assessments o Low VS
• PBI (Protein Bound Iodine) o Mentally sluggish
o Evaluate amount of iodine attached to the protein o Cold intolerant
molecule of the blood o Hypometabolic = weight gain
o 4-8 ug % • Management
o No intake of iodine for 3-4 days o Supplement thyroid extract
▪ Sea foods ▪ Proloid
▪ Iodized salt ▪ Cytomel
▪ Cough syrup ▪ Synthroid
▪ Salicylate (ASA) ▪ Euthroid
▪ Estrogenic preparations ▪ Thyrolar
▪ Dyes ▪ Thyrax
• T3 T4 Determination ▪ Ectroxine
o T3 70-170 ug % ▪ Thyroxine
▪ More potent than T4 ▪ Levo-thyronine
▪ Will not bind with iodine ▪ Lio-thyronine
▪ Can readily/penetrate a cell to
stimulate metabolism HYPERTHYROIDISM
o T4 4.7-11 ug % • Grave’s/Basedoue/Parry’s disease/ Thyroitoxicosis/Toxic
o No special preparations Goiter
• TSH Test • Theories:
o 0.4-6.11 ug/ml o LATS (Long-acting thyroid stimulator)
o Decreased T3 T4 → APG → stimulate TSH ▪ Gammaglobulin
o Increased T3 T4 → APG → inhibit TSH ▪ Cause iodine accumulation and
o Inversely proportional to thyroid function thyroid hyperplasia
• BMR ▪ Triad Symptoms
o Evaluate O2 consumption when at rest • Goiter
o NPO 12 hrs. and good night sleep • Eye signs
o • Hyperthyroidism
• TBMR o Elevated T3 T4
o Theoretical basal metabolic rate o EPS
o 20-30 ▪ Anterior pituitary gland will release an
o Pulse pressure + PR/min – 111 exophthalmos producing substance
o Not definitive • Exophthalmos (protrusion
• RAIU (Radioactive Iodine Uptake) of eyeball)
• Proptosis (downward
displacement of eyeball)
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
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, 20230621020818_64925b928841f_med_surg_1___1_.docx
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20230621020818_64925b928841f_med_surg_1___1_.docx
MEDICAL SURGICAL NURSING 4
• Lid lag • Partial/Sub-total thyroidectomy – 5/6 of 2 lobes
• Infrequent blinking • Thyroid lobectomy
• Fixed stare • Isthmusectomy
• Peri-orbital edema
• Von Graefe (failure of Post-thyroidectomy management
eyelids to follow movement • Promote patent airway
of eyes when the patient o Position Semi-Fowler’s
looks down) o Not High-Fowler’s – cause strain on neck muscle
• Dalyrimple sign (infrequent which causes tension on suture line (bleeding)
blinking and fixed stare) • Turn to sides
o S/sx • Promote adequate nutrition and fluid and electrolytes
▪ Increased T3 T4 o As soon as fully awake and with gag reflex
• Diarrhea (Elevation of palate and contraction of
▪ Voracious increase T3 T4 (Grave’s) pharyngeal muscle)
• Over-excitability SNS (no • Promote adequate bowel-bladder elimination
management sought) o 6-8 hrs. after surgery
o Diaphoresis o If not within 6-8 hrs., palpate presence of bladder
o Tremors distention
o Nervousness • Encourage early ambulation
o Palpitation o Shorten convalescence period
o Constipation o Boost patient’s moral
o Simple goiter/Endemic goiter/ Iodine-deficiency o Get out of bed as soon as VS are stable
goiter/ Non-toxic goiter ▪ Support the head and neck to prevent
o Goiter – enlargement of thyroid gland flexion and hyperextension
▪ Hormone levels • Complications
• May be normal, o Tetany
above/below normal ▪ Occurs upon accidental removal of
because goiter is simply parathyroid glands
enlargement o 2 recurrent laryngeal nerves
Treatment Modalities ▪ Hoarseness (edema of glottis)
• Anti-thyroid preparation ▪ Aphonia
• Prevent synthesis T3 T4 by blocking utilization of o Bleeding
iodine ▪ Failure to tie/ligate the bleeders
• Example ▪ Check for dampness at the nape
o Tapazole/methimazole ▪ Check for feeling of choking
o PTU (Propylthiouracil) ▪ Evaluate VS
▪ Differential count • Rapid, weak, feeble,
o Neomercazole/Carbimazole thready pulse
• Adverse effects (prolonged use) • Rapid but shallow
o Agranulocytosis – infection respiration
▪ Fever o Respiratory obstruction
▪ Complaint of sore throat ▪ Secondary to bleeding
▪ Dyspnea ▪ Accumulation of tracheo-bronchial
• Iodine Preparation secretion
• Lugol’s solution/KISS (Potassium Iodide ▪ Laryngospasm
Saturated Solution) ▪ Laryngeal edema
o Reduce vascularity o Thyroid crises/storm
o Increase firmness of gland ▪ High anxiety level pre-op
o Promote storage of T3 T4 ▪ Increased T3 TT4 → anti-thyroid
• Adrenergic-blocking preparation for 3 months → euthyroid
• Control symptoms of over-excitability of state, normal T3 T4 → operation →
SNS post-op stress, infection → increased
• RAI 131 T3 T4 (over-excitability of SNS)
▪ Fever with tachycardia
• Surgery
▪ Anti-thyroid preparation
• Management
o High caloric diet
DIABETES MELLITUS
o No colas/caffeinated beverages
Assessments
o Monitor weight
• FPG, RBS, PPBS, OGTT, Hgt
o Provide physical mental rest
o Provide calm/restful environment
HHNK Coma/HHNS
o Elevate head to promote drainage and reduce
peri-orbital edema • Hyperglycemia → hyperosmolar diuresis → glycosuria &
polyuria → ECF dehydration → cerebral dehydration →
Surgeries CNS depression → HHNK
DKA
• Sistrunk’s – thyroglossal cyst
• Increased lipolysis → increased oxidation of fatty acids →
• Radical/Total thyroidectomy
hyperlipidemia & ketone bodies → DKA
o Collar-line/Curvilinear
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20230621020818_64925b928841f_med_surg_1___1_.docx
MEDICAL SURGICAL NURSING 1
Man → TOTALITY
• Suprasystem
o Individual, family, community, society ADRENAL CORTEX
• Subsystem Glucocorticoids/Steroids
• Gluconeogenesis (formation of new glucose from fats and
Stress Response/SMR (Sympatho-medullary Response/ SAMR proteins) → increased CHON catabolism (breakdown) → (-)
(Sympatho-adreno-medullary response)/GAS (General Adaptation nitrogen balance (catabolism>anabolism)
Response) o Positive nitrogen balance (more protein
✓ Diaphoresis anabolism)
✓ Increased B Mineralocorticoid/Aldosterone
✓ Increased PR • Fluid and sodium retention
✓ Increased rate/depth resp. o Oliguria <400 ml /24 hrs.
✓ Pallor o Anuria <100 ml /24 hrs.
✓ Cold clammy • Potassium excretion
✓ Weight loss
✓ Weakness NEUROHYPOPHYSEAL (Hypophysis Cerebri/Sella Turcica)
✓ Anorexia Anterior (Adenohypophysis)
✓ Diarrhea • TSH
✓ Constipation • ACTH
✓ Urinary frequency • FSH
✓ Oiguria • LH
✓ Anuria • MSH (Melanocyte-Stimulating Hormone)
✓ Transient hyperglycemia • SH (Somatotrophic Hormone)
✓ Increased in visual acuity
• GH
Posterior (Neurohypophysis)
• Hypothalamus
• ADH
o Sympatho-adrenal medullary
• Oxytocin
o Adreno-cortical
o Neurohypophyseal
ENDOCRINE
Hypoactivity
Adrenal glands
• Congenital absence of glands
• On top of kidneys
• Surgical removal of gland
• Adrenal medulla
o Inner portion • Idiopathic atrophy of glands
o Secretes catecholamines: Hyperactivity
EPINEPHRINE/ADRENALINE • Tumor within or outside the gland
▪ Vasodilator (coronary artery, cerebral • Failure of kidneys to secrete hormones
artery, peripheral blood vessels) • Failure of liver to deactivate of hormones
▪ Vasoconstrictor (peripheral arterioles)
▪ Glycogenolysis (breakdown of DECREASED APG ACTIVITY
glycogen in liver) Pituitary dwarfism
NOREPINEPHRINE/NORADRENALINE • Dwarf (doubled size of infant)
▪ Vasoconstrictor Frohlicks Syndrome
• Dwarf, obese, mentally retarded, genital atrophy
ADRENAL MEDULLA Simmonds disease/ Pituitary Cachexia
Epi/Norepi (Sympathetic/Adrenergic) • Wizened old man, mental lethargy, teeth start to fall,
• Dilated coronary arteries → increased myocardial amenorrhea, absence of spermatogenesis
perfusion → increased myocardial contraction →
increased PR INCREASED APG ACTIVITY
• Dilated peripheral blood vessels Gigantism
• Relaxation of smooth muscular bronchioles • Before closure of epiphyseal line
→bronchodilation → increased rate/depth respiration • Rapid growth of long bones
• Constricted peripheral arterioles → increased o Prolongation/elongation of long bones
peripheral resistance → increased BP Acromegaly
• Constricted arteries of skin → decreased blood supply • After closure of epiphyseal line
→ pallor • Increased in bone thickness and hypertrophy of soft tissues
• Increased glycogenolysis → transient hyperglycemia o Enlargement of cartilages
• Sweat glands → stimulation ▪ Nose
• GIT → decreased gastric secretion → decreased ▪ Ears
gastric motility o Enlargement of larynx
• No urine ▪ Deepened voice
o Urinary bladder muscles →relaxes o Progmathism/protrusion of jaw
o Urinary sphincter → close ▪ Separation of teeth
• Pupils → dilation → increased visual acuity o Thickening of lips and oral mucous membrane
o Lengthening of chin
o Broad hands/spade-like fingers
o Enlargement of visceral organs
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
,20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
MEDICAL SURGICAL NURSING 2
o Calcium preparations (after meals)
▪ Calcium carbonate
▪ Calcium Lactate
• Management ▪ Calcium Chloride 10%
o Cobalt therapy ▪ Calcium gluconate
▪ Radiation
o Surgical removal o Given with vit. D (tachysterol)
▪ Hypophysectomy ▪ Dihydrotachysterol
o Inhibit production of growth hormone ▪ Hytakerol
(subcutaneously) ▪ Calciferol
o Somatostatin ▪ Calcifediol
▪ Sandostatin ▪ Calcidiol
▪ Octreotide/actreotide ADRENAL CORTEX
1. Glucocorticoid/steroid – gluconeogenesis
DIABETES INSIPIDUS • Fat → increased lipolysis → abnormal fat distribution
• Disorder in water metabolism → decreased ADH → prevent • CHON → increased CHON catabolism → tissue
renal tubules reabsorption of water → polyuria = 5-29 L/24 starvation & muscle wasting
hrs. → Polydipsia → diluted (decreased specific gravity = 2. Mineralocorticoid/aldosterone
1.010-1.025) → increased Na (135-145 mEq/L) 3. Androgen
✓ All electrolyte testing do not require NPO
Cushing’s
• ADH • Increased GMA
o Oily preparations (Deep IM) → lipodystrophy (rotate • Increased 3S
route of administration) o Sugar
▪ Pitressin Tannate ▪ Hyperglycemia
▪ Vasopressin – vasoconstrictor → HPN ▪ Moon facies
o Nasal sprays (clear nasal passages) ▪ Buffalo hump
▪ Desmopressin Acetate ▪ Truncal obesity
▪ Lypressin o Salt
• Anti-lipidemic ▪ Fluid retention → Increased BP
o Clofibrate/Atromid S/Clo 5 ▪ Hypernatremia
▪ Hypokalemia
SIADH o Sex
• Increased ADH ▪ Virilism
• Fluid retention ▪ Masculinization
o Increased IV volume (hypervolemia) ▪ Hirsutism
▪ Increased BP • Management
▪ Increased renal perfusion → o Cobalt therapy
enhance/increased GFR/ increased o Adrenalectomy
UO → no leg edema o Cortisol inhibitors
o Electrolyte dilution → Dilutional hyponatremia → ▪ Aminogluthetemide
fluid move into the cell ▪ Trilostane
▪ Cerebral edema → Increased ICP ▪ Metyrapone
▪ Cellular overhydration ▪ Metotane
• Management Addison’s
o Hypophysectomy • Decreased GMA
o Inhibit production of ADH • Decreased 3S
▪ Demeclocyline/Declomycin PO o Sugar
▪ Hypoglycemia
Parathormone ▪ Stimulate anterior pituitary gland →
• Promote reabsorption of Ca in the renal tubules and increased ACTH → MSH → tan
excretion of P, essential for blood coagulation, regulate complexion → bronze-skinned
cardiac rhythmicity o Salt
Hypoparathyroidism ▪ Decreased IV volume → hypotension
• Hypocalcemia = hyperphosphatemia ▪ Hyponatremia
o 4.5-5.5 mEq/L ▪ Hyperkalemia → myocardial irritability
o 8-11 mg/dL → altered electrical conduction →
o High calcium diet dysrhythmias → heart arrest
• Tetany o Sex
o (+) Chvostek – tap the Facial nerve (below the • Management
temporals) → muscle twitching of face o Steroids
o Trousseau – occlude blood flow of an extremity
for 1-2 minutes → carpopedal spasm Conns/Primary aldosteronism
• Management • Adenoma of adrenal cortex (benign)
o Can be given sea foods but not milk, dairy • Hyperactivity
products and egg (rich in phosphorus) so check Pheochromocytoma
levels of phosphorus if among the choices, all is • Adenoma of adrenal medulla (benign)
with calcium • Hyperactivity
20230621020818_64925b928841f_med_surg_1___1_.docx
20230621020818_64925b928841f_med_surg_1___1_.docx
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,20230621020818_64925b928841f_med_surg_1___1_.docx
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20230621020818_64925b928841f_med_surg_1___1_.docx
MEDICAL SURGICAL NURSING 3
• 5H o Evaluate amount of radioactive iodine 131
o Hypertension accumulated by the thyroid gland and excreted
o Headache by the kidneys
o Hyperglycemia o No intake of iodine
o Hypermetabolism o Uptake = 15-40%
o Hyperhidrosis o Urine = 40-80%
• Management o PO RAI 131 cocktail (with brassy taste) → 24 hr.
o Cobalt therapy urine → 2-4 hr. scanner
o Surgical removal of adrenal medullary o E.g. 11am PO RAI 131 6 millicuries → 24 hr.
• Assessment urine → 1pm scanner
o VMA (Vanillylmandellic Acid) ▪ N: 0.9%-2.4 millicuries
▪ Level of catecholamine ▪ Low: 0.67
• Blood 0.2-0.9 mg% ▪ High: 3.6
• Urine 0.2-7 mg/24 hrs. o Directly proportional to uptake
o Inversely proportional to urine
Thyroid glands • Thyroid Scan
• Isthmus – connects the two lobes of the thyroid glands o Evaluate RAI 131 stored by thyroid gland to
• Thyroid hormones determine size, shape, location of thyroid gland
o T3 – tri-iodothyronine
o T4 – Thyroxine HYPOTHYROIDISM
o Thyrocalcitonin • Onset of symptoms
• Plasma iodide + tyrosine (amino acid) = thyroglobulin o Cretinism - childhood
(storage form) → T3, T4 o Myxedema - adulthood
o Level of hormones are related to feedback • Cause
mechanism o Primary – failure of thyroid gland to secrete T3 T4
o Secondary – failure of anterior pituitary gland to
Anterior pituitary gland → trophic hormone → target organ secrete TSH
• TSH → thyroid gland → T3 T4 • S/sx
• ACTH → Adrenal cortex → SSS o Stunted growth
o Delayed onset of puberty
Assessments o Low VS
• PBI (Protein Bound Iodine) o Mentally sluggish
o Evaluate amount of iodine attached to the protein o Cold intolerant
molecule of the blood o Hypometabolic = weight gain
o 4-8 ug % • Management
o No intake of iodine for 3-4 days o Supplement thyroid extract
▪ Sea foods ▪ Proloid
▪ Iodized salt ▪ Cytomel
▪ Cough syrup ▪ Synthroid
▪ Salicylate (ASA) ▪ Euthroid
▪ Estrogenic preparations ▪ Thyrolar
▪ Dyes ▪ Thyrax
• T3 T4 Determination ▪ Ectroxine
o T3 70-170 ug % ▪ Thyroxine
▪ More potent than T4 ▪ Levo-thyronine
▪ Will not bind with iodine ▪ Lio-thyronine
▪ Can readily/penetrate a cell to
stimulate metabolism HYPERTHYROIDISM
o T4 4.7-11 ug % • Grave’s/Basedoue/Parry’s disease/ Thyroitoxicosis/Toxic
o No special preparations Goiter
• TSH Test • Theories:
o 0.4-6.11 ug/ml o LATS (Long-acting thyroid stimulator)
o Decreased T3 T4 → APG → stimulate TSH ▪ Gammaglobulin
o Increased T3 T4 → APG → inhibit TSH ▪ Cause iodine accumulation and
o Inversely proportional to thyroid function thyroid hyperplasia
• BMR ▪ Triad Symptoms
o Evaluate O2 consumption when at rest • Goiter
o NPO 12 hrs. and good night sleep • Eye signs
o • Hyperthyroidism
• TBMR o Elevated T3 T4
o Theoretical basal metabolic rate o EPS
o 20-30 ▪ Anterior pituitary gland will release an
o Pulse pressure + PR/min – 111 exophthalmos producing substance
o Not definitive • Exophthalmos (protrusion
• RAIU (Radioactive Iodine Uptake) of eyeball)
• Proptosis (downward
displacement of eyeball)
20230621020818_64925b928841f_med_surg_1___1_.docx
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MEDICAL SURGICAL NURSING 4
• Lid lag • Partial/Sub-total thyroidectomy – 5/6 of 2 lobes
• Infrequent blinking • Thyroid lobectomy
• Fixed stare • Isthmusectomy
• Peri-orbital edema
• Von Graefe (failure of Post-thyroidectomy management
eyelids to follow movement • Promote patent airway
of eyes when the patient o Position Semi-Fowler’s
looks down) o Not High-Fowler’s – cause strain on neck muscle
• Dalyrimple sign (infrequent which causes tension on suture line (bleeding)
blinking and fixed stare) • Turn to sides
o S/sx • Promote adequate nutrition and fluid and electrolytes
▪ Increased T3 T4 o As soon as fully awake and with gag reflex
• Diarrhea (Elevation of palate and contraction of
▪ Voracious increase T3 T4 (Grave’s) pharyngeal muscle)
• Over-excitability SNS (no • Promote adequate bowel-bladder elimination
management sought) o 6-8 hrs. after surgery
o Diaphoresis o If not within 6-8 hrs., palpate presence of bladder
o Tremors distention
o Nervousness • Encourage early ambulation
o Palpitation o Shorten convalescence period
o Constipation o Boost patient’s moral
o Simple goiter/Endemic goiter/ Iodine-deficiency o Get out of bed as soon as VS are stable
goiter/ Non-toxic goiter ▪ Support the head and neck to prevent
o Goiter – enlargement of thyroid gland flexion and hyperextension
▪ Hormone levels • Complications
• May be normal, o Tetany
above/below normal ▪ Occurs upon accidental removal of
because goiter is simply parathyroid glands
enlargement o 2 recurrent laryngeal nerves
Treatment Modalities ▪ Hoarseness (edema of glottis)
• Anti-thyroid preparation ▪ Aphonia
• Prevent synthesis T3 T4 by blocking utilization of o Bleeding
iodine ▪ Failure to tie/ligate the bleeders
• Example ▪ Check for dampness at the nape
o Tapazole/methimazole ▪ Check for feeling of choking
o PTU (Propylthiouracil) ▪ Evaluate VS
▪ Differential count • Rapid, weak, feeble,
o Neomercazole/Carbimazole thready pulse
• Adverse effects (prolonged use) • Rapid but shallow
o Agranulocytosis – infection respiration
▪ Fever o Respiratory obstruction
▪ Complaint of sore throat ▪ Secondary to bleeding
▪ Dyspnea ▪ Accumulation of tracheo-bronchial
• Iodine Preparation secretion
• Lugol’s solution/KISS (Potassium Iodide ▪ Laryngospasm
Saturated Solution) ▪ Laryngeal edema
o Reduce vascularity o Thyroid crises/storm
o Increase firmness of gland ▪ High anxiety level pre-op
o Promote storage of T3 T4 ▪ Increased T3 TT4 → anti-thyroid
• Adrenergic-blocking preparation for 3 months → euthyroid
• Control symptoms of over-excitability of state, normal T3 T4 → operation →
SNS post-op stress, infection → increased
• RAI 131 T3 T4 (over-excitability of SNS)
▪ Fever with tachycardia
• Surgery
▪ Anti-thyroid preparation
• Management
o High caloric diet
DIABETES MELLITUS
o No colas/caffeinated beverages
Assessments
o Monitor weight
• FPG, RBS, PPBS, OGTT, Hgt
o Provide physical mental rest
o Provide calm/restful environment
HHNK Coma/HHNS
o Elevate head to promote drainage and reduce
peri-orbital edema • Hyperglycemia → hyperosmolar diuresis → glycosuria &
polyuria → ECF dehydration → cerebral dehydration →
Surgeries CNS depression → HHNK
DKA
• Sistrunk’s – thyroglossal cyst
• Increased lipolysis → increased oxidation of fatty acids →
• Radical/Total thyroidectomy
hyperlipidemia & ketone bodies → DKA
o Collar-line/Curvilinear
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