NCLEX study from Mark Klimek Case Study 2024

Hyperthyroidism is also called - Grave's disease or hypermetabolism Tip to remember Grave's disease s/s's - "Run yourself into the Grave" - everything is up ... diarrhea, thin, hot, high BP, high HR, cold tolerance, hot intolerance Treatment for Grave's disease - Radioactive Iodine, PTU (put thyroid under), surgically remove Total thyroidectomy ... totals get - tetany, need lifelong hormone replacement After thyroidectomy patients are at risk for - hypocalcemia, remember hypocalcemia is opposite of the prefix and anything to BP so tetany, parasthesia parathesia - numbness and tingling, first sign of electrolyte imbalance Subtotal thyroidectomy ... subs get - storm S/S of thyroid storm - Extremely high vital signs, hyperpyrexia, psychotic delerium How to treat thyroid storm - give o2, lower temp to spare brain Risks post op for total thyroidectomy - airway, hemorrhage for 1st 12 hours then for 12-48 hours hypocalcemia leading to tetany Risks post op for sub total thyroidectomy - airway, hemorrage for 1st 12 hours then for 12-48 hours thyroid storm Hypothyroidism is also called - Myxedema or hypometabolism S/S of mydexema - everything is down, constipation, heat tolerance, cold intolerance Treatment for mydexema - give thyroid medications Where to put the 5 ice packs to cool a thyroid storm patient - neck pits groin If you cool a patient too fast what might happen? - Heart arrythmias Never hold the hormone for what patient? - patient who is NPO with mydexema Addison's disease easy way to remember - Add a Sone (sone = steroid) Adrenal Cortex diseases easy way to remember - A in Adrenal stands for Addison's C in Cortex stands for Cushing's Addison's disease is - undersecretion of adrenal cortex, not enough hormone, BRONZE/tan, go into shock very easily. STRESS can trigger. Addison's disease treatment - give a steroid, chronic steroid therapy Cushing's syndrome - Over secretion of adrenal cortex, too much hormone, too much steroid. S/S of Cushing's syndrome - same as steroid use ... moon face, think cushman "I'm mad I have an infection", high blood sugar, losing Potassium, Treatment for Cushing's syndrome - Surgery, bi or uni lateral adrenalectomy (bilateral is worse) Donning PPE's order - Gown, Mask, Goggles, Gloves Removing PPE's order - alphabetically inside the room For airborne precautions the mask is removed where? - outside of the room Avoid answers with what words for children 9 mths and younger? - build, sort, stack, construct, make Toddlers (1-3) work on - their gross motor skills (jump, hop, throw), NO fine motor, parallel play Preschoolers (3-6) work on - fine motor, balance (tumbling, dance, tricycle), cooperative play, pretend School age (7-11) work on - creative, collect, competitive Best default order for click and drag order questions? - Hold ..... med Assess ..... what med does Prepare ...... the correction Call ..... or notify Rarely if ever answer ... - call Doctor, NCLEX wants you to think critically Creatinine lab values - same as lithium 0.6-1.2 Not a huge worry, not a dangerous lab to worry about INR lab values - 2-3, critical value if off, potential for patient to bleed. Use default order for order ?'s (hold all coumadin, assess for bleeding, prepare Vit K (antidote for Coumadin), Call or notify Potassium lab values - 3.5-5.3 If low it is a critical lab to worry about assess the heart and then prepare to give K if high, hold all K, assess heart (EKG), give D5W and reg insulin, call if really high, hold, assess, prepare, call STAT Get someone else involved! Dangerous!! pH lab values - 7.35-7.45 if pH is in the 6;s VERY dangerous remember as the patient's pH goes so goes the patient If bad vitals, call rapid response team BUN lab values - 8-30 check for dehydration if elevated not a big deal, just be concerned If a deadly or dangerous lab value is discovered AND they have symptoms call the - rapid response team! HgB lab values - 12-18 check for bleeding if low or high, if low prepare for tranfussion HCO3 lab values - 22-26 if it is abnormal so what! CO2 lab values - 35-45 if in the 50's assess respiratory status and have patient do pursed lip breathing, if in 60's considered deadly and respiratory failure, need intubated Hct lab values - 36-54 thickness of blood if abnormal not too big of a deal, assess for dehydration PO2 lab values - 78-100 this is only obtained from an ABG if low give O2 but if really low it is respiratory failure give O2, prepare for intubation, call resp therapy and call Dr O2 sat lab values - 93-100 pulse ox, if under 93 assess resp status and give O2 BNP lab value - less than 100 is normal, good indicator of CHF, edema, if elevated assess s/s of CHF NA lab values - 135-145, if a change in LOC then evaluate for fall/safety risk WBC lab values - if low assess for infection CD4 count less than 200 equals - AIDS Neutropenic precautions (low WBC) - strict handwashing, avoid crowds, private room, low bacteria diet (no raw or undercooked), no water that has been standing longer than 15 min, vital signs Q4H