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NCLEX study guide AddisonÕs DiseaseCushingÕs Disease -think hyperthyroidism sx-think hypothyroidism sx Hyposecretion of glucocorticoids -not enough aldosterone = lose water (think diuretics..some block aldosterone) Hypersecretion of glucocorticoids -too much aldosterone = water retention HypovolemiaHypervolemia HotCold (CushingÕs = Cold) ↑K ↑Ca ↓ Na (lose H2O, lose Na) ↓K ↓Ca ↑Na (gain H2O, gain Na) Hypoglycemia (↑ insulin production) Hyperglycemia (↓ insulin production) + ketoacidosis Wet skinDry skin (hyper = dryer) hyperglycemia = dry skin Lethargy, fatigue, muscle weakness Generalized muscle wasting, weakness Hypotension (↓Na)Hypertension (↑ Na) Weight lossWeight gain / Slow healing Decreased blood volume + shock Hyperkalemia = meta acidosis + arrhythmias Moon face, buffalo hump, obesity (trunk), thin skin, reddish-purple striae TREATMENT: hormone replacement TREATMENT: hypophysectomy, adrenalectomy Addisonian crisis -medical emergency -critical deficiency of glucocorticoids -generally follows acute stress, sepsis, trauma, surgery, or omission of steroid therapy
s/sx: severe abd pain, sudden profound weakness,
hyperpyrexia followed by hypothermia, coma, renal failure Osteoporosis (excess cortisol = ↑Ca reabsorption from bones) HyperthyroidismHypothyroidism
- fast- slow
-↑ metabolism↓ metabolism -sympathetic NS sx-parasympathetic NS sx -nervousness, irritable, excitable, tachycardia, perspiration, flushed face, exophthalmus, increased appetite, limp hair, wt loss, HTN -extreme fatigue, dry skin, coarse hair, numbness and tingling of fingers, alopecia, wt gain -heat intolerance-cold intolerance Iodine uptake ↑Iodine uptake ↓ Graves diseaseMyxedema coma
Removing tubes and things Thyroid storm -tachycardia -delirium -coma -pt with hyperthyroidism is typically nervous and has insomnia.-don't place in same room with another pt with hyperthyroidism because too much stimuli.-place in private room. Chest tubesHave pt perform valsalva maneuver, or take and hold deep breath (have seen both in nclex books) NG tubeHave pt take and hold a deep breath PICC lineHave pt perform valsalva maneuver TPN lineValsalva maneuver Hyperglycemia hyperosmolar nonketotic syndrome (HHNKS) DKA -occurs in people with DM-2-occurs in peoplee with DM-1 -glucose > 800 ml/dL-glucose > 300-800 mg/dL -gradual onset of sx-sudden onset of sx No ketosis/acidosisKetosis/acidosis / FRUITY breath odor Polyuria, polydipsia, dehydration, mental status changes, wt loss, weakness, headache ↓BP Polyuria, dehydration, wt loss, dieresis ↓BP / Tachycardia Tx = fluid replacement, correct electrolyte imbalance, give insulin /Exercise Tx = give vasopressin IV Fluids / Reg. Insulin Skin warm/ dry and dry mucus memb / high Temp Kussmaul respirations (rapid and deep) -expected outcome = ↑ responsiveness Sympathetic NS (fight/flight)Parasympathetic NS -anticholinergic drugs -vasoconstriction -B blockers -vasodilation TachycardiaBradycardia Dilated pupilsConstricted pupils Inhibits digestion -constipation Stimulates digestion -diarrhea Inhibits nasal secretionsStimulates nasal secretions
Breath sounds # Parietal lobe = primary center for sensation Temporal lobe = auditory reception areas Frontal lobe = involved with personality, behavior, emotions, intellectual function, if injured may have difficulty comprehending what is said Occipital lobe = primary visual receptor center Inhibits saliva production Inhibits liver, kidneys, gallbladder Stimulates sweatingStimulates liver, kidneys, gallbladder Lungs dilateConstricts lungs Increases muscle strength Tracheal breath sounds -very loud and high pitched -can be heard over the trachea
-I = E
Vesicular breath sounds -soft and low pitched -normal breath sound -heard over most of the lungs -I > E Bronchial breath sounds -very loud and high pitched -heard over the manubrium -if heard elsewhere, may indicate consolidation -E > I Bronchovesicular breath sounds-intermediate intensity and pitch -best heard in the first and second ICS (anterior chest) and between scapula (posterior chest)
-I = E
# #
MASLOWÕS
Lab values K3.5 Ð 5.1 (no pee, no K) Na135 Ð 145 Mg1.6 Ð 2.6 Cl98 Ð 107 Ca8.6 Ð 10 Wbc4500 Ð 11000 Serum osmolality 285 Ð 295 ↑ = dehydration ↓ = overhydration Hgb14-16.5 Hct42-52% (3 x Hgb) Amylase25-151 ↑ with pancreatitis (acute 5x nml, chronic 3x nml) -aids in digestion Albumin3.4 Ð 5 Fe65-175 ALT/AST5-60/5-43 (liver function tests) Uric acid4.5 Ð 8 (men) 2.5 Ð 6.2 (women) ↑ with gout
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