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HESI MED SURG

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Hypothyroid- labs Estrogen can effects test results. Suboptimal levels of the thyroid hormone. THESE SHOULD BE DECREASED: Serum cholesterol, Creatinine phosphokinase, Lactate dehydrogenase, Aspartate aminotransferase
Hypothyroid Drug Treatment Levothyroxine (Synthroid). Life-long therapy. Start with low dose. Increase dose in 4-6 week intervals as needed. Monitor cardio side effects (chest pain, dysrhythmias), weight loss, nervousness, tremors, insomnia
Hypothyroid Weight Loss CAN be an indicator of myxedema. Adverse effects of levothyroxine includes cardiac dysrhythmias, angina pectoris, MI, HF, nervousness, insomnia, diarrhea, abdominal cramps, nausea, vomiting, WEIGHT LOSS, fever, and an intolerance to heat have also been reported
Exophthalmos Increased fat deposits and fluid. Eyeballs are forced outward. Appears in graves' disease, exhibits reduced blinking and lid retraction.
Thyroidectomy Post-Op After surgery ablation procedures are carried out with radioactive iodine to eradicate residual microscopic disease. Thyroid hormone is given to lower the levels of TSH to a euthyroid state. If the remaining thyroid tissue is inadequate to produce sufficient thyroid hormone, thyroxine is required permanently.
Goiter- TSH Inspect and auscultate for bruits
Thyroidectomy- hypocalcemia Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia and tetany.
Foot Care in Diabetes Mild soap and water daily - test water temp. Pat completely dry, no lotion. Mild foot powder for sweaty feet. Nail care after bah - straight across or with file. No open toe/heal - support and protect feet. Wear absorbent socks, - cotton or wool
Type I Diabetes Mellitus Education Exercise (but avoid if ketones are in urine), blood sugar should stay between 100*150. Eat a snack prior to exercise with carbs and protein (peanut butter and bread)
Diabetes Mellitus Insulin Education For Illness IMPORTANT TO MONITOR BLOOD GLUCOSE WHEN EXPERIENCING NAUSEA, VOMITING, DIARRHEA. Patients with DM pay require additional or less insulin and medications during times of illness, infection, pregnancy, surgery, or stressful events. Drink sweet, sugary beverages to maintain caloric intake. Eat small, frequent meals like soups, jello, and puddings. Check urine for ketones twice a day. Continue insulin (dosage may be decreased but should speak to provider)
Diabetes Mellitus Safety Before administering insulin, patient safety requires that two nurses always check the dosage
Rapid Acting Insulin (Lispro, Aspart, Glulisine) Instructed to eat no more than 5-15 minutes after injection
Short-Acting Insulin (Regular) Taken 15 minutes before a meal
Intermediate-Acting Insulin (NPH) Should be taken around the time of onset and peak (1-1.5 onset, 4-12 peak)
Long-Acting Insulin (Glargine, Detemir) Should be administered once a day, at any time. Just ensure it is the same time every day.
Rheumatoid Arthritis Originates in synovial tissue of distal joints. Pannus destroys cartilage and erodes the bone. Ultimately the loss of articular surfaces and joint motion. Neuropathies and paresthesia are possible
Rheumatoid Arthritis Symptoms Swelling, warmth, erythema, and lack of function are classic symptoms. Palpation of spongy tissue, fluid in the inflamed joint. Starts in hands and progresses to knees, shoulders, hips, elbows, ankles. Deformities occur. Extra-articular features Raynaud syndrome, nodules and RH factor, Sjogren's Syndrome
SLE- exacerbation Exacerbations often occur due to photosensitivity. Butterfly shaped rash on bride of nose and cheeks
Bariatric Surgery- Osteoporosis Patients who have had bariatric surgery are at increased risk for osteoporosis as the duodenum is bypassed, which is the primary site for absorption of calcium. Patients who have gastrointestinal (GI) diseases that cause malabsorption (e.g., celiac disease, alcoholism) may benefit from additional magnesium supplements. However, in adults who follow a strict gluten free diet, magnesium supplements are currently not recommended.
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