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medsurg exam 2
thyroid cancer/surgery and adrenal conditions
| Question | Answer |
|---|---|
| 5 year relative survival of thyroid cancer 2013-2019 | 98.5% |
| thyroid cancer background | Differentiated: highly treatable and usually curable Poorly differentiated: metastasize, poor prognosis |
| risk of thyroid cancer | Affects women > men Most common 25 - 65 years Incidence increasing over the last decade |
| how is thyroid cancer first detected | Most commonly presents as a cold nodule |
| thyroid cancer presents as | a cold nodule on the scan |
| staging of thyroid cancer | TNM approach tumor, nodes, metastasized? |
| surgery for thyroid cancer | Both lobes if tumor at least 1.0-2.0 cm in diameter, extrathyroid extension or metastases Unilateral lobectomy and isthmusectomy if tumor unifocal and less then 1.0cm |
| thyroid surgery post op care | Observe for respiratory distress Pain control (pain meds) Fluid balance Advise limit talking initially Encourage out of bed as soon as possible |
| during thyroid surgery post op care, to prevent respiratory distress, you should have | an emergency trach tray set up just in case |
| when a pt is recovering from thyroid surgery, support their | neck in high fowlers |
| treatment after total thyroidectomy surgery | Radioactive iodine (I-131) |
| Radioactive iodine (I-131) works by | destroying tissue + metastasis anything that's left |
| in addition to radioactive iodine, after a total thyroidectomy, the pt should remain | left away from the general public and family for 24hrs |
| other treatments for thyroid cancer | Levothyroxine (life long) to keep TSH levels low Radiation therapy for metastasis New molecular drugs |
| rare complications from thyroid surgery | Damage recurrent laryngeal nerve (≤ 2%) Accidental removal parathyroids (≤ 2%) |
| after thyroid surgery, the pt will require | Life long drug therapy for hypothyroidism |
| prognosis of thyroid surgery depends on | on cell type, spread |
| normal adrenal function includes | hypothalamus, pituitary, adrenal glands |
| normally, the hypothalamus sends | sends corticotropin-releasing hormone (CRH) to the pituitary gland |
| when CRH is sent to the pituitary gland, it causes | the pituitary to secrete adreno-corticotropin hormone (ACTH) |
| when the pituitary gland secretes ACTH, it stimulates | the adrenal glands |
| when the adrenals are stimulated, they respond by | respond by releasing cortisol, aldosterone and dehydroepiandosterone into the bloodstream |
| where are the adrenals located | just above the kidneys |
| cortisol levels rise with | stress |
| adrenal insufficiency | addison's disease |
| cause of addison's disease | destruction / dysfunction adrenal cortex due to: Gradual atrophy gland function (idiopathic) Autoimmune disease Corticosteroid Therapy |
| Corticosteroid Therapy causes addison's disease because | synthetic cortisol is going to increase cortisol levels so the adrenal gland is going to produce less cortisol |
| Corticosteroid Therapy does not increase | steroid dose with stress ex= infection, surgery long term steroids need to be decreased |
| Corticosteroid Therapy that is too abruptly tapered can cause | adrenal insufficiency |
| symptoms of adrenal insufficiency (mild) | Lethargy, confusion, depression, weakness, hypoglycemia, hyponatremia, hyperkalemia, nausea, vomiting !! hyperpigmentation !! |
| there is hypoglycemia, hyponatremia, hyperkalemia from adrenal insufficiency because | there is an aldosterone deficiency |
| adrenal crisis symptom = | shock |
| diagnosis of addisons disease | Morning serum cortisol concentration ACTH Stimulation Test |
| Morning serum cortisol concentration: normal | Normal- Cortisol levels higher in morning 6AM cortisol (10-20 mcg/dL) |
| Morning serum cortisol concentration: low cortisol is suggestive of | If low (< 3mcg/dL – strongly suggestive of adrenal insufficiency |
| ACTH Stimulation Test is when | blood cortisol, urine cortisol or both are measured before and after a synthetic form of ACTH is given by injection |
| ACTH Stimulation Test: normal | rise in blood and urine cortisol levels |
| ACTH Stimulation Test: little or no increase of cortisol is suggestive of | adrenal insufficiency |
| Acute Adrenal Insufficiency management is important because condition can be | life threatening |
| acute Adrenal Insufficiency management | increase steroid dose (oral or IV) Monitor fluid/electrolytes Quiet environment, no stress |
| for pts with acute adrenal insufficiency, it is important to | Teach self-care |
| self care for pts with acute adrenal insufficiency | Increase steroid dosage stress, surgery, illness Do not stop steroids abruptly Vomiting – call or IM dose (self administer) Medic alert bracelet Emergency kit on hand (Addisonian Crisis) |
| Cushing’s Syndrome occurs when | Prolonged exposure high levels cortisol |
| cause of Cushing’s Syndrome | Body produces too much cortisol or iatrogenic |
| Body might produce too much cortisol because of | Pituitary or adrenal tumor |
| iatrogenic cause of Cushing’s Syndrome | Long term use of oral corticosteroids |
| Because oral steroids affect the entire body, they cause | systemic SE |
| Longer use & higher doses increase risk of | oral steroids systemic SE |
| oral steroids systemic SE | Glaucoma Fluid retention Hypertension Mood swings Cataracts High blood glucose levels Increased risk of infection Osteoporosis Buffalo hump Thin skin, easy bruising and slower wound healing |
| Buffalo hump | Fat deposits in abdomen, face and back of neck |
| cushings syndrome risks | longer use or corticosteroids |
| what type of corticosteroids causes a greater risk | oral causes greater risk over inhaled meds |
| nursing management of cushings syndrome | Adhere to established dosage Suggest monitoring of bone density Explain may cause emotional lability Recognize when dosage may need increased Taper as prescribed, if possible |
| make sure pts are aware of these signs | infection delayed healing easy bruising |
Created by:
leh195