Addison-Hypoadrenalism

S/S: lethargy, fatigue, muscle weakness, salt craving, anorexia, nausea, vomiting, diarrhea, abd. Pain, menstrual changes, impotence. Dx: low serum cortisol, low glucose, increased BUN, increased ACTH TMT: Replacement therapy Nursing: Strict I&O, daily weights, frequent v/s, watch for dysrhythmias, patient teaching for life long therapy.

Hyperadrenalism (Cushings Syndrome)

S/S: sleep disturbances, weakness, frequent infections, easy bruising, round face, large trunk with thin legs, thin skin, straie, wounds that dont heal, hirsutism, elevated blood glucose, elevated B/P, mood swings. Dx: Plasma levels elevated, ACTH may or may not be elevated, glucose, WBC, lymphocytes sodium levels elevated, decreased Ca and K. TMT: Depends on cause, some drug therapy or sx

Hyperthyroidism
S/S: Body is in hyperstimulatory state: heat intolerance, palpitations, visual disturbances, fatigue, weakness, insomnia, amenorrhea, mood changes, tremors, enlarged thyroid. Many Causes: Most common cause is Graves Disease and exopthalmos Dx: Thyroid profile, elevated levels T3 and T4. TMT: Drug therapy, PTU, Iodine products, Tapazone, Propanolol. Radioactive Iodine Therapy to destroy cell. Surgery: thyroidectomy. THYROID STORM: THYROIDTOXICOSIS.

Hypothyroidism
S/S: Decreased metabolism, Increased sleep, generalized weakness, anorexia, muscle aches, constipation, cold intolerance, decreased libido, menstrual changes (heavier bleeding), periorbital edema, slow about everything, depression, bradycardia. Dx: Thyroid studies (TSH elevated: yes) TMT: Life long replacement therapy, levothyroxine, Synthroid. MYXEDEMA COMA: life threatening characterized of coma, hypotension, hypothermia,resp. failure, hyponatremia, hypoglycemia.

Diabetic Ketoacidosis vs. HHNK

Ketoacidosis Serum Glucose >300 mg/dl Osmolality Variable HHNK >800 mg/dl >350 mOsm/L Negative >7.4 negative

Serum Ketones Positive Serum pH Urine Ketones <7.38 Positive

Autonomic DysreflexiaTreatment
Elevated HOB immediately Check the BP Check for sources of irritation: bladder distension, constipation.

Food sources of Potassium

Artichokes Melons Banana Prune Tangerine Broccoli Brussel Sprouts Cabbage Carrots Celery Collards Mushrooms Potatoes Spinach Apricots Nectarine Orange Strawberries Coffee (brewed not instant)

Hypercalcemia (normal 4.5-5.5)

Decreased Excitablity (Neuromuscular) Decreased GI Motility, Anorexia, Decreased bowel sounds. Decreased CNS, Decreased LOC Decreased Tendon Reflexes Treatment: Restrict Ca Intake-Dairy Products, Oatmeal, Rhuharb,Spinach Tofu

Early Signs of Shock

Level of Consciousness: restless, anxious Vital Signs: Tachycardia,
Normal BP, or slightly lower Decreased Pulse Pressure, Increased Respiratory rate, diminished peripheral pulses. Decreased urine output: increased SG, Thirsty, Cool skin

BURNS
-Infection Prevention -Wound Care -Silvadene -Sulfamylon -Pain Management -Nutrition -High Calcium , High Protein -80-90% of Pre-burn Weight -Prevent and minimize Deformity

Hodkins Disease
Dx: Reed-Sternberg Cell Sx: Painless enlarged nodes Night sweats Puritis Anorexia, Weight Loss, Fever, Fatigue

S/S: Bleeding tendencies Anemia, Pale, Fatigue, Infections, Fever, Pain-Bones and Joints Nursing Care 1. Prevent Infection 2. Prevent Injury 3. Prevent Fatigue

Leukemia Proliferation of WBC (abnormal) Normal RBCs and PLTs

Post-Mastectomy Care
1. Positioning: operative hand-above heart level. 2. Protect Arm: No IV venipunctures, B/P 3. Arm/Shoulder Exercises 4. Discharge Instructions
Prevent Injury to Affected Arm Gloves, Oven Mitts, Thimbles to sew Nail cuticles, no sunburn, no shaving (affected axillae), avoid carrying objects (affected), no constriction (Clothes, Jewelery)

Comparison of Female Cancers

Cervical Cancer Risk Factors: Early sex, multiple partners, early pregnancy, STDs, HPV. Sx: Clear discharge, painful coitus, bleeding after sex. Dx: PAP Smear Endometrial Cancer Risk Factors Infertility, Long-term estrogen exposure (early onset of menses, late menopause) Sx: Irregular uterine bleeding, Postmenopausal bleeding Dx: Endometrial Bx or D&C

Ovarian Cancer
Risk Factors Infertility Fertility Drugs Nulliparity Late Menopause Family History

Testicular Cancer
Age: 20-40 Sx: Painless lump, Swelling of the testes, Dragging Sensation No biopsy AFP, Ultrasound Orchiectomy, chemotherapy Decreased Fertility Good Prognosis

Prostate Cancer
Age: over 50 African American (Earlier) PSA (Prostate Specific Antigen) Rectal Exam Sx: Painless hematuria, s/s BPH Rx: Radiation (external, internal) Surgery, Anti-Testosterone drugs, Orchiectomy

TB Medications
Rifampin: Red-orange body secretions INH: B6 deficiency, peripheral neuropathy INH and Rifampin: Liver toxicity, AST, ALT, LDH Streptomycin: (aminoglycoside), Ototoxicity and Renal Toxicity

TB Teaching
Spread by DROPLET: cover mouth Use tissues and dispose of properly Separate eating and drinking utensils Continue meds Three Negative Acid-Fast Sputums PPD will remain Positive

Childrens reaction to illness and hospitalization

Infants and Toddlers->separation Preschoolers->Fear of Mutilation School aged and adolescents->Fear of loss of control

Priority Setting
AIRWAY BREATHING CIRCULATION SAFETY Who is at most risk or danger? Who is most likely to have serious or lifethreatening consequences if you dont assess them first?