#NP3 Part 1 KEY POINTS

#SPLE

In CUSHINGS disease Because of

changes in fat distribution,
adipose tissue accumulates in the
trunk, face (moonface), and
dorsocervical areas (buffalo
hump).

Chvostekʼs sign is elicited by

tapping the clientʼs face lightly
over the facial nerve, just below
the temple. If the clientʼs facial
muscles twitch, it indicates
hypocalcemia.

Hyponatremia is indicated by
weight loss, abdominal cramping,
muscle weakness, headache, and
postural hypotension.

Hypernatremia can cause

CEREBRAL EDEMA

Hypokalemia causes paralytic

ileus and muscle weakness.
Clients with hypermagnesemia
exhibit a loss of deep tendon
reflexes, coma, or cardiac arrest.

Hyperglycemia, which develops

from glucocorticoid excess, is a
manifestation of Cushingʼs
syndrome. With successful
treatment of the disorder, serum
glucose levels decline.

Hirsutism is common in Cushingʼs

syndrome; therefore, with
successful treatment, abnormal
hair growth also declines.

Osteoporosis occurs in Cushingʼs

syndrome; therefore, with
successful treatment, bone
mineralization in creases.

Amenorrhea develops in
Cushingʼs syndrome.

Regular insulin, which is a short-

acting insulin, has an onset of 15
to 30 minutes and a peak of 2 to
4 hours. IF the nurse gave the
insulin at 2 p.m., the expected
onset would be from 2^15 p.m. to
2^30 p.m. and the peak from 4
p.m. to 6 p.m.

Agitation, irritability, poor

memory, loss of appetite, and
neglect of oneʼs appearance may
signal depression, which is
common in clients with Cushingʼs
syndrome.

Neuropathy affects clients with

diabetes mellitus

Hyperthyroidism typically causes

such signs as goiter,
nervousness, heat intolerance,
and weight loss despite increased
appetite.

Tetany may result if the

parathyroid glands are excised or
damaged during thyroid surgery.

Hemorrhage is a potential
complication after thyroid surgery
but is characterized by
tachycardia, hypotension,
frequent swallowing, feelings of
fullness at the incision site,
choking, and bleeding.

Thyroid storm is another term for

severe hyperthyroidism — not a
complication of thyroidectomy.

Laryngeal nerve damage may

occur postoperatively, but its
signs include a hoarse voice and,
possibly, acute airway
obstruction.
Levothyroxine is the preferred
agent to treat primary
hypothyroidism and cretinism,
although it also may be used to
treat secondary hypothyroidism.
It is contraindicated in Gravesʼ
disease and thyrotoxicosis
because these conditions are
forms of hyperthyroidism.

SIADH secretion causes

antidiuretic hormone
overproduction, which leads to
fluid retention.

Severe SIADH can cause such

complications as vascular fluid
overload, signaled by neck vein
distention.

Pheochromocytoma causes
excessive production of
epinephrine and norepinephrine,
natural catecholamines that raise
the blood pressure.

Phentolamine is the drug of

choice, an alpha-adrenergic
blocking agent given by I.V. bolus
or drip, antagonizes the bodyʼs
response to circulating
epinephrine and norepinephrine,
reducing blood pressure quickly
and effectively.

methyldopa is an
antihypertensive agent available
in parenteral form, it isnʼt
effective in treating hypertensive
emergencies.

Mannitol, a diuretic, isnʼt used to

treat hypert ensive emergencies.

Excessive secretion of
aldosterone in the adrenal cortex
is responsible for the clientʼs
hypertension.

The adrenal medulla secretes the

catecholamines — epinephrine
and norepinephrine.

Addisonʼs disease decreases the

production of all adrenal
hormones, compromising the
bodyʼs normal stress response
and increasing the risk of
infection.

Addisons most appropriate

Nursing diagnosis is RISK of
infection

Other appropriate nursing

diagnoses for a client with
Addisonʼs disease include
Deficient fluid volume and
Hyperthermia.

Acarbose delays glucose

absorption, so the client should
take an oral form of dextrose
rather than a product containing
table sugar when treating
hypoglycemia.

After a transsphenoidal
hypophysectomy, the client must
refrain from coughing, sneezing,
and blowing the nose for several
days to avoid disturbing the
surgical graft used to close the
wound.

The head of the bed must be

elevated, not kept flat, to prevent
tension or pressure on the suture
line.

Within 24 hours after a

hypophysectomy, transient
diabetes insipidus commonly
occurs; this calls for increased,
not restricted, fluid intake.

Visual, NOT auditory, changes are

a potential complication of
hypophysectomy.
The client must continue to
monitor the blood glucose level
during glipizide therapy.

For client with necrosis , wet-to-

dry dressings are most
appropriate because they clean
the foot ulcer by debriding
exudate and necrotic tissue, thus
promoting healing by secondary
intention.

In the client with hyperthyroidism,

Imbalanced
nutrition: Less than body
requirements the most important
nursing diagnosis.

Serum osmolarity is the

mostimportant test for confirming
HHNS

A client with HHNS typically has

hypernatremia and osmotic
diuresis. ABG values reveal
acidosis, and the potassium level
is variable.

Insulin should never be shaken

because the resulting froth
prevents withdrawal of an
accurate dose and may damage
the insulin protein molecules.

Insulin also should never be

frozen because the insulin protein
molecules may be damaged.

Intermediate-acting insulin is
normally cloudy.

if client is having hypoglycemic

episode, the nurse should first
administer a fast-acting
carbohydrate, such as orange
juice, hard candy, or honey.

If the client has lost

consciousness, the nurse should
administer either I.M. or
subcutaneous glucagon or an I.V.
bolus of dextrose 50%.

The client who has undergone

athyroidectomy is at risk for
developing hypocalcemia from
inadvertent removal or damage to
the parathyroid gland.

The client with hypocalcemia will

exhibit a positive Chvostekʼs sign
(facial muscle contraction when
the facial nerve in front of the ear
is tapped) and a positive
Trousseauʼs sign (carpal spasm
when a blood pressure cuff is
inflated for a few mi nutes).

The normal serum amylase level

is 25 to 151 units/L. With chronic
cases of pancreatitis, the rise in
serum amylase levels usually
does not exceed three times the
normal value.

In acute pancreatitis, the value

may exceed five times the normal
value.

The client with cirrhosis needs to

consume foods high in thiamine.
Thiamine is presentin a variety of
foods of plant and animal origin.
Pork products are especially rich
in this vitamin. Other good food
sources include nuts, whole grain
cereals, and legumes.

During the insertion of a

nasogastric tube, if the client
experiences difficulty breathing
or any respiratory distress,
withdraw the tube slightly, stop
the tube advancement, and wait
until the distress subsides.

If the nasogastric tube is in the

stomach, the pH ofthe contents
will be acidic. Gastric aspirates
have acidic pH values and should
be 3.5 or lower.

When the nurse removes a

nasogastric tube,the client is
instructed to take and hold adeep
breath. This will close the
epiglottis. This allows for easy
withdrawal through the
esophagus into the nose. The
nurse removes the tube with one
smooth, continuous pull.

If a client has a nasogastric tube

connected to suction,the nurse
should wait up to 30 minutes
before reconnecting the tube to
the suction apparatus to allow
adequate time for medication
absorption.

When the client has a

Sengstaken-Blakemore tube, a
pair of scissors must be kept at
the clientʼs bedside at all times.
The client needs to be observed
for sudden respiratory distress,
which occurs if the gastric
balloon ruptures and the entire
tube moves upward. If this
occurs, the nurse immediately
cuts all balloon lumens and
removes the tube. An obturator
and a Kelly clamp are kept at the
bedside of a client with a
tracheostomy. An irrigation set
may be kept at the bedside, but it
is not the priority item.