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Adult Health II
NUR 315
Mr. Mahmoud Nasrallah, RN, MSC
Faculty of Nursing
J.U.S.T
Fall, 2010-2011
1.
2.
Assessment:
1.
Health history:
Fatigue and changes in the energy level and its effect on the daily activity
Changes in the heat and cold tolerance
Recent changes in Weight ( increase or decrease)
Fluid loss or retention
Changes in sexual functions
Changes in mood, memory, ability to concentrate and alteration in sleep
2.
Physical assessment:
3.
Diagnostic Evaluation:
Hormonal levels
Urine test for the presence of hormones such as epinephrine and
norepinephrine in the tumor of adrenal gland
Stimulation and suppression test
Thyroid Gland:
:Continue
Hypothalamic-Pituitary-Thyroid Axis
1.
Laboratory measurment
- measurement of serum TSH ( using third generation
immuno-metric assay) is the single best screening test.
- Serum free thyroxin (FT4): to confirm abnormal TSH
- Serum T3 and T4:
- T3 resin uptake test: to determine the amount of thyroid
hormone bound to thyroxine-binding globulin (TBG) and the
number of available binding sites
- Thyroid antibodies
- Thyroglobulin: to detect persistence or recurrence of thyroid
carcinom
- Radioactive Iodine Uptake
Cont
2.
3.
4.
5.
Fine-Needle Aspiration
Thyroid scan, Radioscan, or Scintiscan
Ultrasonography, CT and MRI
Other secondary Lab. Test such as ALT, SGPT, and LDH, ECG
Nursing implication to thyroid tests:
- Nursing role is to assess the patient if taken medication or
agents that may contain Iodine and thus affect test results. (
Chart 42-1 shows list of medications that may alter thyroid
test results)
Thyroid Disorders:
1.
2.
3.
4.
5.
6.
7.
8.
Hypothyroidism
1.
2.
Clinical Manifestations
Extreme Fatigue
Hair loss, brittle nails, and dry skin
Numbness and tingling of the fingers may
occur
Voice husky, hoarseness
Menstrual disturbances
Subnormal temperature and pulse rate
Gaining wt with increasing intake
Cont. manifestations
Medical Management:
1. Replacing missing hormone: to restore a normal metabolic
state: Synthetic Levothyroxin is the drug of choice to treat
hypothyroidism and nontoxic goiter
- Dosage is based on the level TSH
- monitor of TSH level is essential
- Life long therapy
-Teach the patient S/S of low and over dose of medication
2. Supportive therapy:
- Maintain Vital function: arterial blood gases due to
hypoventilation, pulse oximetry to assess O2 saturation.
- Application of external heat is avoided because it increases
oxygen requirement and may lead to vascular collapse
- concentrated glucose may given if hypoglycemia presented.
..Cont
3. Prevention of cardiac Dysfunction: Increase
oxygen supply is required during
replacement thyroid hormones due to the
effect on the heart which may lead to MI or
angina ( if happened Hormonal replacement
should be stopped and restarted in low
doses). Patient with long time
hypothyroidism develop atherosclerosis
which decrease blood supply to the
myocardium ( nurses should monitor for
MI in patient with sever, long-standing
hypothyroidism or myxedema coma)
4. Medication Interactions:
Nursing Management:
1.
2.
3.
4.
5.
:Hyperthyroidism
Clinical Manifestations:
Medical management:
1.
2.
2.
Surgical management:
Thyroidectomy
Postoperative Care
Thyroid Storm:
Manifestations:
- High fever above 38.5
- Extreme tachycardia > 130 bpm
- Exaggerated symptoms of hyperthyroidism: irritability with
disturbances of a major system ( GI: Wt loss, diarrhea, abd
pain; cardiac: edema, chest pain, dyspnea, palpitation )
- Altered neurological or mental state, as delirium, psychosis,
and coma
Medical management:
Adrenal anatomy
Regulation of hormonal secretions
Adrenal cortex Hormones:
1.
glucocorticoids (cortisole):
.Cont
2. Mineralocoticoids (Aldosterone):
- Influence electrolyte balance and blood pressure
hmeostasis.
- Retain sodium and excrete potassium and hydrogen
ions
Adrenocortical Insufficiency
(Addisons disease)
.Cont
Clinical manifestation:
Muscular weakness, Fatigue, Emaciation
GI symptoms: nausea, anorexia
Dark pigmentation of the skin
Hypotension, hypoglycemia
Mental status changes ( confusion,
depression, emotional lability, a pathy
Dehydration, low serum sodium, high serum
potassium, small heart, low cortisole level,
increased plasma ACTH
Cont
Nursing Management:
Cont
Cushings Syndrome:
1.
2.
3.
4.
5.
Clinical Manifestations:
Cont
Diagnosis
Self-care deficit
:Goal
:Intervention
Corticosteroid Therapy
Timing of doses