visceral- dull, aching, cramping, burning... intestines esp.

parietal- more severe and steady pain. like appendisitis

referred- travels from primary site to distal site.

the area with pain is always assessed last

they may gaurd that site

pain, infection/inflammation, GI, skin changes, vascular, loc, visual, urinary

watch for hx of diabetes, cancer treatments, heart disease, breaks in skin integrity(dental procedures), piercings(can cause infects), Allergies(Iodine, and shellfish)

enlarged, or fluid involvement.

liver greater than 12 cm is englarged

adrenals sit on kidneys and need to be healthy. Urine and blood test done. ACTH stimulating test- which is a hormone and watch how your adrenals react to this hormone which is also produced by the pituitary gland.

Eat a high carb diet 24 hrs before test, sometimes they fast, or not prep at all. Draw blood as a base line and inject it and wait an hour before drawing blood again.

too much cortisol in the system which causes a pituitary tumor that can cause the level to be higher.

you will see moonface with this disorder.

adrenal dificiency, a decrease in cortisol

fatigue and weight loss.

can be due to hyper and hypo thyroidism. Includes swelling around the neck that gets huger.

lack of idione-which affects sodium process

tumors

defined to a geographical area. Genetic faulty mechanism that causes it or they eat a type of food that cause it: cabbage (inhibits T4), soybeans, spinache

Lack of idione... thyroid enlarges to try to compensate for the lack of it and gets bigger from overworking.

inadequate T3 and T4 circulating which causes metablic rate to go down.

fatigue,unable to tolerate cold temps, constipation, weight gain, thin skin, brittle fingernails, depression, thinning of hair, joint aches and muscles

Late symptoms: slow thinking process, decrease sensations to taste and smell. This is usually not the primary diagnosis... usually found in other diagnosis going on. Tx is usually life long

mild type of hypothyroid disease

TH are low, but TSH are elevated. Pituitary is working but the thyroid is not.

most severe hypothyroidism

shows up with stress, drug use, trauma, resp failure, swelling around eyes, coma (100% mortality).

When they stop taking their thyroid meds.

Decrease in resp, hypoxia

If they become difficult to arouse... they are deteriorating.

also affects pituitary, gonads, hypothalmic.

Lots of energy, cannot sleep, very nervous and irritable, decreased attention span, weight loss.

hyperthyroidism

Excessive, circulating thyroid hormones in the body. Usually between ages of 20 and 40. More so in women. Normal body functions are increased.

they will have a staring gaze. elevated systolic bp, tachycardia, atrial fib,

eyes feel griddy, cant stand bright lights, hard to time closing eye lids, bulging eyes

reduce stimuli, eye drops, eye patch, elevate bed, decrease salt intake.

can be a fatal symptom

high fever

severe tachy

dehydrated

dilirium

irritability

extreme period of thyroid activity,

iodidepropythiouracil, decreases TH levels

drug of choice for pregnant women as well.

Tapazole can also be given.

Side effects alleviated in 4 to 8 weeks.

They have to take their medicine and in the right way. Do not stop the medication... being med compliant s key.

helps the glands store the thyroid hormone, need to watch for palpitations and tremors... whcih is treated with Indedrol, propanolol, corqard.

These clients need a high calorie diet 4000 to 5000 per day.

only needs 1/6 of the gland to function normally. Decreases the chance of hemorrhage if some is left and reduces chances of crisis.

Could change voice, swelling can cause resp problems, thyroid storm may occur

could have thyroid storm(know symptoms)

become hypocalcemia(accidental removal of parathyroid)signs of hypocalcemia.... call the doctor, have calcium gluconate at the bed side. (patent IV line)

hemorrhage

watch for signs of infection

neck exercises

life long therapy

watch for signs of hypocalcemia and call dr immediately

acute- inflammation of thyroid gland.

acute cause of bacterial invasion in the thyroid which can cause an abscess which can be treated with antibiotics

Sub acute- viral infection, mostly women suffer from this 80%

chronic- hashimoto's disease, will destroy the gland which can be genetic.

women are 3 x more likely to develop. peaks during the 60's but can occur at any age. Very curable because it is slow growing. Hard and irregular nodule in the glad.

Always make sure you have a trach kit at the bedside because of the swelling.

PTH is what the parathyroid produces.

Decreased calcium can leads to a negative feedback so it will keep excreting even when it doesnt need to. More women than men are affected, and clients with renal failure.

kidneys cant keep up, bone cannot keep up, organs are losing calcium

Kidney stones develope (overproduction of calcium)

Bone damage

hypercalcemia

vitamin D deficiency

SAFETY IS PRIORITY

back aches, joint pain, bone pain

calcium too high, excessive PTH

dont need to know secondary and tertiary

indications- too much pth in the blood

complications- tingling, bleeding, trach kit ready (swelling0, tetany (calcium gluconate for that), digitalis if heart rate too fast.

treating hypercalcemia- fluids to dilute calcemia in the blood... 3L per day. NS is fluid of choice which inhibits reabsorption of Ca. Lasix may also be presribed.

they can also place the parathyroids into a different area, muscle of forearm or brachial.

iatrogenic- accidental removal

idiopathic- autoimmune related.

acute hypoparathyroidism- tetany, irritability, chevosteks sign, trach kit is needed

chronic- lethargy, dry skin, depression, brittle nails, calcification in the eyes.

If left untreated can also have heart failure.

calcium and phosphorus supplements which is life long treatment.

teaching: high calcium, low phosphorus, vitamin d increase

omit cheese and milk to avoid phosphorus

Hypofunction of adrenal glands

Addison's

profound fatigue

dehydration

vascular collapse, decreased BP

Renal Shut down (decreased NA, Serum K)

Bronze skin pigmentation

hypoglycemia

postural hypotension

GI disturbances

weight loss

weakness

salt craving

muscle, joint pain

irritability

depression

This occurs when patient is under stress w/o hormone replacement... youll see sudden severe pain in back, abdomen, legs, hypo tension, LOC, shock

includes correction of fluid and electrolyte imblanace

correct hypoglycemia

replace steroids

Main goal: prevent mortality.

What should you watch for in addisonian crisis?

risk for injury

monitor for sudden weakness and other manifestations

reverse shock

restore blood circ.

replinish steroids

rapid hydration, 02, vasopressor, kayexalate resin that releases sodium ions in exchange for potassium.

IV D5 or IV glucose push bolus

Can also be given Hydrocortisone 100 mg, tapered for steroid replacement.

Over activity of the adrenal gland- hypersecretion of glucocorticoids (tumor or adrenal hyperplasia- overproduction of ACTH)

Condition is rare- mainly in women 20-40

surgical management for cushing's

and medical management

removal of both or one adrenal gland

Adrenal blocking agents (ACTH), ACTH-reducing agents (periactin). Radiation therapy

Adrenomedullary disorder:

Pheochromocytoma

middle aged individuals, not over 60

smoking, micturition, histamines, thymine, anesthetics, atropine, opiates, steroids, glucagon

manifestations of diabetes

hypertension, hyperthyroidism, diaphoresis, agitation, rapid pulse, palpitations

Acute attacks, diaphoresis, dilated pupils, cold extremities

this is curable

Regitime IV

surgery, adrenalectomy (avoid caffeine during this procedure).

rest, sedatives, adequate diet, high in vit. minerals and calories.

decrease in ADH and increased urination results. (Polyuria) sometimes up to 181 L a day. Urine would be clear and dilute.

weight loss, dry skin, chronic kidney disease.

removing the tumor will reverse these effects.

increase production of ADH and do not urinate at all. decreased NA level, less than 125 is critical.

fluid over load, mental status

hypertonic solution given to correct this.

Insulin enters blood from pancreas, then to the liver, healthy balance in the blood of glucose. Your cell has to be receptive to the insulin to absorb it.

In T1, same thing happens, but unhealthy amounts of glucose is not in the blood stream. So nothing is there to bind to the cells to get glucose to the cells. So insulin is not effective to transport the glucose.

In T2, body needs more insulin but cant produce it. The body requires more. May have genetic resistance to their insulin. They dont exercise, too much animal food. Patients get overweight, all those fat cells absorb all the glucose.

Genetics

Environmental stressors

Destruction of alpha and beta cells in pancreas.

You will see excess glucose in the body, which comes from protien and fat stores because insulin is not works. Failure to produce insulin as well.

wasting lean body mass

increased ketones in the urine and blood

acidosis because of increase in ph, ketones

fatigue

weight loss

increased urination occurrs (kids will start wetting their beds at night)

Breath will smell like acetone(fruity)

diabetic neuropathy, teach these clients about shoes because they lose sensation in hands and feet. They are prone to ulcers on their feet.

small vessel disease

can have diabetic retinopathy which can be treated through a laser.

Atherosclerosis can also occur

HTN occurs, CAD

Decrease in immune functioning

proned to infection, delayed wound healing

T1 occurs <30 years of age

a more common disorder for children

T2 is more environmental. Usually happens over the age of 40 and more prevelant in africans and hispanics, obese adults.

insulin pins

refrigerators

food situation

increased respirations (extremely) in rate in depth

Kussmaul respirations

nausea and vomiting

loss of 10% of body weight

Treatement: NS-IV 1000ml an hour unless they have cardiac issues

Insulin

rehydrate

Teaching

These patients are acidotic, they can go into a diabetic coma if it is not treated.

get shaky and nervous

sweat

confusion

Blood tests confirm this diagnosis

emergency foods, .5 cup of orange juice, soda

8 life savers, gum drops

toats, fruit juice

underneath the stomach

Acute pancreatitis, is very painful- severe upper abdominal pain resolves within dys of proper tx and medication. Alcoholics and pancreatic tumors are proned to this condition.

wont let them eat or drink for several days

NG tube

IV

diarrhea, oily stools (steatorrhea), weight loss.

Treated:pain mainagement, fluid and nutritional supp, synthetic enzymes may be prescribed in the case of a normal diet. IV, NG tube

Teaching: no smoking or drinking alcohol.

common

abdominal swelling distention or bloating with quick onset. Will occur within mins of a fatty meal.

Fever, chills, nausea, referred pain (abdomin to shoulder)

more likely to occur in women, overweight, older individuals.

Occurs do to cholesterol

NG tube to decrease comfort and meds.

Very light colored stools and heart burn that comes and goes.

Reduce pain, electrolyte and fluid, abdominal ultrasound, shockwave lithotripsy, gallbladder removal.

contra- too large of a gall stones or gall bladder then they have to have cholecystectomy regular

Cough and deep breathing is important.

sign of a disease process

yellow skin, sclear

high levels of billirubin

High billi, can be brown eyes.

clay colored feces, tea colored urine

pruritus

fatigue and anorexia

Med and surg management: cholesteromine resin, antihistimines, phenobarb

Whats cause the jaundice, maintain skin integrity, disturbed body image

thought to be spread from an infected persons stool from no good hand hygiene. incubation: 2 to 6 weeks

Acute condition

most serious condition

mother to child at birth, blood, needles, sexual contact

4 to 25 weeks for incubation period

90% is considered acute.

Direct blood contact, contaminated needles, blood transfusion

Careful when you get manicure and pedicure.

acupuncture needles.

5 to 10 weeks incubations

IV drug users

usually if they have HBV, you have to have HBV before you can have HDV

common precursor to cirrhosis

after several decades of alcohol abuse.

drug is through the inhalation of toxins... like what they use to treat TB, tylenol, some oral contraceptives, erythromycin.

symptoms seem to be flu like, and you dont recover

nausea, vomiting, loss of appitite.

A, E, and nonviral can be recovered from the rest cannot.

liver biopsy

Treatment: A resolves on its own, hep B is rest and high carb diet.

For drug hep C they can flush the stomach.

patients are usually very tired.

high calorie, low fat, high carbs, and high protient.

small meals and frequent snacks.

Questran can be combined with bile salts to get them out of the system.

Serum albumin IV which increases urine output and liver function

Injures and kills liver cells. The liver begins to scar and cannot regenerate themselves when the cells die.

SS:

Can be very edeitimas,yellow eyes, itch, nose bleeds, redness in palms of hands, muscle wasting and weight loss

varisile bleeding, spleen enlarges (low platelet count), altered brain function, encephalopothy

Portal hypertension, the blood cannot flow from the liver to other organs do to the scarred tissue which puts pressure on to the veins leads to fluid build up and renal failure.

Go in and put stents to open it up

major complication of cirrhosis

portal hypertension is the main reason for this.

Vasodialators may be used.

These patients have water retention/ Na retention.

0.25 Albumin given to reduce that extra fluid.

If color is translucent- it is normal

If color is brown- they have hyperbillirunemia

If color is cloudy or turbid- infection

if pink or bloody- trauma

grossly bloody- cancer