Sunday, November 26, 2006

Review again

More review.
Drugs that change the T4 labs--
Heparin, Lithium and ASA DECREASE the T4 levels. Contraceptives increase the T4 levels.
TH supplements--Syntroid is given to treat hypothyroidism. Thyroid hormone supplements increase blood glucose. TH supplements INCREASE the effects of Digitalis glycosides---Check for Dig toxicity.Anticoags--watch for bleeding, hemorrhage. Indomethacin (for RA)..ulcer issues. .AVOID MD to decrease dosage of hypnotics to 1/2...or increase somnolence may occur.
Digoxin Toxicity--Therapeutic levels range from 0.5-2ng/mL. Usually drawn before the next dose. Or 4-10 hours after dose. Signs and symptoms = abd pain, anorexia, n/v, visual disturbances, bradycardia, arrhythmias. If signs are not severe just hold the dose. If arrhythmias….treatment will follow. Life threatening--may include administration of Digibind (digoxin immune Fab) which binds to the dig in the blood and is excreted by the kidneys.
Transphenoidal hypophysectomy. Removal of the pituitary gland. Sx treatment for removal of pituitary tumor. HOB up. CSF leak--glucose check. Antibiotics to prevent meningitis. Replacement therapy for hormones needed. NO bending. No straining for BM for 2 months. No brushing teeth for 10 days (suture removal). If the whole gland is removed…permanent diabetes insipidus.
Thyroidectomy. Pre-op--Antithyroid meds. Lugols solution prep.
Post op--semi fowlers position. Support head. Avoid tension on sutures. Pain control. Humidified O2/suction. Ice--soft diet. Shhhhh….assess voice changes. Check for hemmorage. Report complaints of pressure. Check for resp. distress---edema of glottis, Hematoma, nerve damage. Have trach set and airway at bedside. Call MD for extreme hoarseness. Check for thyroid storm--fever, tachy, agitation, delirium, coma, heart failure, shock.
Pheochromocytoma. Usually a benign tumor on adrenal medulla. Causes hypertension. Tremor headache, flushed, anxious, hyperglycemia. Check urine and plasma levels of catecholamines. 24 hour urine VMA--for test--NO coffee, tea, bananas, chocolate, ASA, vanilla. Adrenalectomy--removal of tumor may cause release of epi & norepi---increased BP & HR. If both adrenals removed….Corticosteroids needed.
Addisons Crisis. Hypotension/shock. Severe. Fever headache. -n/v/d. cyanosis. With slight overexertion or exposure to cold or infections or decrease in salt==circulatory collapse, shock, death. To prevent a crisis= replace Corticosteroids. No exertion.

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