💓 Savvy NurseLouvri aplikasyon an

🫀 Adaptasyon Fizyolojik · Leson 9 sou 10 · 8 min

Tiwoyid, Surrenal ak Òmòn Dlo yo

Thyroid, Adrenal and the Water Hormones

🔥 Tanpèt tiwoyid kwit pasyan an. Koma myxedema friz yo. Kriz Addison desann presyon an epi monte potasyòm nan. Chak gen yon deklanchè, yon imaj ak yon premye medikaman egzamen an espere ou nonmen.

🔥 Thyroid storm cooks the client. Myxedema coma freezes them. Addisonian crisis drops the pressure and raises the potassium. Each one has a trigger, a picture and a first drug the exam expects you to name.

💡 Ide prensipal

Addison: sodyòm ba, potasyòm wo, presyon ba; bay hydrocortisone. Cushing: opoze a. DI vide pipi dilye epi sodyòm nan monte; SIADH kenbe dlo epi sodyòm nan tonbe.

Addison's: low sodium, high potassium, low pressure; give hydrocortisone. Cushing's: the opposite. DI pours out dilute urine and the sodium climbs; SIADH holds water and the sodium falls.

🧠 Poukisa sa enpòtan

IPÈTIWOYIDISM (maladi Graves): entolerans chalè, pèt pwa, takikadi, tranbleman, exophthalmos; trete ak methimazole oswa propylthiouracil, beta blockers ak iodine radyoaktif. TANPÈT TIWOYID, deklanche pa enfeksyon, operasyon oswa estrès: lafyèv, takikadi grav, ajitasyon ak delirium; trete ak refwadisman, beta blockers, medikaman antitiwoyid, iodine ak steroids. IPOTIWOYIDISM: entolerans fredi, pran pwa, bradikadi, konstipasyon, fatig; levothyroxine chak maten sou yon vant vid, dòz verifye pa TSH. KOMA MYXEDEMA: ipotèmi, ipotansyon, bradikadi, ipovantilasyon ak konsans diminye; sipòte wout respiratwa ak respirasyon anvan, apre sa bay IV levothyroxine ak IV hydrocortisone jiskaske ensifizans surrenal elimine, epi chofe gradyèlman ak chofaj pasif tankou dra. Apre THYROIDECTOMY: yon seri tracheostomy ak calcium gluconate bò kabann nan, verifye dèyè kou a pou senyen, koute yon vwa rau, epi veye tetani. MALADI ADDISON (ensifizans surrenal): fatig, pèt pwa, po bwonz, IPOTANSYON, IPONATREMI, IPÈKALEMI ak ipoglisemi; steroids pou tout lavi yo pa janm sispann bridsoukou epi yo ogmante pandan maladi. KRIZ ADDISON: ipotansyon pwofon ak chòk; IV hydrocortisone, likid ak glikoz. SENDWÒM CUSHING: figi lalin, bos buffalo, obezite tronkal, striae, po mens, IPÈTANSYON, IPÈGLISEMI, IPOKALEMI, osteoporoz ak risk enfeksyon. DYABÈT ENSIPID: pipi dilye masif (gravite espesifik anba 1.005), swaf ak IPÈNATREMI; DI santral trete ak desmopressin, alòske DI nefwojenik trete ak dyiretik thiazide, yon rejim ba sodyòm ak retire kòz la (pa egzanp, lithium). SIADH: retansyon likid, pipi konsantre ak IPONATREMI; trete ak restriksyon likid ak saline ipètonik lè grav.

HYPERTHYROIDISM (Graves' disease): heat intolerance, weight loss, tachycardia, tremor, exophthalmos; treated with methimazole or propylthiouracil, beta blockers and radioactive iodine. THYROID STORM, triggered by infection, surgery or stress: fever, severe tachycardia, agitation and delirium; treat with cooling, beta blockers, antithyroid drugs, iodine and steroids. HYPOTHYROIDISM: cold intolerance, weight gain, bradycardia, constipation, fatigue; levothyroxine every morning on an empty stomach, dose checked by TSH. MYXEDEMA COMA: hypothermia, hypotension, bradycardia, hypoventilation and decreased consciousness; support the airway and breathing first, then give IV levothyroxine with IV hydrocortisone until adrenal insufficiency is ruled out, and warm gradually with passive warming such as blankets. After THYROIDECTOMY: a tracheostomy set and calcium gluconate at the bedside, check behind the neck for bleeding, listen for a hoarse voice and watch for tetany. ADDISON'S DISEASE (adrenal insufficiency): fatigue, weight loss, bronze skin, HYPOTENSION, HYPONATREMIA, HYPERKALEMIA and hypoglycemia; lifelong steroids that are never stopped abruptly and are increased during illness. ADDISONIAN CRISIS: profound hypotension and shock; IV hydrocortisone, fluids and glucose. CUSHING'S SYNDROME: moon face, buffalo hump, truncal obesity, striae, thin skin, HYPERTENSION, HYPERGLYCEMIA, HYPOKALEMIA, osteoporosis and infection risk. DIABETES INSIPIDUS: massive dilute urine (specific gravity under 1.005), thirst and HYPERNATREMIA; central DI is treated with desmopressin, while nephrogenic DI is treated with thiazide diuretics, a low-sodium diet and removal of the cause (e.g., lithium). SIADH: fluid retention, concentrated urine and HYPONATREMIA; treat with fluid restriction and hypertonic saline when severe.

🏥 Nan lavi reyèl

🧂 Yon pasyan sou prednisone long tèm pou arthritis sispann pran li paske 'doulè a pi bon'. Twa jou apre li nan depatman ijans ak yon tansyon 76/40, yon sodyòm 126 ak yon glikoz 58. Surrenal yo, siprime pandan ane, pa ka reponn. IV hydrocortisone ak likid ranvèse kriz la. Ansèyman li te bezwen an te kat mo: janm sispann steroids bridsoukou.

🧂 A client on long-term prednisone for arthritis stops taking it because 'the pain is better'. Three days later she is in the emergency department with a blood pressure of 76/40, a sodium of 126 and a glucose of 58. The adrenals, suppressed for years, cannot respond. IV hydrocortisone and fluids reverse the crisis. The teaching she needed was four words: never stop steroids abruptly.

📌 Sa pou retni

  • Tanpèt tiwoyid: cho ak rapid; koma myxedema: frèt ak dousmanThyroid storm: hot and fast; myxedema coma: cold and slow
  • Addison: iponatremi, ipèkalemi, ipotansyon; janm sispann steroids bridsoukouAddison's: hyponatremia, hyperkalemia, hypotension; never stop steroids abruptly
  • DI: pipi dilye, ipènatremi, desmopressin pou DI santral; SIADH: iponatremi, restriksyon likidDI: dilute urine, hypernatremia, desmopressin for central DI; SIADH: hyponatremia, fluid restriction

📖 Tèm nan leson sa a

Kriz Addison (Addisonian crisis): Ipotansyon pwofon ak chòk akoz ensifizans adrenal, souvan maladi, estrès oswa esteroyid yo rete sibit deklanche l; yo trete l ak hydrocortisone IV.

Tanpèt tiwoyid (Thyroid storm): Yon ogmantasyon òmòn tiwoyid ki menase lavi ak gwo lafyèv, takikadi grav ak ajitasyon.

Koma miksedèm (Myxedema coma): Ipotiwoyidi grav ak ipotèmi, bradikadi, ipotansyon ak konsyans diminye.

Dyabèt ensipid (Diabetes insipidus): Twò piti òmòn antidiretik, oswa ren ki pa reponn a li, ki pwodui gwo volim pipi dilye ak yon sodyòm k ap monte.

SIADH: Twòp òmòn antidiretik, ki lakòz retansyon dlo, pipi konsantre ak yon sodyòm k ap bese.

HOT AND NERVOUS, COLD AND SLUGGISH (tiwoyid) (HOT AND NERVOUS, COLD AND SLUGGISH (thyroid)): Ipètiwoyidi kouri cho ak nè (entolerans chalè, pèt pwa, takikadi, tranbleman); ipotiwoyidi kouri frèt ak lant (entolerans fredi, pran pwa, bradikadi, konstipasyon): triye sentòm tiwoyid la.

ADDISON'S = ADD, CUSHING'S = CUSHION (pwoblèm adrenal) (ADDISON'S = ADD, CUSHING'S = CUSHION (adrenal disorders)): Addison's se twò piti cortisol, kidonk ADD steroids (tansyon ba, sodyòm ba, potasyòm wo); Cushing's se twòp, yon CUSHION grès (vizaj lalin, glikoz wo, tansyon wo).

T4 lib (thyroxine) (Free T4 (thyroxine)): T4 lib ozanviwon 0.8 a 1.8 ng/dL (T4 total ozanviwon 5 a 12 mcg/dL); li wo ak yon TSH ba nan ipètiwoyidis epi li ba ak yon TSH wo nan ipotiwoyidis, epi dòz levothyroxine la ajiste dapre TSH.

Cortisol (serom nan maten) (Cortisol (morning serum)): Ozanviwon 5 a 25 mcg/dL a 8 AM, pi ba nan aswè; ba montre maladi Addison oswa sipresyon esteroyid alontèm, wo montre sendwòm Cushing oswa estrès, epi yon valè trè ba nan chòk se yon kriz adrenal.

Levothyroxine: Ranplasman ipotiwoyidis pou tout lavi, pran sou lestomak vid 30 a 60 minit anvan dejene epi a 4 èdtan distans ak kalsyòm, fè oswa antiasid; twòp imite ipètiwoyidis (kè k ap bat vit, ensomni, pèdi pwa), TSH gide dòz la, epi pa janm itilize pou pèdi pwa.

Methimazole ak propylthiouracil (PTU) (Methimazole and propylthiouracil (PTU)): Medikaman antitiwoyid pou ipètiwoyidis ki pran semèn pou travay; toude ka elimine globil blan, kidonk yon malgòj oswa lafyèv rapòte imedyatman, PTU pote yon avètisman nan bwat pou ensifizans fwa men li prefere nan premye trimès la, epi methimazole sinon.

Kortikosteroyid (prednisone, hydrocortisone, dexamethasone) (Corticosteroids (prednisone, hydrocortisone, dexamethasone)): Siprime enflamasyon epi ranplase òmòn adrenal; atann glikoz wo, enfeksyon maske, retansyon likid, pèt zo ak senyen GI, bay yo ak manje nan maten, pa janm sispann bridsoukou, epi bay hydrocortisone IV touswit pou kriz adrenal oswa lè yon pasyan ki depann de esteroyid strese.

✅ Teste tèt ou

Yon pasyan ki gen maladi Addison admèt ak yon tansyon 78/44, sodyòm 127 mEq/L ak potasyòm 5.8 mEq/L. Ki medikaman enfimyè a prevwa anvan?A client with Addison's disease is admitted with a blood pressure of 78/44, sodium 127 mEq/L and potassium 5.8 mEq/L. Which medication does the nurse anticipate first?
  1. Desmopressin
  2. IV hydrocortisone
  3. Levothyroxine
  4. Insulin

Repons: B · IV hydrocortisone

Kriz Addison trete ak glucocorticoids IV ak likid pou restore presyon epi korije elektwolit yo. Insulin ta sèlman deplase potasyòm antre nan selil yo pou yon ti tan epi li pa fè anyen pou ipotansyon an; potasyòm wo a soti nan òmòn surrenal ki manke yo.

Addisonian crisis is treated with IV glucocorticoids and fluids to restore pressure and correct the electrolytes. Insulin would only shift potassium into cells for a while and does nothing for the hypotension; the high potassium comes from the missing adrenal hormones.

Apre yon thyroidectomy, ki rezilta enfimyè a dwe rapòte imedyatman?After a thyroidectomy, which finding should the nurse report immediately?
  1. Yon tanperati 37.4 °C (99.3 °F)A temperature of 37.4 °C (99.3 °F)
  2. Pikotman alantou bouch la ak spasm nan miskTingling around the mouth and muscle spasms
  3. Doulè nan ensizyon an evalye 3/10Pain at the incision rated 3/10
  4. Vwa rau lejè k ap amelyoreMild hoarseness that is improving

Repons: B · Pikotman alantou bouch la ak spasm nan misk

Pikotman alantou bouch ak spasm siyale ipòkalsemi soti nan lesyon paratiwoyid; yo bay calcium gluconate epi yo dwe anpeche laringospasm. Vwa rau lejè komen apre operasyon kou ak entibasyon, epi vwa rau k ap amelyore se pa yon ijans.

Perioral tingling and spasms signal hypocalcemia from parathyroid injury; calcium gluconate is given and laryngospasm must be prevented. Mild hoarseness is common after neck surgery and intubation, and hoarseness that is improving is not an emergency.

Yon pasyan gen pipi 6 lit pa jou ak yon gravite espesifik 1.002 ak yon nivo sodyòm 152 mEq/L. Ki kondisyon ki pi pwobab?A client has urine output of 6 liters per day with a specific gravity of 1.002 and a sodium level of 152 mEq/L. Which condition is most likely?
  1. SIADH
  2. Sendwòm CushingCushing's syndrome
  3. IpètiwoyidismHyperthyroidism
  4. Dyabèt ensipidDiabetes insipidus

Repons: D · Dyabèt ensipid

Gwo volim pipi dilye ak ipènatremi defini dyabèt ensipid; SIADH pwodui imaj opoze a.

Large volumes of dilute urine with hypernatremia define diabetes insipidus; SIADH produces the opposite picture.

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