Nursing Care ● Dietary management- NPO initially, after 24-48 hours, begin jejunal feedings ● When food is tolerated, advance to small frequent feedings- moderate to high carbohydrates, high protein, low-fat meals ● NGT for the severely ill- with intractable vomiting or biliary obstruction ● Pain management- ● Positioning- fetal, sitting up, leaning forward ● Monitor bowel sounds ● Intake and output ● Monitor respirations ● Reassure client and explain procedures. Health Education ● Lifestyle changes- cessation of alcohol- AA ● Diet modification ● Take enzymes before meals or snacks ● Follow up with scheduled lab work and appointment ● Therapeutic measures: TPN, surgery like cholecystectomy, Pancreaticojejunostomy HYPO/HYPERTHYROIDISM: HYPOTHYROIDISM: Hypothyroidism ● Result from deficient production of thyroid hormones by the thyroid glands. ● Most common disorder of the thyroid functions ● Affects between 1-2% of US population ● More common in women than men ● Can be primary (99% of cases) or central ● (related to pituitary or hypothalamic failure)- less common
Signs and symptoms ● Fatigue and weakness ● Increased sensitivity to Cold ● Constipation ● Dry skin, brittle hair and nails ● Weight gain ● Deepened, hoarse voice ● Joint pain ● Hyperlipidemia and anemia ● Depression ● Menstrual disturbances ● TX: Levothyroxine *Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is the most common cause of hypothyroidism in the United States. It is an autoimmune disorder in which antibodies directed against the thyroid gland lead to chronic inflammation.* Laboratory tests that the doctor prescribes for hypothyroidism- Hormones specific to thyroid: T3, T4, TSH (especially in Graves Disease): ● Blood tests ● Low serum T4 and T3 in hypothyroidism ● Elevated TSH in hypothyroidism ● Graves' disease is an autoimmune disorder that causes hyperthyroidism ● If you have Graves’ disease, your thyroid-stimulating hormone (TSH) level will probably be very low because the pituitary gland will try to compensate for the excess T3 and T4 hormones in the blood ● People with Graves’ disease will usually have too much T3 and T4 in their blood HYPERTHYROIDISM: Hyperthyroidism ● The excessive secretions of thyroid hormones ● Grave’s disease- most common type- causes overstimulation of thyroid by circulating immunoglobulins. Symptoms ● Anxiety and irritability ● Insomnia and fatigue ● Tachycardia ● Tremors ● Diaphoresis
● Intolerance to heat ● Weight loss ● Exophthalmos ● Diarrhea ● Light or absent menstrual cycle ● Tx: propylthiouracil (PTU) and methimazole and radioactive iodine If the thyroid hormones are excreted in large amount: Thyroid storm/Thyrotoxicosis ● Signs and symptoms: hyperpyrexia, tachycardia, HTN, exaggerated symptoms of hyperthyroidism ● Increase in pulse rate and basal metabolic rate Hyperthyroidism if not treated can lead to thyroid crisis.
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- acute pain