Nursing 212

Health Differences Across the Lifespan 2 Study Guide The patient with pheochromocytoma is invariably volume depleted. The chronically elevated adrenergic state characteristic of an untreated pheochromocytoma leads to near to total inhibition of renin-angiotensin activity, resulting in excessive fluid loss in the urine and thus reduced blood volume. Once the pheochromocytoma has been resected, removing the major source of circulating catecholamines, a situation arises where there is both very low sympathetic activity and volume depletion. This can result in profound hypotension. It is advised to "salt load" pheochromocytoma patients before their surgery. This may consist of simple interventions such as consumption of high salt food pre-operatively, direct salt replacement, or through the administration of intravenous saline solution. A norepinephrine crisis (similar to panic attack) is increased HR, sweating, increased BP, and angina. It is diagnosed with a urine collection and test for increased VMA. The patient should be place in semi- fowlers and consume a high calorie, high vitamin, high mineral diet. Stimulants should be restricted. Treatment includes regitine (phentolamine), an alpha-adrenergic blocker, and a vasodilator (Nipride). Nurses should monitor blood pressure, urine glucose, and ketones daily. Complications include cardiac arrest, cerebral hemorrhage, blindness, and renal failure. Hyperthyroidism Hyperthyroidism, also known as grave’s disease or thyrotoxicosis, is the excessive secretion of thyroid hormone (TH) from the thyroid gland, leading to increased basal metabolic rate, cardiovascular function, GI function, neuromuscular function, weight loss, and heat intolerance. Thyroid hormone affects metabolism of fats, CHO, and proteins. Hyperthyroidism can be caused by excess secretion of TSH from the pituitary gland, autoimmune reaction (Grave’s Disease), thyroiditis (inflammation or viral infection of thyroid), tumor, side effects of certain drugs, and excessive dose of thyroid medication. Signs and symptoms of hyperthyroidism include heat intolerance, nervousness, mood swings, diaphoresis, tachycardia, palpitations, increased hunger, fine hand tremors, exophthalmos (bulging eyes) dysrthymias, hypertension, diarrhea, possible abdominal pain, possible blurred vision, lacrimation, photophobia, moist skin, thin hair, amenorrhea, decreased fertility (females), and decreased libido and impotence (males). Weight loss, possible fluid volume deficit, and high basal metabolic rate are also symptoms. Thyroid storm (thyroid crisis): temperature over 102F, tachycardia, delirium, agitation, coma, death, hyperpyrexia, hypertension, dehydration, arrhythmias, diarrhea, heart rate greater than 130, diaphoresis, and cardiac dysrhythmias Thyrotoxicosis: high thyroid hormone levels that leads to exophthalmos, which is a protrusion or bulging of the eyeballs; thyroid gland will be enlarged; Elevated T3, T4, and low TSH; endemic goiter is when iodine intake is deficient; tetany manifests with low calcium, caused by accidental removal or nicking of the parathyroid glands during thyroidectomy; symptoms are restlessness, irritability, photophobia, muscle cramps, twitching, tingling, and numbness around mouth, nose, ears, or extremities.

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