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Health Differences Across the Lifespan 2 Study Guide metabolic rate, increased fatigue, low temperature, cold intolerance, low heart rate, stiff joints, weight gain and hair loss are also signs. Diagnostics: decreased T4 and free T; normal T3 and increased TSH levels; elevated serum lipids Treatment: thyroid replacement, such as desiccated thyroid; thyroxine (Synthroid) or triiodothyronine (Cytomel); give medications in morning, one hour before food intake or two hours after food intake to facilitate absorption; adjust environment temperature, use blankets as needed for warmth; chilling increases metabolic rate, cardiac workload, and oxygen demand; pace activities with rest periods; instruct patient to report shortness of breath, fatigue, dizziness, or any discomfort; encourage intake of 2000ml of water daily and a high fiber diet to promote regular bowel movements; give Synthroid on an empty stomach; use caution when administering Coumadin since levothyroxine enhances the effects of Coumadin. Cretinism Cretinism is a congenital condition where there is low thyroid hormone during fetal and newborn development. Cretinism is a condition of severely stunted physical and mental growth due to untreated congenital deficiency of thyroid hormones (congenital hypothyroidism) usually due to maternal hypothyroidism. Symptoms are low heart rate and constipation. Treatment is with a thyroid supplement. Addison’s Disease Addison’s disease is an adrenal insufficiency. It is a secretion of insufficient mineralocorticoids, glucocorticoids, and androgens. The low levels of corticosteroids cause postural low blood pressure, weight loss, nausea and vomiting, with the skin a bronze color. This disease may be a result from an autoimmune disorder, tuberculosis, septicemia, AIDS, bilateral Adrenalectomy, infiltrative diseases, and sudden cessation of long term high dose steroid medication. Decreased aldosterone and cortisol levels lead to hyponatremia, hyperkalemia, decreased extracellular fluid, decreased intravascular volume, decreased gluconeogenesis, hypoglycemia, and stress intolerance. High ACTH levels lead to hyperpigmentation. Signs and symptoms include anorexia, bronzed skin pigmentation of nipples, scars and buccal mucosa, hypoglycemia, orthostatic hypotension, weakness, lethargy and weight loss. Decreased aldosterone (most biologically active mineralocorticoid hormone) is also seen. Aldsoterone increases sodium reabsorption by the kidneys, thereby indirectly regulating blood levels of potassium, chloride, bicarbonate, pH, blood volume, and blood pressure. This causes a disturbance in sodium, water, and potassium metabolism. Decreased cortisol (glucocortical hormone) causes abnormal metabolism of fat, protein, carbohydrate, sodium, and potassium. Medical Management: Maintain fluid and electrolyte balance, analyze lab values, check I&O and daily weight, encourage 3000ml of daily oral fluid intake and added sodium to the diet. Promote safety by using appropriate walking assistive devices, adequate lighting, a clear area for walking, and

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