Med SURG 2 Final HESI review 2020 Latest Graded A

Med SURG 2 Final HESI review 2020 Med surg 1 review/Med surg 2 review: Renal assessment Bun 8 – 25 Creatinine 0.6 – 1.3 Uric acid 2.5 – 8 Potassium 3.5 - 5 GFR 125/min (60 is good for kidney pt) Specific gravity – 1.003 – 1.02 AST: 0 – 35 ALT: 10 – 35 Albumin: 3.5 – 5.5 (same as potassium) Bilirubin: 0.1 – 1.2 mg/dl Amylase: 25-150 Lipase: 10 – 140 Thyroid • Hypothyroid- high TSH (trying to stimulate thyroid to work), low T3 and T4 o Everything slows down (bowel movements), hair falls out, dry skin, fat, fatigue, Puffy face o Give synthroid in morning before meals (at same time) o Myxedema (opposite of thyroid storm) – decrease mental status, hypothermia, slowing of organ function o After a thyroidectomy, a client is at risk for developing hypocalcemia.  Trousseau sign (carpal spasm w BP cuff) • Hyperthyroid- TSH is low (thyroid already working too much) o Thyroid storm, inc BP, diarrhea, weight loss, exopthalamous, heat intolerance, nausea o Thryorid storm - fever, hyperreflexia, abdominal pain, diarrhea, dehydration rapidly progressing to coma, severe tachycardia, extreme vasodilation  Radioactive iodine- stay away from pregnant people and chidren for 24 hours  Thyroidectomy- watch for hypothyroid, HOB raised (incision), watch for blood. Watch for thyroid storm.  Graves disease is the result of increased thyroid, not parathyroid, activity. • Hyperparthyroidism o calcium = too high  bone pain (kidney stones, concentration problems) o Elevated serum calcium levels produce osmotic diuresis and thus polyuria.  This diuresis leads to dehydration (weight loss rather than weight gain).  Calcium is being pulled from the bones  aka excess bone reabsorption  bone pain • Hypoparathyroidism (hypo  LOW calcium) o Parathyroid removed- calcium will drop (brittle nails, cataracts, dry skin) Pituitary Gland • Impaired Posterior pituitary gland  ADH & oxytocin • Impaired Anterior pituitary gland  G, LH and FSH SIADH - edema, fluid volume overload, • give diuretics, replace fluids (keep a balance so not dehydrated) • doctors restrict fluids, not nurses • SS: 1. High urine osmolality 2. Low serum osmolality 3. Hypotonicity of body fluids 4. Continued release of antidiuretic hormone 5. hyponatremia Diabetes Insipidis – not enough ADH; pee a lot; super thristy • s/s- low specific gravity of urine, dehydration • Treatment: desmopressin • give them an antidiuretic  increase urine concentration