explain the definition
Give the definitions
1) Give the full form of DM. Define the DM.(Give the full form of DM and define the DM.)
The full form of DM IS DIABETES MALLITUS.
Diabetes Mellitus is a chronic metabolic disorder characterized by impairment in carbohydrate, protein and lipid metabolism. Mainly carbohydrate metabolism is altered.
Diabetes is a condition in which the blood glucose level of a person’s body increases (Hyperglycemia).
It is mainly if the body is not able to produce enough insulin or the cells are not responding to insulin in adequate amount, so the metabolism of glucose cannot be normal, which leads to conditions like diabetes mellitus.
IN DIABETES MALLITUS 3 ‘P’ SYMPTOMS
P := POLYURIA ( FREQUENT URINATION := frequent urination.),
P:= POLYDYPSIA ( INCREASED THIRST := feeling very thirsty.),
P:= POLYPHAGIA ( INCREASE HUNGER := feeling very hungry. )
2) Define hypoglycemia.
Hypoglycemia is a condition in which the blood glucose level falls below the normal level, this condition is called hypoglycemia.
Normal blood glucose level is 60-120 mg/dl.
In hypoglycemia blood glucose level is less than 60 mg/dl
3) Define hyperglycemia or diabetic ketoacidosis (DKA). (Define hyperglycemia and diabetic ketoacidosis.)
Hyperglycemia is a condition in which the blood glucose level increases above the normal body glucose level.
Diabetic ketoacidosis is a life-threatening complication of diabetes mellitus.
Diabetic ketoacidosis is mainly due to absence of insulin or insufficient amount of insulin in the body.
Due to this, impairment is seen in the metabolism of carbohydrates, proteins and fats. In this condition, due to the absence of insulin, fat is metabolized instead of glucose and excess ketones are released in the body blood in the form of waste, which mainly damages the brain in the body.
Diabetic ketoacidosis is an emergency condition that should be treated immediately.
Normal blood glucose level is 60-120mg/dl.
In hyperglycemia blood glucose level is greater than 125 mg / dl.
4) Define Diabetic nephropathy.
Diabetic nephropathy or renal disease is mainly seen as a complication of microvascular changes due to diabetes and changes are mainly seen in the kidneys.
5) Define diabetic neuropathies.
Diabetic neuropathy is a group of diseases in which all types of nerves are affected such as anatomical nerve, spinal nerve, motor nerve etc. and this problem mainly depends on the affected nerve cell location.
Complications of diabetes on the nervous system are called diabetic neuropathy.
6) Define hypothyroidism.
Hypothyroidism is a condition in which the level of thyroid hormone in the body is less than normal.
7) Define hyperthyroidism.
Hyperthyroidism is a condition in which the amount of thyroid hormone in the body is increased than normal.
8) Define thyroid cancer.
The thyroid gland is mainly located in the neck.
Abnormal and uncontrollable growth of cells in thyroid gland and formation of tumor like structure is called thyroid cancer.
9) Define hyperparathyroidism :=
There are four para thyroid glands located in the neck of human being.
These glands are of oval shape.
Which produces parathyroid hormone which maintains the level of calcium in the blood.
But when the parathyroid gland secretes too much parathyroid hormone into the body and blood stream, the condition of hyperparathyroidism occurs.
10) Define hypoparathyroidism.
Hypoparathyroidism is an endocrine disorder of the parathyroid gland.
Hypoparathyroidism is mainly due to deficiency of parathyroid hormone.
Due to this, the amount of phosphate in the blood is elevated and the amount of calcium is found to be low.
11) Define thyroiditis.
Infection and inflammation in the thyroid gland is called thyroiditis.
Acute suppurative painful thyroiditis.
subacute thyroiditis.
chronic thyroiditis (hashimoto’s disease).
lymphocytic. etc. its types are seen.
11) Define thyroiditis.
Infection and inflammation in the thyroid gland is called thyroiditis.
Acute suppurative painful thyroiditis.
subacute thyroiditis.
chronic thyroiditis (hashimoto’s disease).
lymphocytic. etc. its types are seen.
12) Define Addition’s disease.
Addison’s disease is primarily a rare but chronic disease.
It is mainly seen due to insufficiency of adrenal gland It is mainly seen due to inadequate secretion of hormone (glucocorticoids/mineralocorticoid) of adrenal gland.
13) Define Chusing’s syndrome.
Cushing syndrome is an endocrine disorder.
Which is mainly seen due to excessive secretion of adrenal gland.
14) Define pheochromocytoma. (Define pheochromocytoma.)
It is a tumor of the tissues of the adrenal gland in pheochromocytes.
Because of this, epinephrine and norepinephrine hormones are released in large amounts, which elevate heart rate, metabolism, and blood pressure.
15) Define diabetes insipidus.
Diabetes insipidus is mainly caused by a disorder of the posterior lobe of the pituitary gland.
In which vasopressin (antidiuretic hormone) is secreted in small amounts. Due to this, conditions like polydipsia and polyuria are seen and excessive amount of urine is excreted from the body.
16) Define hypopituitarism.
Hypopituitarism is a condition in which the pituitary gland does not secrete enough of its hormones.
17) Define acromegaly.
Acromegaly is a long-term condition in which growth hormone is secreted in excess and causes the body tissues and the body to enlarge.
17) Define gigantism.
Gigantism is abnormal body growth greater than normal. Mainly due to excessive secretion of growth hormone during childhood. It is seen in children due to increased secretion of growth hormone before the closure of the growth plate of the bone.
18) Define pituitary gland tumor. (Define pituitary gland tumor.)
Pituitary gland tumor is a condition in which abnormal and uncontrollable cell growth occurs in the pituitary gland and leads to tumor formation. Due to which there is disturbance in its function.
1) Explain the diabetes malitus.
2) Explain etiology, clinical manifestation, and diagnostic evaluation of diabetes mellitus. (Write the causes of diabetes mellitus, its signs and symptoms, and diagnostic evaluation.)
3) Explain the management of diabetes mellitus. (Write management of diabetes mellitus.)
1) Explain the diabetes malitus.
Diabetes is a chronic metabolic disorder. In which carbohydrate, protein and lipid metabolism is impaired. Changes are seen mainly in carbohydrate metabolism.
Diabetes is a group of metabolic disorders in which a person’s blood has high blood sugar levels. This is mainly when insulin secretion in the body is less than normal and if there is any impairment in the action of insulin, high blood sugar level is seen in the body.
The “3 P” syndrome is predominantly seen in diabetes mellitus.
1)P:= polyuria (frequent urination),
2)P:= polydypsia (increase thirst)
3)P:=polyphagia (increase hunger := feeling very hungry).
2) Explain the type of diabetes mellitus. Identify the type of diabetes mellitus.
There are four main types of diabetes.
Type:=1 (IDDM) insulin dependent diabetes mellitus.
Type:=2 (NIDDM) Non insulin dependent diabetes mellitus.
Type:=3 diabetes mallitus associated other diseases conditions.
Type:=4 GDM (gestational diabetes mellitus)
Type:=1 (IDDM) insulin dependent diabetes mellitus.
This is a type of diabetes mellitus in which the pancreatic beta cells in the body which are responsible for the production of insulin are destroyed due to any reason or due to autoimmune disease, there is a total deficiency of insulin.
Due to total deficiency of insulin in this, insulin is taken by injection.
This type of diabetes is mainly seen before the age of 30 years.
Type:=2 (NIDDM) Non insulin dependent diabetes mellitus.
Type 2 diabetes is mainly insulin resistance or is seen due to reduced sensitivity of insulin in which pancreatic cells produce insulin in inadequate amount.
This type of diabetes can be prevented mainly by taking a proper diet, exercising, making changes in lifestyle and increasing physical activity.
This type of diabetes is mainly seen after the age of 30 years. So it is also called adult onset diabetes mellitus.
If diabetes is not treated by the above methods, oral hypoglycemic agents are also taken.
Type:=3 diabetes mallitus associated other diseases conditions.
Diabetes is also seen in this body due to any other disease. Its symptoms depend on the disease condition.
Type:=4 GDM (gestational diabetes mellitus)
This type of diabetes is mainly seen in women and even in those women diabetes mellitus is seen during pregnancy due to glucose intolerance.
Explain the Etiology of diabetes mellitus. Explain the causes of diabetes mellitus.
inherited,
environmental factors,
Stress
genetic factor,
Environmental Factors,
obesity,
diabetes from the other diseases conditions..
Hormonal imbalance during pregnancy.
Due to insulin deficiency.
Due to cell resistance to insulin despite insulin.
Due to too much sugar intake.
Due to sedentary life style.
Due to excess cholesterol in the body.
explain Clinical manifestation/sign and symptoms.
1) polyuria (increase urine output, increase urine output),
2) polydipsia (increase thirst)
3) polyphagia (increase appetite)
Fatigue.
weakness.
Visual Changes (difficulty seeing).
Tingling and numbness on hands and feet.
Dry skin.
sore that heal slowly.
Frequent infections.
Nozia.
Vomiting.
decrease wound healing.
Weight loss.
Abdominal pain.
explain diagnostic evaluation (Write diagnostic evaluation.)
history taking and physical examination.
1) Fasting blood sugar (FBS)
This test is done without eating or drinking anything for at least eight hours.
The normal value of blood sugar should be less than 110 mg/dl per mg of perdesilitar.
If the fasting blood glucose level is more than 125 mg/dL, it is diagnosed as diabetes.
2)Random blood sugar (RBS)
It does not require any preparation as the sample is taken anytime.
If the random blood glucose is more than 200mg/dl per milliliter mg then it is indicated as diabetes.
3) PP2bs (post prandial blood sugar)
This test is done after 2 hours after taking a full meal.
Normally, the blood glucose level comes down to the glucose peak level in pulses two hours after a meal, but if someone has smoked or drank caffeine, there is an alteration.
3) Glycosylated HB.
This test is done to assess how much glucose is attached to the blood molecule.
4) Glycosylated Albumin:=
Glucose is usually attached to albumin, so glycosylated albumin is used to assess average glucose levels.
5) oral glucose tolerance test.(gtt)
In this, the patient is provided with 150 mg of carbohydrates for three days.
Then the fasting blood glucose level of the patient is checked.
The client is then given 75 grams of glucose to drink, after which the patient’s glucose tolerance level is checked.
7)ketonuria :=
If ketones are present in the urine, it indicates that the body uses fat as a source of energy.
8) Proteinuria:=
If protein is present in the urine, it indicates that protein is used as a source of energy.
9) serum lipid profile.
10) Serum BUN.
11) Serum creatinine. etc. are tested.
3) Explain the management of diabetes mellitus.
overall principle of management
To eliminate the symptoms of hyperglycemia.
To reduce microvascular and macrovascular complications of diabetes mellitus.
Reducing blood glucose levels.
The patient can achieve a normal life style as far as possible.
Blood glucose levels can be reduced using patient education, dietary management, exercise and pharmacological therapy.
patient education
To provide proper health education to the patient and his family members.
Including teaching how to self-monitor glucose.
Teach monitoring of urine ketones if type 1 diabetes mellitus. (Urine examination)
Teach the patient how to administer insulin.
Teaching the management of hypoglycemia.
Providing education to patients about foot and skin care.
Teach management of diabetes before, during, and after exercise.
Provide patient education about lifestyle modification.
dietary management
aim of dietary management
To reduce the symptoms of hyperglycemia.
To reduce symptoms of hypoglycemia if given treatment of hyperglycemia.
Lowering the overall blood glucose level of the body.
Avoiding diets that increase blood glucose levels.
Ask the patient to lose weight if he is obese.
Making the patient take regular food intake.
Ask the patient not to take excess sugar.
Ask to eat a diet that contains adequate amounts of protein, carbohydrates and fat.
dietary management
The main goal of dietary management is to improve metabolic control in the diabetic client.
To improve the patient’s blood glucose level and lipid level.
Making a daily food intake plan of the patient.
Making a plan for the patient’s weight management.
To provide adequate nutrition of the patient.
A person’s lifestyle and habits play an important role in controlling and managing the disease.
A balanced nutritional diet is very important in all patients.
Asking the patient to increase protein intake in his diet, excessive protein intake increases renal function. and glomerular filtration rate increases.
Maintain the level of dietary fat of the patient, maintain the daily cholesterol level in the diet and limit saturated fat and cholesterol.
To provide carbohydrates according to the patient’s body requirement.
Asking the patient to consume adequate amount of carbohydrates that can maintain the body’s energy requirements.
for type 1 diabetes includes special diet management
After taking the dose of insulin in the morning, breakfast should be taken after half or 1 hour.
Then after three hours a small amount of carbohydrate should be taken.
Lunch should be taken four to five hours after taking morning insulin.
Foods that are sweet and contain sugar should not be taken, such as cakes, ice creams, jams, etc.
Checking the patient’s blood glucose level regularly.
be particular about amount, distribution and timing of nutrition.
Carbohydrates should be taken in small amounts before exercise.
The patient should be asked to check the amount of glucose, ketones and albumin in the urine and all these substances are observed during fasting.
Caloric restriction for obese clients.
Exercise
Advise the patient to do regular exercise to prevent and control his disease condition.
Ask for regular walking.
Ask the patient to ride a regular bicycle.
Ask to go swimming.
Ask to consume adequate amount of carbohydrates before and after exercise.
explain the pharmacological management
It is responsible for maintaining the blood glucose level. It includes administration of insulin and oral hypoglycemic drugs.
If insulin is given on the abdomen, its absorption is fast. When given on arm and leg, its absorption decreases.
Time, course
1)Rapid acting insulin:=
Ex:=Humalog.
Its onset is within 10 to 15 minutes.
2) Short acting insulin:=
It is called regular insulin or R insulin (R insulin) or zinc crystalline insulin (czi).
Its onset is 30 minutes.
3) intermediate acting insulin:=
It is also called regular R insulin.
And its onset period is after 3 to 4 hours and the patient must take food during this period.
4) long acting insulin:=
Ultra lente insulin or peakless insulin.
Its onset period is 6-8 hours and its action lasts from 20 to 30 hours.
insulin dosage
The starting dose of insulin is 0.5 unit /kg/day.
Insulin is 2/3 dose in the morning and 1/3 dose in the evening.
This dose can be increased or decreased based on food intake, exercise, and illness.
insulin pump therapy
A small portable pump is used to administer insulin and its needle has to be changed daily.
combination therapy
The patient is provided with oral meditation insulin.
oral antidiabetic agent:=
1)sulfonyl urea,
2) meglitinides,
3) thiazolidinediones,
4)bigunides,
5) alpha glucoside inhibitor.
This therapy is mainly given to patients with type 2 diabetes
patient teaching about insulin administration
Proper teaching of the patient should be provided for proper administration of insulin because if insulin is not administered properly, tissue damage or conditions like insulin shock may occur.
1)insulin preparation:=
Insulin has to be prepared in the unit. It is present in the vial.
And 100 units of insulin are in milliliters.
2) Insulin syringe:=
Insulin capacity has a series of 0.25, 0.30, 0.50, 1ml and 2ml and according to the capacity of the patient there are long needle and short needle, if there is an obese patient then long needle is used.
3) insulin storage:=
Insulin is stored in a refrigerator at 36°f degrees Fahrenheit to 86°f degrees Fahrenheit and should not be kept longer than 30 days.
4) Insulin preparation and injection.
Before taking the insulin series, the vial should be properly rolled between two hands and brought to room temperature before administration.
5)Route and site of insulin administration:=
Route:=subcutaneous,
Site:= abdomen,
back of arm
Upper part of buttock,
Side of the thighs.
procedure of administration:=
1) Stabilize the skin of the abdomen between the thumb and finger using the left hand.
2) Insert the syringe inside the skin keeping the insulin syringe at 90°.
3) Then push the plunger so that the insulin is injected.
4) Then remove the series from the skin and apply the cotton to the injected site for a few seconds.
5) Then discard the series properly.
surgical management
Surgical management depends on the severity of the disease and the clinical condition. In which pancreas transplantation can be done.
Nursing management of diabetes mellitus
1) Impaired nutritional status more than body requirement related to intake excess of activity expenditure.
The primary goal of the diet plan is to control the glucose level, thereby assessing the patient’s glucose level, and assessing the patient’s lifestyle, cultural background, activity level, dietary habit and food preference.
Ask the patient to take food in adequate amount and also to take snacks in between.
Arrange for an extra mile before the patient engages in physical activity.
Administer insulin as per doctor’s order.
2) Imbalance fluid volume related to increased stress hormone as evidenced by polyuria.
Assessing the patient’s intake output chart.
Ask the patient to take oral fluids.
Provide intravenous fluids to the patient as needed.
Checking the patient’s serum electrolyte level.
To check patient’s vital signs.
3) Activity intolerance related to weakness as evidenced by limited activities.
Assess the patient’s activity level.
Activity planning of the patient.
Provide analgesic medication to the patient before resuming activity.
Ask the patient to rest between activities.
Provide carbohydrate and protein rich food to the patient.
Providing the prescribed medicine to the patient.
4) Knowledge deficit related to cause and disease as evidence by asking questions.
Assessing the patient’s knowledge level.
Provide education to patients about diabetic diet.
Providing education to patients about foot and nail care.
Provide education to the patient or keep his feet covered with soft shoes.
Providing education to patients about safe and self administration of insulin.
5) Fear related to insulin injection.
Monitoring the patient’s blood glucose level.
Provide patient education about self-administration of insulin.
Provide patient education about complications of insulin therapy.
Provide education to the patient about the signs and symptoms of hyperglycemia and hypoglycemia.
1) Explain the hypoglycemia. (Define hypoglycemia.)
2) Explain the Etiology, Clinical manifestation and diagnostic evaluation of hypoglycemia.
3) Explain the management of hypoglycemia.
1) Explain the hypoglycemia. (Describe hypoglycemia.)
Hypo means:= decrease/reduce.
Glycemia means glucose level in blood.
Hypoglycemia:= means reduce glucose level in blood.
Hypoglycemia means reducing/decreasing the level of glucose in the blood such that the glucose level is less than 50-60 mg/dl.
Normal blood glucose level
Is 60-120mg/dl.
In hypoglycemia blood glucose level is less than 50-60 mg/dl.
2) Explain the etiology of hypoglycemia. (Write the cause of hypoglycemia.)
All because of taking too much insulin.
oral hypoglycemic agent.
Due to less food conception.
Due to too much physical activity and exercise.
Due to delayed consumption of meal.
Explain the clinical manifestation/sign and symptoms of hypoglycemia. (Describe the symptoms and signs of hypoglycemia.)
in mild hypoglycemia:=
Paspiration (perspiration).
Tachycardia (increase heart rate).
palpitations.
nervousness.
Air hunger (breathing difficulties).
in moderate hypoglycemia.
Due to the decrease in the blood glucose level, the function of the brain cells decreases due to which impairment is seen in the central nervous system.
Nervousness, unable to concentrate.
Memory loss.
Restlessness.
Numbness feeling in lips and tongue.
headache.
memory lapse.
Double vision or blurred vision.
irritational behaviour.
drowsiness.
Loss of orientation etc. symptoms are seen.
in severe hypoglycemia
In severe hypoglycemia, the central nervous system is severely impaired, so the patient needs another person for its treatment.
The patient is found to be semi-conscious or fully unconscious.
Behavior becomes disoriented.
to be startled
drawing.
Difficulty in sleeping.
explain the diagnostic evaluation
history taking and physical examination.
monitoring blood glucose level.
autonomic neuropathy assessment.
vision check up
vision examination.
explain the medical management
Administer simple glucose to conscious patient. Check rbs
In unconscious patient providing intramuscular or subcutaneous glucagon injection which stimulates the liver and glucose is released.
Provide 50% dextrose solutions intravenously 25-50ml.
Tell the patient not to eat high calorie, high fat, desert food, cookies, cake, ice cream etc.
explain the nursing management
Provide education to the patient to avoid high calorie, high fat and dessert food.
Routine blood glucose level examination of the patient.
Providing health education to the patient and his family members.
Provide education to the patient and ask him to eat in adequate amount.
Ask the patient to take adequate amount of snacks.
Check blood glucose levels regularly.
Provide explanations to family members about the signs and symptoms of hypoglycemia, its causes, and its management.
1) Explain the hyperglycemia.
2) Explain the Etiology, Clinical manifestation and diagnostic evaluation of hyperglycemia.
3) Explain the management of hyperglycemia. (Hyper gl
1) Define hyperglycemia.
hyper means := increase/high.
Glycemia means:=glucose level in blood (quantity of glucose in blood).
Hyperglycemia means:= high glucose level in blood.
Hyperglycemia is also known as diabetic ketoacidosis (DKA).
Hyperglycemia is also called diabetic ketoacidosis.
Diabetic ketoacidosis (DKA) is a life threatening condition of diabetes mellitus (DM).
DKA is mainly due to absence or inadequate amount of insulin.
Due to this, disturbances in carbohydrate, protein and fat metabolism are seen which are called emergency conditions which need to be treated immediately.
Explain the etiology/cause of hyperglycemia (diabetic ketoacidosis).
Write the causes of hyperglycemia.
Hyperglycemia is mainly seen due to low amount of glucose being used by the cells and due to excessive production of glucose by the liver.
Due to low or absence of insulin.
decrease or missed dose of insulin.
undiagnosed diabetes mellitus.
acidosis.
Explain the pathophysiology of hyperglycemia.
When the amount of insulin in the human being body is low or
Glucose utilization in absence is muscle, fat and liver
is not done by and production of glucose is done by liver in very high amount.
|
\/
Due to non-utilization of glucose in the body
Glucose level increases in the body (in blood).
|
\/
Result in (retinopathy:= blurred vision),
polyuria (increase urine output),
Dehydration due to excessive urine excretion from the body.
weakness,
headache,
polydypsia.
Explain the clinical manifestation/.sign and symptoms of hyperglycemia.
Write the signs and symptoms of hyperglycemia.
polyuria (increased urination),
polydypsia (Increase thirst)
fade away,
fatigue
headache
acetone breath (fruity odor),
low blood pressure,
Orthostatic Hypotension: When the patient comes from a lying position to a standing position immediately, the patient feels dizzy due to a sudden drop in blood pressure, this is called orthostatic hypotension.
The pulse becomes weak.
kussmaul breathing (air hunger:= difficulty in breathing),
loss of appetite,
nausea,
vomiting,
Abdominal pain.
Changes in mental status.
Explain the diagnostic evaluation (Write the diagnostic evolution.)
history taking and physical examination.
Monitoring blood glucose level is greater than 300mg/dl.
low blood pH level<7.30.
hyponatremia.
BuN assessment.
nitrogen and hematocrit level.
renal insufficiency (disruptions in kidney function)
explain medical management
To restore hemodynamic status.
Treating dehydration.
Maintain electrolyte balance.
Treating acidosis.
fluid therapy
If the patient has dehydration condition, provide 0.9% normal saline intravenously.
Continuously provide fluid to the patient until the patient’s dehydration is treated.
Continuously monitor the patient’s blood glucose level.
restoring electrolyte
Maintaining the patient’s electrolyte level as the patient’s urine output is in excessive amount.
complication
Fluid overload.
In pulmonary AD.
Heart failure.
Hypokalemia.
Hyperglycemia.
Keto acidosis.
In cerebral AD.
Hypoglycemia.
Nursing management
Normalization of blood glucose levels in the management of hyperglycemia.
Provide patient education about the five components.
A) nutritional therapy,
B) exercise,
C) monitoring,
D) pharmacological therapy,
E) education.
1) Fluid volume deficit related to osmotic diuresis.
Checking the patient’s intake output.
Monitoring the patient’s temperature.
Monitoring the patient’s skin color and moisture.
Checking the patient’s skin turgor and mucous membrane.
Ask the patient to increase fluid intake.
2) Impaired nutritional status related to disease condition.
Monitoring the nutritional status of the patient.
Assess the patient for signs and symptoms of hyperglycemia.
Ask the patient to take food frequently.
3) Impaired skin integrity related to decreased sensation and circulation to lower extremity.
Assess the patient’s leg and his hand to see if his temperature has increased or not.
Assess the patient’s skin integrity.
Checking the patient’s skin moisture and whether there is any abnormality in the skin or not.
4) Activity intolerance related to poor glucose control.
Advise patient to assess blood glucose level before and after exercise.
Advise the patient to do regular exercise.
Provide patient education to avoid exercise when blood glucose levels exceed 250 mg/day.
5) Risk for hypoglycemia related to effect of insulin inability to eat.
Provide patient education to monitor blood glucose levels closely.
Provide insulin in adequate amount to the patient.
Checking the patient for any signs and symptoms of hypoglycemia.
6) Ineffective management of therapeutic regimen related to lack of knowledge about exercise.
Checking the current knowledge level of the client.
Checking the patient’s blood glucose level regularly.
Provide education to patients on insulin administration.
explain the prevention
Provide education to the patient to intake fluid in adequate amount.
Continuously monitor the patient’s blood glucose level.
Consume carbohydrates in small amounts and little by little.
Provide patient education for self-insulin administration.
Ask the patient to take small amounts of food as well.
Ask the patient to take extra fluids.
1) Explain the diabetic nephropathies. (Define diabetic nephropathy.)
2) Explain Etiology, Clinical manifestation and diagnostic evaluation of diabetic nephropathy.
3) Explain the management of diabetic nephropathy.
1) Explain the definition of diabetic neuropathies.
Diabetic nephropathy is a complication of diabetes in which renal impairment is seen due to diabetes and renal lesion is seen in it.
2) Explain Etiology
Due to increase in cholesterol level.
Because of smoking.
Due to increase in blood pressure.
Due to diabetes.
explain the clinical manifestation/sign and symptoms
renal failure,
nocturnal diarrhea,
Hypoglycemia.
Congestive heart failure.
explain diagnostic evaluation (Write diagnostic evaluation.)
history taking and physical examination.
urine examination.
assess the blood urea nitrogen level.
hypertension.
explain the medical management
Maintaining the blood glucose level of the body.
And take care that the following conditions do not arise.
hypertension,
urinary tract infections,
nephrotoxin substances,
low sodium diet.
treatment
Dialysis in which waste cannot be removed due to altered kidney function so the waste is removed from the body by dialysis.
transportation.
1) Explain the diabetic neuropathies.
2) Explain the etiology, clinical manifestation, and diagnostic evaluation of diabetic neuropathy.
3) Explain the management of diabetes neuropathy.
1) Explain the diabetic neuropathies.
Diabetic neuropathy is a group of diseases in which all types of nerves are involved such as autonomic, spinal nerve, sensory, motor nerve etc.
Signs and symptoms depend on the location of this nerve and its type.
2) Explain the Etiology.
due to essential fatty acid abnormalities.
Due to polymerase activation.
Oxidative stress.
due to protein kinase c activation.
poly pathway activation.
explain the clinical manifestation/sign and symptoms
Tingling sensation.
burning sensation.
Numbness in feet.
decrease sensation of touch, decrease sensation of pain and temperature.
explain the management
Provide insulin therapy to the patient.
Assess the patient’s blood glucose level.
Assessing lower extremity pain.
Administering analgesic medicine to the patient.
1) Explain the diabetic foot.
This is a complication seen in the foot due to uncontrolled diabetes in which ulcer, infection or inflammation is seen in the foot.
Causes
1)Neuropathy:=
This causes loss of pain sensation and ski
2) poor vascular disease:=
Impairment in wound healing occurs due to poor blood circulation in the legs.
Due to this, the formation of gangrene is seen.
3) Immunocompromise :=
In this body W.B.C. Due to decrease in the amount of WBC cannot fight against bacteria and due to this Abnormality is seen in feet.
Tissue injury in foot.
formation of fissure.
drainage, swelling, redness and gangrene formation in feet.
explain the management
Ask the patient to bed rest continuously.
Provide antibiotic medicine to the patient
Continuously maintain the patient’s blood glucose level.
Administering adequate amount of antibiotic medicine to the patient.
Care of the patient over his foot to see if there is any cut, blister, soreness or not.
Tell the patient to take proper foot care.
Provide patient education k
Keep feet dry.
Wearing comfortable shoes.
Take doctor’s advice for foot care.
See if there is any cut, soreness, blister on the foot and inform the doctor immediately.
1) define hypothyroidism.
2) Explain the Etiology, Clinical manifestation and diagnostic evaluation of hypothyroidism.
3) Explain the management of hypothyroidism. (Write management of hypothyroidism.)
1) Define hypothyroidism.
Hypothyroidism is an endocrine gland disorder in which the thyroid gland does not secrete adequate amounts of thyroid hormone.
In hypothyroidism, thyroid hormone is secreted in inadequate amount due to which the normal body function is altered.
Hypo means:= less
Thyroidism:= thyroid hormone.
hypothyroidism
means inadequate secretion of thyroid hormone from the thyroid gland.
Congenital hypothyroidism it’s called critinism.
2) Explain the Etiology of hypothyroidism.
Autoimmune thyroiditis.
If any patient has pre-existing condition of hypo thyroidism.
Radiation therapy.
Medication that has lithium and iodine compound.
Due to iodine deficiency.
Congenital problem.
Thyroid dysgenesis.
exposure of goitrogens.
explain the classification
1) Primary or thyroidal hypothyroidism.
This type is mainly seen due to dysfunction of the thyroid gland.
Due to dysfunction of thyroid gland itself.
2) Central hypothyroidism. (central hypothyroidism).
This type is seen due to dysfunction of hypothalamus and pituitary gland.
3) Pituitary or secondary hypothyroidism. (pituitary or secondary hypothyroidism)
This type is seen only due to dysfunction of the pituitary gland.
4) Hypothalamic or tertiary hypothyroidism. (Hypothalamic or tertiary hypothyroidism.)
This type is seen due to the dysfunction of the hypothalamus.
5) congenital hypothyroidism. (congenital hypothyroidism).
If a person is born with a problem in the thyroid gland, then it is called critinism.
6) Myxedema
Myxedema is a severe complication of hypothyroidism. This patient has swelling in his soft tissue. If the brain and consciousness level is altered in this condition, it is called coma or thyroid crisis in McZ.
In myxedema, mucopolysaccharide accumulates in the subcutaneous tissue.
Explain the clinical manifestation/sign and symptoms of hypothyroidism.
Hair loss.
Brittle nails.
dry skin.
Numbness and tingling of fingers.
Thickening of the voice.
Disturbance in the menstrual cycle.
loss of libido.
Menstrual disturbance.
Subnormal temperature and pulse.
patient gain weight.
skin thickness.
The face becomes expression less.
The patient becomes irritable and fatigued.
The patient’s speech is slow.
Tongue enlarge hands and feet increase in size.
Deafness is seen.
A complaint of constipation is seen.
inadequate ventilation.
Pleural effusion.
Respiratory muscles week.
Serum cholesterol level increases and coronary artery disease is seen.
myxedema coma.
feel tired
explain the diagnostic evaluation (Write the diagnostic evaluation.)
history taking and physical examination.
serum T3,T4 and Tsh level assessment (test is done in fasting).
Radioisotope based thyroid scanning.
3) Explain the management of hypothyroidism.
explain the medical management
The missing hormone is replaced to restore normal metabolic function.
synthyroid, levothyroid.
If there is severe hypothyroidism or condition, monitor vital functions, arterial blood gases, monitor oxygen saturation by pulse oximetry.
Administering fluid to the patient.
Providing hormonal therapy to the patient.
Avoid application of external heat as it increases oxygen requirement.
explain the nursing management
Nursing management
Nursing assessment
To monitor patient’s vital signs.
Assess the client’s eating pattern and dietary pattern.
Assess the patient for alcohol consumption and smoking.
To assess whether the patient consumes such as lithium iodine or not.
Assess whether the patient has any symptoms of hypothyroidism or not.
Nursing diagnosis
1) Activity intolerance related to lethargy and weakness.
2) Disturbance body image related to edema.
3) Hyperthermia or hypothermia related to decreased metabolism.
4) Impaired nutritional less than body requirement related to disease condition.
5) Impaired bowel elimination constipation related to disease.
6) ineffective therapeutic regimen related to ignorance about disease and treatment.
Nursing management
Asking the patient to perform daily routine activities in small amounts.
Ask the patient to maintain personal hygiene.
Ask the patient to do regular physical activity.
To monitor patient’s vital signs.
To check the cognitive level of the patient.
If the patient feels excessively cold, provide black cat.
Providing emotional support to the patient.
Informing the patient and his family members about the disease.
To encourage the patient to take diet in edequate amount.
To clear all the doubts of the patient and provide psychological support to him.
1) define hyperthyroidism.
2) Explain the Etiology, Clinical manifestation and diagnostic evaluation of hyperthyroidism. (Write the causes of hyperthyroidism, its signs and symptoms, and diagnostic evaluation.)
3) Explain the management of hyperthyroidism.
1) define hyperthyroidism.
Hyper means:= excessive
Thyroidism means: thyroid hormone.
hyperthyroidism means := excessive secretion of thyroid hormone in the blood from the thyroid gland.
Excessive secretion of thyroid hormone from the thyroid gland into the blood is called hyperthyroidism.
2) Explain the Etiology
due to infection,
emotional grief,
stress,
excessive ingestion of thyroid hormone.
Pituitary adenomas.
Auto immune disorder thyroiditis.
In toxic adeno.
Chronic lymphocytic thyroiditis.
Grave diseases.
Iodine induced hyperthyroidism.
explain the clinical manifestation/ sign and symptoms
nervousness,
Emotionally hyper excitement,
That person cannot sit still,
palpitations,
rapid pulse,
heat intolerance,
The skin should be flushed.
tremor.
exophthalmos (bulging eyes).
Excessive appetite but weight loss.
muscular fatigue and weakness.
(amenorrhea) Amenorrhea,
Pulse rate to increase.
Osteoporosis.
feel tired
tachycardia,
dysrhythmias,
Pulse rate to increase.
Explain the diagnostic evaluation.
history taking and physical examination.
thyroid scan.
inspection,
palpation,
percussion,
palpation.
blood exam
radiological examination
Explain the management of hyperthyroidism.
medical management
The goal of medical management of hyperthyroidism is to reduce the hyperactivity of the thyroid gland.
pharmacological therapy
Pharmacological management involves providing medications that reduce hyperactivity of the thyroid gland and decrease hormone release.
Ex:=propylthiouracil, Tapazole.
Radioactive iodine therapy:=
The goal of radioactive iodine therapy is to destroy the cells of the overactive thyroid gland and this therapy is provided for one week or one month.
Adjunctive therapy:=
In this therapy, iodine and iodine compound mixed with milk and fruit juice should be provided to the patient.
Explain the surgical management
thyroidectomy (surgical removal of whole thyroid gland parts) if other measures fail.
Explain the nursing management of hyperthyroidism
explain nursing assessment
Monitoring the patient’s vital signs.
Continuously measures the patient’s body weight.
Checking the patient’s activity level.
To assess the patient’s food habit.
Assessing whether the patient consumes alcohol and smokes.
Assess the patient’s hands to see if there is any tremor or skin flushing.
Assess the patient’s emotional status.
Assess menstrual history if female patient.
explain the nursing diagnosis
1) Impaired nutritional status more than body requirement related to high metabolic rate.
maintain nutritional status
Assess the nutritional status of the patient.
Making inquiries about the patient’s dietary habit and the food that the patient likes.
Planning a proper diet menu of the client.
Provide high calorie diet to the patient.
Provide diet to the patient in small amounts but little by little.
Provide high calorie diet to the patient.
Serving food to the patient in an attractive manner.
Monitor client’s weight daily.
2) altered body temperature related to high metabolic rate.
maintain normal body temperature:=
To monitor patient’s vital sign.
To maintain personal hygiene of the patient.
Provide adequate amount of fluid to the patient.
Ask the patient to wear clean clothes.
Maintain adequate ventilation in the room.
3) Activity intolerance related to fatigue and weakness and high metabolic rate.
maintain activity level:=
Ask the client to do indoor activities.
Ask the client to rest an adequate amount if he is nervous and cannot sit still.
Ask the client to reduce physical exertion.
Providing reassurance to clients.
4) Altered sleep pattern related to disease condition.
enhancing sleep :=
Assess the client’s sleeping habits.
Providing the client with an environment to improve sleeping.
To provide the nutritional requirement of the client before sleeping.
Tell the client to pray or read a book before going to bed.
5) Impaired knowledge level related to disease condition.
provide knowledge:=
Assessing the patient’s learning level and understanding level.
Asking the client to clear all the doubts.
Ask the patient to adopt coping strategies.
To provide information to the patient about the disease condition and its treatment.
Ask the patient to follow a therapeutic regiment.
Providing the prescribed medicine to the patient.
Anchoring the patient for frequent blood testing.
To monitor for any side effect of anti thyroid drug.
And metabolic rate also increases due to hyperthyroidism.
1) Explain the thyroid cancer. (Describe thyroid cancer
2) Explain the Etiology, Clinical manifestation and diagnostic evaluation of thyroid cancer.
3) Explain the management of thyroid cancer.
Write management of thyroid cancer
1) Define thyroid cancer. (Define thyroid cancer.)
Thyroid is a gland located in the neck.
In thyroid cancer, thyroid cells grow abnormally and uncontrollably, forming a tumor-like formation.
Which can be benign or malignant, if the tumor is malignant it results in thyroid cancer.
2) Explain the classification of thyroid gland cancer. Explain the classification of thyroid gland cancer
1) Anaplastic carcinoma
2) Follicular carcinoma (follicular carcinoma)
3) Medullary carcinoma
4) papillary carcinoma
1) Anaplastic carcinoma
(it also called giant or spindle cell)
This is the most dangerous cancer of the thyroid cancer that occurs rarely and spreads very quickly.
2) Follicular carcinoma (follicular carcinoma)
Follicular carcinoma is the second most common cancer.
This is mainly due to inadequate secretion of iodine.
It has a good prognosis and is generally more aggressive than papillary cancer.
Follicular carcinoma does not primarily spread to lymph nodes but spreads to other organs.
Like lungs or brain.
3) Medullary carcinoma
Medullary carcinoma is a non-thyroid cell cancer.
Which is mainly present in the thyroid gland itself, this type of thyroid cancer is mainly seen in family members.
This cancer mainly develops from the C cells of the thyroid gland.
4) papillary carcinoma
Papillary carcinoma is the most common type of thyroid cancer.
About 80 percent of cases are found to be papillary carcinoma.
Papillary carcinoma is slow growing.
In papillary carcinoma, it grows from follicular cells and affects one or both lobes of the thyroid gland.
This type of cancer spreads in the lymph nodes of the neck but its prognosis is good.
Explain the Etiology of thyroid cancer.
Due to radiation therapy to the neck in childhood.
Being a chronic goiter.
Being a family history.
Due to iodine deficiency.
due to thyroiditis.
Due to older age.
food source contaminated with radioactivity.
Radioactive iodine concentration in the thyroid gland.
Explain the clinical manifestation/sign and symptoms of thyroid cancer.
A lump-like feeling in the neck and it grows immediately.
Pain in front of neck and radiates to ear.
There is a change in voice.
Difficulty swallowing.
Breathing difficulty is seen.
cough.
Enlargement of the thyroid gland.
Swelling in the neck.
Explain the diagnostic evaluation of thyroid cancer (Write the diagnostic evaluation of thyroid cancer.)
History taking and physical examination.
calcitonin blood test.
laryngoscopy.
Thyroid biopsy.
Thyroid scan.
TSH, T3, T4 test.
Ultrasound of thyroid gland.
Thyroid function test.
Biopsy
CT SCAN.
MRI.
Radioactive iodine uptake studies.
Thyroid suppression test.
Explain the management of thyroid cancer (Write the management of thyroid cancer.)
Treatment of thyroid cancer depends on the type of thyroid cancer.
surgery
thyroidectomy.
external beam radiation therapy.
chemotherapy
Ex:=urambicil and sysplastin.
Hormonal therapy.
thyroid replacement therapy.
Thyroxine therapy.
explain the nursing management
1) Acute pain related to pressure/Swelling of the tumor nodule.
2) Ineffective Airway clearance related to obstruction due to tumor mass pressure/laryngeal spasm.
3) Impaired verbal communication related to injury to vocal cord.
4) Anxiety related to concern about cancer, upcoming surgery.
5) Knowledge deficit related to cancer and its treatment.
nursing interventions
Assess the patient’s respiratory rate, depth and breathing pattern.
To auscultate patient’s breath sounds.
Assessing whether the patient has a condition of cyanosis or not.
Assess the patient’s anxiety level and ask him to gain coping abilities.
Check the color and amount of phlegm by suctioning from trachea and mouth.
Ask the patient to take high protein and carbohydrate food.
Asking the patient to take a high calorie diet so that the patient can gain an adequate amount of weight.
Properly assess the dressing side of the patient.
To properly measure the patient’s vital signs.
If the patient is experiencing excessive pain, provide analgesic medicine to the patient.
Provide proper support to the patient’s head.
Provide a comfortable position to the patient.
Provide semi-fowler position to the patient and keep the head elevated by providing support to the head with a pillow.
Provide intravenous fluid to the patient.
Assess whether the patient has any difficulty in swallowing.
Provide steam inhalation to the patient.
Keeping the patient’s room well ventilated for proper breathing.
complication
injury to the voice box.
hoarseness after thyroid surgery.
Low calcium level (due to removal of parathyroid gland).
Spread of the cancer to the lungs, bones, or other parts of the body.
1) Define hyperparathyroidism.
2) Explain Etiology, Clinical manifestation, and diagnostic evaluation of hyperparathyroidism.
3) Explain the management of hyperparathyroidism. (Write management of hyperparathyroidism.)
1) define hyperthyroidism.
The parathyroid gland is located at the back of the neck.
The parathyroid gland is an oval shape and four.
The parathyroid gland that secretes parathyroid hormone
Secretion does.
Due to over activity of more than one parathyroid gland, parathyroid hormone is secreted in very high amount into the blood stream due to which the condition of hyperparathyroidism arises in the body.
Hyper:= excessive , parathyroidism:=parathyroid hormone
hyperparathyroidism :=
Excessive excretion of parathyroid hormone from the parathyroid gland.
Excessive secretion of parathyroid hormone from the parathyroid gland into the blood stream is called hyperparathyroidism.
Explain the type of hyperparathyroidism
1) primary hyperparathyroidism (primary hyperparathyroidism).
Primary parathyroidism is mainly due to any abnormality in one or four para thyroid glands.
2) secondary hyperparathyroidism
Secondary hyperparathyroidism occurs due to any other disease condition.
2) Explain the Etiology of hypothyroidism
1) cause of primary hyperparathyroidism
Due to any non-cancerous growth on the gland.
Due to enlargement of more than one parathyroid gland.
rare cause is cancerous tumor.
2) Secondary hyperparathyroidism.
Due to severe calcium deficiency.
Due to serum vitamin D deficiency.
Due to chronic kidney failure.
Due to meta bolic abnormality.
explain the risk factor
Due to menopause, prolonged and severe calcium and vitamin D deficiency.
due to radiation therapy.
Because of lithium.
explain the clinical manifestation/sign and symptoms
feel tired
Muscle weakness.
Nausea and vomiting.
Hyper tension.
Cardiac dysrhythmias.
A bone becomes brittle.
Kidney stone formation.
Excessive urination.
Abdominal pain.
Weakness.
Getting depressed.
Pain in bones and joints.
The patient makes frequent complaints of illness.
Nausea, vomiting and loss of appetite.
Irritability.
Neurosis or psychosis.
Demineralization of bone.
Skeletal pain.
Tenderness in the back and joints.
explain the diagnostic evaluation (Write the diagnostic evaluation.)
history taking and physical examination.
blood test,
urine test,
ultrasound,
bone mineral density test,
imaging test of kidney,
X Ray,
CT scan,
MRI,
Sestambin scan,
Explain the management
treatment
surgery
parathyroidectomy.
The damaged part of parathyroid gland is removed.
explain the medical management
Provide adequate diet and medication.
Assess the nutritional status of the patient.
If the patient has peptic ulcer then provide antacid medicine.
Taking measures to improve the patient’s appetite.
Ask the patient to drink lotus of fluid.
maintain hydration level.
Ask the patient to intake fluid in adequate amount daily.
Observe the patient for signs and symptoms of any renal calculi such as abdominal pain and hematuria.
The patient should avoid thiazide diuretic because that diuretic medicine causes retention of calcium in the body, thereby increasing the serum calcium level in the body.
If the patient develops a condition of dehydration, report to the physician immediately.
improve mobility level
Ask the patient to do the activity as much as possible.
Ask the patient to walk in small amounts.
Bed rest reduces the level of calcium in the body and reduces the formation of renal calculi.
Providing oral phosphate to the patient which reduces the amount of calcium in the body.
provide health education
Bringing proper awareness to the patient.
To maintain the patient’s calcium phosphorus balance.
Monitoring the patient closely.
Ask the nurse to properly follow up the patient.
Ask the patient to take maximum food.
Nursing management
Nursing assessment
Monitoring the patient’s vital signs.
Assess whether the patient has any symptoms of hyperparathyroidism.
To assess the patient’s dietary habit, alcohol, smoking habit or not.
Perform a thorough physical examination of the patient.
To assess the quality, intensity, duration and other factors of the patient’s pain.
pre operative Nursing diagnosis
1) Activity intolerance related to fatigue and weakness.
2) Impaired nutritional status less than body requirement related to nausea and vomiting.
3) Discomfort related to bone pain.
4) Disturbed sleeping pattern related to pain and psychosis.
5) Anxiety related to disease and surgery.
pre operative nursing interventions.
1) Promote activity level.
Assess the client’s activity level.
Making a nursing care plan for the patient.
Ask the patient to provide rest between activities.
Ask the patient to take a balanced diet.
Ask the patient to take the prescribed amount of fluid.
Providing supplementary vitamins to the patient.
2) Maintain nutritional status.
Assessing the client’s nutritional status.
Assessing the patient’s eating habit.
Provide food to the patient in small amounts and frequently.
Ask the patient to maintain oral hygiene.
Ask the patient to take a balanced diet.
Ask the patient to take soft and balance diet.
Maintaining intake output chart of patient.
3) Promote comfort level.
Assess the patient’s pain level.
Providing a comfortable position to the patient.
Provide diversional therapy to the patient.
Ask the patient to perform range of motion exercises.
Provide comfort devices like pillow, cushion, heat therapy to the patient.
4) Promote sleep.
Assess the patient’s sleeping habit.
Conductive environment of the patient.
Maintain personal hygiene of the patient.
Provide analgesic medicine to the patient.
Asking the patient to read any book before sleeping.
Post-operative nursing interventions
1) Ineffective Airway clearance related to post anesthesia effect.
2) ineffective gas changes related to post operative bed rest.
3) Fluid volume deficit related to post operative bed rest.
4) Risk for infection related to post surgery hospitalization.
Nursing interventions:=
1) Keep airway patent.
To assess the patient’s respiratory status breathing sound.
Provide Fowler position of the patient.
Anchoring the patient to deep breathing exercises.
Ask for oral and endocrine suctioning of the patient.
Pulse oximetry check on the patient.
2) improving breathing pattern.
Assess the patient’s respiratory rate.
Provide fowler position to the patient.
Ask the patient to do deep breathing exercises.
Providing steam inhalation, physiotherapy and incentive spirometry to the patient.
Ask the patient to drink plenty of fluids.
3) maintain fluid and electrolyte balance.
To monitor patient’s vital signs.
Providing intravenous fluid to the patient.
Ask the patient to maintain strict aseptic technique.
Maintaining patient’s intake output chart.
4) prevent occurrence of infections:=
To monitor patient’s vital signs.
Ask the patient to do hand washing.
Instruct the patient to maintain aseptic technique.
To provide a neat and clean environment to the patient.
Asking the patient to wear a clean cotton cloth.
Provide plenty of fluid to the patient.
Administering the prescribed medicine to the patient.
Monitoring the patient for any complications.
1) Define hypoparathyroidism.
2) Explain the Etiology, Clinical manifestation, and diagnostic evaluation of hypothyroidism.
3) Explain the management of hypoparathyroidism
1) Explain the hypoparathyroidism. (Define hypo parathyroidism.)
Hypo parathyroidism is an endocrine disorder of the parathyroid gland.
In hypoparathyroidism, the secretion of parathyroid hormone from the parathyroid gland in an inadequate (less) amount is called hypoparathyroidism.
Hypo parathyroidism is a condition in which the amount of phosphate in the blood is elevated and the amount of calcium is decreased.
2) Explain Etiology. (explain reason)
If the parathyroid gland has been removed due to cancer.
Due to excess amount of iron.
Due to the amount of aluminum in the diet.
infraction of parathyroid gland.
Grave diseases.
Hazimoto’s thyroiditis.
Due to magnesium deficiency due to alcoholism.
Explain the clinical manifestation/sign and symptoms.
Irritability in the neuromuscular system.
numbness and tingling sensation in extremities.
Stiffness in arms and legs.
Broncho spasm.
Difficulty swallowing.
Photo phobia.
to be startled
explain the diagnostic evaluation
history taking and physical examination.
blood test.
examine serum calcium level.
1) Promote activity level.
Assess the client’s activity level.
Making a nursing care plan for the patient.
Ask the patient to provide rest between activities.
Ask the patient to take a balanced diet.
Ask the patient to take the prescribed amount of fluid.
Providing supplementary vitamins to the patient.
2) Maintain nutritional status.
Assessing the client’s nutritional status.
Assessing the patient’s eating habit.
Provide food to the patient in small amounts and frequently.
Ask the patient to maintain oral hygiene.
Ask the patient to take a balanced diet.
Ask the patient to take soft and balance diet.
Maintaining intake output chart of patient.
3) Promote comfort level.
Assess the patient’s pain level.
Providing a comfortable position to the patient.
Provide diversional therapy to the patient.
Ask the patient to perform range of motion exercises.
Providing comfort devices like pillow, cushion, heat therapy to the patient.
4) Promote sleep.
Assess the patient’s sleeping habit.
Conductive environment of the patient.
Maintain personal hygiene of the patient.
Provide analgesic medicine to the patient.
Asking the patient to read any book before sleeping.
Post-operative nursing interventions
1) Ineffective Airway clearance related to post anesthesia effect.
2) ineffective gas changes related to post operative bed rest.
3) Fluid volume deficit related to post operative bed rest.
4) Risk for infection related to post surgery hospitalization.
Nursing interventions:=
1) Keep airway patent.
To assess the patient’s respiratory status breathing sound.
Provide Fowler position of the patient.
Anchoring the patient to deep breathing exercises.
Ask for oral and endocrine suctioning of the patient.
Pulse oximetry check on the patient.
2) improving breathing pattern.
Assess the patient’s respiratory rate.
Provide fowler position to the patient.
Ask the patient to do deep breathing exercises.
Providing steam inhalation, physiotherapy and incentive spirometry to the patient.
Ask the patient to drink plenty of fluids.
3) Maintain fluid and electrolyte balance.
To monitor patient’s vital signs.
Provide intravenous fluid to the patient.
Ask the patient to maintain strict aseptic technique.
Maintaining patient’s intake output chart.
4) prevent occurrence of infections:=
To monitor patient’s vital signs.
Ask the patient to do hand washing.
Instruct the patient to maintain aseptic technique.
To provide a neat and clean environment to the patient.
Asking the patient to wear a clean cotton cloth.
Provide plenty of fluid to the patient.
Administering the prescribed medicine to the patient.
Monitoring the patient for any complications.
1) Define hypoparathyroidism.
2) Explain the Etiology, Clinical manifestation, and diagnostic evaluation of hypothyroidism.
3) Explain the management of hypoparathyroidism
1) Explain the hypoparathyroidism. (Define hypo parathyroidism.)
Hypo parathyroidism is an endocrine disorder of the parathyroid gland.
In hypoparathyroidism, the secretion of parathyroid hormone from the parathyroid gland in an inadequate (less) amount is called hypoparathyroidism.
Hypo parathyroidism is a condition in which the amount of phosphate in the blood is elevated and the amount of calcium is decreased.
2) Explain Etiology. (explain reason)
If the parathyroid gland has been removed due to cancer.
Due to excess amount of iron.
Due to the amount of aluminum in the diet.
infraction of parathyroid gland.
Grave diseases.
Hazimoto’s thyroiditis.
Due to magnesium deficiency due to alcoholism.
Explain the clinical manifestation/sign and symptoms.
Irritability in the neuromuscular system.
numbness and tingling sensation in extremities.
Stiffness in arms and legs.
Broncho spasm.
Difficulty swallowing.
Photo phobia.
to be startled
explain the diagnostic evaluation
history taking and physical examination.
blood test.
examine serum calcium level.
explain the management
medical management
Calcium gluconate should be provided intravenously immediately after thyroidectomy.
Administration of parathyroid hormone by parenteral route to treat hypoparathyroidism.
Provide anti-conversion drug to the patient.
Environment should be noise free and low light.
If the patient is experiencing respiratory distress, provide tracheostomy followed by mechanical ventilation and bronchodilating medicine.
Advise the patient to take high calcium and low phosphorus food (milk, milk product, egg yolk).
Provide aluminum hydroxide gel to the patient.
explain the nursing management
nursing assessment
To monitor patient’s vital signs.
Assess the patient’s dietary habit.
Assessing the patient’s fluid amount.
Perform neuromuscular examination of the patient.
Assess whether there are any changes in the patient’s behavior such as anxiety, irritability, etc.
Observing seizure activity.
nursing diagnosis
1) Risk of injury related to tetany, Seizures.
2) Anxiety related to disease, treatment.
3) Impaired nutritional pattern less than body requirement related to dysphagia.
4) Activity intolerance related to weakness, photophobia.
5) Knowledge deficit related to disease condition, treatment, self care, prognosis and discharge needs.
Nursing interventions
reduce the risk of injury.
To monitor patient’s vital signs.
To assess whether the patient has numbness, tingling sensation or not.
Do not restrain the patient if he has seizures.
Keeping the patient’s side rails up.
Monitor the patient’s serum calcium level.
Administer anticonvulsant medicine to control seizures.
2) relieve anxiety.
Monitoring the patient’s anxiety level.
Explaining all information whatever.
Reducing external stimuli and providing a calm environment.
Providing the patient with mind diversional therapy.
Provide anti-anxiety drug to the patient.
3) Maintain stable weight by reducing malnutrition.
Monitoring the patient’s food intake level.
Ask the patient to take adequate amount of meal.
Ask the patient to take high calorie food that is easily digested.
Provide high calorie high protein and carbohydrate rich food to the patient.
Maintaining intake output chart of patient.
4) Improved ability to participate in desired activities.
Monitor the patient’s vital signs and assess the client’s activity level.
List the patient with tachypnea, dyspnea, pallor, cyanosis.
Providing a calm environment to the patient.
Provide bed rest to the patient and restrict excessive activity.
Provide antacids and anti-anxiety agents to the patient.
enhancing knowledge.
To assess the patient’s knowledge about the disease and its treatment.
To provide knowledge to patients about drug therapy and its side effects.
Providing the patient with a balanced nutritional diet.
Planning the nutritional menu of the patient.
Ask the patient to take regular follow up.
1) define/explain thyroiditis.
2) Explain, types, etiology, clinical manifestation, and diagnostic evaluation of thyroiditis.
3) Explain the management of thyroiditis. (Write management of thyroiditis.)
1) Define/explain thyroiditis.
=> Thyroid gland is a small butterfly shaped gland which is located in the front part of the neck.
=> The thyroid gland is located in the inferior part of the cricoid cartilage.
=> Hormones (T3,T4) from the thyroid gland are released into the blood stream which play an important role in the growth and metabolism of the body.
=> Infection and inflammation in this thyroid gland is called thyroiditis.
==> (Inflammation of the thyroid gland its called Thyroiditis.)
2) Explain the types of thyroiditis.
1) Acute suppurative thyroiditis
2) Subacute or lymphatic thyroiditis.
3) Chronic thyroiditis (HASHIMOTO’S DISEASE)
4) lymphocytic/silent or Painless thyroiditis.
1) Acute suppurative thyroiditis
=> This type of thyroiditis is mainly due to a bacterial invasion.
=> Acute thyroiditis is mainly seen up to one month.
2) Subacute or lymphatic thyroiditis. (Subacute or Lymphatic Thyroiditis)
Subacute and lymphatic thyroiditis
quervain’s thyroiditis ( Quervain’s thyroiditis),
Granulomatous thyroiditis,
giant cell thyroiditis
Also known as
=> In sub acute thyroiditis, the condition of thyroiditis in the patient lasts for three to four months.
3) Chronic thyroiditis (HASHIMOTO’S DISEASE)
=> Chronic thyroiditis is called Hashimoto thyroiditis.
=> Chronic thyroiditis is a long term inflammatory disorder.
=> Chronic thyroiditis is seen in the patient for up to 1 year (12 to 18 months).
4) Lymphocytic/silent or Painless thyroiditis. (lymphocytic/silent or painless thyroiditis)
=> This type of thyroiditis is mainly seen in post partum period in women.
3) Explain the causes/Etiology of thyroiditis.
1)Acute suppurative thyroiditis:=
Due to bacterial infection:=
Staphylococcus bacteria (staphylococcus bacteria)
Streptococcus bacteria (Streptococcus bacteria)
pneumococcus pneumonia (pneumococcus pneumonia),
Due to fungal infection:=
aspergillus (aspergillus),
candida,
histoplasma,
=> This is mainly seen in women aged 20 to 40 years, children and older people.
2) Subacute thyroiditis:=
Due to viral infection,
Due to autoimmune abnormality.,
Due to genetic conditions,
Due to myco bacterial infection.
Due to taking certain types of drugs.
This type of thyroiditis is mainly seen in women aged 40 to 50 years.
3) chronic thyroiditis:=
Due to autoimmune disorders.
Due to genetic abnormality.
This type of thyroiditis is more common in women between 20 and 50 years of age.
4) Explain the clinical manifestation/diagnostic evaluation of thyroiditis.
1) Acute thyroiditis:=
In this there is pain in both front parts of the neck and this pain radiates in the ears and mandibles.
Bacterial toxicity,
Fever,
sweat it out,
feeling cold,
sore throat,
hoarseness,
difficulty swallowing,
2) Subacute lymphocytic thyroiditis:=
The thyroid gland becomes swollen and inflamed.
Pain in the neck,
Fever,
feel tired,
Loss of appetite (loss of appetite := Anorexia),
3) Subacute Granulomatous thyroiditis:=
neck pain,
Pain in the neck radiates to the ear and mandible.
Muscle pain.
sore throat,
Thyrotoxicosis (high level of thyroid hormone in blood for any cause),
4) chronic thyroiditis:=
Enlargement of the thyroid gland occurs.
Difficulty swallowing.
Respiratory distress.
feel tired
Energy will be low.
Joint and muscle pain.
Changes in voice.
5) Explain the diagnostic evaluation of thyroiditis. (Write diagnostic evaluation of thyroiditis.)
history taking and physical examination,
blood culture,
needle aspiration,
thyroid ultrasound,
thyroid stimulating hormone level assessment.
T3, (triiodothyronine),
T4 (thyroxine) level assessment.
needle aspiration.
6) Explain the management of thyroiditis. (Write Management of Thyroiditis)
1) Acute pain related to post operative tissue damage.
2) Imbalance nutritional status less than body requirement related to hyper metabolic rate and impaired utilization and storage of nutrients.
3) Impaired skin integrity related to surgical incision.
Nursing management
Assess the patient’s nutritional status.
Assess the amount of nutrition the patient is taking.
Observe the patient for any difficulty in swallowing.
Administer anti-emetic medicine if patient has nosia and vomiting.
Provide adequate amount of fluid to the patient so that the hydration status of the patient is maintained.
Check the patient’s weight daily.
Assess the patient’s respiratory status every one to two hours.
Assess the patient’s pain level.
Provide the patient in semi-faular position.
The dressing should be clean and dry to prevent infection.
Encouraging the patient to perform diversional activities to improve coping abilities.
During the post-operative period, check the patient’s vital signs every 15 minutes.
Checking the patient’s dressing during the post-operative period.
Checking the patient for any bleeding.
Checking the patient for signs and symptoms of hypocalcemia.
Check the patient’s calcium magnesium and phosphate level.
Assess the patient for any conditions like restlessness, agitation, and tachycardia.
Keep checking the patient’s thyroid function level.
Providing the prescribed medicine to the patient.