ENDOCRINE

Pituitary Gland

- Master gland
- Controlled by hypothalamus

Thyroid Gland

- Hypothyroidism
o Decreased BMR
o Lethargy, fatigue, cold intolerance, dry skin, edema
o Treatment
 Thyroid replacement: Levothyroxine
o Watch out for Myxedema Coma
 Hypoglycemia
- Hyperthyroidism
o Caused by Grave’s disease/toxic goiter
o Adequate rest
o Treatment
 Antithyroid: PTU, propranolol for tachycardia, iodine preparations
 Thyroidectomy
 Hoarsness is normal, minimize talking
 WOF hypercalcemia: damaged parathyroid
o WOF Thyroid Storm
 Fever

Pancreas

- Diabetes Mellitus
o Insulin Use
 Potentiate: Aspirin, alcohol, antidepressants
 Counter: Steroids, diuretics, contraceptives
o Complications
 Hypoglycemia
 Mild (<60): Hunger, Nervousness, Sweating, Palpitations, Tremor
o 10 to 15g simple carbs (sugar, ice cubes, honey, hard candy)
 Moderate (<40): Confusion, Double vision
o 15 to 30g
 Severe (<20): Coma
o D5050
 DKA
 More common in Type 1
 300-800mg/dl, low serum bicarbonate, low pH, acetone breath,
kussmaul
 Regular insulin
  Glucose is maintained at 250mg/dl until ketosis is resolved. IV with 5%
destrose

Med Notes

- Levothyroxine is taken on empty stomach

- Stop Lugol’s if there is burning sensation in the mouth
- Steroids are given early morning

INTEGUMENTARY

Skin Cancer

- Confirm thru skin biopsy

Contact Dermatitis

- Inflammatory response

Lyme Disease

- Ticks

Herpes Zoster

- Shingles
- Unilaterally clustered vesicles on trunk, thorax, face
- Isolate the client

BURN

- Head and neck: 9%, Anterior trunk: 18%, Posterior: 18%, Arms: 9% each, Legs 18% each
- Superficial
o Skin blanches
o Pain is eased by cooling
o Erythema
- Superficial Partial-thickness (2nd degree)
o Large blisters
o Wet, shiny and weeping
o Edema
- Full Thickness (3rd degree)
o Little or no pain
- Deep Full-thickness (4th degree)
o Injured area is black
o Eschar is hard
- Head, neck=respiratory
- Face=corneal abrasion
- Ear=auricular chondritis
- Circumferential=compartment syndrome
- Pathophysiology
o Increased capillary permeability=fluid losses
o Initially hyponatremia and hypokalemia!!!
o Initially oliguria
- Management
o Emergent
 Time of injury to restoration of capillary permeability
 48-72 hours after
 Goal is prevent hypovolemic shock and preserve organs
o Resuscitative
 Initiation of fluids to capillary integrity returns to near-normal levels
 Maintain UO 30-50ml/hr
 Goal=prevent shock
 NPO
 Escharotomy for circumferential
o Acute
 Client is hemodynamically stable with diureses
 Goal=restorative therapy
 Wound care
 Skin grafting
 Split thickness
o Half of the epidermis
o Stamps
 Full Thickness
o Epidermis and dermis
o Used for reconstructive surgery
 Pedicle Flap
 Cultured epithelium
o Keratinocytes
 Skin graft care
 Elevate and immobilize
o Rehabilitative
 Gain independence