nerdnursing

[nerdnursing]

Adrenal Glands

Hi again! Welcome to a crash course of the adrenal glands brought to you directly from my lecture notes.

Before we jump into it, there’s two very important hormones that are secreted from the adrenal cortex. These are going to be the backbone of your major dysfunctions. 

Aldosterone

Aldosterone is a mineralocorticoid that maintains extracellular fluid balance by sodium and water reabsorption and potassium excreted by the kidneys. 

Cortisol

Cortisol is a glucocorticoid that affects the body’s response to stress, immune function, nutrition, sodium and water balance, and emotional balance. Also keep in mind that when cortisol levels are low, glucose levels are low. 

With that out of the way, lets go over a rough adrenal anatomy. 

You’ve got two parts to the gland.

Adrenal Cortex

This makes up 90% of the gland

It secretes 3 types of hormones

mineralocorticoids

glucocorticoids

sex hormones

Adrenal Medulla

This makes up the other 10%

Secretes catecholamines (epinephrine and norepinephrine) 

On to dysfunction!

Adrenal Hypofunction -- Addison’s Disease

Causes:

Primary

autoimmune

aids/infection

adrenalectomy

abdominal radiation therapy

drugs

cancer

Secondary

hypophysectomy

brain/pituitary radiation

sudden cessation of glucocorticoid therapy

Manifestations:

muscle pain/weakness

anorexia and weight loss

nausea

vomiting

diarrhea 

constipation

salt craving*

vitiligo or dark pigmentation of skin 

hair loss

emotional lability/depression/apathy

Lab Findings:

hyponatremia* (remember the salt craving?), hyperkalemia, and hypovolemia

In Addison’s Disease, you have a lack of aldosterone and cortisol? Remember what these hormones do? Maintain fluid volume. Therefore, these lab finding make sense when you think in terms of fluid volume deficit

increased BUN

decreased cortisol and aldosterone (obviously)

higher risk of developing hypoglycemia 

Interventions:

frequent vital signs -- sometimes up to q15 minutes

reduce physical activity/minimize stress

cardiac assessment for changes 

fluid replacement

sodium replacement

IV glucose/insulin (to treat hyperkalemia) 

hormone replacement

prednisone

cortisone

hydrocortisone

fludrocortisone

Common NANDAs for Addison’s Disease

Risk for decreased cardiac output

Deficient fluid volume

Fatigue

Cardiac function is a nursing priority because of hyperkalemia

[nerdnursing]

Parathyroid Dysfunction

Hi, wow. I meant to do this more often, but I got distracted. Oops. Anyway! 

Let’s start on what the parathyroid is and what it does. 

This little gland here regulates the calcium and phosphorus balance in your body. Increased parathormone elevates blood calcium by increasing calcium absorption from the kidney, intestine, and bone while also lowering phosphorus levels. This means that these two electrolytes are inversely correlated. 

On to the fun part: dysfunction.

Hypoparathyroidism

Hyposecretion of parathormone (PTH) causes hypocalcemia and hyperphosphatemia.

Causes:

Destruction of parathyroid glands (i.e., parathyroidectomy)

Renal failure

Autoimmune complications

Manifestations: 

Muscle cramps -- typically in the abdomen and extremities

Anxiety

Positive Trousseau’s or Chvostek’s sign 

Tetany

Nursing Interventions:

Monitor for signs and symptoms of hypocalcemia and tetany

S/S of hypocalcemia

numbness and/or tingling of the extremities

muscle cramps/spasms

seizures

facial twitching

muscle weakness

lightheadedness

slow heart rate 

Seizure precautions

Airway protection -- intubate with tetany

Calcium-gluconate and vitamin D2

Hyperparathyroidism

Hypersecretion of PTH causes hypercalcemia and hypophosphatemia.

Causes:

Primary

noncancerous growth -- adenoma

cancerous growth

Secondary

Renal failure

hypocalcemia -- overworked parathyroid

phosphorus rentention

Manifestations:

Fatigue

Muscle weakness

Skeletal pain/tenderness

Constipation

Bone Deformities

Renal Stones -- due to frequent urination

Pathological fractures

Anorexia/Nausea/Vomiting

Cardiac dysrhythmias

Interventions:

Monitor vital signs and EKG

Strict I&Os

Skeletal pain management

Avoid injury

Parathyroidectomy care

Encourage movement

Patient education

That’s really all I have for you in terms of the parathyroid and nursing care! I hope this helps. If anyone has anything to add, please feel free! 

-- Valkyrie, Future RN

[nerdnursing]

Pressure Injuries!

Ah, the disgusting wonderful world of pressure injuries. Love them, or hate them, you’re going to see a bunch of them in the clinical setting. I suggest you quickly get used to the idea if you haven’t already. 

“But, Valkyrie, I don’t think they’re that bad,” you say. 

My response to you, friend, is oh god, they are THAT bad, but not necessarily for the reasons you might initially think. 

Let’s start from the beginning. 

A pressure injury is defined as localized damage to the skin and underlying tissue that usually occurs over a bony prominence or is related to the use of the device. They mostly develop when when soft tissue is compressed between bone and an external surface for a prolonged time. (i.e., your bed-bound patient that isn’t being properly repositioned every 2 or so hours). 

There are a lot of things that can put a patient at risk. I mean, a lot. 

Immobility

Poor skin hygiene

Diabetes 

Loss of sensation

Fractures

Immunosuppression

Increased body temperature

Microvascular dysfunction

Previous pressure injuries

Significant obesity or thinness

Moisture

Friction

Nutrition

I could go on. The biggest cause of a pressure injury however is in the name it self. Pressure. The pathophysiology is pretty simple. Pressure on an area leads to occluded capillaries and poor circulation to tissues. This can cause ischemia, hypoxia, edema, inflammation, ulcers, and necrosis. 

There’s one factor that I feel like I should point out. Skin moisture is a fine line and a slippery (ha) slope. Our skin needs to be hydrated in order to heal, but too much moisture can lead to maceration. This will only create more issues for you as the nurse and for your patient. Keep a close eye ones that you believe would be at risk, especially the febrile and obese. 

There are of course specific areas that are prone to these types of wounds: 

Back of the head

Shoulder blades

Coccyx

Heels

Mandible

Sternum

Knees

I suggest you go lay down on your bed in every position you can think of and take note of what parts of your body touch the mattress. Any point that touches is at risk for a pressure injury.

Staging

Pressure injuries technically have six stages, but only 4 of them are numbered. 

Stage 1

A localized area of of intact skin with nonblanchable erythema 

May be painful, soft, firm, warmer, or cooler than the adjacent tissue 

Stage 2

Involves partial thickness loss of dermis and presents as a shallow, open ulcer or a ruptured/intact serum-filled blister

Stage 3

Presents as full thickness tissue loss

Subcutaneous fat may be visible at this stage, but bone, tendon, and muscle will not 

Stage 4

Full thickness tissue loss with exposed or palpable bone, cartilage, ligament, tendon, fascia, or muscle. 

Slough or eschar may be present

Tunneling and undermining may occur as well

Unstageable

This is when the clinician is unable to identify the severity of the pressure wound due to slough or eschar

Deep Tissue Pressure Injury

This is when there is a persistent, nonblanchable purple or maroon discoloration of intact or non-intact skin, or separation of the epidermis that reveals a dark wound bed or blood-filled blister

It usually results from intense or prolonged pressure and shearing where the bone and muscle interface.

My point at the end of all of this is pressure injuries are a huge part of HAIs/hospital injuries due to the nature of, well, hospitals. You have patients that are bed bound for days, sometimes weeks. It’s a given that these types of wounds happen. 

There are steps to avoiding these such as repositioning every two hours, barrier creams, attention to how you’re transporting the patient, frequent and through skin assessments, etc, etc...

I’m not here to harp on about how to prevent them. It’s our jobs as nurses to think critically and figure out a way around it ourselves. 

What’s important to take away is the effect that these injuries could potentially have on your patients. Things like this can cause complications other than pain and infection. Anxiety, fear, interference with ADLs, and changes in body image can be just as debilitating for some people. That’s why they’re “that bad.” We have to be conscious of this as well as be there to step in to soothe all of these discomforts and fears. 

As a nurse, you’re more than just there to help heal physical wounds, you’re there to help heal mental and emotional wounds as well. 

If you notice that any of my information is incorrect, please message me, and I will correct and credit you as soon as possible. I’m still just a student and learning just like the rest of you. This is just a way to help me study and learn and potentially help others along the way. 

--Valkyrie, Future RN

[nerdnursing]

Medical School Resources! (and other human biology,physiology,biochemistry-related resources)

Hi Everyone! 

Update: I am now officially done with my second year! I know i’ve been MIA on here for a while now - but that’s only because I was drowning in textbooks and assignments! I will be writing a whole other post on what my second year in medical school was like - so watch out for that :)

I, for one, can not just rely on one method of learning. Meaning, I’ll jump from videos, to textbooks, to flashcards. In this post I’m going to list some of my holy grail youtube channels that have helped saved me. 

1) Handwritten Tutorials

https://www.youtube.com/user/harpinmartin

Every video in this channel is short, but not so much that you feel like you’re missing out on information. Definitely one to save as a favourite!

2) Armando Hasudungan

https://www.youtube.com/user/armandohasudungan

The best thing about this channel is the fact that there are over 300 videos, covering a wide range of core topics in endocrinology, neurology, physiology and pharmacology. Another pro is the presentation of topics (otherwise considered snooze-worthy) in an artistic manner!

3) Speed Pharmacology

https://www.youtube.com/channel/UC-i2EBYXH6-GAglvuDIaufQ

Raise your hand if you’ve ever fallen asleep trying to read about the mechanism of action of opioids, their side effects and contraindications. I know I have. Fret not, for this youtube channel will introduce you to a world where pharmacology is actually interesting.

4) Wendy Riggs 

https://www.youtube.com/user/wendogg1

Wendy Riggs is a very down-to-earth professor in Northern California, and she covers a wide range of  topics in Anatomy, Physiology and General Biology. 

5) Anatomy Zone

https://www.youtube.com/user/TheAnatomyZone

A better way to learn anatomy is to supplement your textbook information with videos from this channel. The explanations and visuals provided are absolute gold.

I hope you all find these channels as helpful as I did!

[nerdnursing]

Hi everyone! I’m fairly new to the nurseblr community, and I wanted to use this place as a way to keep myself motivated through nursing school.

I plan to post some notes and tips that I learn along the way as well reblog a bunch of diagrams/charts/posts that I find useful.

Im about to start my first semester in August, and any advice would be seriously appreciated!

[nerdnursing]

To all students who are looking how to pass the NCLEX

Hurst Review.

Do it, trust me.

I’ll be honest with you, I didn’t pass the first time I took the NCLEX. I was close, I went the full 265 questions. I had studied with ATI and Saunders. I did a ton of questions. It wasn’t enough.

Hurst review is different. They have questions, sure, but it’s different. It goes over the information that a brand new nurse with two weeks of vast knowledge would have. It breaks down the information and states it in such a way that it all connects and it’s easier to remember.

I passed the second time, after waiting over a year from the first time I took it…and I credit Hurst Review with helping me succeed.

Look into it, baby nurses. It’s worth it and it’s guaranteed.

[nerdnursing]

Appendix

The appendix is a finger-like, blind-ended tube connected to the caecum, from which it develops in the embryo. 

Function

The function of the appendix is unknown. Theories include:

Maintaining gut flora - a “safe house” for beneficial bacteria in the recovery from diarrhoea/illness.

Immune and lymphatic system - The appendix has been identified as an important component of mammalian mucosal immune function, particularly B cell-mediated immune responses and extrathymically derived T cells - helps movement and removal of waste matter in the digestive system, contains lymphatic vessels that regulate pathogens, and may produce early defences that prevent deadly diseases.

Vestigiality - the appendix may have lost all or most of its original function or evolved to take on a new function.

Removal of the appendix causes no known health problems.

Pathology

Appendicitis: For unclear reasons, the appendix often becomes inflamed, infected, and can rupture. This causes severe pain in the right lower part of the belly, along with nausea and vomiting.

Tumours: Carcinoid and epithelial tumours are possible but rare.

Surgery (appendectomy) is the only treatment for appendicitis. 

[nerdnursing]

NCLEX Pharmacology Medical Suffixes

-amil = calcium channel blockers

-caine = local anesthetics

-dine = anti-ulcer agents (H2 histamine blockers)

-done = opioid analgesics

-ide = oral hypoglycemics

-lam = anti-anxiety agents

-oxacin = broad spectrum antibiotics

-micin = antibiotics

-mide = diuretics

-mycin = antibiotics

-nuim = neuromuscular blockers

-olol = beta blockers

-pam = anti-anxiety agents

-pine = calcium channel blockers

-pril = ace inhibitors

-sone = steroids

-statin =antihyperlipidemics

-vir = anti-virais

-zide = diuretics

[nerdnursing]

Medical School Resources! (and other human biology,physiology,biochemistry-related resources)

Hi Everyone! 

Update: I am now officially done with my second year! I know i’ve been MIA on here for a while now - but that’s only because I was drowning in textbooks and assignments! I will be writing a whole other post on what my second year in medical school was like - so watch out for that :)

I, for one, can not just rely on one method of learning. Meaning, I’ll jump from videos, to textbooks, to flashcards. In this post I’m going to list some of my holy grail youtube channels that have helped saved me. 

1) Handwritten Tutorials

https://www.youtube.com/user/harpinmartin

Every video in this channel is short, but not so much that you feel like you’re missing out on information. Definitely one to save as a favourite!

2) Armando Hasudungan

https://www.youtube.com/user/armandohasudungan

The best thing about this channel is the fact that there are over 300 videos, covering a wide range of core topics in endocrinology, neurology, physiology and pharmacology. Another pro is the presentation of topics (otherwise considered snooze-worthy) in an artistic manner!

3) Speed Pharmacology

https://www.youtube.com/channel/UC-i2EBYXH6-GAglvuDIaufQ

Raise your hand if you’ve ever fallen asleep trying to read about the mechanism of action of opioids, their side effects and contraindications. I know I have. Fret not, for this youtube channel will introduce you to a world where pharmacology is actually interesting.

4) Wendy Riggs 

https://www.youtube.com/user/wendogg1

Wendy Riggs is a very down-to-earth professor in Northern California, and she covers a wide range of  topics in Anatomy, Physiology and General Biology. 

5) Anatomy Zone

https://www.youtube.com/user/TheAnatomyZone

A better way to learn anatomy is to supplement your textbook information with videos from this channel. The explanations and visuals provided are absolute gold.

I hope you all find these channels as helpful as I did!

[nerdnursing]

Differentiation of T cells

Keep reading

[nerdnursing]

Appendix

The appendix is a finger-like, blind-ended tube connected to the caecum, from which it develops in the embryo. 

Function

The function of the appendix is unknown. Theories include:

Maintaining gut flora - a “safe house” for beneficial bacteria in the recovery from diarrhoea/illness.

Immune and lymphatic system - The appendix has been identified as an important component of mammalian mucosal immune function, particularly B cell-mediated immune responses and extrathymically derived T cells - helps movement and removal of waste matter in the digestive system, contains lymphatic vessels that regulate pathogens, and may produce early defences that prevent deadly diseases.

Vestigiality - the appendix may have lost all or most of its original function or evolved to take on a new function.

Removal of the appendix causes no known health problems.

Pathology

Appendicitis: For unclear reasons, the appendix often becomes inflamed, infected, and can rupture. This causes severe pain in the right lower part of the belly, along with nausea and vomiting.

Tumours: Carcinoid and epithelial tumours are possible but rare.

Surgery (appendectomy) is the only treatment for appendicitis. 

[nerdnursing]

Pancreas

The pancreas is a mixed gland, having both an endocrine and an exocrine function, located in the abdominal cavity behind the stomach. 

The pancreas contains two completely different tissues.

The exocrine pancreas consists of

acinar cells - produce digestive enzymes which are stored in eosinophilic zymogen granules and break down carbohydrates, proteins, and lipids .

centro-acinar cells - form part of the ductal system of the organ 

The intercalated ducts drain into the interlobular ducts, which eventually drain into the main pancreatic ducts.

which secretes pancreatic juice into the duodenum 

contains bicarbonate, which neutralizes acid entering the duodenum from the stomach.

The endocrine pancreas consists of:

Islets of Langerhans - contain different populations of cells that produce the hormones insulin, glucagon and a small number of cells producing somatostatin. 

Islets have a network of capillaries in contact with the endocrine cells.