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medsurg 2 test 5 complete lecture notes
Terms in this set (115)
Iron Deficiency Anemia Occurs when
dietary intake of iron is inadequate for hemoglobin synthesis. The body can store about ¼ to 1/3 of its iron and it's not until those stores are depleted until iron def. anemia develops.
Most common cause in men and post-menopausal women is
bleeding ulcers, gastritis, IBD.
Most common cause in pre-menopausal women is
menorrhagia (heavy menses) & pregnany w/ inadequate iron supplementation.
Chronic _________________ can often cause chronic blood loss thru GI tract.
Iron Deficiency Anemia: Symptoms -
Angular cheilosis- red, swollen patches in corner of mouth, where lips meet and make an angle. There are many causes for this but one being iron def. anemia.
Iron Deficiency Anemia: Treatment -
With iron replacement therapy, hour before meals. *however, If not tolerated, pt. can take w/ meals but know this decreases absorption by 50% and they will need to take iron therapy much longer.
Food sources include -
organ meat (liver), meat in general, beans (black, pinto, garbanzo), leafy green vegetables, raisins, molasses, breads, cereals, egg yolks, potatoes, shell fish, and others. Drink orange juice with it to help enhance the absorption of the iron.
So when Vit.b12 def. is caused by absence of intrinsic factor its called ________________ Factor
Vitamin B12 Deficiency -
Dietary intake deficiency is rare but can develop in strict vegetarians who consume no meat or dairy products. causes-chronic proton pump inhibitor use such as Prilosec, Prevacid, Nexium-Even if vit. B12 and intrinsic factor are present a def. may occur if dz involving the ileum or pancreas impairs absorption.
Vitamin B12 Deficiency S&S -
weakness & fatigue, Paresthesia in extremities (numbness & tingling in hands, feet & legs). Proprioception-ones position of sense, its what allows you to walk thru the doorway instead of walking into the edge of the doorway. It allows you to know your sense within your space or environment.
Vitamin B12 Deficiency: diagnosed -
Schilling Test is the classic method of determination. Pt. receives a small oral dose of radioactive B12 & followed in a few hours by a large dose of nonradioactive dose of IV B12. This IV dose aids in renal excretion of radioactive dose. If oral dose is absorbed more than 8% excreted in the urine within 24h. A 24h urine catch is done and if more than 8% of radioactive is noted in the urine that's only if the oral dose was absorbed. If there was no radioactivity noted this means it was not absorbed and it will be excreted thru the GI tract. Then you would know it is a malabsorption issue. If the radioactivity is detected in the urine then the cause of the dz is either ilium dz or pernicious anemia. So later the same procedure is repeated but this time intrinsic factor is added to the oral radioactive B12. If radioactivity is detected in the urine then again the B12 was absorbed the dx of pernicious anemia can be made.
Vitamin B12 Deficiency: Treatment -
treat by increasing dietary intake B12 foods- meat, eggs, shellfish, fish, cheese. If you have B12 malabsorption d/o you must get IM monthly injections because you will not be able to absorb the supplements.
Folate Deficiency -
Folate stores in the body are much smaller than Vit. B12 stores and can come completed within 4 months when dietary intake of folate is deficient. Usually body does not store any more than 4 months of folic acid that it needs.
Folic acid is found in
green vegetables and liver, deficiency occurs in people that rarely eat uncooked vegetables, alcohol increases folic acid requirements, at the same time alcoholics usually have a diet that is deficient in folic acid putting them at risk for folic def. -Foods high in folic acid- breads, cereals, rice, beans, OJ.
Aplastic Anemia -
is when pancytopenia exists. Pancytopenia is a reduction in all blood cell types. Due to bone marrow failure.
Hemolytic Anemia -
Premature destruction of erythrocytes results in the liberation of HGB into the plasma (something is destroying RBC) & HGB from the RBC is being released into the plasma. The released HGB is converted enlarged into bilirubin and therefore the bilirubin level rises. The increases erythrocyte destruction leads to tissue hypoxia. In turn stimulates erythropoietin production. Erythropoietin stimulates bone marrow to compensate by producing new erythrocytes and releasing some of them into circulation and somewhat prematurely as reticulocytes. reticulocyte count is increased- increase in immature RBC. Supply of haptoglobin (binding protein for HGB) depleted as more HGB is released as a result the plasma haptoglobin is low. If the marrow cannot compensate to replace the RBC destroyed in the circulation the anemia will progress.
Sickle Cell Anemia -
Sickle cell anemia is a hemolytic anemia. The gene causes the HGB molecule to be defective. African descent & Middle Eastern.
S&S of Sickle cell -
pain, swelling, fever. The sickling crisis can be intermittent. Cold temp. can aggravate, vasoconstriction slows blood flow.
Hydration- makes blood thinner more viscous, less risk for clotting.
Pain Management is the most common thing we as nurses will deal with.
-Pain Control-ASA, NSAIDS, opiates, analgesics- pt. develop substance abuse due to chronic pain
-Splenectomy- performed if chronic splenic subsequentration ?? (where spleen absorbs blood cells)
Vaccinations-Pneumococcal & Flu
With ATBX use and teaching the outcome has improved with those living with sickle cell. Though life expectancy is still mid 50's.
It is an inherited blood disorder in which the body makes an abnormal form of hemoglobin. Hemoglobin is the protein molecule in red blood cells that carries oxygen. The disorder results in excessive destruction of red blood cells, which leads to anemia. Hereditary-seen worldwide but highest prevalence in mediteranean, AA, southeast Asia areas. Genetic counseling-offered to those of child birthing age. Alpha or Beta depending on which HGB chain is affected. Alpha is milder form.
Frontal bossing-low profile forehead, Maxillary prominence.
Polycythemia Vera -
Spleen enlarges & resumes embryonic function of hematopoiesis (blood cell production) Risk for thrombosis due to having thick, viscous blood. Marrow becomes "burnt out"- its produced all it can produce. May evolve into AML-(acute myeloid leukemia)
Symptoms result from
increased blood it includes: burning sensation in fingers and toes, only partially relieved by cooling, Headache, Dizziness, Enlarged spleen-splenomegaly, Fatigue, Tinnitus, Paresthesia, Angina from increased blood viscosity, Clottication, Dyspnea, Thrombophlebitis.
Secondary Polycythemia is caused by
a decrease in O2 level. Its not caused by the bone marrow not producing. Hemoglobinopathies-HGB has an abnormally high infinity for O2. Genetic mutations that cause higher levels of erythropoietin. Renal carcinoma (neoplasm) can stimulate erythropoietin production leading to increased RBC production.
It is an insufficiency that occurs when the adrenal cortex is unable to meet the body's need for cortical hormones. Autoimmune or idiopathic atrophy are most likely causes. Can also occur when both adrenal glands surgically removed or from infections such as tuberculosis or histoplasmosis that destroy the adrenal gland tissue. Inappropriate ACTH secretion from the pituitary can also cause adrenal insufficiency.
With disease progression, _________________ __________ develops. This condition is characterized by hypotension, cyanosis, fever, nausea & vomiting, and classic signs of shock. In addition, the patient may have pallor, headache, abdominal pain, and diarrhea, and may show signs of confusion and restlessness. Even slight overexertion, exposure to cold, acute infection, or a decrease in salt intake may lead to circulatory collapse, shock, and death, if untreated.
Treatment is directed toward combating circulatory shock; restoring blood circulation, administering fluids and corticosteroids, monitoring vital signs, and placing the patient in a recumbent position with the legs elevated. Hydrocortisone (Solu-cortef) is administered IV, followed dextrose IV fluids. Vasopressors may be needed.
Consume high sodium foods during gastrointestinal disturbances and hot weather to maintain fluid and electrolyte balance.
Cushing Syndrome -
When over production of the adrenocortical hormone occurs, arrest of growth, obesity, and musculoskeletal changes occur along with glucose intolerance.
The classic picture of Cushing Syndrome in the adult is that of central-type obesity, with a fatty "buffalo hump" in the neck and supraclavicular areas, a heavy trunk, and relatively thin extremities. The skin is thin, fragile, and easily traumatized; ecchymosis (bruises) are present. The patient complains of weakness. Sleep is disturbed because of altered daily secretion of cortisol. Excessive protein catabolism occurs, producing muscle wasting and osteoporosis. Kyphosis, backache, and compression fractures of the vertebrae may result. Retention of sodium and water occurs as a result of increased mineralocorticoid activity, producing hypertension and heart failure.
The patient develops a "moon-face" appearance and may experience and may experience increased oiliness of the skin and acne. Hyperglycemia or overt diabetes may develop. The patient may also report weight gain, slow healing of minor cuts, and bruises.
How is Cushing's diagnosed
The three tests used to diagnose Cushing Syndrome are serum cortisol, urinary cortisol, and low-dose dexamethasone (Decadron) suppression tests. Two of the three tests need to be abnormal to diagnose Cushing Syndrome.
Serum cortisol levels
are usually higher in the early morning (6-8 am) and lower in the evening (4-6 pm). This variation is lost for those with Cushing's.
A urinary cortisol
This requires a 24 hour urine collection. If the results are 3 times higher than normal range and one other test is abnormal, then Cushing's Syndrome is assumed.
An overnight dexamethasone suppression test is used to
diagnosis pituitary and adrenal causes of Cushing syndrome. Oral decadron is given at bedtime and serum cortisol level is drawn in am. If the cortisol was suppressed to a level less than 5 mg/dL, then the hypothalamus-pituitary-adrenal system is functioning properly. Some medications can effect cortisol levels.
Other indicators include increased sodium and blood glucose level and a decrease potassium level.
Lymphomas are cancers of the
lymphoid tissue with abnormal overgrowth of lymphocytes.
Lymphoma is not an issue with stem cell development as in leukemia stem cells. Explain -
lymphoma is not an issue with stem cell development, but rather with fully mature lymphocytes.
What are the pathological hallmark and essential diagnostic criteria for Hodgkin's lymphoma
Reed Sternberg cells. They are the main difference between Hodgkin and non-Hodgkin, because non-Hodgkin's do not have Reed Sternberg cells.
What characteristic of the Reed Sternberg cell differentiates it from that of the normal lymph cell.
Unlike normal lymph cells that have only one nucleus, the Reed Sternberg cells have multiple nucleuses.
The cause Hodgkin's lymphoma is unknown, but it could possibly be ______.
Hodgkin's lymphoma begins as an
enlargement of one or more lymph nodes on one side of the neck, so unilateral.
What is a distinguishing feature about these nodes?
The nodes are painless and firm, but not hard.
The most common sites are the
cervical, super clavicular and mediastinal nodes.
Some patients experience brief but severe pain after drinking _____________. And usually this is at the site of the tumor, and again, there's no known cause for this symptom either.
Diagnostic findings for Hodgkin's lymphoma are
increased SED rate, ESR, and serum copper level.
Differintiate between how Hodgkin's and non-hodgkin's spreads
Hodgkin's is localized single group of nodes and there is continuous spread which means it's predictable along the chain. Whereas in non-hodgkin, there are multiple lymph nodes involved. Extra nodal involvement is common and it unpredictably spreads.
What are the differences in age groups with Hodgkin's and non-hodgkin's
Hodgkin's lymphoma is bi-modal distribution, which means the peak incidents occur at two different times in life, one being in young adulthood, usually early twenties, and the second in older adults, usually around the age of 55 or greater.
Now, non-hodgkin's lymphoma can occur in both children and adults. It's not specific to age.
What is the most common symptom of both of these diseases?
Lymphadenopothy (enlarged lymph nodes)
a malignant disease of the plasma.
The hallmark sign of multiple Myeloma is
Patients suffering from multiple Myeloma report symptoms of
bone pain and the pain is often in the back of the ribs. Their pain actually increases with movement and resolves with rest.
They will report thirst, dehydration, constipation, and some level of confusion or altered mental status, an elevated protein level. So again, they may come in with these signs and symptoms and bone pain, and then be diagnosed with multiple Myeloma.
What lab abnormality would you expect to see
In MM there will be an elevated calcium level due to the destruction of bones caused by osteoclasts.
Lymphoid vs Myeloid -
lymphoid-refers to the stem cell that produce the lymphocyte
Myeloid-refers to stem cell that produce the non-lymphoid cells
idiopathic thrombocytopenic Purpura or ITP occurs after a
viral infection or any immunization. With ITP Platelets are destroyed, lowering the overall platelet count.
It is an inherited disorder in which there is inadequate amount of clotting factors.
Differentiate between Hemophilia A & B
Hemophilia A, there's lack of clotting factor eight and Hemophilia B There's lack of clotting factor nine
D.I.C. or disseminated intravascular coagulation
is a result of trauma or severe injury- during or after a severe trauma such as a motor vehicle accident, or sepsis.
What occurs with D.I.C.
DIC results after severe trauma or injury where the body uses up, all of it's available platelets and bleeding occurs.
Heparin‐induced thrombocytopenia (HIT)
HIT is an immune response to Heparin administration, and again, the body uses up all of his platelets and bleeding results.
What is the first thing a nurse should do if a patient is showing signs and symptoms of HIT?
Stop the transfusion of Heparin.
Symptoms we see with thrombocytopenia include
bruising, Petechia. Bleeding, early bleeding can be seen from the mouth, particularly the gums.
Glucocorticoids increase platelet counts by decreasing the antiplatelet antibody production, so use of glucocorticoids can increase platelet production by preventing antibodies from attacking platelets. SPLENECTOMY has also shown to improve the platelet count because the spleen is the primary site of platelet destruction.
If the bleeding is a result of hemophilia, treatment will be what?
clotting factors will be administered.
If the bleeding is due to DIC, then we will need to
resolve whatever the underlying cause. For example, if it's Sepsis, aggressive antibiotic treatment would be how to treat the DIC, which would in turn treat the decrease in platelet count.
unregulated leukocyte proliferation in bone marrow (abnormal increase in growth rate of leukocytes w/in bone marrow) Normally stem cells develop into differentiated cells (specific cells w/ specific purposes) w/ leukemia the stem cells are poorly differentiated. They do not fully mature. They do not have full properties of what their parents cells have.
Radiation exposure-Benzine-possibly linked.
acute vs chronic Leukemia -
Acute - onset of symptoms is abrupt often occurring within a few weeks. Leukocyte development is halted at the blast phase and thus most leukocytes are undifferentiated cells or blast. Under microscope there would be a high number of immature blast cells noted. Acute leukemia progresses rapidly w/ death occurring within weeks to months without aggressive treatment.
Chronic Leukemia- symptoms evolve over months to years. Majority of leukocytes produced are mature, it progresses more slowly.
Common symptoms of Leukemia -
Resp infections are very common, SOA, Muscle weakness, petechiae.
What patient and staff precautions must be put into place for these patients?
Diagnostics for leukemia -
↑WBC-proliferation of leukocytes, ↓Hgb & Hct, ↓platelets, ↑WBC
Bone marrow aspiration & biopsy.
Treatments for Leukemia
Chemotherapy used to irradicate the overproduction of leukocytes. Risk-infection, bleeding, malnutrition.
She states to look over chemotherapy
-Once pt. is on chemo and they have knocked out WBC production which also lowers RBC and platelet counts a stem cell transplant may be utilized. Donor can be sibling, family member, or non familial match. At the point of the stem cell transplant the pt. body is totally irradicated of stem cells. Hopefully once the transplant occurs the RBC & platelets will increase and stem cells will begin to form cell properly.
-Know that these pts. Are extremely neutropenic and thrombocytopenic. There body is taken down to no immune system. Any sign of infection or bleeding needs to be treated aggressively
Hematopoietic Stem Cell Transplantation
It is a procedure that offers the possibility of a cure for some patients with hematological disorders such as severe aplastic anemia, some forms of leukemia, and thalassemia.
What are the three Anemia classifications -
Hypoproliferative, Hemolytic, Bleeding.
lack of RBC
, Iron-Deficiency Anemia, Vitamin B12 Anemia, Folic Acid Deficiency, Aplastic Anemia. Hypoproliferative anemia the bone marrow is the problem, it cannot produce enough erthyrocytes.
destruction of RBC
, Sickle cell anemia, thalassemia.
Trauma, Menorrhagia, GI tract.
occurs when too little circulating blood volume decreases MAP, resulting in inadequate total body perfusion and oxygenation. Common problems leading to hypovolemic shock are poor clotting with hemorrhage and dehydration.
occurs when the heart muscle is unhealthy and pumping is impaired. Myocardial infarction is the most common cause of direct pump failure. Any type of pump failure decreases cardiac output and MAP.
occurs when blood volume is not lost from the body but is distributed to the interstitial tissues where it cannot perfuse organs. It can be caused by blood vessel dilation, pooling of blood in venous and capillary beds, and increased capillary leak. All these factors decrease mean arterial pressure (MAP) and may be started either by nerve changes (neural-induced) or by the presence of some chemicals (chemical-induced).
is an extreme type I allergic reaction. It begins within seconds to minutes after exposure to a specific allergen in a susceptible person. The result is widespread loss of blood vessel tone, with
decreased blood pressure and decreased cardiac output.
is a widespread infection that triggers whole-body inflammation. It leads to distributive shock when infectious microorganisms are present in the blood and is most commonly called septic shock.
Stages of Shock -
Refractory - Irreversible
there is decreased O2 delivery to the cells. Clinical manifestations are subtle or subclinical, but cellular damage may be occurring.
Hypoxia to the cells
the BP remains within normal limits. Vasoconstriction, increased heart rate, and increased contractility of the heart contribute to maintain adequate cardiac output. This is due to the sympathetic nervous system and subsequent release of catecholamines (epi and norepi). The patient displays the fight or flight response where the body shunts blood away from the skin, kidneys, and GI tract to the brain, heart, and lungs to ensure adequate supply to vital organs. As a result the skin may be cool and pale, bowel sounds are hypoactive, and urine output decreases in response to the release of aldosterone and ADH.
the mechanisms that regulate BP can no longer compensate, and the MAP falls below normal limits. Patients are hypotensive with SBP less than 90 mmHg or a decrease in in systolic BP of 40 mmHg from baseline. The patient shows signs of declining mental status. The overworked heart becomes dysfunctional and biochemical mediators cause myocardial depression worsening perfusion leading to failure of the pump, even if the underlying cause of the shock is not the heart. Microcirculation fails leading to increased capillary permeability and interstitial edema decreasing blood return to the heart. The inflammatory response to injury is activated. Chances of survival depend on the patient's general health before the shock state and the amount of time it takes to restore tissue perfusion. As shock progresses, organ systems decompensate.
Irreversible - the point along the shock continuum at which organ damage is so severe that the patient does not respond to treatment and cannot survive. Multiple organ dysfunction has progressed to complete organ failure and death is imminent.
Multiple organ dysfunction syndrome
Management in all types and all phases of shock include the following:
*Respiratory support - Supplemental O2, Mechanical ventilation.
*Fluid replacement to restore intravascular volume - Monitor for overload, Pulmonary edema, UOP, Perfusion, Right atrial pressure (RAP), VS including CO if pulmonary artery catheter present.
*Vasoactive meds to restore vasomotor tome and improve cardiac function - Central line, VS q 15 mins, Titrated, Keep MAP > 65 mmHg.
*Nutritional support to meet ↑ metabolic requirements - TPN vs Enteral, > 3000 cals/day, Stress ulcer prevention
Parathyroid hormone regulates
calcium and phosphorous levels in the blood. Increased secretion of parathyroid hormone increases calcium absorption by the kidneys, intestines, and bones resulting in increased serum Ca level. Although decreased the level of circulating phosphorous.
What potentiates the effect of parathyroid hormone.
What system stops parathyroid hormone from becoming over produced
negative feedback system - as serum levels of ionized calcium increase, release of parathyroid hormone decreases.
the over production of the parathyroid hormone.
leads to bone decalcification as calcium is pulled out of the bones in response to increased parathyroid hormone. Hypercalcaemia.
The recommended treatment for primary hyperparathyroidism is
surgical removal of abnormal parathyroid tissue. Previously performed under general anesthesia and allowed for exploration of all glands. Now more commonly done under local anesthetic as an outpatient procedure in which only one diseased gland is removed. Monitor airway postoperatively! Also monitor for tetany due to hypocalcemia. Rountine monitoring of Ca level to ensure return to normal postoperatively and over time.
Hydration to prevent renal calculus formation (kidney stones).
Avoid thiazide diuretics as they decrease renal excretion of calcium worsening the serum calcium level.
Walking encouraged as bones stressed with walking are less likely to give up calcium.
Hypoparathyroidism is caused by
abnormal parathyroid development, destruction of the parathyroid glands (surgical removal or autoimmune response), and vitamin D deficiency. With the most common cause being near total removal of the thyroid gland. Hypocalcemia.
Hypocalcemia causes irritability of the neuromuscular system and contributes to the chief symptom of hypoparathyroidism, which is
tetany. Tetany is a general muscle hypertonia, with tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movements.
What are the two positive signs used to diagnose Hypoparathyroidism
Chvostek's sign is positive when a sharp tapping over the facial nerve causes spasm or twitching of the mouth, nose, and eye
Trousseau's sign is positive when carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a blood pressure cuff.
Treatment of Hypoparathyroidism
Treatment is determined by the underlying cause and may include combination pharmaceutical Ca replacements.
Thiazide diuretics decrease urinary calcium excretion.
Currently no synthetic parathyroid hormone replacement is approved to treat hypoparathyroidism.
A diet high in calcium and low in phosphorous is prescribed. Although milk, milk products, and egg yolks are high in calcium, they are restricted because they also contain high levels of phosphorous. Spinach is also avoided when trying to raise calcium level due to its high levels of oxalate.
Foods high in calcium
A disorder in adults in which the pituitary gland produces too much growth hormone causing over growth of extremities.
What is the most common disorder of the posterior lobe of the pituitary gland and is characterized by decrease in anti-diuretic hormone (ADH)
S & S of Diabetes Insipidus
Excessive thirst (polydipsia) and large volumes of dilute urine are manifestations of the disorder.
Causes of Diabetes Insipidus
It may occur secondary to head trauma, brain tumor, or surgical ablation or irradiation of the pituitary gland. It may also occur with CNS infections or with tumors. Another cause is failure of the renal tubules to respond to ADH.
The objectives of therapy are to
replace ADH (which is usually a long-term regimen), to ensure adequate fluid repalcemnt, and to identify and correct the underlying intracranial pathology. Desmopressin (DDAVP) is a synthetic vasopressin administered intranasally daily. As vasopressin causes vasoconstriction it must be used cautiously in patients with coronary artery disease.
are tumors that present 90% of pituitary tumors. These tumors usually do not produce hormones and destroy the pituitary.
Signs of hypopituitarism
Fine, thin hair
dry, soft skin
Polyphagia (↓ basal metabolic rate)
Pituitary Tumor Treatment
Surgical removal of the pituitary gland (hypophysectomy) through a transphenoidal approach is the usual treatment. Stereotactic radiation allows precise delivery of external-beam radiation to the pituitary with minimal effect on normal tissue.
butterfly shaped, and located in the lower neck, anterior to the trachea. It produces 3 hormones (thyroxine (T4), triiodothyronine (T3), and Calcitonin. Iodine is essential to the thyroid gland for hormone production. Iodine is ingested in the diet and absorbed in the GI tract and then stored in thyroid gland. Secretion of thyroid hormones is controlled by the anterior pituitary glands' secretion of TSH. Thyroid hormones control cellular metabolic activity.
______________ reduces the blood level of calcium by increasing its deposition in bone.
Thyroid function tests are used to stimulate the thyroid.
Thyroid-Stimulating Hormone (TSH) free thyroxine (T4) are highly sensitive and are elevated in ___________________________and decreased in ___________________________ .
hyperthyroidism , hypothyroidism
Select medications may alter the results of thyroid tests such as
amiodarone, aspirin, Tagamet, valium, Lasix, heparin, Dilantin, Indera
Thyroid antibodies are present in ______________ ______________, _____________ disease, and other organ-specific autoimmune diseases.
Hashimoto's thyroiditis, Graves'
How does the radioactive iodine uptake test work?
measure the rate of iodine uptake by the thyroid gland. Patients with hyperthyroid exhibit a high uptake of iodine while those with hypothyroid show a very low uptake of the radionuclide.
Hypothyroidism results from decreased level of thyroid hormone. List some of the signs and symptoms.
Slowing of body functions
Women > men
40 - 70 years old
Most commonly due to autoimmune thyroiditis (Hashimoto's Disease)
Thyroid deficiency affects all body functions and can range from mild to myxedema. What is myxedema?
(severe deficiency that's life threatening). Myxedema coma is when the patient becomes hypothermic and unconscious. Cardiovascular collapse and shock can develop requiring aggressive supportive therapy if the patient is going to survive. Mortality rate for myxedema is 30-40%. Older adults and those with cardiac complications are at highest risk.
Hypothyroidism is most commonly due to
autoimmune thyroiditis (Hashimoto's disease)
Thyroid hormone replacement with synthetic levothyroxine (Synthroid or Levothroid) is commonly used to treat hypothyroidism and suppress goiter development.
Medications are administered to the patient with hypothyroidism with extreme caution because of the potential for altered metabolism and excretion, as well as depressed metabolic rate and respiratory status.
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