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LSC Ch 66 Thyroid
LSC Nursing
| Question | Answer |
|---|---|
| Hyperthyroidism | Body in overdrive, visal changes, blurred/double eyes tire early, exopthalamus, heat intolerance (not hot flashes), Increased HR, BP, RR, Wt Loss, Increased appetite & BM's Insomnia, Decreased energy level, Irritability depression |
| Goiter | Hyperplasia of thyroid Gland, insufficient dietary intake of iodine, Grave's Disease, Hashimoto's disease (autoimmune), Nodules |
| Assessment Hyperthyroidism | Eyes- Exopthalmus, excess tearing, bloodshot, photosensativity, Neck: goiter- affect swallowing/breathing? cardiac Increased HR, BP, Dysrhythmias |
| Assessment Hyperthyroidism Cont | Hair/Skin: Fine, Soft Hair, Smooth, Moist Skin, Tremors, Restless, Irritable, Fatigues, Mood swings, insomnia, emotional |
| Lab/Dx Studies Hyperthyroidism | T3 & T4 Increased, TSH LOW - Thyroid Scan: Radioactive iodine inj, goes directly to thyroid, increased uptake w/hyperthyroidism, iodine doesn't go to a tumor- cold spot, not pregnant-or caregivers |
| Nursing Dx for Hyperthyroidism | Imbalanced Nutrition (less), Hyperthermia, Fatigue Collaborative Prob: Potential for Hypertension and Cardiac Failure |
| Grave's Disease Interventions | Monitor VS, esp temp elev. Note Palpitations, dyspnea, vertigo, chest pain, reduce stimulation, rest comfort, quiet, cool environment, Diet Therapy: Increased CHO, Proteins & Calories |
| Antithyroid Drugs (Hyperthyroidism) | Propylthioruacil (PTU), Methimazole (Tapazole) decrease thyroid blood flow short term before surgery or severe thyrotoxicosis LUGOL'S Solution- SSKI- mix w/fruit juice drink thru straw - stains teeth |
| Lithium Carbonate (hyperthyroidism) | Used as a last resort, SE: DI, Tremors, N&V, used when cannot tolerate anti thyroid meds |
| Beta Adrenergic Blockers (Hyperthyroidism) | Propranolol (Inderal), do NOT inhibit TH, Reliee Diaphoresis, anxiety, tachycardia, palpatations |
| Radioactive Iodine Therapy | Oral: low radioactivity: precautions not needed, elimenated quickly, flush toilet twice, not for pg women- crosses placenta. Thyroid tissue p/u iodine, destroys some cells producing thyroid hormone, relif of symptoms 6-8wks, 1-3 doses |
| PreOP for Thyroidectomy | Large goiter, poor response to antithyroid meds, partial or total thyroidectomy - TOTAL need replacement meds for life, Treat pt so Euthyroid b4 surg, Antithyroid meds, radioactive iodine, reduce size and vascularity of gland |
| More Preop Interventions for Thyroidectomy | COntrol HTN, Tachycardia, & dysrhythmias before surg, if low wt, high carbs & high protein weeks B4 surg, Teach CDb, support neck, Hoarseness Endotrach tube, Partial: suture remaining gland to trachea, Total: parathyroids left w/intact blood supply |
| PostOp Thyroidectomy | Continue to monitor VS frequently, Head position straight alignment, Avoid neck extension, SemiFowlers Position, Analgesics, CDB q8hrs, hemorrhage 1st24hrs, check dressing behind neck & incision site |
| Respiratory Distress Post Op Thyroidectomy | Swelling & Tetany, Laryngeal Stridor keep Emergency Trach tray on hand |
| Hypocalcemia & Tetany Post OP | Damaged/removed parathyroid glands, tingling around mouth, toes, fingers, twitching Chevostek's Sign & Trousseau's sign |
| Chevostek's Sign | Cheek Tremor when Tapped (decreased serum Calcium) |
| Trousseau's Sign | Hand Spasm w/BP cuff Tx: IV Calcium (Decreased Serum Calcium) |
| Thyroid Storm/Thyroid Crisis | *Fever, Tachycardia, Systolic HTN, Anxiety, tremors, Mortality Rate 25%, Treat Symptoms |
| Emergency Care Thyroid Storm | Administer PTU & Methimazole, Inderal, glucocorticoids, Monitor VS q30min, provide a cooling blanket or ice packs and comfort measures |
| Hypothyroidism | Under drive, Decreased Metabolism, edema around eyes, hands, feet, between shoulder blades, tounge thickens, laryngeal edema - husky voice |
| Cretin | Child w/untreated hypothyroidism |
| Assessment Hypothyroidism | Overall decrease in energy, more time sleeping, weakness, muscle aches, constipation, cold intolerance, decreased libido, difficulty becoming pg, impotence, use of drugs that impair thyroid, skin cool, pale, yellowish, dry, course, poor wound healing, |
| Physical Assessment Hypothyroidism | Overall Appearance, Heavy, dull expression, edema, thick tongue, slow movements |
| Lab Hypothyroidism | T3 & T4 Decreased, TSH HIGH, opposite hyperthyroidism |
| Nursing Dx Hypothyroidism | Ineffective breathing Pattern, Decreased Cardiac Output, Disturbed Thought Processes, Collaborative Problem: Myxedema Coma |
| interventions Ineffective Breathing Pattern | monitor rate/depth of respiration, check pulse oximetry, avoid narcoticsor sedatives, seere respiratory depression leads to myxedema coma possible death |
| Interventions Decreased Cardiac Output | Respiratory Monitoring, Shock Prevention, Hypothermia tx, Life Long Thyroid Replacement, |
| Levothyroxine (Synthroid) | Hypothyroidism, start w/low dose, gradually increase over couple months until achieve desired effect & blood level, given too much: Hyperthyroidism |
| Interventions Disturbed Thought Processes | Improvement should be seen w/thyroid replacement, Orient to person, place & time, work w/family about client's behavior |
| Myxedema Coma | Coma, Respiratory Failure, Hypotension, Hyponatremia, Hypothermia, Hypoglycemia, If untreated, leads to organ failure & death |
| Treatment Myxedema Coma | maintain patent airway, replace fluids w/IV Normal or Hypotonic Saline, give levothyroxine sodium IV as prescribed, give glucose IV as prescribed, give corticosteroids, check temp, BP hourly, warm blankets, aspiration precautions, turn q2hrs, monitor ment |
| Thyroiditis | Acute: bacterial invasion, Subacute: viral invasion, chronic: hashimoto's disease |
| Hashimoto's Disease | Autoimmune, Women>Men, Gland destroyed low levels of thyroid and increased levels of TSH, Goiter dvlps from increased TSH, antithyroid meds for surgery |
| Thyroid CA | single painless lump/nodule, most slow growing except anaplastic carcinoma: metastasis to larynx/throat, surgery: total thyroidectomy, suppressive doses of thyroid hormones for 3mo after surgery and/or ablation of thyroid Hypothyroid |
| Hyperparathyroidism | Increased Secretion of PTH, Increased Se Calcium, Increased Phosphate Excretion, TUmor on one parathyroid gland, Leads to bone loss of Ca - weakness in bones, GI, Kidneys |
| Interventions for Hyperparathyroidism | Hydration, Lasix: Increases Kidney Excretion of Ca (Monitor Cardiac Function) Phosphates: interfere w/calcium absorption, used only if need to rapidly lower Ca levels, Calcitonin: keeps Ca in bone: excretes se Ca |
| Cont Intervention for Hyperparathyroidism | Ca Chelators: bind w/Ca, Mithramycin- may cause Thrombocytopenia, kidney, liver toxicity |
| Surgical Mgmt Parathyroidectomy | Need Normal Ca Levels, check ptt & pt, may need lifetime Ca & Vit D |
| Hypoparathyroidism | Low PTH causes Low Se Calcium, Rare, Seen w/poor nutritional status, tingling, numbness, tetany, Calcium & Vit D Magnesium Supplements, Foods High in Calcium but low Posphorus minimal dairy products |
| Interventions Hypoparathyroidism | Correct Hypocalcemia: Vit D defiency, & Hypomagnesemia IV calcium chloride or calcium gluconate; Vit D: Calcitrol (Rocaltrol) Magnesium 50% mag sulfate IM or IV, teach drug regine, foods high in calcium, avoid processed cheese, diet colas) life long meds, |
Created by:
ginabeana
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