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TL Hyperthyroidism
Hyperthyroidism HESI
| Question | Answer |
|---|---|
| Define Grave’s disease. | Excessive activity of the thyroid gland resulting in an elevated level of circulating thyroid hormones |
| Give three possible ways that a person could develop hyperthyroidism. | from a primary disease state, from the use of hormone replacement therapy, from overproduction of thyroid stimulating hormone due to an anterior pituitary tumor |
| Describe the process we think is associated with hyperthyroidism. | autoimmune process |
| How is hyperthyroidism diagnosed? | based on serum hormone levels |
| List four common treatments for hyperthyroidism. | thyroid ablation by medication, radiation, thyroidectomy, adenectomy of portion of anterior pituitary where TSH- producing tumor is located |
| What is the common complication associated with all treatments for hyperthyroidism? | all treatments make the patient hypothyroid, requiring hormone replacement |
| What might the nurse find on assessment of a patient with Hyperthyroidism(EAE)? | Enlarged thyroid gland, acceleration of body processes, exophthalamos |
| Give 11 manifestations of accelerated body processes exhibited by the patient with hyperthyroidism/Graves Disease (wl, ia, d, hi, t, p, ibp, d, wms, n, i). | Weight loss, increased appetite, diarrhea, heat intolerance, tachycardia, palpitations, increased BP, diaphoresis, wet/moist skin, nervousness, insomnia |
| What diagnostics apply to hyperthyroidism? | T3 and T4 levels, TSH levels, radioactive uptake (indicates presence of goiter), thyroid scan (presence of goiter) |
| What levels of T3 and T4 indicate hyperthyroidism? | T3 elevated above 220, T4 elevated above 12 |
| How does the TSH level help distinguish if the disease is primary or from the anterior pituitary? | Low TSH indicates primary disease because elevated T4 supressess thyroid releasing hormone thus TSH; If the source is the anterior pituitary both will be elevated. |
| Name two diagnostic tests used to determine if a goiter is present. | radioactive iodine uptake (131 I), Thyroid scan |
| Give four applicable nursing diagnoses for the patient with hyperthyroidism. (ddir) | decreased cardiac output, deficient knowledge, imbalanced nutrition less than, risk for injury |
| What kind of atmosphere should the nurse provide for the patient with hyperthyroidism/Grave’s disease? | calm and restful |
| What life threatening condition is the nurse alert for when the patient has hyperthyroidism/Grave’s disease? | Thyroid storm |
| What is a thyroid storm? | sudden oversecretion of thyroid hormone; a life threatening event that occurs with uncontrolled hyperthyroidism due to Grave’s disease |
| What are the signs of Thyroid Storm? | Fever, Tachycardia, agitation, anxiety, hypertension |
| What are the primary nursing interventions for the patient in thyroid storm? | maintain airway and adequate aeration |
| What drugs are useful for treating thyroid storm? | Propylthiouracil (PTU) and methimazole (Tapazole) are antithyroid drugs. Propranolol (Inderal) is good for treating excess sympathetic stimulation. |
| What teaching will the hyperthyroid/Grave’s disease patient need after treatment? | After TX daily hormone replacement is required; Wear MedicAlert jewelry in case of emergency; signs of hormone-replacement overdose (hyperthyroidism signs) and under dosage (hypothyroid signs); |
| What are the diet recommendations for the patient with hyperthyroidism/Grave’s? | High calorie, high protein, low-caffeine; low-fiber (diarrhea) |
| What interventions address exophthalmos? | artificial tears for moisture, sunglasses in bright light, annual eye exams |
| How do propylthiouracil (PTU) and mehtimazole (Tapazole) work? | They block the synthesis of T3 and T4 |
| How are propylthiouracil (PTU) and Methimazole (Tapazole) dosages calculated and how long does the client take them? | calculated based on body weight and given over several months |
| What is the expected effect of taking propylthiouracil (PTU) and methimazole (Tapazole)? | to make the client euthyroid, often to prepare the client for thyroidectomy |
| What is vital to achieving euthyroid with propylthiouracil (PTU) or methimazole (Tapazole)? | Client should take the medication exactly as prescribed |
| Explain the treatment of hyperthyroid using radiation. | The client is given 131 I to destroy thyroid cells |
| What kind of precautions are necessary for the client receiving 131 I? | Radiation precautions |
| Define radiation precautions. | Use of time distance and shielding to protect others from radiation such pt. avoids close/prolonged contact especially with children/pregnant women for a few days, flush potty twice (radiation in urine), wash all clothing and bedding daily |
| What is a life threatening potential complication post thyroidectomy? | laryngeal edema |
| Name four items that should be available to address potential development of laryngeal edema post-thyroidectomy. | tracheostomy kit at beside along with OX and suction machine; easy access to calcium gluconate |
| What are the nursing responsibilities when caring for a client post- thyroidectomy? | Check frequently for bleeding, support neck when moving – no hyperextension, watch for hoarseness or unclear speech (laryngeal edema), determine the number of parathyroid glands removed, keep drainage devices compressed and empty |
| Define transsphenoidal hypophysectomy. | TSH secreting pituirary tumors are resected using a transnasal approach |
| What role do the parathyroid glands play in serum calcium levels? | The parathyroid glands cause calcium to be released from the bones, kidneys, and GI to the blood |
| What is the normal level for serum calcium? | 9.0 to 10.5 mEq/L |
| What is the best indicator of a parathyroid problem in a post-thyroidectomy patient? | decrease in serum calcium from preoperative value |
| What risk is dramatically increased if the thyroidectomy patient has lost 2 or more parathyroid glands? | Tetany |
| Define tetany. | abnormal condition characterized by periodic painful muscular spasms and tremors, caused by faulty calcium metabolism and associated with diminished function of the parathyroid glands |
| What are the signs of tetany? | decreased serum calcium level; tingling of toes, fingers, around mouth; Chvostek sign; Trousseau sign |
| Which sign of hypocalcemia is assess ed by inflation of a BP cuff? | Trousseau sign |
| Which sign of hypocalcemia is assessed by tapping the facial nerve just in front of the ear? | Chvostek |
Created by:
Perseverandovercome
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