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TL Thyroid Gland
Hyperthyroidism and Hypothyroidism
| Question | Answer |
|---|---|
| What is Grave’s disease? | Excessive secretion of thyroid gland leading to increased basal metabolic rate. The body is in hyper-drive. Increased cardiovascular, GI, neuromuscular function, weight loss and heat intolerance |
| What are some potential causes of thyroid disease? | excessive TSH from the pituitary gland, autoimmune (Grave’s disease), thyroiditis (maybe viral ), tumor, excessive thyroid replacement (synthroid) |
| Discuss Grave’s disease. Who gets it most? What’s the cause? What might be deficient? | 5x more often in women 20-40 yrs old, autoimmune disorder triggers Long Acting Thyroid Stimulator (LATS), highly associated with iodine deficiency |
| Define Thyroid Crisis or Thyroid Storm. How dangerous is it? Who’s most at risk? What usually brings it on? | Thyroid Crisis is a life threatening emergency. Usually occurs in clients with long term untreated hyperthyroidism or client withy hyperthyroidism experiencing an unusual stressor (infection, trauma, thyroid surgery) |
| Name some of the most common manifestations of thyroid storm?(TTSh, AND, CATS) | Temp >102, Tachycardia, Systolic HTN, abdominal pain, N&V, diarrhea, agitation, tremors, confusion, seizures |
| What does the nurse want to include in the assessment of the client with hyperthyroidism? (HVGERPEAEOWFNSC) | HX, VS, neck for Goiter, eyes for Exophthalmos, respiratory effort, peripheral pulses, energy level, activity tolerance, elimination pattern, oxygenation, weight pattern over weeks, fluid balance, nutritional status, sleep pattern, comfort |
| What lab tests are relevant to the diagnosis of hyperthyroidism? | T3, T4, TSH, RAI uptake scan |
| If the pituitary and hypothalamus are functioning normally, what happens to TSH levels if T3 and T4 are high? | decrease |
| If the pituitary and hypothalamus are functioning normally, what would increased TSH levels indicate? | that T3 and T4 levels are low |
| What would an overactive thyroid gland react to an Radioactive Iodine uptake scan? | take up lots of iodine to make lots of T3 and T4 |
| What are the possible “fixes” for hyperthyroidism?(3) | Lifelong anti-thyroid medication, Ablative radioactive I-131, surgical removal of thyroid gland (all or part) |
| Name 2 anti-thyroid medications. | methimazole (Topazole) and propylthiouracil (PTU) |
| Name some applicable nursing diagnoses for the client with hyperthyroidism. | risk for decreased cardiac output; disturbed sensory perception, visual; risk for ineffective airway clearance; risk for imbalanced nutrition less than; disturbed body image; hyperthermia; Activity intolerance; Disturbed sleep pattern; deficient knowledge |
| How does I-131 ablation therapy work? | The patient takes an oral radioactive iodine isotope which is taken up by the thyroid gland. The isotope destrosy thyroid gland tissue over a period of 6-8 weeks. |
| Who cannot have I-131 therapy? | Pregnant women |
| What preoperative teaching will the client scheduled for thyroidectomy need? | deep breathing and appropriate cough, support neck when moving, how to take anti-thyroid medications to decrease vascularity and decrease risk of hemorrhage |
| Name 3 postoperative interventions to provide comfort for the thyroidectomy patient. | analgesics as prescribed, high fowler position with head and neck support by pillows to prevent muscle strain, ice collar to prevent edema and provide comfort |
| What postoperative thyroidectomy interventions decrease the risk of hemorrhage? | check the dressing front and back, skin of neck, upper chest, upper back, shoulders and back of neck for sanguineous exudates, especially the first 24 hours |
| What items need to be on hand in case of emergency post thyroidectomy? | Tracheostomy kit and calcium gluconate or calcium chloride |
| What postoperative interventions are important to maintaining a patent airway for the thyroidectomy patient? | auscultate trachea for stridor (narrowed airway/edema), Keep HOB 30%, assess for respiratory distress, oral and sterile suction available, humidified inspired air if ordered, encourage deep breathing/hr, cough only when needed to clear secretions |
| What do we monitor the client post-thyroidectomy for since parathyroid glands may have been removed/disturbed? | hypocalcemia/tetany, numbness or tingling of toes, extremities, lips, muscle twitches, positive Chvostek’s and Trousseau signs |
| How do we assess for laryngeal nerve damage? | ability to speak loudly, quality and tone of voice |
| What prescriptions might the nurse anticipate for their client with hyperthyroidism ? | potassium iodide, methimazole (Topazole) or prpylthiouracil (PTU) to reduce secretion of the thyroid hormone, ablative I-131 to reduce vascularity and size of the thyroid gland, analgesia for pain post-thyroidectomy |
| What does the client with hyperthyroidism need to know about self care? | how to use medications and that they are for life, how to recognize signs of both hyper- and hypo- thyroidism, symptoms to report, signs of hemorrhage, hypocalcemia, infection, respiratory difficulty and discomfort |
| Since damage to eyes from excess thyroid hormones remains after treatment what instructions does the nurse give the client about eye care? | eye exams, report changes in vision, protect eyes (tinted glasses/eyeshield), use artificial tears, do not contaminate dropper, soothe irritation w cool, moist compresses, sleep w HOB elevated and eye patches (minimize pressure on optic nerve) |
| What does the client need to know about post-thyroidectomy ? | support neck with hands, position neck with pillows and maintain semi-fowler’s, avoid hyperextension and sudden movements, wound care, minimize talking and coughing to protect wound and prevent strain on laryngeal nerve/vocal cords |
| Define hypothyroidism. | not enough thyroid hormone causing decreased metabolic rate and heat production |
| What is the cause of most cases of hypothyroidism? | Primary hypothyroidism accounts for 99% of all cases |
| What is the underlying cause of primary hypothyroidism in 50% of cases? | autoimmune destruction of the thyroid gland |
| Name some other causes of primary hypothyroidism. | thyroiditis, subacute post-partum, external irradiation of the gland, iatrogenic (30-40%) infections, iodine deficiency, congenital or idiopathic |
| What causes secondary or central hypothyroidism? | insufficient secretion of TSH from the pituitary gland or TRH deficiency related to a disease of the hypothalamus |
| Why do goiters develop? | enlargement of the gland is the body’s attempt to secrete more thyroid hormone |
| What are some symptoms of hypothyroidism? | lethargy, diminished reflexes, periorbital edema, bradycardia, dysrhythmias, hypotension, reproductive problems, coarse dry hair-easily lost, dry skin, hypothermia, fatigue, weight gain, anorexia, anemia, elevated serum lipids |
| What are the manifestations of myxedema? | non-pitting edema in connective tissues throughout the body, puffy face and tongue, severe metabolic disorders, hypothermia, cardiovascular collapse, and coma |
| What lab results would indicate primary hypothyroidism? | Elevated TSH and decreased T4 |
| What lab results would indicate secondary hypothryroidism? | decreased TSH and decreased T4 |
| What is the “fix” for hypothyroidism? | replace T4 |
| Give 9 applicable nursing diagnoses for hypothyroidism. | Decreased Cardiac Output; Imbalanced nutrition more than; Constipation; Risk for impaired skin integrity; Risk for activity intolerance; Risk for sexual dysfunction; Disturbed body image; Hypothermia; Deficient knowledge |
| When should T4 be administered to ensure absorption? | 1 hour before food or 2 hours after |
| How and why would the nurse adjust the temperature for the client with hypothyroidism? | keep the client warm (with blankets or set the thermostat) because it takes extra metabolism to produce warmth which increases cardiac workload and oxygen demand |
| How should activities be planned for the client with hypothyroidism? | with periods of rest in between |
| What dietary changes help with constipation? | Encourage intake of 2000mL of water and high fiber |
| Name a couple thyroid replacement drugs. | Thyroxine (Synthroid); Triiodothyronine (Cytomel) |
| What does the client with hypothyroidism need to know about their medication? | needed for life, take 1 hour before breakfast, withhold and notify prescriber if HR is >100, take the same brand of medication because chemical properties and bioavailability vary by brand |
| What does the client with hypothyroidism need to know about self care (other than how to take medication)? | about hypothyroidism, wear medic alert, report weight gain or loss of 5lbs, activity intolerance, and disturbances in sleep patterns; maintain a low fat, calorie-controlled diet |
Created by:
Perseverandovercome
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