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NUR 112
Thyroid and adrenal disorders
| Question | Answer |
|---|---|
| how does the thyroid regulate the bodys metabolic rate | by controlling: heart, muscle & digestive function brain development bone maintenance |
| (THYROID) hypothalamus releases _____ to ______ | TRH to puitatary gland |
| (THYROID) pituitary gland releases _____ to ______ | TSH to thyroid |
| (THYROID) thyroid releases releases _____ | T4 and T3 (TH) |
| TRH stands for | thyrotropin-releasing hormone |
| TSH stands for | thyroid stimulating hormone |
| TH stands for | thyroid hormones |
| T4 is | thyroxine |
| T3 is | TRIIODOTHYRONINE |
| NEURO effects due to hyperthyroidism | Increased sympathetic nervous system’s response “fight or flight”, ------can lead to faster response to stimuli in the environment |
| CARDIAC effects due to hyperthyroidism | Increased cardiac output, peripheral blood flow, ----an lead to rapid and irregular heartbeats and feeling hot (heat intolerance) |
| GI effects due to hyperthyroidism | Increased carbohydrate, protein, lipid metabolism, ---- can lead to weight loss- the body moves and uses the nutrients and energy from food |
| causes of hyperthyroidism | graves disease, hyperfunctioning thyroid nodules (Goiter), thyroiditis |
| what is graves disease | autoimmune disorder that stimulates thyroid to produce T4 |
| what is Hyperfunctioning Thyroid Nodule (goiter) | lumps that form on thyroid that cause it to produce too much T4 |
| risk factors for hyperthyroidism | Age: 20 and 40 years Gender: female Family History: Fam hx of Graves’ disease Diet: Increased iodine intake |
| foods high in iodine | seaweed, fish/seafood, iodized salt- in U.S. |
| s/s of hyperthyroidism | Emotional lability Insomnia Hair changes (fine, thin and loss) Increased sweating Heat intolerance Hypertensive, Tachycardia** Increased appetite with weight loss Hypermotile bowels, Diarrhea Menstrual changes |
| specific physical assessment findings for hyperthyroidism | Toxic Multinodular Goiter (excete excessive TH) Exophthalmos or Proptosis |
| Toxic Multinodular Goiter puts pts at high risk for | aspiration!!! --> dysphagia and dyspnea |
| Exophthalmos or Proptosis puts pts at high risk for | injury/ infection |
| Exophthalmos or Proptosis results in an | inability to close the eyelids completely increases the risk of corneal dryness, irritation, infection, and ulceration |
| exophthalmos or Proptosis can eventually lead to | eye paralysis and vision loss |
| s/s of thyroid storm/ thyroid crisis | Altered mental status, increasing hyperthermia (> 104 to 106 degrees F), Increasing tachycardia (> 130 bpm), Increasing hypertension (SBP > 200) |
| med tx of thyroid storm | rapid tx with antithyroid, F&E replacement!!!!, cool down body temp with antipyretics (NO ASPRIN EVER), beta blockers |
| diagnostic tests for hyperthyroidism | T3 and T4 serum levels, TSH serum levels, TSH receptor antibody test, radioactive iodine uptake test |
| Non-pharmalogical tx of hyperthyroidism | promote visual health, promote balanced nutrition |
| how to promote balanced nutrition for hyperthyroidism | High-carbohydrate High-protein diet In-between-meal snacks Six small meals/day Hydration *caloric intake may need to be increases to 4000 kcal/day if weight loss is severe |
| key medications for hyperthyroidism | Methimazole (Tapazole), Propylthiouracil (Propyl-Thyracil, PTU) |
| methimazole (Tapazole) function | inhibits the production of new TH |
| timeframe for methimazole (Tapazole) therapeutic effect | can take 6-8 weeks to start seeing change in symptoms, so often taken with Beta blockers to treat cardiovascular symptoms |
| common side effects of methimazole (Tapazole) | less serious SE, skin and scalp problems Pregnancy precautions: don’t take during 1st trimester, check with pregnancy test before starting |
| serious side effects of methimazole (Tapazole) | hepatotoxicity- can cause liver damage (Monitor LFT’s) |
| proylthiouracil (PropylThyracil, PTU) function | inhibits the production of new TH |
| timeframe for proylthiouracil (PropylThyracil, PTU) | can take a few days to start working |
| common side effects of proylthiouracil (PropylThyracil, PTU) | lowering WBC and Platelet levels Pregnancy - OK to take |
| serious side effects of PTU | hepatoxicity, thrombocytopenia, leukopenia (Monitor LFT’s, CBC- platelets and WBC) |
| what should you monitor when taking any medications to treat hyperthyroidism | for s/s of hypothyroidism |
| purpose of radioactive iodine (RAI) therapy | RAI concentrates in the thyroid, Destroys thyroid cells leading to less TH production |
| contraindications for RAI | pregnant women and breastfeeding women |
| social precautions for pts receiving RAI | Client will have to distance themselves from other people, especially vulnerable populations (pregnant and children) and avoid shared items |
| environmental precautions for pts receiving RAI | Client will have to avoid public areas |
| hygiene precautions for pts receiving RAI | Client will have to take measures to minimize exposure from body fluids (urine/stools, saliva) i.e. double flush toilet, wash clothes seperate, etc |
| Thyroidectomy Surgery Pre-op | pt should be as close to euthyroid state as possible, May take antithyroid drugs to reduce hormone levels, Educated client that they made be temporarily hoarse and scar (raised, rounded borders) after surgery |
| Thyroidectomy Surgery Post-op | Positioning- Keep neck in neutral position, support neck when moving, avoid neck flexion and extension, elevate head at least 45 degrees, no supine position Pain- assess for discomfort Surgical site- assess dressing for bleeding |
| post thyroidectomy complications | thyroid storm, hypothyroidism, hypocalcemia |
| neuro effects of hypothyroidism | decreased nervous system communication and response, can lead to mental fogginess and fatigue |
| cardiac effects of hypothyroidism | decreased cardiac output, peripheral blood flow, -->can lead to decreased heart rate and heart failure (Cold intolerance) |
| GI effects of hypothyroidism | decreased carbohydrate, protein, lipid metabolism, --> can lead to weight gain- body uses up energy from food slowly and not in time for efficient cell and hormone function |
| causes of hypothyroidism | Hashimoto’s Thyroiditis Medications (meds that tx hyperthyroidism) Thyroid Surgery or Therapy Pituitary Disorders Iodine Deficiency |
| risk factors for hypothyroidism | age >50 female gender fam hx of hashimoto's diet deficient in iodine |
| what is Hashimoto’s Thyroiditis | autoimmune disease where the body produces antibiotics that attack own tissues that sometimes includes the thyroid. Can also produce a goiter (enlarge thyroid to compensate for decreased TH) that can be asymptomatic or cause swelling and cough. |
| s/s hypothyroidism | Impaired mental status Fatigue and Weakness Dry skin and Hair Thinning/Loss Cold Intolerance Hypotension, Bradycardia (Late) Decreased appetite with weight gain Constipation Menstrual Changes |
| what is a myxedema coma (crisis) | severely advance hypothyroidism, not related to a fluid overload problem |
| key s/s of myxedema coma | Swelling of face, lips and tongue and larynx Periorbital edema- around the eyes and eyelids Pretibial edema- Non-pitting edema, waxy appearance, especially in lower legs --> goiter, cold intolerance, weight gain, fatigue |
| cause of myxedema coma | poorly managed hypothyroidism , can be worsened by illness, trauma, CNS depressants (ex. Sedatives, tranquilizers) , Lithium |
| Critical Signs & Symptoms of Myxedema coma | Temperature- hypothermia Neuro- confusion, seizures, coma Respiratory- decreased and slow respirations, hypoventilation Cardiovascular: hypotension and bradycardia GI/GU: diminished or absent bowel sounds, ascites, kidney failure- oliguria/anuria |
| Tx of myxedema coma | Temp- rewarming, heating blankets, warm liquids, warm environment Respiratory- maintain airway, apply o2 devices, intubate as needed, ventilator tx cause: antibiotic for infection, electrolyte replacement, IV thyroid medication |
| NI for myxedema coma | fall and seizure prec., treat abnormal electrolytes, Cardiac monitoring |
| diagnostic tests for hypothyroidism | t4, t3, and TSH serum levels |
| Med tx for hypothyroidism | Levothyroxine (Synthroid) |
| when to take Levothyroxine (Synthroid) | --take PO dose in morning , without food, at least 30 minutes to 1 hour before breakfast --life-long treatment, specific increment of doses |
| med interactions with Levothyroxine (Synthroid) | antacids decrease absorption- separate by 4 hours |
| NI for Levothyroxine (Synthroid) | monitor for signs of hyperthyroidism |
| what do Mineralocorticoids release | Aldosterone |
| what does aldosterone do | -increases Na+ and water retention which helps regulate BP -decreases K+ levels through urine excretion in the kidneys which helps regulate the body’s pH |
| what do Glucocorticoids release | cortisol |
| what does cortisol have affect on | Stress response to the environment Blood pressure regulation Metabolism Immune system by suppressing inflammation |
| how does cortisol affect metabolism | Effective use of glucose, protein, and fat sleep/wake cycle Increases urine excretion of Ca+ levels through the kidneys which effect bone formation |
| what do Sex Hormones release | Androgens and Estrogens |
| Androgens vs estrogens | androgens = male traits from the testes estrogens = female traits from the ovaries |
| what is CRH | Corticotropin- Releasing Hormone |
| what is ACTH | Adrenocorticotropin Hormone |
| (Adrenal) hypothalamus releases _____ to ______ | |
| (Adrenal) pituitary gland releases _____ to ______ | |
| (Adrenal) thyroid releases releases _____ | |
| cushing's disease vs syndrome | DISEASE = tumors or tissue overgrowths that stimulate a increased release of cortisol SYNDROME= from long term use of glucocorticoids |
| seven "s" s/s of steroids and cushing's) | Sugar Soggy bones Sick Salt Sad Sex Sleep |
| specific conditions of cushing's | FATTY HUMP (Buffalo Hump) ROUNDED FACE (Moon Face) STRETCH MARKS THIN SKIN/BRUISING OBESITY HYPERTENSION DIABETES TYPE II OSTEOPOROSIS |
| labs for cushing's | Cortisol: increased Glucose: increased Na: increased K+, Ca+ : decreased |
| Imaging tests for cushing's | X-ray, MRI, CT: checks for tumors that secrete ACTH in the pituitary gland, adrenal gland, lung, GI tract, pancreas |
| special tests for cushing's | 24 hour urine collection; Dexamethasone Suppression test |
| what do the special tests for cushing's identify | elevated cortisol levels |
| what can cause invalid results during 24 hr urine collection | False positives from acute illness and Alcohol use before test |
| NUTRITION for CUSHING’S | Need to eat more: Calcium, Potassium and Protein (healthy) Need to eat less: Sodium, Sugar (carbohydrates) and Fat |
| Hypophysectomy pre op teaching | -avoiding increases in ICP: breathe through mouth, avoid coughing, sneezing, blowing nose, bend at knees, not waist, avoid brushing teeth for 2 weeks- only floss and rinse mouth -numbness and diminished sense of smell for 3-4 month |
| Hypophysectomy post op care | Neuro checks- frequently every hour x 24 hours then every 4 hours Monitor for: headache, vomiting, blurred vision, mental status changes- lethargic, confused, Weakness- decline in movement, talking Cerebral spinal fluid (CSF) leakage |
| indications of CSF leak | headache, nasal drainage (amount and appearance), HALO SIGN (may indicate cerebral spinal fluid CSF) leak- presents as yellow on the edges, sweet tasting from glucose or salty tasting from electrolytes) |
| meds after Hypophysectomy | Steroids- glucocorticoids to prevent abrupt drop in cortisol level Stool softeners to prevent straining, increasing ICP |
| what is an adrenal crisis d/t and what are s/s | abrupt drop in cortisol- severe hypotension, tachycardia, tachypnea, abdominal pain, weakness, confusion, HA, loss of consciousness. |
| meds for cushing's | Adrenal Corticosteroid Inhibitor (Ketoconazole); Anticancer (Mitotane (Lysodren)) |
| causes of addison's disease | Autoimmune Dysfunction Steroid Withdrawal Damage to Adrenal Gland Medical Conditions Surgeries (ex. Hypophysectomy, Adrenalectomy) |
| results of addison's disease | -Low levels of the glucocorticoids cortisol leads to decreased levels of glucose in the body. -Low levels of the mineralocorticoid aldosterone leads to decreased levels of sodium in the body. |
| s/s of addison's | Hyperpigmentation Orthostatic Hypotension, EKG changes Dehydration Craving for salt Hypoglycemia Nausea & Vomiting Abdominal pain Diarrhea Weight loss Weakness |
| expected labs for addison's | Cortisol: decreased Glucose: decreased Na: decreased K, Ca: increased |
| diagnostic tests for addison's | X-ray, CT, MRI, ECG |
| meds for addison's | Mineralocorticoid Replacement or Glucocorticoid Replacement |
| adrenal or addisonian crisis treatment | Rapid, (If not quickly diagnosed and treated, prognosis poor) -infusion of NS (0.9% Normal Saline) or D5N5 (5% Dextrose with 0.9% Normal Saline) -Intravenous Hydrocortisone replacement -Potassium Treatments |
| s/s of adrenal or addisonian crisis | rapid onset of severe hypotension hypoglycemia, hyperkalemia, tachycardia, tachypnea, abdominal pain, weakness, confusion, HA, loss of consciousness. This is a medical emergency! |
| causes of adrenal or addisonian crisis | Steroid withdrawal, Sepsis, trauma, stress-MI, surgery, anesthesia, hypothermia, volume loss, hypoglycemia |
| pt education for adrenal or addisonian crisis | encourage wearing emergency alert bracelet |
| Mineralocorticoid Replacement drug name | Fludrocortisone (Florinef) |
| Glucocorticoid Replacement drug name | Hydrocortisone (Cortef), Prednisone or Methylprednisolone |
| what to know about Mineralocorticoid Replacement | Helps correct electrolyte imbalance and low blood pressure Mild peripheral edema is expected finding when taking, from increased sodium retention Monitor for hypertension, hypernatremia |
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ginnyfoscue
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