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JM Endocrine System
Hyperthryroidism
| Question | Answer |
|---|---|
| What is hyperthyroidism? | Excessive activity of thyroid gland, resulting in excessive thyroid hormones. |
| What is the function of the thyroid gland? | The thyroid controls the rate of body metabolism and growth and produces thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin. |
| What diseases/conditions are associated with hyperthyroidism? | Graves disease and goiter. |
| What are causes of hyperthyroidism? | Primary disease state, use of replacement hormone therapy, or from excess TSH being produced by an anterior pituitary tumor. |
| Name signs and symptoms of hyperthyroidism caused by Graves. | goiter, palpitations, cardiac dysrhythmias (tachycardia, A-fib), (exophthalmos), HTN, HEAT intolerance, diaphoresis, increased appetite,wt loss, diarrhea, smooth, soft skin and hair, nervousness,insomnia, irritable, mood swings.T3> 220 T4>12 |
| What would indicate primary disease of the thyroid and why? | Low level of TSH; elevated T4 level suppresses thyroid-releasing hormone, which suppresses TSH. If source is anterior pituitary, both will be elevated |
| What are some nursing interventions for hyperthyroidism caused by Graves? | ADEQUATE REST,COOL,QUIET ENVIRONMENT, sedatives, daily wt high-calorie diet,avoid stimulants, antithyroid medications (proplythiouracil, PTU)iodine preps, propranolol,radioactive iodine therapy and/or thyroidectomy. |
| What are two test that would indicate presence of a goiter? | radioactive iodine uptake (131I) and thyroid scan. |
| What are some nursing diagnosis for Graves Disease or goiter? | decreased cardiac output r/t, deficient knowledge (specify) r/t, imbalance nutrition; less than body requirements r/t, risk for injury r/t. |
| What are nursing interventions related to Graves or goiter? | Provide a calm, restful atmosphere, observe for signs of thyroid storm (life-threatening event , occurs with uncontrolled hyperthyroidism-s/s fever, tachycardia, agitation, anxiety, and HTN |
| What are primary nursing interventions for thyroid storm? | maintain an airway and adequate aeration |
| What drugs are used for thyroid storm? | Propylthiouracil (PTU) and methimazole (Tapazole). |
| What are signs of hormone-replacement overdosage for the thyroid? | Same as signs for hyperthyroidism (acceleration of body processes): increased appetite, wt loss, tachycardia, palpitations, V-fib, diarrhea, heat intolerance, diaphoresis, wet or moist skin, nervousness, insomnia. |
| What are signs of hormone replacement underdosage for thyroid? | Hashimoto disease,myxedema,fatigue,thin,dry hair,dry skin,thick,brittle nails, constipation, bradycardia, hypotension,goiter,periorbital edema,facial puffiness,cold intolerance,wt gain,dull emotions &mental processes,low T3<70, low T4<5,T4antibodies |
| What are the T3and T4 levels indicative of hypothyroidism? | T3<70 and T4 <5 |
| What are the T3 and T4 levels indicative of hyperthyroidism? | T3>220 and T4 >12 |
| What diet is recommended for pt with hyperthyroidism? | High-calorie, high-protein, low-caffeine, LOW-FIBER DIET IF DIARRHEA IS PRESENT |
| What eye care is appropriate for exophthalmos? | artificial tears, sunglasses in bright light, annual exams. |
| Name treatment options for hyperthyroidism and expected results. | thyroid ablation-propylthiouracil (PTU),methimazole(Tapazole)-block synthesis of T3 T4.calculated on body wt, given over several months.Take exactly as prescribed. Expected effect: make the client euthyroid, often given to prepare pt for thyroidectomy. |
| Name a treatment option for hyperthyroidism. | Radiation-Given to destroy cells, very irritating to GI tract, pts commonly vomit(radioactive vomit!), place pt on radiation recautions |
| Name a surgical treatment option for hyperthyroidism and interventions/precautions/monitoring needed. | Thyroidectomy-monitor bleeding, support the neck when moving(do not hyperextend), check laryngeal edema damage- laryngeal hoarseness or inability to speak clearly, keep drainage devices compressed and empty, determine number of parathyroid glands removed. |
| What are some precautionary measures to take post-op thyroidectomy? | Be prepared for possibility of laryngeal edema, put a tracheostomy set along with O2 near bedside and a suction machine; have calcium gluconate easily accessible. |
| Name a surgical treatment option for hyperthyroidism and and interventions/precautions/monitoring needed. | Adenectomy-TSH-secreting pituitary tumors are resected using a transnasal approach(transsphenoidal hypophysectomy). Monitor serum CA+ levels, ck for tingling of toes, fingers and around mouth, ck Chvostek and Trousseau sign . |
| Discuss how to prepare pt for thyroid ablation. | Propylthiouracil (PTU) and methimazole (Tapazole),dose based on body wt,tk exactly,given over several months,expected effect:make pt euthyroid,prepare pt for thyroidectomy |
| Discuss radiation treatment for hyperthyroidism | 131I given to desstroythyroid cells. VERY IRRITATING TO GI TRACT.pts commonly vomit(vomit is radioactive),place on radiation precautions. Use time,distance, and shielding |
| Discuss THREE PRIORITY nursing interventions for pt post-thyroidectomy. | BE PREPARED FOR LARYNGEAL EDEMA.PLACE TRACHEOSTOMY SET AND O2 AND SUCTION AT BEDSIDE; CALCIUM GLUCONATE EASILY ACCESSIBLE. |
| Discuss nursing interventions for pt post thyroidectomy. | ck frequently for bleeding.support neck when moving-DO NOT HYPEREXTEND,ck for laryngeal edema damage(watch for hoarseness or inability to speak),determine# ofparathyroid glands removed,keep drainage devices compressed and empty. |
| What should RN watch for if parathyroid glands have been removed? | Ca+ levels to drop. Watch for tetany,tingling of toes,fingers,around mouth. ck Chvostek sign and Trousseau sign |
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