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thyroid diso IGGY

WVC IGGY chapt 66 Thyroid

Hyperthyroidism is an excessive thyroid hormone secretion from the thyroid gland.
Thyrotoxicosis The manifestations of hyperthyroidism, regardless of the origin of the thyroid hormones (Davies & Larsen, 2008). (For example, a person who takes a large amount of synthetic thyroid hormones can have thyrotoxicosis but does not have hyperthyroidism.)
Thyroid hormones affect metabolism in all body organs.
Hormones from the thyroid and parathyroid glands affect overall metabolism, electrolyte balance, and excitable membrane activity.
Excessive thyroid hormones stimulate most body systems, causing hypermetabolism and increased sympathetic nervous system activity
Thyroid hormones directly stimulate the heart.
Hyperthyroidism results in increased heart rate and stroke volume which cause increased cardiac output, increased systolic blood pressure, and increased blood flow.
Hyperthyroid skin manifestations •Diaphoresis (excessive sweating) • Fine, soft, silky hair (body) • Smooth, warm, moist skin • Thinning of scalp hair
Hyperthyroid pulmonary manifestations • Shortness of breath with or without exertion• Rapid, shallow respirations • Decreased vital capacity
Hyperthyroid cardiac manifestations • Palpitations • Chest pain • Increased systolic blood pressure • Widened pulse pressure • Tachycardia• Dysrhythmias
Hyperthyroid GI manifestations • Weight loss • Increased appetite • Increased stools • Hypoproteinemia
Musculoskeletal manifestations for hyperthyroidism • Muscle weakness• Muscle wasting
Neurological manifestations for hyperthyroidism • Blurred or double vision• Eye fatigue• Corneal ulcers or infections • Increased tears • Injected (red) conjunctiva• Photophobia • Eyelid retraction, eyelid lag * • Globe lag • Hyperactive deep tendon reflexes • Tremors • Insomnia
Metabolistic changes (hyperthyroidism) • Increased basal metabolic rate • Heat intolerance • Low-grade fever • Fatigue
Psychological/emotional changes (hyperthyroidism) • Decreased attention span • Restlessness • Irritability• Emotional lability• Manic behavior
Reproductive manifestations (hyerthryroidism) • Amenorrhea• Decreased menstrual flow• Increased libido
Other manifestations (hyperthyroidism) • Goiter* • Wide-eyed (startled) appearance • Decreased total white blood cell count • Enlarged spleen (*present in Graves Disease)
Elevated thyroid effects protein synthesis (buildup) and degradation (breakdown) by Breakdown exceeds buildup, causing a net loss of body protein known as a negative nitrogen balance.
In patients with hyperthyroidism, glucose tolerance is_______________, resulting in ____________ decreased, elevated blood glucose levels.
In hyperthyroidism, fat metabolism is ____________, and body fat ____________. increased, decreased
With prolonged hyperthyroidism, the patient has chronic nutritional deficiency.
Thyroid hormones are produced in response to the stimulation hormones secreted by the hypothalamus and anterior pituitary glands. (negative feedback loop)
The most common cause of hyperthyroidism is Graves' disease, also called toxic diffuse goiter.
Physical manifestations of Graves' disease thyrotoxicosis, exophthalmos , and pretibial myxedema. Not all patients with a goiter have hyperthyroidism.
Graves' disease is an autoimmune disorder
In Graves’ disease, antibodies, known as __________ __________ ____________ bind to the thyroid gland, the gland ________ __ _____and overproduces thyroid hormones. thyroid-stimulating immunoglobulins (TSIs), increases in size
Hyperthyroidism caused by multiple thyroid nodules is termed toxic multinodular goiter. The nodules may be enlarged thyroid tissues or benign tumors (adenomas). The patient does not have exophthalmos or pretibial edema.
Hyperthyroidism also can be caused by excessive use of thyroid replacement hormones. This type of problem is called exogenous hyperthyroidism.
A condition called thyroid storm or thyroid crisis can occur when hyperthyroidism is untreated or poorly controlled or when the patient is severely stressed. Most common is patients with Graves’, it is life threatening
Graves' disease has a strong association with other autoimmune disorders, such as diabetes mellitus, vitiligo, and rheumatoid arthritis.
Graves' disease can occur at any age but is diagnosed most often in women between 20 and 40 years of age, affecting women about ten times more often than men (Davies & Larsen, 2008).
Toxic multinodular goiter usually occurs after the age of 50 and affects women four times as often as men.
Goiters are classified in grades 0-2
Lab testing for hyperthyroidism includes triiodothyronine (T3), thyroxine (T4), T3 resin uptake (T3RU), and thyroid-stimulating hormone (TSH). Antibodies to TSH (TSH-RAb) are measured to determine the presence of Graves' disease.
Diagnostic assessments for hyperthyroidism Thyroid scan andRadioactive iodine (RAI [123I], Ultrasonography, Electrocardiography
ECG changes with hyperthyroidism include atrial fibrillation, dysrhythmias, changes in P and T waveforms, and tachycardia
Thyroid scan evaluates the position, size, and functioning of the thyroid gland.
Radioactive iodine (RAI [123I]) is given ___ ______, and the _________of iodine by the thyroid gland (RAIU) is measured. by mouth, uptake
Normal ranges T3 70-205 mg/dL or 1.2-3.4 SI units
T4 normal ranges 4-12 mcg/dL or 51-154 SI units
T3 resin uptake normal ranges 24%-34%
TRH stimulation test normal values doubling of baseline TSH 30 min after IV injection of 500 mcg TRH
Thyroid stimulation test >10% in RAIU or >1.5 mcg/dL
The priorities for nursing care (hyperthyroidism) focus on monitoring for complications, reducing stimulation, promoting comfort, and teaching the patient and family about therapeutic drugs and procedures.
(Hyperthyroidism) Instruct the patient to report immediately any palpitations, dyspnea, vertigo, or chest pain.
Increases in temperature may indicate a rapid worsening of the patient's condition and the onset of “thyroid storm.” Immediately report a temperature increase OF EVEN ONE DEGREE Fahrenheit.
If a temperature elevation is reported by UAP (unlicensed person), immediately assess the patient's CARDIAC STATUS.
Reducing stimulation is important because a noisy or stressful environment can increase the manifestations of hyperthyroidism and increase the risk for cardiac complications.
Promoting comfort can be accomplished through actions such as reducing the room temperature to decrease discomfort caused by heat intolerance.
The preferred drugs for hyperthyroidism are the thionamides, which include propylthiouracil (PTU) and methimazole (Tapazole).
Thionamides Drug reduces blood cell counts and the immune response
Iodine preparations may be used for short-term therapy before surgery. They decrease blood flow through the thyroid gland, reducing the production and release of thyroid hormone.
Iodine preparations can result in hypothyroidism
___________may be used for a patient who cannot tolerate other antithyroid drugs Lithium
These drugs may be used as supportive therapy (Hyperthyroidism) Beta-adrenergic blocking drugs, such as propranolol (Inderal, Detensol) These drugs relieve diaphoresis, anxiety, tachycardia, and palpitations but do not inhibit thyroid hormone production.
Radioactive iodine (RAI) therapy is not used in pregnant women because 131I crosses the placenta and can damage the fetal thyroid gland.
Propylthiouracil (PTU) Reduces manifestations of hyperthyroidism by preventing the new formation of thyroid hormones by inhibiting thyroid binding of iodide and by preventing the conversion of T4 to T3 in the tissues.
Side effects of PTU n/v, skin rash
RN interventions for PTU Assess patient for skin rash/swelling of cervical lymph nodes. D/C if this occurs. Monitor WBC and differential counts. Agranulocytosis may develop rapidly w/i 1st 2 mo.D/C THERAPY). Administer same time in relation to meals qd.
Patient teaching √ slow heart rate, and cold intolerance. May cause drowsiness. Exams to monitor progress/check for side effects. Avoid crowds & sick people. Report darkening of the urine, yellowing of skin/whites of the eyes, and increased tendency to bruise/bleed.
Methimazole (Northyx, Tapazole) Reduces manifestations of hyperthyroidism by preventing the new formation of thyroid hormones by inhibiting thyroid binding of iodide.
Patient teaching for methimazole Possibility of muscle and joint pain, check for: weight gain, slow heart rate & cold intolerance; avoid crowds and people who are ill; to take the drug every 8 hr. (if becoming PG… notify HCP)
Indications for methimazole Palliative treatment of hyperthyroidism, used as an adjunct to control hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy
Side effects for methimazole diarrhea, skin rash AGRANULOCYTOSIS
Methimazole assessments/monitoring for symptoms of hyperthyroidism or thyrotoxicosis development of hypothyroidism. If skin rash or swelling of cervical lymph nodes, discontinue and notify HCP. Monitor WBC s&s of agranulocytosis.
Patient teaching for methimazole monitor wt changes 2-3 lbs/week (call HCP), may cause drowsiness, consult HCP sources of iodine, report sore throat, fever, chills, headache, malaise, weakness, yellowing eyes/skin, unusual bleeding/bruising, rash, or s/s hyperthyroidism/hypothyroidism
Signs and symptoms of hyperthyroidism and thyrotoxicosis tachycardia, palpitations, nervousness, insomnia, fever, diaphoresis, heat intolerance, tremors, weight loss, diarrhea
Signs and symptoms of hypothyroidism intolerance to cold, constipation, dry skin, headache, listlessness, tiredness, or weakness
Lithium purpose/action Reduces the manifestations of hyperthyroidism by inhibiting the release of thyroid hormones (temporarily). Used only when the patient cannot take a thionamide (UNLABELED USE)
Lithium side effects fatigue, headache, impaired memory, dizziness, abdominal pain, anorexia, bloating, diarrhea, polyuria, acneiform eruption, folliculitis, hypothyroidism, leukocytosis, muscle weakness and tremors.
Assess and monitor for lithium Evaluate renal and thyroid function, WBC with differential, serum electrolytes, and glucose periodically during therapy and S&S of toxicity
Non-surgical/pharmaceutical interventions for hyperthryoidism Radioactive Iodine Therapy (RAI)
Surgical interventions for hyperthyroidism total thyroidectomy or subtotal thyroidectomy.
Near normal thyroid function euthyroid
Surgical counter indications for hyperthyroidism Hypertension, dysrhythmias, and tachycardia and over an optimal weight
Monitoring the patient for complications is the most important nursing action after thyroid surgery
Potential complications from thyroidectomy hemorrhage, respiratory distress, parathyroid gland injury
____________is most likely to occur during the first 24 hours after surgery Hemorrhage
Surgical complication of laryngeal stridor harsh, high-pitched respiratory sounds, is heard in acute respiratory obstruction.
After a thyroidectomy, respiratory distress can result from swelling, tetany, or damage to the laryngeal nerve, causing spasms.
If the parathyroid glands are damaged or their blood supply is impaired during thyroid surgery Hypocalcemia and tetany may occur when (PTH) levels decrease.
S&S of hypocalcemia and tetany tingling around the mouth or of the toes and fingers. Assess for muscle twitching as a sign of calcium deficiency
What is the intervention for hypocalcemia and tetany resulting from surgery Calcium gluconate or calcium chloride for IV use should be available in an emergency situation.
Thyroid storm or thyroid crisis is a life-threatening event that occurs in patients with uncontrolled hyperthyroidism and occurs most often with Graves' disease
What can trigger a thyroid storm triggered by stressors such as trauma, infection, diabetic ketoacidosis, and pregnancy. Other conditions that can lead to thyroid storm include vigorous palpation of the goiter, exposure to iodine, and radioactive iodine (RAI) therapy.
S&S of a thyroid storm Manifestations fever, tachycardia, and systolic hypertension. GI (abdominal pain, nausea, vomiting, and diarrhea). Anxious/tremors. Restless/confused/psychotic and may have seizures, leading to coma. Even with treatment, thyroid storm may lead to death.
Interventions for a thyroid storm focus on maintaining airway patency, providing adequate ventilation, reducing fever, and stabilizing the hemodynamic status.
Dietary substances needed to produce enough TSH iodide and tyrosine.
A decreased metabolism causes the hypothalamus and anterior pituitary gland to make stimulatory hormones, especially TSH, in an attempt to trigger hormone release from the poorly responsive thyroid gland.
How does a goiter form The TSH binds to thyroid cells and causes the thyroid gland to enlarge
Glycosaminoglycans are The metabolites are compounds of proteins and sugars
Decrased metabolism causes these compounds build up inside cells, which increases the mucus and water, forms cellular edema, and changes organ texture. Glycosaminoglycan
Myxedema edema is mucinous
Physical manifestations of hypothyroidism non-pitting edema, especially around the eyes, hands , feet and between the shoulder blades. The tongue thickens and edema forms in the larynx, making the voice husky.
Untreated hypothyroidism can result in these cardiovascular changes decreased cardiac output and decreased, perfusion to the brain and other vital organs. A condition called myxedema coma can result which is, life threatening.
The mortality rate for _______ _________is extremely high, and this condition is considered a life-threatening emergency. myxedema coma.
Hypothyroid skin manifestations • Cool, pale or yellowish, dry, coarse, scaly skin• Thick, brittle nails• Dry, coarse, brittle hair• Decreased hair growth, with loss of eyebrow hair• Poor wound healing
Pulmonary manifestations for hypothyroidism • Hypoventilation • Pleural effusion • Dyspnea
Cardiovascular manifestations for hypothyroidism • Bradycardia• Dysrhythmias • Enlarged heart • Decreased activity tolerance • Hypotension
Metabolic manifestations for hypothyroidism • Decreased basal metabolic rate• Decreased body temperature • Cold intolerance
Musculoskeletal manifestations for hypothyroidism • Muscle aches and pains • Delayed contraction and relaxation of muscles
Neurological manifestations of hypothyroidism • Slowing of intellectual functions [Slowness or slurring of speech•Impaired memory•Inattentiveness] • Lethargy or somnolence • Confusion • Hearing loss • Paresthesia (numbness and tingling) of the extremities • Decreased tendon reflexes
Psychological manifestations of hypothyroidism • Apathy • Depression • Paranoia • Withdrawal
GI manifestations of hypothyroidism • Anorexia • Weight gain • Constipation • Abdominal distention
Reproductive manifestations of hypothyroidism
Other manifestations for hypothyroidism •Periorbital edema• Facial puffiness • Nonpitting edema hands and feet • Hoarseness • Goiter• Thick tongue •sensitivity to opioids/tranquilizers • Weakness, fatigue • Decreased U/O • Anemia • bruising • Iron/folate deficiency • Vitamin B12 deficiency
Etiology: Most cases of hypothyroidism in the United States occur as a result of thyroid surgery and radioactive iodine (RAI) treatment of hyperthyroidism
Examples of DECREASED THYROID TISSUE are • Surgical removal of the thyroid • Radiation-induced thyroid destruction • Autoimmune thyroid destruction • Congenital thyroid agenesis • Congenital thyroid hypoplasia • Congenital thyroid dysgenesis • Cancer (thyroidal or metastatic)
Examples of Decreased synthesis of thyroid hormone are • Endemic iodine deficiency • Excessive exposure to iodine • Drugs [Lithium, Phenylbutazone, Propylthiouracil, Sodium or potassium perchlorate, Aminoglutethimide
Examples of INADEQUATE PRODUCTION OF THYROID-STIMULATING HORMONE • Pituitary tumors, trauma, infections, or infarcts• Congenital pituitary defects • Hypothalamic tumors, trauma, infections, or infarcts
In hypothyroidism triiodothyronine (T3) and thyroxine (T4) serum levels are decreased.
TSH levels are _________ in primary hypothyroidism but can be _________ or near normal in patients with secondary hypothyroidism high; decreased
Why are the normal values for T3 and T4 not accurate for an older adult the normal ranges were established using a population of 20 to 30 year olds. Older people have a naturally reduced metabolism.
Thyroid hormone secretion decreases with age. The hormone level remains stable because cellular clearance of the hormone also decreases with age.
The thyroid gland ___________ in size with increasing age decreases
The basal metabolic rate _____________ with age, usually as a result of decreased activity. This decrease changes the body composition from predominantly muscular to predominantly fatty. decreases
The most common cause of death among patients with myxedema coma is respiratory failure.
Sedating a patient with hypothyroidism can make respiratory difficulties worse and is avoided, if possible. When sedation is needed, the dosage is reduced because hypothyroidism increases sensitivity to these drugs
If hypothyroidism has been chronic, the patient may have cardiovascular disease. Instruct the patient to report episodes of chest pain or chest discomfort immediately.
The most common synthetic drug therapy for hypothyroidism is levothyroxine sodium (Synthroid, T4) Therapy is started with low doses and gradually increased over a period of weeks.
Teach patients, as well as the families of patients, who are beginning thyroid replacement hormone therapy to take the drug exactly as prescribed and not to change the dose or schedule without consulting the health care provider.
Assess the patient for chest pain and dyspnea during initiation of therapy. The final dosage is determined by blood levels of TSH and the patient's physical responses.
Any patient with hypothyroidism who has any other health problem or who is newly diagnosed is at risk for myxedema coma.
Factors leading to myxedema coma include acute illness, surgery, chemotherapy, discontinuing thyroid replacement therapy, and the use of sedatives or opioids.
Problems that often occur with myxedema include •Coma•Respiratory failure •Hypotension •Hyponatremia •Hypothermia •Hypoglycemia
Untreated myxedema coma leads to shock, organ damage, and death
Emergency care of patients with myxedema coma patent airway.• Replace fluids with IV normal or hypertonic saline. • Give levothyroxine sodium/glucose IV ed. • corticosteroids• Check patient's temperature/BP qh. • Provide warm blankets. • changes in mental status. • Turn q2h • Aspiration Precautions.
The most important educational need for the patient with hypothyroidism is about hormone replacement therapy and its side effects
Teaching for hypothyroidism hormone therapy The drug should be taken on an empty stomach, don’t take OTC, have a balanced diet, drink water & plenty of fiber. Monitor sleep patterns and bowel elimination patterns
Thyroiditis: three types acute, subacute, and chronic.
The most common type of thyroiditis is chronic (Hashimoto’s Disease)
Acute thyroiditis is caused by __________ ___________ of the thyroid gland. Manifestations include __________ , _____ _______________, ________________, ______________ and ____________. It usually resolves with antibiotic therapy bacterial invasion; pain, neck tenderness, malaise, fever, and dysphagia.
Chronic (Hashimoto’s Disease) is autoimmune disorder, triggered by a bacterial/viral infection. thyroid is invaded by antithyroid antibodies and lymphocytes, thyroid tissue destruction. Large # of the gland are destroyed, serum thyroid hormone levels are low & secretion of TSH increased.
The manifestations of Hashimoto's disease are dysphagia and painless enlargement of the gland
Diagnosis of Hashimoto’s is based on circulating ANTITHYROID ANTIBODIES and NEEDLE BIOPSY of the thyroid gland. SERUM THYROID HORMONE levels, TSH levels, and RADIOACTIVE IODINE UPTAKE (RAIU) vary with disease stage.
What is the treatment for Hashimoto’s thyroid hormone to prevent hypothyroidism and to suppress TSH secretion. Surgery (subtotal thyroidectomy) is needed if the goiter does not respond to thyroid hormone, is disfiguring, or compresses other structures.
The four distinct types of thyroid cancer are papillary, follicular, medullary, and anaplastic
The initial manifestation of thyroid cancer is a single, painless lump or nodule in the thyroid gland. Additional manifestations depend on the presence and location of metastasis (spread of cancer cells).
The most common type of thyroid cancer is Papillary carcinoma, occurs most often in younger women.
What is papillary carcinoma a slow-growing tumor that can be present for years before spreading to nearby lymph nodes. When the tumor is confined to the thyroid gland, the chance for cure is good with a partial or total thyroidectomy.
The type of thyroid cancer most often seen in mature adults Follicular carcinoma occurs most often in older patients.
Follicular carcinoma cancer invades blood vessels, spreads to bone/lung tissue. Can adhere to the trachea, neck muscles, great vessels, and skin, resulting in dyspnea and dysphagia. When the tumor involves the recurrent laryngeal nerves, the patient may have a hoarse voice.
_____________ _____________is most common in patients older than 50 years. This tumor often occurs as part of _________ ________ ____________, a familial endocrine disorder. The tumor usually secretes calcitonin, ACTH, prostaglandins,& serotonin. Medullary carcinoma; multiple endocrine neoplasia (MEN) type II
_____________ ____________ is a rapid-growing, aggressive tumor that directly invades nearby structures. Manifestations include stridor, hoarseness, and dysphagia Anaplastic carcinoma
___________ ___________is used most often for anaplastic carcinoma because this cancer is usually metastasized (spread) at diagnosis. Radiation therapy
Surgery is the treatment of choice for papillary, follicular, and medullary carcinomas.
Suppressive doses of thyroid hormone are usually taken for 3 months after surgery.
A ___________ ________ ________ study is performed after drugs are withdrawn. radioactive iodine uptake (RAIU); If there is RAI uptake, the patient is treated with ablative (enough to destroy the tissue) amounts of RAI. If thyroid cancer does not respond to RAI, a course of chemotherapy is initiated.
Nursing interventions post-surgery focus on teaching the patient about hypothyroidism and its management.
The parathyroid glands maintain calcium and phosphate balance
Increased levels of parathyroid hormone (PTH) act directly on the kidney, causing increased kidney reabsorption of calcium and increased phosphate excretion.
The patient with hyperparathyroidism has hypercalcemia and hypophosphatemia
In bone, excessive PTH levels increase bone resorption (bone loss of calcium) by decreasing osteoblastic activity and increasing osteoclastic . This process releases calcium and phosphate into the blood and reduces bone density, calcium is deposited in soft tissues.
Primary hyperparathyroidism results when one or more parathyroid glands do not respond to the normal feedback of serum calcium.
The most common cause of hyperparathyroidism is a benign tumor in one parathyroid gland.
High levels of PTH cause _________ _________and deposits of _________ in the soft tissue of the kidney. Bone lesions are due to an increased rate of bone destruction and may result in___________ ____________, _______ ________, and _____________ renal calculi (kidney stones); calcium; in pathologic fractures, bone cysts, and osteoporosis.
GI manifestations for hyperparathyroidism are anorexia, nausea, vomiting, epigastric pain, constipation, weight loss, particularly when serum calcium levels are high.
In hyperparathyroidism, elevated serum gastrin levels are caused by hypercalcemia and lead to peptic ulcer disease.
In hyperparathyroidism, serum calcium levels INCREASE and can cause fatigue and lethargy.
When serum calcium levels are greater than ____ mg/dL the patient may have psychosis with mental confusion, which leads to coma and death if left untreated. 12 mg/dL,
The test most commonly used to diagnose hyperparathyroidism are Serum PTH, calcium, and phosphate levels and urine cyclic adenosine monophosphate (cAMP)
Diagnostic test for hyperparathyroidism are x-ray, ateriography, CT, venous catherization of the thyroid veins with blood sampling (PTH levels) and ultrasonography.
__- _______ may show kidney stones, calcium deposits, and bone lesions, such as cysts or fractures. X-rays.
Causes of hyperparathyroidism • Parathyroid adenoma • Parathyroid carcinoma • Congenital hyperplasia • Neck trauma or radiation • Vitamin D deficiency • Chronic kidney disease with hypocalcemia• Parathyroid hormone–secreting carcinomas of the lung, kidney, or GI tract
Causes of hypoparathyroidism • Surgical or radiation-induced thyroid ablation • Parathyroidectomy • Congenital dysgenesis • Idiopathic (autoimmune) hypoparathyroidism • Hypomagnesemia
Serum calcium normal ranges 9.0-10.5 mg/dL . ↑ HYPERPARATHYROIDISM, ↓ hypoparathyroidism
Normal serum phosphate levels 3.0-4.5 mg/dL. ↓Hyperparathyroidism, ↑ hypoparathyroidism
Normal Serum parathyroid hormone C-terminal 50-330 pg/mL, ↑ hyperparathyroidism, ↓ hypoparathyroidism
What is the priority nursing diagnosis for the client with hyperparathyroidism monitoring and prevention of injury
Non-surgical management of hyperparathyroidism include diuretic/hydration therapy and other drug therapy.
_________ & ___________ therapies are used most often for reducing serum calcium levels in patients who are not candidates for surgery(hyperparathyroidism) Diuretic and hydration
Nursing interventions for hyperparathyroidism monitor cardiac function q2-4 during hydration therapy, changes in the T waves and the QT interval, as well as changes in rate and rhythm. ↓ serum Ca2+ , fall risk d/t bone density loss (precautions)
(Hyperparathyroidism) Sudden drops in calcium levels may cause tingling and numbness in the muscles. Report to HCP immediately.
(Hyperparathyroidism) Oral phosphates inhibit bone resorption and interfere with calcium absorption. IV phosphates are used only when serum calcium levels must be lowered rapidly.
(Hyperparathyroidism )Calcitonin decreases the release of skeletal calcium and increases the kidney excretion of calcium. It is not effective when used alone because of its short duration of action. The therapeutic effects are greatly enhanced if calcitonin is given along with glucocorticoids.
Some drugs lower calcium levels by binding calcium, which reduces the levels of free calcium. They are known as calcium chelators [mithramycin, penicillamine (Cuprimine, Pendramine)]
______________, a cytotoxic agent, is the most effective and potent calcium chelator used to lower serum calcium levels. Mithramycin, the toxic effects limit its use to two or three doses.
Dangers of using mithramycin Thrombocytopenia, and kidney and liver toxicity can result after only one dose.
Patients receiving mithranycin are monitored for Liver function studies, blood urea nitrogen and creatinine, complete blood count (CBC), and serum calcium levels.
Surgical management of hyperparathyroidism is a parathyroidectomy
Before surgery (parathyroid), the patient is stabilized. Calcium levels are decreased to near normal. If mithramycin has been used to lower serum calcium levels, studies to determine bleeding and clotting times are needed, as is a CBC to determine bone marrow function.
Teaching regarding parathyroid and thryroid surgery perform coughing and deep-breathing exercises, qh after surgery, remind the patient that talking may be painful for the first day or two. Teach about neck support by having the patient place both hands behind the neck to assist in elevating the head.
After parathyroid surgery, monitor the patient for respiratory distress, which may occur from compression of the trachea by hemorrhage or swelling of neck tissues.
Manifestations of hypocalcemia tingling and twitching in the extremities and face. Check for Trousseau's and Chvostek's signs, either of which signals potential tetany (risks from parathyroid surgery)
Post parathyroid surgery risks/assessments hypocalcemia, laryngeal nerve damage, respiratory distress
_______________, the most common form, is caused by the removal of all parathyroid tissue during total thyroidectomy or by deliberate surgical removal of the parathyroid glands. Iatrogenic hypoparathyroidism
__________ ______________can occur spontaneously. The exact cause is unknown, but an autoimmune basis is suspected. diopathic hypoparathyroidism.
Hypoparathyroidism may occur with other autoimmune disorders such as adrenal insufficiency, hypothyroidism, diabetes mellitus, pernicious anemia, and vitiligo
Hypomagnesemia may also cause hypoparathyroidism. Hypomagnesemia is seen in alcoholics and in patients with malabsorption syndromes, chronic kidney disease, and malnutrition.
Impairment of PTH secretion and may interfere with the effects of PTH on the bones, the kidneys, and calcium regulation.
Physical assessment for hypoparathyroidism may show excessive or inappropriate muscle contractions that cause finger, hand, and elbow flexion. (poss. Tetany) Check for Chvostek's sign and Trousseau's sign;(+ indicate potential tetany). Bands or pits may encircle the crowns of the teeth
Diagnostic tests for hypoparathyroidism include EEG, blood tests, and CT scan can show brain calcifications, which indicate chronic hypocalcemia.
Lab work ups for hypoparathyroidism can include serum calcium, phosphate, magnesium, vitamin D, and urine cyclic adenosine monophosphate (cAMP).
Medical management of hypoparathyroidism focuses on correcting hypocalcemia, vitamin D deficiency, and hypomagnesemia
For patients with acute and severe hypocalcemia, IV calcium is given as a 10% solution of calcium chloride or calcium gluconate over 10 to 15 minutes.
Acute vitamin D deficiency is treated with calcitriol (Rocaltrol), 0.5 to 2 mg daily.
Acute hypomagnesemia is corrected with 50% magnesium sulfate in 2-mL doses (up to 4 g daily) either IM or IV
Nursing management for hypoparathyoidism is teaching about the drug regimen/interventions to reduce anxiety, eat foods high in calcium/low in phosphorus. Therapy for hypocalcemia is lifelong.
With all the endocrine diseases, the patient is advised to wear an ID bracelet
Keep the environment of a patient at risk for thyroid storm cool, dark, and quiet.
Keep in the room of a patient who has had thyroid/parathyroid surgery emergency suctioning and tracheostomy equipment
Use a lift sheet to move or reposition a patient with hypocalcemia.
Teach all patients to take antithyroid drugs or thyroid hormone replacement therapy as prescribed.
(parathyroid) Collaborate with the nutritionist to teach patients about diets that are restricted in calcium or phosphate
Teach patients to use clinical manifestations the number of bowel movements per day, the ability to sleep as indicators of therapy effectiveness and when the dose of thyroid hormone replacement may need to be adjusted.
Monitor the hydration status of patients who have hypercalcemia.
Created by: Jillzs