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wvc endo 66
wvc endo 66 care of PT w thyroid problems iggy
| Question | Answer |
|---|---|
| Hyperthyroidism | excessive thyroid secretion from the thyroid gland. |
| Thyrotoxosis | manifestation of hyperthyroidism |
| Thyroid hormones effect | metabolism in all body organs. |
| Hyperthyroid skin manifestations: | diaphoresis; smooth warm moist skin; thinning of scalp hair. |
| Hyperthyroid pulmonary manifestations: | SOB with or without excretion; rapid, shallow respirations; decreased vital capacity. |
| Hyperthyroid cardiovascular manifestations: | palpitations; chest pain; increased systolic blood pressure; widened pulse pressure; tachycardia; dysrhythmia |
| Hyperthyroid Gastrointestinal manifestations: | weight loss; increased appetite; increased stools; hypoproteinemia |
| Hyperthyroid musculoskeletal manifestations: | muscle weakness; muscle wasting |
| Hyperthyroid neurologic manifestations: | exophthalmos (Grave’s disease only) ; Burred or double vision; eye fatigue; corneal ulcers or infections; increased tears; red conjunctiva; photophobia; eye lid retraction; hyperactive deep tendon reflexes; tremors; insomnia. |
| Hyperthyroid metabolic manifestations | increased metabolic rate; heat intolerance; low grade fever; fatigue. |
| Hyperthyroid psychological manifestations | decreased attention span; restlessness; irritability; emotional liability; manic behavior |
| Hyperthyroid reproductive manifestations | amenorrhea; decreased menstrual flow; increased libido |
| Hyperthyroid Other manifestations: | goiter; wide-eyed startled appearance (Grave’s disease only) decreased total white cell count; enlarged spleen. |
| Increased metabolism is a manifestation of | hyperthyroidism |
| Thyroid hormones are produced by the thyroid gland in response to: | secretions from the hypothalamus and anterior pituitary gland. |
| Most common cause of hyperthyroidism | Grave’s disease |
| Patient with Grave’s disease presents with? | thyrotoxicosis; goiter (enlargement of the thyroid gland); exophthalmos (abnormal protrusion of the eyes); pretibial myxedema (dry waxy swelling on the front surfaces of the lower legs. |
| Goiter | (enlargement of the thyroid gland) (not all patients with a goiter have hyperthyroidism. |
| exophthalmos | (abnormal protrusion of the eyes) |
| pretibial myxedema | (dry waxy swelling on the front surfaces of the lower legs. |
| Grave’s disease | autoimmune disorder where antibodies attach to the thyroid stimulating (TSH) receptor sites on thyroid tissue. When these antibodies attach to the thyroid gland it overproduces thyroid hormones & enlarges. |
| Exogenous hyperthyroidism | caused by excessive use of thyroid replacement hormone (this can be seen in attempts to lose weight…by increasing metabolism, but you get exophthalmos). |
| Thyroid storm/ thyroid crisis | condition when hyperthyroidism is untreated/ poorly controlled, (medical emergency) can result in death. Rapid heartbeats; Greatly increased body temp. Chest pain; SOB; Anxiety; irritability; disorientation; Increased sweating; Weakness; Heart failure |
| Incidence/ prevalence of hyperthyroidism | Common endocrine disorder, Grave’s disease is more common in women and most often diagnosed in women age 20-40. |
| Onset of hyperthyroidism | changes occur over a long period of time and may not be recognized by the patient. First sign that they may report is vision changes (blurred vision tired eyes & double vision). Patient may report unplanned weightloss. |
| Hallmark sign of hypethyroidism | heat intolerance and diaphoresis; Patient may report unplanned weightloss; patient may report heart palpitations. |
| Physical assessment hyperthyroidism | size & symmetry of thyroid gland; started look (Grave’s disease); sensitivity to light; increased systolic BP; tachycardia; disrhythmias; widening pulse pressure; vision problems. Heat intolerance |
| Hyperthyroid psychosocial assessment | mood swings; irritability; decreased attention span; manic behavior; hyper activity / fatigue cycle (patient may report “it is either full speed ahead or completely stopped”) |
| Hyperthyroidism Lab assessment | Increased T3, T4; little or no change on thyroid response test; thyroid stimulating hormone low in Grave’s disease but high in secondary hyperthyroidism. |
| Other diagnostic tests for hyperthyroidism | Thyroid scan; radioactive iodine uptake test; ultrasound ECG (assessment of thyroid related rhythm changes). |
| Medications for hyperthyroidism | iodine- used for short use will resolve cardiac associated complications---PTU (propylthiouracil)- reduces manifestations of hyperthyroidism by preventing the new formation thyroid hormones. |
| Monitoring & care of a patient with hyperthyroidism | vitals Q 4hrs; instruct the patient to report vertigo, dyspena, or chest pain. Reduce stimulation & provide comfort, change bed linen often (diaphoresis) |
| Surgical management of hyperthyroidism | total or subtotal thyroidectomy (note if too much is removed can be a common principal cause of hypothyroidism) |
| Postoperative care of hyperthyroid patient | vitals q15min & assess for complications; pillows support patients head/neck; humidified air provides comfort; respirtory distress; assess for parathyroid related complications (injury gland can occur during thyroid surgery). Keep tracheostomy kit in room |
| Hypothyroidism | thyroid cells fail to produce sufficient or the person fails to ingest substances to make thyroid hormone (low consumption of iodine). Most tissues & organs are effected by low levels of thyroid hormone. |
| The body’s reaction/ response to low thyroid levels | low thyroid serum levels cause the hypothalamus and anterior pituitary gland to secrete thyroid stimulating (TSH) which results in the production of thyroid hormone (TH). |
| Low thyroid levels causes metabolites to build up of glycosaminoglycans causing: | an increase of water and mucus inside the cell which changes the organ texture. This type of edema is known as myxedema. |
| Myxedema | myxedema is a result of water and mucus edema…associated with hypothyroidism. Non pitting edema around the forms around the eyes, hands, feet, between the shoulder blades; tongue thickens & voice becomes husky. Reduced LOC. |
| Myxedema coma | rare, serous complication of untreated or poorly treated hypothyroidism. Decreased metabolism causes heart to become flabby & chamber size increase. Reduced CO results in decreased perfusion to brain, making problem worse by further slowing metabolism. |
| Most cases of hypothyroidism result from | thyroid surgery and radioactive iodine; auto immune destruction of the thyroid; cancer; congenital thyroid hypoplasia, dysgenesis, agenesis. |
| Hypothyroid manifests as: | activity levels are lower than in past; increased sleeping; weakness; anorexia; muscle aches; paresthesias; constipation; cold intolerance; decreased libido; myxedema; blank expression; thick tongue; slow movement; low CO & low RR; lowered LOC. |
| Psychosocial assessment of hypothyroidism | depression, lethargy; drowsy; reduced mental function. |
| Lab assessment of hypothyroidism | T3 & T4 are reduced….TSH is high in primary hypothyroidism and low or near normal in secondary hypothyroidism. |
| Nursing planning and implementation for hypothyroidism | cardiac & respiratory issues as well as respiratory failure related to myxedema coma. |
| Nursing interventions associated with hypothyroidism | Assess breath sounds & lung function, patient may need ventilator support. Sedation of a hypothyroid patient is dangerous. Assess for decreased CO. Myxedema coma can lead to shock, organ damage & death. |
| Health teaching for patients with hypothyroidism | Stress the importance of hormone replacement therapy & that it is a lifelong therapy. Caution against use of OTC drugs due to interactions. Adequate fluid & fiber intake to prevent constipation. Wear a medical ID bracelet. |
| Thyroiditis (3 types) | Inflammation of the thyroid; acute, sub-acute, chronic. Chronic thyroiditis is the most common (Hashimoto’s disease). |
| Acute thyroiditis | caused by a bacterial invasion of the thyroid gland. Presents with: Pain, neck tenderness, malaise, fever, dysphagia. Resolves with anti-biotic therapy. |
| Subacute or granulomatous thyroiditis | viral infection of the thyroid which happens after a cold or URI. Manifestations include: fever, chills, dysphagia & muscle/ joint pain. |
| Chronic thyroiditis (Hashimoto’s Disease) | Mostly affects women in their 30’s-50’s. It is an autoimmune disorder that is usually triggered by a viral or bacterial infection. When large amounts of the gland is destroyed the patient will present with S/S of hypothyroidism. |
| Papillary carcinoma | most common type of thyroid cancer, slow growing can be present for years before spreading to lymph nodes. |
| Follicular carcinoma | occurs most often in older patients; invades blood vessels & spreads to bone & lung tissue; can adhere to trachea & neck muscles. Dysphagia & dyspena. |
| Medullary carcinoma | most common in patients over 50 years; the tumor secreates calcitonin ACTH, prostaglandins & serotonin. |
| Anaplastic carcinoma | rapid growing aggressive tumor, that directly invades nearby structures, Manifestations include stridor, hoarsness, diphaagia. |
| Collaborative care for thyroid cancer | radiation or thyroidectomy is common treatment for cancer, the patient is often hypothyroidic after treatment. |
| SKIN MANIFESTATIONS Associated with Hypothyroidism | 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 Associated with Hypothyroidism | Hypoventilation; Pleural effusion; Dyspnea |
| CARDIOVASCULAR MANIFESTATIONS Associated with Hypothyroidism | Bradycardia; Dysrhythmias; Enlarged heart; Decreased activity tolerance; Hypotension |
| METABOLIC MANIFESTATIONS Associated with Hypothyroidism | Decreased basal metabolic rate; Decreased body temperature; Cold intolerance |
| MUSCULOSKELETAL MANIFESTATIONS Associated with Hypothyroidism | Muscle aches and pains; Delayed contraction and relaxation of muscles |
| NEUROLOGIC MANIFESTATIONS Associated with Hypothyroidism | Slowing of intellectual functions; Slowness or slurring of speech; Impaired memory; Inattentiveness; Lethargy; Confusion; hearing loss; Paresthesia (numbness and tingling) of the extremities; • Decreased tendon reflexes |
| PSYCHOLOGICAL/EMOTIONAL MANIFESTATIONS Associated with Hypothyroidism | Apathy; Depression; Paranoia; Withdrawal; |
| GASTROINTESTINAL MANIFESTATIONS Associated with Hypothyroidism | Anorexia; Weight gain; Constipation; Abdominal distention |
| REPRODUCTIVE MANIFESTATIONS for women Associated with Hypothyroidism | Changes in menses (amenorrhea or prolonged menstrual periods); Anovulation; Decreased libido |
| Reproductive manifestations for Men Associated with Hypothyroidism | Decreased libido; Impotence |
| OTHER MANIFESTATIONS Associated with Hypothyroidism | Periorbital edema; Facial puffiness; Nonpitting edema of the hands and feet; Hoarseness; Goiter (enlarged thyroid gland); Thick tongue; Increased sensitivity to opioids and tranquilizers; Weakness, fatigue Decreased urine output; Anemia; Easy bruising; |
| parathyroid gland | maintain calcium and phosphate balance. Serum calcium level is normally maintained within a narrow range. |
| Increased parathyroid hormones (PTH) causes | increased re-absorption of calcium & increased phosphate excretion in the kidney. (this process can cause hypercalcemia & hypophosphatemia) hyperparathyroidism results when |
| Manifestations of hyperparathyroidism may be related | to the effects of excessive PTH or to the effects of the accompanying hypercalcemia. |
| High levels of PTH causes | renal calculi and deposits of calcium in the soft tissue of the kidney. |
| GI manifestations of hyperparathyroidism | anorexia, nausea, vomiting, epigastric pain, constipation, weight loss (when Ca levels are high) Fatigue and lethargy may be present. laboratory tests to detect hyperparathyroidism |
| 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 |
| Nonsurgical management of hyperparathyroidism | diuretic & hydration therapies to reduce serum calcium levels (Lasix). Monitor cardiac function (ECG) & monitor I&O, prevent injury. |
| Surgical management of hyperparathyroidism | parathyroidectomy. Instruct patient on deep breathing exercises; teach patient to support neck; instruct about expected pain; assess for respiratory distress. Ensure emergency suction & tracheostomy kit is at bedside. ASSESS FOR HYPOCLACEMIA |
| manifestations of hypocalcemia | such as tingling and twitching in the extremities and face. Check for Trousseau's and Chvostek's signs, either of which signals potential tetany |
| Iatrogenic hypoparathyroidism | most common form, is caused by the removal of all parathyroid tissue during total thyroidectomy or by deliberate surgical removal of the parathyroid glands. |
| Idiopathic hypoparathyroidism | can occur spontaneously. exact cause is unknown Hypoparathyroidism may occur with other autoimmune disorders such as adrenal insufficiency, hypothyroidism, diabetes mellitus, pernicious anemia, and vitiligo. |
| Hypomagnesemia may also cause hypoparathyroidism. | Hypomagnesemia seen in alcoholics & patients with malabsorption syndromes, chronic kidney disease, & malnutrition. It causes impairment of PTH secretion & may interfere with the effects of PTH on the bones, the kidneys, & calcium regulation. |
| Assessment for hypoparathyroidism | ask about neck surgery or radiation; trauma or strangulation; assess for hypocalcemia (tingling, numbness, tetney, spasms, chvostek’s, trousseau’s, seizures, cramps); ECG; blood tests; CT scan (for brain calcification); cAMP; |
| Interventions associated with hypoparathyroidism | correcting the condition of hypocalcemia, vit D deficiency, Hypomagnesemia. Teach the patient to eat food high in Ca but low in phosphorus, stress that hypocalcemia is a lifelong condition a ID bracelet should be worn. |
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wvc
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