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Nursing 4 Exam 1

Thyroid Disorders

QuestionAnswer
Where is the thyroid located? just below the neck, below the cricoid cartilage
How is the thyroid shaped? like the letter "H"
How many lobes does the thyroid have and waht is it connected by? 2: Left and Right lateral lobes and connected by the isthmus
what is each lobe composed of? lobules which consist of follicles
What do the cells within the follicles secrete? thyroid hormone(TH)
How is TH secretion initiated? by the release of TSH by the pituitary gland
what is the function of the thyroid ? produces thyroid hormone(TH)
What does the thyroid hormone composed of? Thyroxine(T4) and Triiododthronine(T3)and calcitonin
What is the function of T3 & T4? increase metabolism, growth and development in children
What is the function of calcitonin? decreases excessive calcium by slowing calcium release by bone cells
What is the primary function of thyroid hormone? controls the rate of body metabolism, regulates physical and mental growth and development and aids in Chol, fat protein metabolism, reproduction, and resistance to infection
The synthesis of thyroid hormones depends on... the presence of iodine and amino acid tyrosine
plasma iodine enters the thyroid gland by... active transport
iodine is oxidized and combines w/trosine to form... thyroglobulin(storage)
thyroglobulin forms T3 & T4 which are... released into the blood stream
how does the thyroid gland feel... smooth and rubbery and no nodules
Thyroid abnormalities include... enlargement of gland-goiter, hyperfunction, and hypofunction
etiology of goiters... lack of iodine(simple goiter), inflammation-thyroiditis, benign or malignant tumors, hyperthyroidism-graves' disease
what can you develop thyroid issues from by eating it? non iodized salt, not usually in USA, usually in 3rd world countries
What are lab tests used to diagnose thyroid issues? T3, T4, TSH
What are target groups for thyroid issues? newborns and females over 50(most common)
What are some diagnostic tests for thyroid disorders? thyroid scan, u/s, and ECG
TA test? serum thyroid antibodies(TA):antibodies in graves disease
serum TSH? differentiate pituitary from thyroid dysfunction
T3 & T4? elevated in diagnosis of hyperthyroidism or thyroiditis
RAI uptake scan? Radioactive Iodine test that pt is given oral/IV dose of radioactive iodine(131I) and then gets thyroid scan after 24hrs. size and shape of gland revealed
hyperthyroidism(thyrotoxicosis) causes? graves' disease, nodular toxic goiter, overtreatment w/thyroid drugs, thyroid carcinoma, pituitary adenoma that secretes an excessive amount of TSH, thyroiditis
cardiac manifestations in hyperthyroidism? tachycardia, increased c/o, cardiac enlargement, increased blood volume, elevated systolic pressure, palpitations, afib, CHF
respiratory manifestations in hyperthyroidism? dyspnea with or w/out exertion
GI manifestations in hyperthyroidism? wt loss despite increase in appetite, n/v, diarrhea
nervous system manifestations in hyperthyroidism? extreme nervousness, emotional instability, fine tremor, decreased attention span
muscular manifestations in hyperthyroidism? weakness
integumentary manifestations in hyperthyroidism? skin-smooth,warm,flushed & moist; hair-fine and soft, may be temp hair loss; nails-friable
reproductive manifestations in hyperthyroidism? oligomenorrhea, amenorrhea, decreased libido
renal manifestations in hyperthyroidism? polyuria
speech manifestations in hyperthyroidism? rapid speech and hoarseness
other manifestations of hyperthyroidism? increased susceptibility to infection, heat intolerance, and excessive perspiration
What is a physical sign of hyperthyroidism? bug eyes
What is graves' disease? most common cause of hyperthyroidism and is characterized by the classic triad of goiter, hyperthyroidism, and eye signs(exophthalmus-most common sign).
what is the triad of graves' disease? goiter, hyperthyroidism, and eye signs(exophthalmus-most common sign)
what is the assessment for graves' disease? agitated and irritable person, hand tremor at rest, wt loss, loose bm's, heat intolerance, skin warm and smooth, cycle of hyperactivity and fatigue
complications of graves' disease? exophthalmus, heart disease, and thyroid storm
exophthalmus? protruding eyes
exophthalmus? person has a fixed stare due to edema and fibrosis of the fat pads which lie behind the eyes
complications of exophthalmus... pt's may be unable to close eyes and corneal ulceration, infection and loss of vision can occur
meds for exophthalmus... methylcellulose eye drops, prednisone, taping or suturing eyelids if severe, thyroidectomy
heart disease in pt's with hyperthyroidism include? tachycardia, cardiac arrhythmias(Afib), chest pain
thyroid storm is characterized by... fever, severe tachycardia, HTN(systolic btwn 170-200), delirium(very common), diaphoresis, dehydration(from perspiration & polyuria), extreme irritability, psychosis
prescription for thyroid storm? Emergency tx is necessary to save pt's life, fever is tx'ed by applying a hypothermia blanket & ice packs, non-asa antipyretics, IV fluids to relieve hydration, beta-blockers, diuretics, digoxin, O2 for CHF
prescription for thyroid storm? maintain patent airway, give antithyroid drugs, idodine, glucocorticoids; monitor vitals, monitor cardiac dysrhythmias(Afib)
treatment of hyperthyroidism? drug therapy, radioactive iodine, surgery, and nursing care
antithyroid agents? propylthiouracil(PTU), Tapazole-inhibit TH production
iodine and iodine preps? Lugol solution, SSKI(K iodine)-inhibit TH synthesis and release
beta blockers? inderal and atenolol
Radioactive Iodine (131I) objective? to alleviate the hyperthyroidism by reducing the functioning, not for use in pregnancy and a dose of RAI is given PO **TX of choice**
Surgical management of hyperthyroidism? subtotal thyroidectomy:removal of 5/6 of the thyroid gland total thyroidectomy:total removal thyroid gland
things to remember after pt has partial or total thyroidectomy? keep one arms distance and should really be alone for 24hrs
Pre op care for thyroidectomy? pt should be euthyroid before sx, antithyroid drugs, iodine prep for 10-14 days prior, achievement of good nutritional status and normal wt
nursing objectives for thyroidectomy? to assist the pt in coping w/the manifestations of the disorder and assist the pt to return to a euthyroid state
nursing care for thyroidectomy pt's? provision of a restful environment:cool room w/low key sensory stimulation, diversional activities, care for eye changes, prevention of thyroid storm, and drug administration
post of care for thyroidectomy? support the head to prevent post-op pain and stress on the suture line, position pt in semi-fowlers w/head and neck supported by sandbags & pillows, assess for s&s of respiratory obstruction(very high risk for rep obstruction)
post op care for thyroidectomy? traceostomy set and calcium gluconate at bedside, assess the back of neck for bleeding, monitor for temp elevation
why have calcium gluconate at bedside during post op care? b/c alot of times parathyroid is involved and it secretes calcium
trousseau's sign? inflate bp cuff for several mins-flexion of hand(hyper reflex)
Pre op care for thyroidectomy? pt should be euthyroid before sx, antithyroid drugs, iodine prep for 10-14 days prior, achievement of good nutritional status and normal wt
nursing objectives for thyroidectomy? to assist the pt in coping w/the manifestations of the disorder and assist the pt to return to a euthyroid state
nursing care for thyroidectomy pt's? provision of a restful environment:cool room w/low key sensory stimulation, diversional activities, care for eye changes, prevention of thyroid storm, and drug administration
post op complications of thyroidectomy? major complication is permanent hypothyroidism and others include hypopartathyroidism and vocal cord paralysis
post of care for thyroidectomy? support the head to prevent post-op pain and stress on the suture line, position pt in semi-fowlers w/head and neck supported by sandbags & pillows, assess for s&s of respiratory obstruction(very high risk for rep obstruction)
post op care for thyroidectomy? traceostomy set and calcium gluconate at bedside, assess the back of neck for bleeding, monitor for temp elevation
why have calcium gluconate at bedside during post op care? b/c alot of times parathyroid is involved and it secretes calcium
hyperthyroidism dietary considerations weigh client at least every other day, report any wt loss to the physician
trousseau's sign? inflate bp cuff for several mins-flexion of hand(hyper reflex)
hypothyroidism? thyroid gland produces insufficient amount of thyroid hormone; decreased TH=decreased metabolic rate
chovtack sign? tremor of cheeks
primary(more common) hypothryoidism causes? defect in thyroid gland, congenital defects, post tx of hyperthyroidism, hashimoto's thyroiditis, iodine deficiency
post op care upon discharge? maintenance of close follow-up during the first year to determine thyroid status
secondary hypothryoidism causes deficiency of TSH(pituitary gland) and peripheral resistance to thyroid hormones
post op complications of thyroidectomy? major complication is permanent hypothyroidism and others include hypopartathyroidism and vocal cord paralysis
hyperthyroidsim dietary considerations? pt's increased metabolism requires an increased need for food, may require 6 full meals, plus snaccks to satisfy hunger and prevent breakdown of body tissues
types of hypothyroidism? cretinism and myxedema
hyperthyroidism dietary considerations? provide a well balanced diet w/generous amounts of protein, carbs, vits, and minerals; discourage foods that increase peristalsis, restrict caffeinated beverages
hyperthyroidism dietary considerations weigh client at least every other day, report any wt loss to the physician
myxedema? exact opposite of thyroid storm
hypothyroidism? thyroid gland produces insufficient amount of thyroid hormone; decreased TH=decreased metabolic rate
causes of hypothyroidism? pathological changes within gland and pituitary disorders
primary(more common) hypothryoidism causes? defect in thyroid gland, congenital defects, post tx of hyperthyroidism, hashimoto's thyroiditis, iodine deficiency
secondary hypothryoidism causes deficiency of TSH(pituitary gland) and peripheral resistance to thyroid hormones
types of hypothyroidism? cretinism and myxedema
cretinism? severe condition of infancy caused by a deficiency of thyroid hormone synthesis in utero or soon after birth
myxedema? results from a deficiency of thyroid hormone in adults
myxedema? exact opposite of thyroid storm
causes of hypothyroidism? pathological changes within gland and pituitary disorders
manifestations of hypothyroidism? slowed metabolism, pronounced personality changes, generalized interstitial nonpitting edema
symptoms of hypothyroidism? fatigue or lack of energy, wt gain, feeling cold, dry skin and hair, heavy menstrual periods, constipation, and slowed thinking
myxedema occurs with... severe longstanding hypothyroidism. accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues
myxedema looks similar to... acromegaly
myxedema has... thickened, non-pitting edema
myxedema assessment includes... obese, coarse features, dry and sparse hair, dry, flaky skin, intolerance to cold, decreased sweating, constipation and fecal impactions, increased susceptibility to infection, hypersensitive to narcotics, barbituates and anesthesia
myxedema complications? acute organic psychosis and myxedema coma
care for myxedema coma? maintain airway, levothyroxine IV, cover w/warm blankets, check temp frequently, monitor BP, replace fluids, monitor changes in mental status
myxedema treatment goals? corret thyroid deficiency, reverse symptoms, and prevent further cardiac and arterial damage
myxedema treatment w/medications? synthroid(levothyroxine) and euthroid(liotrix)
Created by: jbittner