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Nursing 4 Exam 1
Thyroid Disorders
| Question | Answer |
|---|---|
| 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
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