Adult II EXAM III
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| What do three things do the Thyroid and Parathyroid hormones affect? | Metabolism, Electrolyte balance, Excitable membrane activity
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| Definition: "Hyperthyroidism" | excessive secretion of thyroid hormone
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| What body systems are stimulated by excessive thyroid hormones? | most of them
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| What are the two general results of excessive hormones stimulation of the body systems? | Hypermetabolism; Increased SNS activity
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| How many of the primary presenting problems of hyperthyroid patients are due to changes in metabolism? | Most of them are due to Hypermetabolism
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| What is the most common cause of Hyperthyroidism? | Grave's Disease
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| What kind of disorder is Grave's Disease? | autoimmune
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| Definition: "autoimmune disease" | disease caused by antibodies produced against substances naturally present in the body
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| What do antibodies attack in Grave's Disease? | Thyroid hormone receptors on thyroid gland cells
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| What is the PHYSICAL result of antibody attack in Grave's Disease? | Enlargement and proliferation of thyroid gland cells; resulting in a goiter
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| What is the HORMONAL result of Thyroid gland cell proliferation in Grave's Disease? | Hyperproduction of Thyroid Hormone d/t multiplication of Thyroid Hormone producing cells
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| What three key features characterize Grave's Disease? | Exophthalmus, Goiter, Pretibial Myxedema
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| Definition: "Exophthalmus" | abnormal protrusion of eyeballs
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| Definition: "Goiter" | swelling of the neck resulting from enlargement of the thyroid gland
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| Definition: "Pretibial Myxedema" (as defined by PPT) | dry, waxy swelling in the anterior lower legs
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| Definition: "exogenous" | caused by an agent or organism outside the body
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| What is the cause of exogenous hyperthyroidism? | excessive thyroid replacement hormone medication use
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| What is the name for hyperthyroidism d/t excessive thyroid replacement hormone medication use? | exogenous hyperthyroidism
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| What is a third cause of hyperthyroidism besides Grave's Disease or exogenous hyperthyroidism? | nodules on the thyroid
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| What is the general description of Hyperthyroidism symptoms? | everything is elevated and sped up
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| What are three cardiopulmonary symptoms of Hyperthyroidism? | Palpitations, Chest pain, Dyspnea
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| What are four neurological symptoms of Hyperthyroidism? | Increased sweating/heat intolerance; Vision changes/light sensitivity; Insomnia; Irritability
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| What is the pathophysiology of Exophthalmus? | edema and fatty tissue behind the eyes make them bulge out; gives the impression of a startled look
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| What may be heard upon auscultation of an enlarged thyroid in hyperthyroidism? | Bruits
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| What are changes in Heart rate, rhythm, and pressure associated with hyperthyroidism? | Increased Systolic BP, Tachycardia, Dysrhythmias
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| What labs are used to diagnose Hyperthyroidism (hint what hormones are effected)? | T3, T4, TSH
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| Definition: "TSH" | Thyroid Stimulating Hormone; hormone from posterior pituitary that stimulates the thyroid gland to produce T3 and T4
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| Definition: "T3" | triiodothyronine
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| Definition: "T4" | thyroxine; synthetic thyroxine is given to patients with hypothyroidism
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| What hormone levels characterize Grave's Disease? | elevated T3 and T4 (because there is a proliferation of hormone producing cells); low TSH (because there is already too much thyroid hormone; this would stimulate more)
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| What must be taken orally before a Thyroid scan may be performed? | radioactive iodine
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| What is measured for diagnostic analysis in a Thyroid scan? | amount of radioactive iodine uptake
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| What would be the result of a Thyroid scan in Hyperthyroidism? | increased radioactive iodine uptake
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| What are the two goals of medical management of Hyperthyroidism? | Decrease effects of excess thyroid hormone on Cardiac System; Reduce secretion of thyroid hormone
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| What extrapersonal conditions may increase symptoms of Hyperthyroidism? | noise and stress
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| What four nursing interventions should be implemented to limit extrapersonal conditions that would = Hyperthyroidism symptom increase? | Keep environment quiet; Close the door; Limit visitors; Avoid nonessential care and treatment
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| What should be done to palliate Hyperthyroid patients' temperature intolerance? | Reduce room temperature; Keep ice water and clean cool linens available
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| Three medications used to treat Hyperthyroidism | PTU; Lithium; Radioactive iodine
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| Definition: "PTU" | Propyl-Thio-Uracil (propylthiouracil)
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| How does PTU treat Hyperthyroidism? | prevents conversion of T4 to T3 (which is the most potent of the two)
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| What is the Adverse Effect of PTU? | HIGH incidence of Liver damage
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| How does Lithium treat Hyperthyroidism? | inhibits thyroid hormone release
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| What Adverse Effect could Lithium cause; what should be checked to prevent or diagnose this Adverse Effect? | Hypothyroidism (d/t excessive thyroid hormone release inhibition); blood levels of Thyroid Hormones should be measured
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| How does Radioactive Iodine treat Hyperthyroidism; what is its administration route? | destroys some of the hyperactive thyroid tissue; administered orally
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| Definition: "thyroidectomy" | surgical removal of Thyroid tissue
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| How much Thyroid Tissue is removed to treat Hyperthyroidism? | sometimes all (total thyroidectomy), but not explicitly, sometimes subtotal thyroidectomy
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| When is surgery indicated in Hyperthyroidism patients? | when patients don't respond well to Antithyroid drugs or Radioactive iodine therapy
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| What is the result of Thyroid Tissue removal? | removal of Hormone producing Thyroid cells = decreased Thyroid Hormone (T3 and T4) production
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| Hyperthyroid patients are treated BEFORE surgery to alter what two things related to their condition? | 1. Thyroid Hormone levels
2. size and vascularity of Thyroid
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| How should Thyroid Hormone levels be BEFORE Thyroid Surgery in Hyperthyroidism? | AS NORMAL AS POSSIBLE
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| What medication is given to affect the size and vascularity of the Thyroid in Hyperthyroidism? | Iodine
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| How should Thyroid size and vascularity be altered BEFORE Thyroid surgery in Hyperthyroidism? | size and vascularity should be reduced
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| Why do we want to alter the size and vascularity of the Thyroid in Hyperthyroidism BEFORE surgery? | reduced size and vascularity reduces the risk of Bleeding and Thyroid Storm
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| Definition: "Thyroid Storm" | rapid worsening of Hyperthyroid condition with uncontrolled BP, HR, and high fever associated with untreated or undertreated Hyperthyroidism
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| What should be monitored closely following Thyroidectomy? | Vital Signs, Bleeding or Respiratory distress d/t tracheal compression, PAIN (medicate for pain!)
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| What should be avoided when positioning a patient following Thyroidectomy? | Distention of the Neck
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| What can be done to help ease respirations and thin any secretions following Thyroidectomy? | give Humidified Air (also assist patient with Deep Breathing)
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| What would be heard in acute obstruction of an airway? | Stridor
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| Definition: "Stridor" | harsh vibrating noise when breathing, caused by obstruction of the windpipe or larynx
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| What three symptoms and electrolyte imbalance may occur following Thyroidectomy? | Tetany, Tingling, and Muscle Twitching D/T Hypocalcemia
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| Where would Tingling occur following a Thyroidectomy and what would it occur as a symptom of? | fingers/toes, mouth; occurs as a symptom of Hypocalcemia
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| Definition: "Tetany" | condition marked by intermittent Muscular Spasms D/T malfunction of parathyroid glands and consequent Ca deficiency (Hypocalcemia)
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| What voice change is common following Thyroidectomy? | hoarseness
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| Is the voice change following Thyroidectomy permanent? | usually temporary
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| What should be done concerning the voice change following a Thyroidectomy and why (what is a possible underlying problem)? | Voice should be assessed; Laryngeal Nerve damage is possible
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| What is a possible SERIOUS reaction of Thyroid Hormone production as a result of Thyroidectomy itself? | Thyroid Hormone production could increase EXCESSIVELY
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| What is it called when this change in Thyroid Hormone production occurs d/t Thyroidectomy, what are its S/S, and HOW SERIOUS is it? | Thyroid Storm/Crisis; Fever, Tachycardia, Severe HTN (basically hyper-action of everything that was wrong in Hyperthyroidism); CAN LEAD TO DEATH
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| What should be reported following Thyroidectomy to make sure any incidence of Thyroid Storm/Crisis is caught early? | ANY Elevation in temperature should be reported
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| What two things should be done in case of Thyroid Storm? | 1. MAINTAIN Patent Airway and Adequate Ventilation!!!!
2. Administer Antithyroid drugs (because this is major hyperthyroid reaction)
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| How do patients with HYPOThyroidism present an why? | with manifestations of DECREASED Metabolism D/T Low levels of Thyroid Hormones
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| Definition: "Primary Hypothyroidism" | decreased hormone production by the Thyroid gland (because of the Thyroid gland itself, not D/T Pituitary)
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| What Hormone levels characterize Primary Hypothyroidism? | 1. HIGH TSH (because there are NOT enough Thyroid Hormones)
2. Low T3 and T4 (because hypoactive Thyroid)
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| What characterizes HR and BP in Hypothyroidism? | slow HR, low BP
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| What psychological/neurological symptoms characterize Hypothyroidism? | Cold intolerance; Depression/withdrawal
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| What is the hematological result of slowed metabolism/function in Hypothyroidism? (remember, bones are creating stuff too, and this is affected by Hypothyroidism) | Anemia
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| What type of edema characterizes Hypothyroidism? | Myxedema
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| Definition: "Myxedema" | generalized mucousy edema (not just water)
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| What are oral/audible symptoms of Myxedema? | thickening of the tongue; voice is husky D/T edema in larynx
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| What is Hypothyroidism usually caused by? | HYPER-Thyroidism Treatment
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| What is a dietary cause of Hypothyroidism and where is it more common? | lack of dietary iodine; common in geographical areas where there is little iodine in the soil
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| Dysfunction of what gland causes Secondary Hypothyroidism and why (how would presenting Hormone levels differ for this instance)? | Pituitary problems/dysfunction; because TSH is produced by the pituitary, problems would = decreased TSH, therefore decreased Thyroid stimulation to produce T3 and T4; (T3, T4, AND TSH would be low)
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| What drugs could cause Hypothyroidism (hint, two are used to tx Hyperthyroidism)? | Lithium, PTU (Propyl-Thio-Uracil), and AMIODARONE
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| Definition: "Amiodarone" | anti-arrhythmic drug; Tx life-threatening heart rhythm problems (arrhythmias) in patients who have already taken other antiarrhythmic medicines
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| What gender and age group is Hypothyroidism most common in? | women 30-60 years old
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| With what does likelihood of Hypothyroidism increase, and with what other condition is Hypothyroidism associated? | Likeliness increases with AGE; associated with Diabetes
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| How does progression of symptoms occur in Hypothyroidism (timeframe); how should you ask patients about their condition? | Progression may occur GRADUALLY (not even slowly, GRADUALLY); ask known or suspected Hypothyroid patients to compare their current condition to a "YEAR AGO"
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| What should you ask Hypothyroid patients to compare their condition/symptoms to? | to their condition/symptoms a YEAR AGO
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| What assessments would be associated with Hypothyroidism? | Decreased activity level, libido; INCREASED weakness, sleep, muscle aches, cold intolerance, constipation, impotence, infertility (everything is tired, worn out, and not working great)
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| What would you expect to find on Physical assessment of Hyperthyroid patient? | Facial edema; Blank expression; Weight gain; Lethargy/depression; Thick tongue (myxedema); LOW Body Temp; SLOW movement, speech, HR, RR
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| What Hormone levels characterize Secondary Hypothyroidism (Hypothyroidism D/T Pituitary problems; what does the Pituitary produce)? | T3 and T4 are low D/T LOW TSH
Summary: low T3, T4, TSH
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| How does Hypothyroidism affect OXYGEN, Metabolism, Cardiac function, Cognitive function? | OXYGENATION, metabolism, cardiac, and cognitive function are DECREASED/IMPAIRED
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| What symptoms are related to Metabolism in Hypothyroidism? | Decreased energy, Weight gain, Fatigue, Muscle weakness (possibly more D/T oxygenation)
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| What symptoms are related to Cardiac function in Hypothyroidism? | Decreased HR and Myocardial metabolism = HYPOTENSION (note, NO metabolism in the body is going to be anything but DECREASED in Hypothyroidism)
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| What causes altered Cognitive function in Hypothyroidism? | Impaired BRAIN metabolism; EDEMA
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| What are three Oxygenation treatment goals for Hypothyroid patients? | 1. Maintain O2 sat at 90% or more
2. No cyanosis
3. Maintain cognitive orientation
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| What type of medication should be used with caution in Hypothyroid patients? | sedatives or pain medications
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| Why should some medications be used with caution in Hypothyroid patients (considering O2)? | doses of sedatives or pain medications SHOULD BE REDUCED to reduce the risk of respiratory effect
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| What are three interventions to meet Oxygenation treatment goals for Hypothyroid patients? | 1. Monitor respirations
2. Monitor O2 sat (apply O2 if indicated)
3. Monitor breath sounds (listen for sounds of pleural effusion)
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| What are three goals for Hypotension in Hypothyroidism? | 1. Maintain HR above 60
2. Keep BP within normal limits
3. No dysrhythmias, no peripheral edema
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| How long-term is the supplementation for Hypothyroidism? | Thyroid supplementation is life-long
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| What do Hypothyroid patients need periodically to monitor Thyroid Hormone status? | periodic blood tests
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| How should Hypothyroid patients approach taking other meds? | don't take other medications unless prescribed by Dr.
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| What can Hypothyroid patients do to avoid constipation? | eat a well balanced High Fiber diet
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| When should Hypothyroid patients take Thyroid Hormone medication? | on an empty stomach
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| What are two indicators that Hypothyroid patients need an adjustment of their Thyroid Hormone medication? | sleep patterns (increased lethargy indicates low hormone levels); constipation (increased constipation indicates low hormone levels)
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| What kind of patients require LOWER doses of Thyroid medication? | Older patients
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| Definition: "Myxedema Coma" | organ failure D/Tfurther reduction of cellular metabolism D/T decreased COutput and organ perfusion D/T heart muscle atrophy and loss of firmness (DUE TO UNTREATED HYPOTHYROIDISM)
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| How serious is Myxedema Coma? | LIFE THREATENING emergency - it is RARE however
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| What are causees of Myxedema Coma? | Acute illness; Chemotherapy; Discontinuation of Thyroid replacement therapy; Use of sedatives or opioids in Hypothyroid patients = Coma, Respiratory FAILURE, Hypotension, Hyponatrema, Hypothermia, Hypoglycemia
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| Tx for Myxedema Coma? | MAINTAIN PATENT AIRWAY; provide fluids (increase BP);
levothyroxine (currently in some level of blood stasis); steroids (speed things up);
warm patient (hypothermia);
turn every 2 hours; aspiration precautions; MONITOR temperature, BP, mental status
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| What are the three types of Thyroiditis? | Acute , Subacute, and Chronic
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| What is Acute Thyroiditis? | bacterial infection; treated with antibiotics
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| What is Subacute Thyroiditis? | viral infection secondary to cold or upper respiratory infection (URI); PAINFUL
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| What is thyroiditis? | MOST COMMON type of Thyroiditis; "Hashimoto's Disease"
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| Definition: "Hashimoto's Disease" | Autoimmune disorder usually triggered by an INFECTION that leads to Thyroid tissue destruction; characterized by low T3 and T4 and high TSH
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| How many different types of Thyroid Cancer are there? | four
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| How do the different types of Thyroid Cancer differentiate? | age group of the patient with cancer
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| Definition: "anaplasia" | loss of differentiation of cells and their orientation to each other, a characteristic of tumor cells
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| What is the treatment for Anaplastic cancer of the Thyroid? | Radiation
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| What kind of cancer are Papillary, Follicular, Medullary, and Aplastic cancer of the Thyroid? | malignant
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| What is the treatment for Papillary, Follicular, and Medullary carcinomas of the Thyroid? | TOTAL Thyroidectomy; dissection of lymph nodes if involved
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| What treatment must patients generally undergo following surgery to treat Thyroid cancer? | Thyroid Replacement therapy
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| Definition: "Parathyroid Glands" | 4 small glands on the back surface of the Thyroid
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| What do the Parathyroid Glands secrete? | Parathyroid Hormone (PTH)
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| What electrolytes do PTH regulate? | Calcium and Phosphoroous
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| What is the main storage site of Calcium? | Bone
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| What effect does PTH have on Calcium? | increases Bone release of Calcium into Blood from storage site, INCREASING serum Calcium
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| Definition: "Hyperparathyroidism" | Increased levels of PTH
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| What are the results of excessive PTH? | Hypercalcemia and Hypophosphatemia (remember Ca and P work inversely/opposite to each other)
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| What are the results of Hyperparathyroid (considering Hypercalcemia)? | 1. Fractures, Cysts, and Osteoporosis
2. Kidney stones, Calcium deposits in Kidney
3. Anorexia, N/V, Constipation (D/T Hypercalcemia)
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| How is Hyperparathyroidism treated? | Diuretics, Hydration, Calcitonin, Ster
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| How does Hyperpaprathyroidism cause decreased bone integrity (considering Hypercalcemia)? | Hypercalcemia D/T increased rate of bone release of Calcium = Bone DESTRUCTION
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| How does Hyperparathyroidism cause Calcium buildup in the Kidneys? | Hypercalcemia D/T overstimulated bone release of Calcium; excessive Calcium needs to be filtered through the kidneys, resulting in buildup
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| How is Hypercalcemia treated in Hyperparathyroidism? | Diuretics = increased Calcium excretion
Hydration = to decrease Calcium concentration in body
Calcitonin = to decrease bone breakdown and subsequent release of Calcium
Steroids = to increase Calcium renal excretion
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| How do Steroids cause loss of bone integrity and increase risk of fractures? | Steroids increase renal excretion of Caclium = low blood Calcium = signal body that it needs more Calcium = bone breakdown to produce more Calcium (to excess = bone instability, at increased risk for fractures)
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| How does Calcium relate to Cardiac Function? | changes in Calcium levels cause Heart contraction in every Systole
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| What should be monitored and what should be prevented in patients with Hypercalcemia (in this case D/T Hyperparathyroidism)? | Monitor Cardiac function (excessive Calcium could cause Arrhythmia)
Prevent injury/fracture D/T decreased bone density
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| Does surgical Parathyroidectomy as treatment for Hyperparathyroidism require removal of ALL FOUR gland necessarily? | no
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| If all four Parathyroids are removed in Parathyroidectomy (as treatment for Hyperparathryoidism), what will be required for the patient from surgery on? | Calcium and vitamin D replacement
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| Definition: "Hypoparathyroidism" | RARE decreased function of Parathyroid
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| What is the electrolytic result of Hypoparathyroidism? | Hypocalcemia
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| What are the three goals of treatment for Hypoparathyroidism? | 1. correct Hypocalcemia
2. Treat Vitamin D deficiency
3. if indicated, treat Hypomagnesemia
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| What electrolyte could cause impairment of Parathyroid Hormone (PTH) secretion? | low levels of Magnesium; Hypomagnesemia
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| How should Hypoparathyroid patients approach dietary management of their condition? | 1. eat foods high in Calcium
2. eat foods LOW in Phosphorous
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| What food (group) contains a high level of Phosphorous? | Dairy: Milk, processed cheese, or yogurt
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