ATI: Chapter 78 - Hyperthyroidism Flashcards
The thyroid gland produces three hormones
triiodothyronine T3
thyroxine T4
thyrocalcitonin (calcitonin)
Secretion of T3 and T4 is regulated by the _____ pituitary gland through a negative feedback mechanism.
anterior
When serum T3 and T4 levels decrease, ______ is released by the anterior pituitary. This stimulates the thyroid gland to secrete more hormones until normal levels are reached.
thyroid stimulating hormone (TSH)
T3 and T4 affect all body systems by regulating overall body _______, energy production, and controlling tissue use of fats, proteins, and carbohydrates.
metabolism
______ inhibits mobilization of calcium from bone and reduces blood calcium levels.
Calcitonin
Dietary intake of protein and ______ is necessary for the production of thyroid hormones.
iodine
Hyperthyroidism is a clinical syndrome caused by excessive circulating _____.
thyroid hormones
Because thyroid activity affects all body systems, excessive thyroid hormone exaggerates normal body functions and produces a ________.
hypermetabolic state
Advise the client with hyperthyroidism to take all _____ as directed.
medications
Advise the client with hyperthyroidism to check with the provider to taking _______ medications.
OTC
Advise the client with hyperthyroidism to keep all the ______.
follow up apppointments
Advise the client with hyperthyroidism to adjust diet to _____ metabolism when needed.
increase
Advise the client with hyperthyroidism to seek measures to _____ stress, and get test as needed.
reduce
Advise the client with hyperthyroidism to notify the provider of fever, increased restlessness, ______, and chest pain.
palpitations
_____ disease is the most common cause of hyperthyroidism. Autoimmune antibodies result in hypersecretion of thyroid hormones.
Graves
The autosomal recessive trait for grave’s disease is passed to _____.
females
Toxic nodular goiter, a less common form of hyperthyroidism, is caused by overproduction of thyroid hormone due to the presence of _____.
thyroid nodules.
Exogenous hyperthyroidism is caused by _______ of thyroid hormone.
excessive dosages
An expected finding of hyperthyroidism is nervousness, irritability, hyperactivity, emotional lability, decreased attention span, cries or laughs without cause, change in ______ or ______ status.
mental or emotional
An expected finding of hyperthyroidism is weakness, _____, and exercise intollerance.
easy fatigability
An expected finding of hyperthyroidism is muscle ____.
weakness
An expected finding of hyperthyroidism is heat _____
intollerance
An expected finding of hyperthyroidism is weight changes (usually _____) and increased appetite.
loss
An expected finding of hyperthyroidism _______ and interrupted sleep.
insomnia
An expected finding of hyperthyroidism is frequent stools and _______.
diarrhea.
An expected finding of hyperthyroidism is menstrual irregularities (_____ or decreased menstrual flow) and decreased fertility.
amenorrhea
An expected finding of hyperthyroidism an increased ______ initially in both men and women, followed by a decrease as the condition progresses.
libido
An expected finding of hyperthyroidism is warm, sweaty, _____ skin with velvety smooth texture.
flushed skin
An expected finding of hyperthyroidism the hair ______ and develops a fine, soft, silky texture.
thins
An expected finding of hyperthyroidism includes _____, hyperkinesia, hyperreflexia.
tremor
With Grave’s disease and expected finding is _______ due to edema in the extraocular muscles and increased fatty tissue behind the eye.
exophthalmos
is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves’ disease)
An expected finding of hyperthyroidism includes blurred or double vision and ______ of the eyes due to pressure on the optic nerve.
tiring
An expected finding of hyperthyroidism includes ______, sensitivity to light.
photophobia
An expected finding of hyperthyroidism is _____ tearing and bloodshot appearance of eyes.
excessive
An expected finding of Grave’s disease is ______: dry waxy welling of the front surfaces of the lower legs that resembles benign tumors.
pretibial myxedema
An expected finding of hyperthyroidism is eyelid _______: movement of the eyelid is delayed when the eye moves downward.
retraction (lag)
An expected finding of hyperthyroidism is ________: upper eyelid pulls back faster than the eyeball when the client gazes upward.
globe (eyeball) lag
An expected finding of hyperthyroidism is hair _____ or ____.
thinning or loss
An expected finding of hyperthyroidism is a mass called a _____.
goiter
An expected finding of hyperthyroidism is a _____ over the thyroid gland.
bruit
An expected finding of hyperthyroidism is elevated systolic blood pressure and widened _____.
pulse pressure
An expected finding of hyperthyroidism is ______, palpitations, and dysrhythmias.
tachycardia
An expected finding of hyperthyroidism is a breathing issue called _____.
dyspnea
An expected finding of hyperthyroidism in older adult clients are often more ____ than those in younger clients.
subtle
Occasionally an older adult client who has hyperthyroidism will demonstrate apathy or ______ instead of the more typical hypermetabolic state.
withdrawal
Older adult clients who have hyperthyroidism often present with heart failure, angina, and _____.
atrial fib
Lab tests for hypothyroidism
Serum TSH test
Free T4 index, T4 (total) T3
Thyroid-stimulating immunoglobulins
Thyrotropin receptor antibodies
Diagnostic procedures
ultrasound
electrocardiogram
radioactive iodine uptake
In the presence of Graves’ disease the serum TSH test will so _______ levels.
decreased
The serum TSH test can be _______ in secondary or tertiary hyperthyroidism.
elevated
With the Free T4 index, T4 (total) T3: in the presence of hypothyroidism the levels will be ______.
elevated
With the thyroid stimulating immunoglobulins with normal types of hyperthyroidism the levels are _______ and with Grave’s disease the levels are ______.
normal
elevated
Thyrotropin receptor antibodies test will show an _______ most indicative of Graves’ disease.
elevation
An _______ is used to produce images of the thyroid gland and surrounding tissue.
ultrasound
An ______ is used to evaluate the effects of excessive thyroid hormone on the heart (tachycardia, dysrhythmias). ______ changes include atrial fibrillation and changes in the P and T waves.
electrocardiogram
ECG
_______ test is a nuclear medicine test that clarifies size and function of the gland. It is contradinicated in pregnant women.
radioactive iodine uptake
Before a radioactive iodine uptake test assess for an allergy to ______ or _________ should be completed prior to this test.
iodine, shellfish
The uptake of radioactive iodine, administered orally ______ prior to the test, is measured.
24 hours
An ________ uptake is indicative of hyperthyroidism with the radioactive iodine uptake test.
elevated
Confirm that the client is not _____ prior to the scan.
pregnant
Take a med history to determine the use of ______.
iodides
Recent use of contrast media and oral contraceptives can cause ________ serum thyroid hormone levels.
falsely elevated
Severe illness; malnutrition; and the use of aspirin, corticosteroids, and phenytoin sodium can cause a _____ in serum thyroid hormone levels.
false decrease
Inform the provider if the client received any iodine contrast ______.
recently
Advise the client to avoid foods high in iodine for ______ prior to the test.
1 week
Suggest that the client use _______, and avoid fish, shellfish, and medications that contain iodine.
noniodized salt
Minimize the client’s energy expenditure by assisting with activities as necessary and by encouraging the client to alternate periods of activity with ___.
rest
Promote a _____ environment.
calm
Assess mental status and _____ ability. Intervene as needed to ensure safety.
decision making
Monitor nutritional status. Provide increased calories, _______, and other nutritional support as necessary.
protein
Monitor ______ and the client’s weight.
I&O
Provide ______ for a client who has exophthalmos.
eye protection
patches, eye lubricant, tape to close eyelids
Monitor vital signs and ______ parameters.
hemodynamic
Reduce room ______.
temperature
Provide cool shower/sponge bath to promote _____.
comfort
Provide ______ changes as necessary.
linen
Report a temperature increase of ____ or more to the provider immediately, because this is indicative of an impending thyroid crisis.
1 F
Monitor ECG for ______.
dysrhythmias
Assure the family that any abrupt changes in the client’s ______ are likely disease related and should subside with anti thyroid therapy.
behavior
Avoid excessive ______ of the thyroid gland.
palpation
Administer _______ medications.
antithyroid
Prepare the client for a total/subtotal thyroidectomy if the client is _____ to antithyroid medications or has an airway-obstructing goiter.
unresponsive
Thionamides (methimazole and propylthiouracil) inhibit the production of _________.
thyroid hormone
Thionamides are used to treat Graves’ disease, as an adjunct to radioactive iodine therapy, to ______ hormone levels in preparation for surgery, and to treat thyrotoxicosis.
decrease
With thionamides monitor for manifestation of hypothyroidism, such as intolerance to cold, _______, bradycardia, increase in weight, or depression.
edema
With thionamides monitor CBC for ______ or thrombocytopenia.
leukopenia
With thionamides monitor for indications of _______.
hepatotoxicity
With thionamides instruct the client to take the medication with ____.
meals
With thionamides advise the client to take the medication in _______ doses at _______ intervals to maintain an even therapeutic medication level.
divided
regular
With thionamides advise the client to report fever, sore throat, or _____ by the provider.
bruising
With thionamides advise the client to report any evidence of ______.
jaundice
yellowing of skin of eyes, darkening of urine
With thionamides advise the client to follow the provider’s instructions about dietary intake of _____.
iodine.
With thionamides advise women to let their provider know if they become _____.
pregnanct
Beta blockers (propranolol, atenolol) treat ______ effects such as tachycardia and palpitations. These meds counteract the effects of increased thyroid hormones but do not alter the levels of the hormones.
sympathetic nervous system
With beta blockers monitor bp, hr, and _____.
ECG
With beta blockers monitor for _______ in clients who have diabetes mellitus.
hypoglycemia
With beta blockers advise the client that the meds can cause _____ and to sit on the side of the bed for a few minutes before standing.
dizziness
With beta blockers teach the client to check pulse prior to each dose and to notify the provider if the heart rate falls below _____.
60/min.
With beta blockers advise the client to ______ the medication only on the advice of the provider.
discontinue
Lugol’s solution is a nonradioactive 5% elemental iodine in 10% potassium iodine that inhibits the release of ________.
thyrodi hormone
Iodine solutions are for short term use only (taken for _____ followed by surgery)
10 days
Iodine solutions are administered ______ after an antithyroid medication.
1 hour
Use of these medications (iodine solutions) are contraindicated in ______.
pregnancy
Iodine medication is available as a solution. Mix with juice or other liquid to mask the taste. Use a _____ to avoid staining teeth. Take with food.
straw
Iodine solutions pass into ______ and can have undesirable effects on a nursing infant.
breast milk
With iodine solutions instruct the client to notify the provider of fever, sore throat, and ______.
mouth ulcers
Radioactive iodine is taken up by the thyroid and destroys some of the ________.
hormone producing cells 1234I
With radioactive iodine _____ dose can be sufficient, but a second or third dose might be needed.
one
The _______ of thyroid destruction with radioactive iodine therapy varies and can require lifelong thyroid replacement.
degree
Radioactive iodine therapy is ______ in pregnant women.
contraindicated
Monitor for manifestations of _______, such as edema, intolerance to cold, bradycardia, increase in weight, and depression with radioactive iodine therapy.
hypothyroidism
Advise the client that the effects of therapy might not be evident for ____ to ____ weeks with radioactive radiation therapy.
6 to 8
Advise clients taking radioactive iodine to take the medication as _____.
directed
Advise the client to stay away from pregnant women, infants, or small children for the _____ following treatment. Avoid contract closer than 3 feet (1 meter) and limit contact to no more than 1 hr daily.
first week
Although a low dose of radiation is used with radioactive iodine therapy, provide the client with precautions to prevent _______ to others.
radiation exposure
With radioactive iodine therapy do not use the same _______ as others for 2 weeks.
toilet
With radioactive iodine therapy males need to sit down to _____.
urinate
With radioactive iodine therapy flush the toilet _____ times.
3
With radioactive iodine therapy take a ____ 2 to 3 days after treatment to help rid the body of stool contaminated with radiation.
laxative
With radioactive iodine therapy wear clothing that is _______, wash clothing separate from clothing of others, and run the washing machine for a full cycle after washing contaminated clothing.
washable
With radioactive iodine therapy avoid contamination from ______, do not share a toothbrush, and use disposable food service items ( paper plates)
saliva
The surgical removal of part of all of the thyroid gland is ________.
thyroidectomy
_______ can be performed for the treatment of hyperthyroidism when medication therapy fails or radiation therapy is contraindicated. It can also be used to correct diffuse goiter and thyroid cancer.
subtotal thyroidectomy
After a subtotal thyroidectomy, the remaining thyroid tissue usually supplies enough thyroid hormone for ______.
normal function
If a _________ is performed, the client will need thyroid hormone replacement therapy.
total thyroidectomy
Explain the purpose of the thyroidectomy to the client. Tell the client that there will be an incision in the _____, a dressing, and possibly a drain in place. Tell the client that some hoarseness and a sore throat from intubation and anesthesia can be experienced.
neck
The client usually receives propylthiouracil or methimazole ____ to _____ weeks before surgery.
4 to 6
The client should receive iodine for ____ to ____ days before thyroidectomy surgery. This reduces the gland’s size and prevents excess bleeding.
10 to 14 days
Beta blockers can be given to control hypertension, ______, or tachycardia before a thyroidectomy.
dysrhythmias
The client can need to follow a high-protein, high ______ diet prior to thyroidectomy surgery.
high carbohydrate
Instruct the client to support the ____ when performing deep breathing and coughing exercises postoperatively thyroidectomy.
neck
Notify the provider immediately if the client does not follow the ______ prior to a thyroidectomy.
medication regimen
Keep the client in a ________ position. Support head and neck with pillows. Avoid neck extension after a thyroidectomy.
semi-fowler’s
Post thyroidectomy follow protocols, monitor vital signs typically every ______ until stable then every _____.
15 minutes
30 minutes
Post thyroidectomy assist with _____ exercises every 30 to 60 minutes.
deep breathing
Post thyroidectomy check the surgical dressing and back of the neck for excessive _______. Respiratory distress can occur from compression of trachea due to hemorrhage, which is most likely to occur in the first 24 hours.
bleeding
Post thyroidectomy respiratory distress also can occur due to ______. Ensure that tracheostomy supplies are immediately available. _____ air, assist to cough and deep breathe, and provide oral and tracheal suction if needed.
edema
humidify
Post thyroidectomy check for _____ nerve damage by asking the client to speak as soon as awake from anesthesia and every _____ thereafter.
laryngeal
2 hours
Post thyroidectomy administer medication to manage ______. Reassure the client that discomfort will resolve within a few days.
pain
Post thyroidectomy _______ and tetany can occur if parathyroid glands are damaged or removed. Indications are tingling of toes or around mouth, and muscle twitching. Check for positive chvostek’s and Trousseau’s signs. Ensure that ______ or calcium chloride are immediately available.
hypocalcemia
calcium gluconate
Post thyroidectomy keep _______ equipment near the bedside.
emergency
Post thyroidectomy advise the client to notify the nurse of any muscle ______ or tingling sensation of the mouth or distal extremities.
twitching
Instruct the client to cough and breathe deeply while stabilizing the _____ after a thyroidectomy.
neck
Show the client how to _______ while supporting the back of the back neck.
change positions
Post thyroidectomy remind the client to be careful of the _______ if applicable.
incisional drain
Post thyroidectomy advise the client that the _____ will become hoarse, and to expect pain.
voice
Post thyroidectomy remind the client that talking at ______ will be expected to check for nerve damage.
intervals
Post thyroidectomy instruct the client to notify the surgeon of incisional drainage, _____, or redness that can indicate infection.
swelling
Post thyroidectomy advise the client to check with the provider before taking _______.
OTC meds.
Post thyroidectomy instruct the client to keep all ______.
follow up appointments
Post thyroidectomy advise the client to notify the surgeon of ______, increased restlessness, palpitations, or chest pain.
fever
An _______, radiologist, pharmacist, and dietitian can collaborate in providing care for a client post thyroidectomy.
endocrinologist
Due to a loosened surgical tie, excessive coughing, or movement a ______ at the incision site post thyroidectomy can be a complication.
hemorrhage
Inspect the surgical incision and dressing for drainage and _____, especially at the back of the neck, and change the dressing as directed for a hemorrhage at the incision site.
bleeding
Expect only ____ drainage after 24 hours of having a hemorrhage at the incision site.
scant
When a pt has a hemorrhage at the incision site after a thyroidectomy support the client’s head and neck with pillows or sandbags. if the client is to be transferred from a stretched to the bed, support the client’s head and neck in good body ______
alignment
When a pt has a hemorrhage at the incision site after a thyroidectomy avoid pressure on the suture line, encourage the client to avoid neck _____ or ______.
flexion or extension
When a pt has a hemorrhage at the incision site after a thyroidectomy instruct the client to cough and deep breathe while supporting the _____.
neck
When a pt has a hemorrhage at the incision site after a thyroidectomy show the client how to change positions while supporting the _____ of the neck.
back
Thyroid storm/crisis results from a sudden surge of large amount of ______ into the bloodstream, causing an even greater increase in body metabolism.
thyroid hormones
A thyroid storm/crisis is a ______ with a high mortality rate.
medical emergency
Precipitating factors for a thyroid storm/crisis include uncontrolled hyperthyroidism occuring most often with _______, infection, trauma, emotional stress, diabeteic ketoacidosis, and digitalis toxicity, all of which increase demands on ______.
Grave’s disease
body metabolism
A ________ can occur following a surgical procedure or a thyroidectomy as a result of manipulation of the gland during surgery.
thyroid storm/crisis
Findings of a thyroid crisis are ________, hypertension, delirium, vomiting, abdominal pain, tachdysrhythmias, chest pain, dyspnea, and palpitations.
hyperthermia
With a thyroid storm/crisis it is critical to maintain a ______ airway.
patent
With a thyroid storm/crisis you must provide continuous cardiac ______.
monitoring
With a thyroid storm/crisis it is important to administer ______ to decrease temperature.
acetaminophen
Salicylate antipyretics (aspirin) are contraindicated because they release thyroxine from ________ sites and increase free thyroxine levels.
protein-binding
Provide cool sponge baths, or apply _____ to decrease fever. If fever continues, obtain a prescription for a cooling blanket for hyperthermia with a thyroid crisis.
ice packs
Administer ________ to prevent further synthesis and release of thyroid hormones with a thyroid storm/crisis.
thionamides (methimazole or propylthioruacil)
With a thyroid storm/crisis administer sodium iodide as prescribed, 1 hr after administering _______ medication.
thionamide
With a thyroid storm/crisis administer beta-adrenergic blocking agents, such as propranolol, to block _______.
sympathetic nervous system
With a thyroid storm/crisis administer _______ if adrenal insufficiency is suspected or to treat shock.
glucocorticoids
With a thyroid storm/crisis administer IV fluids to provide adequate hydration and prevent vascular ______. Fluid volume deficit can occur due to increased fluid excretion by the kidneys or excessive diaphoresis.
collapse
Monitor intake and output _____ to prevent fluid overload or inadequate replacement with a thyroid crisis.
hourly
With a thyroid storm/crisis administer ______ to meet increased oxygen demands.
supplemental O2
With a thyroid crisis advise the client to notify the provider of fever, increased restlessness, palpitations, and ______.
chest pain
Hemorrhage, tracheal collapse, tracheal mucus accumulation, laryngeal edema, and vocal cord paralysis can cause respiratory _______ with sudden stridor and restlessness which is a complication of thyroidectomy.
obstruction
A tracheostomy tray should be kept near the client at all times during the ______ recovery period after a thyroidectomy.
immediate
Maintain the bed in a ________ position to decrease edema and swelling of the neck with the complication of airway obstruction after thyroidectomy.
high-fowlers
Listen for __________ with the complication of an airway obstruction after a thyroidectomy.
respiratory stridor
Provide _____ air for the complication of airway obstruction after thyroidectomy.
humidified
Have suction equipment at the _____ with the complication of airway obstruction after thyroidectomy.
bedside
Medicate as prescribed to reduce _______ with the complication of airway obstruction after thyroidectomy.
swelling
Instruct the client to notify the nurse of ______ or difficulty breathing with the complication of airway obstruction after thyroidectomy..
tightness
Damage to ______ gland is a complication of thyroidectomy caused by hypocalcemia and tetany.
parathyroid
With hypocalcemia and tetany a complication of a thyroidectomy monitor for tingling of the fingers and the toes, carpopedal spasms, and _______.
convulsions
With hypocalcemia and tetany a complication of a thyroidectomy assess for Chvostek’s and ______ signs, which are indicators of neuromuscular irritability from hypocalcemia.
Trousseau’s
With hypocalcemia and tetany a complication of a thyroidectomy have IV ______ available for emergency administration.
calcium gluconate
With hypocalcemia and tetany a complication of a thyroidectomy maintain _______.
seizure precautions
With hypocalcemia and tetany a complication of a thyroidectomy advise the client to notify the nurse of any tingling sensation of the mouth, tingling of _________, or muscle twitching.
distal extremities
A complication of a thyrodiectomy is ______ that can lead to vocal cord paralysis and vocal disturbances.
nerve damage
A complication of a thyrodiectomy is incisional damage or ______ can cause nerve damage.
swelling
With a complication of a thyrodiectomy teach the client that he will be hoarse, be able to speak only rarely, and need to rest his voice for ______.
several days
With a complication of a thyrodiectomy after the procedure, monitor the client’s ability to speak every ______ and document any changes.
2 hours
With a complication of nerve damage with a thyrodiectomy assess the client’s voice tone and ______, and compare it with the preoperative voice.
quality
With a complication of nerve damage with a thyroidectomy remind the client that he will be asked to try to talk at intervals to check for _______. Advise the client that a hoarse voice is not typically permanent.
nerve damage
A nurse in a providers office is reviewing the health record of a client who is being evaluated for Graves’ disease. Which of the following is an expected laboratory finding for this client?
A. Decreased thyrotropin receptor antibodies
B. Decreased thyroid stimulating hormone
C. Decreased free thyroxine index
D. Decreased triiodothyronine
B.
In the presence of Graves’ disease, a low thyroid stimulating hormone (TSH) is an expected finding. The pituitary gland increases the production of TSH when thyroid hormone levels are elevated.
A nurse is reviewing the clinical manifestations of hyperthyroidism with the client. Which of the following findings should the nurse include? Select all that apply.
A. Dry skin B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia
B, D, E
Hyperthyroidism increases the client’s metabolism. Therefore, heat intolerance, palpitations, and weight loss are expected findings.
A nurse is providing instructions to client who has Graves’ disease and has a new prescription for propanolol (Inderal). Which of the following information should the nurse include?
A. An adverse affects of this medication is jaundice.
B. Take your pulse before each dose.
C. The purpose of this medication is to decrease production of thyroid hormones.
D. You should stop taking the medication if you have a sore throat.
B.Propanolol can cause bradycardia. The client should take his pulse before each dose. If there is a significant change, he should withhold the dose and consult his provider.
The nurse is preparing to receive a client from the PACU who is post operative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? Select all that apply.
A. Suction equipment B. Humidified air C. Flashlight D. Tracheostomy tray E. 02 delivery equipment
A, B, D, E
A nurse in a providers office is planning care for a client who has a new diagnosis of Graves’ disease and a new prescription for methimazole (Tapazole). Which of the following should the nurse include in the plan of care? Select all that apply.
A. Monitor CBC
B. Monitor T3
C. Inform the client that the medication should not be taken for more than three months
D. Advise the client to take the medication at the same time every day
E. Inform the client that an adverse effects of this medication is iodine toxicity
A, B, D
Methimazole can cause a number of hematologic effects, including leukopenia and thrombocytopenia. Therefore, the nurse should monitor the clients CBC.
Methimazole reduce his thyroid hormone production.
And it should be taken the same time every day to maintain blood levels.
A nurse is assessing a client who is 12 hr postoperative following a thyroidectomy. Which of the following findings are indicative of a thyroid crisis? Select all that apply.
A. Bradycardia B. Hypothermia C. Tremors D. Abdominal pain E. Mental confusion
C, D, E
Excessive levels of thyroid hormone can cause a client to experience tremors.
When thyroid crisis occurs, the client can experience G.I. conditions, such as vomiting, diarrhea, and abd pain.
Excessive thyroid hormone levels can cause the client to experience mental confusion.
