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Med Surg 1 > ATI: Chapter 79 - Hypothyroidism > Flashcards

ATI: Chapter 79 - Hypothyroidism Flashcards

1
Q

Hypothyroidism is a condition in which there is an inadequate amount of circulating thyroid hormones _______ and thyroxine (T4), causing a decrease in metabolic rate that affects all body systems.

A

triiodothyronine (T3)

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2
Q

Because hypothyroidism can have manifestations that mimic the _______, hypothyroidism is often undiagnosed in older adult clients. This can lead to potentially serious adverse effects from meds (sedatives, opiates, _____).

A

aging process

anesthetics

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3
Q

______ stems from dysfunction of the thyroid gland. This is the most common type of hypothyroidism.

A

primary hypothyroidism

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4
Q

Primary hypothyroidism can be caused by disease: _______________.

A

autoimmune thyroditis

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5
Q

Primary hypothyroidism can be caused by the use of medications that decrease the synthesis of ________.

A

thyroid hormone

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6
Q

Primary hypothyroidism can be caused by ______ of the thyroid gland: iodine deficiency, radioactive iodine treatment, surgical removal of the gland.

A

loss

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7
Q

______ is caused by failure of the anterior pituitary gland to stimulate the thyroid gland or failure of the target tissues to respond to the thyroid hormones (pituitary tumors).

A

secondary hypothyroidism

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8
Q

Tertiary hypothyroidism is caused by failure of the ________ to produce thyroid-releasing hormone.

A

hypothalamus

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9
Q

Women ____ to ____ years old are affected 7 to 10 times more often than men with hypothyroidism.

A

30 to 60 years

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10
Q

Many individuals who have mild hypothyroidism are frequently undiagnosed, but the hormone disturbance can contribute to an acceleration of atherosclerosis or complications of __________ (introperative hypotension, cardiac complications following surgery.

A

medical treatment

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11
Q

Use of certain medications are risk factors for hypothyrodism such as ________ and amiodarone.

A

lithium

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12
Q

Radiation therapy to the ______ and ______ is a risk factor of hypothyroidism.

A

head and neck

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13
Q

Hypothyroidism is often characterized by vague and varied findings that develop slowly over time. Manifestations can vary and are related to the ______ of the condition.

A

severity

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14
Q

Manifestations of hypothyroidism

A 
fatigue, lethargy
irritability
intolerance to cold
constipation
weight gain without an increase in caloric intake
pale skin
thick, brittle fingernails
depression and apathy
periorbital edema
joint or muscle pain
bradycardia, hypotension, dysrhythmias
slow thought processes and speech
hypoventilation, pleural effusion thickening of the skin
thinning of hair on the eyebrows
dry, flaky skin
swelling in face, hands, and feet
with myxedema = non pitting, mucinous edema
decreased acuity of taste and smell 
hoarse, raspy speech
abnormal menstrual periods menorrhagia/amenorrhea)
decreased libido
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15
Q

With hypothyroidism T3 is _____.

A

decreased

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16
Q

With hypothyroidism serum TSH is _____ with primary hypothyroidism.

A

increased

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17
Q

With hypothyroidism serum TSH is _____ the expected reference range with secondary hypothyroidism.

A

decreased or within

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18
Q

With hypothyroidism the free thyroxine index and T4 levels will be _____.

A

decreased

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19
Q

With hypothyroidism the T3 resin uptake is _____.

A

decreased

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20
Q

With hypothyroidism the thyrotropin receptor antibodies will have ________.

A

no response

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21
Q

With hypothyroidism the serum cholesterol will be _____.

A

increased

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22
Q

A diagnostic procedure called radioisotope (1234I) scan and uptake will result in a ______ uptake of the iodine preparation with hypothyroidism.

A

low

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23
Q

An ECG will reveal _______ and dysrhythmias with hypothyroidism.

A

sinus bradycardia

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24
Q

With hypothyrodism monitor for cardiovascular changes (_____, bradycardia, dysrhythmias).

A

low bp

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25
Q

With hypothyrodism monitor the client’s weight. Assess for _______.

A

peripheral edema

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26
Q

With hypothyrodism monitor if ______ is compromised, orient the client periodically, and provide safety measures.

A

mental status

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27
Q

With hypothyrodism increase the client’s ______ gradually, and provide frequent rest periods to avoid fatigue and decrease myocardial oxygen demands.

A

activity level

28
Q

With hypothyrodism apply _______ and elevate the client’s legs to assist venous return.

A

antiembolism stockings

29
Q

Monitor respiratory status including rate, depth, pattern, oximetry and ________. Encourage the client to cough and breathe deeply to prevent pulmonary complications.

A

ABGs

30
Q

With hypothyroidism consult with a dietaitian. Provide a low-calorie, high ______ diet, and encourage fluids and activity to prevent constipation and promote weight loss. Administer

A

bulk

31
Q

With hypothyroidism administer cathartics and stool softeners as needed. Avoid _____ laxatives, which interfere with absorption of levothyroxine.

A

fiber

32
Q

With hypothyroidism provide meticulous _______ care. Turn and reposition the client every 2 hr if the client is on extended bed rest. Use alcohol-free skin care products and an emollient lotion after bathing.

A

skin care

33
Q

With hypothyroidism provide extra ______ and _______ for clients who have decreased cold tolerance. Dress the client in layers, adjust room temp, and encourage intake of warm _____ if possible.

A

clothing and blankets

liquids

34
Q

With hypothyroidism caution the client against using ______ because the combination of vasodilation, decreased sensation, and decreased alertness can result in __________.

A

unrecognized burns.

35
Q

With hypothyroidism encourage the client to verbalize feeling and fears about changes in _______. Return to the euthyroid (normal thyroid gland function) state takes time. The client might need frequent reassurance that most physical manifestations are reversible.

A

body image

36
Q

With hypothyroidism use caution with medications due to alteration in ______.

A

metabolism

37
Q

With hypothyroidism CNS depressants are used with cautioned due to the risk of _____________.

A

respiratory depression

38
Q

With hypothyroidism CNS ________ are prescribed, the dose should be significantly less than for a client who does not have hypothyroidism.

A

depressants

39
Q

Hypothyrodism alters metabolism and ______ of medications. The provider uses caution in prescribing meds to clients who have this condition.

A

excretion

40
Q

_______ coma is a life-threatening condition that occurs when hypothyroidism is untreated or when a stressor (acute illness, surgery, chemotherapy, discontinuing thyroid replacement therapy or use of sedatives) affects a client who has hypothyroidism

A

Myxedema

41
Q

Manifestations of Myxedema

A 
respiratory failure
hypotension
hypothermia
bradycardia 
dysrhythmia
hyponatremia
hypoglycemia
coma
42
Q

With myexedema maintain airway patency with ______ support if necessary.

A

ventilatory

43
Q

With myexedema provide continuous _______ monitoring.

A

ECG

44
Q

With myexedema montior ABGs to detect ______, hypercapnia, respiratory acidosis.

A

hypoxia

45
Q

With myexedema cover the client with _____.

A

warm blankets

46
Q

With myexedema monitor body temp ______ until stable.

A

hourly

47
Q

With myexedema replace fluid with ______ IV.

A

0.9% sodium chloride

48
Q

With myexedema replace thyroid hormone by administering large doses of ______ IV bolus. Monitor vital signs because rapid correction of hypothyroidism can cause adverse cardiac effects.

A

levothyroxine

49
Q

With myexedema monitor I&O and daily weights. With treatment, urine output should _______, and body weight should decrease. Failure to do so should be reported to the provider.

A

increase

50
Q

With myexedema treat hypoglycemia with _____.

A

glucose

51
Q

With myexedema adminster _______.

A

coricosteroids

52
Q

With myexedema initiate _____ precautions.

A

aspiration

53
Q

With myexedema check for possible sources of ______ (blood, sputum, urine) that might have precipitated the coma. Treat any underlying illness.

A

infection

54
Q

A nurse in a provider’s office is reviewing lab results of a client who is being evaluated for secondary hypothyroidism. Which of the following lab findings is expected for a client who has this condition?

A Elevated serum T4
B Decreased serum T3
C Elevated serum thyroid stimulating hormone
D Decreased serum cholesterol

A

B. Decreased serum T3 is an expected finding for a client who has hyperthyroidism

55
Q

A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the following findings should the nurse expect? (select all that apply)

A. Diarrhea
B. Menorrhagia
C. Dry Skin
D. Increased libido
E. Hoarsenss
A

B, C, E

56
Q

_______ is a thyroid hormone replacement therapy is the treatment of choice.

A

Levothyroxine

57
Q

Levothyroxine increases the effects of _______ and can increase the need for insulin and digoxin.

A

warfarin

58
Q

Meciations that decrease the absorption of levothyroxine include cimetidine, lansoprazole, ______, and colestipol. Administration of these meds should be separated from levothyroxine by at least _____.

A

sucralfate

4 hours

59
Q

Medications that can accelerate the metabolism of levothyroxine include phenytoin, ______, rifampin, sertaline, adn phenobarbital, thus requiring an increase in dosage of levothyroxine to achieve therapeutic levels.

A

carbamazepine

60
Q

Use caution when starting thyroid hormone replacement with older adult clients and those who have coronary artery disease to avoid coronary ischemia because of increased oxygen demands of the heart. It is preferable to start with much lower doses and increase gradually, taking ______ to _____ to reach full replacement doses.

A

1 to 2 months

61
Q

With thyroid hormone replacement therapy (levothyroxine) monitor for _______ compromise (chest pain, palpitations, rapid heart rate, sob).

A

cardiovascular

62
Q

Instruct the client that treatment begins slowly and that the dosage is increased every _______ until the desired response is obtained with thyroid hormone replacement therapy. Serum TSH is monitored at scheduled times to ensure correct dosage.

A

2 to 3 weeks

63
Q

Remind the client to take the dose prescribed. Do not stop taking the medication or ______ the does with thyroid hormone replacement therapy.

A

change

64
Q

Tell the client to take the medication on an ________, typically 30 to 60 minutes before breakfast.

A

empty

65
Q

Inform the client that fiber supplements, calcium, iron and _______ interfere with absorption of levothyroxine. Before taking any OTC meds, the client must consult with the provider.

A

antacids

66
Q

Instruct the client to monitor for and report manifestations of hyperhtyroidism when taking levothyroxine (irritability, tremors, tachycardia, palpitations, heat intolerance, _________).

A

rapid weight loss

67
Q

Inform the client that the treatment is considered to be lifelong, requiring ongoing medical assessment of _________ when taking levothyroxine.

A

thyroid funciton

Med Surg 1 (15 decks)

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