ATI: Chapter 79 - Hypothyroidism Flashcards
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.
triiodothyronine (T3)
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, _____).
aging process
anesthetics
______ stems from dysfunction of the thyroid gland. This is the most common type of hypothyroidism.
primary hypothyroidism
Primary hypothyroidism can be caused by disease: _______________.
autoimmune thyroditis
Primary hypothyroidism can be caused by the use of medications that decrease the synthesis of ________.
thyroid hormone
Primary hypothyroidism can be caused by ______ of the thyroid gland: iodine deficiency, radioactive iodine treatment, surgical removal of the gland.
loss
______ 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).
secondary hypothyroidism
Tertiary hypothyroidism is caused by failure of the ________ to produce thyroid-releasing hormone.
hypothalamus
Women ____ to ____ years old are affected 7 to 10 times more often than men with hypothyroidism.
30 to 60 years
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.
medical treatment
Use of certain medications are risk factors for hypothyrodism such as ________ and amiodarone.
lithium
Radiation therapy to the ______ and ______ is a risk factor of hypothyroidism.
head and neck
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.
severity
Manifestations of hypothyroidism
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
With hypothyroidism T3 is _____.
decreased
With hypothyroidism serum TSH is _____ with primary hypothyroidism.
increased
With hypothyroidism serum TSH is _____ the expected reference range with secondary hypothyroidism.
decreased or within
With hypothyroidism the free thyroxine index and T4 levels will be _____.
decreased
With hypothyroidism the T3 resin uptake is _____.
decreased
With hypothyroidism the thyrotropin receptor antibodies will have ________.
no response
With hypothyroidism the serum cholesterol will be _____.
increased
A diagnostic procedure called radioisotope (1234I) scan and uptake will result in a ______ uptake of the iodine preparation with hypothyroidism.
low
An ECG will reveal _______ and dysrhythmias with hypothyroidism.
sinus bradycardia
With hypothyrodism monitor for cardiovascular changes (_____, bradycardia, dysrhythmias).
low bp
With hypothyrodism monitor the client’s weight. Assess for _______.
peripheral edema
With hypothyrodism monitor if ______ is compromised, orient the client periodically, and provide safety measures.
mental status
With hypothyrodism increase the client’s ______ gradually, and provide frequent rest periods to avoid fatigue and decrease myocardial oxygen demands.
activity level
With hypothyrodism apply _______ and elevate the client’s legs to assist venous return.
antiembolism stockings
Monitor respiratory status including rate, depth, pattern, oximetry and ________. Encourage the client to cough and breathe deeply to prevent pulmonary complications.
ABGs
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
bulk
With hypothyroidism administer cathartics and stool softeners as needed. Avoid _____ laxatives, which interfere with absorption of levothyroxine.
fiber
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.
skin care
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.
clothing and blankets
liquids
With hypothyroidism caution the client against using ______ because the combination of vasodilation, decreased sensation, and decreased alertness can result in __________.
unrecognized burns.
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.
body image
With hypothyroidism use caution with medications due to alteration in ______.
metabolism
With hypothyroidism CNS depressants are used with cautioned due to the risk of _____________.
respiratory depression
With hypothyroidism CNS ________ are prescribed, the dose should be significantly less than for a client who does not have hypothyroidism.
depressants
Hypothyrodism alters metabolism and ______ of medications. The provider uses caution in prescribing meds to clients who have this condition.
excretion
_______ 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
Myxedema
Manifestations of Myxedema
respiratory failure hypotension hypothermia bradycardia dysrhythmia hyponatremia hypoglycemia coma
With myexedema maintain airway patency with ______ support if necessary.
ventilatory
With myexedema provide continuous _______ monitoring.
ECG
With myexedema montior ABGs to detect ______, hypercapnia, respiratory acidosis.
hypoxia
With myexedema cover the client with _____.
warm blankets
With myexedema monitor body temp ______ until stable.
hourly
With myexedema replace fluid with ______ IV.
0.9% sodium chloride
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.
levothyroxine
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.
increase
With myexedema treat hypoglycemia with _____.
glucose
With myexedema adminster _______.
coricosteroids
With myexedema initiate _____ precautions.
aspiration
With myexedema check for possible sources of ______ (blood, sputum, urine) that might have precipitated the coma. Treat any underlying illness.
infection
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
B. Decreased serum T3 is an expected finding for a client who has hyperthyroidism
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
B, C, E
_______ is a thyroid hormone replacement therapy is the treatment of choice.
Levothyroxine
Levothyroxine increases the effects of _______ and can increase the need for insulin and digoxin.
warfarin
Meciations that decrease the absorption of levothyroxine include cimetidine, lansoprazole, ______, and colestipol. Administration of these meds should be separated from levothyroxine by at least _____.
sucralfate
4 hours
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.
carbamazepine
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.
1 to 2 months
With thyroid hormone replacement therapy (levothyroxine) monitor for _______ compromise (chest pain, palpitations, rapid heart rate, sob).
cardiovascular
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.
2 to 3 weeks
Remind the client to take the dose prescribed. Do not stop taking the medication or ______ the does with thyroid hormone replacement therapy.
change
Tell the client to take the medication on an ________, typically 30 to 60 minutes before breakfast.
empty
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.
antacids
Instruct the client to monitor for and report manifestations of hyperhtyroidism when taking levothyroxine (irritability, tremors, tachycardia, palpitations, heat intolerance, _________).
rapid weight loss
Inform the client that the treatment is considered to be lifelong, requiring ongoing medical assessment of _________ when taking levothyroxine.
thyroid funciton
