Ch 54: Myxedema Coma Flashcards
A 72-year-old woman with a history of untreated hypothyroidism is brought to the emergency department. She is unresponsive, her skin feels cool to the touch, her blood pressure is 84/50 mm Hg, and her respiratory rate is 6 breaths/min. Which condition does the nurse suspect?
A. Diabetic ketoacidosis
B. Myxedema coma
C. Thyroid storm
D. Sepsis
B. Myxedema coma
Rationale: The symptoms of hypothermia, hypotension, and hypoventilation in a patient with a history of hypothyroidism point strongly toward myxedema coma, a life-threatening emergency.
Which of the following is the primary treatment intervention for myxedema coma?
A. Administer subcutaneous insulin
B. Administer oral levothyroxine
C. Begin IV thyroid hormone replacement
D. Administer IV corticosteroids only
C. Begin IV thyroid hormone replacement
Rationale: IV thyroid hormone replacement is essential for reversing the life-threatening hypothyroid state. Oral administration is ineffective due to the patient’s altered consciousness.
Which of the following drugs are known precipitants of myxedema coma?
A. Beta-blockers
B. Antacids
C. Antibiotics
D. Opioids
D. Opioids
Rationale: Opioids, along with tranquilizers and barbiturates, depress the CNS and can precipitate myxedema coma in hypothyroid patients.
A nurse assesses a patient with suspected myxedema coma. Which set of vital signs would most likely be observed?
A. BP 150/90, HR 110, Temp 38.5°C (101.3°F)
B. BP 180/100, HR 98, Temp 36.7°C (98°F)
C. BP 85/48, HR 50, Temp 34.4°C (93.9°F)
D. BP 100/70, HR 95, Temp 37.0°C (98.6°F)
C. BP 85/48, HR 50, Temp 34.4°C (93.9°F)
Rationale: Hypotension, bradycardia, and hypothermia are classic signs of myxedema coma.
Which of the following are possible causes of myxedema coma? (SATA)
A. Infection
B. Hyperglycemia
C. Sedative drugs
D. Trauma
E. Exposure to cold
A. Infection
C. Barbiturate use
D. Trauma
E. Exposure to cold
Rationale: Myxedema coma can be triggered by infection, sedative drugs (e.g., barbiturates, opioids, tranquilzers), trauma, and cold exposure. Hyperglycemia is not a direct cause.
Which electrolyte abnormality may contribute to cardiovascular collapse in myxedema coma?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
B. Hyponatremia
Rationale: Hyponatremia contributes to cerebral and cardiovascular instability in myxedema coma.
Why is hypoventilation dangerous in patients with myxedema coma?
A. It causes hyperglycemia and fluid overload
B. It leads to lactic alkalosis and respiratory alkalosis
C. It reduces oxygen delivery and contributes to acidosis
D. It causes bronchoconstriction and pulmonary edema
C. It reduces oxygen delivery and contributes to acidosis
Rationale: Hypoventilation results in CO₂ retention and respiratory acidosis, compounding lactic acidosis and leading to cardiovascular collapse.
A nurse is caring for a patient in myxedema coma. Which of the following interventions should be anticipated? (SATA)
A. Warming the patient gradually
B. Rapid fluid boluses to increase BP
C. Mechanical ventilation
D. Continuous cardiac monitoring
E. Administering oral thyroid hormone
A. Warming the patient gradually
C. Mechanical ventilation
D. Continuous cardiac monitoring
Rationale: Gradual warming, ventilatory support, and cardiac monitoring are essential. IV, not oral, thyroid hormone is used due to altered consciousness. Fluid boluses should be used cautiously.
Which lab abnormality would a nurse expect in a patient with myxedema coma?
A. Elevated T3 and T4
B. Decreased TSH
C. Low T3 and T4
D. Elevated blood glucose
C. Low T3 and T4
Rationale: Myxedema coma is a severe hypothyroid state, with markedly decreased T3 and T4 levels.
A patient is admitted with altered mental status. The nurse notes a history of chronic fatigue, weight gain, and cold intolerance. Lab results show hyponatremia, hypoglycemia, and respiratory acidosis. What is the priority nursing action?
A. Start IV levothyroxine and support ABCs
B. Administer insulin IV
C. Begin warming blankets
D. Insert NG tube for enteral feeding
A. Start IV levothyroxine and support ABCs
Rationale: The presentation suggests myxedema coma. Immediate thyroid hormone replacement and supportive care are priority.
A patient in myxedema coma has developed lactic acidosis. Which of the following best explains this finding?
A. Increased metabolism
B. Tissue hypoxia due to hypoventilation
C. Dehydration and hypoglycemia
D. Excess thyroid hormone levels
B. Tissue hypoxia due to hypoventilation
Rationale: Poor oxygenation from hypoventilation leads to anaerobic metabolism and lactic acid buildup.
What is the most concerning clinical finding in a patient with myxedema coma?
A. Mild bradycardia
B. Low-grade fever
C. Unresponsive to stimuli
D. Puffy facial appearance
C. Unresponsive to stimuli
Rationale: Myxedema coma involves altered mental status progressing to coma, requiring immediate intervention.
Which of the following complications are associated with myxedema coma? (SATA)
A. Respiratory failure
B. Hyponatremia
C. Hyperglycemia
D. Hypoglycemia
E. Cardiovascular collapse
A. Respiratory failure
B. Hyponatremia
D. Hypoglycemia
E. Cardiovascular collapse
Rationale: Respiratory failure, hyponatremia, hypoglycemia, and cardiovascular collapse are common in myxedema coma. Hyperglycemia is not typically seen.
What is the initial priority in the management of a patient suspected of myxedema coma?
A. Administer corticosteroids
B. Begin rehydration with oral fluids
C. Draw blood cultures to rule out infection
D. Secure airway and provide ventilatory support
D. Secure airway and provide ventilatory support
Rationale: ABCs always come first. Hypoventilation and risk of respiratory failure make airway support critical.
A nurse notes that a patient recovering from myxedema coma is responding to treatment. Which finding best indicates improvement?
A. Continued low body temperature
B. Improved level of consciousness
C. Decreasing sodium levels
D. Increasing lethargy
B. Improved level of consciousness
Rationale: Mental status improvement indicates that the patient is responding to therapy and the metabolic derangement is being corrected.
An 82-year-old patient in a long-term care facility is newly diagnosed with hypothyroidism.
Which prescribed drug would the nurse discuss with the health care provider?
a. Docusate (Colace)
b. Ibuprofen (Motrin)
c. Diazepam (Valium)
d. Cefoxitin (Mefoxin)
c. Diazepam (Valium)
Rationale: Worsening of mental status and myxedema coma can be precipitated using sedatives, especially in older adults. The nurse should discuss the use of diazepam with the health care provider before administration. The other medications may be given safely to the patient.
A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home?
a. Delay teaching until closer to discharge date.
b. Provide written reminders of information taught.
c. Offer multiple options for management of therapies.
d. Ensure privacy for teaching by asking the family to leave.
b. Provide written reminders of information taught.
Rationale: Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Because the treatment regimen is complex, teaching should be started well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid.
T/F
In the older adult, manifestations of hypothyroidism may be thought of as general aging.
true
T/F
Myxedema is not a medical emergency.
false
lab test
TSH and free T4
What is the drug of choice to treat hypothyroidism?
levothyroxine
severe, longstanding hypothyroidism
myxedema coma
