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NU 340 > Ch. 55 > Flashcards

Ch. 55 Flashcards

1
Q

thyroid gland

A
  • small butterfly shaped gland located in anterior neck
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2
Q

the thyroid gland secretes hormones that affect:

A
  • body metabolism
  • cellular regulation
  • nutrition
  • gas exchange
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3
Q

thyroid imbalances can lead to symptoms that can range from

A

mild to severe and life-threatening

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4
Q

thyroid gland surrounds the (anatomy)

A
  • trachea
  • larynx
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5
Q

palpating the thyroid gland

A
  • hands on either side of the neck
  • palpate with thumbs
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6
Q

thyroid hormones are

A
  • T4 (thyroxine)
  • T3 (triiodothyronine)
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7
Q

thyroid hormones regulate

A

regulates energy metabolism
growth and development
affects every body system (hypo or hyper)

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8
Q

hypothyroidism

A

reduced hormone secretion from the thyroid gland that results in decreased body metabolism

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9
Q

prevalence of hypothyroidism

A
  • women ages 30-60
  • women affected 7-10x more than men
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10
Q

hypothyroidism- most common cause

A

iodine deficiency is the most common cause
- most prevalent in iodine-deficient areas

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11
Q

hyperthyroidism is treated with

A

radio active iodine (RAI)

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12
Q

if the iodine intake is accurate, what is the primary cause of hypothyroidism?

A

the primary cause in the adult is an autoimmune problem resulting from a condition called Hashimoto’s thyroiditis

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13
Q

thyroid surgery

A

thyroidectomy: partial or total removal of the thyroid gland

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14
Q

hyperthryroidism

A

excessive thyroid hormone secretion from the thyroid gland that results in increased body metabolism

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15
Q

most common form of hyperthyroidism

A

Graves disease

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16
Q

prevalence of hyperthyroidism

A
  • women, can occur at any age but most common ages 20-40
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17
Q

Graves Disease

A

autoimmune disorder of unknown etiology
- often occurs after episode of thyroid inflammation

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18
Q

pathophysiology of Graves Disease

A
  • diffuse thyroid enlargement and excessive thyroid hormone secretion (T3&T4)
  • antibodies are developed and attached to the TSH receptors on thyroid gland
  • may progress to destruction of thyroid tissue
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19
Q

goiter

A

hypertrophy of thyroid gland caused by excessive TSH stimulation, usually visible and definitely palpable

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20
Q

Graves Disease Goiter

A

enlargement of thyroid gland, neck is very swollen

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21
Q

health history of patient with thyroid gland problems

A
  • preexisting goiter
  • recent infection or trauma
  • immigration from iodine-deficient area
22
Q

hyperthyroidism: clinical manifestations

A

Increased number of β-adrenergic receptors
Goiters
Bruits: abnormal blood flow (listen on carotids)
Ophthalmopathy (exophthalmos): protruding eyes

23
Q

hyperthyroidism/grave’s: cardiovascular system effects

A

Systolic hypertension
Increased CO
Arrhythmias
Cardiac hypertrophy
Atrial fibrillation

24
Q

hyperthyroidism/grave’s: integumentary system effects

A

Warm, smooth, moist skin
Thin, brittle nails
Hair loss
Clubbing of fingers
Diaphoresis
Vitiligo (loss of skin color in patches)
Eye balls protruding outward

25
Q

hyperthyroidism/grave’s: nervous system effects

A

Fine tremors
Insomnia
Lability of mood, delirium
Hyperreflexia of tendon reflexes
Inability to concentrate

26
Q

hyperthyroidism/grave’s: GI system effects

A

Increased appetite, thirst
Weight loss (r/t metabolism is sped up)
Diarrhea
Splenomegaly
Hepatomegaly

27
Q

hyperthyroidism/grave’s: MS system effects

A

Fatigue
Muscle weakness
Proximal muscle wasting
Dependent edema
Osteoporosis

28
Q

hyperthyroidism/grave’s: reproductive system effects

A

Menstrual irregularities
Amenorrhea: no period
Decreased libido
Impotence
Gynecomastia in men
Decreased fertility

29
Q

thyrotoxic crisis (thyroid storm): sx

A

Acute, life-threatening
Hyperthermia
Severe tachycardia
Hypertension
Heart Failure

30
Q

thyrotoxic crisis (thyroid storm): triggers

A

Trauma, infection, DKA, pregnancy
Vigorous palpation of the thyroid

31
Q

thyrotoxic crisis (thyroid storm): diagnostic studies

A

Laboratory findings for TSH (low) and free thyroxine: T3&T4 (high)
TSH-RAb (Antibodies to TSH)
Radioactive iodine uptake
- Normal 5 to 35%

32
Q

thyrotoxic crisis (thyroid storm): treatment

A

Symptom treatment
- racing HR: low dose beta blocker
- anxious: low dose anti-anxiety, sleeping pill
Antithyroid Medications
Iodine

33
Q

thyrotoxic crisis (thyroid storm): treatment- antithyroid medications

A

Propylthiouracil (PTU)
Methimazole
- Inhibit synthesis of thyroid hormones
- 1-2 weeks to begin
- 4-8 weeks therapeutic

34
Q

thyrotoxic crisis (thyroid storm): treatment- iodine

A

Useful with other antithyroid drugs in preparation for thyroidectomy or treatment of crisis
Large doses rapidly inhibit synthesis of T3 and T4 and block their release into circulation
Potassium iodine (SSKI) or Lugol’s solution (no iodine for pregnant women)

35
Q

thyrotoxic crisis (thyroid storm): treatment- radioactive iodine

A

Damages or destroys thyroid tissue limiting hormone secretion
3 months to see effect
Usually causes hypothyroidism and requires life-long hormone replacement

36
Q

thyrotoxic crisis (thyroid storm): surgical therapy

A

Subtotal thyroidectomy involves removal of significant portion of thyroid
- 90% removed to be effective
- If too much is removed, regeneration will not occur, results in hypothyroidism

37
Q

Subtotal thyroidectomy post-op care

A

Assess for signs of hemorrhage or tracheal compression
Semi-Fowler’s position and support head with pillows
edema around the trachea
Monitor for signs/symptoms of Parathyroid involvement

38
Q

thyrotoxic crisis (thyroid storm): nursing problems

A
  • Activity intolerance: tired, fatigued
  • Risk for injury: from being tired, muscle weakness
  • Imbalanced nutrition: less than body requirements, eating but losing weight due to increased metabolism
  • Anxiety: tremors
39
Q

acute thryrotoxicosis: nursing care

A

Administer medications
Monitoring cardiac arrhythmias
Ensuring adequate oxygenation and IV fluids
Light bed coverings if diaphoretic

40
Q

hypothyroidism s/sx: cardiovascular system

A

Increased capillary fragility
Decreased rate and force of contraction
Cardiac hypertrophy
Distant heart sounds

41
Q

hypothyroidism s/sx: GI system

A

Decreased appetite
Nausea and vomiting

42
Q

hypothyroidism s/sx: integumentary system

A

Dry, thick, elastic, cold skin
Thick, brittle nails

43
Q

myxedema

A

sx of hypothyroidism
Accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues
Causes puffiness

44
Q

hypothyroidism diagnostic tests

A
  • TSH (high)
  • Thyroxine-T4 (low)
45
Q

myxedema coma: manifestations

A

Mental sluggishness
Drowsiness
Lethargy progress gradually or suddenly to impairment of consciousness or coma
puffy eyes

46
Q

myxedema coma: acute intervention

A

Monitor core temperature as patient is often hypothermic
Assess vitals, weight, I & O, and visible edema

47
Q

myxedema coma: medication Levothyroxine

A

*aka synthroid
Monitor with CV patients
Report HR >100 (previously bradycardic, make sure that they do not become tachycardic)
Life-long therapy
Usually given before breakfast (empty stomach)
Thyroid preparations potentiate the effects of some common drug groups
- Antidepressants
- Digitalis compounds
- Anticoagulants

48
Q

hypothyroidism: evaluation

A

think HR, RR, neuro evaluation
- Maintain normal cardiovascular function: BP & HR in normal range
- Maintain adequate respiratory function and gas exchange
- Demonstrate improvement in cognition: if there was an issue with cognition

49
Q

hypothyroidism is most commonly caused by

A

iodine deficiency
- most prevalent in iodine-deficient areas

50
Q

in places where iodine intake is adequate, the primary cause of hypothyroidism in adults is

A

atrophy of the gland

51
Q

causes of hypothyroidism

A
  • iodine deficiency* (#1)
  • atrophy of the gland* (#2)
  • autoimmune thyroid destruction
  • infection of the thyroid tissue
  • congenital absence or hypoplasia of thyroid tissues
  • neck surgery
  • irradiation, trauma
  • wide variety of drugs

NU 340 (26 decks)

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