Endocrine 1 Flashcards
Thyroid Enlargement
Etiology: 2 forms:
- caused by nutritional deficiency **iodine deficiency **
- a genetic predisposition: sporadic
- b dietary goitrogenic foods that inhibit T4 production e.g. rutabaga, cabbage, soy beans, Brussels sprouts (large amounts)
2.c taking goitrogenic medications
> e.g. lithium, sulfonamides, salicylates _____________________________________________________________________________________
Thyroid Disorder: enlargement
75% of hyperthyroidism is caused by Grave’s disease (HYPERTHROID)
Enlargement Management
Identify cause, may perform needle biopsy to rule out tumour
> No tumour: treat medically**
- Iodine supplement,
- Maintenance dose for adults is 50 mg of iodine / day
- In salt or larger dose 200 – 300 mg/day to prevent goitre (potassium iodide)
- Surgery for very large glands.
Hypothyroidism
Def: It is the deficiency of TH
- *Cause**
- Congenital defects of thyroid
- Defective hormone synthesis
- Iodine deficiency
- Antithyroid drugs (e.g. lithium)
- Treatment with radioactive agents
- Chronic inflammatory disease: Hashimoto’s (autoimmune hypothyroidism)
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Check to see where is it not working (structure)
- *Primary**
- Thyroid it self that is damage
Secondary hypothyroidism
-normal thyroid gland (not from thyroid gland), malfunction of ant. pit. or hypothalamus,
-both serum TSH and TH are low
** more of the ant. Pit. Than hypothalamus
Tertiary or central hypothyroidism
-problem with hypothalamus, does not produce TRH (thyrotropin-releasing h.), TSH and TH levels low
** exclusively just the hypothalamus
-Could be a tumor that affect it
Hypothyroidism Behaviors
Overall SLOWING of metabolic rate and all body processes:
- Heat production,
- Slowed digestion, motility, (decreased HCL (gastric acid) production)
- Decreased heart stimulation: Bradycardia
** Pt with synthroid: monitor cardiac status
> It about changing his synthroid rather than his cardiac meds
- Slowed neurological functioning: lethargic
- Decreased thyroid hormone leads to increased in serum cholesterol and triglycerides
> biggest changes
> Must check you labs results: cholesterol, triglycerides - if left unTx CAD, PVD, angina, decreased peripheral pulses
- Affect RBC production: anemia, B12, folate def.
Myxedema: untreated hypothyroidism: dry waxy swelling in facial areas, flat affect
Hypothyroidism Behaviors
- obesity
- sensitivity to cold,
- coarse sparse hair,
- forgetfulness,
- dry flaky skin,
- increased susceptibility to infections,
- ++ fatigue,
- depression d/t not knowing what’s happening,
- weight gain,
- constipation
Hypothyroidism Assessment
- Appearance, facial features
- diet and activity profile,
- any specific changes i.e. energy level, reaction to cold, digestive changes, weight changes,
- change in skin, hair, voice: hoarseness, slurred speech
Blood work:
- serum T3, T4, TSH, (checking thyroid and ant. Pituitary)
- lipid profile d/t high cholesteral,
- CBC d/t anemic
*** IMPORTANT
Hypothyroidism Patient Teaching
- Care with pre-existing heart condition, may precipitate tachycardia, angina, hypertension, arrhythmias, check HR,
- if over 100 notify MD
- Given to much synthroid > overstimulate the production > hyperthroidism
- Do not take with antiacids, iron, milk
- Take med at same time QD., a.m. preferred to prevent insomnia
- If taken at night you’ll be awake..
- TH supplements prolong PTT
- if on blood thinners: reassess dose.
- Warn pt ( elderly) to notify doctor if chest pain, palpitations, sweating, nervousness, SOB, or any signs of toxic levels or CV disease occur.
- Starting to show signs of hyperthyroidism
Hypothyroidism Nursing Dx
- Hypothermia r/t cold intolerance as manifested by complaints of feeling cold, shivering.
- Imbalanced nutrition: more than body requirements r/t
hypometabolism as manifested by weight gain. - Constipation r/t gastrointestinal hypomotility a.m.b. irregular hard stools
- Activity intolerance r/t decreased metabolic rate and mucin deposits in joints and interstitial spaces a.m.b. generalized weakness and muscle and joint stiffness.
- Disturbed thought processes r/t iminished cerebral blood flow secondary to decreased cardiac output a.m.b. forgetfulness, memory loss, personality changes
Hyperthyroidism
Hyperthyroidism
Grave’s disease characterized by:
\> Hyperthyroidism
\> Goitre (gland enlargement)
\> Exophthalmos: protrusion of eyes, 20-40% of pts: excessive fluid behind eyes
\>BIG BULGING EYE
- Grave’s is manifested by diffuse thyroid enlargement, the person develops antibodies to the TSH receptors which stimulates the thyroid gland to release excessive levels of T3, or T4 or both
> Antibodies are forcing to produce T3 or T4 in massive amount
> increase: massive amount of T3 and T4
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Hyperthyroidism
- Hyperthyroid may result due to drugs: amiodarone (for atrial fib and HF)
Hyperthyroidism Behaviors
Increased level of thyroid hormone causes an increase in metabolism (FAST)
- Restlessness, agitation, irritability, anxiety
- Tremors, rapid heart rate
- Diaphoresis, heat intolerance
- Frequent BMs, diarrhoea
- Weight loss, fatigue, goitre, muscle weakness
- Irregular or scant menstrual flow
* EVERYTHING IS WORKING
Hyperthyroidism Assessments
- Neck assessment, eye assessment
- Blood levels of TH;
- lipid profile: low cholesterol
Complications:
\> exophthalmos
> Heart disease: tachycardia** (can lead to MI), atrial fib, in older person HF
Thyrotoxic crisis (thyroid Storm)
- an acute, rare, life-threatening condition,
> severe tachycardia, heart failure, fever, shock, hyperthermia, restlessness, seizures, N&V, diarrhea, delirium, dehydration, & coma
—> LEADS TO SHOCK
Hyperthyroidism Management (Medications)
Goal: decrease TH production, prevent complications
For younger (< 18) antithyroid medication:
- Iodide
- Tapazole: stops thyroid gland from making too much T3 T4
- stomach upset, n/v, rash
- PTU: Blocks production of thyroid hormone
- black tarry stools, chest pain, fever
**Condition improves 4-8 wks
Ablation Therapy
Ablation therapy: Radioactive iodine therapy (sticking radioactive beads into the thyroid),
> Tx of choice for non-pregnant adults
- Client in isolation to prevent exposure and contamination of those around
- Small oral dose, absorbed and thyroid cells destroyed in 8-12 wks
TH decreases
Decline in T4 and T3 production, need to take life-long thyroid replacement therapy
Hyperthyroidism: Surgery
- Thyroidectomy: Total for malignancy
- Subtotal to correct hyperthyroid or in extreme cases of goitre. ~5/6 is removed
- Requires good pre-op state, condition stable, good health, & weight
- Post-op risk:
> haemorrhage (#1),
> infection,
> thyroid storm,
> respiratory obstruction,
> laryngeal edema,
> vocal cord injury - Damage to hypoparathyroid:
> monitor blood Ca, irritability
Hyperthyrodism Post Op Care
- Vital signs q 15min until stable then q1h x 8h, then q2h X 24 hrs, assess for pain
- Assess for hemorrhage (pooling behind neck, vomiting, freq swallowing),
\> tracheal compression, \> irregular breathing, (stridor) \> neck swelling, \> frequent swallowing, \> sensation of fullness, \> choking - Semi-Fowler’s position
- O2, suction equipment,
- Emergency tracheotomy insertion set
- vial of calcium gluconate or calcium chloride at bedside
> lose ability to for calcium
- Assess for hypocalcemia (tingling or numbness around lips of tips of fingers, toes)
\> monitor serum calcium, magnesium, & phosphorous
- Monitor Trousseau’s sign & Chvostek’s sign X 72 hours.
- Trousseau’s sign: carpal spasms induced by inflating BP cuff above systolic, evident in 3 min
\> issue with calcium
- Chvostek’s sign: contraction of facial muscles in response to a tap over facial nerve in front of ea1
- Post operative care
- Teach pt to support head manually while turning in bed, minimizes stress on suture line
- Support head with pillows
\> align with neck
- ROM exercises of the neck, taught pre-op, done 4-5 days post-op
\> slow movements , no Hyperextention
- Talking might be difficult X 3-4 days
\> d/t very sore of the neck
