Endocrine 2 Flashcards
broadly describe radioactive iodine therapy
given for hyperthyroid pt
typically given 1 dose (orally)
destroys thyroid cells
WILL cause hypothyroidism (this is expected)
education for radioactive iodine therapy
taken at home
radioactive precautions
stay away from babies for a wek
what is important to watch for during radioactive iodine therapy
THYROID STORM
describe thyroid storm
aka thyrotoxic crisis
*hyperthyroidism multiplied by 100
give them beta blocker and antithyroid
essentially, if a little piece of thyroid is left, it will over produce TH (rebound effect)
what are the symptoms of thyroid storm
same as hyperthyroid just magnified
cardiac, fever, hypertension, V/D/N, abdominal pain, anxiety/tremors
describe thyroidectomy
leaves enough gland to produce TH
done if hyperthyroidism
total removal=cancer of thyroid
subtotal removal=thyroid is pressing on trachea
pre op care of thyroidectomy
decrease function of thyroid
give PU
antithyroid meds to decrease risk of hemorrhage
post op care thyroidectomy
- semi fowlers
- support head and neck
- assess hoarseness
- assess pressure at neck
- risk for respiratory distress
- tetany (Ca deficiency)
- elevated head of bed to prevent edema
what is most important to watch for in post op thyroidectomy
high risk for HEMORRAHGE
check for bleeding BEHIND head and neck line
what does increased hoarseness indicate after thyroidectomy
laryngeal nerve damage
why do you check for bleeding behind the head
that is where pooling of blood occurs
bruising**
this is one of the most common disorders in the US
hypothyroidism
describe hypothyroidism
caused by removal of thyroid gland most often
affects women>men
can be the effect of the antithyroid drug
what are the common associations with hypothyroidism
depression
decreased metabolic rate (decreased energy!)
removal of a few parathyroids with thyroidectomy will cause…
decreased Ca production
hypocalcemia (assess for signs)
tetany(rigid tight muscles)
signs of increased versus decreased Ca
increased= sedated
decreased=less sedated
manifestations of hypothyroidism
sleepiness/fatigue weakness constipation cold intolerance decrease libido depression anorexia amenorea
appearance of hypothyroidism
increased wt gain edema/blank expression slow movement coarse features myxedema decreased energy and appetite
general puffiness, tongue profusion
myxedema
lab diagnosis of hypothyroidism
decreased T3 and T4
increased TSH levels
*opposite of hyperthyroidism
treatment of hypothyroidism
Levothyroxine (synthoid)
Liothyronine (Cytomel)
Levothyroxine (synthoid)
thyroid hormone
force body to turn T4 into T3
Liothyronine (Cytomel)
thyroid hormone
gives body T3
what are the precautions for thyroid hormone meds
take on empty stomach
start on low dowse, gradually increase
DO NOT want too much pressure on heart (can cause MI)
what do you monitor for if on thyroid meds
bruising and bleeding
monitor for coronary insufficiency, chest pain, dyspnea and tachy
thyroid pts tend to have _____ d/t _____
Coronary artery disease
increased LDL
if on thyroid meds for hypothyroidism…
you will take meds for rest of life
describe the function of the adrenal medulla
middle
secretes epi and norepi and catecholamines
helps handle stress
hyperstimulation of adrenal medulla caused by ____
tumor (benign, familial)
excessive secretion of catecholamines
s/s of hyperstimulation of adrenal medulla
increased BP increased HR palpitations flushed intermittent side effects
lab diagnosis of adrenal medulla hyper stimulation
increased catecholamine levels (epi and norepi)
vanillymadelic (VMA) test-tells if epi/norepi are elevated
education for VMA
avoid vanilla for 1 wk
obtained via 24 hr urine sample (look for epi throughout day, not just one sample)
avoid stressful things and smoking
treatment for hyper stimulation of adrenal medulla
surgery (remove tumor)
after surgery assess BP
common in women 40-60
what are the hormones of the adrenal cortex
SSS (stress, salt, sex) steroids
glucocorticoids, mineralocorticoids, sex hormones
*all have different side effects
what do steroids suppress
immune system and inflammatory response
good for arthritis
kids on steroids…
may not grow correctly due to the decreased protein
action of glucocorticoids
change in mood (unexplainably loopy) altered defense mechanism (increased risk of infection) breakdown fats and proteins (provide energy) inhibit insulin (regulate glucose levels and increase BS
why are steroids given
to decrease inflammation
what needs to be monitored with glucocorticoids
blood glucose monitoring
these diseases are dysfunctions with glucocorticoids and mineralocorticoids
Addison’s and Cushings
