Exam 3 (Ch. 52 & 54) Flashcards
1
Q
Thyroid gland produces what hormones?(3)
A
*Calcitonin
*Thyroxine (T4) (more prevalent)
*Triiodothyronine (T3) (less prevalent but more potent with greater metabolic effects than T4)
2
Q
Parathyroid produces what hormone?
A
Parathyroid hormone (PTH)
3
Q
Parathyroid hormone regulates what?
A
*Regulates serum calcium levels
*Stimulates renal conversion of Vitamin D to most active form
Functions via negative feedback system
4
Q
Parathyroid is located where
A
Within each side of Thyroid - Superior and Inferior parathyroid glands
5
Q
Adrenal gland is composed of what sections
A
Adrenal medulla (interior)
Adrenal cortex (outer layer)
6
Q
Adrenal medulla produces what hormones?
A
Catecholamines (epinephrine, norepinephrine, dopamine)
7
Q
Adrenaline and noradrenaline (catecholamines) (produced in adrenal medulla) are made from what?
A
amino acid tyrosine
8
Q
Function of catecholamines (epinephrine, norepinephrine, dopamine)
A
Essential part of SNS ‘fight or flight response’
9
Q
Adrenal cortex produces what hormones?
A
*Glucocorticoids (cortisol)
*Mineralocorticoids (aldosterone)
*Adrenal androgens
10
Q
Function of Glucocorticoids (cortisol)
A
*Anti-Inflammatory by preventing increased capillary permeability AND increases stabilization of cellular lysosome membranes
*Effects glucose metabolism (Increases by stimulating hepatic glucose formation) (glucose needed for immediate fight-or-flight energy)
Not needed for exam but good to know: (glucocorticoid effect on glucose homeostasis is to preserve plasma glucose for brain during stress, as transiently raising blood glucose is important to promote maximal brain function)
11
Q
What increases Glucocorticoids (cortisol) levels
A
Stress, burns, infection, fever, acute anxiety, hypoglycemia
12
Q
Mineralocorticoids (aldosterone) function
A
Influences fluid and electrolyte balance
*Maintains extracellular fluid volume
* Promotes renal reabsorption of sodium and excretion of potassium and hydrogen ions
13
Q
Function of adrenal androgens
A
production of the body and pubic hair during puberty
14
Q
Define cushing syndrome
A
A chronic disease, characterized by high cortisol levels
15
Q
Low levels of cortisol can cause what autoimmune disease?
A
Adrenal insufficiency AKA Addison disease
16
Q
Gerontologic considerations related to endocrine system
A
*Decreased responsiveness, production, secretion
*Altered metabolism and circadian rhythms
*Medications that change body’s usual response
17
Q
Subjective data related to assessment of endocrine system (4)
A
Health history
medications
surgery or other treatments
functional health problems
18
Q
Objective data taken during a physical assessment relating to endocrine system
A
Vital signs
Height and weight
BMI
Integument
Head
Neck
19
Q
Name diagnostic studies (3) used to assess patients endocrine system
A
*Imaging studies
*Direct or indirect measurement of hormone levels
*Single or multiple blood sampling
20
Q
Diagnostic studies relating to Thyroid
A
TSH - most sensitive and accurate thyroid test
Additional tests include total T4, free T4, and total T3
21
Q
Name parathyroid laboratory studies
A
Abnormal PTH levels reflected in calcium and phosphate levels
22
Q
Diagnostic studies to determine adrenal cortex function
A
Blood plasma and urine levels of glucocorticoids, mineralocorticoids,
androgens
23
Q
Function of calcitonin
A
Lowers serum calcium levels
24
Q
Most common endocrine disorder
A
Problems w/ thyroid function
25
Define goiter
Enlarged thyroid gland
26
Most common worldwide cause of a goiter
lack of iodine
27
Most common cause of a goiter in the U.S
over or underproduction of thyroid hormone or due to nodules
28
What causes a goiter
Hyperthyroidism
Hypothyroidism
Iodine deficient
29
Define thyroiditis
Inflammation of the thyroid gland
30
Subacute thyroiditis
caused by viral infection
31
Acute thyroiditis
Caused by bacterial or fungal infection
32
Define symptoms of abrupt thyroiditis onset
Localized: pain in thyroid area, pain in throat, ears or jaw
Systemic: fever, chills, sweats and fatigue
33
Thyroid tumor/ cancer characteristics
*Characterized by goiters
*Tumors Can be both benign and malignant
34
How to determine if thyroid tumor is cancerous
Tissue biopsy
35
Highest concern relating to thyroid cancer
compromised airway (difficulty breathing)
36
post-op thyroidectomy nursing management focusing on diet
*High calorie intake
*Supplements
*Avoid caffeine sources
37
Post-op thyroidectomy nursing care
*maintain airway
*manage pain
*administer hydration therapy
*Reduce talking to prevent swelling of vocal cords
*physical activity
38
post-op thyroidectomy potential complications
*Hemorrhaging
*Edema
*Monitor blood calcium levels - treat w/ calcium gluconate to prevent tetany (Involuntary contraction of muscles)
39
Define hyperthyroidism
A sustained increased in synthesis and release of thyroid hormones by thyroid gland
40
Most common form of hyperthyroidism
Graves disease
41
Name potential causes of hyperthyroidism
Toxic nodular goiter
Thyroiditis
Excess iodine intake
Pituitary tumors
Thyroid cancer
42
Define thyrotoxicosis
*Physiologic effects/clinical syndrome of hypermetabolism
*Results from increased circulating levels of T3, T4 or both
43
Likelihood a women will be diagnosed with graves disease compared to men
Women are five times more likely than men to develop Graves’ disease
44
Define graves disease
*Causes hyperthyroidism
*An autoimmune disorder, *Immune system produces thyroid-stimulating immunoglobulins (TSIs) antibodies, which mimic thyroid-stimulating hormone (TSH).
*Stimulation from TSIs causes the thyroid gland to grow abnormally
*Overstimulation leads to excessive (T3 and T4), resulting in hyperthyroidism
45
Clinical manifestations of hyperthyroidism
*Increased metabolism
*Increased tissue sensitivity to SNS stimulation (SNS(fight or flight response) -body becomes more sensitive to catecholamines like adrenaline and noradrenaline due to increased thyroid hormones)
46
Clinical manifestations - Why would nurse Inspect a goiter?
*To look for visible swelling or asymmetry in the neck
*Whether the swelling moves upward when the patient swallows. This movement is important because the thyroid gland is attached to the trachea.
*Assess the size, shape, and function of the thyroid gland, aiding in the diagnosis of thyroid disorders
47
Clinical manifestations - Why would nurse auscultate a goiter?
*Listen for a bruit, bruits are abnormal whooshing or blowing sounds heard over the thyroid gland.
*Bruit can indicate increased blood flow to the thyroid, which is often associated with hyperthyroidism, particularly in Graves' disease.
48
Define Ophthalmopathy
*Abnormal eye appearance or function
*Graves' ophthalmopathy (also known as thyroid eye disease or TED)
*The underlying cause involves the immune system attacking tissues behind the eyes, similar to how it attacks the thyroid gland.
49
Define proptosis (aka Exophthalmos)
*Bulging eyes
*A symptom of Ophthalmopathy
50
Difference between proptosis and Ophthalmopathy
Ophthalmopathy is the disease, and proptosis is a potential symptom of that disease
51
Define Exophthalmos
*Increased fat deposits and fluid
*Eyeballs forced outward
*Actually another term for proptosis
*Most common cause in adults is thyroid eye disease
52
Cardiovascular clinical manifestations of hyperthyroidism (7)
*Systolic hypertension
*Bounding, rapid pulse; palpitations
*Increased cardiac output
*Cardiac hypertrophy
*Systolic murmurs
*Dysrhythmias
*Angina
53
Respiratory system clinical manifestations of hyperthyroidism
*Dyspnea on mild exertion
*Increased respiratory rate
54
GI system clinical manifestations of hyperthyroidism (5)
*Increased appetite, thirst
*Weight loss
*Diarrhea
*Splenomegaly
*Hepatomegaly
55
Define Splenomegaly
The enlargement of the spleen
56
Define Hepatomegaly
The enlargement of the liver
57
Musculoskeletal clinical manifestations of hyperthyroidism (5)
*Fatigue
*Weakness
*Proximal muscle wasting
*Dependent edema
*Osteoporosis
58
Skin clinical manifestations of hyperthyroidism (7)
*Warm, smooth, moist skin
*Thin, brittle nails
*Hair loss
*Clubbing of fingers; palmar erythema
*Fine, silky hair; premature graying in men
*Diaphoresis
*Vitiligo
59
Nervous system clinical manifestations of hyperthyroidism (6)
*Hyperactive deep tendon reflexes
*Nervousness, fine tremors
*Insomnia , difficulty focusing eyes
*Lability of mood, delirium
*Lack of ability to concentrate
*Stupor, coma
60
Reproductive system clinical manifestations of hyperthyroidism (6)
*Menstrual irregularities
*Amenorrhea
*Decreased libido
*Decreased fertility
*Impotence and gynecomastia in men
61
Other clinical manifestations of hyperthyroidism not previously listed (5)
Intolerance to heat
Elevated basal temperature
Lid lag, stare
Eyelid retraction
Rapid speech
62
Who is at risk of Thyrotoxic crisis
*Patients with thyroidectomy
*Results from stressors (e.g., infection, surgery, trauma)
63
Define Thyrotoxic crisis
*Excessive amounts of thyroid hormones are released into the bloodstream.
*LIfe threatening
64
Another name for thyrotoxic crisis
thyroid storm
65
Clinical manifestations of acute thyrotoxicosis
*Severe tachycardia, heart failure
*Shock
*Hyperthermia (up to 106° F [41.1° C])
*Agitation
*Seizures
*Abdominal pain, vomiting, diarrhea
*Delirium, coma
66
Diagnostic studies for thyrotoxicosis crisis
* Decreased TSH (less than 0.4 mU/L)
*Increased free thyroxine (free T4)
*Total T3 and T4 (not definitive)
*Radioactive iodine uptake (RAIU)
67
Why is Radioactive iodine uptake (RAIU) lab value assessed in diagnosing thyroid issue?
Distinguishes Graves’ disease from other forms of thyroiditis
68
RAIU in Graves' Disease - Lab value would be high or low?
___ HIGH ___
*In Graves' disease, the thyroid gland is overactive and actively producing excess hormones.
*Results in a high RAIU, meaning the gland absorbs a larger than normal amount of radioactive iodine.
69
RAIU in Thyroiditis - Lab value would be high or low?
___ LOW ___
*During the inflammatory phase, the gland's ability to take up iodine is reduced.
*Therefore, RAIU is typically low in thyroiditis. The gland is not actively producing new hormone, thus the RAIU is low.
70
Interprofessional care GOALS relating to Thyrotoxic crisis
*Block adverse effects of thyroid hormones
*Suppress hormone oversecretion
*Prevent complications
71
Goal of Propylthiouracil and methimazole (Tapazole) an antithyroid medication
Inhibit thyroid hormone synthesis
72
Treatment options for Thyrotoxic crisis
*Antithyroid medications
*Radioactive iodine therapy (RAI)
*Surgery
73
Name Antithyroid Drugs
*Propylthiouracil and methimazole (Tapazole)
*Potassium iodine (SSKI) and Lugol’s solution
74
Would Propylthiouracil and methimazole (Tapazole) be given to a patient with hyper OR hypothyroidism
Hyperthyroidism - to reduce thyroid hormone synthesis
75
Goal of Potassium iodine (SSKI) and Lugol’s solution
Inhibit synthesis of T3 and T4 and block their release into circulation
76
How does Potassium iodine (SSKI) and Lugol’s solution make thyroid surgery safer?
Decreases vascularity of thyroid gland, making surgery safer and easier
76
Patient prescribed Propylthiouracil and methimazole (Tapazole), when should they see results?
Improvement in 1 to 2 weeks
Results usually seen within 4 to 8 weeks
Therapy for 6 to 15 months
77
Patient prescribed potassium iodine (SSKI) and lugol’s solution, how long until medication takes full affect?
Maximal effect within 1 to 2 weeks
78
What medication is prescribed to relieve thyrotoxicosis symptoms?
B-Adrenergic blockers
- LOL
Propranolol (Inderal)
Atenolol (Tenormin)
79
Propanolol (Inderal) & Atenolol (Tenormin) classifications?
β-Adrenergic Blockers
80
Propranolol (Inderal) & Atenolol (Tenormin) reduce what symptoms and how?
*Symptomatic relief
*Block effects of sympathetic nervous stimulation
*Decreases tachycardia, nervousness, irritability, tremors
81
Which specific population should NOT be administered Radioactive Iodine Therapy (RAI)
Pergnant adults
82
How does Radioactive Iodine Therapy (RAI) affect the thyroid?
*The thyroid gland naturally absorbs iodine to produce thyroid hormones. RAI exploits this characteristic.
**When a patient ingests radioactive iodine (I-131), it's absorbed by the overactive thyroid cells.
***Radiation then destroys these cells, reducing the gland's ability to produce excessive hormones
*Simple response: Damages or destroys thyroid tissue
83
How delayed is Radioactive Iodine Therapy (RAI)?
Delayed response of up to 3 months
84
Radioactive Iodine Therapy (RAI) is often prescribed with what other medications
Treated with antithyroid drugs and β-blocker before and during first 3 months of RAI
85
Two main concerns Radioactive iodine (RAI) therapy is prescribed to treat?
*Hyperthyroidism & thyroid cancer
85
What would you teach a patient being administered Radioactive Iodine Therapy (RAI)?
Frequent oral care for thyroiditis/parotiditis
Radiation precautions
Symptoms of hypothyroidism
86
Whos a good canidite for thyroid surgery
*Large goiter causing tracheal compression
*Unresponsive to antithyroid therapy
*Thyroid cancer
*Not a candidate for RAI
*Rapid reduction in T3 and T4 levels is required
87
Define subtotal thyroidectomy
*Preferred surgical procedure
*Involves removal of 90% of thyroid
*Can be done using minimally invasive procedures,
1) Endoscopic thyroidectomy
2) Robotic surgery
88
Post-Op Thyroidectomy Nutritional Therapy Education
*High-calorie diet (4000 to 5000 cal/day)
6 full meals/day with snacks in between
Protein intake: 1 to 2 g/kg ideal body weight
Increased carbohydrate intake
*Avoid highly seasoned and high-fiber foods, caffeine
*Dietitian referral
89
Hyperthyroidism - nursing assessment - subjective data relating to medications
*Medications
Thyroid hormones, herbal therapies
89
Hyperthyroidism - nursing assessment - subjective data relating to health history
*Health history
Goiter, recent infection or trauma, immigration from iodine-deficient area, autoimmune disease
90
Hyperthyroidism - nursing assessment - subjective data to address?
Family history
Iodine intake
Weight loss
Increased appetite, thirst
Nausea/vomiting
Diarrhea, polyuria
Sweating
Dyspnea on exertion
Palpitations
Muscle weakness, fatigue
Insomnia
Chest pain
Nervousness
Heat intolerance, pruritus
91
Hyperthyroidism - nursing assessment - objective data to address?
Agitation
Rapid speech
Anxiety, restlessness
Hyperthermia
Enlarged or nodular thyroid gland
Exophthalmos
Eyelid retraction, infrequent blinking
92
Nursing implications when treating acute thyrotoxicosis
*Necessitates aggressive treatment
*Give medications that block thyroid hormone production and SNS effects
*Monitor for dysrhythmias
*Ensure adequate oxygenation
*Fluid and electrolyte replacement
*Establish trusting relationship to promote coping
*Ensure adequate rest
*Cool, quiet room
*Light bed coverings
*Change linens often
*Encourage and assist with exercise
93
Define Hypothyroidism
Deficiency of thyroid hormone
94
How does hypothyroidism affect the metabolism?
Causes general slowing metabolic rate
95
Define subclinical hypothyroidism
*A condition where the thyroid-stimulating hormone (TSH) level is mildly elevated (above 4.5 mlU/L), but the thyroxine (T4) level remains within the normal range.
*Many experience no symptoms
*Subclinical hypothyroidism can sometimes progress to overt hypothyroidism
*The risk of progression is higher in individuals with higher TSH levels and positive thyroid antibodies.
96
Define Nonthyroidal illness syndrome (NTIS)
*Abnormal thyroid hormone levels in critically ill patients, despite the absence of underlying thyroid disease.
*More common in critically ill patients
*Low T3, T4, and TSH levels
97
Other name for Nonthyroidal illness syndrome (NTIS)?
euthyroid sick syndrome
98
Cause of primary hypothyroidism
Caused by destruction of thyroid tissue or defective hormone synthesis
99
Cause of secondary hypothyroidism
Caused by pituitary disease (decreased TSH) or hypothalamic dysfunction or (decreased TRH)
100
Define atrophy
*General physiological process of reabsorption and breakdown of tissues
*Refers to a decrease in size or wasting away of a body part or tissue
100
How is iodine deficiency linked to hypothyroidism
*Iodine is essential for thyroid hormone synthesis
*In regions with iodine deficiency, the thyroid gland cannot produce adequate hormones, leading to hypothyroidism.
*The thyroid gland may enlarge (goiter) in an attempt to capture more iodine.
101
Atrophy of the Gland being a cause for hypothyroidism?
*Refers to the shrinking or wasting away of the thyroid gland
*It can result from various factors, including autoimmune disease or aging.
102
Hashimoto's Thyroiditis
*This is the most common cause of hypothyroidism in developed countries
*It's an autoimmune disorder where the immune system attacks and destroys the thyroid gland
*This leads to progressive thyroid gland damage and decreased hormone production
103
Graves' Disease relating to hypothyroidism
*Graves' disease typically causes hyperthyroidism, treatment for it can lead to hypothyroidism
*Radioactive iodine therapy or surgical removal of the thyroid gland can result in permanent hypothyroidism
103
How can Treatment for hyperthyroidism
cause hypothyroidism?
*Treatments like radioactive iodine, surgery, and some antithyroid medications can damage the thyroid gland, leading to hypothyroidism.
104
Can certain drugs cause hypothyroidism?
*Certain medications can interfere with thyroid hormone production or metabolism
*Lithium
*Amiodarone
*Interferon-alpha
105
Cretinism (Congenital Hypothyroidism)
*If hypothyroidism occurs in infancy or early childhood, it can lead to cretinism (now commonly called congenital hypothyroidism)
*Results in severe developmental delays, intellectual disability, and growth retardation
*Potential causes: thyroid dysgenesis(abnormal development of the thyroid), thyroid dyshormonogenesis(defects in thyroid hormone production), and iodine deficiency.
106
What clinical manifestations may occur with hypothyroidism patients?
Tired, lethargic, impaired memory, low initiative, weight gain, decreased appetite
106
How is celiac disease related to hypothyroidism?
*Celiac disease damages the small intestine, which can impair the absorption of essential nutrients, including those necessary for thyroid function
*This malabsorption can potentially contribute to thyroid dysfunction or make it more difficult to manage hypothyroidism with medication
*This malabsorption can also interfere with the absorption of levothyroxine, the medication used to treat hypothyroidism
107
Precursors of myxedema coma
infection, drugs, cold, trauma
108
Define myxedema coma
life-threatening condition that represents the most severe form of hypothyroidism
109
Characteristics of myxedema coma
*Impaired consciousness or coma
*Subnormal temperature, hypotension, hypoventilation
*Cardiovascular collapse
110
How is myxedema treated?
IV thyroid hormone
110
TSH levels increase or decrease with primary hypothyroidism?
TSH increases with primary hypothyroidism
111
TSH levels increase or decrease with secondary hypothyroidism?
TSH decreases with secondary hypothyroidism
112
During assessment what medical history related info should be obtained from hypothyroidism patient?
*Symptoms: Fatigue, weight gain, constipation, dry skin, cold intolerance, etc.
*Family history of thyroid disease.
*Previous thyroid treatments (surgery, radioactive iodine).
*Medications.
*Dietary history, particularly *Iodine intake
113
Interprofessional treatment GOAL when treating a myxedema coma patient?
Restore euthyroid state as safely and rapidly as possible
114
What to monitor for myxedema coma patient taking levothyroxine (synthroid)?
Monitor for chest pain, weight loss, nervousness, tremors, insomnia
115
For patient taking levothyroxine (synthroid), when would dose be be increase and what lab value would be assessed prior?
Increase dose in 4- to 6-week intervals as needed based on TSH levels
116
Nursing assessment -patient w/ hypothyroidism what would be addressed for health history?
*Hyperthyroidism treatment
*Iodine-containing medications
*Changes in appetite, weight
*Activity level
*Speech, memory, or skin changes
117
Nursing assessment -patient w/ hypothyroidism what would be addressed for physical assessment?
*Cold intolerance
*Constipation
*Signs of depression
*Decreased heart rate
*Tenderness over thyroid gland
*Edema
118
What are clinical problems to expect with hypothyroidism?
*Activity intolerance
*Constipation
*Nutritionally compromised
119
Who is most ask risk for developing hypothyroidism?
female, white ethnicity, advancing age, type 1 diabetes, down syndrome, family history, goiter, previous thyroid issues, previous radiation treatment
120
Myxedema coma needs what acute care?
*Mechanical respiratory support
*Cardiac monitoring
*IV thyroid hormone replacement
*Monitoring of core temperature
121
Patient with thyroid issues, what should be taught regarding ambulatory care?
*Written instructions important
*Need for lifelong therapy
*Avoid abruptly stopping drugs
*Side effects of medication
*Signs and symptoms of hypothyroidism and hyperthyroidism
122
Nursing implementation - patient teaching should include what?
*Regular follow-up care
*Do not switch brands
*Medication interactions
*Comfortable, warm environment
*Measures to prevent skin breakdown
*Relapses occur if treatment is interrupted
123
Expected effects of corticosteroid therapy?
*Anti-inflammatory action
*Immunosuppression
*Maintenance of normal BP
124
Corticosteroid therapy potential complications/ side effects with long-term use?
Metabolic effect
*Weight gain: particularly in the face, neck and abdomen
*Increased blood sugar
*Fluid retention: leading to edema
*Protein depletion
*Decreased potassium and calcium
*Increased glucose and BP
Musculoskeletal effects
*Osteoporosis
*Muscle weakness
*Delayed wound healing
Cardiovascular effects
*Cataracts
*Glaucoma
Dermatologic effects
*Thinning skin
*Acne
*Increased hair growth
Immunologic effects
*Increased risk of infection
Psychiatric Effects
*Mood swings: Irritability, anxiety, depression
*Insomnia.
*Severe cases, Psychosis
Endocrine Effects
*Adrenal suppression: suppression of natural corticosteroid production leading to potential problems if the medication is stopped abruptly.
Gastrointestinal Effects
*Increased risk of peptic ulcers.
125
What to teach patient with corticosteroid therapy
*Dietary, rest and exercise needs
*Sodium restriction if edema occurs
*Need to monitor for hyperglycemia
*Notify HCP if epigastric pain develops
*Need to prevent injury/ infection
*Inform all HCPs
*Therapies to reduce osteoporosis
*Avoid large crowds
*Wear mask
*Avoid infection
