exam #4 Flashcards
hypothyroidism history cues
- symptoms generally occur slowly
- increased time sleeping- up to 14-16hr day
- generalized weakness
- anorexia
- muscle aches
- paresthesias
- constipation
- decreased libido
- infertility
- assess medications
hypothyroidism physical assessment
- coarse features
- eye and face edema
- thick tongue
- blank expression
- slow movement
- cognition
- decreased HR
- respiratory rate decreased
- decreased body temp
- weight gain
hypothyroidism psychosocial
depression
apathy
hypothyroidism labs
decreased T3 and T4
increased TSH (thyroid stimulating hormone)
T4 (thyroixine)
reduced, main thyroid hormone that influences the metabolic rate
T3 (triodothyronine)
reduced, secondary thyroid hormone that also affects body metabolism
TSH
high with primary disease
produced by pituitary- controls release of thryoid gland hormones
necessary for grwoth and function of thyroid gland
lab used to follow and adjust meds when on treatment (4-6wks)
normal value 0.4-4.3
inverse relationship
hypothyroidism priority problems
improve gas exchange
prevent hypotension
prevent myxedema coma
long term use of thyroid replacement drugy theray
MOA- replace what the thyroid gland cannot produce to achieve normal thyroid levels
change metabolic rate, stimulate cardiovascular system
levothyroxine
synthetic thyroid hormone T4
most ocmmonly prescibed thyroid med
liothyronine
synthetic thyroid hormone
liotrix
synthetic thyroid hormone T3/4 combined
TRD adverse reffects cardiovascular
tachycardia
palipitations
angina
dysrhythmias
HTN
TRD adverse effects CNS
insomnia
tremors
headache
anxiety
TRD adverse effects GI
nausea
cramps
diarrhea
TRD adverse effects other
menstrual irregularities
weight loss
sweating
heat intolerance
fever
hypothyroidism education
need for lifelong treatment
caution with OTC medications
take medication at the same time every day and not to switch brands without primary care provider approval
never stop med abruptly
take on empty stomach
wait 6-8 weeks after dose adjustment to repeat TSH
medical alert bracelet
well balanced diet0 adequate fluid and fiber
hypothyroidism evaluate outcomes
2 easiest- sleep and bowel function
others- CV, respiratory, cognition
hyperthyroidism
excessive thyroid hormone secretion from thyroid gland: decreased cellular regulation- hypermetabolism and increased sympathetic NS activity
graves disease
autoimmune disorder
- auto-antibodies develop in the thyroid gland and attach to thyroid stim hormone receptors
- thyroid gland responds by increasing hormone production, increased glandular cells
- goiter develops
graves disease cues
exophthalmos with photophobia
dry gritty sensation
tearing
diplopia
pressure
pretibial myxedema (dry waxy thickening of pretibial skin’ looks liek benign tumors)
usually mild and overshadowed by opthalmopathy
toxic multinodular goiter
nodules or benign tumors cause increase hormone excretion
exogenous hyperthyroidism
excess use of thyroid replacement hormone
hyperthyroidism cues skin
diaphoresis
thinning scalp hair
pretibial myxedema (graves)
hyperthyroidism cardiopulmonary
increase HR and SV
palpitations
increased SBP
hyperthyroidism GI
weight loss
increased appetite
increase stools
hyperthyroidism neuro
vision changes
photophobia
exophthalmos (graves)
hyper metabolic
breakdown exceeds buildup with icnrease blood sugar and fat metabolism
heat intolerance
fatigue
hyper psych
decrease attnetion psan
emotional lability
restless
hyper other
goiter
wide eyed or startled appearance
muscle weakness
hyper T4
increased
hyper T3
increased
TSH hyper
low in graves
- produced by pituitary- controls release of thyroid gland hormones
- necessary for growth and function of thyroid gland
- lab used to follow and adjust meds when on treatment
- normal value 0.4-4.2
- inverse relationship
hyper thyrotropin receptor antibodies
dx grave’s
thryoid scan hyper
evaluate postion, size and funciton of thyroid gland
- radioactive iodine uptake is measured identifies nodules
ultrasonography hyper
determine size and general composition of gland
ecg hyper
evaluate for dysrhythmias
hyper solutions
drug therapy (antithyroid drugs)
radioactive iodine
surgery (thyroidectomy)
hyper action
decrease effect of thyroid hormone on cardiac function
decrease thyroid hormone secretion
monitor vitals Q4
report palipitations, dyspnea, vertigo, chest pain
uncontrolled hyperthyroidism ovserve for thyroid storm
reduce stimulation
promote comfort (cool room temp, shower, fluids, linen changes)
support therapy0 beta blocker
educate
antithyroid drugs
thionamide derivatives
- methimazole
propylthiouracil- used less because toxic liver effects
treatm hyperthyroidism and to prevent the surge in thryoid hormones after surgery or RAI
antithyroid CNS
drowsiness
headache
vertigo
paresthesia
antithyroid GI
nausea
vomiting
diarrhea
hepatitis
loss of taste
antithyroid GU
smoky urine
decreased urine output
antithyroid hematologic
angranulocytosis
leukopenia
thrombocytopenia
hypothrombinemia
lymphadenopathy
bleeding
integumentary
rash
pruritus
antithyroid musculoskeletal
myalgia
arthralgia
renal antithyroid
increased bun and creatinine
antithyroid other
enlarged thryoid gland, nephritis, fever
hyperthyroid drug therapy condsiderations
Obtain baseline vital signs and weight.
Caution with cardiac disease, HTN & pregnant women.
Avoid crowds & people that are ill; drug reduces immune response
Take at the same time every day and not to switch brands without primary care provider approval.
Never stop med abruptly.
Avoid foods high in iodine (seafood, soy sauce, tofu, and iodized salt).
Drug dose adjustment is done slowly; anticipate dosage changes no more frequent than every 6-8 wks; report weight gain, slow HR, cold intolerance (signs of too much med)
