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N1115 - Trans. to Associates > Exam 4 - Thyroid > Flashcards

Exam 4 - Thyroid Flashcards

1
Q

the thyroid gland is very ___

A

vascular

5 x’s the blood flow to the liver

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2
Q

Thyroid hormones

A

T3, T4, calcitonin

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3
Q

where is the parathyroid?

A

inside the thyroid gland

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4
Q

TSH comes from the ___ ___ ___

A

anterior pituitary gland

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5
Q

what controls the release of T3, T4

A

TSH

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6
Q

when is calcitonin released?

A

high plasma calcium levels

increases calcium deposit in bone

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7
Q

thyroid hormone production within normal limits

A

euthyroid

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8
Q

thyroid is controlled by what feedback system?

A

negative

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9
Q

low T3, T4 will cause an increase in

A

TSH

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10
Q

what is the issue with primary thyroid disorder

A

thyroid is the issue

no longer listening to the anterior pituitary gland

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11
Q

what is the issue with secondary thyroid disorder

A

anterior pituitary gland

no longer listening to the hypothalamus

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12
Q

what is the issue with central thyroid disorder

A

hypotalamus

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13
Q

childhood thyroid disoder

A

cretinism

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14
Q

neonatal hypothyroidism is tested when?

A

24-48 hours after birth

r/t low iodine, mental retardation

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15
Q

most common condition r/t hyperthyroidism

A

Grave’s disease

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16
Q

excess output of thyroid hormone

A

thyrotoxicosis

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17
Q

hyperthyroidism s/sx

A 
nervousness
rapid pulse
heat intolerance
tremors
skin flushed, warm, soft and moist
exophthalmos
increased appetite
weight loss
elevated SBP
cardiac dysrhythmias
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18
Q

thyrotoxicosis puts the body in which state?

A

hyper-metabolic state

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19
Q

most sever hyperthyroid disorder

A

thyroid storm

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20
Q

protruding or bulging eyes as a result of impaired venous drainage from the orbit

A

exophthalmos

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21
Q

exophthalmos is only seen in ___ disease

A

Grave’s

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22
Q

early stage of hyperthyroidism may only have which 2 s/sx

A

nervousness

weight loss

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23
Q

meds to tx hyperthyroidism

A

propylthiouracil (PTU) + methimazole
Na, K iodine solutions
dexamethasone
beta-blockers (propranolol

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24
Q

purpose of PTU + methimazole

Tapazole

A

inhibit/block synthesis of thyroid hormones

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25
Q

how long does it take to see improvement with PTU + methimazole

A

1-2 weeks but can take 4-8 weeks

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26
Q

side effects/labs of PTU + methimazole

A

agranulocytosis
**low WBC, neutrophil, eosinophil
thrombocytopenia
hepatoxicity

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27
Q

how often is PTU taken?

who can take it?

A

TID

pregnant women in their 1st trimester

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28
Q

how often is Tapazole taken

A

daily

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29
Q

propranolol is contraindicated in who?

A

asthma

severe heart disease

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30
Q

cause of thyroid storm

A

stressors such as infection, trauma, surgery

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31
Q

thyroid storm s/sx

A 
severe tachycardia
heart failure
hyperthermia (up to 105.3)
agitation
seizures
N/V/D
delirium
coma
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32
Q

pts who have a ___ are in danger of having a thyroid storm

A

thyroidectomy

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33
Q

hyperthyroidism TSH and T4 level will be ___

A

elevated

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34
Q

best indicator of hyperthyroidism

A

free thyroxine (T4)

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35
Q

hyperthyroidism treatment of choice for most nonpregnant adults

A

radioactive iodine therapy (RAI)

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36
Q

how does radioactive iodine therapy work?

A

damages, destorys thyroid tissue

37
Q

how long until RAI is affective?

A

3 months

PTU, tapazole, and inderal taken until effective

38
Q

PO RAI can cause what?

A

dryness
throat irritation
thyroiditis

*frequent sips of water, ice chips or magic mouth wash (Benadryl, lidocaine, mylanta - swish + spit)

39
Q

RAI precautions

A

avoid pregnant women and children for at least 7 days

40
Q

RAI education

A

use separate lavatory
*flush twice
wash clothes separately

41
Q

how much of the thyroid is removed with a subtotal thyroidectomy?

A

90%

42
Q

why is a subtotal thyroidectomy performed

A

prevent damage to parathyroid gland

43
Q

why are parathyroid glands rarely removed?

A

prevent hypocalcemia

44
Q

complications s/p subtotal thyroidectomy

A 
hypothyroidism
hypocalcemia
hemorrhage
injury to laryngeal nerve
thyroid storm
45
Q

hyperthyroidism nutrition therapy

A 
high calorie (4000-5000/day)
6 meals (high protein, carb, vitamins, minerals)

avoid high fiber, highly seasoned foods, and beverages high in caffeine

46
Q

hyperthyroidism protein intake should __-__ g/kg

A

1-2 g/kg of ideal body weight

47
Q

after a thyroidectomy, will a high calorie diet still need to be implemented?

A

No, they will gain weight.

48
Q

methods to relieve eye discomfort with hyperthyroidism

A 
Na restriction
elevate HOB
use dark glasses
tape shut at night
turn eyes in complete ROM
49
Q

severe exophthalmos treatment options

A

corticosteroids
radiation of retroorbital tissue
orbital decompression
corrective lid, muscle surgery

50
Q

a temperature increase of __ degree should be reported

A

1

51
Q

how often to assess after thyroidectomy

A

q2h for the first 24 hours

monitor for tracheal compression, irregular breathing, swelling, frequent swallowing, presence of blood

52
Q

pt positioning after thyroidectomy

A

semi-fowlers

avoid neck flexion

53
Q

how long to assess for tetany, Trousseau’s, and Chvostek’s after thyroidectomy?

A

72 hours

54
Q

a complete thyroidectomy requires what for life?

A

lifelong thyroid hormone replacement

55
Q

what can provide sufficient iodine intake?

A

seafood once weekly

iodized salt

56
Q

what is encouraged regularly to stimulate the thyroid gland

A

exercise

57
Q

what type of environment inhibits thyroid regeneration

A

high temperatures

58
Q

what is a strong risk factor for Graves disease

A

smoking

59
Q

hypothyroidism occurs from ___ levels of T3, T4 in the bloodstream

A

deficient

60
Q

hypothyroidism causes

A

Hashimotos (autoimmune)
atrophy associated with agin
iodine deficiency
hyperthyroidism treatment

61
Q

cause of secondary hypothyroidism

A

inadequate secretion of TSH

pituitary gland issue

62
Q

does hypothyroidism have a fast or slow onset?

A

slow

63
Q

s/sx of hypothyroidism

A 
decreased HR
anemia
decreased appetite
weight gain
constipation
dry, thick, cold skin
thick nails
dry, coarse hair
puffy face
SOB on exertion
cold intolerance
sleepiness
64
Q

mis-Dx hypothyroidism is r/t

A

aging

65
Q

meds that depress the CNS and should used with caution if a pt has hypothyroidism

A

opioids
barbituates
anesthesia

66
Q

accumulation of mucopolysaccharides in the dermis and other tissue

A

myxedema

67
Q

s/sx of myxedema coma

A 
slow, gradual onset
progressive drowsiness, lethargy
below subnormal temperature*
hypotension*
hypoventilation*
68
Q

causes of myxedema coma

A

infection
meds (CNS depressants)
exposure to cold
trauma

69
Q

what metabolic state will a myxedema coma pt be in?

A

respiratory alkalosis

kidneys will retain bicarb

70
Q

myxedema coma treatment

A

IV thyroid hormone - STAT
airway management - possible vent
temperature management - warmer

71
Q

TSH, T3, T4 will be low or high with primary hypothyroidism

A

TSH - high
T3, T4 - low

issue is with the thyroid gland

72
Q

TSH, T3, T4 will be low or high with secondary hypothyroidism

A

TSH - low
T3, T4 - low

issue is with the anterior pituitary gland

73
Q

best time to administer Synthroid

A

first thing in AM; on an empty stomach

74
Q

what to educate pts on when taking Synthroid

A

report chest pain immediatley

75
Q

initial dose of Synthroid will be low or high

A

low

dose may be increased q4-6 weeks depending on labs

76
Q

is Synthroid a short-term or life-long med?

A

life-long

77
Q

side effects of synthroid

A

insomnia

hyperthyroidism s/sx

78
Q

what to assess weekly if taking Synthroid

A

pulse

79
Q

hypothyroidism pts activities should be ___ out with lots of ___ periods

A

spaced; rest

80
Q

hypothyroidism nursing interventions

A 
provide extra clothes, blankets
protect from drafts
increase fiber, fluids in diet
low calorie diet
administer stool softeners PRN
avoid use of heating pads, electric blankets*
81
Q

mental alertness should increase within ___ - ___ days after treatment

A

2-14 days

82
Q

myxedema coma nursing interventions

A 
cardiac monitoring
mechanical ventilation
monitor temp/warming needed
monitor for MI
report angina
administer all meds IV
**incase of paralytic ileus
83
Q

how many parathyroid glands are on the thyroid gland

A

4; posterior thyroid gland

84
Q

parathyroid gland regulates which 2 electrolytes via parathormone (PTH)

A

Ca; Ph

85
Q

PTH increases __ by increasing absorption from they ___, ___, and ___.

A

Ca

kidney, intestines, bone

86
Q

does PTH increase or decrease Ph

A

decreases

remember Ca + Ph have an inverse relationship

87
Q

s/sx of hyperparathyroidism mimic those with

A

hypercalcemia

88
Q

hyperparathyroidism treatment

A

surgical removal of parathyroid tissue

hydration therapy

89
Q

hypercalcemic crisis treatment

A

IV bolus isotonic solution (NS)

calcitonin + corticosteriods

N1115 - Trans. to Associates (21 decks)

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