Hyper/Hypothyroidism Flashcards
Drug Therapy (Hyper)
Antithyroid drugs propylthiouracil (PTU) and methimazole (Tapazole)
- Inhibit synthesis of thyroid hormone
- Improvement begins in 1-2 weeks
- Continued 6 months to 2 years
- Not curative
Iodine (Hyper)
Useful with other antithyroid drugs in preparation for thyroidectomy or treatment of crisis
Large doses rapidly inhibit synthesis of T3 and T4 and block their release into circulation
Iodine (Hyper)
Decreases vascularity of thyroid gland
Maximal effect seen within 1-2 weeks
Long-term iodine therapy is not effective
B-Adrenergic Blockers (Hyper)
Symptomatic relief of thyrotoxicosis resulting from B-adrenergic receptor stimulation
Propanolol (Inderal) administered with other antithyroid agents
Radioactive Iodine Therapy (RAI) (Hyper)
Damages or destroys thyroid tissue
Delayed response 2-3 months
Treated with antithyroid drugs and propranolol before and during first 3 months of RAI
Radioactive Iodine Therapy (RAI) (Hyper)
High incidence of post-treatment hypothyroidism
Need for lifelong thyroid hormone replacement
Surgical Therapy (Hyper)
Subtotal thyroidectomy involves removal of significant portion of thyroid
- 90% removed to be effective
- If too much is removed, regeneration will not occur, results in hypothyroidism
Surgical Therapy (Hyper)
Indicated for those:
- unresponsive to drug therapy
- with large goitres causing tracheal compression
- with possible malignancy
Surgical Therapy (Hyper)
Endoscopic thyroidectomy appropriate with small nodules with no malignancy
Less scarring, pain, and recovery time
Nutritional Therapy (Hyper)
High-calorie diet may be ordered for hunger and prevention of tissue breakdown
Protein allowance 1-2 g/kg ideal body weight
Avoid caffeine, highly seasoned foods, and high-fibre foods
Health Hx (Hyper)
Pre-existing goitre Recent infection or trauma Immigration from iodine - deficient area Medications Family history of thyroid or autoimmune disorders Weight loss Nausea Diarrhea Dyspnea on exertion Muscle weakness Insomnia Heat intolerance Decreased libido Impotence Amenorrhea Irritability Personality changes Delirium
Objective Data (Hyper)
Agitation Hyperthermia Enlarged or nodular thyroid gland Eyelid retraction Diaphoretic skin Brittle nails Edema Tachypnea Tachycardia Hepatosplenomegaly Hyperreflexia Fine tremors Muscle wasting Coma Menstrual irregularities Infertility
Nursing Diagnoses (Hyper)
Activity intolerance
Risk for injury
Imbalanced nutrition: less than body requirements
Anxiety
Nursing Implementation: Acute thyrotoxicosis (Hyper)
Administer medications
Monitor cardiac arrhythmias
Ensuring adequate oxygenation and IV fluids
Light bed coverings if diaphoretic
Encourage and assist with exercises
Restrict visitors
Establish supportive relationship
Apply artificial tears to relieve eye discomfort
Elevate HOB, and salt restriction for edema
Tape eyelids shut for sleep if they cannot close
Nursing Implementation: Thyroid Surgery (Hyper)
Assess for signs of iodine toxicity
Teach DB&C and leg exercises
Suction equipment, tracheostomy tray available in room
Calcium salts available for tetany
Nursing Implementation: Post-Op (Hyper)
Assess for signs of hemorrhage or tracheal compression
Semi-Fowlers position and support head with pillows
Monitor VS
Check for signs of tetany
Trousseau’s sign and Chvostek’s sign should be monitored
Administer pain medications
Nursing Implementation: Ambulatory and Home Care (Hyper)
Monitor hormone balance periodically
Reduce caloric intake to prevent weight gain
Avoid goitrogens
Adequate iodine is necessary for thyroid function, but excess inhibits the thyroid
Exercise helps stimulate the thyroid
Avoid high environmental temperatures, as they inhibit regeneration
Nursing Implementation: RAI Therapy
May cause dryness and irritation of mouth and throat
Teach symptoms of hypothyroidism
Evaluation (Hyper)
Relief of symptoms
No serious complications r/t disease or treatment
Cooperate with therapeutic plan
Health History (Hypo)
Changes in BP
Anemia
Family Hx of CHF, thyroid disorders
Immigration from area deficient in iodine
Dyspnea
Decreased appetite, N/V, weight gain
Fatigue, weakness, aches and pains
Lethargy, forgetfulness, hoarseness, paresthesias, anxiety or depression
Prolonged or absent menstrual periods, infertility, decreased libido
Cold intolerance
Objective Data (Hypo)
Distant heart sounds Distended abdomen Enlarged, scaly tongue Dry, thick, inelastic cold skin Poor turgor of mucosa Puffy face Pallor Slow movements Slow, slurred speech Decreased hearing
Nursing Diagnoses (Hypo)
Hypothermia Imbalanced Nutrition: more than body requirements Activity intolerance Constipation Disturbed thought processes
Planning (Hypo)
Experience relief of symptoms
Maintain a euthyroid state
Maintain a positive self-image
Comply with life-long thyroid replacement therapy
Acute Intervention (Hypo)
Client with myxedema coma often requires mechanical respiratory support and cardiac monitoring
Administer thyroid replacement therapy and other medications IV
Monitor core temperature as client is often hypothermic
Assess vitals, weight, I&O, and visible edema
Nursing Implementation: Ambulatory and Home Care (Hypo)
Explain nature of thyroid hormone deficiency and self-care practices to prevent complications
- Client and family must understand replacement therapy and that it is lifelong
Teach measures to prevent skin breakdown
Emphasize need for warm environment
Discuss measures to minimize constipation
Avoid enemas because of vagal stimulation in cardiac clients
Caution client to avoid sedatives or use lowest dose as possible
Teach client to notify physician immediately if signs of overdose appear
Client with DM should test CBG at least daily as return to euthyroid state frequently increases insulin requirements
Nursing Implementation: Ambulatory and Home Care (Hypo)
Thyroid preparations potentiate the effects of some common drug groups - Antidepressants - Digitalis compounds - Anticoagulants Teach client side effects of these drugs
Evaluation: Expected Outcomes (Hypo)
Have relief from symptoms
Maintain euthyroid state as evidenced by normal thyroid hormone and TSH levels
State need to adhere to lifelong therapy
