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Nursing Theory III > Hyper/Hypothyroidism > Flashcards

Hyper/Hypothyroidism Flashcards

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1
Q

Drug Therapy (Hyper)

A

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
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2
Q

Iodine (Hyper)

A

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

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3
Q

Iodine (Hyper)

A

Decreases vascularity of thyroid gland
Maximal effect seen within 1-2 weeks
Long-term iodine therapy is not effective

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4
Q

B-Adrenergic Blockers (Hyper)

A

Symptomatic relief of thyrotoxicosis resulting from B-adrenergic receptor stimulation
Propanolol (Inderal) administered with other antithyroid agents

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5
Q

Radioactive Iodine Therapy (RAI) (Hyper)

A

Damages or destroys thyroid tissue
Delayed response 2-3 months
Treated with antithyroid drugs and propranolol before and during first 3 months of RAI

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6
Q

Radioactive Iodine Therapy (RAI) (Hyper)

A

High incidence of post-treatment hypothyroidism

Need for lifelong thyroid hormone replacement

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7
Q

Surgical Therapy (Hyper)

A

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
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8
Q

Surgical Therapy (Hyper)

A

Indicated for those:

  • unresponsive to drug therapy
  • with large goitres causing tracheal compression
  • with possible malignancy
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9
Q

Surgical Therapy (Hyper)

A

Endoscopic thyroidectomy appropriate with small nodules with no malignancy
Less scarring, pain, and recovery time

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10
Q

Nutritional Therapy (Hyper)

A

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

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11
Q

Health Hx (Hyper)

A 
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
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12
Q

Objective Data (Hyper)

A 
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
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13
Q

Nursing Diagnoses (Hyper)

A

Activity intolerance
Risk for injury
Imbalanced nutrition: less than body requirements
Anxiety

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14
Q

Nursing Implementation: Acute thyrotoxicosis (Hyper)

A

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

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15
Q

Nursing Implementation: Thyroid Surgery (Hyper)

A

Assess for signs of iodine toxicity
Teach DB&C and leg exercises
Suction equipment, tracheostomy tray available in room
Calcium salts available for tetany

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16
Q

Nursing Implementation: Post-Op (Hyper)

A

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

17
Q

Nursing Implementation: Ambulatory and Home Care (Hyper)

A

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

18
Q

Nursing Implementation: RAI Therapy

A

May cause dryness and irritation of mouth and throat

Teach symptoms of hypothyroidism

19
Q

Evaluation (Hyper)

A

Relief of symptoms
No serious complications r/t disease or treatment
Cooperate with therapeutic plan

20
Q

Health History (Hypo)

A

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

21
Q

Objective Data (Hypo)

A 
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
22
Q

Nursing Diagnoses (Hypo)

A 
Hypothermia
Imbalanced Nutrition: more than body requirements
Activity intolerance
Constipation
Disturbed thought processes
23
Q

Planning (Hypo)

A

Experience relief of symptoms
Maintain a euthyroid state
Maintain a positive self-image
Comply with life-long thyroid replacement therapy

24
Q

Acute Intervention (Hypo)

A

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

25
Q

Nursing Implementation: Ambulatory and Home Care (Hypo)

A

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

26
Q

Nursing Implementation: Ambulatory and Home Care (Hypo)

A 
Thyroid preparations potentiate the effects of some common drug groups 
- Antidepressants
- Digitalis compounds
- Anticoagulants
Teach client side effects of these drugs
27
Q

Evaluation: Expected Outcomes (Hypo)

A

Have relief from symptoms
Maintain euthyroid state as evidenced by normal thyroid hormone and TSH levels
State need to adhere to lifelong therapy

Nursing Theory III (17 decks)

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