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Hyperthyroidism & HYPOTHYROIDISM Flashcards

1
Q

What is the most common type of hyperthyroidism

A

The autoimmune disease called Graves’ disease

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2
Q

What are signs and symptoms of hyperthyroidism

A

Hyper metabolism( ^ appetite with weight loss)
Heat intolerance ( ^ sweating is the hallmark sign)
Widening pulse pressure
Systolic HTN
tachycardia ( 90-160), atrial fibrillation, dysrhythmias, palpitations
Angina, CHF ( decompensation leads to HF)
Increased peristalsis ( diarrhea), hyperactive bowel sounds
Nervousness, restlessness, insomnia
Fine tremors ( hyperreflexia)
Mood swings, decrease in concentration
Hair loss, smooth, warm skin, facial flushing
Amenorrhea
Libido increase then decreases as condition progresses

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3
Q

Graves’ disease is most common in who

A

Females ages 20-40

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4
Q

What are signs and symptoms of Graves’ disease

A

Signs of hyperthyroidism AND enlarged thyroid gland ( goiter)
Proprosis ( forward displacement of eyes causing blurred vision, diplopia, lacrimation, and photophobia.)
Exophthalmos
Changes in menstration

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5
Q

What is exophthalmos

A

Forward protrusion of the eyes causing corneal dryness, irritation, ulceration ; it is a classic sign of Graves’ disease
The eyelids won’t close, give artificial tears to control dryness along with cool moist compresses, wear tinted glasses or eye shields to protect the eyes.
Elevate the bed 45 degrees to keep pressure off optic nerve.

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6
Q

What is toxic multinodular goiter

A

Nodules in thyroid tissue that secrete excessive thyroid hormone.
Is usually appears in woman 60-70 yrs of age, who had a goiter for a number of years

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7
Q

What is thyroid crisis

A

AKA thyroid storm or thyroidtoxicosis
It is a medical emergency, has a high mortality rate
Occurs with untreated hyperthyroidism

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8
Q

What can bring about thyroid crisis

A

Digoxin toxicity
Increase in stress
Extreme state of hyperthyroidism ( rare now)
Occurs with untreated hyperthyroidism or hyperthyroid person with stressors such as infection, trauma, manipulation of thyroid during surgery.

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9
Q

Why is thyroid crisis dangerous

A

It is a life threatening condition with excess metabolic symptoms such as temp of 102-106, HTN, tachycardia, and agitation advancing to seizures, psychosis, delirium.

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10
Q

What is treatment of thyroid crisis

A

Reducing thyroid secretion
Stabilizing cardiovascular system
Managing respiratory distress

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11
Q

What are diagnostic tests for hyperthyroidism

A 
Serum thyroid antibodies ( TA)..... Antibodies in Graves' disease
TSH test ( from pituitary)
T3 & T4
RAI uptake test
Thyroid suppression test
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12
Q

In diagnosing hyperthyroidism what will the clients TSH levels look like

A

They will be suppressed with primary hyperthyroidism

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13
Q

In diagnosing hyperthyroidism, what will the clients T3 &and ; T4 look like

A

They will be elevated

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14
Q

What is the RAI uptake test

A

Oral or intravenous dose of radioactive iodine 131 is given, then a thyroid scan after 24 hours, the size and shape of the gland is revealed. Uptake is increased with Graves’ disease.

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15
Q

What is thyroid suppression test

A

RAI and T4 are measured then remeasured after client takes thyroid hormone
( no suppression is noted with hyperthyroid

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16
Q

What is hyperthyroidism

A

Excessive delivery of thyroid hormone to peripheral tissues

It can be caused by excessive intake of medications ( exogenous) or neoplasms ( toxic multinodular goiter)

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17
Q

What are medications for hyperthyroidism

A

Antithyroid medications that block the synthesis of thyroid hormones such as; propylthiouracil (PTU) &; methimazole ( tapazole) more toxic than PTU
BETA BLOCKERS that controls symptoms such as tachycardia, tremor etc such as Propanolol ( Inderal) & atenolol ( temormin) for those with cardiac or asthma problems.

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18
Q

What is used to treat hyperthyroidism

A

Radioactive iodine therapy
The process includes iodine being taken up by the thyroid I which it concentrates in the thyroid gland and destroys cells, thus less hormone is produced

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19
Q

How is radioactive iodine therapy administered

A

Orally
Results occur in 6-8 weeks
DO NOT GIVE TO PREGNANT WOMAN
The client is often HYPOTHYROID after treatment

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20
Q

What is surgery for hyperthyroidism

A

Subtotal thyroidectomy: only part of the thyroid is removed

Total thyroidectomy to treat cancer of thyroid( client will need lifelong thyroid replacement).

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21
Q

What must be done prior to surgery for hyperthyroidism

A

Get client into a euthyroid state

Give potassium iodine prior to surgery to decrease size and vascular its of thyroid

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22
Q

What are post op concerns for surgery for hyperthyroidism

A

Airway: maintain airway; oxygen, suction, have tracheostomy set available.
Hemmorage: check neck dressing including posteriorly: it can compress the trachea.
Hypocalcemia: parathyroid glands may be removed or damaged, resulting in low calcium

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23
Q

For hypocalcemia what should be on hand

A

Calcium chloride or calcium gluconate

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24
Q

What is hypothyroidism

A

The thyroid gland produces insufficient amounts of thyroid hormone

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25
What is myxedema
It is related to hyperthyroidism It the the characteristic accumulation of non pitting edema in connective tissues throughout the body, water retention in mucoprotien deposits in interstitial spaces More common in females ages 30-60.
26
What is the pathophysiology of hypothyroidism
``` Primary is more common There is a defect in the thyroid gland Congenital defects Post treatment of hyperthyroidism is a cause Iodine deficiency is a cause ```
27
The thyroid gland produces what hormones
Thyroxine T4 Triiodothyronine T3 Calcitonin
28
When serum T3 and T4 levels drop what occurs
TSH is released by the anterior pituitary, this stimulates the thyroid gland to secrete more hormones until normal levels are obtained
29
What does T3 and T4 affect
All body systems by regulating overall body metabolism, energy production, fluid and electrolyte balance, and controlling tissue use of fats, proteins, and carbohydrates
30
What does calcitonin do
It inhibits mobilization of calcium from bone and reduces blood calcium levels
31
Is TSH elevated or decreased in hyperthyroidism
Decreased
32
Radioiodine uptake
Clarifies the size and function of the gland | It is administered 24 hr prior to the test, then measured. And elevated uptake indicates hyperthyroidism
33
What are nursing considerations of radioiodine
Confirm the client is not pregnant Recent use of contrast media and clients use of oral contraceptives may cause falsely elevated serum thyroid hormone levels. Severe illness, malnutrition, and the use of aspirin, corticosteroids, phenytoin sodium may cause a false decrease in serum thyroid levels. Inform provider if and iodine contrast was taken within 4 weeks of test.
34
What is client education regarding radioiodine
Advise to avoid foods high in iodine for one week prior to test Suggest client uses noniodized salt, avoid fish, shellfish, and meds that contain iodine: reduce milk intake, avoid canned fruits and vegetables
35
Name 2 drugs that belong to the drug class thionamides
Methimazole ( tapazole) | Propylthiouracil (PTU)
36
What is the therapeutic effect of thionamides
Inhibits the production of thyroid hormone
37
What are thionamides used to treat
Graves' disease As an adjunct to radioactive iodine therapy To decrease hormone levels in preparation for surgery To treat thyrotoxicosis
38
What are manifestations of hypothyroidism
Intolerance to cold, edema, bradycardia, increase in weight, or depression
39
What are nursing considerations for administering thionamides
Monitor CBC for leukopenia or thrombocytopenia | Monitor for indications of hepatotoxicity
40
What is client education regarding thionamides
Take med with meals Take in divided doses at regular intervals Remind thionamides are typically take for 1-2 yrs Advise to report fever, sore throat, or bruising Report signs of jaundice
41
Name iodine solutions
Lugols solution Saturated solution of potassium iodine ( SSKI) They inhibit release of thyroid hormone
42
What are nursing considerations of iodine solutions such as lugol and SSKI
Short term use only Administer 1 hr AFTER anti thyroid meds Contraindicated in pregnancy Mix with juice or milk to mask bad taste, use a straw to avoid staining teeth.
43
What are preprocedures for a thyroidectomy
Explain purpose of procedure Tell them their will be an incision in the neck, a dressing and a possible drain. Tell them a sore throat from intubation and anesthesia may be experienced They are usually prescribed PTU or methimazole for 4-6 weeks prior to surgery The client should receive iodine for 10-14 days before surgery, this reduces the gland size and prevents bleeding Propranolol may be given to block Adrenergic effects
44
What are post procedure tasks for a thyroidectomy
Keep client in high fowlers Avoid neck extension Check site and back of neck for bleeding, be aware that respiratory distress can occur because of compression of the trachea due to hemorrhage or edema
45
What are complications of a thyroidectomy
Hypocalcemia and tetany can occur if parathyroid gland are damaged or removed indications are tingling of toes or around mouth, and muscle twitching. Check for positive Chvosteks and trousseau signs. Ensure calcium gluconate or calcium chloride are available
46
What is calcium gluconate and calcium chloride
A calcium supplement used for emergency treatment of hypocalcemia due to damaged of the parathyroid glands
47
What are findings of thyroid crisis
Hyperthermia, hypertension, delirium, vomiting, abdominal pain, hyperglycemia and tachydysrhythmias Additional findings include chest pain, dyspnea, and palpitations
48
What is a expected lab finding of Graves' disease
Decrease thyroid stimulating hormone
49
What are clinical manifestations of hyperthyroidism
Heat intolerance Palpitations Weight loss
50
What is recommended teaching for propranolol ( Inderal)
Take pulse before each dose
51
What should the nurse have on hand in PACU for a patient who is post thyroidectomy
Suction equipment Humidified air Tracheostomy tray O2 delivery equipment
52
A client is newly diagnosed with Graves' disease and is prescribed methimazole ( tapazole). What should be included in the plan of care
Monitor CBC because it can cause leukopenia, and thrombocytopenia Monitor T3 because this med decreased thyroid hormone production Take at the same time every day
53
Hypothyroidism is classified how
By age of onset
54
Cretinism
Is a state of severe hypothyroidism found in infants When infants do not produce normal amounts of thyroid hormones, CNS development and skeletal maturation may be altered resulting in retardation of cognitive development, physical growth or both
55
What are the 3 classes of hypothyroidism
Cretinism Juvenile hypothyroidism Adult hypothyroidism
56
What are risk factor for hypothyroidism
Woman ages 30-60 Lithium Amidarome Inadequate intake of iodine
57
What are expected lab findings of hypothyroidism
T3, TSH, T4 levels will be decreased Thyroid antibodies will be increased Serum cholesterol will be increased CBC will show anemia ( low HCT levels)
58
What are meds for hypothyroidism
Levothyroxine ( synthroid) | it increases the effects of warfarin and can increase the need for insulin and digoxin
59
What are meds that decrease the absorption of levothyroxine
Cimetidine ( Tagamet) Lansoprazole ( prevacid) Colestipol ( Cholestid)
60
What interfere with absorption of synthroid
Fiber supplements Calcium Iron Antacids
61
When should synthroid be administered
1-2 hr before breakfast
62
Myxedema coma
Is a life threatening condition that occurs when Hypothyroidism is untreated or when a stressor occurs such as trauma, infection, HF, stroke or surgery. Clients taking synthroid and suddenly stop are also at risk.
63
What are clinical manifestations of myxedema coma
Severely depressed respirations ( hypoxia, hypercapnia) Decrease CO lethargy, stupor, coma, hypothermia, bradycardia, hypotension, hyponatremia, cerebral hypoxia.
64
What is the expected range for T3
70-205
65
What is the expected range for T4
4-12
66
For a client experiencing myxedema coma what should the nurse anticipate to do
Observe cardiac monitor for inverted T wave Observe for evidence of UTI initiate IV fluids using 0.9% NaCl Expect a prescription for synthroid IV bolus

MED SURG (15 decks)

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