Med Surg: Care of Patients with Thyroid and Parathyroid Problems Flashcards
What does the Thyroid Gland?
Control of metabolism
Produces thyroxine, triiodothyronine and thyrocalcitonin
What is hypothyroidism?
Hypothyroid state resulting from a hyposecretion of the thyroid horomone T3 and T4
Characterized by a decreased rate of body metabolism
What is the assessment of hypothyroidism
Lethargy and fatigue
Personality and mental changes, forgetfulness
Slowed speech, decreased initiative, somnolence
Bradycardia, cardiac enlargement, tendency to develop CHF
Anemia
Decreased GI motility
Weakness, muscle aches, paresthesias
Intolerance to cold
Weight gain
Dry skin and hair, loss of body hair, brittle nails
Constipation, decrease GI motility
Interventions of hypothyroidism?
Monitor VS including HR and rhythm
Administer thyroid replacement
Instruct about thyroid replacement therapy
Instruct clinet in low-calorie, low-cholesterol, low-saturated-fat diet
Assess for constipation: provide roughage and fluids
Provide a warm environment
Avoid sedatives and narvotics
Monitor for overdose and thyroid meds
Instruct to report chest pain immediately
What is a myxedema coma?
rare but serious disorder that results from persistently low thyroid production
Coma can be precipitated by acute illness, rapid withdrawal of thyroid medicaiton, anesthesia and surgery, hypothermia and the use of sedatives and narcotics
What is the assessment of myxedema coma?
hypotension
bradycardia
hypothermia
hyponatremia
hypogymcemia
generalized edema
respiratory failure
coma
Interventions for myxedema coma?
maintain patent airway
administer IV fluids
Administer levothyroxine sodium IV
Administer glucose IV
Assess client’s temperature frequently
Monitor blood pressure
Keep client warm
Monitor for mental status changes
Monitor electrolytes and glucose level
What is hyperthyroidism?
resulting from hypersecretion of thyroid hormones
characterized by increased rate of body metabolism
Common cause is Grave’s disease
Clinical manifestations are called thyrotoxicosis
What is the assessment of hyperthyroidism?
Enlarged thyroid gland
Palpitations, cardiac dysrhthmias
Protruding eyeballs
Pretibilal myxedema
Hypertension
Heat intolerance
Diaphoresis
Weight loss
Diarrhea
Smooth, soft skin and hair
Nervousness and fine tremors of hands
Personality changes-irritability and agitation, mood swings
What are the interventions of hyperthyroidism?
adequate rest
administer sedatives as prescribed
cool, quiet environment
daily weight
high calorie diet
avoid administration of stimulants
administer antithyroid medications
administer iodine preparation that inhibit the release of thyroid hormone
administer propranlol for tachycardia as prescribed
Prepare the clinet for radioactive iodine therapy to destroy thyroid cells
Prepare the client for thyroidectomy
What is a thyroid storm?
acute and life threatening condition that occurs in a client with uncontrollable hyperthyroidism
Occcurs from manipulation of the thyroid gland during surgery and the release of thyroid hormone into the bloodstream or from severe infection and stress
Antithyroid medications, Beta-blockers, glucocorticoids, and iodides are administered pro-op thyroid surgery to prevent it
What is the assessment for Thyroid Storm?
Elevated temperature
Tachycardia
Systolic hypertension
N&V, diarrhea
Agitation, tremors and anxiety
Irritability, agitation, restlessness, confusion, and seizures as it progresses
Delirium and coma
What are the interventions for a Thyroid Storm?
Maintain pt airways and adquate ventilation
Administer antithyroid medications, sodium iodide solution, propranolol and glucocorticoids
NS infusion to combat dehydration
Monitor VS
Continual cardiac monitoring for dysrhythmias
Administer nonsalicylate antipyretics
Cooling blanket to decrease fever
What is thyroidectomy?
Removal of the thyroid gland
Performed for persistent hyperthyroidism
What are pre-op interventions for Thyroidectomy?
VS and weight
Electrolyte levels
Assess for hyperglycemia and glycosuria
Instruct on C&DB exercises, how to support the neck when coughing and moving
Administer antithyroid medications, sodium iodide solution, propranolol and glucocorticoids to prevent thyroid storm
What is the post-op intervention for thyroidectomy?
monitor for respiratory distress
have a trach set, oxygen and suction at bedside
maintain client in semi-fowler position
Monitor surgical site for edema and signs of bleeding
limit client talking and assess level of hoarseness
monitor for laryngeal nerve damage
monitor for signs of hypocalcemia and tetany
prepare to administer calcium gluconate tetany monitor for thyroid storm
What are the signs of tetany?
cardiac dysrhythmias
carpopedal spasm
Dysphagia
Muscle and abdominal cramps
Numbness and tingling of the face and extremetities
Postitive Chvosteks sign
Positive Trousseus sign
Seizures
Visual disturbances
Wheezing and dyspnea
What is a parathyroid gland?
Calcium and phosphorus balance
Produce parathroid hormone
What is hypoparathyroidism?
Condition caused by hyposecretion of parathyroid hormone by parathyroid gland
Can occur after thyroidectomy because of removal of parathyroid tissue
What does the parathyroid gland?
calcium and phosphorous balance
profuce parathroid hormone
What is Hypoparathyroidism?
condition caused by hyposecretion of parathyroid hormone by parathyroid gland
can occur after thyroidectomy because of removal of parathyroid tissue
What is the assessment of hypoparathyroidism?
Hypocalcemia and hyperphosphatemia
Numbness and tingling of the face
Muscle cramps and cramps in abdomen or extremities
Positive Trousseau’s sign or Chvostek’s sign
Signs of overt tetany
Hypotension
Anxiety, irritability and depression
What are intervetnios for hypoparathyroidism/
monitor VS
monitor signs of hypocalcemia and tetany
initiate seizure precautions
place a trach set, oxygen and suction at bedside
Prepare to administer calcium gluconate IV for hypocalcemia
provide a high calcium, low phosphous diet
Instruct client in administration of calcium supplement
Instruct client on administration of Vit D supplement
Instruct cleitn on administration of phosphate binders
Instruct client to wear a medic-alert bracelet
What is hyperparathyroidism?
Coniditon caused by hypersecretion of parathyroid hormone by the parathroid gland
What are the assessment for hyperparathyroidism?
hypercalcemia dn hypophosphatemia
fatigue and muscle weakness
skeletal pain and tenderness
bone deformities that result in pathological fratiures
anorexia, N&V, epigastric pain
weight loss
Constipation
hypertension
Cardiac dysrhythmias
renal stones
What are the interventions of hyperparathyroidism?
monitor VS esp BP
monitor for cardiac dysrhymias
monitor I&O and for sign of renal stones
monitor for skeletal pain, move client slow and careful
Encourage fluid intake
Administer furosemide
administer normal saline IV for hydration
administer phosphates
administer calcitonin
monitor caluim and phosphorus levels
assess for sign of hypocalcemia
prepare the client for parathyroidectomy
What is a parathyroidectomy?
removal of one or more of the parathyroid glands
What are the pro-op interventions for parathyroidectomy?
Monitor electrolytes, calcium, phosphate and magnesium levels
Ensure that calcium levels are decreased to near normal
Inform the client that talking may be painful for 1-2 post surgery
What are post-op interventions for parathyroidectomy?
Monitor for respiratory distress
Place a trach set, oxygen and suction at bedside
Position in semi-fowler position
Assess neck dressing for bleeding
Monitor for hypocalcemic crisis
Assess for positive Trousseu’s or Chvosteks’s sign
Monitor for changes in voice pattern and hoarseness
Monitor for laryngeal nerve damage
Instrust the client in the administration of calcium and Vitamin D supplements
