Medsurg Final 2 Flashcards
most common cause of hyperthyroidism
Graves’ disease
Graves’ disease is the most common cause of
hyperthyroidism
____ hyperthyroidism is caused by excessive dosages of thyroid hormone.
Exogenous
hyperthyroidism findings in older adult clients are often more ___ than those in younger clients.
subtle
Older adult clients who have hyperthyroidism often present with heart failure and ___ ___
atrial fibrillation
Testing for hyperthyroid: Recent use of ____ media and client’s use of ___ ____ may cause falsely elevated serum thyroid hormone levels
Contrast media and oral contraceptives
Severe illness; malnutrition; and the use of aspirin, corticosteroids, and phenytoin sodium may cause
a false decrease in serum thyroid hormone levels.
Testing for hyperthyroid: Inform the provider if the client received any ___ ___ within 4 weeks of the test.
iodine contrast
hyperthyroid: Minimize the client’s
energy expenditure (they wear out easy)
hyperthyroid: Report a temperature
increase of 1 degree or more to the provider immediately.
hyperthyroid: Assure the family that any abrupt changes in the client’s behavior are likely disease related and
should subside with antithyroid therapy.
Thionamides – methimazole (Tapazole) and propylthiouracil (PTU) inhibit
the production of thyroid hormone.
used to treat Graves’ disease, as an adjunct to radioactive iodine therapy
Thionamides
hyperthyroid tx: Remind the client that thionamides typically are taken for
1 to 2 years
hyperthyroid: Treat sympathetic nervous system effects (tachycardia, palpitations) with
beta blocker
Which hyperthyroid med: Teach the client to check pulse prior to each dose
beta blocker
SSKI is used to treat
hyperthyroid
Lugol’s solution and SSKI: administer
1 hr after an antithyroid medication
Use of Lugol’s solution and SSKI is contraindicated in
pregnancy
Which hyperthyroid med: Advise the client that the effects of therapy may not be evident for 6 to 8 weeks
radio iodine 131
Take a laxative 2 to 3 days after treatment to help rid the body of stool contaminated with
radiation
Do not use same toilet as others for 2 weeks, sit down to urinate, and flush toilet three times.
radiation
thyroidectomy: The client should receive ____ for 10 to 14 days before surgery. This reduces the gland’s size and prevents excess bleeding.
iodine
thyroidectomy: The client should receive iodine for 10 to 14 days before surgery. This
reduces the gland’s size and prevents excess bleeding.
thyroidectomy Postprocedure: Check for laryngeal nerve damage by
asking the client to speak as soon as awake from anesthesia
thyroidectomy: ___ and ___ can occur if parathyroid glands are damaged or removed
Hypocalcemia and tetany
thyroidectomy: Advise the client that the voice will become hoarse, and to expect
pain
Instruct clients who have had a total thyroidectomy they will have to take thyroid replacement medications for
ever
thyroidectomy: ____ reduce postoperative edema
Corticosteroids
thyroidectomy: with Corticosteroids tx, provide ____ to reduce swelling.
humidity
Thyroid Storm/Crisis: Administer _____ to treat shock.
glucocorticoids
Thyroid Storm/Crisis: Caution – If given before PTU, ___ ___ can exacerbate manifestations in susceptible clients.
sodium iodide
In tx of hyperthyroid, there’s a risk for Hypocalcemia and Tetany. Have IV ___ ___ available for emergency administration
calcium gluconate
Secondary hypothyroidism is caused by failure of the
anterior pituitary gland to stimulate the thyroid gland or failure of the target tissues to respond to the thyroid hormones
Tertiary hypothyroidism is caused by failure of the hypothalamus to
produce thyroid-releasing factor.
a state of severe hypothyroidism found in infants
Cretinism
Cretinism results in retardation of
cognitive development, physical growth, or both
most often caused by chronic autoimmune thyroiditis and affects the growth and sexual maturation of the child
Juvenile hypothyroidism
hypothyroidism is often undiagnosed in older adult clients because
it may mimic the normal aging process
2 meds that may cause hypothyroid
lithium
amiodarone
Radioisotope (123I) scan: Clients who have hypothyroidism have a
low uptake of the iodine preparation
hypothyroidism ECG
flat or inverted T waves, and ST deviations
hypothyroidism diet
low-calorie, high-bulk
hypothyroidism: Avoid fiber laxatives, which interfere with absorption of
levothyroxine
hypothyroidism: Avoid ___ laxatives, which interfere with absorption of levothyroxine
fiber
hypothyroidism: client is cold, Caution the client against using
electric blankets
hypothyroidism: drugs that are avoided because of the risk of respiratory depression.
CNS depressants (barbiturates or sedatives)
hypothyroidism: If CNS depressants are prescribed,
the dose should be significantly lower
hypothyroidism: treatment of choice.
Thyroid hormone replacement therapy
hypothyroidism: Thyroid hormone replacement therapy drug
levothyroxine
hypothyroidism: Thyroid hormone replacement therapy increases the effects of
warfarin
hypothyroidism: Thyroid hormone replacement therapy can increase the need for ___ and ___
insulin and digoxin
hypothyroidism: Use caution when starting thyroid hormone replacement with __ ___ clients and those who have ___
older adult
CAD
hypothyroidism: What is the main system you’re concerned about with hormone replacement therapy
cardiac
hypothyroidism: Thyroid hormone replacement therapy: Instruct the client that treatment begins
slowly
hypothyroidism: Inform the client that fiber supplements, calcium, iron, and antacids interfere with absorption.
Thyroid hormone replacement therapy (levothyroxine)
hypothyroidism: Thyroid hormone replacement therapy will last for
always
life-threatening condition that occurs when hypothyroidism is untreated or when a stressor (such as infection, heart failure, stroke, or surgery) affects an individual who has hypothyroidism
Myxedema coma
at risk for Myxedema
Clients who have been taking levothyroxine and suddenly stop the medication
Myxedema coma pharma tx
large doses of levothyroxine via IV bolus
Myxedema tx: urine output should
increase (makes sense bc you’re reversing hypo symptoms)
Myxedema: treat hypoglycemia with
glucose
