TEST 3 - Thyroid/parathyroid

Question 1

Hyperthyroidism nursing priorities

Answer 1

Fatigue/activity intolerance
Anxiety
Sleep disturbance
Knowledge deficit
Risk for imbalanced nutrition – less
Risk for decreased cardiac output
Risk for hyperthermia

Question 2

3 hyperthyroidism causes

Answer 2

Graves disease
Thyroiditis
Excess ingestion of thyroid hormone

Question 3

Hypothalamic – Pituitary – Thyroid Axis

Answer 3

Hypothalamus -TRH –> Pituitary gland - TSH

–>Thyroid –T3 and T4 –> body

Question 4

Anti-thyroid drugs

Answer 4

Propylthiouracil (PTU)

Methiamazole

Question 5

Anti-thyroid AE

Answer 5

liver toxicity
bone marrow toxicity
leukopenia

Question 6

Anti-thyroid important edu

Answer 6

Report signs of infection (sore throat)

Avoid foods high in iodine

Question 7

Other drugs for hyperthyroidism (3)

Answer 7

Dexamethasone
Beta-blockers
radioactive iodine

Question 8

Pre- subtotal thyroidectomy meds

Answer 8

Anti-thyroid drugs and beta blockers

Question 9

Pre-op considerations (subtotal thyroidectomy)

Answer 9

expectations
post-positioning (semi-fowler)
post-op communication
6000 cal/day

Question 10

Post- subtotal thy. complications

Answer 10

hemorrhage
stridor
tetany (hypocalcemia)
laryngeal nerve damage
thyroid storm/crisis
Meningitis
Increased ICP

Question 11

check for hypocalcemia

Answer 11

Chvostek

Trousseau

Question 12

What to have at bedside for post- subtotal thy

Answer 12

tracheostomy tray

calcium gluconate

Question 13

S/s thyroid storm

Answer 13

High fever (>38.5, >101.3)
Extreme tachycardia (>130)
Exaggerated hyperthyroid symptoms w/ disturbance of major system
Altered neurologic or mental state

Question 14

HypOthyroidsim meds

Answer 14

Levothyroxine
Iodine
Pressors
Fluids

Question 15

s/s myxedema

Answer 15

subnormal temp
hypotension
hypoventilation
coma

Question 16

Action of parathormone

Answer 16

enhances release of calcium from bone into bloodstream

Question 17

Calcium normal range

Answer 17

9.0 - 11.0

Question 18

Normal P range

Answer 18

3.0 -4.5

Question 19

Primary cause of hyperparathyroidism (2)

Answer 19

over production of PTH

Adenoma

Question 20

Secondary cause of hyperparathyroidism

Answer 20

Hypocalcemia

• vitamin D def
• malabsorption
• chronic renal failure
• hyperphosphatemia

Question 21

manifestations hyperparathyroidism

Answer 21

elevated serum calcium
osteoporosis
chronic weakness
malaise
loss of appetite
constipation
pancreatitis
GERD
PUD
renal calculi
polyuria and polydipsia
cardiac dysrhythmias - tachy, palpitations, HPB, dysrhythmias

Question 22

Hyperparathyroidsim Diagnostics

Answer 22

PTH up
Calcium up
P down
Alkaline phosphatase up
MRI, CT, US

Question 23

Hyperparathyroidism meds

Answer 23

Alendronate
Calcitonin
Vitamin D

Question 24

Hypercalcemic crisis

Answer 24

Ca+ >15

Question 25

Interventions hypercalcemic

Answer 25

• caclitonin, mithromycin
• IV bisphosphonates (alendronate)
• IV/oral phosphate - effect caclium reuptake in gut
• IV/oral furosemide

Question 26

Action of calcitonin, mithromycin

Answer 26

Offloads Ca+ quickly

Question 27

Action of bisphosphonates

Answer 27

Inhibits Ca+ resorption (bone –> blood)

Promotes Ca+ blood –> bone

Question 28

Action of phosphate

Answer 28

effect Ca+ uptake in gut

Question 29

Action of furosemide

Answer 29

Reduce edema from rehydration and remove excess Ca+

Question 30

Hypoparathyroidism s/s

Answer 30

tetany
tingling
increased muscle tension
dysphagia/laryngeal spasm
compromised resp
hypotension
ECG changes

Question 31

Med mgmt

Answer 31

calcium gluconate

Question 32

Calcium considerations

Answer 32

prednisone can decrease effectiveness
take with/after meals
take after antacid

Question 33

Dietary considerations hypoparathyroid

Answer 33

avoid oxaclic acid (spinach) avoid phytic acid (bran, whole grain)