TEST 3 - Thyroid/parathyroid Flashcards
Hyperthyroidism nursing priorities
Fatigue/activity intolerance Anxiety Sleep disturbance Knowledge deficit Risk for imbalanced nutrition – less Risk for decreased cardiac output Risk for hyperthermia
3 hyperthyroidism causes
Graves disease
Thyroiditis
Excess ingestion of thyroid hormone
Hypothalamic – Pituitary – Thyroid Axis
Hypothalamus -TRH –> Pituitary gland - TSH
–>Thyroid –T3 and T4 –> body
Anti-thyroid drugs
Propylthiouracil (PTU)
Methiamazole
Anti-thyroid AE
liver toxicity
bone marrow toxicity
leukopenia
Anti-thyroid important edu
Report signs of infection (sore throat)
Avoid foods high in iodine
Other drugs for hyperthyroidism (3)
Dexamethasone
Beta-blockers
radioactive iodine
Pre- subtotal thyroidectomy meds
Anti-thyroid drugs and beta blockers
Pre-op considerations (subtotal thyroidectomy)
expectations
post-positioning (semi-fowler)
post-op communication
6000 cal/day
Post- subtotal thy. complications
hemorrhage stridor tetany (hypocalcemia) laryngeal nerve damage thyroid storm/crisis Meningitis Increased ICP
check for hypocalcemia
Chvostek
Trousseau
What to have at bedside for post- subtotal thy
tracheostomy tray
calcium gluconate
S/s thyroid storm
High fever (>38.5, >101.3)
Extreme tachycardia (>130)
Exaggerated hyperthyroid symptoms w/ disturbance of major system
Altered neurologic or mental state
HypOthyroidsim meds
Levothyroxine
Iodine
Pressors
Fluids
s/s myxedema
subnormal temp
hypotension
hypoventilation
coma
Action of parathormone
enhances release of calcium from bone into bloodstream
Calcium normal range
9.0 - 11.0
Normal P range
3.0 -4.5
Primary cause of hyperparathyroidism (2)
over production of PTH
Adenoma
Secondary cause of hyperparathyroidism
Hypocalcemia
- vitamin D def
- malabsorption
- chronic renal failure
- hyperphosphatemia
manifestations hyperparathyroidism
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
Hyperparathyroidsim Diagnostics
PTH up Calcium up P down Alkaline phosphatase up MRI, CT, US
Hyperparathyroidism meds
Alendronate
Calcitonin
Vitamin D
Hypercalcemic crisis
Ca+ >15
Interventions hypercalcemic
- caclitonin, mithromycin
- IV bisphosphonates (alendronate)
- IV/oral phosphate - effect caclium reuptake in gut
- IV/oral furosemide
Action of calcitonin, mithromycin
Offloads Ca+ quickly
Action of bisphosphonates
Inhibits Ca+ resorption (bone –> blood)
Promotes Ca+ blood –> bone
Action of phosphate
effect Ca+ uptake in gut
Action of furosemide
Reduce edema from rehydration and remove excess Ca+
Hypoparathyroidism s/s
tetany tingling increased muscle tension dysphagia/laryngeal spasm compromised resp hypotension ECG changes
Med mgmt
calcium gluconate
Calcium considerations
prednisone can decrease effectiveness
take with/after meals
take after antacid
Dietary considerations hypoparathyroid
avoid oxaclic acid (spinach) avoid phytic acid (bran, whole grain)
