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Module 4 (MedSurg 2) > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What is the thyroid hormone feedback loop?

A

Ant. Pituitary stimulates thyroid hormone production & release
If blood levels of TH are low then the hypothalamus release TRH
TRH causes the Ant Pituitary to release TSH
TSH stimulates the thyroid to release TH
High TH levels inhibit the secretion of TRH & TSH

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2
Q

If blood levels of TH are low then the

A

hypothalamus releases TRH

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3
Q

Hormone Orders IF LOW LEVELS

A

Thyroid releasing hormone
Thyroid-stimulating hormone
T3 and T4

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4
Q

TRH causes

A

Anterior pituitary to release TSH

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5
Q

TSH releases what

A

T3 and T4 from thyroid

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6
Q

High T3 and T4 levels inhibit the secretion

A

TRH
TSH

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7
Q

TRH

A

Thyroid releasing hormone

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8
Q

TSH

A

thyroid-stimulating hormone

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9
Q

Thyroid assessment

A

physical
Lab work (serum TSH, T3, T4, and free T4)
Ultrasound with bx (remove portion)
Thyroid scan
RAI uptake

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10
Q

If questioning hyperthyroidism/enlarged thyroid,

A

listen for bruit and audible vibration

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11
Q

Is the thyroid normally palpable?

A

no, only when enlarged or hyperthyroidism

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12
Q

How do you assess the thyroid?

A

stand posterior to pt
warn and place hands around the neck
pt swallows - brings it forward to feel for nodules in thyroid

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13
Q

When should you not palpate the thyroid?

A

pt has Thyroiditis
esp if notice visibly enlarged gland bc palpation triggers release of thyroid hormones

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14
Q

RAI uptake

A

Radioactive Iodine uptake test
- if low iodine in thyroid with test hypoactive visa versa

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15
Q

RAI uptake contraindications

A

allergies to shellfish and iodine
Meds need to be withheld

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16
Q

Goiter

A

abnormal enlargement of the thyroid gland

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17
Q

Goiter occurs with

A

Hyperthyroidism (too much)
hypothyroidism (too little)
Euthyroidism (correct amount)

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18
Q

T/F: The presence of a goiter does mean the thyroid gland is malfunctioning.

A

False

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19
Q

Goiter pts c/o

A

inability to swallow
shirt collars too small

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20
Q

TSH normal

A

2-10

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21
Q

T4 normal

A

4-12

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22
Q

T3 normal

A

70-205

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23
Q

Hypothyroidism lab values
TSH
T3
T4

A

TSH high
T3 low
T4 low

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24
Q

Hyperthyroidism lab values
TSH
T3
T4

A

TSH LOW
T3 HIGH
T4 HIGH

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25
Q

TSH is used when monitoring

A

thyroid replacement therapy

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26
Q

TSH STIMULATES

A

T3 and T4

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27
Q

T3

A

accurate meaure of hyperthyroidism
after admin of iodine

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28
Q

Free T4

A

measures the free unbound thyroxine levels of the bloodstream

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29
Q

Hyperthyroidism

A

excess of thyroid hormone

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30
Q

Hyperthyroidism results in

A

Increase BMR, CV, GI & neuromuscular function
Affects metabolism of fats, carbs & proteins
Wt loss & heat intolerance

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31
Q

Hyperthyroidism caused by

A

Autoimmune rxn (Graves’ disease)
Excess of dose of thyroid replacement
Thyroiditis
Tumor

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32
Q

Thyrotoxicosis

A

thyroid storm

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33
Q

Assessment of Hyperthyroidism

A

High Temp, Pulse, Resp. and BP
-clubbing, localized edema
Nervous, tremors
wt loss, hunger
N/V/D
breast enlargement
weakness, fatigue
intolerance to heat
Grave’s disease

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34
Q

S/S of hyperthyroidism is related to

A

directly increases metabolism and tissue sensitivity to stimulation by the sympathetic nervous system

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35
Q

Graves’ disease s/s

A

Goiter
Bulging eyes
raised red rash not painful

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36
Q

Hyperthyroidism is prone to

A

comorbidities
* irregular heartbeats
chest pain
cognition low
excess fatigue**

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37
Q

Hyperthyroidism Mgmt

A

lifelong antithyroid med
Iodine 131
Thyroidectomy
infertility specialist

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38
Q

Nursing problems with Hyperthyroidism

A

knowledge deficit
insufficient nutrition (give them frequent small meals with more protein and carbs)
altered sleep patterns
altered body image due to goiter and eye bulging
low CO or endurance
vision changes (dry and shape)

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39
Q

Exophthalmos

A

bulging eyes

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40
Q

Hyperthyroidism pts have a

A

high active
can’t sit still
Revved up constantly but tired from overexertion

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41
Q

Hyperthyroid pts should avoid

A

spicy
high fiber foods
caffeine
decongestants and diet pills

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42
Q

Hyperthyroid pts need to monitor weight loss if and be notified if they

A

more than 10% of body wt

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43
Q

Hyperthyroidism education

A

meds
wt and nutrition increased
balance activity and rest (fatigue)
lifestyle changes
Eye exams with drops and protection due to bulging
HOB elevated

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44
Q

Hyperthyroid meds

A

Methimazole/propylthiouracil (PTU)

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45
Q

PTU goal

A

inhibits thyroid hormone synthesis

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46
Q

PTU adverse effects

A

**agranulocytosis
hypothyroidism

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47
Q

PTU contraindications

A

allergy to thioamides
impaired liver
Pregnancy leads to fetal harm

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48
Q

PTU care

A

signs of hypothyroidism and hyperthyroidism
Lab work WNL
(PT, INR, CBC, Liver, and Ts)
VS and wt

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49
Q

Do not stop PTU abruptly or

A

risk of severe HYPERTHYROIDISM
- fever, sore throat, unusual bleeding

50
Q

PTU should be taken

A

same time of day
with food

51
Q

Radioactive Iodine 131 goal

A

destroy thryoid cells at high doses

52
Q

Radioactive Iodine 131 adverse effects

A

radiation sickness
bone marrow suppression
hypothyroid

53
Q

Radioactive Iodine 131 contraindications

A

pregnancy
young children

54
Q

Radioactive Iodine 131 dosage

A

4-10 PO

55
Q

Radioactive Iodine 131 TEACHING

A

baseline and monitor CBC
private toilet and flush twice
Bathe daily and frequent handwashing
disposable utensils
sleep alone and avoid prolonged intimate contact for 3-4 days
separate linens
limit visitors and private room needed

56
Q

Radioactive Iodine 131 can jar the thyroid when the pt does this so avoid

A

avoid coughing and expectoration

57
Q

Strong Iodine solution - NONradioactve goals

A

reduces iodine uptake, inhibits hormone production
blocks release of T3 and T4

58
Q

Strong Iodine solution - NONradioactve ADVERSE EFFECTS

A

iodism

59
Q

Strong Iodine solution - NONradioactve dosage

A

2-6 drops TID for 10 days

60
Q

Iodism

A

corrosive and toxicity
metallic taste with irritation sore gums, teeth, ulcers, swelling in the upper throat

61
Q

Strong Iodine solution - NONradioactve mixed with

A

juice

62
Q

Strong Iodine solution - NONradioactve mgmt

A

signs of iodism
VS , WT gain, I&O
under and overdosing

63
Q

Strong Iodine solution - NONradioactve TEACHING

A

Dilute medication in juice to help with taste
Avoid foods high in iodine (ionized salt)
Take medication same time each day
Increase fluid intake

64
Q

Hyperthyroidism in older adults

A

2x wt loss from anorexia as well
apathy
lassitude
depression
confusion
dysrhythmia to heart failure
exophthalmos less common

65
Q

Thyrotoxic Crisis aka

A

Thyroid storm

66
Q

Causes of thyroid storm

A

severe infection/stress
manipulation of thyroid gland

67
Q

Thyroid storm assessment

A

101.3+ temp
increase HR 130+, HTN
agitation, confusion, seizure
exaggerated s/s of hyperthyroidism

68
Q

Dx testing of thyroid storm

A

plus cardiac testing

69
Q

Tx of Thyroid Crisis

A

Stabilize Cardiac
beta blockers
O2
Replace fluids and electrolytes - D5NS or D5LR
When stabile = Antithyroid meds PTU, corticosteroids, lithium or iodinated contrast
Calm environment - cold, dark, limits visits, no kids

70
Q

Thyroiditis

A

inflammation of thyroid
acute, subacute, chronic

71
Q

Acute Thyroiditis is caused by

A

bacteria
fungal
parasite

72
Q

Acute Thyroiditis s/s

A

painful
swelling
dysphagia
dysphonia
s/s of hyperthyroidism

73
Q

Tx of Acute Thyroiditis

A

antibiotics
fluid replacement

74
Q

Acute Thyroiditis function

A

returns after tx

75
Q

Subacute thyroiditis caused by

A

granulomatous - viral

76
Q

Subacute Thyroiditis s/s

A

low fever
fatigue
swelling
pain

77
Q

Subacute Thyroiditis s/s
Phases

A

Phase 1: hyperthyroid (1-3 months)
Phase 2: hypothyroid (9-12 months)

78
Q

Subacute Thyroiditis Tx

A

NSAIDs
Beta-blockers in Phase 1 (heart beats)
steroids for swelling

79
Q

Subacute Thyroiditis function

A

normal after 12-18 months

80
Q

Subacute Thyroiditis Miantain good

A

birth control
because babies pop out more

81
Q

Chronic Thyroiditis s/s

A

lymphocytic - autoimmune

82
Q

Chronic Thyroiditis aka

A

Hashimoto’s disease

83
Q

Chronic Thyroiditis s/s

A

painless
hypothyroid s/s

84
Q

Chronic Thyroiditis Tx

A

thyroid replacement

85
Q

Chronic Thyroiditis function

A

never returns slowly

86
Q

Thyroidectomy

A

tx of choice for thyroid CA and goiters if airway problems

87
Q

CA surgery may include

A

modified or radical neck dissection

88
Q

Radioactive Iodine in Thyroid CA

A

minimize metastasis
shrink thyroid

89
Q

Thyroidectomy Pre-op teachings

A

nutrition soft foods (soups, mash, Jello)
avoid caffeine and stimulants

90
Q

Thyroidectomy post-op care

A

head & neck support (pillows, no rocking forward with head to strain the neck, use arms to side for pushing)
HOB for swelling
feeding tubes
incision painful to swallow for 24 hours
Incision & airway: bleeding (anterior and side collarbones), airway obstruction
thyroid hormone: depends on the amount left, if total lifelong thyroid replacement, weaning can occur but usually very slow

91
Q

Thyroidectomy Post-Op Care
BOW TIE

A

Bleeding
Open airway: HOB 30, avoid hyperextending
Whisper: laryngeal nerve next to the thyroid to reassess with a small voice
Trache set depends
Incision
Emergency: muscle twitching

92
Q

Pain meds for thyroidectomy

A

before eating to ease swallowing of foods

93
Q

Why do you need to watch for muscle twitching after thyroidectomy?

A

parathyroid triggered and can go into hypocalcemia

94
Q

Hypothyroidism

A

Insufficient T3 & T4 leads to  BMR, low heat production

95
Q

Hypothyroidism Causes

A

tx of hyperthyroidism - PTU
antibody destruction of thyroid
iodine deficiency

96
Q

Hypo/Hyper Thyroidism analogy

A

Hypo - tortoise
Hyper - energizer bunny

97
Q

Hypothyroidism Assessment LABS

A

high TSH and lipids
low T4 and T3

98
Q

Hypothyroidism VS

A

low BMR, Temp, Pulse, BP

99
Q

Hypothyroidism ASSESSMENTS

A

wt gain
dry skin and hair
constipation
lethargic and fatigued
intolerance to cold
mixed edema

100
Q

Hypothyroidism late s/s

A

mixed edema
subnormal temp
bradycardia
wt gain
low LOC
thickened skin
cardiac complications

101
Q

Hypothyroidism mgmt

A

thyroid replacement (T3 and T4)

102
Q

Hypothyroidism NURSING Problems

A

Knowledge deficit: don’t know how or when to meds
low CO, endurance, & temperature
Excess nutrition: fatter
Constipation
Skin integrity: dry (need hydration)
Body image: fat and skin integrity

103
Q

Hypothyroidism anaesthesiology and sedation meds need to be

A

minimal dose
-increase risk of oversedation and respiratory compensation

104
Q

Hypothyroidism meds to caution

A

sedatives
hypnotics
narctoics

105
Q

Hypothyroid meds

A

levothyroxine (Synthroid)

106
Q

levothyroxine (Synthroid) goal

A

Synthetic T4 – produces various physiologic effects, including increasing metabolism

107
Q

levothyroxine (Synthroid) adverse effects

A

thyrotoxicosis
Extremes; jitters, grumpy, thyroid storm
wt loss too much too quickly

108
Q

levothyroxine (Synthroid) is dosed in

A

micrograms

109
Q

levothyroxine (Synthroid) contraindications

A

acute MI
CVD
Thyroid storm

110
Q

levothyroxine (Synthroid) nursing care

A

Assess vital signs, BP, weight, history of; weight change, diet, energy level, mood, temperature response
Monitor thyroid function test results & glucose levels
Give dose in morning before breakfast
Teach symptoms of thyrotoxicosis

111
Q

levothyroxine (Synthroid) teaching

A

Daily lifelong if not mixed edema
report any signs of chest pain, nervousness, tremors, sleeplessness, heat intolerance, & excessive sweating
Do not discontinue medication suddenly

112
Q

What is the major warning sign for med attention in thyroid storm

A

chest pain

113
Q

If Synthroid dose is too low

A

bradycardia
lethargy
constipation
excessive fatigue and sleeping

114
Q

If Synthroid dose is too high

A

irritability
palpations
tachycardia
diarrhea
tremors
insomnia

115
Q

Hypothyroid clients need

A

follow up
contact if unplanned wt loss/gain of 5 lbs in a week
avoid sedatives
take in the morning

116
Q

Mixed edema

A

severe hypothyroidism

117
Q

Mixed edema causes

A

sudden d/c thyroid replacement
acute illness, trauma

118
Q

Mixed edema assessment

A

s/s of hypothyroid
edema non pitting
low T4, Na, glucose
High TSH
possible CV collapse and coma
HR less than 50
tongue swells

119
Q

Myxedema Management

A

Replace T4
Treat precipitating factors
Respiratory & CV support**
Increase body temperature
Maintain fluid, electrolytes, & acid-base
HIGH flow O2warming blanket
Vasopressors

120
Q

The nurse is completing a health assessment of a patient with suspected hyperthyroidism. What should the nurse assess the client for?
Anorexia
Tachycardia
Weight gain
Cold skin

A

Tachycardia

121
Q

The nurse is evaluating a patient who is taking PTU for hyperthyroidism. Which patient statement indicates the drug is effective?
I have excess energy.
I can sleep at night.
I have lost weight since taking this medication.
I perspire throughout the day w/o exertion.

A

I can sleep at night.

122
Q

Following a subtotal thyroidectomy, a patient begins to have tingling in the fingers and toes. What should the nurse do first?
Encourage the patient to flex & extend fingers & toes
Notify the healthcare provider
Assess for thrombophlebitis
Ask the client to speak

A

Notify the healthcare provider
hypocalcemia factor

Module 4 (MedSurg 2) (36 decks)

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