Thyroid and adrenals Flashcards
What does the thyroid do?
regulate metabolism
when you see the word thyroid replace with metabolism
Hyperthyroidism and s/s
hypermetabolism = Graves disease
s/s:
- weight loss
- hr, bp up
- hyper personality
- heat intolerance- body is like a furnace
- exophthalmos- building eyes
3 Treatment options for hyperthyroidism
- Radioactive iodine- pt must flush three times when urinating
call hazmat if urine spill
isolation first 24 hrs
visit restriction in home and hospital first 24 hrs - Propylthiouracil- puts thyroid under
-monitor wbc since it immunosupresses - Thyroidectomy: pay attention whether or not its total or sub
total: needs life long hormone replacement to prevent hypocalcemia
subtotal: does not need lifelong hormone replacement
- at risk for thyroid storm
What is a thyroid storm and who is at risk?
those with hyperthyroidism who have a subtotal thyroidectomy
medical emergency
s/s- high temp over 105
o Get temp down, bring oxygen up
o Bring body temperature down using ice packs/cooling blankets
o Oxygen per mask at 10L
o Stay with patient
* High BP, stroke level — about 210/180
* Severe tachycardia 180 as high as 200
* Psychotically delirious
* will come out of by themselves, meds don’t help
- First step is ice pack
- Best step is cooling blanket
Post op risk in total and sub thyroidectomy
- First 12 hours—risks are the same for both total and subtotal
1. Top priority is airway, due to edema
2. Next is hemorrhage because it is an endocrine gland—very vascular * Next 12 to 48 hours—It matters what kind of surgery you’ve had now
1. Total: big danger is tetany due to low calcium
TOTAL = TETANY … Can close off airway with an irreversible spasm
2. Subtotal: big danger is thyroid storm SUBTOTAL = STORM (Severe) - After 48 hours—risk is infection
when does infection become a risk with surgery?
after 72 hours
Hypothyroidism
So, what are the S/Sx of hypomatabolism?
o Obesity
o HR down, BP down
o Personality: Flat, boring, dull
o They have cold intolerance … Can tolerate heat o Academically challenged
Myxedema
- This is when a pt with severe hypothyroidism presents with skin involvement
edema, dry skin, coarse or thinning hair
no sedation
Myxedema coma
- Severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs
- Medical emergency
- No sedatives
warming blankets
nursing interventions: IV fluids, needs ICU
IV levothyroxine and steroids
low temp, hr,bp, rr
drowsy
hyponatremia
hypoglycemia
Treatment of hypothyroidism
Levothyroxine
* Taken in the morning 30 minutes to 1 hour before breakfast * Taken alone on an empty stomach with water
- don’t withhold thyroid meds unless explicit order
What is the job of the adrenals?
release steroids
Addison’s disease
- Under secretion of steroids (they are a time bomb!) * S/Sx: pts are Hyperpigmented (very tan)
high k - They do NOT adapt to stress
What is the purpose of the stress response in an individual?
To maintain:
o A normal blood pressure to perfuse the brain and other organs
o An adequate level of glucose to feed the body
What could happen if Addison’s pt can’t adapt to stress?
- Under stress, pts with Addisson disease will go into shock and have an hypoglycemic episode (Addisonian crisis)
low bp, glucose= shock
Addisons disease treatment
1 priority iv push steroid
Give steroids
* Glucocorticoids drugs that end in -SONE
o Prednisone
o Methylprednisone
* “In Addison, you ADD-a-SONE”
steroid treatment is lifelong
high protein, sodium, and carb diet
