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
Cushing’s
- If you have a cushy touchie … You got more
- Oversecretion of adrenal cortex (steroids)
Cushing’s disease s/s
- Draw picture of a little man
- Give man a MOON FACE
- Give him a beard—hirsutism
- Draw a big body—truncal or central obesity
- Arms and legs are skinny—muscle atrophy
- Bump on front—gynecomastia (big breast)
- Bump on back—buffalo hump
- Fill him full of water (he is retaining Na+ and water) He is losing K+ out the back
- Give him some striae—stretch marks
- Most important one of all—high serum glucose o Do Accu-Checks q6h. They look like diabetics
- Easy bruising—put bruises all over him
- Make him say something in a speech balloon …
“I’M MAD, BECAUSE I HAVE AN INFECTION”
o Grouchy (“Roid rage”) o Immunosuppressed
Cushing’s disease s/s
- Draw picture of a little man
- Give man a MOON FACE
- Give him a beard—hirsutism
- Draw a big body—truncal or central obesity
- Arms and legs are skinny—muscle atrophy
- Bump on front—gynecomastia (big breast)
- Bump on back—buffalo hump
- Fill him full of water (he is retaining Na+ and water) He is losing K+ out the back
- Give him some striae—stretch marks
- Most important one of all—high serum glucose o Do Accu-Checks q6h. They look like diabetics
- Easy bruising—put bruises all over him
- Make him say something in a speech balloon …
“I’M MAD, BECAUSE I HAVE AN INFECTION”
o Grouchy (“Roid rage”) o Immunosuppressed
brittle bones, bruising, bad infections
Cushing’s treatment
- Adrenalectomy
- What happens with a bilateral adrenalectomy?
o Now pt has Addison disease
o Now give steroids (ending in SONE) to treat.
o Pt will start looking like Cushman (Cushinoid-like)
o It takes about a year or so—after a lot of titration—for the pt to start looking normal
Hyperparathyroidism and s/s
oversecretion of the PTH causing hyper calcium normal 9-10.5
s/s: stones, moans, and groans
kidney stones
fractured bones- takes calcium from bones
constipation
Hyperparathyrodism causes
tumor: adenoma not cancerous
GI malabsorption of calcium
renal issues
Hyperparathyroidism treatment
Lower the high blood calcium
* IV furosemide & saline to flush out Ca * IV phosphate to lower Ca
* Parathyroidectomy - cut the tumor out
Hypoparathyroidism and s/s
Decreased production or resistance of PTH - Parathyroid Hormone, resulting in LOW calcium!
MEMORY TRICK
Hypoparathyroid = Hypocalcemia (under 9.0)
Think LOW calcium in the blood, signs include: 1. T - Trousseau’s Sign:
T - Twerk with BP cuff 2. C - Chvostek’s Sign
C - Cheeky smile when stroking the face 3. Diarrhea
Hypoparathyroidism causes
Thyroidectomy NCLEX TIP
* Low Mag+ (Hypomagnesemia)
* Autoimmune - body attacks the parathyroids * Radiation Treatment - damages thyroid
Hypoparathyroidism
treatment
Increase the low blood calcium * IV Calcium gluconate
* Vitamin D (helps absorption of Ca)
* Seizure precautions & phenobarbital to decrease neuro excitability
