Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NSG 219 Med-Surg 1 > Thyroid and Parathyroid, Ch. 58 (Iggy) > Flashcards

Thyroid and Parathyroid, Ch. 58 (Iggy) Flashcards

1
Q

-Triiodothyronine (T3)
-Thyroxine (T4)
-Calcitonin.
The body takes iodine from food and converts it into T3 and T4. Calcitonin is produced by C cells and is released based on serum calcium levels.

A

The 3 hormones the Thyroid secretes
–Thyroid PATHO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What kind of relationship do TSH and T3/T4 have?

A

-Introverted
If TSH is LOW, then T3/T4 ^ (Hyperthyroidism)
Same for hypothyroidism TSH ^, T3/T4 is LOW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

-Has 4 glands
- Secrete PTH to regulate CALCIUM levels
-PTH affects bones, kidneys, and GI tract
-impaired gland fxn causes Hyperparathyroidism (to much PTH) and Hypoparathyroidism (to little PTH)

A

Parathyroid PATHO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  • T3/T4 ^, TSH Low
    CAUSES:
    -Graves DZ (autoimmune disorder that leads to an overactive thyroid gland)=accounts for 80% of cases
    -Thyroiditis, ^Iodine Intake, Pituitary Tumors, and Thyroid Cancer
    –The ^T3/T4 causes HYPERMETABOLISM
A

Hyperthyroidism
(a.k.a. Thyrotoxicosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If need to decrease Iodine intake what is a phrase from 1st Semester that makes it easy to remember? (May need to decrease due to gland impairment or meds)

A

“If it is from the sea, It is not for me”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

An autoimmune disorder, often occurring after an episode of thyroid inflammation.
–Causes the production of autoantibodies (thyroid-stimulating hormone- TSI) that attach to thyroid-stimulating hormone (TSH) receptors on the thyroid gland GREATLY ^ production of TSH

A

Graves’ Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

An autoimmune disorder that experiences acute flare-ups
–pt.s will often also have other autoimmune disorders like…
Rheumatoid Arthritis (usually attacks joints), Systemic Lupus Erythematosus, and Celiac DZ

A

Graves’ Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What autoimmune disorder could lead to thyroid tissue destruction (atrophy), which leads to hypothyroidism?
**

A

Graves’ Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Do you need precautions for a Radioactive Iodine Uptake (RAIU) thyroid scan? Why?

A

No
Because the radioactive capsule has a very short half life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

-TSH LOW=Grave’s Disease.
-TSH ^ = non-Graves hyperthyroidism.
-T3 and T4 HIGH
—Thyroid SCAN with radioactive iodine uptake (RAIU) helps determine whether the patient has Graves’ disease/ thyroiditis or Hypo/Hyper
–>Iodine is admin. PO or IV. Usually by a capsule containing a radioactive substance the day before the scan. The substance is targeted for absorption by the thyroid gland.

A

Hyperthyroidism Diagnostics
**Graves’ or Thyroiditis?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

S/SX: plus all other possible sx of hyperthyroidism
-Possible GOITER
-EXOPHTHALMOS
—>abnormal protrusion of the eyes; ^ fat deposits and edema in the periorbital area.
–>Permanent
-PRETIBIAL MYXEDEMA
—>dry, waxy swelling of the front surfaces of the lower legs; resembles benign tumors or Keloids

A

CLINICAL MANIFESTATIONS: Hyperthyroidism due to Graves’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Visibly enlarged thyroid gland
NEVER PALPATE if pt. has sx of HYPERthyroidism; it will stimulate production of TSH/T3/T4 causing Thyroid Storm
-Auscultation reveals BRUIT r/t ^ blood flow to the gland
-CAUSE: TSH binds to thyroid cells=enlargement of gland; TSH does not ^
–Common for many thyroid problems; doesn’t strictly mean Hypo and Hyperthyroidism

A

Goiter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

S/SX: Hypermetabolism
–^ body temp. ; ^ appetite and thirst; N/V ; Weight LOSS; thin hair;
–HTN ; Tachypnea and Dyspnea
Rapid, bounding HR; Dysrhythmias
–Fatigue, weakness
–Insomnia, restlessness, tremors, Muscle Fatigue/Wasting; Finger clubbing
–Heat intolerance (Often 1st sx noticed always hot); Facial flushing
–Hyperglycemia, Diaphoresis
–Manic behaviors (Laugh w/out cause); Increased libido (decreases w/ exhaustion)
–^ Peristalsis=Diarrhea/ ^ BM; Amenorrhea

A

CLINICAL MANIFESTATION:
Hyperthyroidism
**TSH affects most body systems–>Hypermetabolism and ^ Sympathetic Nervous sx
**Cognitive: either full speed or stopped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Severe overproduction of T3 and/or T4
A life-threatening COMPLICATION.
S/SX:
–critically ^ ,^ BP, and ^body temp.
–Insomnia, delirium, and restlessness.
RISK: Cardiac Dysrhythmias
Com. w/ AID NEED TO KNOW IF TEMP GOES UP BY 1 DEGREE

A

Thyroid Crisis (Thyroid Storm)

Key S/SX: fever, tachy, and systolic HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

-Contact provider; do all below while waiting for doc.
-Assess for ^ body temp. by 1
-Lower external stimulation to help prevent ^ in sx
-Lower body with ice packs or cooling blanket
-ADMIN Beta Blocker
“-olol” med
-IF TEMP RISE IMMEDIATELY assess cardiac status and check for dysrhythmias

A

INTERVENTIONS: Thyroid Crisis (Thyroid Storm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PropylThioUracil (PTU)
**Antithyroid Agent
*DOC for thyroid crisis/storm
REPORT: darkening of the urine or SX of Jaundice = possible liver toxicity or failure, a serious side effect
REPORT: fever or sore throat
TEACH: s/sx of hypoTH= ^wt., low HR, Cold intolerance=> lower dose needed

A

MED: Hyperthyroidism

Propylthiouracil (PTU)
THINK: “Put the Thyroid Underground”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

THERAPY: Results in Hypothyroidism
—Limits thyroid hormone production by destroying thyroid tissue. Prevents T3 and T4 production and decreases thyroid vascularity to make it safe for surgery.
–For GOITER surgery=Lowers vascularity to limit Risk of hemorrhage
**3 months for the effects to be seen.
Requires precautions: Pt. is Radioactive for >2wk. Toxic to other humans; all body fluids must be contained and cleaned, NO gel fem. pads. or Tamps

A

INTERVENTION:
Radioactive Iodine Therapy

Need Pregnancy Test Prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Methimazole—Antithyroid
–Prevents production of thyroid hormones
–AVOID crowds and people who are ill because med is an immune suppressant & ^ RISK of infection
TEACH patients s/sx of infection
CONTRAINDICATED for pregnancy r/t birth defects; women must wear gloves

A

MED: Hyperthyroidism

METHIMAZOLE
Lowers immunity/causes Birth Defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Propranolol
Beta-adrenergic blockers
—> (end in –olol)
ACTION: block sympathetic nervous system stimulation. Used to alleviate cardiac sx of hyperthyroidism (^HR, ^BP)
REPORT dizziness
TX: Relieve diaphoresis, anxiety, tachy, and palpations

A

Med: Hyperthyroidism

PROPRANOLOL
*Supportive Therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Iodine (Inorganic)
–Prevents T3 and T4 production and decreases thyroid vascularity to make it SAFE FOR SURGERY (goiters are ^ vascular)
—> Potassium iodide (SSKI) is also used

A

Med: Hyperthyroidism
*Surgery Prep

IODINE or SSKI
(inorganic, so is therapeutic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Lugol Solution
Saturated solution of potassium iodide (SSKI)
REPORT: GI distress, *metallic taste/ Sour, or mouth sores, as these are indications of iodism (HIGH RISK of toxicity)
Surgery Prep Solution

A

Med: Hyperthyroidism

Lugol Solution
Metalic taste; High Risk of Toxicity; Surgery Prep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

–^ caloric intake to compensate for the higher metabolic demands.
–Low-sodium diet
–Six full meals with snacks
–AVOID spicy and high-fiber foods and High-Iodine (Seafood) “If it is from the sea it is not for me”

A

TEACH: Hyperthyroidism

23
Q

ASSESS: for laryngeal stridor, dyspnea, ^ swallowing, or bloody dressings. (RESP.)
–>MUST keep tracheostomy kit at the bedside r/t pos. obstruction
BLEEDING: ^ IV fluid and notify RR team.
THYROID STORM:
Apply cooling blanket, decrease stimuli, admin. beta blocker, and call doc ASAP.
–MONITOR: q2hr VS and CA levels for pos. Parathyroid injury. Admin Calcium Gluconate if needed.
ASSESS for Chvostek’s and Trousseau’s signs.
–Temporary laryngitis: r/t laryngeal nerve damage; EDU. pt. pre-op of horse voice
–Place pt. in semi-Fowler’s position with pillows behind the head/neck.DON’T overextend neck
*Thyroid hormone replacement therapy for life (Levothyroxine)

A

SURGICAL MANAGEMENT: Thyroidectomy

For Hypo or Hyper

for Goiter, Mass, or Tumor

24
Q

What is the Nursing Priority for a thyroidectomy?

A

Respiratory Distress

25
Q

Inflammation of the thyroid gland

A

Thyroiditis

26
Q

–Subacute granulomatous thyroiditis is caused by a virus.
–Acute thyroiditis r/t bacteria or fungi.
–Hashimoto’s thyroiditis is an autoimmune response.

A

The 3 types of Thyroiditis

27
Q

Caucasian
Relative (Family Hx)
Age (increased)
Women

A

Hashimoto’s Thyroiditis RISK FACTORS think “CRAW”

28
Q

Short hyperthyroidism then develops into Hypothyroidism
S/SX:
–Radiating Thyroid Pain to throat, ears, or jaw.
–Fever, chills, sweats, heart palpitations, and fatigue.
–Prominent goiter (trouble swallowing)
–Change in voice or breathing pattern if thyroid obstructs trachea.

A

Hashimoto’s Thyroiditis

29
Q

Regardless of the cause=thyroid is not functioning.
– ^ T3 /T4 levels (w/ inflamed goiter) HYPER at first but decrease as inflammation decreases HYPO
– ^ TSH in an attempt to produce more T3 and T4. (Intervention)

A

Hashimoto’s Thyroiditis

30
Q

–>Nonsteroidal anti-inflammatory Meds (NSAIDs) = TX Pain and Decease Inflammation
–>Corticosteroids = Decrease inflammation
–>Beta-Blockers = TX Cardiovascular Complications
–>Thyroid Hormone Replacement = replace thyroid hormones (USED after T3/T4 dec. & NEVER in the beginning stages)

A

MEDS: Thyroiditis

Inflammation, Pain, Cardiac, Hormones

31
Q

-PRIMARY: thyroid tissue is destroyed or inadequate amount of hormone is produced.
-SECONDARY: pituitary or hypothalamic (brain area that controls hunger, thirst, and temp) dysfxn= inadequate hormone production.
***The worldwide leading cause is iodine deficiency.
**In US leading cause is thyroid atrophy related Hashimoto’s thyroiditis.
OTHER CAUSES: thyroidectomy and medications.

A

PATHO: Hypothyroidism
*Primary and Secondary

32
Q

–Fatigue; Lethargy; ^ sleep
–Personality changes;
Impaired memory; Depression; Apathy; Forgetfulness, Slow speech (r/t Thick tongue)
–Cold intolerance
–Amenorrhea (no period)
–Bradycardia; Dyspnea
–Constipation
–Weight ^, Anorexia (decreased appetite); Husky voice
–Hair loss; Brittle hair and nails; Thickened Skin
Decreased Metabolic Rate

A

CLINICAL MANIFESTATION:
Hypothyroidism

33
Q

Serious COMPLICATION
S/SX: periorbital and facial edema and a mask-like appearance. Loss of Expression
CAUSE: From lowered metabolic rate Protein, Sugar, and Water retention in cells=nonpitting Generalized Edema
—> Long-standing/ untreated Hypothyroidism
ASSESS: VS, Wt., I&O’s, Mental Status, and Edema; PROVIDE skin care

A

Myxedema
Hypothyroidism Complication

34
Q

Myxedema => Hypothyroid Crisis=> (untreated) Death
–Emergency
–LOW Resp., BP, HR, and body temp. Need tracheostomy kit at bedside
–Admission to ICU w/ mech. resp. support when it progresses to COMA
RISKS: Post thyroidectomy/ abrupt stop of levothyroxine/ untreated hypothyroidism

A

Myxedema Coma
(AKA Hypothyroidism Crisis)

DECREASED Cardiopulmonary, Neurological fxn, and Cardiac Output

35
Q

-Lithium (Antimanic)
-Thiocyanates (AntiHTN)
-Aminoglutethimide (AntiSteroid)
-Sodium or Potassium Perchlorate (Antithyroid)
-Cobalt (^RBC production; vit B12 component for anemia)

A

Drugs that IMPAIR thyroid hormone production.

36
Q

The nurse is caring for a patient who tells the nurse she is always cold, always tired, and more forgetful. What information does the nurse expect to find in the patient’s medical record?

A

Hypothyroidism
r/t Decreased T3/T4

37
Q

^ TSH
LOW T3/T4
–Radioactive iodine uptake (RAIU) SCAN = to measure the rate of iodine uptake by the thyroid gland
–Iodine is administered PO or parenterally.
No precautions need
AVOID if pregnancy

A

DIAGNOSTICS:
Hypothyroidism

38
Q

Levothyroxine (Synthroid)
–>HypoTH DOC
–AM qday b4 breakfast, on EMPTY STOMACH
–3-4 weeks to work.
–AVOID Ca suppl. > 4 hr after to ^ absorption
–Dose is adjusted as needed to return TH lvl to normal ranges.
–1st dose low to prevent tachycardia and hypertension.
REPORT/ TEACH s/sx of hyperthyroidism/thyroid storm immediately
–lab work needed for TSH lvl
–TEACH pt. consult HCP before taking new meds=can ^ or decrease the absorption
–Medication must be taken for life (abruptly stopping med can cause MYXEDEMA COMA).

A

MED: Hypothyroidism DOC
Levothyroxine (Synthroid)

Helps to decrease size of goiter, Hypothyroid life treatment, avoid Ca, Report HYPER sx asap

39
Q

A nodule on the thyroid gland may be benign (>95%) or malignant
– ^ @ RISK: >women than men, ^ dx in Caucasians and Asian American; Radiation to neck during childhood, + family hx, & personal hx of a goiter.
—>PAPILLARY thyroid cancer is the most common type. It is slow-growing and spreads to the lymph nodes in the neck.
—>FOLLICULAR thyroid cancer occurs > older pt. and metastasizes to the cervical lymph nodes before the neck lymph nodes.
—>MEDULLARY thyroid cancer has a genetic link; it metastasizes early and is poorly differentiated in cell type.
—>ANAPLASTIC thyroid cancer is the most aggressive type and responds poorly to treatment.

A

PATHO AND TYPES:
Thyroid Cancer

*4 Types

40
Q

Who is most at risk for Thyroid Cancer?

A
  1. Girls and Women
  2. Caucasians and Asian Americans
41
Q

–Painless, palpable nodules noted on an enlarged thyroid gland
–Goiter
–Dysphagia (dif. swallowing)
–Dyspnea (SOB)
–Hemoptysis (coughing up blood)
–Airway obstruction

A

CLINICAL MANIFESTATION:
Thyroid Cancer

42
Q
  1. Surgery: Removal; Determines Metastatic sites but does not treat
  2. Radioactive Iodine Treatment: radioactive iodine is given to remove remaining cancer cells aftr 1st tx
  3. Radiation Treatment: external beam radiation when metastasis
  4. Chemotherapy: meds for advance dz; target therapy to tx metastatic cancerous cells
  5. Drug Therapy: High dose of TH therapy to STOP rls of TSH
A

TX OPTIONS: Thyroid Cancer

43
Q

Precautions for pt. tx with radioactive iodine?

A

–Avoid children completely.
–Restrict time w/ and maintain >3 feet from adults for several days.
–DISCHARGE teaching =instructing patients to empty their bladders often and flush the toilet several times afterward.

44
Q

A patient with a diagnosis of metastatic thyroid cancer is preparing for treatment. Which would be the best collaborative care treatment modality for the health care provider to prescribe for this patient?

A

Targeted Therapy

45
Q

-*Maintain the pt. airway r/t proximity of surgical site to the trachea
ASSESS for laryngeal stridor; dyspnea, ^ swallowing, or bloody dressings, Chvostek’s and Trousseau’s signs
**Keep tracheostomy kit at the bedside RISK airway obstruction.
NOTIFY: HCP of purulent drainage from the neck incision.
MONITOR: VS and CA, Pain
–Thyroid hormone levels should be checked q4-6wk
–pt. needs thyroid replacement therapy for life.
–Place pt. semi-Fowler’s pos. w/ pillows behind the head/neck.

A

POST-OP CONSIDERATIONS
Thyroidectomy

46
Q

^ PTH levels
^ CA level
LOW serum phosphorus level
^ CL
Bone density testing

A

DIAGNOSTICS: Hyperparathyroidism

47
Q

LEADS TO LOW bone density (risk for fractures); Osteoporosis (CA is pulled from the bones)
CAUSES: ^ CA excretion in the urine; Renal Calculi

S/SX: LOW appetite (Anorexia),
Constipation, Fatigue,
Emotional disorders,
Shortened attention span,
Muscle weakness

A

PATHO: Hyperparathyroidism

48
Q

LOW PTH
LOW CA (causes diarrhea)
^ Phosphorus

A

DIAGNOSTICS: Hypoparathyroidism

49
Q

Parathyroid can’t maintain CA lvls=hypocalcemia
–Positive Chvostek’s and Trousseau’s signs
–Dysrhythmias
–Hypotension
–Weakness; Fatigue
–Tetany (involuntary muscle contractions)
–Seizures; Paresthesias (Tingling)
–Abdominal cramps; diarrhea
–Dry, scaly skin

A

S/SX: hypoparathyroidism

50
Q

TEACH: ^ CA rich foods (dark green leafy vegetables, soy products e.g., tofu, and dairy)
Oral calcium supplements
**ADMIN: IV calcium and infuse it at a SLOW RATE
MONITOR: Telemetry (Dysrhythmias)
LABS: CA levels should be monitored q3 to 4X year

A

IMPLEMENTATIONS:
Hypoparathyroidism

51
Q

-Chvostek’s and Trousseau’s signs
-Serum calcium levels
-Hyperactive reflexes
-Dysrhythmias

A

ASSESSMENT:
Hypoparathyroidism

52
Q

A charge nurse working in the medical surgical unit receives a report on a patient hypoparathyroidism who will be admitted during the upcoming shift. What equipment should the charge nurse ensure is placed in the patient’s room?

A

Telemetry Monitor

53
Q

Which assessment finding made by the nurse may indicate the onset of hypoparathyroidism?

A

Positive Chvostek’s Sign

NSG 219 Med-Surg 1 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions