thyroid and parathyroid glands and disorders Flashcards
describe thyroid gland hormones
thyroid hormone - T3 and T4 (T3 is 5x more potent than T4) and calcitonin
- synthesis if thyroid hormone, iodine is needed for TH
- controlled by TSH
- calcitonin is secreted in response to high plasma calcium levels, increases calcium deposits in the bone
function of thyroid hormone:
- accelerates cellular reaction in most body cells
- increases BMR and growth
- stimulates protein synthesis
- regulates energy metabolism
- exerts chronotropic and inotropic cardiac effects
- acts as insulin antagonist
what is a goiter
overgrowth of thyroid tissue, can be caused by hypo or hyper thyroidism
describe the assessment of the thyroid gland
- physical exam: hair, skin, nails, bowels, sleep patterns, energy
- inspection and palpation
describe diagnostic evaluation of the thyroid gland
thyroid tests
- serum TSH, T3, T4
- serum free T4
- T3 resin uptake test
- thyroid antibodies
- radioactive iodine uptake
- fine needl aspiration biopsy
- thyroid scan, radioscan
- serum thyroglobulin
what are some nursing implications for thyroid management
- assess for iodine allergies
- assess for meds that contain iodine (esp contrast)
- foods that contain iodine (salt, fish, kelp, seaweed)
- meds that are known to affect thyroid testing
what are some meds that are known to affect thyroid testing
- amiodarone (antiarrhythmic)
- aspirin
- simetadine (histamine blocker)
- glucocorticoids (can enlarge thyroid and cause respiratory issues)
describe hypothyroidism
- deficiency of thyroid hormone (TH)
- slowed body metabolism
- decreased heat production
- decreased oxygen consumption by the tissues
describe primary hypothyroidism
- autoimmune thyroiditis - hashimotos
- 95% of cases
describe secondary hypothyroidism
- overtreatment of hyperthyroidism
- thyroidectomy
- radioactive iodine
whats a gerontologic considerations for hypothyroidism
whatch for toxicities r/t metabolism changes
what are some clincial maniestations of hypothyroidism
- skin: dry, brittle
- pulmonary: thick secretions in lungs, decreased RR
- CV: decreased HR and decreased BP
- psychological: depressed, apathetic
- GI: constipation (increase fiber and fluid intake)
- MSK: aches and weakness
- neurologic: slow and sluggish
- metabolic: bad. increased weight and drug toxicity
describe myxedema
- elevated serum cholesterol
- rare life-threatening condition
- undiagnosed/undertreated hypothyroidism patients - stressors
symptoms:
depression, diminished cognitive status, lethargy, and somnolence
hat are some complications of myxedema
- major complication = coma (40% mortality rate)
other complications: - hyponatremia
- hypercalcemia 2’ adrenal insufficiency
- hypoglycemia
- water toxicity
- hypoventilation
- hypotension and bradycardia
- hypothermia
these symptoms, along with CV collapse and shock, require aggressive and intensive supportive therapy and hemodynamic therapy if the patient is to survive
describe medical management of hypothyroidism
- pharmacologic therapy - levothyroxine (take first thing in the mroning on an empty tummy)
- prevention of cariac dysfunction (tele/EKG)
- prevention of medication interactions
describe preventing med interactions with drugs for hypothyroidism
- increase effects of warfarin
- CV effects of adrenergic agents
- diabetic meds may need adjusted
- caution when taking estrogen
- absorption may be effects by calcium, iron, mag, or zinc
- may need lower dose narcotics
describe nursing management of hypothyroidism
- administer thyroid hormones (dont switch back and forth between brands)
- provide stimulation
- monitor response to increased activity
- monitor heat and cold intolerance
- monitor neurologic status
- monitor VS
- explain life long therapy
- interventions for myxedema: recognize and treat as soon as possible and assess compliance
describe hyperthyroidism
excess of thyroid hormone
what are the most common forms of hyperthyroidism
- toxic multinodular goiter
- toxic adenoma
- thyroiditis
- graves disease (toxic, diffuse goiter)
describe graves disease
- three hallmarks: goiter, exophthalmos, and hyperthyroidism
- women more than men
- autoimmune disorder
what are some clinical manifestations of hyperthyroidism
- skin: thin oily hair
- pulmonary: increased RR
- CV: increased HR and BP
- psychological: irritible, anxious, easily agitated, restless
- GI: increased appetite, diarrhea
- MSK: muscle wasting, premature osteoporosis
- neurologic: nervous, tremors, heat intolerance
- metabolic: everything is sped up
what are some complications of hyperthyroidism
- exopthalmos: use eye drops, tape em up at night, keep HOB elevated, corneal abrasion risk, surgical decompression
- heart disease: beta blockers, prevent stress on heart
- thyroid storm: monitor closely, can be fate; sx include t>38.5C, hr>130, increased BP, delirium and psychosis
whats included in the medical management of hyperthyroidism
- antithyroid meds: PTU (blocks synthesis of TH)
- SSKI: decrease size and vascularity of thyroid b4 OR
- radioactive iodine: give test dose, can initially cuase thyroid storm; contraindicated in pregnancy, dont conceive for 6mo after using
- thyroidectomy: cause hypothyroidism
what are some nursing interventions for hyperthyroidism
- maintaining CO: monitor VS, EKG, and tele
- maintain high calorie, high protein diet (4k-5k cal)
- assist with coping
- weigh daily
- monitor appetite
- body temp regulation
- monitor sx of complications
describe goiter
- enlargement of the thyroid gland
- may occur from hypothyroidism or hyperthyroidism
- can be benign or malignant
types:
- endemic (iodine deficient): most common
- nodular
describe thyroid cancer
- women more likely and patients over 50 years
risk factors:
- preveious external radiation to chest area
- smoking
- low physical activity
- unhealthy eating habits
- high stress levels
describe medical management of thyroid cancer
diagnostic testing and surgical management
diagnostic testing:
- thyroid function tests
- CT, MRI, scans
surgical management:
- thyroidectomy
describe nursing management of thyroid cancer
- preop care: teach about meds
- post op care: watch for bleeding, elevate HOB, stabilize head, monitor resp, have trach and suction @ bedside
- monitor for complications
describe thyroidectomy nursing considerations
- hemorrhage most likely within first 24hrs
- protect the airway
- monitor calcium levels
- thyroid replacement therapy for rest of life
- monitor VS
- use sandbags to support head and neck
- semi-fowlers position
- pain meds
- inspect neck dressing
- monitor for myocardial ischemia/infarct
how many parathyroid glands are there generally
4
what hormone does the parathyroid release and where are the major sites of action
parathyroid hormone (PTH)
major sites of action are skeleton, kidneys, and intestine
describe the action of the parathyroid gland
maintain a normal concentration of calcium in the body fluid
PTH stimulates the kidneys production of the enzyme that converts various products to active form of vitamin D
describe the etiology and risk factors of hyperparathyroidism
overactivity of one or more parathyroid glands
- excess PTH = increased serum calcium
- bone decalcification
- renal calculi
risk factors:
- clients >60 years of age
- women more than men
- higher level in renal patients
types: primary and secondary
what are some clinical manifestations of hyperparathyroidism
- anorexia, N/V
- constipation, abd pain
- deep bone pain
- muscular weakness
- bone cysts/lesions, bone fx
- elevated serum calcium and PTH levels
- cardiac dysrhythmias
- renal calculi, pyelonephritis
- peptic ulcer formation
- fatigue
what are some complications of hyperparathyroidism
hypercalcemic crisis
describe hypercalcemic crisis and what do you do to treat it
serum calcium levels >13mg/dl
have neurologic, CV, and kidney sx
need rapid hydration, calcitonin promotes renal excretion, bisphosphonates, cytotoxic agents, may need dialysis
whats used for the diagnosis of hyperparathyroidism
- labs: increased Ca+ and PTH (double antibody parathyroid hormone test)
- Xrays and bone scans (bone changes)
- US
- MRI
- thallium scan
- fine needle biopsy
describe medical management of hyperparathyroidism
- surgical removal
- hydration therapy
- mobility
diet and medications:
- administration of calcium chelators
- administer phosphates
- calcitonin (secreted in response to high plasma levels of calcium)
whats included in nursing care of hyperparathyroidism
- assess for s/sx renal calculi
- VS
- strain urine
- encourage fluid intake
- assist with ambulation
- limit fluids high in calcium (dairy and OJ)
- provide cardiac monitoring
- medicate for bone pain
what are some causes of hypoparathyroidism
- iatrogenic (treatment induced) hypoparathyroidism
- idiopathic (unknown, autoimmune, vit D deficiency)
what are some clinical findings of hypoparathyroidism
- mild tingling and numbness to tetany
- muscle cramps
- carpo-pedal spasms
- seizures
- mental changes
- excessive or muscle contractions
- chvosteks sign (facial muscles)
- trousseau’s sign (wrist and hand spasms)
what are some complications related to hypoparathyroidism
- respiratory obstruction secondary to tetany/laryngospasms
- calcifications of eyes and basal ganglia (brain) -> risk for seizures
whats used in the diagnosis of hypoparathyroidism
- EEG
- labs
- CT of head
whats included in medical/nursing management of hypoparathyroidism
- focus on correcting: hypocalcemia, vit D deficiency, and hypomagnesia
- give IV calcium gluconate (tissue toxic)
- may need long term therapy
- food high in calcium and low in phosphorus
- medic alert bracelet
