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adults > thyroid and parathyroid glands and disorders > Flashcards

thyroid and parathyroid glands and disorders Flashcards

1
Q

describe thyroid gland hormones

A

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

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2
Q

what is a goiter

A

overgrowth of thyroid tissue, can be caused by hypo or hyper thyroidism

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3
Q

describe the assessment of the thyroid gland

A
  • physical exam: hair, skin, nails, bowels, sleep patterns, energy
  • inspection and palpation
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4
Q

describe diagnostic evaluation of the thyroid gland

A

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

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5
Q

what are some nursing implications for thyroid management

A
  • 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
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6
Q

what are some meds that are known to affect thyroid testing

A
  • amiodarone (antiarrhythmic)
  • aspirin
  • simetadine (histamine blocker)
  • glucocorticoids (can enlarge thyroid and cause respiratory issues)
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7
Q

describe hypothyroidism

A
  • deficiency of thyroid hormone (TH)
  • slowed body metabolism
  • decreased heat production
  • decreased oxygen consumption by the tissues
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8
Q

describe primary hypothyroidism

A
  • autoimmune thyroiditis - hashimotos
  • 95% of cases
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9
Q

describe secondary hypothyroidism

A
  • overtreatment of hyperthyroidism
  • thyroidectomy
  • radioactive iodine
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10
Q

whats a gerontologic considerations for hypothyroidism

A

whatch for toxicities r/t metabolism changes

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11
Q

what are some clincial maniestations of hypothyroidism

A
  • 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
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12
Q

describe myxedema

A
  • elevated serum cholesterol
  • rare life-threatening condition
  • undiagnosed/undertreated hypothyroidism patients - stressors

symptoms:
depression, diminished cognitive status, lethargy, and somnolence

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13
Q

hat are some complications of myxedema

A
  • 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

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14
Q

describe medical management of hypothyroidism

A
  • pharmacologic therapy - levothyroxine (take first thing in the mroning on an empty tummy)
  • prevention of cariac dysfunction (tele/EKG)
  • prevention of medication interactions
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15
Q

describe preventing med interactions with drugs for hypothyroidism

A
  • 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
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16
Q

describe nursing management of hypothyroidism

A
  • 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
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17
Q

describe hyperthyroidism

A

excess of thyroid hormone

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18
Q

what are the most common forms of hyperthyroidism

A
  • toxic multinodular goiter
  • toxic adenoma
  • thyroiditis
  • graves disease (toxic, diffuse goiter)
19
Q

describe graves disease

A
  • three hallmarks: goiter, exophthalmos, and hyperthyroidism
  • women more than men
  • autoimmune disorder
20
Q

what are some clinical manifestations of hyperthyroidism

A
  • 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
21
Q

what are some complications of hyperthyroidism

A
  • 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
22
Q

whats included in the medical management of hyperthyroidism

A
  • 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
23
Q

what are some nursing interventions for hyperthyroidism

A
  • 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
24
Q

describe goiter

A
  • enlargement of the thyroid gland
  • may occur from hypothyroidism or hyperthyroidism
  • can be benign or malignant

types:
- endemic (iodine deficient): most common
- nodular

25
Q

describe thyroid cancer

A
  • 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

26
Q

describe medical management of thyroid cancer

diagnostic testing and surgical management

A

diagnostic testing:
- thyroid function tests
- CT, MRI, scans

surgical management:
- thyroidectomy

27
Q

describe nursing management of thyroid cancer

A
  • 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
28
Q

describe thyroidectomy nursing considerations

A
  • 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
29
Q

how many parathyroid glands are there generally

A

4

30
Q

what hormone does the parathyroid release and where are the major sites of action

A

parathyroid hormone (PTH)

major sites of action are skeleton, kidneys, and intestine

31
Q

describe the action of the parathyroid gland

A

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

32
Q

describe the etiology and risk factors of hyperparathyroidism

A

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

33
Q

what are some clinical manifestations of hyperparathyroidism

A
  • 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
34
Q

what are some complications of hyperparathyroidism

A

hypercalcemic crisis

35
Q

describe hypercalcemic crisis and what do you do to treat it

A

serum calcium levels >13mg/dl

have neurologic, CV, and kidney sx

need rapid hydration, calcitonin promotes renal excretion, bisphosphonates, cytotoxic agents, may need dialysis

36
Q

whats used for the diagnosis of hyperparathyroidism

A
  • labs: increased Ca+ and PTH (double antibody parathyroid hormone test)
  • Xrays and bone scans (bone changes)
  • US
  • MRI
  • thallium scan
  • fine needle biopsy
37
Q

describe medical management of hyperparathyroidism

A
  • surgical removal
  • hydration therapy
  • mobility

diet and medications:
- administration of calcium chelators
- administer phosphates
- calcitonin (secreted in response to high plasma levels of calcium)

38
Q

whats included in nursing care of hyperparathyroidism

A
  • 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
39
Q

what are some causes of hypoparathyroidism

A
  • iatrogenic (treatment induced) hypoparathyroidism
  • idiopathic (unknown, autoimmune, vit D deficiency)
40
Q

what are some clinical findings of hypoparathyroidism

A
  • 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)
41
Q

what are some complications related to hypoparathyroidism

A
  • respiratory obstruction secondary to tetany/laryngospasms
  • calcifications of eyes and basal ganglia (brain) -> risk for seizures
42
Q

whats used in the diagnosis of hypoparathyroidism

A
  • EEG
  • labs
  • CT of head
43
Q

whats included in medical/nursing management of hypoparathyroidism

A
  • 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

adults (51 decks)

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