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med surg 2 > Thyroid disease > Flashcards

Thyroid disease Flashcards

1
Q

Hyperthyroidism: Pathophysiology and etiology

A
  • caused by excessive delivery of TH
  • increased metabolic rate
  • heightens sympathetic nervous systems response
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2
Q

HYPERTHYROIDISM ETIOLOGY

A
  • autoimmune stimulation
  • excess secretion of thyroid -stimulating (TSH)
  • excessive intake of thyroid medications
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3
Q

HYPERTHROIDISM RISK FACTORS

A
  • women (10 times more likely )
  • Genetic factors
  • family history of graves disease
  • increased iodine intake
  • age 20-40 years in age
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4
Q

HYPERTHYROIDISM CLINICAL MANIFESTATIONS

A
  • increased appetite with weight loss
  • hypermotile bowels
  • heat intolerance, insomnia
  • palpitations
  • increased sweating
  • hair changes (hair loss, brittle)
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5
Q

THYROIDITIS

A
  • T4 and T3 levels initially elevated but over time become depressed
  • recovery may be complete in weeks or months
  • bacterial - treat with antibiotics or surgical drainage
  • NSAIDS - progressing to corticosteroids if needed
  • Propranolol or atenolol- may be used to treat cardiovascular symptoms R/T to hyperthyroid state
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6
Q

THYROID STORM ( THYROTOXIC CRSIS)

A
  • extreme state of hyperthyroidism
  • considered life threatening emergency, death rare when treatment started early

CLINICAL MANIFESTATIONS:
severe tachycardia, heart failure, shock, hyperthermia, restlessness, agitation, seizures, abdominal pain,N/V/D, delirium, and coma

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7
Q

THYROID STORM TREATMENT

A
  • decreased circulating thyroid hormone levels with drug therapy
  • managing respiratory distress
  • fever reduction
  • fluid replacement
  • elimination or management of the initiating stressor
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8
Q

EXCESS TSH STIMULATION

A
  • secondary form of hyperthyroidism - rare
  • caused by over production of TSH by the pituitary gland and usually stimulates the thyroid gland to produce excess of thyroid hormone.
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9
Q

DRUG THERAPY

A
  • Antithyroid Drugs
  • Iodine
  • Beta adrenergic blockers
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10
Q

RADIOACTIVE IODINE THERAPY

A
  • damages or destroys thyroid tissue
  • outpatient treatment-RAI given orally
  • radioactive iodine is low - no radiation precations needed
  • dryness and irritation of mouth and throat during treatment
  • high incident of post treatment hypothyroidism in 80%
    of cases
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11
Q

HYPERTHYROIDISM SURGERY

A
  • subtotal - leaves about 10% of thyroid gland and the remainder of gland will produce adequate TH
  • total- thyroid gland and patients will require lifelong hormone replacement
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12
Q

HYPERTHYROIDISM POST- OP COMPLICATIONS

A
  • hypothyroidism
  • hemorrhage
  • damage to parathyroid glands - hypocalcemia
  • injury laryngeal nerve -vocal cord paralysis
  • infection
  • respiratory distress
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13
Q

HYPERTHYROIDISM ASSESSMENT

A
  • health history
  • muscle strength , tremors
  • size of thyroid
  • eyes and vision
  • cardiovascular(Afib)
  • vital signs (inceased HR,BP,RR)
  • bruit over thyroid
  • integument (warm ,sweating)
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14
Q

HYPERTHYROIDISM NURSING DIAGNOSIS

A
  • decreased cardiac output
  • impaired comfort
  • impaired health maintenance
  • risk for infection
  • imbalanced nutrition- less than body requirements
  • disturbed body image
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15
Q

HYPERTHYROIDISM PLANNING

A
  • patient reports improvement
  • patient will describe situations requiring contact with the provider
  • patient explains how to take medications
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16
Q

HYPERTHYROIDISM EVALUATION

A
  • cardiac status will stabilize
  • regains or maintains visual acuity
  • takes in appropriate amount of calories per day
  • communicates feeling about changes in body image
  • explains importance of daily medication if required
17
Q

HYPOTHYROIDISM PATHOPYSIOLOGY AND ETIOLOGY

A
  • TH production decreases
  • thyroid gland enlarges in attempt to produce more hormone
  • hypothyroid state leads to myxedema
18
Q

HYPOTHYROIDISM ETIOLOGY

A

PRIMARY:
- defects in gland , loss of thyroid tissue, antithyroid medications, thyroiditis, endemic iodine deficiency

SECONDARY:

  • pituitary TSH deficiency or peripheral resistance to TH
  • medications can cause
  • common in women 30-60 years
19
Q

HYPOTHYROIDISM RISK FACTORS

A
  • more common in women older than 50 years
  • relatives with autoimmune disorders
  • history of thyroid surgery
  • radiation of neck
  • iodine deficiency
  • hashimoto thyroiditis
20
Q

HYPOTHYROIDISM

A
  • hashimoto thyroiditis
  • common cause of goiter and primary hypothyroidism
  • autoimmune disorder- AB destroy tissue
21
Q

HYPOTHYROIDISM CLINICAL MANIFESTATIONS

A
  • slow onset
  • goiter
  • fluid retention and edema
  • decreased appetite, weight gain
  • constipation
  • dry skin
  • dyspnea
  • slow HR
  • menstrual problems
  • pallor
  • anemia
  • cardiac enlargement
  • abnormalities in lipid metabolism
  • decreased taste, smell
  • muscle stiffness
22
Q

MYXEDEMA COMA

A
  • untreated hypothyroidism triggered by factors
  • life threatening
  • severe metabolic disorder
  • precipitated by: trauma, CNS depressants, failure to take medications, infection, exposure to cold
23
Q

PHARMOCOLOGIC THERAPY FOR HYPOTHYROIDISM

A

-levothyroxine(senthroid)

24
Q

HYPOTHYROIDISM

A

HEALTH HISTORY:

  • onset, severity of symptoms
  • diet, use of ionized salt
  • pituitary diseases (secondary hypothyroidism)
  • treatment of hyperthyroidism

PHYSICAL ASSESSMENT:

  • muscle strength, deep tendon reflexes(decreased)
  • vital signs, cardiovascular, integument (decreased)
  • thyroid gland, weight
25
Q

HYPOTHYROIDISM NURSING DIAGNOSIS

A
  • decreased cardiac output
  • constipation
  • risk for impaired skin integrity
  • impaired body image
  • impaired nutrition
  • fatigue, fall risk
26
Q

HYPOTHYROIDISM PLANNING

A
  • pulse and BP
  • arrhythmias controlled
  • skin remains intact, warm and dry
  • free of edema
  • activities resumed with normal heart rate
  • elimination pattern returns to normal
27
Q

HYPOTHYROIDISM IMPLEMENTATION

A
  • monitor cardiac output
  • monitor BP,apical, peripheral pulses
  • monitor respiratory rate, breath sounds(crackles)
  • avoid becoming chilled
  • explain need to alternate periods of rest/activity
  • prevent constipation
  • encourage fluid intake 2000ml /day
  • high fiber diet
  • increase activity
28
Q

HYPOTHYROIDISM EVALUATION

A
  • determine whether patient has met expectations
  • make changes to care plan if not
  • repeat diagnostic tests to ensure proper medication level
29
Q

HYPOTHYROIDISM NURSING CONSIDERATIONS

A

maintain skin integrity

  • monitor skin for redness, lesions
  • provide and teach immobile patients measures to promote circulation
  • implement ROM exercises
  • provide and teach patient to maintain skin integrity
30
Q

WHAT IS THE THYROID

A

-small saddle shaped gland that wraps around the anterior portion of the trachea

PRIMARILY EFFECTS:
metabolism 
cardiovascular
gastrointestinal
neuromuscular
31
Q

DIAGNOSTIC TESTS

A
  • thyroid antibodies (TA) test
  • TSH test (sensitivity)
  • T4
  • T3
  • T3 uptake test
  • RAI uptake test (thyroid scan )
  • thyroid suppression test
32
Q

GRAVES DISEASE

A
  • most common cause of hyperthyroidism
  • autoimmune disorder(presence of MG/PA)- antibody in serum binds to TSH receptors in thyroid follicles causing hyperfunction
  • enlarged thyroid gland (goiter)
  • manifestations of hyperthyroidism
33
Q

EXOPHTHALMOS

A
  • graves disease
  • eye pain
  • blurred vision
  • diplopia
  • lacrimation and photophobia
  • increased risk of corneal dryness, irritation and ulceration
34
Q

TOXIC MULTINODULAR GOITER

A
  • develops slowly, usually in women 60-70
  • no opthalmopathy nor dermopathy clinical manifestations
  • small, independently functioning nodules
35
Q

THYROIDITIS

A
  • subacute granulomatous-viral infection
  • acute thyroiditis- bacterial or fungal
  • acute disorder that may become chronic,resulting in a hypothyroid state as the repeated infections destroy the thyroid gland tissue
36
Q

THYROIDITIS TREATMENT

A
  • T4 and T3 levels initially elevated but over time become depressed
  • recovery may be complete in weeks or months
  • bacterial treat with antibiotics or surgical drainage
  • NSAIDS progressing to corticosteroids if needed
  • propranolol (inderal) and atenolol (Tenormin) may be used to treat cardiovascular symptoms r/t hyperthyroid state
37
Q

THYROID STORM TREATMENT

A
  • decrease circulating thyroid hormone levels with drug therapy
  • managing respiratory distress
  • fever reduction
  • fluid replacement
  • elimination or management of the initiating stressors
38
Q

HYPERTHYROIDISM POST-OP NURSING CARE

A
  • standard post op care protocols
  • assess patient for signs of hemorrhage or tracheal compression
  • place patient in semi-fowlers position and support the patients’s head with pillows
  • avoid flexion of the neck and tension on suture line
39
Q

HYPOTHYROIDISM NURSING CONSIDERATIONS

A
  • maintain skin integrity
  • provide and teach immobile patients measures to promote circulation
  • implement ROM exercises
  • provide and teach patient to maintain skin integrity

med surg 2 (17 decks)

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