Thyroid Disorder Flashcards
Hypothyroid Hyperthyroid
PROPYTHIOURACIL (PTU) -action of mediction -S/E? -Monitor for…??? -Evaluate for effectiveness?
*inhibits synthesis of thyroid hormone *Nausea, vomiting, drowsiness *Monitor for S/S of hyperthyroidism, Hypothyroidism and skin rash, or swollen lymph nodes *Evaluate a < in severity of symptoms of hyperthyroidism
S/S of synthroid toxicity
toxicity would present as S/S of Hyperthyroidism
- tachycardia
- feeling hot
- sweating
Nursing actions (4) for VISION changes (for hyperthyroidism)
*administer eye drops / ointment *provide eye patch or tape *encourage use of sunglasses *monitor visual acuity and lid closure
CAUSES / RISK FACTORS
HYPERTHYROIDISM
“TOXIC WOMEN <50 YRS USE TOO MUCH IODINE & SYNTHROID CAUSING TUMORS, THYROIDITIS AND GRAVES”
- TOXIC Nodular Goiter
- Women
- <50 yrs old
- excess iodine or synthroid
- tumors
- thyroiditis
- Graves Disease
Client is diagnosed with hypothyroiism…The nurse performs an assessment on the client, expecting to note which findings?
Select all that apply
- weight loss
- bradycardia
- hypotension
- dry, scaly skin
- heat intolerance
- decreased body temperature
2 , 3 , 4 , 6
Nursing Care
for
IMBALANCED BODY TEMPERATURE
(hypothermia)
- provide extra blankets
- avoid drafts, adjust room temperature
- no heating pads / electric blankets
- provide warm liquids to drink
- monitor temperature for decrease in baseline
management of MYXEDEMA COMA
“TGIF AEB Synthroid Weight” T-emps hourly (until stable) G-lucose I-and O F-luid replacement (0.9% sodium Chloride) A-irway patency E-CG monitoring B-lood gases (ie, hypoxia) S-ynthroid (via IV) W-eight (daily)
RISK FACTORS (CAUSES) OF HYPOTHYROIDISM (7)
“I Will Always Run Away, Thyroid Hormone” I-odine definciency W-omen A-ge >50 years old R-adiation therapy (head/neck) A-ntithyroid medication (toxicity) T-hyroidectomy H-ashimotos Disease (Autoimmune)
Labs for Hypothyroidism should look like this: T3 T4 TSH
T3 is decreased T4 is decreased TSH is elevated
Synthroid increases the effects of _________________
and can increase the need for _________ & _________
WARAFIN
INSULIN & DIGOXIN
Type of HYPOTHYROIDISM caused by dysfunctional Pituitary Gland
Secondary Hypothyroidism
Normal lab values for: T3 T4
T3 (80-200) T4 (4.5 11.5)
photophobia (light sensitivity)
(hyperthyroidism) or (hyperthyroidism)
hyper
PROPYLTHIOURACIL
- HOW DOES IT WORK?
- MOST COMMON DANGEROUS SIDE EFFECTS
- PATIENT TEACHING
- INHIBITS SYNTHESIS OF THYROID HORMONE
-
SIDE EFFECTS
- NAUSEA, VOMITING, DROWSINESS
- MANIFESTATIONS OF HYPOTHYROIDISM
- MONITOR CBC (LEUKOPENIA OR THROMBOCYTOPENIA)
- HEPATOTOXICITY
- sTEVENS JOHNSON SYNDROME
-
PATIENT TEACHING
- Take with meals-at regular intervals-in divided doses to maintain therapeutic level
- advise pt to report fever, sore throat, bruising, jaundice, rash to provider immediately
Nursing Care
for DECREASED
CARDIAC OUTPUT
(HYPOTHYROIDISM)
- Check blood pressure for hypotension
- Check for decrease apical and peripheral pulses
- Increase acitivity slowly (gradually increase demand on heart)
- Monitor for respiratory depression-check pulse ox and ABG
- Use sedatives with caution
- encourage coughing and deep breathing
The nurse provides medication instructions to a client who has been prescribed levothyroxine…
Select all that apply
- monitor your pulse rate
- take the medication in the morning
- Notify provider if chest pain occurs
- Take medication at the same time each day
- expect your pulse rate to be >100 bpm
- it may take 1-3 weeks for a full therapeutic effect to occurr
1 , 2 , 3 , 6
Patient education for Synthroid (4)
1) Don’t stop taking abruptly 2) take in the am without food 3) don’t take within 4 hours of GI meds (Carafate, simethicone) 4)monitor for S/S of hyperthyroidism (TOXICITY)
Nursing actions (4) for Altered Body Temperature (for hyperthyroidism)
*Adjust room temp *Cool bath *offer cool drinks *Monitor for fever…must report a 1 degree increase in temp.
Diagnostic Procedures
for
HYPERTHYROIDISM
LABS: T3 , T4, TSH
U/S..—used to produce imaged of thyroid gland
ECG —-Tachycardia or arrhythmia
Radioactive Iodine Uptake—elevated uptake indicative of hyperthyroidism
Nursing Care
for CONSTIPATION
- ENCOURAGE FLUIDS
- HIGH FIBER
- INCREASED MOBILITY AS TOLERATED
- ADMINISTER STOOL SOFTENER / LAXATIVE
- MONITOR BOWEL MOVEMENTS
when you have hyperthyroidism you should avoid ________ and food/supplements with _______
Salicylates Iodine
excessive tearing and bloodshot eyes
(hyperthyroidism) or (hyperthyroidism)
hyper
HYPERTHYROIDISM
what labs would be checked?
would the values be decreased or elevated?
T3 & T4 ===increased
Serum TSH = Elevated
Most common type of HYPOTHYROIDISM
PRIMARY HYPOTHYROIDISM **caused by dysfunctional Thyroid Gland
Thyroid can NOT make thyroid hormone without _______________
Iodine
Primary vs secondary thyroid disease?
Primary - this occurs when the thyroid doesn’t produce thyroid hormones Secondary—This occurs when the pituitary gland fails
exophthalmos
(hyperthyroidism) or (hyperthyroidism)
Hyper
TX for HYPOthyroidism
- thyroid hormone replacement (ie, synthroid Cytomel)
- Avoid sedatives & narcotics —b/c these patients are very sensitive to them and they increase the chances of myedema coma
“3” hormones produced by the thyroid
T3, T4, Calcitonin
Management of Thyroid Storm
- Maintain patent airway-Oxygen for high metabolic demand
- Cooling w/o ASA
- replace fluids, glucose, electrolytes
- continuous cardiac monitoring for dysrhythmias
- antithyroid medications-PTU
(4) important facts to know about Radioactive Iodine Therapy
* contraindicated in pregnancy * Thyroid gland takes up the “special iodine” * Thyroid cells are destroyed *Results in 6-8 weeks
S/S of Thyroid storm
H.H C.A.T H-Hypertension H-eartrate >130 C-onfusion A-bdominal pain-vomiting, Diarhea T-Temp >102
TRUE OR FALSE
a patient on synthroid should use Fiber laxatives to assist
with the constipation
FALSE
Fiber laxatives reduce absorption of the synthroid and should be avoided3
Assessment of Hyperthyroidism
patient
(CV) Hypertensive, Palpitations, Resting pulse rate 90-160,
S/S of HF (elderly)
(Sensory) Exopthalmos, photophobia, blurry vision, diplopia, corneal
irritation
(NEURO) Hyperactivity, Insomnia, Emotional Lability, Tremors
Nervousness, Heat w/diaphoresis
(INTEG) Flushed warm moist skin, fine-thin hair, Goiter
(GI) Weight loss despite increased intake, Hyperactive bowel
sounds, diarrhea
(REPRODUCTIVE) amenorrhea/infertility
impotence and decreased libido
Effects that Synthroid has on cardiac
-Arrhythmias -Tachycardia -Angina (OVERALL AN INCREASED CARDIOVASCULAR EFFECT)
Nursing actions (4) for Decreased Cardiac Output (for hyperthyroidism)
*TELEMETRY monitor for arrhythmias *Monitor VS for tachycardia, tachypnea and HTN *assess for activity intolerance, JVD, peripheral edema *balance activity and rest to decrease workload of heart
Tachycardia, palpitations, dysrhythmias
(hyperthyroidism) or (hyperthyroidism)
HYPER
_________ produces TSH
Pituitary gland
___________ treat sympathetic nervous system effects (ie, palpitations, tachycardia) by counteractiing the effects of increased thyroid hormones, but does NOT alter the levels of the hormones
Beta adrenergic blockers
(propranolol, atenolol, metoprolol)
complication of hyperthyroidism
Thyroid Storm
Interactions between Synthroid and “anti-ulcer” medications?
YES- it decreases absorption of Synthroid take >4 hours apart
a
Radioactive Iodine Therapy (RAI)
- what is it?
- Contraindications?
- CLIENT EDUCATION?
- nuclear medicine test that clarifies the size and function of thyroid gland. Thyroid cells take up iodine and are destroyed. Results in 6-8 weeks
- CONTRAINDICATIONS:
- PREGNANCY
- ALLERGY TO IODINE OR SHELLFISH
- RECENT USE OF CONTRAST MEDIA / ORAL CONTRACEPTIVES (CAUSE FALSELY ELEVATED SERUM THYROID LEVEL)
- ASA, CORTICOSTEROIDS, DILATION (CAUSE FALSE DECREASE IN SERUM THYROID LEVEL)
- CLIENT EDUCATION
- Advise client to avoid foods high in iodine for 1 week prior to test.
- suggest use of non-iodinized salt
- avoid fish, shellfish, meds containing iodine
Patient that has been treated with Radioactive iodine (RAI) may need to have ________ TH replacement therapy
lifelong
surgical removal or all or part of the thyroid gland
subtotal thyroidectomy—remove part of thyroid
total thyroidectomy —removal of entire thyroid
Interactions between Synthroid and Warfarin
YES- Synthroid increases the effects of the warfarin
blurred or double vision
(hyperthyroidism) or (hyperthyroidism)
HYPER
POST OP CARE OF THYROIDECTOMY (5)
*Semi-Fowlers position *pillows to support head/neck *Avoid neck extension *Assess for respiratory distress- hematoma *Assess for bleeding or sensation of pressure at incision site
TX PROTOCOL FOR MYXEDEMA COMA
T.G.I.F AG T-emp checks G-ases for Resp. Acidosis I-V Synthroid F-luid replacement A-irway management G-lucose (for hypoglycemia)
Assessment of HYPOTHYRODISM Patient
(CV) Hypotensive, Hypothermia, Hypoglycemia Edema (peripheral, periorbital) Elevated Triglycerides (MS) Muscle Stiffness, Fatigue (GI) Constipation, Weight Gain (Neuro) Slow Speech, Impaired memory Cold Intolerance (RESP) Pleural Effusion, Dyspnea (Integumentary) Dry Skin, Goiter, “Mask” like expression
BEFORE INITIATING PTU THERAPY
WHAT ARE THE LAB TEST CONSIDERATIONS?
tHYROID FUNCTION STUDIES SHOULD BE MONITORED:
- Prior to therapy
- monthly during therapy
- every 2-3 months throughout therapy
TX of Thyroid Storm
1) Vital signs- (tachycardic, Irregular HR, fever, HTN) 2) Maintain airway-o2 3) Tylenol and a cooling blanket 4) IV fluids with dextrose 5) Antithyroid meds (PTU)
Nursing actions (6) for < Nutrition (for hyperthyroidism(
*6 small meals / day *High calorie- High Protein *Avoid spicy food, caffeine, etoh *Fluid replacement *I &O, weight checks *Check electrolyte levels
Potential NURSING DX for
HYPOTHYROIDISM
- activity intolerance r/t to fatigue
- RIsk for imbalanced body temperature
- constipation r/t depressed bowel function
- Deficient knowledge of thyroid replacement therapy
- Decreased cardiac output
Diagnostic tests for hyperthyroidism
T3 & T4 === increased US and EKG===tachycardia / arrhythmia Radioiodine uptake and thyroid scan===elevated intake
GOITER
(hyperthyroidism) or (hyperthyroidism)
HYPER
S/S of Thyroid Storm
- Hyperthermia (Temp >102)
- HR (>130)
- Hypertension
- Abdominal pain, vomiting, diarrhea
- confusion, delirium, psychosis, seizures, tremors
Thyroid Storm management
*AntiThyroid meds (Tapazole) & (PTU) *Beta Blockers (Inderal / propranolol) *Radioactive Iodine Therapy *Thyroidectomy
hair thinning / loss of hair
(hyperthyroidism) or (hyperthyroidism)
hyper
