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G240 Exam #4 > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

What hormones are secreted by the thyroid?

A
  • T4
  • T3
  • calcitonin
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2
Q

What is the thyroid gland palpated and inspected for? -4

A
  • Swelling
  • Asymmetry
  • Tenderness
  • Texture / Firmness
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3
Q

What does a tender thyroid mean?

A

thyroiditis

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4
Q

What does a soft textured thyroid mean?

A

grave’s disease

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5
Q

What does a firm thyroid mean?

A

hashimotos

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6
Q

TSH levels in hypo/hyperthyroidism

A

hypothyroidism=elevated

hyperthyroidism=decreased

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7
Q

T3, T4 levels in hypo/hyperthyroidism

A

hypo=decreased

hyper=increased

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8
Q

Iodine uptake levels in hypo/hyperthyroidism

A

hypo=decreased

hyper=increased

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9
Q

What is hypothyroidism?

A

deficient level of thyroid hormone

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10
Q

Who is more affected by hypothyroidism?

A

women are affect 5-8x more than men

occurs between 40-70 years old

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11
Q

Causes of hypothyroidism-6

A
  • Autoimmune thyroiditis (Hashimoto disease)  most common
  • Antithyroid medications
  • Occurs after thyroidectomy
  • Dysfunction of thyroid gland
  • Atrophy of thyroid gland due to aging
  • Radiation to head and neck
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12
Q

If enlargement of the gland is felt, the nurse can auscultate for bruit. What does it mean if they hear bruit?

A

hyperthyroidism

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13
Q

Common symptoms of hypothyroidism-8

A
  • Extreme fatigue
  • Hair loss
  • Brittle nails
  • Dry skin
  • Numbness / tingling of fingers
  • Hoarse / husky voice
  • Menstrual disturbances
  • Decreased libido
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14
Q

Severe symptoms of hypothyroidism-8

A
  • Low body temperature
  • Bradycardia
  • Weight gain, enlarged hands & feet
  • Thickened skin
  • Slowed speech
  • Altered mentation
  • Elevated cholesterol
  • Constipation
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15
Q

Medical management hypothyroidism-2

A

 Hormone replacement (levothyroxine)

 Monitor for cardiac dysfunction

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16
Q

What is hypothyroidism associated with?-3

A

elevated cholesterol, atherosclerosis, coronary artery disease

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17
Q

Which medications interact with hypothyroidism replacement therapy?

A

antacids, digitalis, anticoags, sedatives

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18
Q

How do antacids interfere with thyroid replacement?

A

o Decrease in absorption of thyroid hormones

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19
Q

How does digitalis interfere with thyroid replacement?

A

o Thyroid hormones decrease the effects of digitalis glycosides

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20
Q

How do anticoags interfere with thyroid replacement?

A

o Should be decreased when beginning thyroid replacement because of the increased risk of bleeding

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21
Q

How do sedatives interfere with thyroid replacement?

A

o May produce profound somnolence lasting longer than anticipated

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22
Q

nursing mangement- hypothyroidism- 5

A

 Monitor patients taking sedatives / analgesics
 Maintain normal body temperature
 Monitor for constipation
 Monitor for signs of altered mental status
 Educate patient on treatment regimen- lifelong hormone replacement

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23
Q

hypothyroidism nursing management-maintain normal body temp-4

A
  • Provide extra layer of clothing or blanket
  • Avoid use of external heat sources (heating blanket)
  • Monitor body temp
  • Protect from exposure to cold or drafts
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24
Q

hypothyroidism nursing management-constipation-4

A
  • Encourage increased fluid
  • Provide foods high in fiber
  • Encourage mobility
  • Encourage to use laxatives sparingly
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25
Q

hypothyroidism nursing management-educate patient on treatment-3

A
  • Explain reason for thyroid hormone
  • Describe desired effects
  • Assist to develop schedule
26
Q

potential complication of hypothyroidism

A

myxedema coma

27
Q

How does myxedema coma happen

A

prolonged hypothyroidism (occurs most often in older women in the cooler months)

28
Q

s/s myxedema coma-6

A
  • Decreased mental status
  • Hypothermia
  • Hypoglycemia
  • Precipitated by infection and use of sedatives / opioids
  • Decreased function in multiple organs
  • Progressive lethargy, stupor, and coma
29
Q

causes of hyperthyroidism-5

A
  • Graves disease
  • Toxic goiter
  • Toxic adenoma
  • Thyroiditis
  • Excessive ingestion of thyroid hormone
30
Q

Most common cause of hyperthyroidism

A

grave’s disease

31
Q

s/s graves disease

A
  • Bulging eyes

* Thick red skin to shin & tops of feet

32
Q

What is goiter?

A

abnormal enlargement of thyroid

33
Q

What can cause goiter?

A

lack of dietary iodine

34
Q

What can goiter affect?

A

swallowing/breathing

35
Q

clinical manifestations of hyperthyroidism-13

A 
	Nervousness / anxiety
	Hyperexcitable, can’t sit still
	Emotional / irritable
	Tachycardia / palpitations
	Warm, flushed skin
	Hand tremors
	Bulging eyes
	Increased appetite
	Weight loss
	Weakness
	Finger clubbing
	Menstrual changes
	Changes in bowel function
36
Q

Medical management hyperthyroidism-4

A

 Antithyroid medications (thionamides)
 Radioactive iodine
 Thyroidectomy
 Symptom management (beta blockers)

37
Q

radioactive iodine- (tx for, contraindications)

A
  • Most common form of treatment of Grave’s disease

* Contraindicated during pregnancy (Should not conceive for at least 6 months after treatment)

38
Q

Who can receive a thyroidectomy?

A

• Reserved for patients with obstructive symptoms, pregnant women in second trimester, and for patients that need a rapid normalization of thyroid function

39
Q

nursing management hyperthyroidism

A
  • assess nutritional status
  • monitor VS
  • monitor for emotional changes/anxiety
  • maintain normal body temp
40
Q

nursing management hyperthyroidism-nutritional status

A
  • Several, small meals

* Replace fluid lost through diarrhea

41
Q

nursing management hyperthyroidism-monitor for emotional changes/anxiety-

A
  • Stressful experiences should be minimized and a quiet, uncluttered environment should be maintained
  • Balance periods of activity with rest
42
Q

nursing management hyperthyroidism-maintain normal body temp

A
  • Cool, comfortable temperature

* Cool baths and cold fluids

43
Q

potential complications of hyperthyroidism

A

thyroid storm

44
Q

s/s thyroid storm

A
  • Fever > 101.3 F
  • Tachycardia > 130 bpm
  • Exaggerated symptoms of hyperthyroidism
  • Altered mental status
45
Q

what can cause a thyroid storm?-6

A

stress, infection, abrupt withdrawal of antithyroid meds, diabetic ketoacidosis, surgery, pregnancy

46
Q

What does parathormone do?

A

regulates calcium and phosphate metabolism

47
Q

Causes of hyperparathyroidism

A
  • Enlargement of one or more parathyroid gland

* Any disease that causes low Ca levels, resulting in increased production of parathormone

48
Q

What happens in hyperparathyroidism?

A

 Increased calcium absorption from kidney, intestines, bones- raises serum Ca level
 Results in bone decalcification and kidney stones
 Results in decreased serum phosphate levels

49
Q

clinical manifestations of hyperparathyroidism-12

A 
	Fatigue
	Muscle weakness
	Nausea
	Vomiting
	Constipation
	HTN
	Cardiac dysrhythmias
	Kidney stones
	Skeletal pain
	Pain with weight bearing
	Pathologic fractures
	Bone loss
50
Q

Medical management hyperparathyroidism-4

A

 Parathyroidectomy
 Hydration therapy- prevention of renal calcium
 Monitor dietary calcium
 Encourage patient mobility

51
Q

Medical management hyperparathyroidism-hydration therapy

A
  • At least 2000 mL

* Thiazide diuretics are avoided

52
Q

Medical management hyperparathyroidism-monitor dietary calcium

A

• Avoid diet with restricted or excessive amounts of calcium

53
Q

Medical management hyperparathyroidism-encourage patient mobility

A

• Bed rest increases calcium excretion and the risk of renal calculi

54
Q

potential complication of hyperparathyroidism

A

hypercalcemic crisis

55
Q

hypercalcemic crisis

A
  • Occurs with serum Ca levels > 13 mg/dL
  • Can cause life threatening neurologic, cardiovascular, kidney symptoms
  • Patient is given Calcitonin (Promotes renal excretion of excess Ca)
  • Patient is hydrated with large volumes of IV fluids
56
Q

hypoparathyroidism causes-4

A
  • abnormal parathyroid development
  • surgical removal of glands
  • thyroidectomy
  • vit D deficiency
57
Q

What happens to calcium and phosphate levels in hypoparathyroidism

A

 Results in increased serum phosphate levels & decreased serum calcium levels

58
Q

clinical manifestations of hypoparathyroidism-8

A 
	Tetany- intermittent muscular spasms
	Muscle cramping
	Numbness / tingling 
	Stiffness in hands and feet
	Dysphagia
	Photophobia
	Cardiac dysrhythmias
	Seizures
59
Q

Assessment and dx hypoparathyroidism

A

 Positive Chvostek or Trousseau sign indicate latent tetany
 Labs (Serum calcium, Serum phosphate)
 X-ray shows increased bone density

60
Q

Medical management hypoparathyroidism

A

 Increase serum calcium level to. 9-10 mg/dL
 If tetany occurs –> IV calcium gluconate, Provide non-stimulating environment
 Diet- high calcium, low phosphorus (Milk, milk products, and eggs are avoided due to high amounts of calcium)
 Monitor for respiratory distress
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G240 Exam #4 (7 decks)

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