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Critical Care > Thyroid Study Guide > Flashcards

Thyroid Study Guide Flashcards

1
Q

When performing a physical examination of the thyroid gland, precautions are taken in performing the correct technique because palpation can result in:

A

An exacerbation of symptoms by releasing additional thyroid hormone

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2
Q

What is the hallmark finding of hyperthyroidism

A

Heat intolerance

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3
Q

What is one of the first signals of hyperthyroidism that is often noticed by a client?

A

Vision changes or tiring of the eyes

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4
Q

The clinical manifestation resulting from an increase in thyroid hormone production is known as?

A

Thyrotoxicosis

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5
Q

What is the most common cause of hyperthyroidism?

A

Graves’ disease

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6
Q

What is exophthalmos?

A

Abnormal protrusion of the eye

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7
Q

Hat is pretibial myxedema?

A

Dry waxy swelling of front surface of lower extremities

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8
Q

What is eyelid retraction?

A

“Lid lag” - upper lid fails to descend when client gazes slowly downward

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9
Q

What is globe lag aka eyeball lag?

A

Upper lid pulls back faster than the eyeball when client gazes up

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10
Q

What interventions would a nurse teach a client to perform to help with dry eyes associated with exophalmus?

A

Take the eyes closed with non-allergenic tape

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11
Q

What is a thyroid storm?

A

An extreme state of hyperthyroidism that is life threatening
Comes on quickly and occurs in clients who are uncontrolled

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12
Q

What triggers a thyroid storm?

A

Stressors such as trauma, infection, DKA, pregnancy, vigorous palpation of goiter

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13
Q

what clinical manifestations would a nurse expect on assessment for a pt who is having a thyroid storm?

A

Fever
Tachycardia
Systolic HTN
N/V/D
Abnormal pain
Anxiety
Tremors
Restless
Confusion
Psychosis
Seizures
Coma
Mortality 25% even with treatment

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14
Q

Two priority problems for a patient with thyroid storm

A

Decreased cardiac output due to tachycardia
Hyperthermia

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15
Q

Interventions for decreased cardiac output

A

ABC’s:
Ventilation
O2 sat
VS
ECG
Teach to report chest pain or palpation
Avoid antithyroid drugs

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16
Q

Interventions for hyperthermia

A

Antipyretics
Cooling blanket
Frequent linen changes
Sponge baths
Rest
Quiet environment

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17
Q

Management of a client with hyperthyroidism involves:

A

Blocking the effect of excessive thyroid secretion
Treating the S/S the client experiences
Establishing euthyroid function

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18
Q

Function of tapazole

A

Prevents formation of new thyroid hormone by inhibiting binding of iodide

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19
Q

Adverse effects of tapazole

A

Hypothyroidism
Birth defects
Increased risk of infection

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20
Q

nursing implications for tapazole

A

Teach to take q8h
Remind women to notify HCP of pregnancy
Avoid crowds and people who are ill

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21
Q

Action of PTU

A

Inhibits thyroid binding with iodide
Prevents conversion of T4 to T3

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22
Q

Adverse effects of PTU

A

Hypothyroidism
Liver toxicity
Increased risk of infection

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23
Q

Nursing implications for PTU

A

Teach to take q8h
Report dark urine, jaundice, easy bruising
Check for weight gain, bradycardia, cold intolerance
Avoid crowds and people who are ill

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24
Q

Action of iodine preparations

A

Inhibitors thyroid release and resolves CV and other manifestations of hyperthyroidism
Not intended for long term therapy

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25
Q

Adverse effects of iodine preparations

A

Toxicity

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26
Q

Nursing implications for iodine preparations (symptoms of toxicity)

A

Check for fever, rash, sore throat, metal taste, mouth sores, GI distress

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27
Q

Action of lithium carbonate

A

Temporarily inhibits release of thyroid hormone

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28
Q

Adverse effects of lithium carbonate

A

Hypothyroidism
DI
N/V

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29
Q

Nursing implications of lithium carbonate

A

Drink 3-4 quarts of fluid per day
Check for weight gain, bradycardia, cold intolerance

30
Q

Action of beta blocking agents (inderal)

A

Relieves tachycardia and anxiety

31
Q

Adverse effects of beta blocking agents

A

Hypotension
Bradycardia
Fatigue
Depression

32
Q

Nursing implications for beta blocking agents

A

Only temporary until definitive therapy takes effect

33
Q

Radioactive iodine actions

A

Destroys thyroid tissue

34
Q

Adverse effects of radioactive iodine

A

Hypothyroidism

35
Q

Nursing implications for radioactive iodine

A

No special radiation precautions

36
Q

Preoperative instructions for patients having thyroid surgery

A

Support head when turning
Hoarseness normal
Humidification/suction
Report Hypocalcemia symptoms
Drain

  • Teach moving and turning technique of manually supporting the head and avoiding neck extension to minimize strain on the suture line
  • Inform client that hoarseness for a few days after surgery is usually the result of a breathing tube used during surgery, but will be monitored with respiration and weakness of voice
  • Humidification of air may be helpful to promote expectoration of secretions, suctioning may also be used
  • Teach to report immediately any respiratory difficulty, tingling around lips or fingers, or muscular twitching
  • A drain may be present in the incision. All drainage and dressings will be closely monitored for 24 hours
37
Q

Items that should be available for a patient post op

A

Tracheostomy equipment
Calcium Gluconate or calcium chloride for IV administration
Oxygen and suction equipment

38
Q

Why does trach equipment need to be available for a pt post op?

A

Respiratory distress secondary to swelling or tetany
Laryngeal stridor is heard in respiratory assessment

39
Q

Why does calcium gluconate or calcium chloride for IV admin need to be ready for a client post op?

A

For Hypocalcemia and tetany - tingling around mouth, toes and fingers, positive Trousseau and Chevosteks

40
Q

Why does oxygen and suction equipment need to be available for a pt post op?

A

For respiratory distress/stridor

41
Q

Tingling around the mouth and muscle twitching are symptoms of what?

A

Hypocalcemia, parathyroid gland injury

42
Q

Assessment findings that may indicate laryngeal nerve damage. What would you tell the pt?

A

Hoarseness and weak voice
Reassure them that this is usually temporary and that you will assess q2h

43
Q

What is the hallmark finding of hypothyroidism?

A

Fatigue

44
Q

Possible causes of decreased synthesis of thyroid hormones

A

Most common = thyroid surgery and RAI
Iodine insufficiency

45
Q

Interventions to teach a pt with hypothyroidism for constipation and dry, rough skin

A

High fiber and fluids
Taking replacement hormones as prescribed
Lotion after bath

46
Q

Which condition is a life-threatening emergency and serious complication of untreated/poorly treated hypothyroidism?

A

Myxedema coma

47
Q

With correction of hypothyroidism with thyroid hormone, a pt can expect improvement in mental awareness within ho long?

A

2 weeks

48
Q

3 common problems for a pt with hypothyroidism

A
  • Ineffective breathing patterns due to decreased energy, obesity, inactivity
  • Decreased cardiac output due to bradycardia
  • Disturbed thought process related to cerebral edema
49
Q

Nursing interventions for a pt with ineffective breathing patterns bc of hypothyroidism

A

Monitor RR, rhythm, depth, breath sounds, sat
Report SpO2 < 90 and RR <10
Be prepared for intubation
Assist ventilation with ambu bag PRN with 100% FiO2
AVOID SEDATION

50
Q

Nursing interventions for a pt with hypothyroidism who has decreased cardiac output

A

Montior VS, UOP, LOC, check pain, O2 sat
*Administer thyroid hormones to correct the cause

51
Q

Nursing interventions for a pt with hypothyroidism cerebral edema

A

Monitor for change in LOC
Support pt and family, tell them symptoms should decrease in 2 weeks
Orient pt frequently
Explain procedures slowly and carefully
Provide safe environment

52
Q

What would a nurse teach a client receiving thyroid hormone replacement therapy?

A
  • Emphasize need for life long replacement therapy
  • Review S/S of increased/decreased thyroid function (this helps family know when to seek medical attention for possible dose adjustment)
  • Review side effects
  • Do NOT take OTC meds
  • Periodic check of blood level
  • Well balanced diet and adequate fiber and fluids
  • Medic alert bracelet
  • Adequate rest
53
Q

Things that may cause a myxedema coma?

A

Rapid withdrawal of thyroid medication
Untreated hypothyroidism
Surgery

54
Q

How does parathyroid hormone (PTH) and calcitonin maintain the serum calcium levels?

A

PTH hormones increase bone resorption (leads to demineralization)
Causes increased reabsorption in the kidney
Activates vitamin D, causing increased GI absorption
Calcitonin keeps calcium in the bone

55
Q

Effect of parathyroid hormone production on serum calcium levels

A

Raises them

56
Q

Effect of calcitonin production on serum calcium levels

A

Lowers them

57
Q

Parathyroid hormone and calcitonin regulate the circulation blood levels of?

A

Calcium levels
Phosphate

58
Q

What does a positive Trousseau’s or Chvostek’s sign indicate?

A

Done on pts with hypoparathyroidism
Indicated Hypocalcemia

59
Q

Which food should a client with hypoparathyroidism avoid?

A

Milk

60
Q

Muscle spasms in a pt with hypoparathyroidism are an clinical manifestation of?

A

Tetany

61
Q

Chronic renal disease can cause which parathyroid disorder?

A

Hyperparathyroidism

62
Q

Vitamin D deficiency can cause which parathyroid disorder?

A

Hyperparathyroidism

63
Q

Removal of the thyroid gland can cause which parathyroid disorder?

A

Hypoparathyroidism

64
Q

Neck trauma can cause which parathyroid disorder?

A

Hyperparathyroidism

65
Q

A parathyroidectomy can cause which parathyroid disorder?

A

Hypoparathyroidism

66
Q

Carcinoma of the lung, kidney, or GI tract producing PTH-like substance can cause which parathyroid disorder?

A

Hyperparathyroidism

67
Q

Most common initial treatment in a client with Hyperparathyroidism and high levels of serum calcium?

A

Force fluids (IV or PO) and administer Lasix

68
Q

Post op nursing care for parathyroidectomy may need emergency intervention for?

A

Hypocalcemia

69
Q

Four medications that are frequently used to treat hypoparathyroidism

A

Ca chloride
Ca gluconate
Calcitrol (Rocaltrol)
Mg sulfate IV or IM

70
Q

Discharge planning for a client who has hypoparathyroidism should include:

A

Reinforcing that prescribed meds must be taken for life
Teaching client to eat food high in calcium but low in phosphorous

Critical Care (35 decks)

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