Thyroid Study Guide Flashcards
When performing a physical examination of the thyroid gland, precautions are taken in performing the correct technique because palpation can result in:
An exacerbation of symptoms by releasing additional thyroid hormone
What is the hallmark finding of hyperthyroidism
Heat intolerance
What is one of the first signals of hyperthyroidism that is often noticed by a client?
Vision changes or tiring of the eyes
The clinical manifestation resulting from an increase in thyroid hormone production is known as?
Thyrotoxicosis
What is the most common cause of hyperthyroidism?
Graves’ disease
What is exophthalmos?
Abnormal protrusion of the eye
Hat is pretibial myxedema?
Dry waxy swelling of front surface of lower extremities
What is eyelid retraction?
“Lid lag” - upper lid fails to descend when client gazes slowly downward
What is globe lag aka eyeball lag?
Upper lid pulls back faster than the eyeball when client gazes up
What interventions would a nurse teach a client to perform to help with dry eyes associated with exophalmus?
Take the eyes closed with non-allergenic tape
What is a thyroid storm?
An extreme state of hyperthyroidism that is life threatening
Comes on quickly and occurs in clients who are uncontrolled
What triggers a thyroid storm?
Stressors such as trauma, infection, DKA, pregnancy, vigorous palpation of goiter
what clinical manifestations would a nurse expect on assessment for a pt who is having a thyroid storm?
Fever
Tachycardia
Systolic HTN
N/V/D
Abnormal pain
Anxiety
Tremors
Restless
Confusion
Psychosis
Seizures
Coma
Mortality 25% even with treatment
Two priority problems for a patient with thyroid storm
Decreased cardiac output due to tachycardia
Hyperthermia
Interventions for decreased cardiac output
ABC’s:
Ventilation
O2 sat
VS
ECG
Teach to report chest pain or palpation
Avoid antithyroid drugs
Interventions for hyperthermia
Antipyretics
Cooling blanket
Frequent linen changes
Sponge baths
Rest
Quiet environment
Management of a client with hyperthyroidism involves:
Blocking the effect of excessive thyroid secretion
Treating the S/S the client experiences
Establishing euthyroid function
Function of tapazole
Prevents formation of new thyroid hormone by inhibiting binding of iodide
Adverse effects of tapazole
Hypothyroidism
Birth defects
Increased risk of infection
nursing implications for tapazole
Teach to take q8h
Remind women to notify HCP of pregnancy
Avoid crowds and people who are ill
Action of PTU
Inhibits thyroid binding with iodide
Prevents conversion of T4 to T3
Adverse effects of PTU
Hypothyroidism
Liver toxicity
Increased risk of infection
Nursing implications for PTU
Teach to take q8h
Report dark urine, jaundice, easy bruising
Check for weight gain, bradycardia, cold intolerance
Avoid crowds and people who are ill
Action of iodine preparations
Inhibitors thyroid release and resolves CV and other manifestations of hyperthyroidism
Not intended for long term therapy
Adverse effects of iodine preparations
Toxicity
Nursing implications for iodine preparations (symptoms of toxicity)
Check for fever, rash, sore throat, metal taste, mouth sores, GI distress
Action of lithium carbonate
Temporarily inhibits release of thyroid hormone
Adverse effects of lithium carbonate
Hypothyroidism
DI
N/V
Nursing implications of lithium carbonate
Drink 3-4 quarts of fluid per day
Check for weight gain, bradycardia, cold intolerance
Action of beta blocking agents (inderal)
Relieves tachycardia and anxiety
Adverse effects of beta blocking agents
Hypotension
Bradycardia
Fatigue
Depression
Nursing implications for beta blocking agents
Only temporary until definitive therapy takes effect
Radioactive iodine actions
Destroys thyroid tissue
Adverse effects of radioactive iodine
Hypothyroidism
Nursing implications for radioactive iodine
No special radiation precautions
Preoperative instructions for patients having thyroid surgery
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
Items that should be available for a patient post op
Tracheostomy equipment
Calcium Gluconate or calcium chloride for IV administration
Oxygen and suction equipment
Why does trach equipment need to be available for a pt post op?
Respiratory distress secondary to swelling or tetany
Laryngeal stridor is heard in respiratory assessment
Why does calcium gluconate or calcium chloride for IV admin need to be ready for a client post op?
For Hypocalcemia and tetany - tingling around mouth, toes and fingers, positive Trousseau and Chevosteks
Why does oxygen and suction equipment need to be available for a pt post op?
For respiratory distress/stridor
Tingling around the mouth and muscle twitching are symptoms of what?
Hypocalcemia, parathyroid gland injury
Assessment findings that may indicate laryngeal nerve damage. What would you tell the pt?
Hoarseness and weak voice
Reassure them that this is usually temporary and that you will assess q2h
What is the hallmark finding of hypothyroidism?
Fatigue
Possible causes of decreased synthesis of thyroid hormones
Most common = thyroid surgery and RAI
Iodine insufficiency
Interventions to teach a pt with hypothyroidism for constipation and dry, rough skin
High fiber and fluids
Taking replacement hormones as prescribed
Lotion after bath
Which condition is a life-threatening emergency and serious complication of untreated/poorly treated hypothyroidism?
Myxedema coma
With correction of hypothyroidism with thyroid hormone, a pt can expect improvement in mental awareness within ho long?
2 weeks
3 common problems for a pt with hypothyroidism
- Ineffective breathing patterns due to decreased energy, obesity, inactivity
- Decreased cardiac output due to bradycardia
- Disturbed thought process related to cerebral edema
Nursing interventions for a pt with ineffective breathing patterns bc of hypothyroidism
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
Nursing interventions for a pt with hypothyroidism who has decreased cardiac output
Montior VS, UOP, LOC, check pain, O2 sat
*Administer thyroid hormones to correct the cause
Nursing interventions for a pt with hypothyroidism cerebral edema
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
What would a nurse teach a client receiving thyroid hormone replacement therapy?
- 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
Things that may cause a myxedema coma?
Rapid withdrawal of thyroid medication
Untreated hypothyroidism
Surgery
How does parathyroid hormone (PTH) and calcitonin maintain the serum calcium levels?
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
Effect of parathyroid hormone production on serum calcium levels
Raises them
Effect of calcitonin production on serum calcium levels
Lowers them
Parathyroid hormone and calcitonin regulate the circulation blood levels of?
Calcium levels
Phosphate
What does a positive Trousseau’s or Chvostek’s sign indicate?
Done on pts with hypoparathyroidism
Indicated Hypocalcemia
Which food should a client with hypoparathyroidism avoid?
Milk
Muscle spasms in a pt with hypoparathyroidism are an clinical manifestation of?
Tetany
Chronic renal disease can cause which parathyroid disorder?
Hyperparathyroidism
Vitamin D deficiency can cause which parathyroid disorder?
Hyperparathyroidism
Removal of the thyroid gland can cause which parathyroid disorder?
Hypoparathyroidism
Neck trauma can cause which parathyroid disorder?
Hyperparathyroidism
A parathyroidectomy can cause which parathyroid disorder?
Hypoparathyroidism
Carcinoma of the lung, kidney, or GI tract producing PTH-like substance can cause which parathyroid disorder?
Hyperparathyroidism
Most common initial treatment in a client with Hyperparathyroidism and high levels of serum calcium?
Force fluids (IV or PO) and administer Lasix
Post op nursing care for parathyroidectomy may need emergency intervention for?
Hypocalcemia
Four medications that are frequently used to treat hypoparathyroidism
Ca chloride
Ca gluconate
Calcitrol (Rocaltrol)
Mg sulfate IV or IM
Discharge planning for a client who has hypoparathyroidism should include:
Reinforcing that prescribed meds must be taken for life
Teaching client to eat food high in calcium but low in phosphorous
