Thyroid Study Guide Flashcards by Katy Peterson

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

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What is the hallmark finding of hyperthyroidism

Heat intolerance

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

Vision changes or tiring of the eyes

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

Thyrotoxicosis

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What is the most common cause of hyperthyroidism?

Graves’ disease

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What is exophthalmos?

Abnormal protrusion of the eye

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Hat is pretibial myxedema?

Dry waxy swelling of front surface of lower extremities

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What is eyelid retraction?

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

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What is globe lag aka eyeball lag?

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

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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

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What is a thyroid storm?

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

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What triggers a thyroid storm?

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

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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

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Two priority problems for a patient with thyroid storm

Decreased cardiac output due to tachycardia
Hyperthermia

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Interventions for decreased cardiac output

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

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Interventions for hyperthermia

Antipyretics
Cooling blanket
Frequent linen changes
Sponge baths
Rest
Quiet environment

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Management of a client with hyperthyroidism involves:

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

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Function of tapazole

Prevents formation of new thyroid hormone by inhibiting binding of iodide

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Adverse effects of tapazole

Hypothyroidism
Birth defects
Increased risk of infection

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nursing implications for tapazole

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

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Action of PTU

Inhibits thyroid binding with iodide
Prevents conversion of T4 to T3

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Adverse effects of PTU

Hypothyroidism
Liver toxicity
Increased risk of infection

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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

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Action of iodine preparations

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

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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