Week 1 - Thyroid Disorders Flashcards
what is the fnxn of the thyroid gland
- produces hormones (T3 and T4) that regulate energy, metabolism, growth, and development
what is hyperthyroidism
- condition caused by having too much thyroid hormone
what does excess thyroid hormone in hyperthyroidism cause (2)
- increased metabolism
- increased tissue sensitivity to stimulation by the sympathetic nervous system
what might you find upon assessment of the thyroid gland during hyperthyroidism
- enlarged thyroid gland –> goitre
what effect does hyperthyroidism have on the eyes
- bulging eyes = exophthalamus
what effect does hyperthyroidism have on the musculoskeletal system (5)
- muscle wasting
- weight loss
- muscle weakness
- fatigue
- dependent/localized edema
what effect does hyperthyroidism have on the GI tract (4)
- increased appetite
- increased thirst
- increased peristalsis = diarrhea
- increased bowel sounds
what effect does hyperthyroidism have on the cardio system (4)
- systolic HTN
- tachycardia
- dysrhythmias
- palpitations
what effect does hyperthyroidism have on the resp system
- increased resp rate
what effect does hyperthyroidism have on the integumentary system (7)
- warm, smooth, moist skin
- finger clubbing
- fine, straight hair
- hair loss
- thin, brittle nails
- diaphoresis
- facial flushing
what effect does hyperthyroidism have on the nervous system (5)
- tremors
- insomnia
- irritability & agitation
- nervousness
- depression
what effect does hyperthyroidism have on the reproductive system (3)
- menstrual changes
- amenorrhea
- decreased libido
what effect does hyperthyroidism have temp regulation
- causes heat intolerance
what is a complication of hyperthyroidism
- thyroid storm/thyrotoxic crisis
what is a thyroid storm
- an acute, rare condition where all hyperthyroid manifestations are intensified
what are manifestations of thyroid storm (7)
- tachycardia
- heart failure
- shock
- hyperthermia
- coma
- seizures
- agitation & restlessness
how can hyperthyroidism be diagnosed (3)
- decreased TSH lvls
- elevated T4
- elevated T3
describe the type of diet someone w hyperthyroidism would be on (4)
- high cal
- high protein
- avoid GI stimulating foods
- high carbs
how many cal per day should a person w hyperthyroidism have? why?
- 4000-5000 cal/day
- for hunger and prevention of tissue breakdown
how much protein should someone w hyperthyroidism have per day
- 1-2 g per kg of ideal body weight
what are some GI stimulating foods someone w hyperthyroidism avoid (3)? why should they avoid this
- caffeine
- spices
- high fibre foods
- avoid bc the GI tract is already hyperactive
what is the overall goal of treatment for hyperthyroidism (2)
- block the adverse effects of thyroid hormones
- and stop their over-secretion
what are the 3 primary treatments for hyperthyroidism
- drug therapy
- radioactive iodine therapy
- surgery
what are 3 types of drugs used for hyperthyroidism
- antithyroid meds
- iodine
- beta blockers
what is a type of antithyroid med
- methimazole (tapazole)
what is methimazole (tapazole)
- drug that suppresses thyroxine production
describe the response of a pt w hyperthyroidism to methimazole (tapazole)
- individual response varies
- improvement typically begins 1-2 weeks after initiation of therapy
- good results within 4-8 weeks `
what fnxn does iodine have in treatment of hyperthyroidism (2)
- rapidly inhibits production of T3 and T4 & blocks its release into circulation
- decreases the vascularity of the thyroid gland = safer and easier surgery
when is iodine used for hyperthyroidism (2)
- treatment of thyroid crisis
- prep for surgery
why are beta blockers used for treatment of hyperthyroidism
- for symptomatic relief of thyrotoxicosis that results from increased beta receptor simultaion caused by excess thyroid hormone
what kind of symptoms do beta blockers help block (4)
- palpitations
- increased HR
- tremors
- agitation
what is a type of beta blocker used for hyperthyroidism
- propranolol (inderal)
why is radioactive iodine used for treatment of hyperthyroidism
- it damages/destroys thyroid tissue = limits thyroid hormone secretion
who can radioactive iodine not be used in
- pregnant or nursing women
how is radioactive iodine taken
- in a drink or capsule
what is something to monitor in pts taking radioactive iodine
- signs of hypothyroidism
what is the preferred method of treatment for nonpregnant adults w hyperthyroidism
- radioactive iodine
what 2 types of surgery can be done for hyperthyroidism
- thyroidectomy
- subtotal thyroidectomy
when is surgery done for a pt with hyperthyroidism
- if drug therapy and radioactive iodine is not working
- if a large goitre is compressing the trachea
what is a subtotal thyroidectomy
- removal of a significant portion (90%) of the thyroid gland
what happens if too much tissue is taken during a thyroidectomy?
- the gland does not regenerate after surgery = hypothyroidism
describe pre-op care for someone with hyperthyroidism
- iodine is administered bc pt must be euthyroid prior, and to reduce risk of hemorrhage
what are some potential post-op complications during a thyroidectomy (5)
- hypothyroidism
- damage to or inadvertent removal of parathyroid glands = hypoparathyroidism & hypocalcemia
- hemorrhage
- infection
- thyrotoxic crisis
what should a nurse assess/ monitor post-op for a pt who got thyroidectomy (4)
- airway
- voice –> may be hoarse bc of location
- ambulate same day
- pain control
how can the nurse avoid stress on the sutures and sugrical site after a thyroidectomy (2)
- keep HOB elevated and head supported
why is it important for a nurse to assess airway after thyroidectomy
- bc thyroid is by the trachea
- assess for swelling and hemorrhage
what lvls should be monitored post-thyroidectomy (2)
- calcium
- thyroid
why should calcium be monitored post-thyroidectomy
- if the parathyroid was involved they could get hypocalcemia
what is a sign of hypocalcemia
- tetany
describe a pt’s diet post-thyroidectomy (3)
- reduced caloric intake
- fluids right away
- soft foods post op day 1
list what should be discussed during discharge teaching after a thyroidectomy (3)
- lifelong follow up appointments for thyroid lvls
- nutrition
- avoid high temps
if a pt had a subtotal thyroidectomy, describe what their follow ups will be like
- will require close monitoring for thyroid lvls
if a pt had a total thyroidectomy, describe what their follows up will be lik
- will need lifelong thyroid replacement therapy
list what to tell a pt during discharge teaching after a thyroidectomy regarding nutrition & exercise (3)
- need to reduce cal
- need regular exercise
- need iodine or iodized salt
why does a pt need regular exercise post-thyroidectomy
- to stimulate the thyroid gland and avoid weight gain
what is a good source of iodine for pts post-thyroidectomy? how often should they eat theis
seafood –> 1-2 x/week
why is iodine imp in their diet after a thyroidectomy
- important for thyroid fnxn
why should a pt should avoid high temps post-thyroidectomy
- can inhibit thyroid function
what is hypothyroidism
- condition resulting from insufficient thyroid hormone
= slowing of body processes & metabolism
what can cause hypothyroidism (4)
- destruction of thyroid tissue
- defective hormone synthesis
- iodine deficiency
- post thyroidectomy
other causes in textbook
what effect does hypothyroidism have on the cardio system (5)
- bradycardia
- cardiac complications (heart failure, angina, MI)
- decreased rate & force of cardiac contractions
- varied changes in BP
- decreased CO
what effect does hypothyroidism have on the resp system (2)
- dyspnea
- decreased breathing capacity
what effect does hypothyroidism have on the GI tract (6)
- decreased appeitie
- NV
- weight gain
- constipation
- distended abdomen
- enlarged, scaly tongue
what effect does hypothyroidism have on the integumentary system (7)
- dry, course, scaly, thick, cold skin
- thick, brittle nails
- dry, sparse, coarse hair
- hair loss – receding hairline
- facial and eyelid edema (puffy face)
- decreased sweating
- pallor
what effect does hypothyroidism have on the musculoskeletal system (5)
- fatigue
- weakness
- slow movements
- muscle aches & pains
- arthalgia
what effect does hypothyroidism have on the nervous system (7)
- fatigue
- slowed mental processes
- forgetfulness
- slow, slurred speech
- depression & anxiety
- stupor, coma
- decreased initiative
what effect does hypothyroidism have on the reproductive system (1)
- menstrual disturbances
how does hypothyroidism impact temp regulation
- causes intolerance of cold
what does hypothyroidism cause increased sensitivity to (3)
- narcotics
- barbituates
- anasthetics
what effect does hypothyroidism have on the hematological system (5)
- anemia
- low or normal erythropoietin
- low hematocrit
- decreased O2 demand
- bruise easily
what is myxedema
- swelling of the skin & soft tissue that occurs in people w hypothyroidism
what characteristics does myxedema cause (3)
- puffiness
- periorbital edema
- masklike affect
what is a complication of hypothyroidism
- myxedema coma
what is myxedema coma
- medical emergency
- when the sluggishness, drowsiness, and lethargy of hypothyroidism progress gradually or suddenly to a notable impairment of consciosness or coma
what can precipitate myxedema coma (3)
- infection
- exposure to cold
- trauma
what is myxedema coma characterized by (3)
- subnormal temp –> hypothermia
- hypotension
- hypoventilation
how can hypothyroidism be diagnosed (5)
- thyroid hormone lvls
- TRH stimulation test
- elevated cholestrol & triglycerides
- anemia
- increased creatine kinase lvls
what is the goal of treatment for hypothyroidism
- restore a euthyroid state safely & rapidly
what kind of diet is a pt with hypothyroidism on? why?
- low calorie diet to promote weight loss
what is used to treat hypothyroidism
- hormone replacement therapy
what is the drug of choice for hypothyroidism
- levothyroxine (synthroid)
what is the fnxn of levothyroxine
- thyroid supplement
how long does a pt have to be on levothyroxine
- typically lifelong
how often is the dose of levothyroxine adjusted
- every 4-6 weeks based on pt’s response (side effects and lab findings)
what is the treatment for myxedema coma (5)
- oxygen
- VS
- support
- cardiac monitoring
- IV thyroid hormone replacement
what should be discussed during pt teaching for a pt w hypothyroidism (5)
- need for lifetime thyroid replacement therapy
- comfortable warm enviro
- prevent skin breakdown
- avoid sedatives
- minimize constipation
how can a pt w hypothyroidism avoid skin breakdown
- use soap sparingly
- apply lotion to dry skin
why should a pt with hypothyroidism avoid sedatives
- bc already lethargic
how can we teach a pt to minimize constipation (2)
- high fibre diet
- stool softeners
a pt with hyperthyroidism experience activity intolerance due to weakness, fatigue, and exertional dyspnea.
what nursing interventions will help the pt achieve a program of activity that balances physical activity w energy-conserving activities, and help the pt report increased activity tolerance (7)
- monitor pt for evidence of excess physical and emotional fatigue
- monitor cardioresp response to activity
- assist w regular physical activities
- assist the pt to unnderstand energy conservation principles
- assist the pt in scheduling rest periods
- avoid care activities during scheduled rest periods
a pt with hyperthyroidism can experience imbalanced nutrition, where it is less than body requirements.
what nursing interventions can help the pt maintain weight approp for height, consume food and fluid adequate to meet needs, and correct nutritional deficiencies (8)
- determine, w dietician, number of cals and type of nutrients needed
- determine pt’s food preferences
- adjust diet as necessary (high protein, high cal)
- offer nutrient-dense snacks
- monitor calorie and dietary intake
- monitor weight gain and loss
- instruct pt about nutritional needs
- assist pt in accessing community nutritional programs
a pt with hypothyroidism may become overweight.
what nursing interventions can help the pt attain the weight appropriate for their height, and maintain caloric intake that meets nutritional needs (5)
- discuss w pt the medical conditions that may affect weight
- discuss w pt the relationship between food intake, exercise, weight gain, and weight loss
- determine pt’s ideal body weight
- assist in developing a well-balanced meal plan consistent w energy expenditure
- develop w the pt a method to keep a daily record of intake, exercise, changes in body weight
what nuritional management can be used for a pt with hypothyroidism (4)
- determine, w dietician, number of cals and types of nutrients needed to meet nutrition requirements
- instruct pt about nutritional needs
- monitor calorie and dietary intake
- monitor trends in weight gain & loss
a pt with hypothyroidism is at risk for constipation.
what nursing interventions can help the pt experience regular, soft formed stools that are easy to pass (5)
- encourage increased fluid intake
- instruct pt & family on high fibre diet
- monitor bowel movements –> frequency, consistency, shape, volume, color
- suggest use of laxatives/stool softeners
- teach pt & family about timeframe for resolution of constipation (it will improve w treatment of hypothyroidism)
a pt with hypothyroidism will experience fatigue.
what nursing interventions will help the pt participate in ADLs with minimal discomfort & fatigue, and report increased energy and endurance
- assess pt’s physiological status for deficits resulting in fatigue
- monitor pt for evidence of excess physical and emotional fatigue
- monitor cardioresp response to activity
- encourage alternate rest & activity periods
- teach activity organization & time management to prevent fatigue
- promote bed rest & activity limitation (increase # of rest periods)
- monitor & record pt’s sleep pattern & number of sleep hours
how can we pevent eye injury in hyperthyroidism (6)
- keep pt upright to reduce swelling
- cool, quiet room
- artificial tears
- salt restriction (reduce swelling)
- dark glassess
- if eyes cant close at night, tape shut
