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NURS 2003 > Week 8 > Flashcards

Week 8 Flashcards

1
Q

How many people out of 100 does hypothyroidism affect?

A

2

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2
Q

What is hypothyroidism a result of?

A

Insufficient circulating thyroid hormone.

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3
Q

What is primary hypothyroidism?

A

Related to the destruction of thyroid tissues or defective hormone synthesis.

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4
Q

What is secondary hypothyroidism?

A

Related to pituitary disease with decreased secretion of TSH or hypothalamic dysfunction with decreased secretion of thyrotropin-releasing hormone.

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5
Q

What is transient hypothyroidism?

A

Related to thyroiditis or discontinuation of thyroid hormone therapy.

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6
Q

What is the most common cause of hypothyroidism worldwide?

A

Iodine deficiency.

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7
Q

What is the most common cause of hypothyroidism in Canada?

A

Atrophy of the thyroid gland. The end result of Hashimotos and Graves Disease.

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8
Q

What treatments for hyperthyroidism can cause hypothyroidism?

A

Surgical removal of the thyroid gland, or radioactive iodine therapy.

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9
Q

what is cretinism?

A

Hypothyroidism that develops in infancy.

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10
Q

What is cretinism caused by?

A

Thyroid hormone deficiencies during fetal or early neonatal life. Infants in Canada are screened at birth.

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11
Q

What are the CM of hypothyroidism?

A 
MOM'S SO TIRED - C
Memory loss
Obesity
Malar flush/Menorrhagia
Slowness
Skin and hair dryness
Onset gradual
Tiredness
Intolerance to cold
Really low BP
Energy levels fall
Depression/delay in reflexes.
Constipation
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12
Q

How does hypothyroidism affect the cardiovascular system?

A

Associated with a decreased cardiac output, and decreased cardiac contractility. Client may experience low exercise tolerance and SOB on exertion.

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13
Q

What lab values decrease in someone with hypothyroidism?

A

Decrease in iron, erythropoietin, oxygen demand, low hematocrit cobalamin, and folate.

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14
Q

What lab values increase in someone with hypothyroidism?

A

Serum cholesterol and triglycerides result in atherosclerosis.

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15
Q

What is myxedema?

A

The accumulation of hydrophilic mucopolysaccharides in dermis and other tissues.

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16
Q

What is a myxedema coma?

A

A coma that is a result of mental and physical sluggishness. Can be precipitated by infections and drugs, exposure to cold, and trauma.

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17
Q

What are the characteristics of myxedema coma?

A

Subnormal temperature, hypotension, hypoventilation.

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18
Q

What are the diagnostic tests used for hypothyroidism?

A 
History and physical exam
Serum T3 and T4
Serum TSH and free T4 levels
Thyroid peroxidase antibodies
TRH stimulation test
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19
Q

What are some collaborative therapy interventions for hypothyroidism?

A

Monitoring thyroid hormone levels and adjustig dosage.
Nutritional therapy to promote weight loss.
Patient and caregiver teaching.
Thyroid hormone replacement.

20
Q

What are the goals for a client with hypothyroidism?

A

Experience relief from symptoms
Maintain euthyroid state
Maintain a positive self-image
Adhere to the lifelong regimen of thyroid replacement therapy.

21
Q

What are some important education points for clients and families for hypothyroidism?

A

Explain thyroid hormone deficiency and self-care
Emphasize the need for a warm comfortable environment.
Teach measures to prevent skin breakdown.
Avoid sedatives
Discuss ways to minimize constipation.

22
Q

what is diabetic ketoacidosis?

A

An acute metabolite complication of DM occuring when fats are metabolized in the absence of insulin.

23
Q

What are the characteristics of DKA?

A

Hyperglycemia, ketosis, metabolic acidosis, dehydration.

24
Q

What are precipitating factors of DKA?

A

Illness, infection, inadequate insulin dosage, insulin omission, undiagnosed 1 DM, poor self-management.

25
Q

What happens in DKA?

A

When the circulating supply of insulin is insufficient, glucose cannot be used for energy, so the body metabolizes fats instead.

26
Q

What are ketones?

A

Acidic by-products of fat metabolism that cause problems when they become excessive in the blood.

27
Q

What do ketones alter?

A

The blood’s pH. Causes metabolic acidosis.

28
Q

What is ketonuria?

A

The process that begins when ketones enter the urine.

29
Q

What happens when ketonuria begins?

A

The electrolytes become depleted as cations are eliminated along with anionic ketones to maintain balance in the body.

30
Q

How does insulin deficiency affect protein?

A

It impairs protein synthesis and causes excessive protein degeneration.

31
Q

What does insulin deficiency stimulate?

A

Stimulates the production of glucose from amino acids in the liver and leads to hyperglycemia.

32
Q

What happens if DKA is not treated?

A

It causes a severe depletion of sodium, potassium, chloride, magnesium, and phosphate.

33
Q

What does acidosis cause hydrogen ions to do?

A

It causes H+ ions to move from extracellular fluid to intracellular fluid. This promotes K+ movement out of the cell.

34
Q

What happens to the extracellular potassium as a result of the shift from DKA?

A

Most of it is lost in the urine because of osmotic diuresis. Serum K+ can appear normal or high, but this finding is misleading.

35
Q

What are the CM of DKA?

A

Polyuria, polydipsia, dehydration, lethargy, weakness, nausea, vomiting, Kussmaul’s respiration.

36
Q

What are the diagnostic tests for DKA?

A

History and physical
Blood studies: blood glucose, CBC, ketones, pH, electrolytes, blood urea nitrogen, arterial blood gases.
Urinalysis: specific gravity, pH, glucose, ketones.

37
Q

What is the collaborative therapy for DKA?

A

Admin: IV fluids, electrolyte replacement, short-acting insulin.
Assess and monitor: blood and urine for ketones, glucose levels, vitals, mental status, ECG, intake and output.

38
Q

What organs are involved in the thyroid hormone feedback loop?

A

Hypothalamus, Anterior Pituitary Gland, Thyroid Gland.

39
Q

What hormones are involved in the thyroid hormone feedback loop?

A

Thyrotropin-releasing hormone (TRH), thyroid-stimulating hormone (TSH), tri-iodothyronine (T3), thyroxine (T4).

40
Q

What does the thyroid do?

A

Processes iodine and produce T3 and T4.

41
Q

Explain the thyroid feedback loop.

A

Stimuli triggers the hypothalamus (controls thermostate) which releases TRH, this stimulates the anterior pituitary gland, which triggers TSH. This stimulates the thyroid gland, which triggers a release of T3 and T4, which circle back to the hypothalamus and pituitary gland to stop the release of TRH and TSH.

42
Q

Describe the pathogenesis of hypothyroidism?

A

If the thyroid gland fails, the anterior pituitary gland will secrete TSH to try and get it to work. This causes the TSH level to be super high. Due to insufficient T3 and T4, the body will keep releasing TSH.

43
Q

What is acetoacetate?

A

Made in liver, becomes beta-hydroxybutyrate and acetone (both are ketones) when metabolized.

44
Q

What is polyphagia?

A

Increase in hunger.

45
Q

What are the 4 characteristics of DKA?

A

Dehydration, hyperglycemia, ketosis, acidosis.

NURS 2003 (12 decks)

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