Unit 5 & 6 Chapter 58 Hypothyroidism (HASHIMOTO Disease) and Hyperthyroidism (GRAVES Disease) , Thyroidectomy Flashcards

1
Q

What is the function of the Thyroid gland?

A

The thyroid gland produces hormones that regulate the body’s metabolic rate, growth and development.

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2
Q

What is Hypothyroidism (HASHIMOTO)

A

Hypothyroidism is reduced or absent hormone secretion from the thyroid gland that results in whole-body decreased metabolism from inadequate cellular regulation .

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3
Q

Normal Range for T4

A

5-12

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4
Q

Normal Range for T3

A

70-220

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5
Q

Your patient who has been diagnosed with Hypothyroidism has presented to the clinic with an enlarged throat? What is the name of this clinical finding?
A. Epiglottis
B. Goiter
C. Trachel Deviation
D. Tonsilitis

A

B. Goiter

The TSH binds to thyroid cells and causes the thyroid gland to enlarge, forming a goiter,
Although thyroid hormone production does not increase. The presence of goiter is common to many thyroid problems and does not definitively indicate either hypothyroidism or hyperthyroidism.

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6
Q

What are the signs and symptoms of Hypothyroidism?

A

Intolerance to cold
-hypotension
-constipation
-lethargy
-weight gain
-thin hair
-brittle finger nails’
-bradycardia
-Ammenorhea
* Hypoventilation
* Pleural effusion * Dyspnea
-dry skin
-facial puffiness
-muscle aches and weakness
-decreased metabolic rate
-apathy
-decreased urinary output
cool pale skin
thick tongue
-poor wound healing
* Slowing of intellectual functions:
* Slowness or slurring of speech
* Impaired memory
* Ina

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7
Q

What is the medical treatment for Hypothyroidism?

A

LIFELONG THYROID REPLACEMENT MEDICATION
-Levothyroxine(take same drug name

-Take the drug exactly as prescribed and not to change the dose or schedule without consulting the primary health care provider.

Therapy is started with low doses and gradually increased over a period of weeks

The patient with more severe symptoms of hypothyroidism is started on the lowest dose of thyroid hormone replacement.

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8
Q

Nursing Intervention for Hypothyroidism

A

Measure oxygen saturation by pulse oximetry, and apply oxygen if the patient has hypoxemia. Auscultate the lungs for a decrease in breath sounds or presence of crackles. If hypothyroidism is severe, the patient may require ventilatory support. Severe respiratory distress occurs with myxedema coma.
. Monitor blood pressure and heart rate and rhythm and observe for indications of shock (e.g., hypotension, decreased urine output, changes in mental status).
If hypothyroidism is chronic, the patient may have cardiovascular disease. Instruct the patient to report episodes of chest pain or chest discomfort immediately.

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9
Q

The Health care provider has ordered laboratory work to be done for a patient with suspected hypothyroidism. Which lab level would warrant immediate attention?
A. Sodium 134
B. serum T3 20
C. Potassium 3.5
D. Calcium 10

A

B. serum T3 20

DEPLETED THYROID HORMONE LEVELS CAN INDUCE MYXEDMA COMA WHICH IS LIFE-THREATENING

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10
Q

What can occur if the patient increases their prescribed doses of Levothyroxine?

A

Starting at too high a dose or increasing the dose too rapidly can cause severe hypertension, heart failure, and myocardial infarction.

S/S OF HYPERTHYROIDISM CAN OCCUR

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11
Q

Which of the following is a life-threatening complication of Hypothyroidism if is not treated with Levothyroxine?
A. Myxedema Coma
B. Thyroid Crisis
C. Thyroid Storm
D. Tetany

A

A. Myxedema Coma

Myxedema coma, sometimes called hypothyroid crisis, is a serious complication of untreated or poorly treated hypothyroidism with dangerously reduced cardiopulmonary and neurologic functioning, although few affected adults become comatose (McCance et al., 2019).

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12
Q

Is Myxedema Coma Life-threatening?

A

The mortality rate for myxedema coma is extremely high, and this condition is a life-threatening emergency. Myxedema coma can be caused by a variety of events, drugs, or conditions.

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13
Q

S/s of Myxedema Coma

A
  • Greatly reduced level of consciousness and cognition
  • Respiratory failure
  • Hypotension
  • Hyponatremia
  • Hypothermia
  • Hypoglycemia
  • with dangerously reduced cardiopulmonary and neurologic functioning, although few affected adults become comatose
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14
Q

Emergency Plan for Myxedema Coma

A

With myxedema coma, the drug may need to be given IV because of the severely reduced motility and absorption of the GI tract.

  • Maintain a patent airway.
  • Replace fluids with IV normal or hypertonic saline as prescribed.
  • Give levothyroxine sodium IV as prescribed.
  • Give glucose IV as prescribed.
  • Give corticosteroids as prescribed.
  • Check the patient’s temperature hourly.
  • Monitor blood pressure hourly.
  • Cover the patient with warm blankets.
  • Monitor for changes in mental status.
  • Turn every 2 hours.
  • Institute Aspiration Precautions.
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15
Q

Complications of Myxedma

A

Myxedema coma can lead to shock, organ damage, and death.
-HYPOGLYCEMICSHOCK
-HYOPTENSIVE SHOCK

Assess the patient with hypothyroidism at least every 8 hours for changes that indicate increasing severity, especially changes in mental status, and report these promptly to the primary health care provider.

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16
Q

Focused Asssessment for Hypothyroidism

A

Assess cardiovascular status:
* Vital signs, including apical pulse, pulse pressure, presence or absence of
orthostatic hypotension, and the quality and rhythm of peripheral pulses * Presence or absence of peripheral edema
* Weight gain or loss
Assess cognition and mental status:
* Level of consciousness, with orientation to time, place, and person
* Ability to accurately read a seven-word sentence containing no words
greater than three syllables
* Ability to count backward from 100 by 3s
Assess the condition of skin and mucous membranes:
* Moistness of skin, most reliable on chest and back * Skin temperature and color
Assess neuromuscular status:
* Reactivity of patellar and biceps reflexes
* Oral temperature
* Handgrip strength
* Steadiness of gait
* Presence or absence of fine tremors in the hand
Ask about:
* Sleep in the past 24 hours
* Patient warm enough or too warm indoors
* 24-hour diet recall and 24-hour activity recall
* Over-the-counter and prescribed drugs taken
* Last bowel movement
Assess patient’s understanding of illness and adherence with therapy:
* Symptoms to report to primary health care provider
* Drug therapy plan (correct timing and dose)

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17
Q

Patient and Family Teaching for Hypothyroidism

A

During this time the patient may continue to have mental slowness. Teach the family to orient the patient often and to explain everything clearly, simply, and as often as needed.

Emphasize the need for lifelong drugs, and review the symptoms of both hyperthyroidism and hypothyroidism

Teach the patient to wear a medical alert bracelet.

Teach the patient and family when to seek medical interventions for dosage adjustment and the need for periodic blood tests of hormone levels.

Instruct the patient not to take any over-the-counter drugs without consulting his or her primary health care provider because thyroid hormone preparations interact with many other drugs.

Advise the patient to maintain nutrition by eating a well-balanced diet with adequate fiber and fluid intake to prevent constipation. Caution him or her that use of fiber supplements may interfere with the absorption of thyroid hormone.

Thyroid hormones should be taken on an empty stomach, at least 4 hours before or after a meal. Remind the patient about the importance of adequate rest.

Teach the patient to monitor himself or herself for therapy effectiveness. The two easiest parameters to check are need for sleep and bowel elimination

When the patient requires more sleep and is constipated, the dose of replacement hormone may need to be increased by the primary health care provider.

When the has difficulty go ing to sleep and has more bowel movements than normal for him or her, the dose may need to be decreased.

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18
Q

Should you take food with levothyroxine?

A. Yes
B. No

A

B. No

Thyroid hormones should be taken on an empty stomach, at least 4 hours before or after a meal. Remind the patient about the importance of adequate rest.

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19
Q

Is rest important for patients with hypothyroidism

A

Remind the patient about the importance of adequate rest.

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20
Q

Your patient with Hypothyroidism is presenting with constipation and lethargy for 6 months.The healthcare provider has kept the dose the same for the patient for 2 years. What is the nurses next action?
A. Document the finding
B. Call a Rapid Response
C. Recommend the provider increase the dose
D. Recommend the provider decrease the dose

A

C. Recommend the provider increase the dose

When the patient requires more sleep and is constipated, the dose of replacement hormone may need to be increased by the primary health care provider.

When the has difficulty going to sleep and has more bowel movements than normal for him or her, the dose may need to be decreased.

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21
Q

Should patients get their hormone levels checked once while on thyroid medication?
A. Once
B. Periodically

A

B. Periodically

Teach the patient and family when to seek medical interventions for dosage adjustment and the need for periodic blood tests of hormone levels.

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22
Q

Should the patient take over the counter medications without consulting their health care provider?
A. No
B. Yes

A

A. No

Instruct the patient not to take any over-the-counter drugs without consulting his or her primary health care provider because thyroid hormone preparations interact with many other drugs.

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23
Q

Why should a patient eat a well-balanced diet with adequate fiber when diagnosed with Hypothyroidism?
A. Weight loss promotion and prevent constipation
B. Increase heart rate and concoiunesness
C. Reduce the size of the goiter
D. Reduce the size of the thick tongue

A

A. Weight loss promotion and prevent constipation

Advise the patient to maintain nutrition by eating a well-balanced diet with adequate fiber and fluid intake to prevent constipation.

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24
Q

Your patient has a low socioeconomic status and he is diagnosed with Hypothyroidism. He has been prescribed Levothyroxine and reports he has been using fiber supplements to decrease constipation. What is the nurse’s next action?
A. Document patient report in chart
B. Advise that the fiber supplement will help decrease constipation
C. Instruct to client to stop taking fiber supplements it can lead to myxedma coma due to low drug absorption
D.Call a rapid response

A

C. Instruct to client to stop taking fiber supplements it can lead to myxedma coma due to low drug absorption

Caution him or her that the use of fiber supplements may interfere with the absorption of thyroid hormone.

C. Instruct to client to stop taking fiber supplements it can lead to myxedma coma due to low drug absorption

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25
Q

The expected outcomes are that with proper management of Hypothyroidism

A

The expected outcomes are that with proper management the patient should:
*Maintain normal cardiovascular function with a pulse above 60 beats/min and a blood pressure within normal limits for age and general health
* Maintain adequate respiratory function and gas exchange with SpO 2 above 90%
* Demonstrate improvement in cognition

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26
Q

Which procedure is most likely to cause hypothyroidism?
A. Cholecystitis
B. Thyroidectomy
C. Gastrectomy
D. Pericardial Window

A

B. thyroidectomy

Thyroid surgery, Removing all or large portion of your thyroid can diminish or halt hormone production. In that case, you’ll need to take thyroid hormone for life

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27
Q

What is Hyperthyroidism

A

GRAVES DISEASE

Hyperthyroidism (thyrotoxicosis) is excessive thyroid hormone secretion from the thyroid gland.

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28
Q

The Health care provider has ordered laboratory work to be done for a patient with suspected hyperthyroidism. Which lab level would warrant immediate attention?
A. Sodium 134
B. serum T3 350
C. Potassium 3.5
D. Calcium 10

A

B. serum T3 350

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29
Q

What are the s/s of Hyperthyroidism

A

Palpitations
Hyperglycemia
* Chest pain
* Increased systolic blood pressure (175/80)
* Tachycardia
* Dysrhythmias
* Rapid, shallow respirations
* Increased basal metabolic rate
* Heat intolerance
* Low-grade fever
* Fatigue
Blurred or double vision
* Eye fatigue
* Increased tears
* Injected (red) conjunctiva
* Photophobia
* Eyelid retraction, eyelid lag
* Globe lag
* Hyperactive deep tendon reflexes
* Tremors
* Insomnia
Diaphoresis (excessive sweating)
* Fine, soft, silky body hair
* Smooth, warm, moist skin
* Thinning of scalp hair
Weight loss
* Increased appetite
* diarrhea
Decreased att ention span
* Restlessness and irritability
* Emotional instability
* Manic behavior
* Goiter
* Wide-eyed or startled appearance (exophthalmos) a
* Enlarged spleen
* Muscle weakness and wasting

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30
Q

Graves Disease S/s

A

In Graves disease, all the general symptoms of hyperthyroidism are present. In addition, other changes specific to Graves disease may occur, including exophthalmos (abnormal protrusion of the eyes) and pretibial myxedema (dry, waxy swelling of the front surfaces of the lower legs that resembles benign tumors or keloids).

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31
Q

What is the first sign a patient may notice when they have Hyperthyroidism
A. Heat intolerance
B. weight loss without trying
C Goiter
D. Lethargy

A

A. Heat intolerance

Heat intolerance is often the first symptom the patient notices. He or she may have increased sweating even when environmental temperatures are comfortable for others, and often wears lighter clothing in cold weather.

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32
Q

what is Exophthalmos

A

is common in patients with Graves disease. The wide-eyed or “startled” look is due to edema in the extraocular muscles and increased fa y tissue behind the eye, which pushes the eyeball forward and may cause problems with focusing.

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33
Q

Complications of Exophthalmos

A

Pressure on the optic nerve may impair vision. If the eyelids fail to close completely and the eyes are unprotected, they may become dry, and corneal ulcers may develop. Observe the eyes for excessive tearing and a bloodshot appearance. Ask about sensitivity to light (photophobia).

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34
Q

Would a patient with hyperthroidism need rest

A

Yes

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35
Q

is Goiter sometimes present in hyperthyroidism hypothyroidism or both

A

Both

36
Q

Should you palpate the goiter
A.no
B.yes

A

A.no

Do not palpate a goiter or thyroid tissue in a patient with hyperthyroid symptoms. This action can stimulate the sudden release of excessive thyroid hormones and trigger a life-threatening episode of thyroid storm (crisis).

37
Q

Which of the following is a depiction of a widened pulse pressure?
A. 120/80
B. 90/60
C.175/80
D. 140/120

A

C.175/80

38
Q

Is T3 and T4 elevated in hyperthyroidism?
A.No
B.Yes

A

B.Yes

T3: 70-220
T4: 5-12

39
Q

Nursing Care for Hyperthyroidism

A

PROMOTE REST
MONITOR FOR DYSRTHMIAS ON EKG
MONITOR WEIGHT AND VITAL SIGNS
INCREASE INTAKE OF CALORIE AND PROTEIN
Maintain Patent airway

EXOPHATHALUS CARE
-tape eyelids shut for sleep
-provide eye lubricant

40
Q

EXOPHATHALUS CARE

A

EXOPHATHALUS CARE
-tape eyelids shut for sleep
-provide eye lubricant

For patients with exophthalmos, prevent eye dryness by encouraging the use of artificial tears.

Eye and vision problems of Graves disease are not corrected by treatment for hyperthyroidism, and management is symptomatic.
Teach the patient with mild problems to elevate the head of the bed at night and use artificial tears.

If photophobia (sensitivity to light) is present, dark glasses may be helpful.

For those who cannot close the eyelids completely, recommend gently taping the lids closed at bedtime to prevent irritation and injury.

41
Q

What cardiac rhythms would you suspect to see in a patient with hyperthyroidism?
A. ST Elevation
B. Sinus Bradycardia
C. Sinus Normal Rhythym’
D. Supraventricular Tachycardia

A

D. Supraventricular Tachycardia

ECG usually shows supraventricular tachycardia.

Other ECG changes include:
-atrial fibrillation,
-dysrhythmias
-premature ventricular contractions.

42
Q

Which of the following needs to be reported to the healthcare provider?
A. A patient with asterexis who is diagnosed with Cirrhosis
B. The patient with hyperthyroidism who has an increased temperature of 1F from 99F to 100F
C. The client who has flank pain who is diagnosed with Acute Kidney Injury
D. The patient with exopthamalus and complains of dry eyes

A

B. The patient with hyperthyroidism who has an increased temperature of 1F from 99F to 100F

Temperature increases may indicate a rapid worsening of the patient’s condition and the onset of thyroid storm (thyroid crisis), a life-threatening event that occurs in patients with uncontrolled hyperthyroidism, most often with Graves disease. It presents with uncontrolled hyperthyroidism and is characterized by high fever and severe hypertension.
Immediately report a temperature increase of even 1°F.

43
Q

What is Thyroid Storm and What can cause Thyroid storm(Crisis)?

A

It is
-Life threatening event that occurs in patients with uncontrolled hyperthyroidism

What can trigger it
-Uncontrolled hyperthyroidism
-trauma,
-infection,
-diabetic ketoacidosis
-pregnancy
-vigorous palpation of the goiter,
-exposure to iodine,
-radioactive iodine (RAI) therapy.

44
Q

Key Manifestations of Thyroid Storm (Crisis)

A

-Systolic Hypertension
-Fever- 1 degree elevated is an emergency
-Tachycardia

45
Q

s/s of Thyroid storm

A

The patient may have abdominal pain, nausea, vomiting, and diarrhea.
-Systolic Hypertension
-Fever- 1 degree elevated is an emergency
-Tachycardia
Often he or she is very anxious and has tremors. As the crisis progresses, the patient may become restless, confused, or psychotic and may have seizures, leading to coma. Even with treatment, thyroid storm may lead to death.

46
Q

Can Thyroid Storm lead to death?
A. Yes
B. No

A

A. Yes

47
Q

EMERGENCY CARE OF THE PATIENT IN THYROID STORM

A

Maintain a patent airway and adequate ventilation.
Give oral antithyroid drugs as prescribed: methimazole or propylthiouracil.
* Administer sodium iodide solution IV daily as prescribed.
* Give propranolol IV as prescribed, slowly over 3 minutes. The patient should be connected to a cardiac monitor, and a central venous pressure catheter should be in place.
Give glucocorticoids as prescribed: hydrocortisone, prednisone, or dexamethasone as they inhibit the conversion of T3 and T4
* Monitor continually for cardiac dysrhythmias.
* Monitor vital signs every 30 minutes.
* Provide comfort measures, including a cooling blanket.
* Give non-salicylate antipyretics as prescribed.ACETOMINOPHEN
* Correct dehydration with normal saline infusions.
* Apply cooling blanket or ice packs to reduce fever.

48
Q

The nurse is caring for a client who developed a thyroid storm. The nurse should obtain a prescription for

A. enalapril
B. regular insulin
C. levothyroxine
D. dexamethasone

A

D. dexamethasone

Give glucocorticoids as prescribed: hydrocortisone, prednisone, or dexamethasone as they inhibit the conversion of T3 and T4

49
Q

You are getting night shift report, which patient should you prioritize decreasing stimuli for?
A. A patient diagnosed with seasonal depression
B. A patient with Hyperthyroidism
C. A patient with hypothyroidism
D. A patient with past medical history of Asthma

A

B. A patient with Hyperthyroidism

**Reducing stimulation helps prevent increasing the symptoms of hyperthyroidism and the risk for cardiac complications. **Encourage the patient to rest.

Keep the environment quiet by closing the door to the room, limiting visitors, and postponing nonessential care or treatments.

50
Q

Does a patient with Hyperthyroididm need a cooling blanket for a heating blanket?

A

COOLING BLANKET

Promoting comfort includes reducing the room temperature to decrease discomfort caused by heat intolerance. Instruct AP to ensure that the patient always has a fresh pitcher of ice water and to change the bed linen whenever it becomes damp from diaphoresis. Suggest that the patient take a cool shower or sponge bath several times each day. For patients with exophthalmos, prevent eye dryness by encouraging the use of artificial tears.

51
Q

Should your patient with hyperthyroidism be placed on a cardiac monitor?

A

Immediately report a temperature increase of even 1°F. If this task is delegated to assistive personnel (AP), instruct them to report the patient’s temperature to you as soon as it has been obtained. If temperature is elevated, immediately assess the patient’s cardiac status. If the patient has a cardiac monitor, check for dysrhythmias.

52
Q

What are the drugs of choice for Hyperthyroidism

A

thioamides, especially methimazole.
Propylthiouracil is used less often because of its liver-toxic effects

Beta-adrenergic blocking drugs such as propranolol may be used as supportive therapy.

53
Q

Action of Methimazole and Propylthiouracil

A

These drugs block thyroid hormone production by preventing iodide binding in the thyroid gland. The response to these drugs is delayed because the patient may have large amounts of stored thyroid hormones that continue to be released.

54
Q

Action of Propranolol

A

These drugs relieve diaphoresis, anxiety, tachycardia, and palpitations but do not inhibit thyroid hormone production.

55
Q

Patient teaching for Prophythyluracil and Methimazole

A

-takes time to work
Teach patient to avoid crowds and people who are ill because the drug reduces the immune response, increasing the risk for infection.
Teach patients to check for weight gain, slow heart rate, and cold intolerance, which are indications of hypothyroidism and the need for a lower drug dose.
Teach patients taking propylthiouracil to report darkening of the urine or a yellow appearance to the skin or whites of the eyes, which indicates possible liver toxicity or failure, a serious side effect of propylthiouracil.
Remind women taking methimazole to notify their primary health care providers if they become pregnant because the drug causes birth defects and should not be used during pregnancy.

56
Q

Medical Management of Hyperthyroidism

A

-Radioactive iodine (RAI) therapy
-Thyroidectomy
-Subtotal thyroidectomy

57
Q

What is Radioactive Iodine Therapy

A

it destroys t3 and t4 cells

The dosage depends on the thyroid gland’s size and sensitivity to radiation. The thyroid gland picks up the RAI, and some of the cells that produce thyroid hormone are destroyed by the local radiation.

58
Q

Is Radioactive Iodine therapy advised for pregnant women

A

Radioactive iodine (RAI) therapy is not used in pregnant women because 131I crosses the placenta and can damage the fetal thyroid gland

59
Q

How often is Radioactive Iodine Therapy performed and how long does treatment usually last

A

RAI therapy is performed on an outpatient basis. One dose may be sufficient, although some patients need a second or third dose.

Treatment duration
Because the thyroid gland stores thyroid hormones to some degree, the patient may not have complete symptom relief until 6 to 8 weeks after RAI therapy. Additional drug therapy for hyperthyroidism is still needed during the first few weeks after RAI treatment.

60
Q

After radioactive iodine therapy is the radiation still active

A

The radiation dose is low and is usually completely eliminated within a month; however, the source is unsealed, and some radioactivity is present in the patient’s body fluids and stool for a few weeks after therapy

61
Q

While receiving RAIT, Should you share a restroom with a family member
A.yes
B.no

A

B.no

Radiation precautions are needed to prevent exposure to family members and other people.

62
Q

Should you monitor for symptoms of hypothyroidism in a patient taking Radioactive Iodine Therapy
A.yes
B.no

A

A.yes

The degree of thyroid destruction varies. Some patients become
hypothyroid as a result of treatment. The patient then needs lifelong thyroid hormone replacement. All patients who have undergone RAI therapy should be monitored regularly for changes in thyroid function

63
Q

What is the treatment for hypothyroidism
A. low calorie foods
B. High fiber foods
C. life long levothyroxine
D. Methimazole

A

C. life long levothyroxine

64
Q

Is Calcium increased or decreased in hyperthyroidism

A

Increased

65
Q

Safety Precautions for the Patient Receiving an Unsealed Radioactive Isotope

A
  • Use a toilet that is not used by others for at least 2 weeks after receiving the radioactive iodine.
  • Sit to urinate (males and females) to avoid splashing urine on the seat, walls, and floor.
  • Flush the toilet (with the lid closed) three times after each use.
  • If urine is spilled on the toilet seat or floor, use paper tissues or towels to clean it up, bag them in sealable plastic bags, and take them to the hospital’s radiation therapy department.
  • Men with urinary incontinence should use condom catheters and a drainage bag rather than absorbent gel-filled briefs or pads.
  • Women with urinary incontinence should use facial tissue layers in their clothing to catch the urine rather than absorbent gel-filled briefs or pads. These tissues should then be flushed down the toilet exclusively used by the patient.
  • Using a laxative on the second and third days after receiving the radioactive drug helps you excrete the contaminated stool faster (this also decreases the exposure of your abdominal organs to radiation).
  • Wear only machine-washable clothing and wash these items separately from others in your household.
  • After washing your clothing, run the washing machine for a full cycle on empty before it is used to wash the clothing of others.
  • Avoid close contact with pregnant women, infants, and young children for the first week after therapy. Remain at least 3 feet (about 1 m) away from these people and limit your exposure to them to no more than 1 hour daily.
  • Some radioactivity will be in your saliva during the first week after therapy. Precautions to avoid exposing others to this contamination (both household members and trash collectors) include:
  • Not sharing toothbrushes or toothpaste tubes
  • Using disposable tissues rather than cloth handkerchiefs and
    either flushing used ones down the toilet or keeping them in a plastic bag and turning them in to the radiation department of the hospital for disposal
66
Q

In what case should a thyroidectomy be performed
A. The patient who has taken Propranolol and reports a decrease in heart rate
B. The patient who has been prescribed methamizole reports weight gain
C. The patient who has completed their cycle of radioactive iodine therapy but still presents with tachycardia, hypertension, and heat intolerance.
D. The client who has been prescribed prophy =uracil and reports getting enough sleep

A

C. The patient who has completed their cycle of radioactive iodine therapy but still presents with tachycardia, hypertension, and heat intolerance.

Surgery to remove all or part of the thyroid gland is used to manage Graves and other types of hyperthyroidism that do not respond to nonsurgical management strategies.

67
Q

When should Thyroidectomy be considered?

A

Surgery to remove all or part of the thyroid gland is used to manage Graves and other types of hyperthyroidism that do not respond to nonsurgical management strategies.\

It is also used when a large goiter causes tracheal or esophageal compression.

68
Q

What are some complications of Thyroidectomy?

A

-Hypothyroidism
-Hemrohage
-Hypocalcemia
-Seizure
-Infection
Respiratory Distress
Parathyroid gland injury

69
Q

Should a patient with a total thyroidectomy take lifelong Levothyroxine?

A. Yes
B. No

A

After a total thyroidectomy, patients must take lifelong thyroid hormone replacement

A. Yes.

70
Q

Pre-op Care for Thyroidectomy

A

The patient is treated with thionamide drug therapy first to have near-normal thyroid function (euthyroid) before thyroid surgery.

Iodine preparations also decrease thyroid size and vascularity, reducing the risk for bleeding and the potential for thyroid storm during surgery.

HOB 30 DEGREES

Hypertension, dysrhythmias, and tachycardia must be controlled before surgery. The patient with hyperthyroidism may need to follow a high-protein, high-carbohydrate diet for days or weeks before surgery.

71
Q

What must be controlled prior to Thyroidectomy?
A. Hypertension
B. Exopthalmus
C. Continence of stool
D. BMI of 24

A

A. Hypertension

Hypertension, dysrhythmias, and tachycardia must be controlled before surgery.

The patient with hyperthyroidism may need to follow a high-protein, high-carbohydrate diet for days or weeks before surgery.

72
Q

When preparing your client for a thyroidectomy which teaching requires further teaching?
A. Hypertextend your neck
B. Use a pillow for elevation
C. Monitor for bleeding
D. Ask for pain medications when discomfort occurs

A

A. Hypertextend your neck

Teach the patient to perform deep-breathing exercises. Stress the importance of supporting the neck when coughing or moving by placing both hands behind the neck to reduce strain on the incision.

Use pillows to support the head and neck. Place the patient, while he or she is awake, in a semi-Fowler position. Avoid positions that cause neck extension.

73
Q

What is the priority after the patient comes out of thyroidectomy surgery?

A

Monitoring the patient for complications is the most important nursing action after thyroid surgery.

Monitor vital signs Q15 minuteswhen patient is stable Q30 minutes

74
Q

Post Op Care Thyroidectomy

A

Help the patient deep-breathe every 30 minutes to 1 hour. Suction oral and tracheal secretions when necessary.

Monitor vital signs Q15 minuteswhen patient is stable Q30 minutes

Monitor for Hemmrohage: Inspect the neck dressing and behind the patient’s neck for blood. A drain may be present, and a moderate amount of serosanguineous drainage is normal.

Keep emergency tracheostomy equipment in the patient’s room. Check that oxygen and suctioning equipment are nearby and in working order.

Ask the patient hourly about tingling around the mouth or of the toes and fingers. Assess for muscle twitching as a sign of calcium deficiency.

assess labs for calcium levers

Laryngeal nerve damage may occur during surgery. This problem results in hoarseness and a weak voice. Assess the patient’s voice at 2-hour intervals and document any changes. Reassure the patient that hoarseness is usually temporary.

75
Q

What are the s/s of Hypocalcemia?

A

parathyroid gland injury
Hypocalcemia
-Positive Trousseau and Chvostek signs,
-Numbness and tingling around extremities,
-Seizures,
-Tetany,
-Hyperactive reflexes.

76
Q

How would you assess Hemmrohage post op Tracheotomy

A

Hemorrhage is most likely to occur during the first 24 hours after surgery. Inspect the neck dressing and behind the patient’s neck for blood. A drain may be present, and a moderate amount of serosanguineous drainage is normal. Hemorrhage may be seen as bleeding at the incision site or as respiratory distress caused by tracheal compression.

77
Q

Your patient has just recovered a thyroidectomy. He presents with stridor on expiration and is holding his throat?
What is the interdisciplinary teams priority action?
A. Prepare the client for an emergency tracheostomy.
B. Prepare the client for the operation room to re-
C. Administer IV Levothyroxine
D. Administer IVmethizaole

A

A. Prepare the client for an emergency tracheostomy.

Keep emergency tracheostomy equipment in the patient’s room. Check that oxygen and suctioning equipment are nearby and in working order.

Respiratory distress and reduced gas exchange can result from swelling, tetany, or damage to the laryngeal nerve, resulting in spasms.

Laryngeal stridor (harsh, high-pitched respiratory sounds) is heard in acute respiratory obstruction.

78
Q

When symptoms should you call a rapid response team for after thyroidectomy? SELECT ALL THAT APPLY
A. Drooling
B. 120/80
C. SaO2 from 95% to 87%
D.Stridor
E. Pulse 76
F. Ability to talk

A

A. Drooling
C. SaO2 from 95% to 87%
D.Stridor

(stridor, dyspnea, falling oxygen saturation, inability to swallow, drooling) after thyroid surgery. If any indications are present, respond by immediately initiating the Rapid Response Team.

79
Q

What medications should be administered if the patient reports numbness and tingling?
A. Methadone
B. Calcium gluconate
C. Magnesium sulfate
D. Potassium chloridwe

A

B. Calcium gluconate

Calcium gluconate or calcium chloride for IV use should be available in an emergency situation.

80
Q

What should you keep on the bedside post THYROIDECTOMY

A

-Oxygen
-suction equiptment
-Bf cuff and stethoscope
-extra pillows
-intubation equipment
-tracheostomy
-calcium gluconate

81
Q

Which assessment finding indicates a potential complication following a thyroidectomy?
A) Decreased serum calcium levels
B) Bradycardia
C) Increased blood pressure
D) Elevated serum potassium levels

A

A) Decreased serum calcium levels

82
Q

Prior to a thyroidectomy, the nurse educates the client about the importance of avoiding which substance to prevent exacerbating thyroid storm?
A) Calcium supplements
B) Iodine-rich foods
C) Nonsteroidal anti-inflammatory drugs (NSAIDs)
D) Vitamin D supplements

A

B) Iodine-rich foods

83
Q

The nurse is caring for a client following a thyroidectomy. Which action should be the nurse’s priority to prevent respiratory distress?
A) Administering pain medication
B) Assisting with neck range of motion exercises
C) Encouraging deep breathing and coughing exercises
D) Elevating the head of the bed

A

C) Encouraging deep breathing and coughing exercises

84
Q

A client is scheduled for a thyroidectomy and asks the nurse about potential complications. Which complication should the nurse include in the client’s education?
A) Hypocalcemia
B) Hypertension
C) Hyperkalemia
D) Hyperglycemia

A

A) Hypocalcemia

85
Q

The nurse is assessing a client after a thyroidectomy and notes numbness and tingling around the lips and in the extremities. Which electrolyte imbalance should the nurse suspect?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypocalcemia

A

D) Hypocalcemia