Unit 5 & 6 Chapter 58 Hypothyroidism (HASHIMOTO Disease) and Hyperthyroidism (GRAVES Disease) , Thyroidectomy Flashcards
What is the function of the Thyroid gland?
The thyroid gland produces hormones that regulate the body’s metabolic rate, growth and development.
What is Hypothyroidism (HASHIMOTO)
Hypothyroidism is reduced or absent hormone secretion from the thyroid gland that results in whole-body decreased metabolism from inadequate cellular regulation .
Normal Range for T4
5-12
Normal Range for T3
70-220
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
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.
What are the signs and symptoms of Hypothyroidism?
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
What is the medical treatment for Hypothyroidism?
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.
Nursing Intervention for Hypothyroidism
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.
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
B. serum T3 20
DEPLETED THYROID HORMONE LEVELS CAN INDUCE MYXEDMA COMA WHICH IS LIFE-THREATENING
What can occur if the patient increases their prescribed doses of Levothyroxine?
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
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. 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).
Is Myxedema Coma Life-threatening?
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.
S/s of Myxedema Coma
- 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
Emergency Plan for Myxedema Coma
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.
Complications of Myxedma
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.
Focused Asssessment for Hypothyroidism
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)
Patient and Family Teaching for Hypothyroidism
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.
Should you take food with levothyroxine?
A. Yes
B. No
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.
Is rest important for patients with hypothyroidism
Remind the patient about the importance of adequate rest.
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
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.
Should patients get their hormone levels checked once while on thyroid medication?
A. Once
B. Periodically
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.
Should the patient take over the counter medications without consulting their health care provider?
A. No
B. Yes
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.
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. 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.
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
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
The expected outcomes are that with proper management of Hypothyroidism
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
Which procedure is most likely to cause hypothyroidism?
A. Cholecystitis
B. Thyroidectomy
C. Gastrectomy
D. Pericardial Window
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
What is Hyperthyroidism
GRAVES DISEASE
Hyperthyroidism (thyrotoxicosis) is excessive thyroid hormone secretion from the thyroid gland.
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
B. serum T3 350
What are the s/s of Hyperthyroidism
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
Graves Disease S/s
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).
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. 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.
what is Exophthalmos
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.
Complications of Exophthalmos
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).
Would a patient with hyperthroidism need rest
Yes
