ATI Unit 12 Hypothyroidism Flashcards Preview

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Flashcards in ATI Unit 12 Hypothyroidism Deck (10):
1

what is hypothyroidism

decreased amount of circulating hormones (remember T3 = triiodothyronine; T4 = thyroxine), causing decrease in overall metabolic activities

2

classifications of hypothyroidism

mechanism
1. primary: most common; either autoimmune disease (Hashimoto's disease) or loss of thyroid gland (radioactive iodine therapy; iodine depletement in diet; thyroidectomy)

2. secondary: failure of anterior pituitary (secretion or response) eg pituitary tumors

3. tertiary: problem with hypothalamus releasing thyroid-releasing factor (TRF)

also....
age of onset
1. Cretinism: hypothyroidism in infants; inhibits skeletomuscular growth and CNS = cognitive retardation, inhibited growth or both
2. juvenile hypothyroidism: usually autoimmune thyroiditis; same treatment as adult
3. adult hypothyroidism

3

most at risk group for hypothyroidism

30-60 yo women using meds lithium (Lithobid) or amiodarone (Cordaronel) with inadequate intake of iodine

4

what are the manifestations of hypothyroidism?

Early
Can't go in because the weight slows, very cold
Can't go
- lethargy, fatigue
- depression
- joint/muscle pain

Because the weight slows
- constipation
- weight gain with no increase in calorie intake

Very cold
- intolerance to cold
- pale skin
- hair loss
- brittle fingernails

Late findings
Slow down, it won't go down
Slow down
- braydcardia, hypotension, dysrhythmias
- slow thought process/speech (raspy voice)
- hypoventilation., pleural effusion
- decrease taste/smell
- amenorrhea/menorrhagia
- decreased libido

It won't go down
- mucousal, non-pitting edema in face, hands, feet (myxedema)
- thickening of skin (dry, flaky sin)

remember: thinning of hair on eyebrows

5

Important lab findings for hypotyroidism

1. T3 and T4 decreased
2. CBC = anemia
3. Ok so for TSH
primary: think the thyroid isn't secreting or maybe not there so hypothalamus/pituitary picking up that there isn't enough T3/T4, so it releases more to compensate but thyroid doesn't respond properly
so primary = increased TSH

secondary: malfunction with pituitary gland so TSH never get released
so secondary = decreased TSH

6

if you use a radioisotope scan/uptake (remember radioisotope = 123I), what would happen

- clients with hypothyroidism have low uptake of iodine preparations

7

Nursing implications for hypothyroidism

1. Remember to monitor BP, RR, HR b/c all of these are lowered. Put on anti-emboli stockings to promote venous return/prevent clots.
2. Give low-calorie, high bulk diet and laxatives to relieve constipation. Promote activity with lots of rest periods for this reason and to promote oxygenation.
(remember AVOID FIBER LAXATIVES b/c they mess with levothyroxine absorption)
3. Clothing layers, room temp higher, warm liquids but avoid electric blankets b/c of desensitivity of patient to feeling burns

8

what meds are highly cautioned in patients with hypothyroidism?

CNS depressant like barbs or sedatives (Resp depression)

9

Medications for hypothyroidism

1. Thyroid hormone replacement therapy = levothyroxine (Synthroid)
- increases effects of warfarin (Coumadin) and can increase need for insuling and digoxin (Lanoxin)
- meds that decrease absorption of levothyroxine = cimetidine (Tagament); lansoprazole (Prevacid); and colestipol (Colestid)
- causes increased oxygen demand on heart so titrate up (so nurse needs to monitor for angina, palpitations, rapid heart rate, SoB)
- take med 1-2 hrs before breakfast
- NO fiber supplements (calcium, iron, antacids)
- monitor for hyperthyroidism (tremors, tachycardia, heat intolerance, palpitations, rapid weight loss)
- lifelong therapy

10

what is myxedema

- non-pitting, mucousal edema of face/extremities that is life-threatening when hypothyroidism is untreated, a stressor like infection or stroke hits someone with hypothyroidism, or if levothyroxine is suddenly stopped

Manifestations (Think SLOW again)
- resp depression (hypoxia, hypercapnia)
- decreased cardiac output
- leathargy, stupor, coma
- hypothermia
- bradycardia/hypotension
- hyponatremia

Nurse
- ABCs, warmth
- administer large IV bolus doses of levothyroxine (Synthroid)
- treat hypoglycemia with glucose
- administer corticosteroids