Exam 4 - Thyroid Flashcards
(89 cards)
1
Q
the thyroid gland is very ___
A
vascular
5 x’s the blood flow to the liver
2
Q
Thyroid hormones
A
T3, T4, calcitonin
3
Q
where is the parathyroid?
A
inside the thyroid gland
4
Q
TSH comes from the ___ ___ ___
A
anterior pituitary gland
5
Q
what controls the release of T3, T4
A
TSH
6
Q
when is calcitonin released?
A
high plasma calcium levels
increases calcium deposit in bone
7
Q
thyroid hormone production within normal limits
A
euthyroid
8
Q
thyroid is controlled by what feedback system?
A
negative
9
Q
low T3, T4 will cause an increase in
A
TSH
10
Q
what is the issue with primary thyroid disorder
A
thyroid is the issue
no longer listening to the anterior pituitary gland
11
Q
what is the issue with secondary thyroid disorder
A
anterior pituitary gland
no longer listening to the hypothalamus
12
Q
what is the issue with central thyroid disorder
A
hypotalamus
13
Q
childhood thyroid disoder
A
cretinism
14
Q
neonatal hypothyroidism is tested when?
A
24-48 hours after birth
r/t low iodine, mental retardation
15
Q
most common condition r/t hyperthyroidism
A
Grave’s disease
16
Q
excess output of thyroid hormone
A
thyrotoxicosis
17
Q
hyperthyroidism s/sx
A
nervousness rapid pulse heat intolerance tremors skin flushed, warm, soft and moist exophthalmos increased appetite weight loss elevated SBP cardiac dysrhythmias
18
Q
thyrotoxicosis puts the body in which state?
A
hyper-metabolic state
19
Q
most sever hyperthyroid disorder
A
thyroid storm
20
Q
protruding or bulging eyes as a result of impaired venous drainage from the orbit
A
exophthalmos
21
Q
exophthalmos is only seen in ___ disease
A
Grave’s
22
Q
early stage of hyperthyroidism may only have which 2 s/sx
A
nervousness
weight loss
23
Q
meds to tx hyperthyroidism
A
propylthiouracil (PTU) + methimazole
Na, K iodine solutions
dexamethasone
beta-blockers (propranolol
24
Q
purpose of PTU + methimazole
Tapazole
A
inhibit/block synthesis of thyroid hormones
25
how long does it take to see improvement with PTU + methimazole
1-2 weeks but can take 4-8 weeks
26
side effects/labs of PTU + methimazole
agranulocytosis
**low WBC, neutrophil, eosinophil
thrombocytopenia
hepatoxicity
27
how often is PTU taken?
who can take it?
TID
pregnant women in their 1st trimester
28
how often is Tapazole taken
daily
29
propranolol is contraindicated in who?
asthma
| severe heart disease
30
cause of thyroid storm
stressors such as infection, trauma, surgery
31
thyroid storm s/sx
```
severe tachycardia
heart failure
hyperthermia (up to 105.3)
agitation
seizures
N/V/D
delirium
coma
```
32
pts who have a ___ are in danger of having a thyroid storm
thyroidectomy
33
hyperthyroidism TSH and T4 level will be ___
elevated
34
best indicator of hyperthyroidism
free thyroxine (T4)
35
hyperthyroidism treatment of choice for most nonpregnant adults
radioactive iodine therapy (RAI)
36
how does radioactive iodine therapy work?
damages, destorys thyroid tissue
37
how long until RAI is affective?
3 months
PTU, tapazole, and inderal taken until effective
38
PO RAI can cause what?
dryness
throat irritation
thyroiditis
*frequent sips of water, ice chips or magic mouth wash (Benadryl, lidocaine, mylanta - swish + spit)
39
RAI precautions
avoid pregnant women and children for at least 7 days
40
RAI education
use separate lavatory
*flush twice
wash clothes separately
41
how much of the thyroid is removed with a subtotal thyroidectomy?
90%
42
why is a subtotal thyroidectomy performed
prevent damage to parathyroid gland
43
why are parathyroid glands rarely removed?
prevent hypocalcemia
44
complications s/p subtotal thyroidectomy
```
hypothyroidism
hypocalcemia
hemorrhage
injury to laryngeal nerve
thyroid storm
```
45
hyperthyroidism nutrition therapy
```
high calorie (4000-5000/day)
6 meals (high protein, carb, vitamins, minerals)
```
avoid high fiber, highly seasoned foods, and beverages high in caffeine
46
hyperthyroidism protein intake should __-__ g/kg
1-2 g/kg of ideal body weight
47
after a thyroidectomy, will a high calorie diet still need to be implemented?
No, they will gain weight.
48
methods to relieve eye discomfort with hyperthyroidism
```
Na restriction
elevate HOB
use dark glasses
tape shut at night
turn eyes in complete ROM
```
49
severe exophthalmos treatment options
corticosteroids
radiation of retroorbital tissue
orbital decompression
corrective lid, muscle surgery
50
a temperature increase of __ degree should be reported
1
51
how often to assess after thyroidectomy
q2h for the first 24 hours
monitor for tracheal compression, irregular breathing, swelling, frequent swallowing, presence of blood
52
pt positioning after thyroidectomy
semi-fowlers
avoid neck flexion
53
how long to assess for tetany, Trousseau's, and Chvostek's after thyroidectomy?
72 hours
54
a complete thyroidectomy requires what for life?
lifelong thyroid hormone replacement
55
what can provide sufficient iodine intake?
seafood once weekly
| iodized salt
56
what is encouraged regularly to stimulate the thyroid gland
exercise
57
what type of environment inhibits thyroid regeneration
high temperatures
58
what is a strong risk factor for Graves disease
smoking
59
hypothyroidism occurs from ___ levels of T3, T4 in the bloodstream
deficient
60
hypothyroidism causes
Hashimotos (autoimmune)
atrophy associated with agin
iodine deficiency
hyperthyroidism treatment
61
cause of secondary hypothyroidism
inadequate secretion of TSH
pituitary gland issue
62
does hypothyroidism have a fast or slow onset?
slow
63
s/sx of hypothyroidism
```
decreased HR
anemia
decreased appetite
weight gain
constipation
dry, thick, cold skin
thick nails
dry, coarse hair
puffy face
SOB on exertion
cold intolerance
sleepiness
```
64
mis-Dx hypothyroidism is r/t
aging
65
meds that depress the CNS and should used with caution if a pt has hypothyroidism
opioids
barbituates
anesthesia
66
accumulation of mucopolysaccharides in the dermis and other tissue
myxedema
67
s/sx of myxedema coma
```
slow, gradual onset
progressive drowsiness, lethargy
below subnormal temperature*
hypotension*
hypoventilation*
```
68
causes of myxedema coma
infection
meds (CNS depressants)
exposure to cold
trauma
69
what metabolic state will a myxedema coma pt be in?
respiratory alkalosis
kidneys will retain bicarb
70
myxedema coma treatment
IV thyroid hormone - STAT
airway management - possible vent
temperature management - warmer
71
TSH, T3, T4 will be low or high with primary hypothyroidism
TSH - high
T3, T4 - low
issue is with the thyroid gland
72
TSH, T3, T4 will be low or high with secondary hypothyroidism
TSH - low
T3, T4 - low
issue is with the anterior pituitary gland
73
best time to administer Synthroid
first thing in AM; on an empty stomach
74
what to educate pts on when taking Synthroid
report chest pain immediatley
75
initial dose of Synthroid will be low or high
low
dose may be increased q4-6 weeks depending on labs
76
is Synthroid a short-term or life-long med?
life-long
77
side effects of synthroid
insomnia
| hyperthyroidism s/sx
78
what to assess weekly if taking Synthroid
pulse
79
hypothyroidism pts activities should be ___ out with lots of ___ periods
spaced; rest
80
hypothyroidism nursing interventions
```
provide extra clothes, blankets
protect from drafts
increase fiber, fluids in diet
low calorie diet
administer stool softeners PRN
avoid use of heating pads, electric blankets*
```
81
mental alertness should increase within ___ - ___ days after treatment
2-14 days
82
myxedema coma nursing interventions
```
cardiac monitoring
mechanical ventilation
monitor temp/warming needed
monitor for MI
report angina
administer all meds IV
**incase of paralytic ileus
```
83
how many parathyroid glands are on the thyroid gland
4; posterior thyroid gland
84
parathyroid gland regulates which 2 electrolytes via parathormone (PTH)
Ca; Ph
85
PTH increases __ by increasing absorption from they ___, ___, and ___.
Ca
kidney, intestines, bone
86
does PTH increase or decrease Ph
decreases
**remember Ca + Ph have an inverse relationship**
87
s/sx of hyperparathyroidism mimic those with
hypercalcemia
88
hyperparathyroidism treatment
surgical removal of parathyroid tissue
| hydration therapy
89
hypercalcemic crisis treatment
IV bolus isotonic solution (NS)
| calcitonin + corticosteriods
