Pituitary and Thyroid Dysfunction - EXAM 5 Flashcards Preview

SEMESTER FOUR!! Nursing 214 > Pituitary and Thyroid Dysfunction - EXAM 5 > Flashcards

Flashcards in Pituitary and Thyroid Dysfunction - EXAM 5 Deck (27):
1

What are symptoms of hyperthyroid?

  1. Decreased weight
  2. Increased appetite
  3. Diarrhea
  4. Frequent defecation
  5. Cardiac dysrhythmias
  6. Warm, moist skin
  7. Palmar erythema

2

What are symptoms of hypothyroid?

  1. Increased weight
  2. Constipation
  3. Dry, thick, cool skin
  4. Decreased sweating
  5. Pallor
  6. Generalized edema

3

What are symptoms of thyrotoxicosis?

  1. Severe tachycardia
  2. Shock
  3. Hyperthermia
  4. Restlessness
  5. N/V/D
  6. Coma
  7. Death

4

What are symptoms of myxedema coma?

  1. Subnormal temperature
  2. Hypotension
  3. Hypoventilation
  4. Lethargy
  5. Change in level of consciousness
  6. Coma

5

What are symptoms of SIADH?

  1. Increased weight
  2. Decreased urine output
  3. Increased specific gravity
  4. Decreased BP
  5. Hyponatremia
  6. Lethargy
  7. Risk for seizures
  8. Coma

6

What are symptoms of DI?

  1. Polydipsia
  2. Polyuria
  3. Decreased specific gravity of urine

7

Levothyroine (Synthroid)

Classification: thyroid replacement

Mechanism of action: absorbed through the GI tract and used by the body to replace thyroid hormone

Use: hypothyroidism, post thyroid surgery

Side/Adverse Effects: symptoms of hyperthyroid CHA, palpitations, insomnia, diarrhea, tem)

Nursing Implications:

  1. Many drug interactions
  2. Take with full glass of H20
  3. Preferable to take on an empty stomach and in the morning
  4. Educate patient on need for consistent dose and process of taking drug

8

What is the pathophysiology of SIADH?

  1. Increased antidiuretic hormone
  2. Increased water reabsorption in renal tubules
  3. Increased intravascular fluid volume
  4. Dilution hyponatremia and decreased serum osmolality

9

What is the pathophysiology of DI?

  1. Decreased antidiuretic hormone
  2. Decreased water reabsorption in renal tubules
  3. Decreased intravascular fluid volume
  4. Increased serum osmolality
  5. Excessive urine output

10

What happens in SIADH?

Syndrome of inappropriate secretion of ADH

Overproduction of ADH

Fluid retention

serum decreases in osmolality

Hypochloremia

Concentrated urine despite normal or increased intravascular volume and normal RFT

11

What is the SIADH nursing assessment?

  • VS
  • I&O
  • Urine SG
  • Weight
  • LOC
  • Hyponatremia increases risk for
    • decreased neuro
    • Seizures
    • N&V
    • Muscle cramps and weakness
  • Heart and lung sounds

12

What is the nursing management of SIADH?

  1. Remove potential cause (ex. meds)
  2. Fluid restriction (less than or equal to 1000mL daily)
  3. Safety
  4. Seizure precautions
  5. Oral care

13

How can the RN assist a patient who is thirsty while on fluid restrictions?

distraction

ice chips

sugarless gum

save fluids for social occasion

14

What is DI?

Diabetes Inspidous

Underproduction of ADH or decreased renal response

Fluid and electrolyte imbalances

Increased urinary output 5-20 L/day

Increased plasma osmolality (d/t hypernatremia)

15

What are the causes of DI?

Organic lesions (central DI, neurogenic DI)

Lithium (nephrogenic DI)

Cranial surgery/head injury

16

What is the DI nursing management?

  1. Keep fluids at bedside
  2. I&O
  3. Urine SG
  4. Weights daily
  5. Hormone replacement
    1. DDAVP (desmopressin) (ADH) - oral, subcutaneous, intravenous, or intranasal hormone replacement

17

What are the nursing interventions that DI and SIADH have in common?

  • Fluid balance
  • serum and urine osmolalities (simultaneous
  • Weight
  • I&O

18

What is the most common and reliable lab work for hypothyroidism?

serum TSH and free T4

 

19

What would the expected free T4 levels be in hypothyroidism?

Low

20

What happens when TSH is high?

Serum TSH is high when the defect is in the thyroid and low when the defect is in the pituitary gland. TSH level determine the cause of the hypothyroidism

21

What teaching would the RN provide before levothyroxine (synthroid) therapy?

Patients with cardiovascular disease: drug therapy will be started slowly

All others: symptoms of toxcitiy such aas chest pain, weight loss, nervousness, tremors and insominia should be reported. The need for lifelong therapy must be stressed

22

What teaching would the RN provide about risk factors to avoid a myxedema coma?

Myxedema is a medical emergency and is precipitated by infection, drugs, exposure to cold and trauma. Avoid these exposures

23

How will the NP know whether or not the levothyroxine (synthroid is effective)?

The maintenance dose of synthroid is adjusted according to the patient's response and lab data. The TSH will be rechecked in 4-6 weeks and the dosages may be adjusted.

24

What are priority TNIs for hyperthyroidism?

  1. Place on cardiac monitor with IV access
  2. Consider O2 if SpO2 indicates
  3. Initiate IV access
  4. Frequent VS to monitor effect of meds
  5. Encourage rest
  6. Encourage nutrition as tolerated

25

What is the nursing assessment for thyroid crisis (thyrotoxicosis) or thyroid storm?

  1. Severe tachycardia
  2. Heart failure
  3. Shock
  4. Hyperthermia
  5. Restlessness
  6. Coma
  7. Agitation
  8. Seizures
  9. Abdominal pain/N/V/D

26

What are the options for definitive treatment for hyperthyroidism?

Radioactive iodine

Subtotal thyroidectomy

27

Why are many people who have had treatment for hyperthyroidism actually taking levothyroxine (synthroid)?

Their thyroid glands have been "killed" (radioactive iodine) or partially removed (subtotal thyroidectomy) and variable amounts of exogenous thyroid hormone (levothyroxine) are needed to maintain metabolic rate. Dosages will be adjusted depending on residual (if any) endogenous thyroid hormone secretion.

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