Thyroid disease Flashcards
(39 cards)
1
Q
Hyperthyroidism: Pathophysiology and etiology
A
- caused by excessive delivery of TH
- increased metabolic rate
- heightens sympathetic nervous systems response
2
Q
HYPERTHYROIDISM ETIOLOGY
A
- autoimmune stimulation
- excess secretion of thyroid -stimulating (TSH)
- excessive intake of thyroid medications
3
Q
HYPERTHROIDISM RISK FACTORS
A
- women (10 times more likely )
- Genetic factors
- family history of graves disease
- increased iodine intake
- age 20-40 years in age
4
Q
HYPERTHYROIDISM CLINICAL MANIFESTATIONS
A
- increased appetite with weight loss
- hypermotile bowels
- heat intolerance, insomnia
- palpitations
- increased sweating
- hair changes (hair loss, brittle)
5
Q
THYROIDITIS
A
- T4 and T3 levels initially elevated but over time become depressed
- recovery may be complete in weeks or months
- bacterial - treat with antibiotics or surgical drainage
- NSAIDS - progressing to corticosteroids if needed
- Propranolol or atenolol- may be used to treat cardiovascular symptoms R/T to hyperthyroid state
6
Q
THYROID STORM ( THYROTOXIC CRSIS)
A
- extreme state of hyperthyroidism
- considered life threatening emergency, death rare when treatment started early
CLINICAL MANIFESTATIONS:
severe tachycardia, heart failure, shock, hyperthermia, restlessness, agitation, seizures, abdominal pain,N/V/D, delirium, and coma
7
Q
THYROID STORM TREATMENT
A
- decreased circulating thyroid hormone levels with drug therapy
- managing respiratory distress
- fever reduction
- fluid replacement
- elimination or management of the initiating stressor
8
Q
EXCESS TSH STIMULATION
A
- secondary form of hyperthyroidism - rare
- caused by over production of TSH by the pituitary gland and usually stimulates the thyroid gland to produce excess of thyroid hormone.
9
Q
DRUG THERAPY
A
- Antithyroid Drugs
- Iodine
- Beta adrenergic blockers
10
Q
RADIOACTIVE IODINE THERAPY
A
- damages or destroys thyroid tissue
- outpatient treatment-RAI given orally
- radioactive iodine is low - no radiation precations needed
- dryness and irritation of mouth and throat during treatment
- high incident of post treatment hypothyroidism in 80%
of cases
11
Q
HYPERTHYROIDISM SURGERY
A
- subtotal - leaves about 10% of thyroid gland and the remainder of gland will produce adequate TH
- total- thyroid gland and patients will require lifelong hormone replacement
12
Q
HYPERTHYROIDISM POST- OP COMPLICATIONS
A
- hypothyroidism
- hemorrhage
- damage to parathyroid glands - hypocalcemia
- injury laryngeal nerve -vocal cord paralysis
- infection
- respiratory distress
13
Q
HYPERTHYROIDISM ASSESSMENT
A
- health history
- muscle strength , tremors
- size of thyroid
- eyes and vision
- cardiovascular(Afib)
- vital signs (inceased HR,BP,RR)
- bruit over thyroid
- integument (warm ,sweating)
14
Q
HYPERTHYROIDISM NURSING DIAGNOSIS
A
- decreased cardiac output
- impaired comfort
- impaired health maintenance
- risk for infection
- imbalanced nutrition- less than body requirements
- disturbed body image
15
Q
HYPERTHYROIDISM PLANNING
A
- patient reports improvement
- patient will describe situations requiring contact with the provider
- patient explains how to take medications
16
Q
HYPERTHYROIDISM EVALUATION
A
- cardiac status will stabilize
- regains or maintains visual acuity
- takes in appropriate amount of calories per day
- communicates feeling about changes in body image
- explains importance of daily medication if required
17
Q
HYPOTHYROIDISM PATHOPYSIOLOGY AND ETIOLOGY
A
- TH production decreases
- thyroid gland enlarges in attempt to produce more hormone
- hypothyroid state leads to myxedema
18
Q
HYPOTHYROIDISM ETIOLOGY
A
PRIMARY:
- defects in gland , loss of thyroid tissue, antithyroid medications, thyroiditis, endemic iodine deficiency
SECONDARY:
- pituitary TSH deficiency or peripheral resistance to TH
- medications can cause
- common in women 30-60 years
19
Q
HYPOTHYROIDISM RISK FACTORS
A
- more common in women older than 50 years
- relatives with autoimmune disorders
- history of thyroid surgery
- radiation of neck
- iodine deficiency
- hashimoto thyroiditis
20
Q
HYPOTHYROIDISM
A
- hashimoto thyroiditis
- common cause of goiter and primary hypothyroidism
- autoimmune disorder- AB destroy tissue
21
Q
HYPOTHYROIDISM CLINICAL MANIFESTATIONS
A
- slow onset
- goiter
- fluid retention and edema
- decreased appetite, weight gain
- constipation
- dry skin
- dyspnea
- slow HR
- menstrual problems
- pallor
- anemia
- cardiac enlargement
- abnormalities in lipid metabolism
- decreased taste, smell
- muscle stiffness
22
Q
MYXEDEMA COMA
A
- untreated hypothyroidism triggered by factors
- life threatening
- severe metabolic disorder
- precipitated by: trauma, CNS depressants, failure to take medications, infection, exposure to cold
23
Q
PHARMOCOLOGIC THERAPY FOR HYPOTHYROIDISM
A
-levothyroxine(senthroid)
24
Q
HYPOTHYROIDISM
A
HEALTH HISTORY:
- onset, severity of symptoms
- diet, use of ionized salt
- pituitary diseases (secondary hypothyroidism)
- treatment of hyperthyroidism
PHYSICAL ASSESSMENT:
- muscle strength, deep tendon reflexes(decreased)
- vital signs, cardiovascular, integument (decreased)
- thyroid gland, weight
25
HYPOTHYROIDISM NURSING DIAGNOSIS
- decreased cardiac output
- constipation
- risk for impaired skin integrity
- impaired body image
- impaired nutrition
- fatigue, fall risk
26
HYPOTHYROIDISM PLANNING
- pulse and BP
- arrhythmias controlled
- skin remains intact, warm and dry
- free of edema
- activities resumed with normal heart rate
- elimination pattern returns to normal
27
HYPOTHYROIDISM IMPLEMENTATION
- monitor cardiac output
- monitor BP,apical, peripheral pulses
- monitor respiratory rate, breath sounds(crackles)
- avoid becoming chilled
- explain need to alternate periods of rest/activity
- prevent constipation
- encourage fluid intake 2000ml /day
- high fiber diet
- increase activity
28
HYPOTHYROIDISM EVALUATION
- determine whether patient has met expectations
- make changes to care plan if not
- repeat diagnostic tests to ensure proper medication level
29
HYPOTHYROIDISM NURSING CONSIDERATIONS
maintain skin integrity
- monitor skin for redness, lesions
- provide and teach immobile patients measures to promote circulation
- implement ROM exercises
- provide and teach patient to maintain skin integrity
30
WHAT IS THE THYROID
-small saddle shaped gland that wraps around the anterior portion of the trachea
```
PRIMARILY EFFECTS:
metabolism
cardiovascular
gastrointestinal
neuromuscular
```
31
DIAGNOSTIC TESTS
- thyroid antibodies (TA) test
- TSH test (sensitivity)
- T4
- T3
- T3 uptake test
- RAI uptake test (thyroid scan )
- thyroid suppression test
32
GRAVES DISEASE
- most common cause of hyperthyroidism
- autoimmune disorder(presence of MG/PA)- antibody in serum binds to TSH receptors in thyroid follicles causing hyperfunction
- enlarged thyroid gland (goiter)
- manifestations of hyperthyroidism
33
EXOPHTHALMOS
- graves disease
- eye pain
- blurred vision
- diplopia
- lacrimation and photophobia
- increased risk of corneal dryness, irritation and ulceration
34
TOXIC MULTINODULAR GOITER
- develops slowly, usually in women 60-70
- no opthalmopathy nor dermopathy clinical manifestations
- small, independently functioning nodules
35
THYROIDITIS
- subacute granulomatous-viral infection
- acute thyroiditis- bacterial or fungal
- acute disorder that may become chronic,resulting in a hypothyroid state as the repeated infections destroy the thyroid gland tissue
36
THYROIDITIS TREATMENT
- T4 and T3 levels initially elevated but over time become depressed
- recovery may be complete in weeks or months
- bacterial treat with antibiotics or surgical drainage
- NSAIDS progressing to corticosteroids if needed
- propranolol (inderal) and atenolol (Tenormin) may be used to treat cardiovascular symptoms r/t hyperthyroid state
37
THYROID STORM TREATMENT
- decrease circulating thyroid hormone levels with drug therapy
- managing respiratory distress
- fever reduction
- fluid replacement
- elimination or management of the initiating stressors
38
HYPERTHYROIDISM POST-OP NURSING CARE
- standard post op care protocols
- assess patient for signs of hemorrhage or tracheal compression
- place patient in semi-fowlers position and support the patients's head with pillows
- avoid flexion of the neck and tension on suture line
39
HYPOTHYROIDISM NURSING CONSIDERATIONS
- maintain skin integrity
- provide and teach immobile patients measures to promote circulation
- implement ROM exercises
- provide and teach patient to maintain skin integrity
