Thyroid Gland Disorders Flashcards by Anonymous 1

Thyroid gland secretes the following hormones

T3
T4
Thyrocalcitonin

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T3 (Triidothyronine) Function

Metabolism and Growth

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T4 (Thyroxine, tetraiodothyronine)

Catabolism and Body Heat Production

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regulates serum Ca++ levels
bring down the blood Ca++ level

Thyrocalcitonin

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Increase T3 = Increase metabolic rate
Increase T4 = Increase body heat production
Increase Thyrocalcitonin = Decrease calcium

Hyperthyroidism (Thyrotoxicosis)

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Hyperthyroidism Cause: most common cause

Grave’s Disease

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Hyperthyroidism Cause: autoimmune disorder due to the production of an antibody/immunoglobulin TSI (thyroid stimulating immunoglobulin) that has the same effect as TSH…this stimulates the body to produce high amounts of thyroid hormones (genetic)

Grave’s Disease

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Hyperthyroidism Cause: not autoimmune…growths of nodular goiters that are independently functioning to cause hypersecretion of thyroid hormones

Toxic Nodular Goiter

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Hyperthyroidism Cause: inflammation of the thyroid gland and this can cause T3 and T4 leak into the body

Thyroiditis

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Hyperthyroidism Cause: Protruding eyeballs, goiter, pretibial myxedema: waxy orange peel appearance of the skin found in the feet and legs

Grave’s Disease

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Hyperthyroidism Cause: won’t see ophthalmic signs like the protruding eye balls but the classic signs and symptoms of hyperthyroidism

Toxic Nodular Goiter

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Hyperthyroidism CM: HR?, BP?

Tacycardia, Hypertension

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Hyperthyroidism CM: ? Appetite, ? Loss

Voracious
Weight

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Hyperthyroidism CM: Frequent ?, ? Intolerance

Sweating (Diaphoresis)
Heat

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Hyperthyroidism CM: absence of ? in F, ? hair, ? nails

Menstruation (Amenorrhea)
Fine Silky
Pliable

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Hyperthyroidism CM: Mood Changes?, Fine ?

Irritability, Restlessness, Nervousness
Tremors

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Hyperthyroidism Interventions: Provide a ? and ? environment

Cool, Quiet

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Hyperthyroidism Interventions: Provide adequate ? Administer ? as prescribed

Rest
Sedatives

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Hyperthyroidism CM: Due to accumulation of fluids, mucopolysaccharides at the fat-pads behind the eyeballs, it can lead to corneal ulceration

Exopthalmos

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Hyperthyroidism CM: Long and deep palpebral fissure is still evident when one looks down

Von Graefe’s Sign (Lid Lag)

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Hyperthyroidism CM: Forehead remains smooth when one looks up

Jeffrey’s Sign

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Hyperthyroidism CM: Bright-eyed stare, infrequent blinking

Dalyrimple’s Sign (Thyroid Sign)

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Hyperthyroidism CM: Warm, flushed sweaty skin
Thickened hyper-pigmented skin at the pretibial area

Dermopathy

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Hyperthyroidism Interventions: Diet ?

High Calorie and CHON Vitamin and Mineral Supplements Fluid Intake (If there's diarrhea)

Hyperthyroidism Interventions: Avoid Stimulants like ?

Coffee, Tea, and Nicotine

Hyperthyroidism Interventions: Obtain ? daily

Weight (Same Time, Clothes, Weighing Scale)

Hyperthyroidism Interventions: Protect the eyes by ?

Using artificial tears at regular intervals Wearing dark sunglasses Taping eyelids at night (if necessary)

Hyperthyroidism Interventions: Prepare the client for ? therapy, → destroys thyroid cells

Radioactive Iodine

Hyperthyroidism Interventions: Prepare the client for ?if prescribed

Subtotal Thyroidectomy

Hyperthyroidism Pharmacotherapy: ß-blockers

Propanolol

Hyperthyroidism Pharmacotherapy: These drugs are given to control tachycardia and HPN

Ca+ Channel Blockers

Hyperthyroidism Pharmacotherapy: Are given to inhibit release of thyroid hormone

Iodides: Lugols Solution (SSKI Saturated Solution of Potassium Iodide)

Hyperthyroidism Pharmacotherapy: Iodides: Lugol’s solution shoul be mix with ? with ? or glass of water to improve its palatability

Fruit Juice Ice

Hyperthyroidism Pharmacotherapy: Iodides: Lugol's Solution - Provide drinking straw to prevent permanent ?

staining of teeth

Hyperthyroidism Pharmacotherapy: Iodides: Lugol's Solution Side Effects?

Allergic Reaction, Increased Salivation, Colds

Hyperthyroidism Pharmacotherapy: These are given to inhibit synthesis of thyroid hormones

Thioamides

Hyperthyroidism Pharmacotherapy: Thioamides

PTU (Propylthiouracil) Tapazole (Methimazole)

Hyperthyroidism Pharmacotherapy: Side effects of PTU

Agranulocytosis Neutropenia

Hyperthyroidism Pharmacotherapy: ? must be avoided because it can displace the T3/T4 from the albumin in the plasma causing increased manifestations

Aspirin

Hyperthyroidism Pharmacotherapy: inhibit the action of thyroid hormones

Dexamethasone

Hyperthyroidism Pharmacotherapy: NOT recommended in pregnant women because of potential teratogenic effects. Pregnancy should be delayed for ? months after therapy

Radiation Therapy (Iodine) 6 mos

Hyperthyroidism Subtotal Thyroidectomy: Usually about ? of the gland is removed

5/6

Hyperthyroidism Subtotal Thyroidectomy: Position

Semi-fowler's with head, neck, shoulders erect

Hyperthyroidism Subtotal Thyroidectomy: Prevent Hemorrhage

Ice collar over the neck

Hyperthyroidism Subtotal Thyroidectomy: Keep ? set available for the first ? post-op

Tracheostomy 48 hrs

Hyperthyroidism Subtotal Thyroidectomy: Ask the patient to ? (to assess for recurrent laryngeal nerve damage)

Speak every hour

Hyperthyroidism Subtotal Thyroidectomy: Keep ? readily available – ? occurs if hypocalcemia is present. This may be secondary to the accidental removal of the parathyroid gland

Ca+ Gluconate Tetany

Hyperthyroidism Subtotal Thyroidectomy: Monitor Body Temperature - ? is an initial sign of thyroid crisis

Hyperthermia

Hyperthyroidism Subtotal Thyroidectomy: ? exercises of the neck ? days after discharge

ROM 3-4 days

Sudden, life-threatening exacerbation of hyperthyroidism/thyrotoxicosis

Thyroid Crisis/Storm

Thyroid Crisis Causes

Stress, Infection, Unprepared Thyroid Surgery

Thyroid Crisis Causes: taking medications that increase thyroid hormones

Salicylates (ASA)

Thyroid Crisis CM: Initial sign

Elevated Temperature (Fever)

Thyroid Crisis CM: HR, BP, RR

Tachycardia Hypertension Tachypnea

Thyroid Crisis CM: Neurologic State and Conciousness

Restlessness, Apprehension, Tremors, Delirium, Psychotic State, Coma

Thyroid Crisis Interventions: Monitor?

BP, HR, RR, Temperature, I and O Neurologic Status

Thyroid Crisis Interventions: Keep environment ? and ? cool (? and ? as prescribed)

Quiet, Cool Cooling Blankets, Sedatives

Thyroid Crisis CM: No foods containing ? (seafood…seaweed, dairy, eggs)

Iodine

Thyroid Crisis Interventions: Administer increasing doses of oral ?- (? mg q ? hrs) as ordered, following a loading dose of ? mg. p.o as ordered

PTU, 200-300mg, 6hrs 800-1,200mg

Thyroid Crisis Interventions: Administer ? to help inhibit the release of thyroid hormone Administer ? to control hypertension and tachycardia

Dexamethasone Propranolol

Thyroid Crisis Interventions: Implement measures to lower fever - cooling devices - cold baths - ? (avoid ?)

Acetaminophen Aspirin

hyposecretion of thyroid hormones

Hypothyroidism

characterized by a decreased rate of body metabolism

Hypothyroidism

thyroid gland cannot produce the necessary amount of hormones

Primary Hypothyroidism

thyroid is not being stimulated by the pituitary gland to produce hormones

Secondary Hypothyroidism

Decrease T3 = Decrease metabolic rate Decrease T4 = Decrease body heat production Decrease Thyrocalcitonin = Increase calcium

Hypothyroidism

Hypothyroidism Causes: an autoimmune disorder in which your immune system inappropriately attacks your thyroid gland causing an inflammation

Hashimoto's Disease or Chronic Lymphocytic Thyroiditis

Hypothyroidism Causes: after surgery ? after radiation therapy ? ? drugs

Thyroidectomy Radioactive Iodine Antithyroid

Hypothyroidism CM: ? Hair, Loss of ? Hair, ? Face

Dry, Coarse Hair Eyebrow Puffy

Hypothyroidism CM: Swelling of the skin (eyes and face) that gives it a waxy appearance Dull, ? , mask-like ?

Myxedema Expressionless, Face

Hypothyroidism CM: ? Skin, ? Nails

Dry Brittle

Hypothyroidism CM: Weight Gain? , ? Pain

Hyperlipidemia & Atherosceloris Muscle

Hypothyroidism CM: Slow ? ? voice ? tongue

Slowed Husky, Hoarse Enlarged

Hypothyroidism CM: Irregular menstruation

Menorrhagia, Amenorrhea

Hypothyroidism CM: GI Disturbance

Constipation Anorexia

Hypothyroidism CM: ? physical, mental reactions, ? Extremely tired and ?

Slowed, Apathy Fatigue

Hypothyroidism CM: ? intolerance, ? temperature HR ?

Cold, Subnormal Bradycardia

Hypothyroidism Intervention: Monitor ?

VS (HR, BP, EKG) Weight daily

Hypothyroidism Intervention: Diet, Encourage ?

Low Calorie, High Fiber Fluids

Hypothyroidism Pharmacotherapy: Thyroid hormonal replacement

Proloid (Thyroglobulin) Synthroid (Levothyroxin) Dessicated Thyroid Extract Cytomel (Liothyronine)

Hypothyroidism Pharmacotherapy: Thyroid hormonal replacement - Most Common

Synthroid (Levothyroxine)

Hypothyroidism Pharmacotherapy: Thyroid hormonal replacement - Before administration, the nurse should monitor ? & ?

BP, PR

Hypothyroidism Pharmacotherapy: Thyroid hormonal replacement - Start with ? and gradually ?

Low dose Increase

Hypothyroidism Pharmacotherapy: Thyroid hormonal replacement - Don’t ? taking (takes a while for signs and symptoms to improve)

abruptly stop

Hypothyroidism Pharmacotherapy: Thyroid hormonal replacement - Take at the ? every day in the morning without ?

Same time Food

Hypothyroidism Pharmacotherapy: Thyroid hormonal replacement - Don’t take within ? of multivitamins, GI medications like Carafate, aluminum hydroxide, simethicone….decreases absorption of thyroid medication

4 hours

Hypothyroidism Pharmacotherapy: Note patients with hypothyroidism are sensitive to narcotics like ? (avoid dilaudid, morphine, fentanyl) and other ? (could lead to myxedema coma). Instead use alternatives for pain as prescribed like non-narcotics ?

Opoids, Sedatives Tylenol, Ibuprofen

Extreme, severe stage of hypothyroidism, in which the client is hypothermic and unconscious

Myxedema Coma

Myxedema Coma CM: ? (not just cold intolerance)

Hypothermia

Myxedema Coma CM: swelling of tissues that have a waxy appearance or orange peel texture which will be located on the eyes and face

Myxedema

Myxedema Coma CM: ? heart rate and ? blood pressure ? failure (most likely will need mechanical ventilation)

Slow, Low Respiratory

Myxedema Coma CM: due to the increased antidiuretic hormone which causes the body to conserve water & decreased glomerular filtration rate because there is decreased blood flow to the kidneys

Hyponatremia

Myxedema Coma CM: due to the reduced metabolic rate hence decreased gluconeogenesis

Hypoglycemia

Myxedema Coma CM: Very ? may progress to a coma

Confused/Drowsy

Thyroid Gland Disorders Flashcards

(97 cards)