Week 8

Question 1

How many people out of 100 does hypothyroidism affect?

Answer 1

2

Question 2

What is hypothyroidism a result of?

Answer 2

Insufficient circulating thyroid hormone.

Question 3

What is primary hypothyroidism?

Answer 3

Related to the destruction of thyroid tissues or defective hormone synthesis.

Question 4

What is secondary hypothyroidism?

Answer 4

Related to pituitary disease with decreased secretion of TSH or hypothalamic dysfunction with decreased secretion of thyrotropin-releasing hormone.

Question 5

What is transient hypothyroidism?

Answer 5

Related to thyroiditis or discontinuation of thyroid hormone therapy.

Question 6

What is the most common cause of hypothyroidism worldwide?

Answer 6

Iodine deficiency.

Question 7

What is the most common cause of hypothyroidism in Canada?

Answer 7

Atrophy of the thyroid gland. The end result of Hashimotos and Graves Disease.

Question 8

What treatments for hyperthyroidism can cause hypothyroidism?

Answer 8

Surgical removal of the thyroid gland, or radioactive iodine therapy.

Question 9

what is cretinism?

Answer 9

Hypothyroidism that develops in infancy.

Question 10

What is cretinism caused by?

Answer 10

Thyroid hormone deficiencies during fetal or early neonatal life. Infants in Canada are screened at birth.

Question 11

What are the CM of hypothyroidism?

Answer 11

MOM'S SO TIRED - C
Memory loss
Obesity
Malar flush/Menorrhagia
Slowness
Skin and hair dryness
Onset gradual
Tiredness
Intolerance to cold
Really low BP
Energy levels fall
Depression/delay in reflexes.
Constipation

Question 12

How does hypothyroidism affect the cardiovascular system?

Answer 12

Associated with a decreased cardiac output, and decreased cardiac contractility. Client may experience low exercise tolerance and SOB on exertion.

Question 13

What lab values decrease in someone with hypothyroidism?

Answer 13

Decrease in iron, erythropoietin, oxygen demand, low hematocrit cobalamin, and folate.

Question 14

What lab values increase in someone with hypothyroidism?

Answer 14

Serum cholesterol and triglycerides result in atherosclerosis.

Question 15

What is myxedema?

Answer 15

The accumulation of hydrophilic mucopolysaccharides in dermis and other tissues.

Question 16

What is a myxedema coma?

Answer 16

A coma that is a result of mental and physical sluggishness. Can be precipitated by infections and drugs, exposure to cold, and trauma.

Question 17

What are the characteristics of myxedema coma?

Answer 17

Subnormal temperature, hypotension, hypoventilation.

Question 18

What are the diagnostic tests used for hypothyroidism?

Answer 18

History and physical exam
Serum T3 and T4
Serum TSH and free T4 levels
Thyroid peroxidase antibodies
TRH stimulation test

Question 19

What are some collaborative therapy interventions for hypothyroidism?

Answer 19

Monitoring thyroid hormone levels and adjustig dosage.
Nutritional therapy to promote weight loss.
Patient and caregiver teaching.
Thyroid hormone replacement.

Question 20

What are the goals for a client with hypothyroidism?

Answer 20

Experience relief from symptoms
Maintain euthyroid state
Maintain a positive self-image
Adhere to the lifelong regimen of thyroid replacement therapy.

Question 21

What are some important education points for clients and families for hypothyroidism?

Answer 21

Explain thyroid hormone deficiency and self-care
Emphasize the need for a warm comfortable environment.
Teach measures to prevent skin breakdown.
Avoid sedatives
Discuss ways to minimize constipation.

Question 22

what is diabetic ketoacidosis?

Answer 22

An acute metabolite complication of DM occuring when fats are metabolized in the absence of insulin.

Question 23

What are the characteristics of DKA?

Answer 23

Hyperglycemia, ketosis, metabolic acidosis, dehydration.

Question 24

What are precipitating factors of DKA?

Answer 24

Illness, infection, inadequate insulin dosage, insulin omission, undiagnosed 1 DM, poor self-management.

Question 25

What happens in DKA?

Answer 25

When the circulating supply of insulin is insufficient, glucose cannot be used for energy, so the body metabolizes fats instead.

Question 26

What are ketones?

Answer 26

Acidic by-products of fat metabolism that cause problems when they become excessive in the blood.

Question 27

What do ketones alter?

Answer 27

The blood's pH. Causes metabolic acidosis.

Question 28

What is ketonuria?

Answer 28

The process that begins when ketones enter the urine.

Question 29

What happens when ketonuria begins?

Answer 29

The electrolytes become depleted as cations are eliminated along with anionic ketones to maintain balance in the body.

Question 30

How does insulin deficiency affect protein?

Answer 30

It impairs protein synthesis and causes excessive protein degeneration.

Question 31

What does insulin deficiency stimulate?

Answer 31

Stimulates the production of glucose from amino acids in the liver and leads to hyperglycemia.

Question 32

What happens if DKA is not treated?

Answer 32

It causes a severe depletion of sodium, potassium, chloride, magnesium, and phosphate.

Question 33

What does acidosis cause hydrogen ions to do?

Answer 33

It causes H+ ions to move from extracellular fluid to intracellular fluid. This promotes K+ movement out of the cell.

Question 34

What happens to the extracellular potassium as a result of the shift from DKA?

Answer 34

Most of it is lost in the urine because of osmotic diuresis. Serum K+ can appear normal or high, but this finding is misleading.

Question 35

What are the CM of DKA?

Answer 35

Polyuria, polydipsia, dehydration, lethargy, weakness, nausea, vomiting, Kussmaul's respiration.

Question 36

What are the diagnostic tests for DKA?

Answer 36

History and physical Blood studies: blood glucose, CBC, ketones, pH, electrolytes, blood urea nitrogen, arterial blood gases. Urinalysis: specific gravity, pH, glucose, ketones.

Question 37

What is the collaborative therapy for DKA?

Answer 37

Admin: IV fluids, electrolyte replacement, short-acting insulin. Assess and monitor: blood and urine for ketones, glucose levels, vitals, mental status, ECG, intake and output.

Question 38

What organs are involved in the thyroid hormone feedback loop?

Answer 38

Hypothalamus, Anterior Pituitary Gland, Thyroid Gland.

Question 39

What hormones are involved in the thyroid hormone feedback loop?

Answer 39

Thyrotropin-releasing hormone (TRH), thyroid-stimulating hormone (TSH), tri-iodothyronine (T3), thyroxine (T4).

Question 40

What does the thyroid do?

Answer 40

Processes iodine and produce T3 and T4.

Question 41

Explain the thyroid feedback loop.

Answer 41

Stimuli triggers the hypothalamus (controls thermostate) which releases TRH, this stimulates the anterior pituitary gland, which triggers TSH. This stimulates the thyroid gland, which triggers a release of T3 and T4, which circle back to the hypothalamus and pituitary gland to stop the release of TRH and TSH.

Question 42

Describe the pathogenesis of hypothyroidism?

Answer 42

If the thyroid gland fails, the anterior pituitary gland will secrete TSH to try and get it to work. This causes the TSH level to be super high. Due to insufficient T3 and T4, the body will keep releasing TSH.

Question 43

What is acetoacetate?

Answer 43

Made in liver, becomes beta-hydroxybutyrate and acetone (both are ketones) when metabolized.

Question 44

What is polyphagia?

Answer 44

Increase in hunger.

Question 45

What are the 4 characteristics of DKA?

Answer 45

Dehydration, hyperglycemia, ketosis, acidosis.