Medical 3-MS67-Hyperthyroidism

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What do thyroid and parathyroid glands affect overall?: metabolism
electrolyte balance
excitable mambrane activity
Excessive thyroid hormones produce hypermetabolism and increase SNS or PNS?: SNS
How do thyroid hormones directly stimulate the heart?: by increasing heart rate and stroke volume
An increase in heart rate and stroke volume causes increased?: cardiac output
blood flow
Fat metabolism is ________, and body fat ________.: increased
decreased
Client has _________ appetite, but food intake doesn't meet energy demands, and client _________ weight. Prolonged case may cause nutritional deficiency.: increased
loses
Thyroid hormones may have some influence over sex hormones in men and women causing _________ problems and _________ fertility. Libido is ________ in both sexes.: menstrual
decreased
increased
Not all clients with a ______ have hyperthyroidism.: goiter
The risk for Graves' disease is increased in people who have other autoimmune disorders such as _____ ____ _________ ________and __________ ________.: type 1 diabetes mellitus
pernicious anemmia
What is thyroid storm (thyroid crisis)?: can occur when hyperthyroidism is untreated or poorly controlled or when the client is severely stressed; may be life threatening
Hyperthyroidism or Graves' disease can occur at any age, but most often occurs in women between: 20 and 40
While taking the history of a Graves' disease client, during assessment, record the following.: age
gender
usual weight
increased weight loss?
increased appetite?
increased number of bowel
movements per day
heat intolerance? (hallmark)
palpitations or chest pain?
ophthalmopathy?
blurring, double vision,
tiring of eyes?
fatigue?
weakness?
insomnia?
irritable?
depressed?
amenorrhea?
increased libido?
previous thyroid surgery?
radiation therapy?
past or current drugs?
Two types of ophthalmopathy?: eyelid retraction (eyelid
lag)
globe (eyeball) lag
What is eyelid lag?: occurs in all forms of
thyrotoxicosis
upper eyelid fails to descend
when gazing slowly
downward
What is globe lag?: upper eyelid pulls back
faster than eyeball when
gazing upward
When assessing eyes, have patient look _________ and ________.: upward-test for globe lag
downward-test for eyelid lag
What is the wide-eyed or "starlted" look seen in infiltrative ophthalmopathy leading to exophthalmos (abnormal protrusion of the eyeball) due to?: edema in extraocular muscles and increased fatty tissue behind the eye, which pushes eyeball forward...causes swelling and shortening of muscles...problems focusing...eyelid may fail to close completely...become overdry...develop corneal uclers or infection..excessive tearing and bloodshot appearance and photophobia may be indicative of condition
What may be heard with stethoscope when palpating goiters?: bruits - turbulence from
increased blood flow
Goiter may cause the thyroid gland to increase size by _____ times.: four
Cardiac problems of hyperthyroidism include:: increased systolic blood pressure
tachycardia
other dysrhythmias
diastolic pressure usually
decreased
With HT, hair and skin will be?: fine, soft, silky hair and smooth, moist skin
With HT, muscles may be _____, _______,_________.: weak
hyperactive deep tendon
reflexes
tremors (hands)
With HT, patient may be r____, i____, f____: restless
irritable
fatigued (can't sleep well)

assess by asking patient if he's been crying or laughing inappropriately or has had difficulty concentrating
What are tests for HT?: triiodothyronine (T3)
thyroxine (T4)
T3 resin uptake (T3RU)
thyroid-stimulating hormone
(TSH)
A goiter classification of zero means?: no palpable or visible goiter
A goiter classification of one means?: mass is not visible with neck in the normal position.
A goiter classification of two means?: mass is visible as swelling when the neck is in the normal position. Goiter is easily palpated and is usually asymmetric.
Diagnostic assessments include:: thyroid scan-pregnancy
contraindicated; d/c
iodine containing drugs 1
week before scan
ultrasonography - painless,
takes 30 minutes
electrocardiography
Nursing diagnosis: Imbalanced nutrition: less than body requirements related to?: inadequate intake in relation to metabolic needs
Nursing diagnosis: Hyperthermia related to?: increased metabolic rate
Nursing diagnosis: Fatigue related to?: sleep deprivation
Nursing diagnosis: Potential for hypertension and cardiac failure okay: okay
Nonsurgical management of HT is:: monitor apical pulse
b.p.
temperature
(all of these at least every
4 hours)

client should immediately report:
palpitations
dyspnea
vertigo
chest pain

encourage rest, keep it quiet, frequent bed linen changes, sponge baths, cool environment (heat intolerance)
Drug therapy for HT? (5): *thiomides to control thyroid...
*add cardiac meds until thiomides work..
*iodine preparations are used to decrease blood flow through thyroid gland...may take 2 weeks
*lithium carbonate inhibits thyroid hormone release...
*beta-adrenergic blocking drugs for cardiac
Thiomides used to treat HT?: propylthiouracil (PTU)
methimazole (Tapazole)
carbimazole (Neo-Mercazole)
blocks thyroid hormone
production
Thiomide results may be delayed because?: large amounts of stored thyroid hormones continue to be released...so other drugs are needed to control cardiac manifestations until hormone production and release are reduced
Lithium is sometimes given for HT patients who can't tolerate other antithyroid drugs...however side effects may include?: depression
diabetes insipidus
tremors
nausea
vomiting
The most common treatments for HT are?: antithyroid drugs
RAI therapy (radioactive
iodine therapy)
outpatient, one dose
usually, hypothyroidism
may occur, REINFORCE need
for REGULAR FOLLOWUP
because HYPOthyroidism
can occur several years
AFTER RAI
Preoperative care for HT includes?: give antithyroid drugs that decrease secretion of thyroid hormones...
give iodine preparations to decrease thyroid size and vascularity, which reduces risk for hemorrhage and thyroid storm during surgery..
patient may need to be on a high-protein, high-carbo diet for days or weeks before surgery...
hypertension, dysrhythmias, and tachycardia must be controlled before surgery..
teach patient coughing and deep-breathing exercises...support neck when coughing or moving..place both hands behind neck when moving ...hoarseness may be present for a few days due to endotracheal tube
Postoperative care for HT?: *monitor VS q 15 min...and then q 30 min
*use sandbags or pillows to support head and neck....place in semi-Fowler's position...give rx as needed for pain..
humidify air...cough and deep breath every 30 minutes to 1 hour...suction oral and tracheal secretions
What complications can thyroid surgery cause?: hemorrhage
respiratory distress
parathyroid gland injury
resulting in hypocalcemia
tetany
damage to laryngeal nerves
thyroid storm
Within 24 hours of thyroid surgery, a complication may be?: hemorrhage...if present, check drain for serosanguinous fluid...may be bleeding at incision site...may be respiratory distress caused by tracheal compression
Immediately following thyroid surgery, respiratory distress can result from?: swelling or tetany...assess for stridor...keep oxygen and suctioning equipment handy
Hypocalcemia and tetany following thyroid surgery may occur because?: there has been damage to the parathyroid glands or their blood supply has been impaired which decreases PTG levels...assess patient for muscle twitching as signs of calcium deficiency...can be reversed by starting calcium IV
Laryngeal nerve damage may occur during thyroid surgery and result in?: hoarseness and weak voice...assess client's voice at 2-hour intervals...this is temporary
Key manifestations of thyroid storm are?: fever
tachycaardia
systolic hypertension

other manifestations include:
abdominal pain
nausea
vomiting
diarrhea
anxiety
tremors
restlessness
confusion
psychosis
seizures leading to coma
After thyroid storm is identified, emergency measures include?: airway patency
providing adequate
ventilation
reducing fever
stabilizing hemodynamic
status
Does treatment for hyperthyroidism correct eye and vision problems of Graves disease?: no
To treat infiltrative ophthalmopathy, instruct client with mild symptoms to?: elevate the head of the bed at night and to use artificial tears...dark glasses or eye patches may help if photophobia present...if patient can't close eyelids completely, gently tape lids closed ...short-term steroid therapy (Prednisone, Deltasone, Winpred) may be indicated to reduce swelling and halt infiltrative process...reduce prednisone gradually from 120 mg daily then lowered
After the client has had thyroid surgery, the incisions in the neck are usually removed withint: third or fourth postop day...patient should INSPECT
inicision area to report redness, tenderness, drainage, swelling
What psychotic condition might patient still have following thyroid surgery?: mood changes
(these should decrease with continued treatment)
What 4 things should the aged person know about the changes in thyroid as a person ages?: thyroid gland decreases in size with increased age

thyroid hormone secretion decreases with age

basal metabolic rate decreases with age

older clients require lower doses of replacement thyroid hormone
Why does metabolic rate of thyroid decrease with age?: Because body composition changes from predominantly muscular to perdominantly fatty tissue
Why do older clients require lower doses of replacement thyroid hormone?: Because too large a dose may adversely affect the heart muscle
Home care assessment of a patient with thyroid dysfunction includes assessing which 4 systems?: cardiovascular
neural
integumentary
muscular
Home care assessment of a patient's cardiovascular status accompanying thyroid dysfunction includes?: VS, including apical pulse, pulse pressure, presence or absence of orthostatic hypotension, and quality and rhythm of peripheral pulses

presence or absence of peripheral edema

weight gain or loss
Home care assessment of a patient's cognition and mental status accompanying thyroid dysfunction includes?: LOC

accurately reading a seven-word sentence containing no words greter than 3 syllables

can client count backward from 100 by threes?
Home care assessment of a patient's integumentary status accompanying thyroid dysfunction includes?: Are skin and mucous membranes moist...most reliable on chest and back

skin temp and color
Home care assessment of a patient's neuromuscular status accompanying thyroid dysfunction includes?: reactivity or patellar and biceps reflexes

oral temp

handgrip strength

steadiness of gait

presence or absence of fine tremors in hand
Home care assessment of a patient's thyroid dysfunction includes asking the following 6 things?: sleep in past 24 hours
client warm enough or too
warm indoors
24-hour diet recall
24-hour activity recall
OTC and rx meds taken
last bowel movement

also assess client's understanding of illness and adherence with treatment
manifestations to report
to hcp
med plan (correct timing
and dose)

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