NR203 Test 4 hypothyroidism (Endocrine 10 Final Questions)
Terms
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- Hypothyroidism
-
Results when the thyroid gland produces an insufficient amount of thyroid hormone .
• Everything SLOOOOWS Down!
– Metabolism rate decreases
– Heat production decreases
• May be primary or secondary -
Hypothyroidism
Cretinism -
• Congenital hypothyroidism
– Results in mental and physical retardation
if not treated immediately
• Cretin: Normal developing infant with replacement therapy -
Hypothyroidism
primary -
– Primary: Most common, may be caused by congenital defects in gland, loss of thyroid tissue
following treatment of hyperthyroidism, antithyroid medications, thyroiditis, endemic iodine insufficiency -
Hypothyroidism
⬢ Secondary: -
• Secondary:
– Results from a pituitary TSH deficiency
– Peripheral resistance to thyroid hormones
• Slow onset, months to years
– With treatment mental and physical symptoms reverse in clients of all ages!
• Replacement of thyroid hormones may lead to hyperthyroidism – it is a balancing act!! -
Hypothyroidism
More common in
Myxedema:describe -
• More common in women, ages 30 to 60.
• Myxedema: characteristic accumulation of nonpitting edema in the connective tissues throughout the body. The edema is water retention in mucoprotein deposits in the interstitial spaces.
– Face is puffy
– Tongue is enlarged -
Hypothyroidism
As TH production decreases, the thyroid gland _______ -
⬢ As TH production decreases, the thyroid gland
Enlarges in an attempt to produce more of the hormone.
⬢ A goiter will typically form.
⬢ A lack of iodine may precipitate hypothyroidism. Iodine is necessary for the synthesis and secretion of TH. -
Hypothyroidism
What does this disorder look like? -
What does this disorder look like?
⬢ Presence of the goiter
⬢ Dyspnea
⬢ Fluid retention and edema
⬢ Decreased appetite
⬢ Weight gain
⬢ Constipation
⬢ Dry Skin
⬢ Muscle Stiffness
⬢ Neurologic changes
⬢ Anemias
⬢ Cardiovascular Deficits (Increased risk for atherosclerosis) -
Hypothyroidism
⬢ Iodine Deficiency -
• Iodine Deficiency
– Certain goitrogenic drugs (block TH synthesis)
– Lithium carbonate (manic-depressive disorders)
– Antithyroid drugs
– Certain foods containing goitrogenic compounds:
• Turnips, rutabagas, soybeans -
Hypothyroidism
Hashimoto’s Thyroiditis -
• Hashimoto’s Thyroiditis
– Most common cause of primary hypothyroidism
– Antibodies develop that destroy thyroid tissue
– Fibrous tissue develops, TH levels decrease -
Hypothyroidism
Myxedema coma, or hypothyroid crisis -
Myxedema coma, or hypothyroid crisis
is a serious complication to prolonged hypothyroidism.
• Life-threatening:
– Severe metabolic disorders (hyponatremia, hypoglycemia, lactic acidosis
– Hypothermia
– Cardiovascular collapse
– Coma
• Life Threatening
• End stage of hypothyroidism. Usually occurs in older adults
• More prevalent in winter months /exposure to cold temperature
• Certain medications
• Mortality Rate: 50% Treat with 300-500 mcg IV of T4 , followed by 50-100 mcg IV daily until stable -
Hypothyroidism
Treatment -
Hypothyroidism
Treatment
⬢ Maintaining a patent airway
⬢ Maintaining fluid, electrolyte and acid-base balance
⬢ Maintaining cardiovascular status
⬢ Increasing body temperature
⬢ Increasing TH levels -
Hypothyroidism
Lab and Diagnostics -
Lab: TH, T4 tests
⬢ Pharmacology: Drug therapies that replace TH.
⬢ Surgery: If goiter is causing respiratory or dysphagia, a subtotal thyroidectomy may be performed -
Hypothyroidism
Pharmacology
Synthroid / Levothroid -
– Take drug for life
– Don’t switch to generic
– Take drug in a.m.
– Take drug 1 hr before or 2 hrs after a meal for best absorption
– Monitor for coronary insufficiency (chest pain, dyspnea, tachycardia
– Avoid excessive consumption of foods that inhibit TH utilization
– Potentiate effect of anticoagulant drugs and digitalis
– Insulin needs may need to be adjusted as thyroid function increases - Nursing Care for Clients with Hypothyroidism
-
⬢ Decreased cardiac output
⬢ Constipation
⬢ Risk for Altered Skin Integrity
⬢ Altered Thought Processes
⬢ Risk for Altered Body Temperature
⬢ Activity Intolerance
⬢ Impaired Verbal Communication
⬢ Self-Esteem Disturbance -
Hypothyroidism
Expected Outcomes: -
Expected Outcomes:
Regain normal bowel elimination patterns, having a soft, formed stool at least every other day
Eat a diet high in fiber and in fluids
Experience improvement in verbal communication
Regain positive self-esteem as medications reduce physical changes and increase activity levels. -
Hypothyroidism
Nursing Interventions: -
Nursing Interventions:
Thorough history,
Attention to change in activity, hair, skin, nail, chest pain, syncope, change in wt., bowel elimination
Skin texture, nonpitting edema, neck/hair - presence of goiter, body hair