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NR203 Test 4 Hyperthyroidism (Endocrine 10 Final Questions)


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Excess of what hormone
Affects____ _____ organs
Untreated leads to ________
⬢ Is an excess of TH in the body.
⬢ Affects all major organs of the body.
⬢ Untreated may lead to cardiac failure, psychiatric disorders and thyroid crisis
⬢ Diet high in iodine (kelp)
⬢ Radioactive contrast media, cough syrup high in codeine
⬢ Genetic
⬢ Emotional stress
⬢ Infection
• Autoimmune Reactions: Grave’s Disease
• Excess secretion of the thyroid-stimulated hormone (TSH)
• Thyroiditis
• Neoplasms (such as multinodular goiter)
• Excessive intake of thyroid medications
What’s the difference between primary and secondary hyperthyroidism?
Primary hyperthyroidism:
T3 T4 Increase TSH decrease

Secondary hyperthyroidism:
T3 T4 Increase TSH increase
How does hyperthyroidism affect the body systems?
• All systems are on overdrive!
– HR & Stroke Volume increased
– Increase metabolism of carbohydrates, proteins, and lipids
– Glucose tolerance decreases
– Protein catabolism, negative nitrogen balance
– Nutritional and caloric deficiences
Client’s symptoms of hyperthyroidism
Know !!!!
Client will typically have:

⬢ An increased appetite, but will continue to lose weight
⬢ Hypermotile bowels and diarrhea
⬢ Heat intolerance and increased sweating
⬢ Hair is fine, skin smooth and warm
⬢ Emotional lability is very common
Grave’s disease
Most common cause of _______
Commonly occur in _____
Under age_____
Link to _______ and _______ ______
⬢ Most common cause of hyperthyroidism
⬢ 7 to 10 times more likely to occur in women than men
⬢ Generally occurs under age 40
⬢ May be a link to hereditary and emotional stress
Describe Grave’s disease
⬢ Multisystem autoimmune disorder
⬢ Increased levels of TH are produced
⬢ May result in diffuse enlargement of the thyroid gland
⬢ Exophthalmos-eyes ***
⬢ Proptosis
• Accumulation of fat deposits and inflammation of by-products in the retro-orbital tissues
• Upper lid is retracted, sclera may be visible above the iris, unblinking stare
• Usually bilateral
• May cause: blurred vision, eye pain, lacrimation, and photophobia, inability to close eyes
• Inability to close eye may increase risk of corneal dryness, irritation, infection and ulceration
• Treatment of Grave’s Disease does not reverse changes in the eyes.
Nursing Intervention???
• Teaching related to eye care such as:
– Eye drops
– Eye patch / sleeping mask
– Lightly tape eyes shut with nonallergic tape
– Protective glasses
– Sunglasses
– Avoid dust/ dirt to eyes
– Elevate head of bed
– Restrict sodium (relieve edema)
Grave’s disease
Client may complain of
⬢ Fatigue
⬢ Difficulty sleeping
⬢ Hand Tremors
⬢ Changes with menstruation cycles
⬢ Older clients may present with atrial fib, angina or CHF
• Toxic multinodular goiter
– Goiter: enlargement of thyroid gland
• May result from excess TSH stimulation
• Growth stimulating immunoglobulins
• Substances that inhibit TH synthesis
• Toxic multinodular goiter has small independently functioning nodules in the thyroid gland that are secreting TH
Causes of Hyperthyroidism
• Excess TSH Stimulation: usually from a pituitary adenoma?

• Thyroiditis: Viral infection of the gland
– Usually acute, but may become chronic as repeated infections destroy gland tissue, which may result in hypothyroidism
Hyperthyroidism: Physical Assessment
⬢ History of emotional and mental status changes
⬢ Chest pain/pounding
⬢ Dyspnea with/without exercise
⬢ Changes in hair, skin, nails
⬢ Sweating
⬢ Visual disturbances
⬢ Weight changes
⬢ Increased stool freq.
⬢ Heat intolerance
⬢ C/O weakness, fatigue
⬢ Change in menses/libido⬢
Lab and Diagnostics
• Elevated levels of TH and increased iodine uptake are diagnostic criteria for hyperthyroidism.
– T3 and T4
– TSH test (differentiates between primary hyperthyroidism (from the thyroid gland) and secondary hyperthyroidism (from the pituitary gland)
⬢ Pharmacology:
• Pharmacology:
-Drugs act to reduce levels of TH production
-Effects may not be seen for several weeks because drugs do not affect the release or activity of hormones already formed
Thioamides – Block thyroid synthesis
• Propylthiouracil (PTU)
• Tapazole

Toxic S & S
• Fever
• Sore throat
• Skin eruptions
⬢ Pharmacology with
Nursing implications
Pharmacological agents & nursing implications
Thioamides--PTU & methimazole blocks thyroid synthesis
Takes 2-4 weeks to effect
Must be taken frequently
Toxic S/S: fever, sore throat, skin eruptions, S/S of infection
Used to prepare for surgery, management of thyrotoxic crisis, & treat hyperthyroidism chronically.

Lugol’s solution inhibits thyroid hormone and TSH
Preparation for surgery
Unpleasant taste, burning in mouth, sore mouth and throat
Drink through a straw to prevent staining teeth
Used 1-3 weeks for short term only
• Radioactive Therapy:
-Thyroid gland absorbs iodine in any form. Radioactive iodine destroys/damages cells so they produce less
-Results may not be seen for 6 to 8 weeks
• Radioactive Therapy
– Contraindicated in pregnant women
– Amount of gland destroyed is not controllable, may result in
• Surgery
– Enlarged thyroid may cause pressure on esophagus or trachea resulting in difficulty breathing or swallowing. Subtotal thyroidectomy is performed.
– Total thyroidectomy required for CA of the thyroid
Radioactive Iodine - I-131
Faster Treatment and safer
Given orally in one dose
Excreted in 2 days
Precautions due to secretion:
⬢ Flush toilet 2-3 X after each use, increase fluid intake, use separate eating utensils, towels, washcloths
⬢ Rinse bathrooms sinks and tubs thoroughly after each use
⬢ Sleep alone for a few days and avoid kissing and sexual intercourse
⬢ Avoid direct contact with baby
⬢ Contraindicated in pregnant women
Propranolol Adm. to block the effects of the hyperthyroid state
Lithium Inhibits thyroid hormone release & is used for persons who are iodine-sensitive
Care of the Pre & Post – Thyroidectomy Patient
Pre Op
⬢ Prior to surgery patient should be in an euthyroid state
⬢ Patient may receive antithyroid drugs and iodine to decrease vascularity and size of thyroid prior to surgery
⬢ Pre-Op Teaching: Support neck, decrease pressure/tension on suture line
⬢ Answer questions
Care of the Post op – Thyroidectomy Patient
• Post-Op: Semi-fowlers position
– Decrease risk for hemorrhage (greatest risk occurs 12-24 hours post op
– Respiratory distress – Trach Kit
– Assess laryngeal damage
– Tetany: Calcium gluconate / calcium chloride
Nursing Care for Clients with Hyperthyroidism
⬢ Risk for Decreased Cardiac Output
⬢ Sensory-Perceptual Alterations: Vision
⬢ Risk for Altered Nutrition: Less than Body Requirements
⬢ Body Image Disturbance
⬢ Hyperthermia
⬢ Activity Intolerance
⬢ Anxiety
Expected Outcomes
Expected Outcomes
– Gain at least 1 # per week
– Regain normal bowel elimination patterns
– Maintain normal vision and verbalize measures to protect eyes
– Verbalize medical treatment and self-care
– Verbalize decreased anxiety

Health teaching
Health teaching
⬢ Oral medications are lifelong tx.
⬢ Regular annual visits to health care provider to monitor thyroid levels

Unique nutritional needs
Unique nutritional needs
GI hypermotility with nausea, vomiting, diarrhea, and abd. Pain.
Diet high in carbohydrates and protein and include between-meal snacks.
Six small meals a day may be more desirable than three large meals.
Caloric intake may need to be increased to 4000 calories per day
• Also called Thyroid storm / Thyrotoxicosis
– Rare today because of medications
– Life threatening condition
• Hyperthermia 102F to 106F
• Tachycardia
• Hypertension
• GI symptoms
• Agitation, restlessness, tremors
• Confusion, psychosis, delirium, seizures
• Comatose
(Thyroid storm / Thyrotoxicosis)
• Mortality 75%
• Precipitated by stress
– Infection
– Physical /Emotional Trauma
– Gland Manipulation
• Treatment
– Acetaminophen
– Avoid Salicylates

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