NR203 Test 4 Hyperthyroidism (Endocrine 10 Final Questions)
Terms
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HYPERTHYROIDISM
Describe⬦
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 -
HYPERTHYROIDISM
PREDISPOSING FACTORS: -
PREDISPOSING FACTORS:
⬢ Diet high in iodine (kelp)
⬢ Radioactive contrast media, cough syrup high in codeine
⬢ Genetic
⬢ Emotional stress
⬢ Infection -
HYPERTHYROIDISM
Causes: -
Causes:
• 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?
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Primary hyperthyroidism:
T3 T4 Increase TSH decrease
Secondary hyperthyroidism:
T3 T4 Increase TSH increase - How does hyperthyroidism affect the body systems?
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• 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
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⬢ Multisystem autoimmune disorder
⬢ Increased levels of TH are produced
⬢ May result in diffuse enlargement of the thyroid gland
⬢ Exophthalmos-eyes ***
⬢ Proptosis - What is EXOPHTHALMOS
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• 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???
EXOPHTHALMOS
Know!!!! -
• 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
Symptoms
KNOW!! -
Client may complain of
⬢ Fatigue
⬢ Difficulty sleeping
⬢ Hand Tremors
⬢ Changes with menstruation cycles
⬢ Older clients may present with atrial fib, angina or CHF - OTHER CAUSES OF HYPERTHYROIDISM
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• 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
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• Excess TSH Stimulation: usually from a pituitary adenoma?
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• 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
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⬢ 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⬢ -
Hyperthyroidism
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) -
Hyperthyroidism
⬢ 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 -
Hyperthyroidism
⬢ Pharmacology with
Nursing implications
KNOW!!!! -
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 -
Hyperthyroidism
Treatments
RADIOACTIVE THERAPY
SURGERY -
• 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 -
Hyperthyroidism
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
KNOW!!! -
⬢ 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
Know!!! -
• 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
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⬢ Risk for Decreased Cardiac Output
⬢ Sensory-Perceptual Alterations: Vision
⬢ Risk for Altered Nutrition: Less than Body Requirements
⬢ Body Image Disturbance
⬢ Hyperthermia
⬢ Activity Intolerance
⬢ Anxiety -
Hyperthyroidism
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 -
Hyperthyroidism
Health teaching -
Health teaching
⬢ Oral medications are lifelong tx.
⬢ Regular annual visits to health care provider to monitor thyroid levels -
Hyperthyroidism
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 - THYROID CRISIS
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• Also called Thyroid storm / Thyrotoxicosis
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– 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 CRISIS
(Thyroid storm / Thyrotoxicosis) -
• Mortality 75%
• Precipitated by stress
– Infection
– DKA
– Physical /Emotional Trauma
– Gland Manipulation
• Treatment
– Acetaminophen
– Avoid Salicylates