1
Q
The thyroid gland produces three hormones:
A
- thyroxine (T4)
- triiodothyronine (T3)
- hyrocalcitonin (calcitonin)
Secretion of T3 and T4 is regulated by the anterior pituitary gland.
2
Q
When serum T3 and T4 levels decrease, thyroid‑stimulating hormone (TSH) is released by
A
the anterior pituitary.
- This stimulates the thyroid gland to secrete more hormones until normal levels are reached.
3
Q
calcitonin
A
inhibits mobilization of calcium from bone and reduces blood calcium levels.
4
Q
hyperthryoidism
A
clinical syndrome caused by excessive circulating thyroid hormones.
Because thyroid activity affects all body systems, excessive thyroid hormone exaggerates normal body functions and produces a hypermetabolic state.
5
Q
most common hyperthryoidism
A
graves
6
Q
causes of hyperthroidims
A
- graves
- toxic nodular goiter
- Exogenous hyperthyroidism is caused by excessive dosages of thyroid hormone.
7
Q
graves
A
Autoimmune antibodies result in hypersecretion of thyroid hormones.
Autosomal recessive trait passed to females
8
Q
Toxic nodular goiter
A
Caused by overproduction of thyroid hormone due to the presence of thyroid nodules
9
Q
hyperthyroidism clinical findings emotion
A
Nervousness
Irritability
Hyperactivity
Emotional lability
Decreased attention span
Cries or laughs without cause
Change in mental or emotional status
Weakness, easy fatigability, exercise intolerance
Muscle weakness
Heat intolerance
10
Q
hyperthroidism clinical findings
weight
sleeo
stools
mesntral
fertility
libido
skin ntem
hair
muscle activity
A
- Weight change (usually loss) and increased appetite
Insomnia and interrupted sleep - Frequent stools and diarrhea
- Menstrual irregularities (amenorrhea or decreased menstrual flow)
- Decreased fertility
- Libido initially increased in both men and women, followed by a decrease as the condition progresses
- Warm, sweaty, flushed skin with velvety-smooth texture
- Hair thins, and develops a fine, soft, silky texture
Tremor, hyperkinesia, hyperreflexia
11
Q
hyperthroidim clinical findings of eye
A
- Exophthalmos (Graves’ disease only) due to edema in the extraocular muscles and increased fatty tissue behind the eye
- Blurred or double vision and tiring of eyes due to pressure on the optic nerve
- Photophobia (sensitivity to light)
- Excessive tearing and bloodshot appearance of eyes
- Vision changes
- Eyelid retraction (lag): movement of the eyelid is delayed when the eye moves downward
- Globe (eyeball) lag: upper eyelid pulls back faster than the eyeball when the client gazes upward
12
Q
more clinical findings hyperthroidism, heart and breathing
A
- Hair thinning or loss
- Goiter
- Bruit over the thyroid gland
- Elevated systolic blood pressure and widened pulse pressure
- Tachycardia, palpitations, and dysrhythmias
- Dyspnea
- Findings in older adult clients are often more subtle than those in younger clients.
13
Q
lab test for hyperthroidism
A
- Serum TSH test: Decreased in the presence of Graves’ disease (can be elevated in secondary or tertiary hyperthyroidism)
- Free T4 index, T4 (total) T3 : Elevated in the presence of disease
- Thyroid-stimulating immunoglobulins: Elevated in Graves’ disease, normal in other types of hyperthyroidism
14
Q
diagnsotic test for hyperthryoidm
A
ultasound
electrocardiogram
radioactive iodine uptake: nuclear medicine test
15
Q
ultra sound for hyperthy
A
Used to produce images of the thyroid gland and surrounding tissue
16
Q
Electrocardiogram for hyperthy
A
- Used to evaluate the effects of excessive thyroid hormone on the heart (tachycardia, dysrhythmias).
- ECG changes include atrial fibrillation, and changes in the P and T waveforms.
17
Q
Radioactive iodine uptake: Nuclear medicine test for hyperthy
A
- Clarifies size and function of the gland.
- Contraindicated in pregnant women.
- An assessment for an allergy to iodine or shellfish should be completed prior to this test.
- The uptake of radioactive iodine, administered orally 24 hr prior to the test, is measured.
- An elevated uptake is indicative of hyperthyroidism.
18
Q
hyperthy Diagnostic Procedures: Nursing Considerations
A
- Confirm that the client is not pregnant prior to the scan
- Take a medication history to determine the use of iodides
- Recent use of contrast media and oral contraceptives can cause falsely elevated serum thyroid hormone levels
- Severe illness; malnutrition; and the use of aspirin, corticosteroids, and phenytoin sodium can cause a false decrease in serum thyroid hormone levels
- Inform the provider if the patient received any iodine contrast recently
19
Q
hyperthryoidm nursing care
A
- Minimize energy expenditure by assisting with activities and by encouraging alternate periods of rest with activity.
- Promote a calm environment.
- Assess mental status and decision-making ability.
- Monitor nutritional status.
- Monitor I&O
- Monitor patient’s weight.
- Provide eye protection (patches, eye lubricant, tape to close eyelids) for a patient who has exophthalmos.
- Monitor vital signs and hemodynamic parameters.
- Reduce room temperature.
- Provide cool shower/sponge bath to promote comfort.
- Provide linen changes as necessary.
- Report a temperature increase of 1° F or more to the provider immediately, because this is indicative of an impending thyroid crisis.
- Monitor ECG for dysrhythmias.
- Avoid excessive palpation of the thyroid gland.
- Administer antithyroid medications.
- Prepare the patient for a total/subtotal thyroidectomy if unresponsive to antithyroid medications or has an airway-obstructing goiter.
20
Q
A nurse in a provider’s office is reviewing the health record of a client who is being evaluated for Graves’ disease. The nurse should identify that which of the following laboratory results is an expected finding?
A. Decreased thyrotropin receptor antibodies
B. Decreased thyroid‑stimulating hormone (TSH)
C. Decreased free thyroxine index
D. Decreased triiodothyronine
A
b
21
Q
storm
A
- Thyroid storm is a life-threatening condition seen in untreated or uncontrolled hyperthyroidisms.
- Manifestations include hyperpyrexia, tachycardia, hypertension, and other exaggerated symptoms of hyperthyroidism
22
Q
thionamides
A
meds for hyperactive thy
23
Q
Thionamides
NURSING CONSIDERATIONS
A
Monitor for manifestations of hypothyroidism
intolerance to cold
Edema
Bradycardia
increase in weight
Depression
Monitor CBC for leukopenia or thrombocytopenia.
Monitor for indications of hepatotoxicity.
24
Q
radioactive therapy
A
- Radioactive iodine is taken up by the thyroid and destroys some of the hormone-producing cells (131I).
- One dose can be sufficient, but a second or third dose might be needed.
- The degree of thyroid destruction varies and can require lifelong thyroid replacement.
25
nursing considerations for radioactice iodine therapy and s/s
- Radioactive iodine therapy is contraindicated in women who are pregnant
- Monitor for manifestations of hypothyroidism, such as edema, intolerance to cold, bradycardia, increase in weight, and depression.
26
pt. ed on medications for hyperthyroid
- The effects of therapy might not be evident for 6 to 8 weeks.
- Take the medication as directed.
- Stay away from pregnant women, infants, or small children for the first week following treatment.
- Avoid contact closer than 3 feet (1 meter) and limit contact to no more than 1 hr daily.
- Although a low dose of radiation is used, provide the patient with precautions to prevent radiation exposure to others.
27
A nurse in a provider’s office is planning care for a client who has a new diagnosis of Graves’ disease and a new prescription for methimazole. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)
A. Monitor CBC.
B. Monitor triiodothyronine (T3).
C. Instruct the client to increase consumption of shellfish.
D. Advise the client to take the medication at the same time every day.
E. Inform the client that an adverse effect of this medication is iodine toxicity.
a.b.d.
28
A nurse is reviewing the laboratory findings for a client who might have hyperthyroidism. The nurse should identify an elevation which of the following substances as an indication that the client has this disorder
A. Triiodothyronine
B. Plasma‑free metanephrine
C. Urine cortisol
D. Urine osmolality
a
29
A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include?
(Select all that apply.)
A. Anorexia
B. Heat intolerance
C. Constipation
D. Palpitations
E. Weight loss
F. Bradycardia
b,d,e
30
hypothyroidism
Suboptimal levels of thyroid hormone resulting in decreased metabolism.
Occurs most frequently in older women
31
hypoparathroidms presents like
awake or tired
sensitive to what temp
poop
skin
weight
voice
joint
labs
mood
period
Fatigue
Increased sensitivity to cold
Constipation
Dry skin, brittle hair and nails
Weight gain
Deepened, hoarse voice
Joint pain
Hyperlipidemia and anemia
Depression
Menstrual disturbances
32
A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following information should the nurse include in the teaching?
(Select all that apply.)
A. Weight gain is expected while taking this medication.
B. Medication should not be discontinued without the advice of the provider.
C. Follow‑up serum TSH levels should be obtained.
D. Take the medication on an empty stomach.
E. Use fiber laxatives for constipation.
b,c,
33
Myxedema
Myxedema coma is a life-threatening condition that occurs when hypothyroidism is untreated or when a stressor (e.g., acute illness, surgery, chemotherapy, discontinuing thyroid replacement therapy, or use of sedatives/opioids) affects a client who has hypothyroidism.
34
manifestations of myxedema
Respiratory failure
Hypotension
Hypothermia
Bradycardia, dysrhythmia
Hyponatremia
Hypoglycemia
Coma
35
myxedema nursing considerations
- Maintain airway patency with ventilatory support if necessary.
- Provide continuous ECG monitoring.
- Monitor ABGs to detect hypoxia, hypercapnia, respiratory acidosis.
- Monitor mental status.
Cover the client with warm blankets.
- Monitor body temperature hourly until stable.
- Replace fluid with 0.9% sodium chloride IV.
36
myxedema nursing considerations
- Replace thyroid hormone by administering large doses of levothyroxine IV bolus.
- Monitor vital signs because rapid correction of hypothyroidism can cause adverse cardiac effects.
- Monitor I&O and daily weights.
With treatment, urine output should increase, and body weight should decrease. Failure to do so should be reported to
the provider.
- Treat hypoglycemia with glucose.
- Administer corticosteroids.
- Initiate aspiration precautions
- Check for possible sources of infection
37
A nurse in an intensive care unit is planning care for a client who has myxedema coma. Which of the following actions should the nurse include?
(Select all that apply.)
A. Observe cardiac monitor for dysrhythmias.
B. Observe for evidence of urinary tract infection.
C. Initiate IV fluids using 0.9% sodium chloride.
D. Administer a levothyroxine IV bolus.
E. Provide warmth using a heating pad.
`
a,b,c,d
38
hypoparathyroidism
The hyposecretion of parathyroid hormone (PTH), resulting in hypocalcemia and hyperphosphatemia
39
hypoparathyroidism cause
Usually caused by surgical removal of the parathyroid gland disuse during
Parathyroidectomy
Thyroidectomy
Radical Neck Dissection
40
hypoparathyroidism clinical manifestation from hypocalcemia
- Paresthesia
- Muscle cramps and tetany
- Chvostek’s sign
- Trousseau’s sign
- Circumoral paraesthesia with numbmess and tingling of the fingers
- Severe tetany may lead to bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia, cardiac dysrhythmias, and seizures
41
hypoparathyroidism nursing interventions
Monitor ECG
Assess for neuromuscular irritability
Provide high calcium, low phos diet
Institute seizure precautions
42
meds for acute hypoparathyroidms
IV calcium gluconate
43
meds for chronic hypoparathyroidism
Oral calcium salts, Vitamin D
44
hyperparathyroidism
Hypersecretion of PTH (caused by tumor or renal disease) that leads to the loss of calcium from the bones into the blood, resulting in hypercalcemia and hypophosphatemia.
May not have symptoms
45
hyperparathyroidism may cause
Kidney stones
Osteoporosis
Hypercalcemia
Abdominal pain
Constipation
Nausea/Vomiting
Polyuria
HTN
Dysrhythmias
46
A nurse is preparing to receive a client from the PACU who is postoperative following a thyroidectomy. The nurse should ensure that which of the following equipment is available?
(Select all that apply.)
A. Suction equipment
B. Humidified oxygen
C. Flashlight
D. Tracheostomy tray
E. Chest tube tray
a,b,d
Med Surg 2
flashcards
Decks in class (35)
# Cards
-
medication52
-
fluid and electrolyte balance95
-
anesthesia30
-
post op63
-
transition to med surg unit30
-
Endocrine system18
-
pituitary disorders50
-
adrenal gland15
-
thyroid46
-
neuro disorders18
-
seizures and epilepsy21
-
head injuries43
-
neurosensory disorders69
-
Stroke47
-
spinal cord injuries51
-
problems with vascular system33
-
venous insufficiencies40
-
heart inflammation and value issues46
-
cardiovascular disorders: diagnostics procedures35
-
angina and myocardial infarction48
-
heart failure20
-
cancer25
-
cancer disorders68
-
chemo and radiation and pain41
-
hematological function46
-
anemias41
-
shock52
-
ventilation19
-
acid base balance16
-
burns42
-
immune system30
-
HIV16
-
lupus20
-
gout18
-
RA19
