COA exam #4

Thyroid gland is comprised of:

Thyroid gland is comprised of:

2 hormones:

T3 & T4 (Amino Acids)

T4 is a:

Weak hormone —> maintains body’s metabolism in a steady state

T3 is a:

POTENT hormone & increases metabolism in the body

TSH

From Anterior pituitary

Amnt of hormone in the blood then regulates the release of this hormone

TSH controls:

Rate of the thyroid hormone

Calcitonin is released in response to?

high plasma levels of Ca+, reduced calcium from plasma by depositing into the bones

Serum Free T4 levels (measurement of free-unbound- Thyroxine:

0.7-2.0 ng/dL

Serum T3 Bound & Free Hormone levels:

260-480 pg/dL

Serum T4 Bound & Free Hormone levels:

5.4-11.5 ug/dL

T3 Resin Uptake test is?

Thyroid Testing

Indirect measurement of thyroid hormones for pts that have received iodine for testing or Tx

Causes of hypothyroidism:

Autoimmune disease

Atrophy due to aging

Infiltrative disease: amyloidosis, Scleroderma, Lymphoma

Iodine deficiencies/excess

Meds (lithium)

Radioactive iodine

Therapy/surgery for hyperthyroidism radiation

Thyroid deficiencies can cause:

autoimmune thyroiditis—> Hashimoto Disease (immune system attacks thyroid gland)

Myxedema (severe swelling of the sin and underlying tissue)

Skin becomes waxy consistency

Manifestations of hypothyroidism:

Fatigue

decreased metabolism

lethargy

Wt gain

Cold intolerance

dry skin

bradycardia

menstral changes

Deepening of voices (some pts)

Medical Management of Hypothyroidism:

Levothyroxine (Synthroid, 74,150mcg per day)

Prevention of cardiac dysfunction: decrease serum cholesterol, monitor and Tx atherosclerosis & CAD

Replacement of thyroid hormone can cause O2 demand but O2 can’t be increased b4 atherosclerosis is fixed

During thyroid replacement if Angina/Arrythmia occurs STOP replacement immediately

Nursing care for Hypothyroidism:

Pt education: lasting affects of analgesics, sedatives and anesthetic agents, taking Synthroid 1st thing in the am w no other meds (1hr b4 other meds)

Monitor liver & renal functions in older adults

hyperthyroidism

excessive synthesis & secretion of hormones

Thyroiditis (inflammation of thyroid)

Graves disease

Thyroid storm:

acute, life threatening condition

Associated w Hyperthyroidism

Multi system involved

Manifestation of hyperthyroidism

Nervousness

rapid pulse

heat intolerance

tremors

skin flushed, warm, soft & moist

exophthalmos

increased appetite

wt loss

elevated systolic BP

cardiac dysrhythmias

Medical Management of Hyperthyroidism

Radioactive 131I therapy

Surgery; subtotal thyroidectomy

Meds: Antithyroid- Propylthiouracil and methimazole, Na or K iodine solutions, Dexamethasone, Beta Blockers

Nursing Care For hyperthyroidism

Maintaining adequate Cardiac output & normal body temp

Improve nutrition

support

Which med blocks synthesis of thyroid hormone?

Methimazole- blocks synthesis of thyroid hormone

Manifestations of thyroid cancer:

Less prevalent than other cancers

Lump/swelling in neck

Pain in front of neck, possibly radiating to the ear

change in voice

trouble swallowing

constant cough

Nursing care for thyroid cancer:

Reduce anxiety

educate pt & prepare for surgery

post op: monitor for bleeding, monitor airway & breathing, vitals, pain controls, fluids, keep pt to whispers & limited talking

Hyperparathyroidism

Caused by overproduction oh parathyroid hormone

characterized by bone decalcification & formation of renal calculi (kidney stones)

majority of ppl diagnosed w disease don’t have symptoms

Parathormone regulates:

calcium & phosphorus balance (lowers phosphorus level)

Increased parathormone elevates blood ca by increasing ca absorption from the kidney, intestine, and bone

Manifestations of hyperparathyroid:

No symptoms possible

Apathy

fatigue

muscle weakness

nausea/vomiting

constipation

Hypertension

cardiac arrhythmias

High calcium blood levels- monitor for hypercalcemic crisis (serum calcium >13mg/dL)

Medical management for Hyperparathyroid

Surgical removal of abnormal parathyroid tissue

hydration therapy

Nursing care for Hyperparathyroid

Monitor pt for depression & frustration

Educate & prepare pt for surgery

Post op:

monitor for bleeding, airway & breathing

Vitals

pain controls

Fluids

Keep pt to whispers & limited talking

Hypoparathyroidism

Abnormal parathyroid development

destruction of parathyroid glands (surgical removal or autoimmune response)

Vit D deficiency

Decreased intestinal absorption of calcium

decreased reabsorption of calcium from bone through renal tubules

Clinical manifestations of Hypoparathyroidism:

Tetany

numbness

tingling in extremities

stiffness of hands & feet

bronchospasm, laryngeal spasm, Carpopedal spasm

anxiety,irritability, depression

delirium

ECG changes

Assessment & Diagnostic for Hypoparathyroidism

Tetany: general muscle hypertonia w tremor & spasmodic/uncoordinated contractions occurring w or w/out efforts to make voluntary movements

Trousseau sign: carpopedal spasm is inducd by occluding the blood flow to the arm for 3mins w BP cuff

Chvostek sign: sharp tapping over facial nerve infront of parotid gland Causes spasm/twitching of the mouth, nose & eye

Medical Tx for Hypoparathyroidism

Goal is to increase Ca+ to 9-19mg/dL

Possible combination Tx of Calcium, Magnesium, and calcitrol

Thiazide Diuretic (help decrease urinary calcium excretion)

Tx for bone loss

Nursing care for Hypoparathyroidism

Educate pt abt dieet & meds, prepare pt for surgery

Reduce anxiety

Post op care:

Monitor for bleeding, airway & breathing

vitals

pain control

Calcium Gluconate IV

Addison’s disease is:

Adrenocortical insufficiency

Adrenal suppression by exogenous steroid use

can cause Addisonian crisis

Manifestations of Addison’s disease:

Muscle weakness

Anorexia

GI symptoms

Fatigue

dark pigmentation of skin & mucosa

low glucose & serum sodium

High serum K

Apathy

emotional lability

Confusion

Assessment & testing for Addison’s disease:

ACTH stimulation test

ACTH levels will be greatly increased w primary Addison’s

Adrenocortical hormone levels

Medical Management for Addison’s disease:

Combating &/or Tx circulatory crisis:

Low BP, Low Glucose levels

High levels of K

Nursing Management for Addison’s disease":

Assess for fluid imbalance

Assess pt level of stress

monitor BP & HR

do orthostatic BP’s

assess skin often for changes in color

restore fluid balance

improve activity as tolerated