Unit 5

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Unit 5
2012-04-27 12:48:55
Thyroid Parathyroid

Unit 5
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  1. What causes englargement of the thyroid gland (aka goiter)
    • lack of iodine
    • inflammation
    • benign tumors
    • malignant tumors
  2. The physiologic process of exophthalmos in hyperthroidism is due to what
    accumulation of fluid in the fat pads and muscles that lie behind the eyeballs
  3. What is likely to happen if client has a diet lacking in iodine or if production of thyroid hormone is suppressed?
    the thyroid enlarges to compensate for hormonal deficiency
  4. Reduction in thyroid hormones causes increase in
    • triglyceride levels
    • serum cholesterol
    • arteriosclerosis and coronary heart disease
  5. What is hyperthyroidism due to?
    excessive levels of circulating thyroid hormone (TH)
  6. Lab values indicating hypothyroidism would include
    • decreased TH level
    • Increased TSH level
  7. What are the signs and symptoms of hypothyroidism
    • sensitivity to cold
    • dry skin or hair
    • weight gain
    • irregular menses
    • bradycardia
    • slowed neurologic functioning
  8. What are S/S of myxedema coma?
    • decreased metabolic rate
    • hypothermia
    • hypotension
  9. Lab values indicating hyperthyroidism would include
    • increased TH levels
    • decreased cholesterol
  10. What does the nurse look for in assessing a patient with thyroid storm
    • increased fever
    • severe tachycardia
    • delirium
    • dehydration
    • extreme irritability
  11. What is the client having a thyroidectomy at risk for?
    • thyroid storm
    • tetany
    • respiratory obstruction
    • laryngeal edema
    • vocal cord injury
  12. lab values indicating hypoparathyroidism are
    decreased calcium
  13. Manifestations of hypoparathyroidism are mainly related to what
  14. What diet is preferred for the hyperthyroid client
    high calorie, high protein
  15. What is an enlargement of the thyroid gland
  16. What causes hypothyroidism
    • deficiency of TH hormone
    • Causes slowed body metabolism, decreased heat production, and decreased O2 consumption by the tissues
  17. What is primary hypothyroidism
    • low TH levels
    • Elevated TSH levels
    • Pituitary is attempting to stimulate the secretion of thyroid hormones but the thyroid is not responding
  18. What is secondary hypothyroidism
    • insufficient stimulation of a normal thyroid gland
    • decreased TSH levels
    • may start as malfunction of the pituitary or hypothalamus
    • may start as peripheral resistance to TH, means low TH & TSH
  19. what is tertiary or central hypothyroidism
    • develops if the hypothalamus can't produce TRH
    • Low TH & TSH levels
    • does not stimulate the pituitary to secrete TSH
    • due to tumor or destructive lesion
  20. What is subclinical hypothyroidism
    • diagnosed with elevated TSH level
    • normal to low-normal T4 levels
    • resembles those of mild hypothyroidism with subtle cardiac defects
  21. What happens to lipid metabolism due to hypothyroidism (reduced levels of TH)
    • increase in cholesterol and triglyceride levels
    • increase in atherosclerosis
    • increase in arteriosclerosis
    • coronary heart disease
  22. What is the most common hypothyroidism and what are the S/S?
    • mild hypothyroidism is most common
    • asymptomatic
    • but may experience cold, lethargy, dry skin, forgetfulness, depression, weight gain, constipation, lack of physical activity
  23. What happens when hypothroidism worsens?
    • thyroid enlarges in attempt to produce enough T4
    • when goiter growns medical advice is sought
  24. What is myxedema
    • undertreated hypothyroidism
    • characterized by dry, waxy type of swelling with abnormal deposits of mucin in skin and tissues
    • non-pitting edema in pretibial and facial areas
  25. What is myxedema coma?
    • most severe, mortality rate of 100%
    • drastic increase in metabolic rate, hypoventilation, hypothermia, hypotension, hyponatremia, hypercalcemia, hypoglycemia
  26. How do you manage hypothyroidism
    • Correct TH deficiency
    • reverse manifestations
    • TH taken for life
    • prevent cardiac damage
    • Levothyroxine sodium is replacement therapy
  27. What does a person with Grave's disease look like
    • protruding eyes
    • agitated expression
    • enlarged neck
  28. What is Grave's disease (hyperthyroidism)
    autoimmune disorder mediated by IgG anitbody that binds to and activates TSH receptors on surface of thyroid cells
  29. What is hyperthyroidism
    • characterized by loss of normal regulatory controls of TH secretion.
    • Excessive amounts of TH stiumlate cardiac system, leads to tachycardia, increased cardiac output, stroke volume, and peripheral blood flow. Metabolism increases and can lead to weight loss
  30. What are the clinical manifestations of hyperthyroidism
    • agitated and irritable
    • hand tremors at rest
    • large appetite with weight loss
    • heat intolerance
    • profuse diaphoresis
    • mood swings
  31. What are the 3 complications of Graves' disease
    • Exopthalmos - protruding eyes and fixed stare
    • heart disease - heart failure found among those with long-standing thyrotoxicosis
    • thyroid storm (thyrotoxicosis) - potentially fatal acute episode of thyroid overactivity
  32. what are some S/S of thyroid storm
    • high fever
    • severe tachycardia
    • delirium
    • dehydration
    • increased temp
    • dyspnea
    • irritability
  33. What equipment is needed post op after a thyroidectomy
    • BP cuff
    • stethoscope
    • pillows
    • O2
    • suction
    • intubation supplies
    • tracheostomy set (edema in trachea)
    • calcium gluconate (b/c parathyroid no longer there)
    • teach client neck exercises
    • and vitamin E for healing
  34. What is hyperparathyroidism
    overactivity of parathyroid glands, leads to bone damage, hypercalcemia and kidney damage
  35. what is the Dx for hyperparathyroidism
    serum calcium levels are elevated and serum phosphate levels are depressed
  36. what diet should the client be on with hyperparathyroidism
    diet low in calcium and vitamin d
  37. how do you treat hyperparathyroidism
    lower elevated Ca levels. can be done with hydration
  38. What is hypoparathyroidism
    Serum Ca levels low and serum phosphate levels are high
  39. what are characteristics of acute hyperparathyroidism
    neuromuscular irritability which causes painful muscle spasms, grimacing, tingling in fingers, assessment reveals Chvostek's and Trousseau's sign
  40. How do you Dx hypoparathyroidism
    • presence of chvostek's sign
    • presence of trousseau's sign
    • hyperactive deep tendon reflexes
    • circumoral paresthesia
    • numbness and tingling in fingers
    • low Ca level, low PTH level, high phosphorus level
  41. What kind of diet would you want for a client with hypoparathyroidism
    diet high in calcium and low in phosphorus
  42. What is the most commonly used antithyroid med
    propylthiouracil (PTU)
  43. What does propylthiouracil do?
    corrects hyperthyroidism by impairing TH synthesis
  44. What is a drug used for hyperparathyroidism
  45. What does calcitonin do?
    decreases the release of Ca by the bones
  46. What drug is used for hypoparathyroidism
  47. What does calcitriol do
    increase Ca levels in body
  48. What drug is used for hypothyroidism
    Synthroid (levothyroxine)