endocrine disorders - hyperthyroidism

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  1. hyperthyroidism
    • excessive TH secretion
    • - hyperactivity of gland
    • risk:
    • more in woman than man esp 20-40
    • genetic, autoimmune
  2. Graves disease
    • most common form of hyperthyroidism
    • toxic, diffuse goiter
    • autoimmune disorder
    • - abnormal stimulation of thyroid by immunoglobins
    • hallmarks: hyperthyroidism, goiter, exopthalmus
  3. hyperthyroidism
    manifestations
    • opposite of hypothyroidism
    • incre appetite
    • wt loss
    • irritable, nervousness, hyperexcitablity
    • loose stools
    • tachycardia, palpitations
    • chaotic emotions - up and down
    • heat intolerance, skin flushed
    • - hot
  4. hyperthyroidism
    manifestations
    • amenorrhea- wt loss, chx in estrogen
    • fatigue, weakness
    • goiter- incr release of TH
    • exopthalmus
    • - not able blinking
    • - injury
  5. Dx
    • elev T4, t3, t3u
    • dec TSH
    • dec chol
  6. complications of hyperthyroidism
    • exopthalmos
    • heart disease- d/t incr demands
    • thyroid storm
    • more TH incr effects of catecholamines (this is release during stress)
  7. Thyroid storm
    • potentially fatal
    • - early id and tc are essential
    • various causes-
    • - hyperthyroidism, infection, surgery, med OD, trauma, labor, MI, PE, after thyroidectomy
    • ** high fever, > 103 severe tachycardia > 130, delerium (chx in mentation), dehydration (incr glome rate, diuresis), extreme irritability, HTN
  8. management thyroid storm
    • cooling blanket, tylenol
    • oxygen therapy- inc O2 demand
    • IVF
    • Po/IV antithyroid drg
    • glucocorticoids
    • beta- blocker
  9. management of graves disease
    • meds
    • radiodine
    • surgery
    • choice is based on age, goiter size, coexisting medical problems
    • goal decre TH
  10. Antithyroid meds
    • to inhibit stages of TH development and release
    • PTU- most commonly used
    • - impairs TH synthesis
    • - se- agranulcytosis, profound neutropenia (incr risk infection- mouth, respitory infectuib
    • NI: effects in 1-2 months, compliance
    • f/u
    • take 3 x day
  11. antithyroid meds 2
    • Methimazole (tapazole)
    • - blocks TH action in body
    • - SE agranulocytosis- incr risk infection
    • Iodine therapy
    • - decr vascularity
    • - dec circulating TH
    • se- stains teeth- use straw, n/v, angioedema- airway
  12. adjunct med
    • beta blocker- propanalol
    • glucocticoids- dec some TH
  13. pt teaching
    • maybe a delay of weeks to months between the start of therapy and improvement of symptoms
    • not overnight
  14. radioiodine therapy
    • for middle age- elderly pt
    • contraindicated in pregnancy
    • local irradiation destroys cells
    • **may go to far and cause myxedema
    • symptoms should subside in 3-4 weeks
    • f/u for hyperthyroidism
    • cause u may loss too much
  15. managment of alt in nutrition
    • diet-
    • high protein and cal
    • - 6-8 meals a day 4000-5000 al
    • incre fluids
    • supplements
    • monitor protein/albumin- at risk for underwt
    • check wt q day- call md if loss > or = 2kg
  16. Activity intolerance
    • restful environment
    • assess activity, pulse, o2 stat- may have difficulty sleeping
    • assist and promote mobility
  17. risk of injury
    exothalmus
    • artifical tears
    • eye patches taping, PRN, dark glasses
    • protect from irritants- dusk and smoke
    • elev HOB a night
    • NA restriction- dec edema
    • glucocticoids
    • surgery- last resort
  18. Hyperthermia
    • cool environemnt
    • cooling blanket PRNchange beddings freg
  19. surgical management of hyperthyroidism
    total
    • total thyroidectomy:
    • - to remove thyroid CA
    • - permanant TH replacement
    • - parathyroid is also removed
    • ---- risk for hypocalcemia
  20. surgical management of hyperthyrodism
    subtotal
    • subtotal thyroidectomy- preferred 5/6 removed
    • - may not need TH after
    • - parathyroid maybe inadvertenly removed- risk for hypocal
    • - need to be euthyroid preop- normal TSH- take antithyroid meds- prevent thyroid storm
    • - effective in most peeps with graves disease
  21. complications of thyroidectomy
    • vocal cords paralysis- norm after surg should return in 3-4 days
    • hypoparathyroidism
    • hemorrhage
    • throtoxicosis
    • respiratory obstruction- edema of vocal cords
  22. nursing management for thyroidectomy
    • VS q 15 mins then q 30 min x 12 hr
    • semi fowler's
    • fluids then diet as tolerated
    • pain management
    • careful cough, deep breathing q 30 mins
    • trachostomy set at the bedside
    • humidified o2 via mask
  23. nursing management thyroidectomy
    more
    • assess for dec in ca- tetany, muscle spasm, weakness, trosseau, chovect
    • monitor Ca. Mg, Po4
    • assess bleeding
    • education
    • - support head, ROM no flexion
    • meds- may need synthyroid
    • lanolin?
    • f/u

Card Set Information

Author:
Prittyrick
ID:
319204
Filename:
endocrine disorders - hyperthyroidism
Updated:
2016-04-21 02:18:22
Tags:
endo
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Description:
thyroid
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