Nurse practitioner

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Author:
northlover
ID:
48107
Filename:
Nurse practitioner
Updated:
2010-11-08 08:19:44
Tags:
Endocrine
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Description:
Thyroid disorders
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  1. Hyperthyroidism causes/Etiology
    • 1. More common in women
    • 2. Onset most commonly between 20 and 40 year of age
    • 3. Grave's disease is the most common presentation
    • 4. Other causes of hyperthyroidism include toxic adenoma, subacute thyroiditis, TSH secreting tumor of the pituitary, high dose of amiodarone
  2. Hyperthyroidism s/s
    • 1. Nervousness
    • 2. Anxiety
    • 3. Increased sweating
    • 4. Fatigue
    • 5. emotional lability
    • 6. Fine tremors
    • 7. Hyperreflexia of DTRs
    • 8. Increased appetite
    • 9. Weight loss
    • 10. Smooth, warm, moist vevety skin
    • 11. Fine/thin hair
    • 12. Exophamlosis
    • 13. Lid lag
    • 14. Tachycardia
    • 15. Heat intolerance
  3. Hyperhytoridism laboratory/diagnostics
    • - TSH assay is the most sensitive test and is low in most cases
    • - Serum T3, T4, thyroid resin uptake,and free thyroxine index increased
    • Sometimes T4 is normal, but T3 elevated
    • - Serum ANA usually elevated without evidence of lupus or other collagen disease
    • -Thyroid radioactive iodine uptake and scan usually performaed to establish etiology of hyperhytoidism
    • - a high iodine uptake is consistent with Grave's disease
    • - A low uptake is consistent with subacute thyroiditis
    • - MRI of the orbits is the preferred choice for visualizing Grave's ophtalmopathy
  4. Hypothyroidism causes/ etiology
    • - Primary disease of the thyroid gland
    • - Pituitary deficiency of TSH
    • - Hypothalamic deficiency of TRH
    • - Iodine deficiency
    • - Hashimoto's thyroiditis
    • _Idiopathic causes
    • - Damage to the gland
  5. Hypothyroidism s/s
    • - Extreme weakness
    • - Muscle fatigue
    • - Arthralgias
    • - Cramps
    • - Cold intolerance
    • - constipation
    • - Weight gain
    • - Dry skin
    • - Hair loss
    • - Brittle nails
    • - Puffy eyes
    • - Edema of the hands and face
    • - Bradycardia
    • - Slowed DTRs
    • - Hypoactive bowel sounds
  6. Hypothyroidism laboratory/diagnostics
    • - TSH elevated
    • - T4 low or normal
    • - resin T3 uptake - decreased (T3 is not a reliable test)
    • - Hyponatremia
    • - Hypoglycemia
  7. Hyperhyroidism management
    • - referral
    • propranolol (inderall) for symptomatic relief- begin dosing with 10 mg po, may goto 80 mg four times daily
    • Thiourea drugs for patients with mild cases, small goiters of fear of isotopes
    • - methimazole (tapazole )
    • - Propylthiouracl
    • - Radioactive iodine
    • 131 -1 used to destroy goiters
    • - thyroid surgery must b e euthyroid preop
    • - Lugol's solution 2-3 gtts po every day for 10 days to reduce vascularity of the gland
    • patients with subacute thyroiditis are best treated symptomatically with propranolol
  8. Treatment of Thyroid crisis
    • - Prophylthiouracil 150-250 mg every 6 hours
    • -Methimazole (Tapazole) with the following:
    • - Lugol's solution
    • - Sodium iodide IV
    • -Propranolol IV
    • - Hydrocortisone with rapid reduction as situation improves
    • Avoid ASA
  9. Hypothyroidism treatment
    Levothyroxine
  10. Hyxedema coma
    • - Protect airway - mechanical ventilation as needed
    • - fluid replacement as needed
    • - Levothyroxine IV
    • - Support hypotension
    • - Rewarming with blankets
    • - symptomatic care

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