What are the clinical manifestations of hypothyroidism?
weight gain - but with poor appetite because of slow metabolism
joint muscle pain
decreased pulse (low heart rate)
hair loss, brittle nails, and dry skin
expressionless, masklike, apathetic
myxedema - puffiness in the face, hands, feet
inadequate ventilation - severe
elevated cholesterol, atherosclerosis, CAD - severe
myexedema coma - MOST SEVERE
abnormally sensitive to sedatives, opiod, and anesthetic agents - administer with extreme caution
increased susceptiblity to infection
increased risk for intraoperative complications
What is myxedema coma?
Hypothyroidism in its most severe state
Can be precipitated by: infection, drugs, cold, or trauma
All of s/sx of hypothyroidism exacerbated
Myxedema - characterized by masklike expression, puffy eyelids, hair loss in eyebrows, thick lips, and a broad tongue - because of an accumulation of mucopolysaccharides in these areas
What is the medical management of hypothyroidism?
Goal is to restore patient to a normal metabolic state by replacing the missing thyroid hormones
Synthetic levothyroxine (Synthroid or Levothyroid)
Prevention of cardiac dysfunction - caution for ANGINA which could lead to MI - when giving levothyroxine it increases oxygen demand that wasn't there before because of the decreased metabolic demand; atherosclerosis needs to improve first. IF ANGINA OCCURS - d/c thyroxine administration and then cautiously administered at a lower dose
Prevention of medication interactions - thyroid medications increase glucose levels, dig, anticoagulants. phenytoin (dilantin) and TCAs increase thryoid hormone effect. sedative hypnotics may further decrease metabolic function - be wary of respiratory depression.
What is the nursing management of hypothyroidism?
Modify activity - encourage patient to partcipate in exercise
Monitoring physical status - monitor for response to therapy (gets better or worse?)
Promoting physical comfort - provide blankets and extra clothing to deal with cold intolerance (even if the room is warm). DO NOT USE heating pads or electric blankets because of risk of peripheral vasodilation or risk of burns.
Enhancing coping measures - inform patient and family that symptoms and inability to recognize are common. must teach symptoms.
What are the main symptoms that you should monitor as a nurse?
Cardiovascular - decreased HR. atherosclerosis may lead to angina and then MI.
Respiratory - tends to be depressed
What are some nursing diagnosis for a patient with hypothyroidism?
Imbalanced nutrition: more than body requirements
Activity intolerance related to fatigue and depressed cognitive process
Risk for imbalanced body temperature
Constipation related to depressed gastrointestinal function
Deficient knowledge about the therapeutic regimen for lifelong thyroid replacement therapy
Ineffective breathing pattern related to depressed ventilation
Disturbed thought process related to depressed metabolism and altered cardiovascular and respiratory status