NU 340 > Ch. 55 > Flashcards

Ch. 55 Flashcards

(51 cards)

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1
Q

thyroid gland

A
  • small butterfly shaped gland located in anterior neck
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2
Q

the thyroid gland secretes hormones that affect:

A
  • body metabolism
  • cellular regulation
  • nutrition
  • gas exchange
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3
Q

thyroid imbalances can lead to symptoms that can range from

A

mild to severe and life-threatening

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4
Q

thyroid gland surrounds the (anatomy)

A
  • trachea
  • larynx
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5
Q

palpating the thyroid gland

A
  • hands on either side of the neck
  • palpate with thumbs
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6
Q

thyroid hormones are

A
  • T4 (thyroxine)
  • T3 (triiodothyronine)
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7
Q

thyroid hormones regulate

A

regulates energy metabolism
growth and development
affects every body system (hypo or hyper)

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8
Q

hypothyroidism

A

reduced hormone secretion from the thyroid gland that results in decreased body metabolism

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9
Q

prevalence of hypothyroidism

A
  • women ages 30-60
  • women affected 7-10x more than men
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10
Q

hypothyroidism- most common cause

A

iodine deficiency is the most common cause
- most prevalent in iodine-deficient areas

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11
Q

hyperthyroidism is treated with

A

radio active iodine (RAI)

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12
Q

if the iodine intake is accurate, what is the primary cause of hypothyroidism?

A

the primary cause in the adult is an autoimmune problem resulting from a condition called Hashimoto’s thyroiditis

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13
Q

thyroid surgery

A

thyroidectomy: partial or total removal of the thyroid gland

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14
Q

hyperthryroidism

A

excessive thyroid hormone secretion from the thyroid gland that results in increased body metabolism

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15
Q

most common form of hyperthyroidism

A

Graves disease

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16
Q

prevalence of hyperthyroidism

A
  • women, can occur at any age but most common ages 20-40
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17
Q

Graves Disease

A

autoimmune disorder of unknown etiology
- often occurs after episode of thyroid inflammation

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18
Q

pathophysiology of Graves Disease

A
  • diffuse thyroid enlargement and excessive thyroid hormone secretion (T3&T4)
  • antibodies are developed and attached to the TSH receptors on thyroid gland
  • may progress to destruction of thyroid tissue
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19
Q

goiter

A

hypertrophy of thyroid gland caused by excessive TSH stimulation, usually visible and definitely palpable

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20
Q

Graves Disease Goiter

A

enlargement of thyroid gland, neck is very swollen

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21
Q

health history of patient with thyroid gland problems

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A
  • preexisting goiter
  • recent infection or trauma
  • immigration from iodine-deficient area
22
Q

hyperthyroidism: clinical manifestations

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A

Increased number of β-adrenergic receptors
Goiters
Bruits: abnormal blood flow (listen on carotids)
Ophthalmopathy (exophthalmos): protruding eyes

23
Q

hyperthyroidism/grave’s: cardiovascular system effects

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A

Systolic hypertension
Increased CO
Arrhythmias
Cardiac hypertrophy
Atrial fibrillation

24
Q

hyperthyroidism/grave’s: integumentary system effects

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A

Warm, smooth, moist skin
Thin, brittle nails
Hair loss
Clubbing of fingers
Diaphoresis
Vitiligo (loss of skin color in patches)
Eye balls protruding outward

25
hyperthyroidism/grave's: nervous system effects
Fine tremors Insomnia Lability of mood, delirium Hyperreflexia of tendon reflexes Inability to concentrate
26
hyperthyroidism/grave's: GI system effects
Increased appetite, thirst Weight loss (r/t metabolism is sped up) Diarrhea Splenomegaly Hepatomegaly
27
hyperthyroidism/grave's: MS system effects
Fatigue Muscle weakness Proximal muscle wasting Dependent edema Osteoporosis
28
hyperthyroidism/grave's: reproductive system effects
Menstrual irregularities Amenorrhea: no period Decreased libido Impotence Gynecomastia in men Decreased fertility
29
thyrotoxic crisis (thyroid storm): sx
Acute, life-threatening Hyperthermia Severe tachycardia Hypertension Heart Failure
30
thyrotoxic crisis (thyroid storm): triggers
Trauma, infection, DKA, pregnancy Vigorous palpation of the thyroid
31
thyrotoxic crisis (thyroid storm): diagnostic studies
Laboratory findings for TSH (low) and free thyroxine: T3&T4 (high) TSH-RAb (Antibodies to TSH) Radioactive iodine uptake - Normal 5 to 35%
32
thyrotoxic crisis (thyroid storm): treatment
Symptom treatment - racing HR: low dose beta blocker - anxious: low dose anti-anxiety, sleeping pill Antithyroid Medications Iodine
33
thyrotoxic crisis (thyroid storm): treatment- antithyroid medications
Propylthiouracil (PTU) Methimazole - Inhibit synthesis of thyroid hormones - 1-2 weeks to begin - 4-8 weeks therapeutic
34
thyrotoxic crisis (thyroid storm): treatment- iodine
Useful with other antithyroid drugs in preparation for thyroidectomy or treatment of crisis Large doses rapidly inhibit synthesis of T3 and T4 and block their release into circulation Potassium iodine (SSKI) or Lugol’s solution (no iodine for pregnant women)
35
thyrotoxic crisis (thyroid storm): treatment- radioactive iodine
Damages or destroys thyroid tissue limiting hormone secretion 3 months to see effect Usually causes hypothyroidism and requires life-long hormone replacement
36
thyrotoxic crisis (thyroid storm): surgical therapy
Subtotal thyroidectomy involves removal of significant portion of thyroid - 90% removed to be effective - If too much is removed, regeneration will not occur, results in hypothyroidism
37
Subtotal thyroidectomy post-op care
Assess for signs of hemorrhage or tracheal compression Semi-Fowler’s position and support head with pillows edema around the trachea Monitor for signs/symptoms of Parathyroid involvement
38
thyrotoxic crisis (thyroid storm): nursing problems
- Activity intolerance: tired, fatigued - Risk for injury: from being tired, muscle weakness - Imbalanced nutrition: less than body requirements, eating but losing weight due to increased metabolism - Anxiety: tremors
39
acute thryrotoxicosis: nursing care
Administer medications Monitoring cardiac arrhythmias Ensuring adequate oxygenation and IV fluids Light bed coverings if diaphoretic
40
hypothyroidism s/sx: cardiovascular system
Increased capillary fragility Decreased rate and force of contraction Cardiac hypertrophy Distant heart sounds
41
hypothyroidism s/sx: GI system
Decreased appetite Nausea and vomiting
42
hypothyroidism s/sx: integumentary system
Dry, thick, elastic, cold skin Thick, brittle nails
43
myxedema
sx of hypothyroidism Accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues Causes puffiness
44
hypothyroidism diagnostic tests
- TSH (high) - Thyroxine-T4 (low)
45
myxedema coma: manifestations
Mental sluggishness Drowsiness Lethargy progress gradually or suddenly to impairment of consciousness or coma puffy eyes
46
myxedema coma: acute intervention
Monitor core temperature as patient is often hypothermic Assess vitals, weight, I & O, and visible edema
47
myxedema coma: medication Levothyroxine
*aka synthroid Monitor with CV patients Report HR >100 (previously bradycardic, make sure that they do not become tachycardic) Life-long therapy Usually given before breakfast (empty stomach) Thyroid preparations potentiate the effects of some common drug groups - Antidepressants - Digitalis compounds - Anticoagulants
48
hypothyroidism: evaluation
think HR, RR, neuro evaluation - Maintain normal cardiovascular function: BP & HR in normal range - Maintain adequate respiratory function and gas exchange - Demonstrate improvement in cognition: if there was an issue with cognition
49
hypothyroidism is most commonly caused by
iodine deficiency - most prevalent in iodine-deficient areas
50
in places where iodine intake is adequate, the primary cause of hypothyroidism in adults is
atrophy of the gland
51
causes of hypothyroidism
- iodine deficiency* (#1) - atrophy of the gland* (#2) - autoimmune thyroid destruction - infection of the thyroid tissue - congenital absence or hypoplasia of thyroid tissues - neck surgery - irradiation, trauma - wide variety of drugs
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