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27 Cards in this Set
- Front
- Back
HYPERTHYROIDISM
Describe… Excess of what hormone Affects____ _____ organs Untreated leads to ________ |
• Is an excess of TH in the body.
• Affects all major organs of the body. • Untreated may lead to cardiac failure, psychiatric disorders and thyroid crisis |
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HYPERTHYROIDISM
PREDISPOSING FACTORS: |
PREDISPOSING FACTORS:
• Diet high in iodine (kelp) • Radioactive contrast media, cough syrup high in codeine • Genetic • Emotional stress • Infection |
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HYPERTHYROIDISM
Causes: |
Causes:
• Autoimmune Reactions: Grave’s Disease • Excess secretion of the thyroid-stimulated hormone (TSH) • Thyroiditis • Neoplasms (such as multinodular goiter) • Excessive intake of thyroid medications |
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What’s the difference between primary and secondary hyperthyroidism?
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Primary hyperthyroidism:
T3 T4 Increase TSH decrease Secondary hyperthyroidism: T3 T4 Increase TSH increase |
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How does hyperthyroidism affect the body systems?
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• All systems are on overdrive!
– HR & Stroke Volume increased – Increase metabolism of carbohydrates, proteins, and lipids – Glucose tolerance decreases – Protein catabolism, negative nitrogen balance – Nutritional and caloric deficiences |
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Client’s symptoms of hyperthyroidism
Know !!!! |
Client will typically have:
• An increased appetite, but will continue to lose weight • Hypermotile bowels and diarrhea • Heat intolerance and increased sweating • Hair is fine, skin smooth and warm • Emotional lability is very common |
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Grave’s disease
Most common cause of _______ Commonly occur in _____ Under age_____ Link to _______ and _______ ______ |
• Most common cause of hyperthyroidism
• 7 to 10 times more likely to occur in women than men • Generally occurs under age 40 • May be a link to hereditary and emotional stress |
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Describe Grave’s disease
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• Multisystem autoimmune disorder
• Increased levels of TH are produced • May result in diffuse enlargement of the thyroid gland • Exophthalmos-eyes *** • Proptosis |
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What is EXOPHTHALMOS
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• Accumulation of fat deposits and inflammation of by-products in the retro-orbital tissues
• Upper lid is retracted, sclera may be visible above the iris, unblinking stare • Usually bilateral • May cause: blurred vision, eye pain, lacrimation, and photophobia, inability to close eyes • Inability to close eye may increase risk of corneal dryness, irritation, infection and ulceration • Treatment of Grave’s Disease does not reverse changes in the eyes. |
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Nursing Intervention???
EXOPHTHALMOS Know!!!! |
• Teaching related to eye care such as:
– Eye drops – Eye patch / sleeping mask – Lightly tape eyes shut with nonallergic tape – Protective glasses – Sunglasses – Avoid dust/ dirt to eyes – Elevate head of bed – Restrict sodium (relieve edema) |
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Grave’s disease
Symptoms KNOW!! |
Client may complain of
• Fatigue • Difficulty sleeping • Hand Tremors • Changes with menstruation cycles • Older clients may present with atrial fib, angina or CHF |
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OTHER CAUSES OF HYPERTHYROIDISM
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• Toxic multinodular goiter
– Goiter: enlargement of thyroid gland • May result from excess TSH stimulation • Growth stimulating immunoglobulins • Substances that inhibit TH synthesis • Toxic multinodular goiter has small independently functioning nodules in the thyroid gland that are secreting TH |
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Causes of Hyperthyroidism
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• Excess TSH Stimulation: usually from a pituitary adenoma?
. • Thyroiditis: Viral infection of the gland – Usually acute, but may become chronic as repeated infections destroy gland tissue, which may result in hypothyroidism |
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Hyperthyroidism: Physical Assessment
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• History of emotional and mental status changes
• Chest pain/pounding • Dyspnea with/without exercise • Changes in hair, skin, nails • Sweating • Visual disturbances • Weight changes • Increased stool freq. • Heat intolerance • C/O weakness, fatigue • Change in menses/libido• |
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Hyperthyroidism
Lab and Diagnostics |
• Elevated levels of TH and increased iodine uptake are diagnostic criteria for hyperthyroidism.
– T3 and T4 – TSH test (differentiates between primary hyperthyroidism (from the thyroid gland) and secondary hyperthyroidism (from the pituitary gland) |
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Hyperthyroidism
• Pharmacology: |
• Pharmacology:
-Drugs act to reduce levels of TH production -Effects may not be seen for several weeks because drugs do not affect the release or activity of hormones already formed Thioamides – Block thyroid synthesis • Propylthiouracil (PTU) • Tapazole Toxic S & S • Fever • Sore throat • Skin eruptions |
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Hyperthyroidism
• Pharmacology with Nursing implications KNOW!!!! |
Pharmacological agents & nursing implications
Thioamides--PTU & methimazole blocks thyroid synthesis Takes 2-4 weeks to effect Must be taken frequently Toxic S/S: fever, sore throat, skin eruptions, S/S of infection Used to prepare for surgery, management of thyrotoxic crisis, & treat hyperthyroidism chronically. Lugol’s solution inhibits thyroid hormone and TSH Preparation for surgery Unpleasant taste, burning in mouth, sore mouth and throat Drink through a straw to prevent staining teeth Used 1-3 weeks for short term only |
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Hyperthyroidism
Treatments RADIOACTIVE THERAPY SURGERY |
• Radioactive Therapy:
-Thyroid gland absorbs iodine in any form. Radioactive iodine destroys/damages cells so they produce less -Results may not be seen for 6 to 8 weeks • Radioactive Therapy – Contraindicated in pregnant women – Amount of gland destroyed is not controllable, may result in • Surgery – Enlarged thyroid may cause pressure on esophagus or trachea resulting in difficulty breathing or swallowing. Subtotal thyroidectomy is performed. – Total thyroidectomy required for CA of the thyroid |
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Hyperthyroidism
Radioactive Iodine - I-131 |
Faster Treatment and safer
Given orally in one dose Excreted in 2 days Precautions due to secretion: • Flush toilet 2-3 X after each use, increase fluid intake, use separate eating utensils, towels, washcloths • Rinse bathrooms sinks and tubs thoroughly after each use • Sleep alone for a few days and avoid kissing and sexual intercourse • Avoid direct contact with baby • Contraindicated in pregnant women Propranolol Adm. to block the effects of the hyperthyroid state Lithium Inhibits thyroid hormone release & is used for persons who are iodine-sensitive |
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Care of the Pre & Post – Thyroidectomy Patient
Pre Op KNOW!!! |
• Prior to surgery patient should be in an euthyroid state
• Patient may receive antithyroid drugs and iodine to decrease vascularity and size of thyroid prior to surgery • Pre-Op Teaching: Support neck, decrease pressure/tension on suture line • Answer questions |
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Care of the Post op – Thyroidectomy Patient
Know!!! |
• Post-Op: Semi-fowlers position
– Decrease risk for hemorrhage (greatest risk occurs 12-24 hours post op – Respiratory distress – Trach Kit – Assess laryngeal damage – Tetany: Calcium gluconate / calcium chloride |
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Nursing Care for Clients with Hyperthyroidism
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• Risk for Decreased Cardiac Output
• Sensory-Perceptual Alterations: Vision • Risk for Altered Nutrition: Less than Body Requirements • Body Image Disturbance • Hyperthermia • Activity Intolerance • Anxiety |
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Hyperthyroidism
Expected Outcomes |
Expected Outcomes
– Gain at least 1 # per week – Regain normal bowel elimination patterns – Maintain normal vision and verbalize measures to protect eyes – Verbalize medical treatment and self-care – Verbalize decreased anxiety |
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Hyperthyroidism
Health teaching |
Health teaching
• Oral medications are lifelong tx. • Regular annual visits to health care provider to monitor thyroid levels |
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Hyperthyroidism
Unique nutritional needs |
Unique nutritional needs
GI hypermotility with nausea, vomiting, diarrhea, and abd. Pain. Diet high in carbohydrates and protein and include between-meal snacks. Six small meals a day may be more desirable than three large meals. Caloric intake may need to be increased to 4000 calories per day |
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THYROID CRISIS
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• Also called Thyroid storm / Thyrotoxicosis
• – Rare today because of medications – Life threatening condition • Hyperthermia 102F to 106F • Tachycardia • Hypertension • GI symptoms • Agitation, restlessness, tremors • Confusion, psychosis, delirium, seizures • Comatose |
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THYROID CRISIS
(Thyroid storm / Thyrotoxicosis) |
• Mortality 75%
• Precipitated by stress – Infection – DKA – Physical /Emotional Trauma – Gland Manipulation • Treatment – Acetaminophen – Avoid Salicylates |