Transcript Chapter 67

Chapter 67
Interventions for Clients with
Problems of the Thyroid and
Parathyroid Glands
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Hyperthyroidism
• Thyrotoxicosis
• Graves’ disease, the most frequent causes:
goiter, exophthalmos, pretibial myxedema
• Laboratory assessment
• Thyroid scan
• Ultrasonography
• Electrocardiography
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Drug Therapy
• Radioactive iodine therapy; not used in pregnant
women
– Additional drug therapy may be needed.
– Implement radiation precautions.
– Monitor regularly for changes in thyroid
function.
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Surgical Management
• Surgery possible in absence of good response
to drug therapy.
• Postoperative care for:
– Hemorrhage
– Respiratory distress
– Hypocalcemia and tetany
– Laryngeal nerve damage
– Thyroid storm or thyroid crisis
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Infiltrative Opthalmopathy
• Provide symptomatic treatment.
• Treatment of hyperthyroidism does not correct
eye and vision problems of Graves’ disease.
• Elevate the head of bed at night.
• Instill artificial tears.
• Treat photophobia with dark glasses.
(Continued)
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Infiltrative Opthalmopathy (Continued)
• Give steroid therapy.
• Provide diuretics.
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Hypothyroidism
• Decreased metabolism from low levels of thyroid
hormones
• Myxedema coma a rare, serious complication
• Mostly a result of thyroid surgery and radioactive
iodine treatment of hyperthyroidism
• Clinical manifestations
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Decreased Cardiac Output
• Interventions:
– Monitor circulatory status.
– Monitor for signs of inadequate tissue
oxygenation.
– Monitor for changes in mental status.
– Monitor fluid status and heart rate.
– Administer oxygen or mechanical ventilation,
as appropriate.
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Ineffective Breathing Pattern
• Interventions:
– Observe and record rate and depth of
respirations.
– Auscultate the lungs.
– Assess for respiratory distress.
– Assess the client receiving sedation for
respiratory adequacy.
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Disturbed Thought Processes
• Interventions:
– Assess lethargy, drowsiness, memory deficit,
poor attention span, and difficulty
communicating.
– These problems should decrease with thyroid
hormone treatment.
– Provide a safe environment.
– Provide family teaching.
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Myxedema Coma
• Coma, respiratory failure, hypotension,
hyponatremia, hypothermia, hypoglycemia
• Emergency care
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Thyroiditis
• Inflammation of the thyroid gland
• Three types of thyroiditis: acute, subacute
(granulomatous), and chronic (Hashimoto’s
disease)—the most common type
• Dysphagia and painless enlargement of the
gland
• Nonsurgical management, drug therapy
• Surgical management
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Thyroid Cancer
• Papillary, follicular, medullary, and anaplastic
• Collaborative management
• Surgery treatment of choice: thyroidectomy
• Suppressive doses of thyroid hormone for 3
months after surgery
• Study performed after drugs are withdrawn
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Hyperparathyroidism
• Parathyroid glands: calcium and phosphate
balance
• Hypercalcemia and hypophosphatemia
• Nonsurgical management:
– Diuretic and fluid therapy
– Drug therapy: phosphates, calcitonin, calcium
chelators
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Surgical Management
• Parathyroidectomy preoperative care:
– Client stabilized; calcium levels normalized
– Studies: bleeding and clotting times, CBC
– Teaching: coughing, deep-breathing
exercises, neck support
• Operative procedures
(Continued)
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Surgical Management (Continued)
• Postoperative care includes:
– Observe for respiratory distress.
– Keep emergency equipment at bedside.
– Hypocalcemic crisis can occur.
– Recurrent laryngeal nerve damage can occur.
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Hypoparathyroidism
• Decreased function of the parathyroid gland
• Iatrogenic hypoparathyroidism
• Idiopathic hypoparathyroidism
• Hypomagnesemia
• Interventions: correcting hypocalcemia, vitamin
D deficiency, and hypomagnesemia
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