Transcript 21 .Interventions for Clients with Problems of the Thyroid a

Evaluating Outcomes
for Clients with Thyroid
and Parathyroid
Problems
Hyperthyroidism
 Thyrotoxicosis
 Graves’
disease, the most
frequent causes: goiter,
exophthalmos, pretibial
myxedema
 Laboratory assessment
 Thyroid scan
 Ultrasonography
 Electrocardiography
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.
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
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)
Infiltrative Opthalmopathy
(Continued)
 Give
steroid therapy.
 Provide diuretics.
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
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.
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.
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.
Myxedema Coma
 Coma,
respiratory
failure, hypotension,
hyponatremia,
hypothermia,
hypoglycemia
 Emergency care
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

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
Hyperparathyroidism
 Parathyroid
glands: calcium and
phosphate balance
 Hypercalcemia and
hypophosphatemia
 Nonsurgical management:
– Diuretic and fluid therapy
– Drug therapy: phosphates,
calcitonin, calcium chelators
Surgical Management
 Parathyroidectomy
care:
preoperative
– Client stabilized; calcium levels
normalized
– Studies: bleeding and clotting
times, CBC
– Teaching: coughing, deep-breathing
exercises, neck support
 Operative
procedures
(Continued)
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.
Hypoparathyroidism
 Decreased
function of the
parathyroid gland
 Iatrogenic hypoparathyroidism
 Idiopathic hypoparathyroidism
 Hypomagnesemia
 Interventions: correcting
hypocalcemia, vitamin D
deficiency, and hypomagnesemia
If a manifestation is caused by hyperthyroidism,
indicate “HYPER”. If a manifestation is caused
by hypothyroidism, indicate “HYPO.”
Tremors
 Heat intolerance
 Weight gain
 Tachycardia
 Insomnia
 Dry, coarse,
brittle hair
 Decreased
activity tolerance

Decreased body
temperature
 Palpitations
 Apathy
 Diaphoresis
 Thinning of scalp
hair
 Thick, brittle nails
 Constipation

HYPO = Hypothyroidism
HYPER = Hyperthyroidism




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
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Tremors: HYPER
Heat intolerance:
HYPER
Weight gain: HYPO
Tachycardia: HYPER
Insomnia: HYPER
Dry, coarse, brittle
hair: HYPO
Decreased activity
tolerance: HYPO







Decreased body
temperature: HYPO
Palpitations: HYPER
Apathy: HYPO
Diaphoresis: HYPER
Thinning of scalp hair:
HYPER
Thick, brittle nails:
HYPO
Constipation: HYPO
Myxedema
During hypothyroidism, cellular energy
production is decreased and metabolites
build up.
 The metabolites are compounds of
proteins and sugars called
glycosaminoglycans.
 These compounds build up inside cells,
which increases mucous and water, forms
cellular edema, and changes organ
texture.
 The edema is mucinous edema (called
myxedema) rather than edema caused by
water alone.

Myxedema Coma
A rare, serious complication of untreated
or inadequately treated hypothyroidism.
 Decreased metabolism leads to a flabby
heart increased chamber size
 Cardiac output decreases
 Perfusion to the brain and other organs
decreases
 Decreased perfusion makes slowed cellular
metabolism worse.
 Tissue and organ failure occurs.

Causes of hyperparathyroidism include the BOLD
items:
 Congenital
dysgenesis
 Parathyroid carcinoma
 Vitamin D deficiency
 Hypomagnesemia
 Chronic renal failure with
hypocalcemia.
 Neck trauma

Other causes are parathyroid
adenoma, congenital hyperplasia,
neck radiation, parathyroid
hormone-secreting carcinomas of
lung, kidney , or GI tract.