Transcript 401-Thyroid-Disorders

Nursing Care & Interventions for the
Client with Disorders of the Thyroid
Gland
Keith Rischer RN, MA, CEN
1
1
Today’s Objectives…





Compare and contrast pathophysiology &
manifestations of thyroid/parathyroid gland
dysfunction.
Identify, nursing priorities, and client education
associated with thyroid/parathyroid gland dysfunction.
Interpret abnormal laboratory test indicators of
thyroid/parathyroid gland dysfunction.
Analyze assessment to determine nursing diagnoses
and formulate a plan of care for clients with
thyroid/parathyroid gland dysfunction.
Describe the mechanism of action, side effects and
nursing interventions of pharmological management
with thyroid/parathyroid gland dysfunction.
2
Thyroid Glands:Patho

Thyroid gland
•
•

Thyroxin (T3)
Triiodothyronine (T4)
Functions
•
•
•
Controls metabolism
of all cells
Regulate protein,
CHO, fat metabolism
Exert
chronotropic/inotropic
cardiac effects
3
Hyperthyroidism:Causes





Graves disease
Goiter
T3 Thyrotoxicosis
Thyroid cancer
Tumors in body
4
4
Hyperthroidism: Assessment
chart 67-1 p.1482
Early
• Visual changes



•
•
•
Blurred
Double vision
Photophobia
Heat intolerance/diaphoresis
Weakness, fatigue
Other







exopthalmos
Tachycardia or systolic
hypertension
Agitation, tremors, anxiety
Palpitations
Increased libido, amenorhea
Restlessness, confusion,
psychosis
seizures
5
5
Hyperthyroidism:Diagnostic Tests
•
•
•
Serum thyronine (T4)
Serum Triodothyronine (T3)
Thyroid stimulating hormone (TSH)
 low
in Graves
 high in secondary (due to pituitary disorder)
•
Thyroid scan
 increase
•
•
radioactive iodine uptake
Ultrasound
ECG
6
6
Nursing Diagnostic Priorities

Imbalanced nutrition…less than body requires
•

Hyperthermia r/t increased metabolic rate
•
•
•

•

Bedding change frequently (diaphoresis)
Sponge baths
Cool environment
Fatigue r/t sleep deprivation
•

High in calories, proteins, and carbohydrates with
supplemental feedings
Encourage rest – fatigue
Keep environment quiet
Deficient knowledge
Exopthalmos
7
Thyroid Crisis/Storm
Patho
• Uncontrolled hyperthyroidism
• Excess thyroid hormone release
 Physical assessment
• Extreme temperature
• Hypertension
• Tachycardia
 Treatment
• Inderal
• Closely monitor VS-rhythm-temp
• Fever reduction

8
8
Hyperthyroidism:Medical Management

Antithyroid medications
• Propylthiouracal (PTU)

•
block synthesis of thyroid hormone
Iodine (SSKI)

reduce vascularity of thyroid gland
Beta blockers
 Radioactive iodine therapy
• To ablate thyroid to make the pt become hypothyroid;
 Taken orally
 Relief of symptoms may take 6-8 weeks
•
9
9
Hyperthyroidism:Surgical Management
Preop
care
Post op care
•ABC’s

Humidified O2
•Support
of neck with movement
& coughing
•Semi-Fowlers position
•Incisional care
Postoperative
complications
•Hemorrhage
•Respiratory


Stridor
Tracheotomy equipment readily
available
•Laryngeal

distress
nerve damage
Hoarseness/weak voice
10
10
Hypothyroidism
 Patho
•
•
Decreased
metabolism
Myxedema coma

Cellular edema
– Generalized NP
edema…eyes, hands,
feet, tongue
 Causes
•
•
Thyroid
surgery/radioactive
iodine treatment
Iodide deficiency
11
11
Hypothyroidism: Assessment
 Change
•
chart 67-5 p.1488
in sleep habits
more lethargic
 Decreased
libido
 Generalized weakness
 Muscles aches
 Cold intolerance
 Constipation
12
12
Myxedema Coma



Those at highest risk
• Surgery
• Chemo
• Withdrawal thyroid meds
Assessment
• Respiratory failure
• Hypotension
• Labs
Emergency care
• ABC’s
• Replace fluids
• Administering meds. Steroids, IV glucose, Levothyroxine sodium
(thyroid)
• Monitor Temp. & BP frequently
13
13
Hypothyroidism: Diagnostic Tests
 Laboratory
•
•
•
studies
Serum T3
Serum T4
TSH
 high
in primary
 Low in secondary
Treat with Lifelong thyroid replacement
•
•
Levothyroxine (Synthroid)
Assess thyroid levels. May start low to avoid
cardiac problems
14
14
Nursing Diagnostic Priorities
1.
2.
3.
4.
5.
Decrease cardiac output
• Assess for bradycardia, dysrhythmias
• O2 if needed
Ineffective Breathing pattern
• care when giving sedation
Disturbed thought processes
• assess lethargy, memory deficit, poor attention span,
difficulty communicating
Constipation
Deficient knowledge
15
15
Hyperparathyroidism
 Parathyroid
•
glands
Regulate calcium and
phosphate balance
 Labs
•
Hypercalcemia and
hypophosphatemia
 Causes
•
•
•
•
Tumor
Chronic renal failure
Vit. D deficiency
Neck trauma or radiation
16
16
Hyperparathyroidism: Assessment
Bone fractures from demineralization from bones
 Recent weight loss
 Arthritis
 Psychological distress
 History of Radiation to neck
 GI
• N/V, diarrhea, constipation
 Renal stones

17
17
Hyperparathyroidism: Medical Management
Diet
• restrict Calcium…esp milk products
 Medications
• Lasix
 Increased excretion of calcium
• Phosphates
 Inhibits bone resorption and interferes with
calcium absorption
• Calcitonin
 Use to decrease skeletal calcium release
 Hyperparathyroidectomy
• Same

18
18
Hyperparathyroidism:
Nursing Interventions

Hydration
•
•
•
(strict I & O)
IV saline in large amounts and lasix to excrete calcium
Assess for Congestive heart failure R/T fluid overload
Cardiac monitoring
 Serum Calcium levels need to be done frequently
 Educate client to report N/V, palpations, numbness
 Care to reduce fractures – lift gently

•

Ambulation helps prevent demineralization
Observe for renal calculi
19
19