Transcript Nursing care of the client with endocrine parathyroid diso Spring

Chapter 35
Care of the Clients with Thyroid
and Parathyroid Disorders
Location of Endocrine glands
Actions of the “Master Gland”
Function of the Endocrine
system
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Hormones are controlled by:
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Negative feedback control
Circadian rhythms
Stress
Example of Negative feedback
control
Example of Negative feedback
control
Thyroid gland
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Where is it located?
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What does it do?
Assessment of the Thyroid
gland
Diagnostic exams to assess
function of the Thyroid gland
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TRH stimulation test
TSH stimulation test
TSH
Serum T4
Serum T3
Free T4
Thyroid scan
Ultrasound
Hyperthyroidism
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1.
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Caused by an excess production of thyroid hormone.
More often in women and older adults.
Disorders associated with hyperthyroidism are
Graves disease- most common cause of
hyperthyroidism. Autoimmune disorder.
2. Thyrotoxic Crisis- Thyroid storm, rare today.
Caused by: auto immune response, excessive doses
of thyroid medication or by excess secretion of
thyroid-stimulating hormone from the pituitary
gland. Result is increase in metabolic rate.
Hyperthyroidism
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Hyperthyroidism can place a strain on the
cardiovascular system.
If left untreated can result in cardiac dysrhythmias
and heart failure.
Increased metabolism of CHO proteins and lipids
client has increased appetite yet loses weight.
Nutritional deficiencies can occur.
Multisystem manifestations. See text.
Graves’ Disease
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Most common cause of hyperthyroidism, autoimmune
disorder.
More often in women under age of 40 than general
population.
Increased production of TH results in enlargement of
the thyroid gland or Goiter.
Also causes forward protrusion of the eyeball called
exophthalmos. This can lead to corneal dryness,
infection and ulceration of the eyeball due to
protruding eyeball.
Hyperthyroidism
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Hyperthyroidism
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Most common
cause= toxic
multinodular
goiter
What is
Exopthalmos?
What causes
Exopthalmos?
vs
Graves
(cont)
Exophthalmos
What is a goiter
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Is is a tumor?
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Why do people get goiters?
Goiter
Thyroid Crisis (Storm)
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Extreme state of hyperthyroidism rare today.
Untreated hyperthyroidism or from hyperthyroidism
along with a stressor such as infection untreated
DKA, physical or emotional trauma or thyroid
surgery.
Life threatening condition and requires immediate
medical attention.
CM- fever over 102F, tachycardia, hypertension,
restlessness and tremors, confusion, delirium, coma
and seizures. Antithyroid medications (PTU) are given
reduce thyroid production
Goiter
Hyperthyroidism Care
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Interdisciplinary: Reducing the production of TH and
preventing or treating complications.
DX: H&P. laboratory test elevated serum T3, and T4
decreased TSH levels
1. Medications to inhibit thyroid production- takes
several weeks to see results.
2. Radioactive iodine therapy- destroy thyroid cells.
3. Surgery- partial removal of the thyroid gland.
Discussion Textbook! Complications! Hypocalcemia,
tetany.
Nursing Diagnosis for
Hyperthyroidism
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Risk for Imbalanced Nutrition: Less than
body requirements
Fatigue
Risk for Decreased Cardiac Output
Risk for Injury: Corneal Abrasion
Distrurbed Body Image
Tetany
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Trousseau’s sign
Tetany
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Chvostek’s sign
Getting ready for the post-op
thyroidectomy client
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Calcium Gluconate
Freq. Ca levels
Tracheostomy set at bedside
Oxygen therapy
Suction
Case study, Thyroid
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Ms. Bernice Bell is a 40 year old single
mother of two children. She works as a high
school counselor and is a member of the
city council. She was diagnosed with
hyperthyroidism and is being admitted to
the hospital for I 131 treatment. She is
extremely anxious about the procedures as
well as the results it will produce.
Questions 1-4, thyroid case
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1. What signs and symptoms might you
expect to find during your assessment?
2. Why should Ms. Bell undergo a cardiac
assessment?
3. What labs should be drawn and what
findings would you expect?
4. What is Graves disease?
Question 7, thyroid case
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7. Ms. Bell did not respond to I131 and will
have to undergo a thyroidectomy.
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A. ) What is the pre-op care for Ms. Bell?
B.) What are the complications associated with
a thyroidectomy?
C) What is the nursing care for the post op
thyroidectomy client?
Hypothyroidism
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Cause:
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Thyroid surgery
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Radioactive iodine therapy
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Lack of iodine—underdeveloped
countries—lack in soil and water
Signs and symptoms of
Hypothyroidism
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Freq. Sleeping
Weight gain
Low appetite
Low temp—cold intolerance
Low B/P
Constipation
Goiter Slow onset of all CM months or
years. See textbook. Discussion
Untreated Hypothyroidism
leads to Myxedema Coma
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Life threatening
Cause: stress, untreated
hypothyroidism
Appearance
Coarse features, edema around the
eyes and face, a blank expression and a
thick tongue
Goiter
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When TH production decreases the thyroid gland
enlarges in an attempt to produce more hormone.
This enlargement is called a goiter.
Iodine deficiency can result in hypothyroidism.
Iodine is necessary for TH synthesis and secretion.
Iodized salt has reduced this risk in the US.
Myxedema/Hypothyroidism
Myxedema Coma
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Life threatening form of hypothyroidism
requires immediate medical attention.
Exposure to cold temperatures,
infection or surgery along with trauma
or use of central nervous system
depressants- narcotics and tranquilizers.
Winter older women with
hypothyroidism
TX: intravenous thyroid hormone. Text.
Hypothyroidism
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Hashimoto’s thyroiditis- most common cause of
primary hypothyroidism.
Autoimmune disorder antibodies destroy thyroid
tissue.
Primary CM is goiter
Common women 30-50 years old family history of
thyroid disease.
Treatment of Hypothyroidism
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Thyroid replacement
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Synthyroid - Levothyroxine
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IV
PO
Final dose determined by TSH levels
Subtotal Thyroidectomy
Nursing Diagnosis Hypothyroidism
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Decreased Cardiac Output
Imbalanced Nutrition: More than body
requirements
Activity Intolerance
Disturbed Thought Processes
Bowel elimination
Critical thinking challenge
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The client is a 22 yr college senior nursing
student who has been brought to the health
center by her friends, who say she is not
“acting right”. This former straight A student
has been oversleeping and missing classes.
Her grades have dropped to B’s and C’s. She
has gained 40 lbs during the past semester
and has not had a period for 5 months.She is
wearing 2 sweaters and asking for a blanket
even though the room is quite warm.
Do you think it is Hypothyroidism?
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What assessment data should you
obtain first?
What comfort measures will you provide
to this client?
What questions will you ask the client,
and what questions will you ask her
friends?
Parathyroid hormone
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Secreted by:
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Parathyroid Gland
Controlled by:
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Calcium levels
Remember—we are talking about
calcium in the serum (blood)
 Where does the calcium come from?
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Bones
 Urine
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Hyperparathryoidism
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Causes:
Cancer
 Neck trauma
 Chronic renal failure
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What happens?
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PTH excretion
Hyperparathyroidism
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(Cont.)
What happens? (cont)
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Increase calcium out of the bone and
decrease calcium excretion in the urine
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Bone fractures
Bone cysts
Osteoporosis
Renal calculi
Results in
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serum calcium levels
serum phosphorus levels
Relationship of Calcium and
Phosphorus
Calcitonin
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When does Calcitonin get released?
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Calcitonin decreases bone breakdown of
calcium
Remember:
Calcitonin
calcium
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Phosphorus
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Parathyroid Hormone (PTH)
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PTH=
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PTH =
Calcium levels
Phosphorus levels
Hyperparathyroidism
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Treatment:
Bisphosphonates
 Calcitonin
 Lasix
 Hydration
 Surgery
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(Cont.)
Hypoparathryoidism
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Causes:
Thyroidectomy
 Hypomagnesemia—this causes impairment
of PTH secretion and may decrease
effectiveness of PTH on bones and kidneys
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Hypoparathryoidism
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(cont.)
Vitamin D is needed for calcium
absorption
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PTH= decreased calcium levels
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Decreased calcium levels= Tetany
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S/S of Tetany?
Results of low serum calcium
Numbness and tingling (circumoral)
 (+) Chvostek’s sign
 (+) Trousseau’s sign
 Cataracts
 Mental changes
 Loss of calcium from the teeth with
enamel loss
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Tetany
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Chvostek’s sign
Tetany
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Trousseau’s sign
Nursing Diagnosis
Hyperparathyroidism
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Main treatment is surgical removal of the parathyroid
glands.
Nursing care is the same for that of a client having a
thyroidectomy.
Prioritizing Nursing Care: See text discussion.
Nursing Diagnosis
Hypoparathyroidism
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1. Risk for ineffective airway clearance R/T laryngeal
muscle spasms
2. Risk for injury R/T tetany
3. Acute confusion r/t parathyroid disorder