Transcript Thyroid Dysfunction

MS II
Charnelle Lee, RN, MSN
Endocrine
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Secretion of t 3 and
t4 is under the
control of thyroid
stimulating
hormone from the
_____ pituitary
gland.
Endocrine
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Regulation of cellular metabolic activity
T3 is very potent 5 x more potent than T4
and is more rapid acting
T4 is relatively weak hormone maintains body
metabolism in a steady state.
Important in cellular replication, important in
brain development
Endocrine
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Secreted by the thyroid gland
Secreted in response to high plasma levels of
calcium
Decreases plasma level of calcium by
increasing its deposition in bone
Endocrine
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Inspect lower neck region between the
sternocleidomastoid muscles for swelling or
asymmetry
Instruct the patient to extend the neck
slightly and swallow, normal(rises with
swallowing) Palpate for size, shape,
consistency, symmetry and presence of
tenderness
Endocrine
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What is the best screening lab test for
abnormal thyroid function?
Endocrine
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Assess medication historyor ingestion of
agents that contain iodine.
Iodine containing agents:
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contrast agents
those used to treat thyroid disorders
Topical antiseptics, multivitamin preparation
food supplements, cough syrups
amiodarone, antidysrhythmic
Estrogens
Endocrine
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Inadequate
secretion of thyroid
hormone during
fetal and neonatal
development
Physical and mental
growth is stunted
Endocrine
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Lethargy
Slow mentation
Generalized slowing
of body function
Endocrine
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The most common form of hypothyroidism
Immune system attacks the thyroid
Endocrine
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Hair loss
Brittle nails
Dry skin
Menstrual
disturbances
Amennorrhea
menorrhagia
Voice –hoarseness or
husky
Fatigue
Endocrine
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Temperature- subnormal
Weight – gain initially
Skin- thickened
Hair- thins, falls out
Facial expression-tongue
enlarges, masklike
Mental function- slow,
Bowel function-constipation
including speech
Hearing- deafness
Temperature tolerance-cold
Emotional function
Endocrine
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Pulmonary effects will
Cholesterol levels are :
manifest as: pleural effusion, elevated
sleep apnea, resp. muscle
weakness
Disease processes that will
be present: atherosclerosis,
CAD, pericardial effusion,
LV dysfunction
Medication administration
with caution due to: med
sensitivity to sedatives,
opiods, anesthetics
Endocrine
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Temperature - Hypothermic Precipitated by – deficiency
of circulating thyroid
Level of consciousnesshormone due to infection,
Unconscious
systemic disease
Cardiovascular collapse
Shock
Respiratory drive is
depressed resulting in:
alveolar hypoventilation &
CO2 retention, narcosis,
coma
Endocrine
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Pathophysiology
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Skin
Cardiopulmonary system
Pulmonary system
Kidneys and fluid and electrolyte balance
Nutrition and elimination
Thermoregulation
Anemia
Copyright © 2014, 2010 by
Mosby, an imprint of Elsevier Inc.
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Endocrine
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Medical management
◦ Ventilator, fl & electrolyte correction
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Pharmacologic management
◦ Corticosteroids
◦ Thyroid hormone replacement
 Levothyroxine IV and po
Copyright © 2014, 2010 by
Mosby, an imprint of Elsevier Inc.
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Nursing management (Cont.)
◦ Skin care
◦ Elimination
◦ Patient education
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Collaborative management
Copyright © 2014, 2010 by
Mosby, an imprint of Elsevier Inc.
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Very common from 40 to 70 years of age
Often missed
Regular screening needed
Presents: as depression, fatigue, altered
mobility, sensitivity to analgesics, and
anesthetics
Endocrine
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Dose based on TSH
levels
Must be taken for
the rest of the
patient’s life
Endocrine
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Monitor for s/s of cardiac ischemia during
replacement therapy with synthroid.
Patients with hypothyroid for long periods of
time may have atherosclerosis
What signs and symptoms would signify that
the patient is having coronary ischemia?
Endocrine
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Thyroid hormones will _____ blood glucose
levels, may need adjustment in insulin, and
oral anti-diabetics
Increased levels of thyroid hormone may be
potentiated by digoxin, anticoagulants, and
indocin
Endocrine
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Increased susuceptibility to all hynotics and
sedatives
Even in small doses may induce profound
somnolence lasting far longer than
anticipated.
Dose should be decreased one half to one
third with normal thyroid function
Endocrine
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What monitoring equipment would you place
on a patient with this condition?
What assessments would you perform, and
how frequently?
Endocrine
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Activity intolerance
Altered comfort related to cold
intolerance
Knowledge deficit
Ineffective family coping
Risk for infection
Altered nutrition
Constipation risk for
Endocrine
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Oversecretion of thyroid hormones
Greatly increase metabolic rate
Increase in circulating catecholamines
epinephrine and norepinephrine
Goiter r/t low iodine intake – causes
increased TSH which = TSH release and
overproduction of thyroglobulin, hypertropy
Endocrine
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Emotional stress
Infection
Thyroidiitis
Excessive ingestion
of thyroid hormone
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Endocrine
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Nervousness
Excitability
Irritable
Palpitations
Tachycardia
Sweat easily Warm
Moist skin
Hand tremor
Exopthalmos
Hunger
Weight loss
Endocrine
ApprehenSive
fatigue
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Amenorrhea
Hypertension
Atrial fibrillation
CHF
S3
Osteoporosis
Emaciated
Delirious
Confusion
Complete heart
failure
Widened pulse
pressure greater
than 50 mm hg
Endocrine
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Enlarged thyroid
gland
Palpable thrill
Bruit
Increased T4
Endocrine
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Destroy overactive thyroid cells
Will eventually result in hypothyroidism
80% are cured by one treatment
Radiation dose will initially cause an acute
release of thyroid hormone
Treatment - ___________
Endocrine
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Purpose: inhibit one or more stages of
hormone synthesis or release
Common agents used – Propacil, Tapazole
Continued till the patient is euthryoid
Maintenance dose is established then a
gradual withdrawal of the medication over the
several months
Endocrine
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Notify the physician of fever, rash, urticaria,
Agranulocytosis, thrombocytopenia
Any sign of infection especially pharyngitis,
and fever, or the occurrence of mouth ulcers,
stop the medication, and notify the physician
immediately
Endocrine
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Decrease the release of thyroid hormones
Reduce the vascularity of the thyroid gland
Compounds: Potassium Iodide, Lugol’s
solution, saturated solution of potassium
iodide (SSKI)
Endocrine
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Give in milk or fruit juice
Give it through a straw to prevent teeth
staining!!!!!!!!!!!
Do not take cough medicines,
bronchodilators, salt substitutes, may contain
iodide and will potentiate iodide compounds.
Endocrine
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Very important in the management of
hyperthyroidism
◦ Block sympathetitc nervous system effects
◦ Propanolol-used for nervousness, anxiety, heat
intolerance, tachycardia, tremor, anxiety, anxiety
Endocrine
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Patients receiving iodide preparations need to
be monitored for toxicity, manifested by:
Swelling of the buccal mucosa
Excessive salivation
Coryza
Skin eruptions
Endocrine
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Removal of 5/6ths of the thyroid
Pre-medication with porpylthiouracil until the
signs of hyperthyroidism have decreased
Beta-blocker pre-medication
Endocrine
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Thyroid Storm
◦ Increased cellular o2
consumption
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Temperature >101.3
Heart rate
Blood pressure
Symptoms of shock
Exaggerated signs of
hyperthyroidism
◦ Multiple organ systems
Endocrine
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Goals:
◦ prevent CV collapse, decrease hyperthermia,
reverse dehydration
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Humidifed oxygen titrate to o2 requirement
IV fluids with dextrose to supply glucose
needs
Propacil or mmethimazole to impede
formation of thyroid hormone
Hydrocortisone – adrenal insufficency
Beta blockers (inderal) for cardiac symptoms
Endocrine
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Pharmacologic management
◦ Medications that block the catecholamine effect
 B blockers or Ca channel blockers
◦ Medications that block thyroid synthesis
◦ Medications that block release of thyroid hormone
Copyright © 2014, 2010 by
Mosby, an imprint of Elsevier Inc.
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Med Administration
Rehydrate and correct metabolic
derangements
Reduce fever
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Hypothermia blanket
Tylenol
Cool baths
Hydorcortisone
Endocrine
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Endocrine
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Several types: toxic
Non-toxic
Most common type of goiter is associated
with _______ deficency.
Treatment balance iodine needs
Endocrine
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Partial or complete
Pre-operative teaching◦ Support of the head and neck with movement to
prevent stress on the incision
◦ Large bulky dressing on the incisional area
◦ Pain control
◦ Report airway obstruction
Endocrine
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Airway maintenance
◦ Assessment performed
◦ Desired outcome
◦ Equipment to have available at the bedside
Endocrine
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Dressing check at each patient contact, often
will have a hemovac
What will the patient feel if they are bleeding
into the incision site?
Endocrine
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Patient advised to talk as little as possible
But care provider should report changes in
the voice. Abnormalities may indicate
laryngeal injury
Endocrine
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Turning with support of the ______ and _____
Position of comfort:
Pain medications
Oxygen
IV fluids
Endocrine
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Calcium levels are _________
S/S-bone decalcification, renal calculi
More common in women than men
Endocrine
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Increased parathormone = increased calcium
absorption from the kidney, intestine, and
bones, raising the blood calcium level
The opposite effect occurs with the
phosphorus levels which decrease
reciprocally
Endocrine
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Apathy fatigue
Muscular weakness
Skeletal pain, tenderness
Pathological fractures
Hypertension
Cardiac dysrthymias
Nausea, vomiting,
Constipation
Psychological
manifestations
Endocrine
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Large volumes of
IV fluids
Diuretic to
promote _____
excretion
Calcitionin and
corticosteroids to
increase calcium
deposition back
into the bones
Phosphate therapy
to inhibit calcium
production by the
glands
Endocrine
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Fluid intake ________ ml
__________ juice
Report symptoms of flu or other illness that
would precipitate dehydration
Endocrine
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Walking/rocking chair
What is the purpose and importance of
weight bearing exercise in the patient with
this diagnosis?
Endocrine
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