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40 Cards in this Set
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•___ aka __2___ isan acute, severe, and rare condition that occurs when excessive amounts ofthyroid hormones are released into the circulation. |
Thyrotoxicosis (also called thyrotoxic crisis or thyroid storm) |
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•Thyrotoxicosisis thought to result from ___ like ___3___ in apatient with preexisting hyperthyroidism, either diagnosed or undiagnosed. |
stressors (e.g., infection, trauma, surgery) |
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____ a clinical syndrome in which there is a sustained increase in the synthesis and release of thyroid hormones by the thyroid gland. |
hyperthyroidism |
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_____ a hypermetabolic state caused by excessive circulating levels of T4, T3, or both. |
thyrotoxicosis |
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Thyrotoxicosis Manifestations 12 •Inthyrotoxicosis, all the symptoms of hyperthyroidism are prominent and severe. |
•Tachycardia (up to 200),heart failure•Shock•Hyperthermia (up to 105.3 - hard on brain) •Restlessness,irritability•Seizures•Abdominalpain, vomiting, diarrhea•Delirium,coma |
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Graves disease manifestations - a lot |
• Increased cardiac output • Bounding, rapid pulse Hungry, thirst all the time, weight loss Nervous, restless, talk fast • Intolerance to heat exophthalmos : bulging "bug eyes" Thin hair - patchy Everything is running fast in a hyper metabolic state throughout the body. |
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Condition that occurs in a patient with existing graves disease/ hyperthyroidism in which there is a excessive amount of thyroid hormones in circulation. An individual that just received a thyroidectomy, a large amount of hormones are released during manipulation of the gland |
thyroid storm |
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Thyrotoxicosis •Treatmentis aimed at ___ circulating thyroid hormone levels and the clinicalmanifestations with appropriate drug therapy. •Supportivetherapy is directed at __4__. |
reducing managing respiratory distress, fever reduction, fluid replacement, and elimination or management of the initiating stressor(s) |
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•Thetwo primary laboratory findings used to confirm the diagnosis ofhyperthyroidism are ___ •TotalT3 and T4 levels may also be assessed, butthey are not as definitive. |
decreased TSH levels and elevated free thyroxine (free T4) levels.
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•TheRAIU test is used to differentiate Graves’ disease from other forms ofthyroiditis. •Thepatient with Graves’disease will show a diffuse, homogeneous uptake of 35% to 95%, whereas thepatient with thyroiditis will show an uptake of less than 2%. •Theperson with a nodular goiter will have an uptake in the high normal range. |
nursing |
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•Thegoal of management of hyperthyroidism is directed toward blocking the adverseeffects of excessive thyroid hormone, suppressing oversecretion ofthyroid hormone, and preventing complications. |
nursing |
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Thyrotoxicosis •Thereare several treatment options, including 3 |
antithyroid medications, radioactive iodine therapy, and surgical intervention. |
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Radioactive Iodine Therapy. To limit radiation exposure to others, instruct the patient receiving RAI on the importance of home precautions, including (1) using private toilet facilities if possible and flushing two or three times after each use; (2) separately laundering towels, bed linens, and clothes daily at home; (3) not preparing food for others that requires prolonged handling with bare hands; and (4) avoiding being close to pregnant women or children for 7 days after therapy. |
nursing |
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•These drugs are useful in the treatment of thyrotoxicstates, but they are not considered curative. |
nursing |
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•Thefirst-line antithyroiddrugs are __2__ They work by: ____ •Improvement in ____ •Good results in___ •Therapy for ___ |
propylthiouracil (PTU) and methimazole (Tapazole). •Inhibit synthesis of thyroid hormone 1 to 2 weeks, 4 to 8 weeks, 6 to 15 months |
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•___ is also considered first line in thyrotoxiccrisis as it also blocks the peripheral conversion of T4 to T3. |
PTU |
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•Iodineis available in the form of saturated solution of ___2___ works by: ___2___ •Maximal effect within ___ •Used before surgery and to treat crisis |
potassium iodine (SSKI) and Lugol’s solution. •Inhibit synthesis of T3 and T4and block their release into circulation •Decreases vascularity of thyroid gland 1 to 2 weeks |
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____: •Symptomatic relief of thyrotoxicosis•Block effects of sympathetic nervousstimulation examples: __2__ |
β-Adrenergic Blockers •Propranolol (Inderal) •Atenolol (Tenormin) |
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thyrotoxic crisis •___:Treatment of choice in nonpregnantadults Method: ___ •Delayed response of__2__ •Treated with antithyroiddrugs and β-blockerbefore and during first 3 months of this |
RadioactiveIodine Therapy (RAI) •Damages or destroys thyroid tissue 2 to 3 months |
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RadioactiveIodine Therapy (RAI) •Given on outpatient basis •Patient teaching: Oralcare for __2__ / ____ precautions •Symptomsof ___ |
thyroiditis/parotiditis Radiation hypothyroidism |
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•Instructthe patient that radiation thyroiditis and parotiditis arepossible and may cause dryness and irritation of the mouth and throat. •Reliefmay be obtained with frequent sips of water, ice chips, or the use of asalt-and-soda gargle three or four times per day. •Thisgargle is made by dissolving 1 teaspoon of salt and 1 teaspoon of baking sodain 2 cups of warm water. •Thediscomfort should subside in 3 to 4 days.•Amixture of antacid (Mylanta or Maalox), diphenhydramine (Benadryl), and viscouslidocaine canbe used to swish and spit, allowing for better patient comfort during eating. |
nursing |
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•Patientsare asked to follow some radiation precautions after treatment in order tolimit radiation exposure to others. Instructthe patient receiving RAI on the importance of home precautions, including thefollowing:__4__ |
•Use private toilet facilities, if possible, and flush two to three times after each use. •Separately launder towels, bed linens, and clothes daily at home. •Do not prepare food for others that requires prolonged handling with bare hands. •Avoid being close to pregnant women and children for 7 days. |
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thyrotoxic crisis SurgicalTherapy Indications 4 •More rapid reduction in T3 and T4levels |
•Largegoiter causing tracheal compression•Unresponsiveto antithyroidtherapy•Thyroidcancer•Nota candidate for RAI |
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•Asubtotal thyroidectomy is often the preferred surgical procedure and involvesthe removal of a significant portion___of the thyroid gland. •Canbe done ___ |
(90%) endoscopically |
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thyrotoxic crisisNutritionalTherapy •High-calorie diet (____cal/day) - ___ full meals/day with snacks in between / Proteinintake: ___ •Avoid __3__ |
4000 to 5000 Six 1 to 2 g/kg highly seasoned and high-fiber foods, caffeine |
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Obtainthe following important health information from the patient:•Pasthealth history:preexisting goiter; recent infection or trauma; immigration fromiodine-deficient area; autoimmune disease •Medications: useof thyroid hormones, herbal therapies that may contain thyroid hormone Health perception–health management: positivefamily history of thyroid or autoimmune disorders Nutritional-metabolic:iodine intake; weight loss; increased appetite, thirst; nausea, vomiting Elimination: diarrhea; polyuria; sweatingActivity-exercise: dyspneaon exertion; palpitations; muscle weakness, fatigue Sleep-rest: insomnia Cognitive-perceptual:Chest pain; nervousness; heat intolerance; pruritus Sexuality-reproductive: decreasedlibido; impotence; gynecomastia (inmen); amenorrhea (in women) Coping–stress tolerance: emotionallability,irritability, restlessness, personality changes, delirium General observation:agitation, rapid speech and body movements; anxiety, restlessness,hyperthermia, enlarged or nodular thyroid gland Eyes: exophthalmos, eyelid retraction;infrequent blinking Integumentary:warm, diaphoretic, velvety skin; thin, loose nails; fine, silky hair and hairloss; palmar erythema; clubbing; white pigmentation of skin (vitiligo);diffuse edema of legs and feet Respiratory:tachypnea, dyspnea on exertion Cardiovascular:tachycardia, bounding pulse, systolic murmurs, dysrhythmias, hypertension,bruit over the thyroid gland Gastrointestinal:increased bowel sounds; increased appetite, diarrhea, weight loss, hepatosplenomegaly Neurologic: hyperreflexia;diplopia; fine tremors of hands, tongue, eyelids Musculoskeletal:muscle wasting Reproductive:menstrual irregularities, infertility; impotence, gynecomastia inmen |
nursing |
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Lab findings in thyrotoxicosis 6 |
↑ T3, ↑ T4; ↑ T3 resin uptake; ↓ or undetectable TSH; chest x-ray showing enlarged heart; ECG findings of tachycardia, atrial fibrillation |
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•Acutethyrotoxicosis is a systemic syndrome that necessitates aggressive treatment,often in an intensive care unit. •Providesupportive therapy to the patient. This includes monitoring for cardiacdysrhythmias and decompensation,ensuring adequate oxygenation, and administering IV fluids to replace fluid andelectrolyte losses. This is especially important in a patient who experiencesfluid losses as a result of vomiting and diarrhea. |
nursing |
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•Ensuringadequate rest may be a challenge because of the patient’sirritability and restlessness.•Providea calm, quiet room because increased metabolism and sensitivity of thesympathetic nervous system causes sleep disturbances. •Otherinterventions may include placing the patient in a cool room away from very illpatients and noisy, high-traffic areas. •Uselight bed coverings and changing the linen frequently if the patient isdiaphoretic.•Encourageand assist with exercise involving large muscle groups (tremors can interferewith small-muscle coordination) to allow the release of nervous tension andrestlessness. •It isimportant to establish a supportive, trusting relationship to help the patientwho is irritable, restless, and anxious to cope. |
nursing |
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•If exophthalmos present, •Apply___ to relieve eye discomfort •___ restriction and ___ head of bed •Darkglasses •___ if needed for sleep •___ of intraocular muscles |
artificial tears Salt elevate Tape eyelids closed ROM |
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NursingImplementationPreoperativeCare •Administermedications to achieve euthyroidism•Administeriodine to ↓vascularity•Assessfor signs of iodine toxicity•Patientteaching•Comfort and safety measures•Leg exercises, head support, neck ROM•Routine postoperative care |
nursing |
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Thyroidectomy Postoperative Care •Monitor for complications 5 What needs to be at bedside___ |
•Hypocalcemia•Hemorrhage•Laryngealnerve damage•Thyrotoxic crisis•Infection Calcium gluconate |
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Thyroidectomy PostoperativeCare •Maintain patent airway - __3__ in patient’s room •Monitorfor ____ •____ readily available |
Oxygen, suction equipment, tracheostomy tray laryngeal stridor IV calcium |
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For test •Laryngealstridor (harsh, vibratory sound) may occur during inspiration and expiration asa result of edema of the laryngeal nerve. Laryngeal stridor may also be relatedto tetany,which occurs if the parathyroid glands are removed or damaged during surgery,leading to hypocalcemia. •Totreat tetany, IVcalcium salts (e.g., calcium gluconate, calcium gluceptate)should be available. |
nursing |
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ThyroidectomyPostoperative •Assess every ___ hours during first 24hours for signs of hemorrhage or tracheal compression•___ position•Support head with ___ •Avoid __2__ Ifpostoperative recovery is uneventful, the patient is ambulated ___ |
2 Semi-Fowler’s pillows neck flexion and tension on suture line within hours after surgery |
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•Signs of hypocalcemia___2__ |
•Difficulty speaking and hoarseness •Trousseau’s and Chvostek’s signs |
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To elicit the sign, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct. |
Trousseau’s sign |
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reaction to the stimulation of the facial nerve. When the facial nerve is tapped at the angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of the face will contract momentarily (typically a twitch of the nose or lips) because of hypocalcemia |
Chvostek’s sign |
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Discharge Teaching for thyroidectomy
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•Discharge teaching•Monitorhormone balance periodically•Decreasecaloric intake •Adequatebut not excessive iodine intake•Regularexercise•Avoid↑ environmental temperature |
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Ifa complete thyroidectomy has been performed, instruct the patient about theneed for ___ like ___ |
lifelong thyroid hormone replacement. synthroid |
