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49 Cards in this Set
- Front
- Back
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THYROID GLAND
contains two types of cells |
follicular cells
Parafollicular cells |
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follicular cells (thyroid)
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that produce thyroxine (T4) & triiodothyronine (T3)
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Parafollicular cells
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secrete calcitonin
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calcitonin
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lowers serum calcium levels in response to increased plasma levels of calcium
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Together, thyroxine (T4) & triiodothyronine (T3)
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Are amino acids that contain Iodine molecules. T4 contains 4 and T3 contains 3
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thyroid gland can store a large amount of this hormone
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calcitonin (for months)
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Thyroid Hormone Effects
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Increase rate protein, fat and cho catabolism. Affects most body tissues.
Regulates metabolic rate all cells. Regulates body heat production. Insulin antagonist. Maintains GH. CNS development. Maintains cardiac rate, force, CO. Maintains secretions GI tract. RBC production. Regulates SNS activity (catecholamine). |
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Regulation of Thyroid Function
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Regulated by hypothalamus pituitary-thyroid feedback mechanism.
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hypothalamus pituitary-thyroid feedback mechanism.
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The hypothalamus senses a decreased level thyroid hormone blood and stimulates release TRH (thyroid releasing hormone) to go to anterior pituitary which releases TSH causing follicular cells to release hormones. Also stimulated with cold and stress.
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Typical symptoms of hypothyroidism include
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weight gain, fatigue, decreased energy, brittle nails, dry skin, cold intolerance, hair loss, constipation, and numbness and tingling.
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Early signs of hypothyroidism
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Extreme fatigue & weight gain.
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Metabolic s/s of hypothyroidism
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decreased body temperature; cold tolerance. Weight gain without food intake increased. Hypoglycemia.
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cardiovascular s/s of hypothyroidism
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hypotension, decreased cardiac output, decreased
RBC production (anemia), decreased activity tolerance. Bradycardia. Dysarrhythmias. Elevated serum cholesterol. |
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Pulmonary s/s of hypothyroidism
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dyspnea, pleural effusion
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GI s/s of hypothyroidism
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constipation, abdominal distention (decreased motility)
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Integumentary s/s of hypothyroidism
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ivory or yellow tint (carotine production), skin thick; accumulation of mucopolysaccharides in subq tissues of facial and pre-tibial areas and is called myxedema. Non-pitting edema. Also dry skin & hair loss.
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Menstrual disturbances with hypothyroidism
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decreased ovulation, irregular and heavy menses. Decreased libido and erectile dysfunction.
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Neurologic s/s of hypothyroidism
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increased sleep, lethargy, somnolence, confusion, hearing loss, impaired memory, increased sensitivity to sedatives
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Musculoskeletal s/s of hypothyroidism
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muscle aches and weakness
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Endocrine s/s of hypothyroidism
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goiter
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Normal T3
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80-200 ng/dl
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Normal T4
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5-12 mcg/dl
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TSH (thyroid-stimulating hormone)
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TSH regulates the secretion of T3 and T4; circulating level of T3 and T4 serve as a feedback mechanism to turn off TSH.
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T3 and T4 decreased-stimulates
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TSH to increase production of T3 & T4.
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TSH elevated
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Thyroid stimulating hormone; regulates secretion of T3 & T4 and serves as feedback to turn off T3 & T4
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Appropriate Nursing Diagnoses for a client with Hypothyroidism would probably include which of the following?
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Activity intolerance related to fatigue associated with the disorder.
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LEVOTHYROXINE (SYNTHROID) Patient teaching needs:
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take empty stomach-1 hour ac/2 hours pc
Do not stop without consulting MD Report... Chest pain, SOB, palpitations Pulse > 100 Food and Drug interactions Do not substitute |
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Thyroid replacement
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is for life to restore a normal metabolic state by replacing missing hormone.
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Synthroid (Levothyroxine) (T4) is preferred medication
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Dosage based on TSH levels and client’s response. Maintenance .1-.4 mg/day. Has a half-life of 6-7 days. Gradually increase every 2-3 weeks to maintenance levels.
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Levothyroxine medication interactions
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anticoagulants, iron supplements, fiber, calcium and MVI.
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hypothyroidism teaching issues
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Maintain well-balanced diet; fluids and fiber and low calorie & activity to prevent constipation: Normal amount salt. Treat constipation.
Moderate exercise. Adequate rest. Good skin care-lubricate, sufficient clothing. Prevent breakdown. Lifelong hormone replacement therapy. Monitor pulse. Teach how to take. Avoid OTC meds because of interactions |
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Before administering levothyroxine (Synthroid) to a client, the nurse should:
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Check the pulse because Tachycardia is a side effect
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MYXEDEMA COMA s/s
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Extreme form of hypothyroidism
Hypotension Bradycardia Hypothermia Coma Respiratory depression Hypoglycemia |
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MYXEDEMA COMA be precipitated by
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rapid withdrawal of thyroid medication; infection in undiagnosed hypothyroidism; acute illness, stress
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MYXEDEMA COMA is
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Rare but very serious.
Prevention: Take medication as directed. Rest of life. Avoid stressful events; infection; trauma; surgery. Wear ID. |
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What are the Nursing Responses for MYXEDEMA COMA?
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ABC: Maintaining vitals, acid-base balance, C-V status, body temperature and thyroid hormone levels.
Airway patency with ventilatory support; respiratory drive is depressed. IV hormone replacement; Levothyroxine IV IV fluids to support circulation; replace glucose Continuous EKG monitoring; BP monitoring; Hourly I/O Administer IV Corticosteroids Treat underlying cause (usually infection) Wrap in blankets; do not use warming blanket as causes peripheral vasodilatation and increases s/s Avoid sedation. Continue to monitor very closely. Recovery depends on promptness of treatment. High mortality rate. |
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A Client is admitted to the emergency department and a diagnosis of myxedema coma is made. What nursing actions should the nurse prepare to carry out initially?
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The client is in need of IV levothyroxine need to be kept warm, have fluids replaced but the initial nursing action is to maintain an airway
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Hyperglycemia teaching
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Re-think what was eaten
Insulin at the correct time Adhere to diet. Good hygiene Sick-day rules Monitor blood glucose levels more frequently Contact MD if levels high Wear ID |
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Hypoglycemia teaching
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Insulin at correct time
Eat at proper times Compensation for exercise/activity Recognize s/s immediately Carry simple CHO Monitor blood glucose levels Avoid alcohol ; potentiates hypoglycemic effects if insulin and other agents |
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A client with Type I DM comes to the ED with deep respirations, lethargy and extreme thirst. The nurse realizes that this client may be demonstrating
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These are symptoms of DKA. The reason that this is occurring is possible because of an infection such as the flu. The client with hypercapnea will be lethargic but have diminished respirations. Insulin shock is hypoglycemia.
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What do you think could have precipitated DKA
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an absence or inadequate amount of insulin. The underlying reason is severe insulin deficiency. Usually only occurs with Type I DM. It can occur when there is too little insulin with increased caloric intake, physical or emotional stress, or infection
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3 main features of DKA
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Hyperglycemia, Dehydration and electrolyte loss, and Acidosis. Blood glucose may vary from 300-800, usually > 400.
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Emergency Care:
What needs to be assessed |
Kussmaul’s respiration's: Respiratory system compensates for metabolic acidosis. Metabolic acidosis from acidic lowering of ketones.
Foul (fruity) breath, altered LOC, flushed skin, dry mucous membranes, hypotension, tachycardia S/S dehydration, hypovolemic shock, fluid and e-lyte loss (Na, Phos, K, Cl, Bicarb) |
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Goals of treatment for diabetic ketoacidosis are
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rehydration, restoration of electrolyte balance, and eduction of blood glucose levels.
Biggest complication is shock. |
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CALLS FOR NURSING DKA
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Risk for injury: r/t e-lyte imbalances especially hypokalemia. Explain how potassium drops when acidosis corrected.
Altered tissue perfusion: r/t fluid and e-lyte balance Risk for decreased cardiac output: r/t dehydration |
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Regular insulin order for DKA
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followed by a drip it may be mixed this way: Insulin drip 100u Humulin R in 100 cc NS. Infuse at 6 u/hr for blood glucose > 250
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IMMEDIATE ORDERS for DKA
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Regular insulin IVP followed by
Insulin drip 100u Humulin R in 100 ml NS at 6 u/hr for blood glucose > 250 Hourly blood glucose Repeat e-lytes 2 hr 1000 0.9% NS wide open (500-1000ml/hour) |
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additional orders for DKA
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Fluid replacement: Fluids are administered intravenously, usually at a fast rate (200-500 ml/hr). Initially NS administered. May need Potassium or phosphate replacement.
Hourly I/O Foley Frequent assessments: Hourly I/O. Foley. Watch for fluid overload in the elderly. May need bicarb if pH <7.2. Judicious use of bicarb. Assess: blood sugar hourly, VS, LOC, I/O. Also assess underlying condition that may have precipitated this. |
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When teaching the client how to manage her diabetes during episodes of minor illness, the nurse should include what measuresmeasures in the teaching plan?
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Increase the frequency of blood or urine glucose testing
This is the most important sick day rule |
