Med Surge - Test 3 P. 1-16 Endocrine

Front 1

The thyroid gland produces 2 hormones.. what are they?

Back 1

Thyroid hormones (T3 and T4)

Calcitonin

Front 2

Thyroid gland

Triiodothyronine (T3) and thyroxine (T4) = thyroid hormones.
-what do they control?

Back 2

-both hormones increase metabolism, which causes an increase in oxygen use and heart production in all tissues.

Front 3

The hypothalamus secretes thyrotropin-releasing hormone (TRH). TRH triggers the release of what? from where?

Back 3

the anterior pituitary gland to secrete thyroid-stimulating hormone (TSH) which stimulates the thyroid gland to make and release thyroid hormones.


If the thyroid hormone levels are high, TSH release is inhibited. If thyroid hormone levels are low, TSH release is increased

Front 4

Thyroid gland
-Calcitonin does what?

Back 4

Calcitonin lowers serum calcium and serum phosphorus levels by reducing bone reabsorption (breakdown)


The serum calcium level determines calcitonin secretion. Lower serum calcium levels inhibit the release of calcitonin. Elevated serum calcium levels increase its secretion

Front 5

What 2 things in one's diet is needed to produce thyroid hormones (T3 and T4)

Back 5

intake of protein and iodine

Front 6

Hyperthyroidism

A metabolic imbalance that results from what?.

Back 6

excessive thyroid hormone (T3 and T4) secretion.

Front 7

Hyperthyroidism

-most common form is:

-which is an increase in what?

Back 7

“Grave’s Disease” (aka: Thyrotoxicosis),


-increases T4 production

Front 8

Hyperthyroidism

Graves diseae
-an increase in T4 production causes multisystem changes, such as: (3 major ones)

Back 8

enlargement of the thyroid gland (goiter),

exophthalmos (abnormal protrusion of the eyes,

pretibial myxedema (dry waxy swelling of the front surfaces of the lower legs)

Front 9

Hyperthyroidism

Graves disease
-Diagnosis: why would antibodies be present?

Back 9

graves disease is an autoimmune disorder in which antibodies are made and attach to the thyroid stimulating hormone (TSH) receptor sites on the thyroid tissue.

-When these antibodies bind to the thyroid gland, the gland increases in size and overproduces thyroid hormones.

Front 10

Graves Disease/Hyperthyroidism

What is pretibial myxedema look like

Back 10

dry, waxy, swollen skin

Front 11

Why could a thyroid storm occur?

Back 11

when hyperthyroidism is poorly controlled or when the pt is severely stressed.

Front 12

Thyroid storm

what are some triggers?

Back 12

stressors such as:
- trauma,
-infection,
-DKA,
-pregnancy,
-exposure to iodine,
-radioactive iodine therapy

Front 13

Thyroid storm

-what causes the s/s?

Back 13

excessive thyroid hormone release dramatically increases metabolic rate.

Front 14

Thyroid storm


S/S?

Back 14

-Hyperthermia – up to 106 degrees F

-Severe systopilc hypertension b/c of vasoconstriction

-Delirium (confusion)

-N/V, abdominal pain, tremors, anxiety is high

-Severe tachycardia can lead to cardiac arrhythmias

-Dyspnea on exertion & even at rest!

Front 15

Hyperthyroidism
Lab assessment

-TSH:
-Thyroid hormones (T3 & T4)

Back 15

TSH: low





T3/T4: high

Front 16

Hyperthyroidism
Lab assessment

What will an idodine thyroid scan show:

Back 16

if the cause is a single nodule or the whole gland

Front 17

Hyperthyroidism
Lab assessment


What does a thyroid scan show?

Back 17

evaluates the position, size, and functioning of the thyroid gland.

Front 18

Interventions–Hyperthyroidism

-the goals of medical management are to decrease the effect of thyroid hormones on what? what else do we want to reduce?

Back 18

cardiac function and to reduce thyroid hormone secretion.

Front 19

Interventions–Hyperthyroidism


initial treatment is what?

Back 19

Drug therapy with antithyroid drugs

Front 20

Interventions–Hyperthyroidism


Drug therapy with antithyroid drugs. The preferred drugs are what?

-what are 2 examples?

Back 20

-The preferred drugs are the thionamides

-PTU (propylthiouracil), & Tapazole (methimazole)

Front 21

Interventions–Hyperthyroidism


Drug therapy: What do antithyroid drugs do?

Back 21

block thyroid hormone production by preventing iodide binding in the thyroid gland.

–-PTU also prevents T4 from being converted to the more powerful T3 in the tissues

Front 22

Interventions–Hyperthyroidism

Iodine preparations may be used for what?



what does iodine do to the thyroid gland?

Back 22

short term therapy before surgery.


They decrease blood flow through the thyroid gland, reducing the production and release of the thyroid hormone.

Front 23

Interventions–Hyperthyroidism

Drug therapy: besides antithyroid drugs, what other class of drugs can you use?



what do these drugs do?

Back 23

beta adrenergic blocking drugs, such as propranolol (Inderal), used for:







supportive theray

These drugs relieve anxiety, diaphoresis, tachycardia, & palpitations but do NOT inhibit thyroid hormone production.

Front 24

Interventions–Hyperthyroidism

drug therapy: Lithium

what does it do?

Back 24

inhibits thyroid hormone release but it’s use is limited because of SE such as depression diabetes insipdius, tremors, nausea and vomiting.

-It can be used for a pt who cannot tolerate other antithyroid drugs

Front 25

Radioactive Iodine Therapy (RAI)

-who is this contraindicated in

Back 25

-Contraindicated in pregnant women b/c it crosses the placenta and can damage the fetal thyroid gland.

Front 26

Radioactive Iodine Therapy (RAI)

What does this do to the thyroid gland?


when may the patient see relief?

Back 26

Thyroid gland picks up the RAI & some cells that produce the thyroid hormone are destroyed by the local radiation.

Since the thyroid gland stores thyroid hormone, the patient may not see complete symptom relief until 6-8 weeks after treatment.

Front 27

Radioactive Iodine Therapy (RAI)

May need a second or third dose! What is the negative effect does this therapy have?

Back 27

Some patients may become hypothyroid which then require lifelong thyroid hormone replacement.

Front 28

Radioactive Iodine Therapy (RAI)


Radioactive iodine kills. It burns the thyroid gland up and kill it. the gland dies and the pituitary gland doesn’t know it died so it stimulated TSH production and numbers rise.

Now we have hypothyroid and need thyroid supplement. Person is on lifelong treatment

Back 28

:(

Front 29

Antithyrodi drugs and RAI therapy are now the most common treatments for patients with hyperthyroidism.
what may be needed for patients who have a larger goiter or a secreting tumor causing tracheal or esophageal compression or who do not have a good response to antithyroid drugs?

Back 29

Thyroidectomy which is the removal of all or part of the thyroid tissue decreases the production of the thyroid hormones.



If it’s all removed, must take life-long thyroid replacements.

Front 30

Thyroidectomy

-Pre-Op treatment:
what is the patient treated with?



what is used for treatment? (2)

Back 30

the patient is treated with drug therapy first to have near normal thyroid function (euthyroid) before thyroid surgery.











This state is achieved with with antithyroid drugs that decrease the secretion of thyroid hormones.

IN addition, iodine preparations are used to decrease thyroid size and vascularity, thereby reducing the risk for hemorrhage and the potential for thyroid storm during surgery

Front 31

Thyroidectomy


Post-Op care:
-monitoring the pt for complications is the most important nursing action after thyroid surgery


-how often should VS be monitored?


-assess respiratory status for what?

Back 31

- monitor vitals signs every 15 minutes until the patient is stable and then every 30 minutes



-cough and deep breathe every 30 min-1hr. assess for stridors

Front 32

Thyroidectomy

-support head and avoid tension on sutures...use


-assess the dressing and monitor for:

Back 32

pillows to support head and neck


hemorrhage

Front 33

Thyroidectomy

-monitor their voice change..why?

Back 33

laryngeal nerve damaged could happen which results in hoarseness and a weak voice

Front 34

Thyroidectomy

-thyroid surgery can cause what: 3 things

Back 34

-hemorrhage,

respiratory distress,

parathyroid gland injury

Front 35

Thyroidectomy

Accidential removal of the parathyroid gland causes injury.
-what do you have to watch for:

Back 35

resulting in hypocalcemia and tetany


tetany is hyperexcitablity of nerves and muscles, or twitching secondary to accidental removal of parathyroids

Front 36

Hypothyroidism
-a state of decreased metabolism resulting from what?

Back 36

-low levels of Thyroid hormone

Front 37

Hypothyroidism

When the production of thyroid hormones is too low or absent, the blood levels of TH are very low and the pt has a decreased metabolic state. This lowered metabolism causes what??

Back 37

the anterior pituitary gland to make stimulatory hormones such as TSH in an attempt to trigger hormone release for the poorly responsive thyroid gland.



WHAT DOES THE TSH BIND TOO?



-The TSH binds to thyroid cells and causes the thyroid gland to enlarge, forming a goiter, although thyroid hormone production does not increase

Front 38

Hypothyroidism

-Can be caused by: (4)

Back 38

autoimmune thyroiditis,

thyroidectomy,

radioactive iodine therapy,

antithyroid meds

Front 39

Hypothyroidism

can occur secondary to what?

Back 39

a tumor

Front 40

Hypothyroidism

-Low metabolic rate causes the cellular energy to be decreased and metabolites do what in the cells?

Back 40

-build up inside the cells. WHICH CAUSES WHAT?



-which increases the mucous and water, forms ceullular edema, and changes organ texture. The edema is mucinous (called myxedema).

This edema changes the pts appearance. WHAT KIND OF EDEMA FORMS EVERYWHERE?

nonpitting edema forms everywhere.

Front 41

Myxedema coma is a rare but seriosu complications of what?

Back 41

untreated or poorly treated hypothyroidism.

The decreased metabolism causes what to the heart????


heart to become flabby and the result is decreased cardiac output, perfusion to the brain and other vital organs.



This decreased perfusion makes the already slowed cellular metabolism worse, resulting in what????



tissue and organ failure.

Front 42

Hypothyroidism
-Lab diagnostics

TSH:
T3 & T4:


thyroid antibodies:

Back 42

TSH is elevated


t3 & t4 are below normal


may be present or elevated

Front 43

Interventions for hypothyroidism

observe and record the rate and depth of _______. Measure oxygen saturation by pulse oximetry

Back 43

respirations

Front 44

Interventions for hypothyroidism



monitor BP, HR and rhythm,


observe closely for s/s of shock such as hypotension, decreasing urine output, and changes in mental status

Back 44

:(

Front 45

Interventions for hypothyroidism

patient will need lifelong treatment of thyroid hormone replacement

-administer what kind of med?

Back 45

Synthroid (Levothyroxin) -------- increasing T3 and T4

Front 46

Interventions for hypothyroidism

what 2 medications are these patient's extra sensitive too?

Back 46

narcotics & sedatives



WHAT CAN THEY DO???








(can make respiratory difficulties worse)

Front 47

Interventions for hypothyroidism

-administer what??



-try to relieve what???


-what do they have a hard time doing??

Back 47

-Administer fluids cautiously.


-Relieve constipation (increase fiber and fluid intake)


-Hard time losing weight, they need to exercise



-Monitor temperature, resp, assistance prn




-Institute infection control methods

Front 48

Interventions for hypothyroidism


Teaching: the most important education need is about what??




instruct the patient to not take what?

Back 48

hormone replacement therapy and its SE.


Emphasize the need for lifelong drugs and teach the patient to wear a medical alert bracelet.



Instruct the patient to not take any over the counter drugs.

Front 49

Hashimoto's Thyroiditis is also known as

Back 49

(Chronic Thyroditis)

-Thyroditis is an inflammation of the thyroid gland.

Front 50

-Most common type of hypothyroidism is:

Back 50

Hashimoto's Thyroiditis

Front 51

Hashimoto's Thyroiditis is an autoimmune disorder that is usually triggered by what

Back 51

a bacterial or viral infection

Front 52

Hashimoto's Thyroiditis

TSH:
T3 & T4:

Back 52

TSH: increased


t3 and t4: low

-When large amounts of the gland are destroyed, serum thyroid hormone levels are low and secretion of thyroid-stimulating hormone (TSH) is increased

Front 53

Hashimoto's Thyroiditis


Manifestations include: 2

Back 53

dysphagia and painless enlargement of the gland

Front 54

During the course of what disease, do the cells of the thyroid becomes inefficient in converting iodine into thyroid hormone and "compensates" by enlarging

Back 54

Hashimoto's Thyroiditis

Front 55

Hashimoto's Thyroiditis


The pt is given what?

Back 55

thyroid hormone to prevent hypothyroidism and suppress TSH secretion, which decreases the size of the thyroid gland.

Front 56

General Assessment of Patients with Endocrine Disorders

-Physical – inspect for abnormalities of facial structure

Back 56

features and expression, i.e., prominent forehead or jaw, round or puffy face, dull or flat expression, exophthalmos

Front 57

General Assessment of Patients with Endocrine Disorders

assess skin for:

Back 57

Vitiligo – patchy areas of depigmentation (pigment loss with increased pigmentation at the edges)

Front 58

General Assessment of Patients with Endocrine Disorders


Abnormal chest size & symmetry, truncal obesity, supraclavicular fat pads, “Buffalo Hump” may indicate __________excess

Back 58

adrenocortical

Front 59

General Assessment of Patients with Endocrine Disorders


inspect for striae (reddish purple stretch marks) often seen with ____________ excess

Back 59

adrencortical

Front 60

Parathyroid Gland is located where:

Back 60

-These 4 small glands are located posterior to the Thyroid Gland

Front 61

Parathyroid Gland: secretes what hormone?

Back 61

-Secretes parathyroid hormone (PTH)

Front 62

Parathyroid Gland
-what 2 electrolyte levels does this control?

Back 62

-Controls Calcium & Phosphorus levels
by acting on bone, kidney, and the intestinal tract. The bone is the major storage site of calcium.

Front 63

Parathyroid Gland
-how does PTH increase serum calcium?

Back 63

PTH increases bone resorption (bone release of calcium into the blood from bone storage sites), thus increasing serum calcium.

Front 64

Parathyroid Gland

In the kidneys, how does PTH absorrb calcium?

Back 64

activates vitamin D, which increases the absorption of calcium and phosphorus from the intestines.

Front 65

Parathyroid Gland

In the kidney tubules, how does PTH absorb calcium?

Back 65

In the kidney tubules, PTH allows calcium to be reabsorbed and put back into the blood

Front 66

Parathyroid Gland


what is the major controlling factor of PTH secretion?

Back 66

Serum calcium level is the major controlling factor of PTH secretion.




Secretion decreases when serum calcium levels are high, and it increases when serum calcium levels are low.

Front 67

Hormone Deficiency

Growth hormone

children:

Back 67

Growth retardation, short stature, increased adiposity

Front 68

Hormone Deficiency

Growth hormone

adults

Back 68

Reduced exercise capacity, impaired psychological well-being, increased cardiovascular risk, increased central obesity, reduced lean body mass

Front 69

Hormone Deficiency


Prolactin

Back 69

failure of lactation

Front 70

Hormone Deficiency

Antidiuretic hormone

Back 70

Polyuria, polydipsia including nocturnal