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70 Cards in this Set

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The thyroid gland produces 2 hormones.. what are they?
Thyroid hormones (T3 and T4)

Calcitonin
Thyroid gland

Triiodothyronine (T3) and thyroxine (T4) = thyroid hormones.
-what do they control?
-both hormones increase metabolism, which causes an increase in oxygen use and heart production in all tissues.
The hypothalamus secretes thyrotropin-releasing hormone (TRH). TRH triggers the release of what? from where?
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
Thyroid gland
-Calcitonin does what?
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
What 2 things in one's diet is needed to produce thyroid hormones (T3 and T4)
intake of protein and iodine
Hyperthyroidism

A metabolic imbalance that results from what?.
excessive thyroid hormone (T3 and T4) secretion.
Hyperthyroidism

-most common form is:

-which is an increase in what?
“Grave’s Disease” (aka: Thyrotoxicosis),


-increases T4 production
Hyperthyroidism

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

Graves disease
-Diagnosis: why would antibodies be present?
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.
Graves Disease/Hyperthyroidism

What is pretibial myxedema look like
dry, waxy, swollen skin
Why could a thyroid storm occur?
when hyperthyroidism is poorly controlled or when the pt is severely stressed.
Thyroid storm

what are some triggers?
stressors such as:
- trauma,
-infection,
-DKA,
-pregnancy,
-exposure to iodine,
-radioactive iodine therapy
Thyroid storm

-what causes the s/s?
excessive thyroid hormone release dramatically increases metabolic rate.
Thyroid storm


S/S?
-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!
Hyperthyroidism
Lab assessment

-TSH:
-Thyroid hormones (T3 & T4)
TSH: low





T3/T4: high
Hyperthyroidism
Lab assessment

What will an idodine thyroid scan show:
if the cause is a single nodule or the whole gland
Hyperthyroidism
Lab assessment


What does a thyroid scan show?
evaluates the position, size, and functioning of the thyroid gland.
Interventions–Hyperthyroidism

-the goals of medical management are to decrease the effect of thyroid hormones on what? what else do we want to reduce?
cardiac function and to reduce thyroid hormone secretion.
Interventions–Hyperthyroidism


initial treatment is what?
Drug therapy with antithyroid drugs
Interventions–Hyperthyroidism


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

-what are 2 examples?
-The preferred drugs are the thionamides

-PTU (propylthiouracil), & Tapazole (methimazole)
Interventions–Hyperthyroidism


Drug therapy: What do antithyroid drugs do?
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
Interventions–Hyperthyroidism

Iodine preparations may be used for what?



what does iodine do to the thyroid gland?
short term therapy before surgery.


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

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



what do these drugs do?
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.
Interventions–Hyperthyroidism

drug therapy: Lithium

what does it do?
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
Radioactive Iodine Therapy (RAI)

-who is this contraindicated in
-Contraindicated in pregnant women b/c it crosses the placenta and can damage the fetal thyroid gland.
Radioactive Iodine Therapy (RAI)

What does this do to the thyroid gland?


when may the patient see relief?
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.
Radioactive Iodine Therapy (RAI)

May need a second or third dose! What is the negative effect does this therapy have?
Some patients may become hypothyroid which then require lifelong thyroid hormone replacement.
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
:(
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?
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.
Thyroidectomy

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



what is used for treatment? (2)
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
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?
- 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
Thyroidectomy

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


-assess the dressing and monitor for:
pillows to support head and neck


hemorrhage
Thyroidectomy

-monitor their voice change..why?
laryngeal nerve damaged could happen which results in hoarseness and a weak voice
Thyroidectomy

-thyroid surgery can cause what: 3 things
-hemorrhage,

respiratory distress,

parathyroid gland injury
Thyroidectomy

Accidential removal of the parathyroid gland causes injury.
-what do you have to watch for:
resulting in hypocalcemia and tetany


tetany is hyperexcitablity of nerves and muscles, or twitching secondary to accidental removal of parathyroids
Hypothyroidism
-a state of decreased metabolism resulting from what?
-low levels of Thyroid hormone
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??
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
Hypothyroidism

-Can be caused by: (4)
autoimmune thyroiditis,

thyroidectomy,

radioactive iodine therapy,

antithyroid meds
Hypothyroidism

can occur secondary to what?
a tumor
Hypothyroidism

-Low metabolic rate causes the cellular energy to be decreased and metabolites do what in the cells?
-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.
Myxedema coma is a rare but seriosu complications of what?
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.
Hypothyroidism
-Lab diagnostics

TSH:
T3 & T4:


thyroid antibodies:
TSH is elevated


t3 & t4 are below normal


may be present or elevated
Interventions for hypothyroidism

observe and record the rate and depth of _______. Measure oxygen saturation by pulse oximetry
respirations
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
:(
Interventions for hypothyroidism

patient will need lifelong treatment of thyroid hormone replacement

-administer what kind of med?
Synthroid (Levothyroxin) -------- increasing T3 and T4
Interventions for hypothyroidism

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



WHAT CAN THEY DO???








(can make respiratory difficulties worse)
Interventions for hypothyroidism

-administer what??



-try to relieve what???


-what do they have a hard time doing??
-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
Interventions for hypothyroidism


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




instruct the patient to not take what?
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.
Hashimoto's Thyroiditis is also known as
(Chronic Thyroditis)

-Thyroditis is an inflammation of the thyroid gland.
-Most common type of hypothyroidism is:
Hashimoto's Thyroiditis
Hashimoto's Thyroiditis is an autoimmune disorder that is usually triggered by what
a bacterial or viral infection
Hashimoto's Thyroiditis

TSH:
T3 & T4:
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
Hashimoto's Thyroiditis


Manifestations include: 2
dysphagia and painless enlargement of the gland
During the course of what disease, do the cells of the thyroid becomes inefficient in converting iodine into thyroid hormone and "compensates" by enlarging
Hashimoto's Thyroiditis
Hashimoto's Thyroiditis


The pt is given what?
thyroid hormone to prevent hypothyroidism and suppress TSH secretion, which decreases the size of the thyroid gland.
General Assessment of Patients with Endocrine Disorders

-Physical – inspect for abnormalities of facial structure
features and expression, i.e., prominent forehead or jaw, round or puffy face, dull or flat expression, exophthalmos
General Assessment of Patients with Endocrine Disorders

assess skin for:
Vitiligo – patchy areas of depigmentation (pigment loss with increased pigmentation at the edges)
General Assessment of Patients with Endocrine Disorders


Abnormal chest size & symmetry, truncal obesity, supraclavicular fat pads, “Buffalo Hump” may indicate __________excess
adrenocortical
General Assessment of Patients with Endocrine Disorders


inspect for striae (reddish purple stretch marks) often seen with ____________ excess
adrencortical
Parathyroid Gland is located where:
-These 4 small glands are located posterior to the Thyroid Gland
Parathyroid Gland: secretes what hormone?
-Secretes parathyroid hormone (PTH)
Parathyroid Gland
-what 2 electrolyte levels does this control?
-Controls Calcium & Phosphorus levels
by acting on bone, kidney, and the intestinal tract. The bone is the major storage site of calcium.
Parathyroid Gland
-how does PTH increase serum calcium?
PTH increases bone resorption (bone release of calcium into the blood from bone storage sites), thus increasing serum calcium.
Parathyroid Gland

In the kidneys, how does PTH absorrb calcium?
activates vitamin D, which increases the absorption of calcium and phosphorus from the intestines.
Parathyroid Gland

In the kidney tubules, how does PTH absorb calcium?
In the kidney tubules, PTH allows calcium to be reabsorbed and put back into the blood
Parathyroid Gland


what is the major controlling factor of PTH secretion?
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.
Hormone Deficiency

Growth hormone

children:
Growth retardation, short stature, increased adiposity
Hormone Deficiency

Growth hormone

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


Prolactin
failure of lactation
Hormone Deficiency

Antidiuretic hormone
Polyuria, polydipsia including nocturnal