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40 Cards in this Set

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Hypothyroidism can occur?
anytime throughout life
Reasons that hypothyroidism may occur?
*cells are damaged and no longer funtioning normally
*person doesn't ingest enough of substances needed to make thyroid hormones, esp. iodide and tyrosine
Myxedema can change client's appearance by?
nonpitting edema forms everywhere, esp. around eyes, hands, feet, between shoulder blades...tongue thickens and edema forms in larynx, making voice husky
What does myxedema coma cause?
decreases metabolism causing heart muscle to become flabby and chamber size to increase...results in decreased cardiac output and decreased perfusion to brain and other vital organs...tissue and organ failure ensues...life-threatening
Most cases of hypothyroidism occur as a result of?
thyroid surgery and RAI treatment of hyperthyroidism
Worldwide, hypothyroidism is caused by a lack of?
iodide
Hypothyroidism occurs most often in women between?
30 and 60 years
Women are more affected with hypothyroidism how many more times than men?
7 to 10
Hypothyroidism can increase sleep time sometimes up to?
14 to 16 hours daily
Symptoms of hypothyroidism?
generalized weakness
anorexia
muscle aches
paresthesias
constipation
cold intolerance
decrease in libido
amenorrhea or heavy,
prolonged bleeding
difficulty becoming pregnant
impotence and infertility
The following drugs can impair thyroid hormone production?
lithium
aminoglutethimide
perchlorate
thiocyanates
cobalt
Hypothyroid physical changes in appearance include?
coarse features
edema around eyes and face
blank expression
thick tongue
overall muscle movement slow
Hypothyroid psychosocial assessment?
depression
lethargic
apathetic
drowsy
withdrawn
impaired attention span and
memory
Laboratory assessment for hypothyroidism is opposite of HT?
triiodothyronine (T3) down
thyroxine (T4) serum levels
down
TSH levels high in primary
hypothyroidism, but down
or near normal in
secondary hypothyroidism
Nursing diagnosis:
Decreased cardiac output related to?
altered heart rate and rhythm as a result of decreased myocardial metabolism
Nursing diagnosis:
Ineffective breathing pattern related to?
decreased energy, obesity, and fatigue
Nursing diagnosis:
Disturbed thought processes related to?
impaired brain metabolism and edema
The major collaborative problem with hypothyroidism is?
Potential for myxedema coma
Nursing diagnosis:
Imbalanced nutrition: more than body requirements related to?
excessive intake in relation to metabolic need
Nursing diagnosis:
Hypothermia related to?
decreased metabolic rate
Nursing diagnosis:
Constipation related to?
decreased motility of GI tract
Nursing diagnosis:
Disturbed body image related to?
illness
Nursing diagnosis:
Deficient knowledge of condition, diagnosis, and treatment related to?
cognitive limitation
Nursing diagnosis:
Potential for paralytic ileus and potential for cardiomyopathy

okay
okay
Expected outcomes for nursing diagnosis of Decreased Cardiac Output for client with hypothyroidism is?
maintains heart rate above
60 beats/min
maintains blood pressure
within normal limits for
his or her age and general
health
has no dysrhythmias,
peripheral edema, or neck
vein distention
Interventions for nursing diagnosis of Decreased Cardiac Output for client with hypothyroidism?
Monitor blood pressure, heart rate, and rhythm and observe closely for signs of shock, such as hypotension, decreasing urine output, and changes in mental status..

Instruct client to report episodes of CHEST PAIN or DISCOMFORT IMMEDIATELY!!

requires lifelong thyroid hormone replacement
ex: levothyroxine in the
form of Synthroid, T4,
or Eltroxin
start low doses and gradually
increase over a period of weeks..the more severe cases of hypothyroidism start on lowest dose..too high dose or increasing dose too rapidly can cause severe hypertension, heart failure, myocardial infarction

assess for chest pain and dypnea during start of therapy...HYPERthyroidism may be a condition of replacement therapy
Hypothyroidism
Expected Outcomes for nursing diagnosis of Ineffective Breathing Pattern?
may have mildly compromised respiratory function...indicators include:
maintenance of SpO2 of at
least 88%
absence of cyanosis
maintenance of cognitive
orientation
Hypothyroidism
Interventions for nursing diagnosis of Ineffective Breathing Pattern?
record respirations
auscultate for decreased
breath sounds
ventilatory support may be
required

(since there are respiratory difficulties associated with hypothyroidism, be sure and give LOW doses of SEDATIVES, because patient is more sensitive)
Severe respiratory distress often occurs with?
myxedema coma
Hypothyroidism
Expected outcomes for nursing diagnosis of Disturbed Thought Processes?
thought process disturbance
may be mild...assess to
see that patient:
demonstrates immediate
memory
communicates clearly and
appropriately for age
and ability
is attentive during
conversations
Hypothyroidism
Interventions for nursing diagnosis of Disturbed Throught Processes?
record presence and severity
of:
lethargy
drowsiness
memory deficit
poor attention span
difficulty communicating

takes about 2 weeks for medication to kick in..so use LOC and explain all procedures slowly and carefully..provide safe environment
Problems that occur with myxedema coma include?
coma
respiratory failure
hypotension
hyponatremia
hypothermia
hypoglycemia
Untreated myxedema coma leads to?
shock
organ damage
death

(check MENTAL STATUS every shift...DON'T wait for lab confirmation to treat!)
Hypothyroidism is usually a chronic condition? T or F
true
Home care management of hypothyroid patient includes?
one-floor living due to
fatigue
extra heat or clothing due
to cold intolerance
help with drug regimen due
to decreased attention
span
The most important educational need for hypothyroid patient is?
hormone replacement therapy
and its side effects

Others:
lifelong drugs mandatory
medical alert bracelet
dosage adjustment may be
necessary over time
NO OTC DRUGS
adequate fiber and fluid
intake to prevent
constipation...fiber
supplements may interfere
with thyroid replacement
hormone absorption
adequate rest
family needs to understand
it takes time for med to
work and they should
expect mental dullness
or slowness for some time..
speak clearly and slowly
to patient
Name 9 conditions or events precipitating myxedema?
acute illness
anesthesia
chemotherapy
hypothermia
inadequately treated
hypothyroidism
rapid withdrawal of thyroid
medications
sedatives/opioids
surgery
untreated hypothyroidism
Causes of hypothyroidism are classified by?
primary causes
decreased thyroid tissue
decreased synthesis of
thyroid hormone

secondary causes
inadequate production of
thyroid-stimulating
hormone
Primary causes of hypothyroidism include?
Decreased Thyroid Tissue
surgical removal of thyroid
radiation-induced thyroid
destruction
autoimmune thyroid
destruction
congenital thyroid agenesis
congenital thyroid
hypoplasia
congenital thyroid
dysgenesis
cancer (thyroidal or
metastatic)

Decreased Synthesis of
Thyroid Hormone:
endemic iodine deficiency
excessive exposure to
iodine
medications including:
lithium
phenylbutazone
propylthiouracil
sodium or potassium
perchlorate
aminoglutethimide
Secondary causes of hypothyroidism include?
Inadequate Production of Thyroid-Stimulating Hormone:
pituitary tumors, trauma,
infections, or infarcts
congenital pituitary
defects
hypothalamic tumors,
trauma, infections, or
infarcts