Nur135 Endo - Thyroid

Front 1

Since hyperthyroid speeds up all body processes, list some of the clinical manifestations.

Back 1

systolic hypertension
increased rate and force of contractions
bounding rapid pulse
increased cardiac output

increased RR
increased appetite, thirst
weight loss
increased peristalsis
diarrhea
warm smooth moist skin
hair loss
clubbing of fingers
fatigue (insomniacs and tired)
difficulty sleeping
EXOPHTHALMOS

Front 2

What is the name of the most common form of hyperthyroid disease?

Back 2

Grave's disease

Front 3

Graves disease is an increased state of thyroid hormone. Two physcial findings with Grave's disease are enlarged ___________ and protruding _________.

Back 3

enlarged THYROID

protruding EYEBALLS

Front 4

What is the patient with exopthalmus at risk for?

Back 4

corneal abrasion

may need to have them wear a patchy

Front 5

What "type" of disease is Grave's disease?

Back 5

autoimmune

Front 6

Other than Grave's disease, there are two other main causes of hyperthroidism. Name them.

Back 6

Thyroid Nodules

Thyroiditis

Front 7

There are 5 different ways that a thyroid nodule can be evaluated. Name as many as you can.

Back 7

US - ultrasound
CT - catscan
MRI
FNA - fine needle aspiration
Thyroid scan

Front 8

An ultrasound study may be done on a thyroid to determine if the nodules are ________ or _________.

Tell your patient that a transducer will be used over the neck. The test will last for 15 minutes and neither fasting NOR sedation is required.

Back 8

fluid filled (cystic) or solid

(she said to know this)

Front 9

What causes thyroiditis?

Back 9

inflammation usually is a result of viral infection

Front 10

If your thyroid stays inflammed, what can happen over time?

Back 10

although the acute inflammation will cause increased TH, overtime, a HYPOTHYROID state will happen b/c of destruction of the thyroid

Front 11

Your patient has thyroiditis. The cause of it is viral. What meds do you expect to give?

Back 11

NSAIDs for pain

Steroids to decrease inflammation

Front 12

If the cause of your patient's thyroiditis is BACTERIAL, what medications would you expect to give?

Back 12

NSAIDs for pain

ABX (maybe/maybe not)

***but NO STEROIDS in bacterial

Front 13

Your receive report and one of your patients is recovering from TAH. She has PMH of Grave's disease. What MUST you monitor for?

Back 13

Thyroid Crisis - thyroid storm

(An acute rare condition in which all hyperthyroid manifestations are heightened. Brought on by stressors (infection, trauma, or surgery)

Front 14

What are the manifestations of thyroid crisis?

Back 14

Hyperthermia (temp 102 or higher)

Severe tachycardia

Systolic HTN

GI symptoms (n/v/d/pain)

Agitation, restlessness, tremors

Progressing to confusion, psychosis, delirum, seizures, then coma....PC: death!

Front 15

How do you treat the fever of your thyroid storm patient?

Back 15

Cool her without ASA...you do not want to make her shiver

Front 16

The main treatments for thyroid crisis are....

Back 16

rapid RX essential

Cooling without ASA

Replace fluids, glucose, electrolytes

Relieve respiratory distress

Stabilize CV function (telemetry)

Reduce TH

Front 17

Although lab work (TSH/T4/T3) are the main ways to diagnose thyroid problems, there are two other thyroid diagnostics to know. Name them.

Back 17

RAI uptake test

Thyroid suppression test

Front 18

What is the RAI uptake test? What do you need to do as a nursing responsibility for this test?

Back 18

Measures thyroid activity. Patient is given radioactive iodine either orally or intravenously. Then the thyroid is scanned at intervals.

Check for allergy to iodine. No fasting. Check to see if they are on thyroid meds (contraindicated). Make sure they haven't taken iodine supplement for several wks b/4 test)

Front 19

There are two types of drugs used to "slow" the thyroid. What are they?

Back 19

iodines

antithyroids

Front 20

Specifically, what are the names of the drugs that are Iodines?

Back 20

SSKI, Thyro Block, Pima

Front 21

How do you administer iodine drugs for hyperthyroid conditions?

Back 21

if they are liquid:
.dilute them
.give with juice
.through a straw

Front 22

Iodines potentiate _______________. So be careful to monitor for ___________ if the patient is concurrently taking _____________.

Back 22

Iodines potentiate anticoagulants. Be careful to monitor for BLEEDING if the patient is concurrently taking (Coumadin/Heparin)

PT/INR, pTT labs are useful

Front 23

Antithyroid drugs are used for "long term" drug therapy for hyperthyroid. Name the ANTITHYROID drugs.

Back 23

Tapazole (methimazole)
PTU (propylthiouracil)

Front 24

How do you instruct a patient to take Tapazole?

antithyroid drug

Back 24

BID at SAME TIME every day
(lecture)

Q day at SAME TIME every day
(book)

Front 25

How do you instruct a patient to take PTU?

Back 25

take at SAME TIME every day...may be once a day to QID. (lecture)

Book says....

Front 26

There are a couple of drug interactions with antithyroid drugs. What are they?

Back 26

digoxin and oral anticoagulants

Front 27

Your patient is receiving radioactive iodine as a treatment for hyperthyroid. What is an important to teach the patient about medicine compliance?

Back 27

Teach the client that it might take 2-3 months for this medication to work.

Front 28

What are the contraindications for radioactive iodine?

Back 28

pregnancy

Front 29

What is the preop teaching for subtotal thyroidectomy?

Back 29

NPO
Might be bleeding b/c very vascular area

NO incentive spirometry...but YES deep breathe, cough from diaphram, deep breath in and blow out.

Get up and moving to prevent pneumonia

**Teach client to support kneck by placing both hands behind the neck when sitting up in bed to decrease stress on suture line

Front 30

What are the post op interventions for thyroidectomy?

Back 30

semi fowler's

observe for hemorrhage (below, above & behind)

Monitor for hypobolemic shock (from hemorrhage)

Assess for respiratory distress (have trach tray at bedside)

Have oxygen set up

Observe for tetany

Check for laryngeal nerve damage

Front 31

If your patient is hemorrhaging and going into shock:

1. what type of shock is it?
2. what would the vital signs be?

Back 31

hypovolemic

BP down
HR up
(at first...compensatory and then both would go down with LOTS of blood loss)

Front 32

If your patient is intubated for surgery, what issues are you looking for post op?

Back 32

localized trauma....make sure they can speak and the hoarsness gets better over 48 hours

You do not want STRIDOR from swelling...may need to HUMIDIFY the air

Front 33

Why would a post op thyoidectomy patient have tetany?

Back 33

accidental removal of parathyroid glands....can happen up to 7 days later

Front 34

PACU calls. Post op thyroidtectomy patient coming to your unit. List the items you want to have in the room.

Back 34

Calcium Chloride @ bedside (hypocalcemia)

Trach tray

Oxygen set up

Humidified oxygen

Suction set up

Front 35

Explain the ND Risk for decreased cardiac output secondary to hyperthyroidism.

Back 35

Excess TH directly affects heart, resulting in increased rate and O2 demands. Beating faster, less time to fill....less blood pushed out of heart=decreased cardiac output

Front 36

What are the nursing interventions for decreased cardiac output?

Back 36

Monitor BP, HR, rhythm, RR, breath sounds

Administer beta blockers

Assess for peripheral edema, JVD, increased activity intolerance

Keep environment as cool and quiet as possible

Front 37

What type of diet does a hyperthyroid patient require?

Back 37

High calories 4000-5000

High CHO, High PRO, between meal snacks

Front 38

What is myxedema?

Back 38

accumulation of nonpitting edema throughout the body

Front 39

What are the manifestations of hypothyroid?

Back 39

goiter
dyspnea
fluid retention, nonpitting edema
anorexia weight gain constipation
dry skin, hair loss
muscle stiffness
anemia
fatigue
lethargy
mental changes

Front 40

What is the crisis state of hypothyroid?

Back 40

myxedema coma

Front 41

What are the manifestations of myxedema coma?

Back 41

hypothermia
cardiovascular collapse
coma

(precipitated by trauma, infection, failure to take thyroid replacement meds)

Front 42

What are the medications used to treat hypothyroid?

Back 42

Levothyroxine sodium

Liotrix

Front 43

Name three teaching points for hypothyroid meds.

Back 43

take in AM to avoid insomnia

administer 1 hr ac or 2 hrs pc for best absorption

thyroid meds potentiate effect of digoxin and anticoagulants

Front 44

When a patient returns to a euthyroid state, what might happen to their BG if they have diabetes?

Back 44

BG may go up...which would increase need for insulin