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101 Cards in this Set
- Front
- Back
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What are the 3 hormomes that are released from the Thyroid?
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T3
T4 Thyrocalcitonin |
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Which is there more of T3 or T4?
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T4 (1/2 life is 6 days, T3 1/2 life is 1 day)
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Which is more potent T3 or T4?
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T3
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What is the purpose of T3 & T4?
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Controls cellular metabolism and BMR as well as growth and development
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Thryocalcitonin does what?
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It is secreted by Parafollicular cells in response to increased Ca levels
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What does it do to calcium?
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Drives it back into the bones and also excretes it through renal and GU
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TRH is realsed from where?
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Hypothalamus
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TRH stimulates the release of what?
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TSH which is from the Anterior Pituitary gland
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What is then released after TSH?
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T3/T4 release from the Thyroid
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Disorders of the Thyroid can be what type?
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Hypofunctional
Hyperfunctional inflammation enlargement |
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The other problem can be what?
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Change in the sturcture or in the production of the hormone
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Who should have their Thyroid checked often?
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Those who have
-Hyperlipidemia -women over 50 -people with family hx of thyroid problems |
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how is the Thyroid assessed?
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-Neck checks,
-mirror -swallowing of water to see bulges or projections |
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Why don't you palpitate the Thyroid?
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Palpitation increases release of T3/T4
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Studies for the Thyroid is what?
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Radioactive Iodine uptake (131 I)
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What is the procedure for giving 131 I?
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-a tracer dose first (oral, or IV)
-Then 2 hrs -4 hrs -then 24 hrs |
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The Pt is then scanned for what?
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to check for enlargment (scintiscan)
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What should a normal Thyroid look under the scan?
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even distribution and uniformed uptake
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Hot spots show what?
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gray or black spots that show hyperfunction or Benign Tumor
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Cold spots show what?
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White, hypofunction or Malignant tumors
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Euthryoid is what?
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a normal functioning Thyroid
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Normal T4 is what?
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5-12 micro g/dl
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normal T3 is what?
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65-195 ng/dl
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T3 resin uptake shows what?
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> 35%= hyperthyroidism
< 25%= hypothryroidism |
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normal TSH is what?
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0.3-5.4 micro units/ml
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TRF is either what?
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a two step test that should be <10, but >2 (manual of diagnostic tests)
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What esle should we test for?
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Thyroid circulating antibodies
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Structural changes in the Thryoid
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Structural changes with Thyroid
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(DEF)
Hypertrophy of the gland caused by excess of TSH |
Goiter
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Goiterogens
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are foods or drugs that supress the thryoid
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Endemic Goiters are what?
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goiters that are increased due to lack of iodine in diet. Thryoid releases more TSH causing hyperplasia and hypertrophy of Thyroid gland
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(DEF)
inflammation of gland, chronic inflammation is most common |
Thyroiditis
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An autoimmune disease which Thyroid tissue is replaced by lymphocytes & fibrous tissue
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Hashimoto's
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Hashimoto can cause what?
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HypOthyroidisim
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Hyperthyroidisim is considered what?
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a functional disorder
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Hyperthryoidisim increases what?
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over production of thyroid
increases metabolism |
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S/S of Hyperthryoid is what?
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-Palpitations
-HTN -Wt loss -fine silky hair -angina -diarrhea -HEAT INTOLERANCE -insomnia -diaphoresis -fatigue -tremors -decreased concentration |
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What condition has antibodies to TSH receptor and so over stimulation of T3/T4?
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Graves disease
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What are the 3 hallmarks of Graves?
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-Hyperthyroidisim
-Goiter -Exophthalmos |
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Exophthalmos (bulging eyes) is caused how?
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impaired venous drainage leading to deposits of fat and fluid in the retro orbital
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CNS problems and Hyperthryoid
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-Nervousness
-restlessness -irritable -compulsion to move -tremors -hyperflexia |
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CV problems and Hyperthryoid
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-increased C. Output
-increased contraction -increased rate |
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immune problems with Hyper
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decreased WBC
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Hyperthyroid Pt's are more prone to bones breaking because....
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Hyperthroidism increases the amount of "bone-remodeling cycles" you go through, and it's ineffective each time so your bones are getting thinner rather than building
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Skin and Hyperthyroid
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-Heat intolerance
-warm -flushed -moist -thin skin -soft, brittle nails -hair loss |
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GI and Hyperthyroidisim
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-increased peristalsis
-Wt loss -Calorie and Nut. inadequacy |
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Reproductive and Hyperthyroidisim
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decrease fertility
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GU and hyperthyroidism
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polyuria
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What are some RN Dx for Hyper?
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-Activity intol R/T fatigue, heat intol. exhuation
-Anxiety R/T over stimulation -Imbalanced Nut less than body requirements -Diarhea R/T increased GI -Ineffective Health Maintance R/T Knoweldge Def, regarding meds, coping -Insomina R/T anxiety -Risk for eye damage |
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Nutritional care for Hyperthyroidism
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Increased calories
increased protein frequent meals (fast metabolism, always running) |
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Rx thearpy includes what 4 groups?
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-Antithyroid
-Iodine -B Blockers -Radioactive Iodine Therapy |
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What are our 2 Antithyroid drugs?
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-PTU
-Tapazol |
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What are our B Blockers and what are we using them?
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-Inderal
-Tenormin (to decrease the contraction of the heart) |
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What does the radioactive idoine do?
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decreases Thyroid production
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What is always left if drugs don't work?
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Surgery... Lets cut
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Thyroidectomy is used when?
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When drugs don't work, or when goiter is so large it presses on the Trach.
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What could happen after surgery?
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Pt could end up developing hypOthyroidisim if to much is taken out
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What is our PostOp rules?
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-airway clearance (Laryngeal stridor)
-assess and monitor V/S -control Post Op pain |
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What are some complications?
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-Hemorrhage (the back of the neck is where blood will pool, since Pt in Semi-Fowlers)
-Resp. Distress -Hypocalcemia -Thryoid Storm -Laryngeal nerve damage (Pt will be unable to speak) |
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Hypocalcemia occurs how?
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due to injury to parathyroid glands which decreases calcium levels
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What can hypocalcimia look like?
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-Tetany
- (+) Trou/ Chvo signs |
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What do we give for hypocalcemia?
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-calcium gluconate (IV)
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Cal. gluconate rules are?
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-monitor IV
-Dilute (to decrease irritation) -Large central or deep vein -Confirm Patency of IV prior to adm. -Mon V/S -Watch for HYPERCalcemia -Watch for hyperchloremic acidosis -Watch for extravasation |
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if Extravasation occurs what do you do?
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leave the room as quietly as possible and close the door behind you
(just to make sure you're awake) |
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If extravasation occurs what do you do?
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-inject 1% of procain hydrochloride & hyaluronidase using a 25-27 gauge needle (this reduces vasospasms)
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A Thyroid Storm can occur from what?
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-Trauma
-Surgery -Infection |
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What are S/S of a storm?
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-Tachicardia
-Elevated Temp -Perfuse diaphoresis -Dehydration -Tremors -Restlessness -Irritable -hyperglycemia |
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Tx of a storm is what?
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-tx underlying cause
-cooling blankets -monitor heart/lungs -Rx therapy |
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Care for a storm is what?
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-Airway and ventilation
-Anti Thyroid Rx's |
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What is the standing order for PTU, Propyl-Thyracil
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300-900 mg
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What is the standing order for Tapazole
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60 mg
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What is the standing order for Sodium Iodide?
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2g IV
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Propranolol (Inderal or Detensol)
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1-3mg IVP over 3 min
(Pt should be connected to cardiac monitor and central venous pressure catheter should be in place) |
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What is the standing order for glucortisol?
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-hydrocotison 100-500mg IV
-Prednisone 4-60mg IV -Dexamethason 2mg IM Q6 |
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Storm care involves what?
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-monitor Cardiac dysrthymias
-V/S 30min -Give antipyretic -Correct Dehydration -Give ASA -Give cooling blankets or ice packs (reduce fever) |
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What is the D/C planning?
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-Community resources
-Health promotion -Follow up appointment |
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Myedema is what?
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Thyroid homrmone deficiency
-decrease in BMR -increase osmolarity on interstitial space |
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Common causes of Hypo are?
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-Hashimoto
-Lymphocytic thryroidits -Thyroid destruction -Pituitary or hypothalamic disease -Rx's -Severe iodine deficiency |
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Hypothryoidism that occurs in either fetal or early neonatal life that
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Cretinism
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CNS and Hypothroidism
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-Lethargy
-fatigue -personality changes -slwo speech and mental function -depressed reflexes |
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Skin and Hypothroidism
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-COLD INTOLERANCE
-puffiness and edema, facial edema -cool, dry skin, coarse hair/nails -easy bruise |
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Reproductive and Hypothyroid
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-decreased libido
-impotence -infertility |
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GU and hypothyroid
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-decreased urine output
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GI and hypothyroid
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-decreased peristalsis
-Wt gain -Pernious edema (gastric mucosa isn't secreting IF) |
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MS and hypothyroid
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-muscle edema
-slow contractions -aches -stiffness in joints |
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S/S of Hypo
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-Fatigue
-depression -Cold intol -Constipation -increased Cholesterol level -swelling of legs -decreased concentration |
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Elderly S/S
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-fatigue
-Cold dry skin -Hoarseness -Hair loss -Constipation -Cold intol. |
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Myxedema is what?
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LIFE THREATING
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When is it most often seen?
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in elderly
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What can bring it on?
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precipitated by stressors
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What body systems slow down as a result?
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All of them
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RN Dx of Hypothyroid are?
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-activity intol
-constipation -disturbed thought -imbalanced nut. -impaired gas -impaired skin -ineffective health maintenance |
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Rx therapy for Hypothyroid is?
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-Synthroid (1.6 per Kg) women75-100, men 100-150mg
-check levels after first 8 weeks, then 3 months -monitor annually after 3 months -if Preg. every 2-3 months |
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What are the meds of choice?
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Levothyroxine (snythetic T4)
Liotheyronine (snythetic T3) Liotrix (both T3/T4) |
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Who is part of the Multidisciplinary team?
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-Registered dietician
-Physical Therapist -Recriational Therapist -Social Worker |
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Who mainly covers Hyperthyroidism?
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-Endocrinologist
-PCP when Pt is stable |
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Who covers Hypo?
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-PCP
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What are some community resources for Rx's
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-Orleans Parish-Sickles Pharmacy
-Daughter of Charity or Tulane's Covenant clinics -Free Samples -Part D of Medicare -Medically indigent progms from pharmacy compaines |
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Nutritional programs for below poverty level
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-Food for families
-WIC/Commodities -Food stamp |
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What are some others?
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-Second Harvester Food Bank
-Religious food banks -Cogregate meals -Vol. benefits |
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General Elderly concerns
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-organ/body slowing down
-slower excretion -slower absorption -loss of some senses -decreased exercise -co-morbidities/polypharm -fixed income |
