Hyperthyroidism
Thyrotoxicosis"; most common is Graves' disease
Symptoms of Hyperthyroidism
-intolerant to heat
-bulging eyes
-enlarged thyroid
-tachycardia
-increased BP
-weight loss
-muscle wasting
Why do hyperthyroid pts have bulging eyes?
Exophthalmos; increased edema & fat behind the eye, pushing the eye forward; pressure on optic nerve can cause impaired vision
Why do hyperthyroid pts have enlarged thyroid?
Goiter; gland responds by increasing the number & size of glandular cells, enlarging the gland & overproduces thyroid hormones
Why do hyperthyroid pts have tachycardia, increased BP, and other vital sign changes?
There is increased activity in the sympathetic nervous system which causes:
-tachycardia
-elevated BP
-increased RR
-dyspnea
Why do hyperthyroid pts have weight loss?
there are an overabundance of protein break down that outnumbers protein synthesis. Pt will also have:
-increased appetite
-nutritional deficiency
Why does hyperthyroidism occur?
Hypothalamus secretes hormones to pituitary gland to stimulate the thyroid; there are increase thyroid hormones which are responsible for metabolism of nutrient.
-Cause believed to be autoimmune
Risk factors for Hyperthyroidism
-female & older adults
-3rd or 4th decade of life
-probable autoimmune condition
Diagnostic Test for Hyperthyroidism
-increased serum levels T3, T4, & free T4
-decrease in TSH
-radioactive iodine uptake test
Blood Levels for Hyperthyroidism
-Thyroxine (T4) 5-12 mcg/dL
-Thriiodothyronine (T3) 70-220 ng/dL
-Thyroid-stimulating hormone (TSH) 0.2-5.4 mIU/L
Medical Treatment of Hyperthyroidism
-administer meds
-monitor for complications
-non-stimulating environment
-reduce thyroid tissue through irradiation
What to monitor for hyperthyroidism?
-pulse (tachycardia)
-BP (especially systolic)
-temp (inc can indicate thyroid storm)
Thyroidectomy
removal of the thyroid glands; pt would be permanently hypothyroid and need replacement therapy
Antithyroid Agents
-Iodine (inhibits T3&T4 synthesis)
-Propylthiouracil "PTU" (inhibits thyroid hormone synthesis)
-Sodium Iodine (destroys thyroid tissue to limit thyroid hormone secretion)
Nursing Implications for Hyperthyroidism
-admin meds same time daily
-admin meds 1hr before or 2hrs after meals
-dilute iodine with H2O/juice for taste
-monitor serum thyroid levels
-assess pt for S&S of toxicity (hypothyroidism)
-educate pt: eating iodized salt, iodine rish foods, compliance an
Symptoms of Hypothyroidism
-intolerance to cold
-facial edema
-extreme fatigue
-muscle aches
-weakness
-bradycardia
-weight gain
Early Clinical Manifestations of Hypothyroidism
-extreme fatigue
-menstrual disturbances
-hair loss, brittle nails, & dry skin
-intolerance to cold
-anorexia
-constipation
-apathy
Late Clinical Manifestations of Hypothyroidism
-cardiac complications (bradycardia, HF, HTN)
-weight gain
-edema
-thicken skin
-changes/decreased LOC
Diagnostic Tests for Hypothyroidism
-decreased serum T3 & T4 levels
-increased TSH levels
Hypothyroidism
hypothalamus releases hormones to pituitary, pituitary releases TSH, but the thyroid does no respond
What is myxedema?
swelling of the skin and underlying tissues; develops when hypothyroidism is not treated properly; mortality rate is very high if pts get this out of hand
Medical management of Hypothyroidism
-thyroid hormone replacement
-low calorie diet
-decrease cholesterol intake
Complications of Hypothyroidism
-increased workload of heart
-HF (heart is unprepared for inc workload)
-chest pain/coronary artery problems due to atherosclerosis
-abnormal EKG
Thyroid Agents Mechanism of Action (Hypothyroidism)
-control metabolic rate of tissues & accelerate heat production and O2 consumption
-synthetic hormone has same physiologic effects as natural hormones
-T3 activity; replace hormonal deficits, suppress excessive hormone production
*Levothyroxine (Levoxyl)
Thyroid Agents Nursing Implications (Hypothyroidism)
-pt should take same brand the entire time; hormones are not interchangeable due to the amount of medication/chemical make-up
Who is at risk for Hyperparathyroidism?
women after menopause
What are the clinical manifestations of Hyperparathyroidism?
primary: adenomas, hyperplasia, carcinomas
secondary: renal failure, renal calculi
CNS: lethargy, strupor, psychosis
GI: anorexia, nausea, vomiting, constipation, peptic ulcers
Diagnostic Tests for Hyperparathyroidism
-increased serum total Ca
-decreased serum phosphorous
-increased PTH
-CT/X-ray to see demineralized cystic areas in bone
Treatment of Hyperparathyroidism
-diuretic & hydration therapies
-parathyroidectomy
Who is at risk for Hypoparathyroidism?
adults: after the removal of the gland
children: idiopathic
very rare
What are the insidious onset clinical manifestations of Hypoparathyroidism?
-muscle weakness spasms
-loss of hair
-dry skin
What are the acute clinical manifestations of Hypoparathyroidism?
-overt/acute tetany
-bronchospasm, laryngospasm
-seizure, cardiac dysrhythmias
-circumoral paresthesia
-abdominal cramps, nausea, vomiting, diarrhea, anorexia
-positive Chvostek's sign
-Trousseau's phenomenon
What are the pediatric manifestations of Hypoparathyroidism?
-carpopedal spasms, muscle cramps, twitching
-seizures : generalized or absent
-brittle hair, thin nails
What are the diagnostic assessments of Hypoparathyroidism?
-decreased serum Ca
-increased serum phosphate
-low PTH levels
What treatment is used for Hypoparathyroidism?
-Vitamin D
-Dietary Ca
Acute: replacement IV drip (calcium gluconate, calcium chloride), sedatives, and anticonvulsants
Foods high in calcium and low in phosphorus
-leafy greens (not spinach)
-broccoli
-soy beans
-tofu
-nuts
-sardines (edible bones)
Pathophysiology of Diabetes Mellitus
-carbs are not available for energy, oxidize fats & proteins
-circulating glucose cannot be used for energy = hyperglycemia
Polyuria
increased urine output
Polydipsia
increased thirst
Polyphagia
increased hunger
Type 1 Diabetes
NO insulin secretion
Type 2 Diabetes
combination of insulin resistance & inadequate insulin secretion to compensate
Gestational Diabetes
develops during 24-28 weeks into pregnancy; glucose tolerance returns to normal after delivery; reoccurs in future pregnancies (causing type 2 later in life)
What symptoms will the baby have if the moth has gestational diabetes?
-large infant
-hypoglycemia
Diagnostic tests for Diabetes
-fasting blood glucose
-glucose tolerance test
-random glucose with symptoms
-pre-diabetes
--glucose tolerance (200+ GTT)
--fasting glucose (>100, <126)
-glycosylated hemoglobin (HbA1C)
Treatment of Diabetes
-regular physical activity (planned exercise)
-diet (low calorie but maintain optimal glucose level)
-pharmacologic intervention (insulin and/or oral hypoglycemic agents)
-monitoring
-education
Rapid-Acting Insulin
Humalog;
O: 10-15m
P: 1hr
D: 3hr
Short-Acting Inusulin
Regular;
O: .5-1hr
P: 2-3hr
D: 4-6hr
Intermediate-Acting Insulin
NPH;
O: 2-4hr
P: 6-12hr
D: 16-20hr
Long-Acting Inuslin
Ultralente;
O: 6-8hr
P: 12-16hr
D: 20-30hr
Very Long-Acting Insulin
Lantus;
O: 1hr
P: no peak
D: 24hr
Complications of Insulin Therapy
-hypoglycemia
-lipoatrophy & lipohypertrophy
-somogi effects (dec insulin)
-dawn phenomenon (inc insulin)
Sulfonylureas
stimulates the pancreas to make more insulin
Biguanides
decrease sugar production in liver & help muscles use insulin to break down sugar
Alpha-Glucosidase Inhibitors
slow down body absorption of sugar after eating; aka starch blockers
Tiazolidinedione
enhance insulin at receptor sites; aka insulin sensitizers
Meglitinides
stimulates insulin release from beta cells
Dipeptidyl Peptidase-4 Inhibitors
stimulates release of insulin & decrease hepatic glucose production
Amylin Mimetics
complement the effects of insulin by delaying gastric emptying & supressing glucagon secretion
Incretin Mimetics
stimulates the release of insulin, decrease glucagon secretion, decrease gastric emptying, suppress appetite
Complications of Long-Term Diaberes
-angiopathy
-peripheral vascular disease
-HTN
-diabetic gastroparesis
-cerebrovascular disease
-coronary artery disease
-ocular complications
-nephropathy
-infections
Diabetes Mellitus