What hormones are secreted by the thyroid gland?
Thyroxine (T4) and Triiodothyronine (T3)
What is a normal TSH level?
0.2-4.2
Would the TSH, T3 and T4 levels be low or elevated in hypothyroidism vs. hyperthyroidism?
Hypothyroidism = lowHyperthyroidism = elevated
What is a goiter? Who can develop one?
enlargement of the thyroid glandIndividuals with hyperthyroidism can develop a goiter
What are the signs & symptoms of hypothyroidism?
Fatigue and dulled mental processesDepression ForgetfulDry skin, brittle nails, hair lossCold intoleranceHoarsenessFluid retention and weight gainDecreased appetite
What are the signs & symptoms of hyperthyroidism?
Enlarged thyroid gland (goiter) ExophthalmosNervousHeat intolerance and sweating Weight loss but increased appetiteFlushed skinDiarrheaTremor PalpitationsMuscle fatigue and weaknessAmenorrheaIncreased pulse pressure Heart failure if severe
How does the nurse differentiate hypothyroidism and hyperthyroidism?
Hypothyroidism = Weight gain and fluid retention with decreased appetiteCold Intolerance Dulled mental processesHyperthyroidism = Weight loss but increased appetiteHeat intoleranceIf severe, heart failure
What are the distinguishing characteristics between hypo and hyperthyroidism?
Hypothyroidism has cold intolerance and weight gain as well as fluid retention with decreased appetite Hyperthyroidism has an increased appetite but weight loss as well as heat intolerance
How is hypothyroidism treated?
Levothyroxine (synthroid) is the treatment of choice
What is myxedema & myxedema coma (the major complication of hypothyroidism)?
Myxedema = in severe hypothyroidism is when there is thickening of the facial features and there are indurations of the skin Myxedema coma = occurs in severe hypothyroidism and is a progression from myxedema
How will myxedema & myxedema coma be recognized? How is it treated?
It can be recognized by the appearance of skin and subcutaneous tissue and this edema causes puffiness, facial and periorbital edema and a masklike effectMyxedema coma can lead to high mortality, hypothermia, unconsciousness, depressed respiratory drive and cardiovascular collapse and shocktreated by IV levothyroxine, and treatment of shockMaintain adequate ventilationstabilize cardiac statusnormalize temperature
What is Grave's disease?
It is an autoimmune disease where the pt. develops antibodies to the TSH receptor which results in the release of T3 and T4It can have remissions and exacerbations and it may progress to destruction of thyroid tissue
How is hyperthyroidism treated (the interventions)?
Irradiation Antithyroid medications that block the use of iodine such as (methimazole and propylthiouracil) ThyroidectomyBeta blockers and digoxin, relaxation, well balanced diet and fluids, and monitoring signs of hypothyroidism may also be used
How will a nurse suspect a patient developed thyroid storm/thyrotoxicosis? What are nursing interventions (i.e. how is it managed)?
High fever (above 38.5), extreme tachycardia, and exaggerated hyperthyroid symptoms. Interventions include cardiac monitoring, pulse oximetry and administration of O2, monitoring for altered LOC, and administering IV fluids.Can also give hypothermia blanket, icepacks, hydrocortisone acetaminophen, propanolol and digoxin, or give iodine
What are the nursing interventions for a thyroidectomy? Specifically, the post-op care.
Monitor for hemorrhage or hematoma formation and difficulty swallowingObserve for bleeding Monitor VS and for shockMonitor for respiratory status (laryngeal stridor) Have a trach set at the bedside, O2, and suctioning equipment in case of emergency
What is hyperparathyroidism?
Involves increased secretion of parathyroid hormone (PTH) that leads to hypercalcemia and hypophosphatemia.
What hormone does the parathyroid excrete?
PTH or parathyroid hormone
How does that affect the calcium level in a patient with hyperparathyroidism?
Parathyroid hormone that is secreted in high amounts results in high levels of calcium being released as well
What is the treatment of choice for hyperparathyroidism?
Surgery
What is a normal calcium level?
8.6-10.2
What signs & symptoms would distinguish hyperparathyroidism from other disorders?
High calcium levels present with fragile bones the easily fracture, kidney stones, excessive urination, ab pain, tiring easy or weakness, forgetfulness, bone and joint pain
How will the nurse suspect a patient was in a hypercalcemic crisis?
High calcium readings
What signs will be monitored for in a patient with suspected hypoparathyroidism and, therefore, possible hypocalcemia?
Low CalciumTingling, cramps in the handCardiac arrhythmias and EKG changesSeizuresLow BPIncreased bone densityIncreased phosphorus levels
What is the emergency treatment of tetany (i.e. after a parathyroidectomy)
IV calcium chloride, calcium gluconate, calcium glucepate slow
Diabetes insipidus is characterized by a deficiency of which hormone?
Deficiency of ADH
What are the characteristic signs & symptoms of DI (diabetes insipidous)?
Polyuria/polydipsiaUsually follows a hypophysectomyCan also occur postoperative intracranial surgery
What would the urine specific gravity level be in a pt. with DI?
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When will a patient be given DDAVP?
In diabetes insipidous
How will a nurse recognize hypovolemia that can lead to cardiovascular collapse? (i.e. vital signs)
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Nursing interventions for DI?
fluid and hormonal therapy
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When would the nurse suspect SIADH?
Excess production of ADH, older adult, malignancy present, fluid retention
What are the key features (signs & symptoms) of SIADH?
hyponatremic and has muscle cramps, pain, weakness, fatigue, low urine output, and increased body weight.
What happens to the sodium level in a patient with SIADH as a result of increased secretion of ADH?
Sodium levels drop
How would the urine & specific osmolarity and specific gravity levels be affected in a pt. with SIADH?
Low osmolality
How would the nurse intervene in a patient with SIADH?
fluid restriction 800-1000mL a day, assess intake and output, VS, heart and lung sounds, neurologic status, monitor labs