Chp. 42-audio lecture (Thyroid)

Chapter 42 : 

Chapter 42 Assessment and Management of Patients with Endocrine Disorders (Thyroid)

Major Hormone Secreting Glands of the Endocrine System : 

Major Hormone Secreting Glands of the Endocrine System

Thyroid Gland : 

Thyroid Gland Thyroid hormones: T3 and T4 also produce calcitonin Iodine is contained in the thyroid hormone TSH from the anterior pituitary controls the release of the thyroid hormone Thyroid hormone controls cellular metabolic activity T3 is more potent and more rapid-acting than T4 Calcitonin is secreted in response to high plasma calcium level and increases calcium deposition in bone

Thyroid Diagnostic Tests : 

Thyroid Diagnostic Tests TSH Serum-free T4 T3 and T4 T4 resin uptake Thyroid antibodies Radioactive iodine uptake Fine-needle biopsy Thyroid scan, radio scan, or scintiscan Serum thyroglobulin

Thyroid Disorders : 

Thyroid Disorders Cretinism Hypothyroidism Hyperthyroidism Thyroiditis Goiter Thyroid cancer

Hypothyroidism : 

Hypothyroidism Causes: autoimmune thyroiditis and Hashimoto’s disease (most common cause) (see Chart 42-2) Affects women 5X more frequently than men Manifestations early symptoms may be nonspecific fatigue hair loss tongue, hands, and feet may enlarge personality and cognitive changes cardiac and respiratory complications

Hypothyroidism (cont.) : 

Hypothyroidism (cont.) Manifestations (cont.) skin and nail changes numbness and tingling of fingers menstrual disturbances subnormal temperature and pulse weight gain subdued emotional and mental responses slow speech Myxedema may progress to stupor, coma, and death

Medical Management of Hypothyroidism : 

Medical Management of Hypothyroidism Synthetic levothyroxine-replacement therapy Levothyroxine (T4) replacement. In elderly individuals, the starting dose should be low and increased slowly, so as not to precipitate any underlying heart disease. Dose of levothyroxine is based on TSH levels Myxedema coma- intravenous levothyroxine plus intravenous hydrocortisone Levothyroxine dose may need to be increased during pregnancy, or in patients taking Phenobarbital or bile acid binding resins Effects of hypnotic and sedative agents; reduce dosage Support of cardiac function and respiratory function Prevention of complications

Nursing Management of Hypothyroidism : 

Nursing Management of Hypothyroidism Gradually increase activity level; provide frequent rest periods Encourage to cough, turn and deep breathe Provide high-bulk, low calorie diet Provide extra clothing and blankets Provide meticulous skin care; turn every 2 hrs Encourage patient to verbalize feelings; promote a positive self image

Nursing Management of Myxedema Coma : 

Nursing Management of Myxedema Coma Maintain airway/may need ventilator support Maintain circulation Provide continous EKG monitoring Monitor ABGs Monitor body temp Monitor I/O’s and daily weight Check for possible sources of infection Administer corticosteroids and glucose, as ordered Replace fluids

Hyperthyroidism : 

Hyperthyroidism The second most prevalent endocrine disorder Excessive output of thyroid hormone Graves disease (most common cause) Affects women 8X more frequently than men Manifestations: nervousness palpitations; rapid pulse poor heat toleration tremors skin is flushed, salmon color, warm, soft, and moist (however, elders’ skin may be dry and pruritic)

Hyperthyroidism : 

Hyperthyroidism Manifestations (cont.): exophthalmos increased appetite and dietary intake weight loss elevated systolic BP; may progress to cardiac dysrhythmias and heart failure

Medical Management of Hyperthyroidism : 

Medical Management of Hyperthyroidism Radioactive 131I therapy Medications: see Table 42-3 Propylthiouracil and methimazole Sodium and potassium iodine solutions Dexamethasone Beta blockers Surgery and subtotal thyroidectomy Relapse of disorder is common Disease or treatment may result in hypothyroidism

Nursing Management of Hyperthyroidism : 

Nursing Management of Hyperthyroidism Administer antithyroid medications Monitor for s/sx of hypothyroidism, which may occur with overmedication Assess nutritional status Provide increased calories and protein Provide eye protection Eye patches, eye lubricant, tape eyes closed in needed Prepare patient and family for thyroidectomy

Thyroid Storm : 

Thyroid Storm Manifestations include Tachycardia Heart failure Shock Hyperthermia Restlessness Abdominal pain Vomiting /Nausea Diarrhea Agitation Seizures Delirium Coma

Management of Thyroid Storm : 

Management of Thyroid Storm Treatment ↓ Thyroid hormone levels and clinical manifestations with drug therapy Therapy Aimed at managing respiratory distress, fever reduction, fluid replacement, and management of stressors

Thyroidectomy : 

Thyroidectomy Treatment of choice for thyroid cancer and diffuse goiter and when drug therapy of hyperthyroidism fails Cancer surgery may include modified or radical neck dissection, and may include treatment with radioactive iodine to minimize metastasis Preoperative goals include the reduction of stress and anxiety to avoid precipitation of thyroid storm Preoperative teaching includes dietary guidance to meet patient metabolic needs and to avoid caffeinated beverages and other stimulants, explanation of tests and procedures, and demonstration of proper postoperative head support

Thyroidectomy : 

Thyroidectomy Before surgery Antithyroid drugs, iodine, and β- adrenergic blockers may be administered To achieve euthyroid state To control symptoms To reduce bleeding Preoperative teaching Coughing, deep breathing and leg exercises Supporting head while turning in bed Range of motion exercises of neck Speaking difficulty for a short time after surgery Routine postop care

Nursing Management/Thyroidectomy : 

Nursing Management/Thyroidectomy Postoperative care Every 2 hours for 24 hours Assess for signs of hemorrhage Assess for tracheal compression Irregular breathing, neck swelling, frequent swallowing, choking Keep tracheostomy tray near patient at all times during immediate post-op (24-hours) High-Fowler’s - Semi-Fowler’s position Support head with pillows Avoid flexion of neck Tension on suture lines

Nursing Management/Thyroidectomy : 

Nursing Management/Thyroidectomy Postoperative care (cont.) Monitor vitals Control pain Check for tetany Trousseau’s and Chvostek sign should be monitored Monitor for 72 hours Evaluate difficulty in speaking/hoarseness Some hoarseness for 3 to 4 days is expected

Discharge teaching after Thyroidectomy : 

Discharge teaching after Thyroidectomy Monitor thyroid levels periodically Decrease caloric intake to prevent weight gain Avoid high environmental temperatures Teach signs and symptoms of thyroid failure After complete thyroidectomy: Lifelong thyroid replacement instruction