Chapter 43 and 44
when I say parathyroid, you should think
calcium
caused by disorders affecting the anterior pituitary gland or the hypothalamus
hypothyroidism
enlargement of thyroid gland secondary to thyroid gland hypertrophy in an attempt to produce TH; not cancerous
goiter
clinical manifestations of hypothyroidism?
condition resulting from an increased deposition of glycosaminoglycans in cells and tissues
myxedema
the diagnosis of hypothyroidism is confirmed through analysis of laboratory data, including ___, ___, and ___
T3, T4, and TSH
primary treatment for hypothyroidism?
replacement of thyroid hormone
the most commonly prescribed medication for hypothyroidism?
levothyroxine (Synthroid)
what is important teaching for our patients taking levothyroxine (Synthroid)?
what are T3, T4, and TSH levels doing in hypothyroidism?
T3 and T4 are decreased
TSH is increased
in patients with a history of cardiovascular disease, the increases in dosage of levothyroxine are made cautiously because?
sudden increases in cardiac rate and contractility secondary to the medication may lead to angina or CHF
possible complication of hypothyroidism?
most severe type of hypothyroidism and is characterized by hypoxia and CO2 retention (secondary to hypoventilation), fluid and electrolyte imbalances, and hypothermia; bradycardic and hypotensive
myxedema coma
patients with hypothyroidism who are receiving sedatives, hypnotics, or narcotics require close observation because??
the metabolism of the medication is slower, and respiratory compromise may occur with normal dosages
most common cause of hyperthyroidism and is an autoimmune disorder involving antibodies that bind to the thyroid gland, resulting in enlargement of the thyroid gland and subsequent hypersecretion of thyroid hormone
Graves' disease
accelerated metabolism is characteristic of hyperthyroidism and affects most body systems
hyperthyroidism
hyperthyroidism clinical manifestations?
what are T3, T4, and TSH levels doing in hyperthyroidism?
pharmacological agents that may be used for symptom management include?
beta-adrenergic blocking agents because these agents slow heart rate and decrease palpitations
patients with hyperthyroidism require close monitoring of their fluid and electrolyte status because??
the hypermetabolic state increases insensible water loss through perspiration as well as elevated metabolic rate
thyrotoxicosis is a medical emergency requiring definitive treatment to prevent
respiratory compromise and cardiac collapse
what are the 2 most common anti-thyroid meds?
postop thyroidectomy things to monitor for?
airway compromise, hemorrhage, hypocalcemia secondary to removal of all parathyroid gland tissue and damage to the laryngeal nerve
postop thyroidectomy, the patient is positioned in __________ to???
semi-fowler's to ease the work of breathing and to decrease the risk of aspiration of oral secretions associated with lying flat on the back
a _______ is maintained at the bedside because of the risk of respiratory compromise secondary to postoperative swelling, tetany, and laryngeal damage
tracheostomy tray
what are some things that may be indicative of laryngeal nerve damage?
what can develop with poorly managed hyperthyroidism?
thyroid storm or thyrotoxicosis
clinical manifestations of thyroid storm or thyrotoxicosis?
during hyperthyroid crisis, the patient must be monitored closely for?
Ca+ range?
8.2-10.2
Mg+ range?
1.6-2.2
Phosphorus range?
2.5-4.5
hypocalcemia is the primary disorder of?
hypoparathyroidism
clinical manifestations of hypoparathyroidism?
what are calcium, PTH, and phosphate levels during hypoparathyroidism?
low calcium and PTH
high phosphate
hypocalcemia is a medical emergency when associated with tetany and laryngospasm because
this complicates placement of the ET tube; a trach tray is often placed at the bedside of patients at risk as a result of thyroid surgery or severe hypocalcemia
in patients with a history of cardiac disease, IV administration of calcium should be slow to minimize
hypotension and bradycardia
what are some foods high in calcium used in the treatment of hypoparathyroidism?
fruits and fruit juices
dark green, leafy vegetables
soy products
causes hypercalcemia secondary to its actions on bone, kidneys, and the bowel
hyperparathyroidism
clinical manifestations of hyperparathyroidism?
in hyperparathyroidism, increased fluid intake is indicated to minimize potential?
renal injury secondary to elevated calcium, and in patients with mild disease, increased oral fluid intake may treat the disorder
patients with hyperparathyroidism should decrease consumption of?
calcium-containing antacids and vitamin D
what medication should be avoided in patients with hyperparathyroidism because it increases the reabsorption of calcium in the kidney?
thiazide diuretics
what are calcium, PTH, and phosphate levels during hyperparathyroidism?
high calcium and PTH
low phosphate
The nurse correlates which clinical manifestation to the pathophysiology of hypothyroidism?
A. Cold intolerance
B. Weight loss
C. Insomnia
D. Diarrhea
A.
The nurse correlates an increase in which laboratory value to the diagnosis of primary hyperthyroidism?
A. Thyroxine (T4)
B. Thyroid-stimulating hormone (TSH)
C. Serum calcium
D. Serum iodine
A
The patient experiencing thyroid storm is ordered to receive beta-adrenergic agents. The nurse monitors for which therapeutic effect of these medications?
A. Increased respiratory rate
B. Increased appetites
C. Decreased heart rate
D. Decreased bowel sounds
C
The nurse correlates a positive Chvostek sign to hyposecretion of which hormone?
A. Thyroxin (T4)
B. Thyrocalcitonin
C. Parathyroid hormone (PTH)
D. Triiodothyronine (T3)
C
The nurse monitors the calcium levels closely in the patient taking digoxin (Lanoxin) because hypocalcemia may lead to which complication?
A. Elevated heart rate
B. Dysrhythmias
C. Increased cardiac contractility
D. Hypertension
B
The nurse prioritizes which nursing diagnosis in the patient after partial parathyroidectomy?
A. High risk for ineffective airway clearance linked to hypocalcemia
B. High risk for ineffective breathing pattern linked to hypercalcemia
C. High risk for hyperventilation linked to hypersecretion of triiodothyronine
D. High risk for airway compromise linked to insufficient iodine stores
A
A nurse is caring for a client who is 8hr postoperative following a subtotal thyroidectomy. In which of the following positions should the nurse keep the client?
A. High fowler's with neck extended
B. High fowler's with neck in a neutral position
C. Semi-fowler's with neck extended
D. Semi-fowler's with neck in a neutral position
D. Semi-fowler's with neck in a neutral position
A nurse is caring for a client who has developed agranulocytosis as a result of taking propylthiouracil to treat hyperthyroidism. The nurse should understand that this client is at increased risk for which of the following conditions?
A. Excessive bleeding
B. Ecchymosis
C. Infection
D. Hyperglycemia
C. Infection
decrease in WBC
agranulocytosis
A nurse is assessing a client who has hypothyroidism. The nurse should expect which of the following findings?
A. Exophthalmos
B. Palpitations
C. Weight gain
D. Diaphoresis
C. Weight gain
A nurse is caring for a client who had total thyroidectomy and a serum calcium level of 7.6mg/dL. Which of the following findings should the nurse expect?
A. Tingling of the extremities
B. Hypoactive deep tendon reflexes
C. Shortened QT intervals
D. Constipation
A. Tingling of the extremities
A nurse is teaching about levothyroxine with a client who has primary hypothyroidism. Which of the following statements should the nurse use when teaching the client?
A. "Take this medication until your symptoms are gone and then discontinue."
B. "Tremors, nervousness, and insomnia may indicate your dose is too high."
C. "Symptoms improve immediately after starting the medication."
D. "The medication decreases the overproduction of the thyroid hormone thyroxine."
B.
A nurse is assessing a client who has hypothyroidism. Which of the following findings should the nurse expect?
A. Lethargy
B. Exopthalmos
C. Weight loss
D. Photophobia
A. Lethargy
A nurse is teaching a client who has a new diagnosis of hyperparathyroidism. The nurse should include in the teaching that the client is at risk for which of the following complications?
A. Impaired skin integrity
B. Fluid retention
C. Pathologic fractures
D. Dysphagia
C. Pathologic fractures
A nurse is reviewing the laboratory results for four clients. The nurse should recognize which of the following clients has a manifestation of hypoparathyroidism?
A. A client who has a vitamin D of 25ng/mL
B. A client who has a magnesium of 1.8mEq/L
C. A client who has a calcium of 9.8mg/dL
D. A client who has a phosphate of 5.7mg/dL
D.
A nurse is assessing a client who has hypoparathyroidism. Which of the following findings should the nurse expect?
A. Flaccid muscles
B. Client report of numbness in his hands
C. Negative Chvostek's sign
D. Client report of anorexia
B. Client report of numbness in his hands