Endocrine System - (part 2 of 3)
Hypoparathyroidism
1) Deficiency of parathormone usually due to surgery (thyroidectomy, parathyroidectomy, or radical neck dissection) 2) Results in hypocalcaemia and hyperphosphatemia
Thyroidectomy - Post Op Care
1) Monitor dressing for potential bleeding & hematoma formation; check posterior dressing 2) Monitor respirations; potential airway impairment 3) Monitor for hypocalcemia: tingling, muscle twitching, numbness of mouth or distal extremities (potential hypocalcemia related to injury or removal of parathyroid glands) 4) Assess pain and provide pain relief measures 5) Assess for laryngeal nerve damage by asking patient to speak 6) Semi-Fowler's position for venous return from head & neck, decreases oozing into the incision, support head 7) Chvostek Sign, Trousseau Sign neuro muscular irritability from hypocalcemia
Hyperthyroidism - Complications:
1) Myxedema Coma - a life threatening condition 2) Occurs when hypothyroidism is untreated or when a stressor, such as infection affects a patient with hyperthyroidism 3) Patients who have been taking synthroid and suddenly stop
Total Thyroidectomy
1) Performed for certain types of cancer 2) Lifelong thyroid replacement is required
Subtotal Thyroidectomy
A) Surgical removal of part or all of the thyroid B) Remaining thyroid tissue usually supplies enough hormone for normal function C) Treatment of hyperthyroidism when medication therapy fails or radiation is contraindicated D) May be used to correct diffuse goiter & thyroid cancer
Hyperthyroidism - NSG DX
Activity intolerance Constipation Risk for imbalanced body temp Ineffective breathing pattern related to depressed ventilation Deficit knowledge about therapeutic regimen for life long thyroid replacement therapy {ACRID}
Hyperthyroidism - Therapy
Affects women 5X more frequently than men Radioactive Iodine, Iodine deficiency, Iodine excess Thyroidectomy Meds lithium, iodine compounds, antithyroid meds, amiodarone, sulfonamides Iodine deficiency, & iodine excess Insufficient Iodine in the diet {slide #31 is a mess -?}
Hypothyroidism - Causes
Autoimmune thyroiditis; Hashimoto's disease (most common cause), #1 cause of hypothyroidism in USA
Hemorrhage (post op)
Bleeding at the site secondary to excessive coughing or movement Support head and neck Avoid flexion and extension of the neck
Hyperparathyroidism - Signs & Symptoms
CALCIUM ACTS LIKE A SEDATIVE Too much calcium in the body, everything is sedated. Too little calcium in the blood, everything is hyperactive- muscles tight and twitchy. When you think of the parathyroid glands, think CALCIUM.
Hyperparathyroidism - Causes
Dysfunction of the parathyroid gland, adenoma - benign tumor - secrete PTH Renal failure - secondary cause of hyperparathyroidism Renal failure phosphorus is not excreted, causing hyperphosphatemia, therefore causing hypocalcemia (due to inverse relationship) This situation stimulates the production of PTH Vitamin D deficiency
Myxedema
Extreme symptoms of severe hypothyroidism May progress to stupor, coma, & death Mucopolysacchides that trap fluid in the interstitial space Pleural, cardiac & abdominal effusions can result from this process Stupor, hypoventilation, hypoglycemia, hypotension, hypothermia
Parathyroid gland
Four glands on the posterior thyroid gland Parathormone regulates calcium & phosphorus balance Increased parathyroid hormone elevates blood calcium by increasing calcium absorption from the kidney, intestine, and bone. Parathormone lowers phosphorus level.
Nerve damage (post op)
Incision damage or swelling can cause nerve damage Assess voice: A hoarse voice is not typically permanent
Hyperthyroidism - Nursing Care
Increase activity level gradually Provide extra clothing, blankets, dress in layers, increase temp of the room. Avoid heating blankets. Provide low calorie, high bulk diet, stool softeners. Avoid fiber laxatives which interfere w absorption of synthroid. Levothyroxine (synthroid) - thyriod replacement therapy Increases effects of coumadin, can increase need for insulin and digoxin Titration of levothyroxine is slow, life long therapy, will have to monitor TSH CNS depressants are contraindicated or given in lower doses Monitor cardiovascular changes ( low B/p, bradycardia, dysrythmias External warming devices are contraindicated - cause vasodilation and vascular collapse
Hypoparathyroidism - Treatment
Increase serum calcium level to 9—10 mg/dL Diet high in calcium & low in phosphorus Po calcium, increase dietary intake of calcium Calcium acetate given w meals to bind phosphate Calcium gluconate IV Cacium potentiates dig Phosphorous binding drugs; Maalox, Mylanta, amphogel Vitamin D, Maintain airway, Seizure precautions Environment free of noise, drafts, bright lights, sudden movement Parathormone may be administered; potential allergic reactions May also use sedatives (ex. pentobarbital) to decrease neuromuscular irritability
Myxedema Coma - NSG Care
Maintain airway IV fluids ECG monitoring ABG Warm with blankets Synthroid IV, watch cardiac status Monitor glucose Assess for sources of infection
Thyroid Storm (Nsg Actions)
Maintain patent airway, cool sponge bath, Admin PTU, sodium iodide 1 hour after PTU, Propranolol, corticosteroids, admin IV fluids, monitor CHF & stroke, O2, decrease body temp, sedate for comfort
A 20 year old female comes to the clinic because she has experienced a weight loss of 20lbs over the last month, even though her appetite has been ravenous and she hasn't changed her activity level. She's diagnosed with Graves' disease. Which other signs and symptoms support the diagnosis of Graves' disease? Select all that apply: 1. Rapid bounding pulse 2. Bradycardia 3. Heat intolerance 4. Mild tremors 5. Nervousness 6. Constipation
Okay, so...what's the correct response?
A 56 year old female patient is being discharged after undergoing a thyroidectomy. Which discharge instructions would be appropriate for this patient? Select all that apply: 1. "Report signs and symptoms of hypoglycemia 2. "Take thyroid replacement medication as ordered" 3. "Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, dry skin, and report these changes to the physician." 4. "Recognize the signs of dehydration." 5. "Carry injectable dexamethasone at all times."
Okay, so...what's the correct response?
A client receiving thyroid replacement therapy develops the flu and take her thyroid replacement medicine. The nurse understands that skipping this medication will put the patient at risk for developing which life-threatening complication? 1. Exophthalmos 2. Thyroid Storm 3. Myxedema Coma 4. Tibial myxedema
Okay, so...what's the correct response?
A patient is being treated for hypothyroidism. The nurse knows that thyroid replacement therapy has been inadequate when she notes which findings? Select all that apply: 1. Prolonged QT interval on EKG 2. Tachycardia 3. low body temp 4. Nervousness 5. Bradycardia 6. Dry mouth
Okay, so...what's the correct response?
Parathyroid hormone (PTH) has which effects on the kidney? 1. Stimulation of calcium re-absorption & phosphate excretion. 2. Stimulation of phosphate re-absorption & calcium excretion. 3. Increased absorption of Vit D & excretion of Vit E. 4. Increased absorption of Vit E & excretion of Vit D.
Okay, so...what's the correct response?
What does a positive Chvostek's sign indicate? 1. Hypocalcemia 2. Hyponatremia 3. Hypokalemia 4. Hypermagnesemia
Okay, so...what's the correct response?
Hyperparathyroidism
Overproduction of parathromone Hypercalcemia, hypophosphatemia, cognitive changes
Tests (for Hyperparathyroidism?)
Parathormone elevated Imaging studies Serum calcium elevated Serum phosphate low Bone mineral density
Hyperparathyroidism - Treatment
Parathyroidectomy Biphosphates- given to elevate phosphorous level Calcitonin- drives calcium into bone. Encourage mobility Hydration therapy a) Risk for renal calculi b) Avoid thiazides - decrease the renal excretion of calcium Watch for peptic ulcer- high serum calcium causes stomach to produce excess acid Hypercalcemic crisis - serum calcium level > 15mg/dl- result in neuro, cardiac, renal symptoms - Rx IV fluids, calcitonin, diuretics, biphosphates {Why is this on the Treatment slide? Is this a treatment or a condition?}
Thyroidectomy - Post Op Meds
Prednisone: for post op edema Lasix: reduces swelling caused by fluid retention Calcium gluconate: Calcium supplement for emergency treatment of hypocalcemia due to damage of the parathyroid {PLC = TLC!}
Airway Obstruction (post op)
Suctioning equipment Humidified air Tracheostomy tray at the bedside {oh, SHiT!}
Hyperthyroidism - Lab Values
T3 T4 decreased, TSH elevated (primary hypothyriodism) T3 T4 decreased, TSH decreased (secondary hypothyroidism) Serum Cholesterol high
Thyroidectomy - Post Op Complications
Thyroid Storm Hemorrhage Airway Obstruction Nerve Damage {THAN}
Thyroid Storm
Thyrotoxicosis crisis Medical emergency High mortality rate
Hypoparathyroidism
Too little PTH
Thyroid Storm (Symptoms)
hyperthermia, hypertension, delirium, vomiting, abdominal pain, hyperglycemia, and tachydysrythmias
Hypercalcemic Crisis & Rx
serum calcium level > 15mg/dl - result in neuro, cardiac, renal symptoms Rx IV fluids, calcitonin, diuretics, biphosphates
Hypoparathyroidism - Signs & Sx
tetany, numbness and tingling in extremities stiffness of hands & feet, bronchospasm, laryngeal spasm, carpopedal spasm anxiety, irritability, depression, delirium, ECG changes seizures Lack of calcium- not enough sedative a) Chvostek's sign b) Trousseau's sign