Addison, Cushing, Hypothyroid, Hyperthyroid,

Androgens

(adrenal sex hormones/sex steroids) -the 3rdmajor type of steroid hormones produced by the adrenal cortex - Not essential to life - Play some role in female adolescent - The adrenal gland may also secrete small amounts of estrogens (female hormones) - ACTH controls the secretion of adrenal androgens

Glucocorticoids

(the "sugar" hormones) - have an influence on glucose metabolism - cortisol - essential to life - The prototype is hydrocortisone - increased hydrocortisone secretions result in high glucose levels/gluconeogenesis - Decreases protein synthesis, increase protein catabolism/breakdown

PRIMARY ALDOSTERONISM

- Aldosterone secreting tumor - patient exhibits profound alkalosis and hypokalemia - Hypertension is the most prominent and almost a universal sign of aldosterorism - Hypokalemic alkalosis may decrease serum calcium level resulting in tetany and paresthesia - - Glucose intolerance may occur leading to hyperglycemia - The urine volume is excessive, leading to polyuria - Serum by contrast becomes concentrated leading to polydipsia

assessment findings for cushings

- Cortisol excess . Increased protein breakdown . Alteration in carbohydrate metabolism producing muscle wasting and osteoporosis . Abdominal pain, gastritis, ulcers . Immnunosuppression -slow healing of minor cuts and bruises, thin, fragile skin; easily traumatized, ecchymosis, strae . Mood swings/disturbances, psychosis . "Moon-faced" appearance - Aldosterone excess: . Weight gain, edema . Hypernatremia, hypokalemia . Hypertension - Sex steroid excess: . In female -acne, hirsutism,amenorrhea, breast atrophy, thinning of scalp hair . In male -gynecomastia, decreased libido

cortisol replacement

- Cortisone, hydrocotisone, prednisolone, prednisone - Taken BID -larger doses in a.m. and smaller doses in p.m. - Increase dose of therapy during stressful procedures or significant illnesss - May need to supplement dietary intake with added salt during GI losses of fluids during vomiting and diarrhea - Advise to carry an emergency kit with Solu-cortef and a syringe

diagnostics for cushings

- Elevated cortisol level in a.m. and p.m. - Metabolic alkalosis, decreased chloride - Elevated 17-OHCS - Elevated 17-KS

diagnostics Pheochromocytoma

- Elevated urinary catecholamines and vanillymandelic acid (VMA) - Regitine test: Measures BP before and after administration of regitine (phentolamine) - Immediate decrease of 35mmHg systolic and 25mmHg diastolic indicates positive test - CT scan and MRI - MIBG (metaiodobenzylguanidine): Radioactive dye concentrates in tumor only is vidualized on xray i.e this imaging test uses a radioactive substance (called a tracer) and a special scanner to find or confirm the presence of pheochromocytoma and neuroblastoma

post op teaching thyroidectomy

- Exercise - inform patient to do head and neck exercises 2 to 3 times a day as tolerated - Avoid iodine - Avoid premature use of hormone replacement - Risk for thyroid storm (thyroidectomy) - Teach s/s of hypothyroidism - Alternate exposure to hot and cold.

musculoskeletal s&s hypothyroid

- General muscular weakness and pain, including cramps, and stiffness - General joint pain, achiness, stiffness, known as "arthropathy" - Tendonitis in the arms and legs involves pain, tingling, weakness, achiness or numbness in the wrist, fingers or forearm - Tarsal tunnel syndrome - similar to carpal tunnel, with pain, tingling, burning and other discomfort in the arch of your foot - Carpel tunnel syndrome - which involves pain, tingling, weakness, achiness or numbness in the wrist, fingers or forearm

causes of congenital hypothyroidism

- In most cases, the cause of congenital hypothyroidism is unknown. - Medication during pregnancy, such as radioactive iodine therapy - Maternal autoimmune disease - Too much iodine during pregnancy - Anatomic defect in thyroid gland

cardiac changes in hypothyroidism

- Include a decrease in cardiac output and cardiac contractility - Reduction in heart rate - Also significant changes including diastolic htn **For people with almost any type of heart disease, disorders of the thyroid gland can worsen old cardiac symptoms or cause new ones, and can accelerate the underlying heart disorder. **Thyroid disease can even cause cardiac problems in people with healthy hearts**

Acute Adrenal Crisis:Addisonian Crisis

- It is life threatening - Characterized by cyanosis and classic signs of circulatory shock such as pallor, tachypnea, hypotension, etc. - Patient may c/o headache, abdominal pain, nausea, diarrhea - Precipitated by stressors - Severe fluid loss - The stress of surgery -possibly hypophysectomy and adrenalectomy or dehydration resulting from preparation for tests or surgery may precipitate Addisonian Crisis

Care for Acute Adrenal Crisis

- Medical emergency -restore BP, replace hormone therapy - Fluid replacement with D5 NS, albumin and whole blood for volume - Administer steroids -Solu-cortef 100-200 mg bolus IV, then 100 mg IVPB every 6 hours as ordered - Monitor for hypoglycemia -give 50% dextrose bolus IV, high carbohydrate diet - Minimize stressors STRICT BEDREST: - Provide periods of rest in a quiet environment - Minimize physical and psychological stressors such as cold exposure , overexertion as much as possible - Encourage to increase activity gradually as tolerated - Treat underlying cause - Protect from infection - Offer emotional support

Aldosterone Replacement

- Need to increase salt intake - Fludrocortisone acetate (florinef) -0.5-2 mg po once daily - Desoxycorticosterone acetate (DOCA) . 1-2 mg IM daily . Subcutaneous implants -last 9 to 12 months

diagnostics for PTH

- PTH intact - Serum calcium as well as phosphorus - The urinary phosphorus is elevated in the hypersecretion of the parathyroid hormone

Cushing's Syndrome

- Primary hyperfunction due adrenal nodules or hyperplasia - More common in women than in men

diagnostics for hyperpatathyroidism

- Primary parathyroidism - persistent elevation of serum calcium levels >10 and elevated parathyroid hormone - Decreased serum phosphorus - Increased urinary phosphorus and calcium - Xray showing bone changes

ADRENOCORTICAL INSUFFICIENCY/ADRENAL CORTICAL HYPOFUNCTION

- Reduced adrenal gland activity due to damage to the adrenal gland or lack of stimulation of the gland - Deficiency of cortisol, aldosterone and adrenal sex hormones/steroids (androgens)

treatment and nursing care for cushings

- Reduction of hormone levels - Pituitary surgery for ACTH secreting tumor - Adrenalectomy:Either both glands, 1 gland or resection/removal of the tumor (if 1 adrenal gland is removed; replacement therapy may be temporary necessary, if both glands are removed then replacement of corticosteroids will be lifelong) . Laparoscopic approach for single nodules . Convertional surgery:Risk for adrenal crisis, care similar for adrenal crisis. May require hormone replacement Drugs to Block Synthesis of Cortisol: -Metyrapone, mititane, aminoglultethamide -Will cause hormone deficit, replacement required

PTH

- Regulates serum calcium and phosphorus/tends to lower the blood phosphorus level and increases calcium - Activates vitamin D in the kidney - Stimulates osteoclastic activity thus increasing bone resorption - Stimulated by hypocalcemia and hyperphosphatemia - Increases renal excretion of phosphorus - Inhibited by high calcium levels (hypercalcemia) and low phosphorus levels (hypophosphatemia)

treatment and nursing care for hyperparathyoidism

- Resection of the tumor - parathyroidectomy - For asymptomatic patients with mildly elevated calcium levels, and normal renal function surgery may be delayed - Restore fluid and electrolyte balance - Replace fluids accordingly - Reduce calcium levels - Monitor lab values/potassium levels and assess arrhythmias - Administer lasix IV - Assist with ADL's and encourage weight bearing activity

treatment for aldosteronism

- Surgical removal/resection of the tumor - Encourage low sodium and high potassium diet -may need potassium supplements - Administer spiranolactone (aldactone) -potassium sparing diuretic - Monitor vital signs especially BP, daily weight, and strict I/O's

hair, skin, nails s&s hypothyroid

- Thickened dry skin, the face becomes expressionless and masklike, the tongue enlarges, the hands and feet enlarge in size - Reports of thinning hair leading to hair loss - The nails are weak and brittle

treatment for addisonian crisis

- Treatment is directed toward combating circulatory shock, restoring blood circulation - Lifelong hormone replacement if adrenal gland does not regain function (to prevent recurrence of adrenal insufficiency) - Never stop taking medications or skip doses - Identify other factors, stressors or illnesses that led to the acute episode

treatment and nursing care for hypoparathyroid

- Treatment is usually not with PTH replacement - Assess for signs of hypocalcemia - tetany, etc. - Offer lifetime calcium replacement - Give a high calcium and lowphosphorus diet - Give tums, phoslo, aluminum based anti acids with meals - they bind with phosphorus by preventing the body from absorbing the phosphorus from the food one eats, help to pass excess phosphorus out of the body in the stool, reducing the amount of phosphorus that gets into the blood (usually taken 5-10 minutes before meals)

Iatrogenic Cushing's Syndrome

- Treatment with glucocorticoids for conditions other than hormone deficit

thyroid hypofunction causes...

- Untreated permanent/physical retardation - Congenital lack of T3 and T4 - Cretinism (A congenital condition caused by a deficiency of thyroid hormone during prenatal development and characterized in childhood by dwarfed stature, mental retardation, dystrophy of the bones, childhood by dwarfed stature, mental retardation, dystrophy of the bones, and a low basal metabolism - also called congenital myxedema.

treatment and nursing care for Pheochromocytoma

- Very crucial to stabilize the BP and remove the tumor WATER: Increased cardiac output - Patient need intensive care and monitoring of BP and other vital signs - Administer IV nitroprusside titrated to reduce the BP or use of regitine IV - Change to dibenzyline po or regitine po once patient is stabilized - Administer propanolol (beta blocker) ACTIVITY AND REST: - Maintain bedrest with HOB elevated - Provide a quiet and semi-darkened room - Conserve energy as much as possible - Reassure patient and offer emotional support *Surgical Treatment: Important to stabilize the BP first - No atropine pre-operatively - Possible laparoscopic approach -not as invasive - BP very labile post-operatively - Life long hormone replacement therapy required if both adrenal glands are removed

Thyroid Storm (Thyrotoxicosis)

- a medical emergency condition and needs to be treated emergently; even before all confirmatory diagnostic tests are performed - a severe hypermetabolic state, hyperthemia associated with untreated or undertreated hyperthyroidism. - During thyroid storm person is critically ill and requires aggressive and supportive nursing care during and after the acute stage of illness - Individual's heart rate, blood pressure, and body temperature can soar to dangerously high levels - without prompt, aggressive treatment, thyroid storm is often fatal

corticosteroids

- given frequently to inhibit the inflammatory response to tissue injury (i.e. Produces anti-inflammatory effect) and to suppress allergic manifestations - Their side effects include the development of diabetes mellitus, osteoporosis, peptic ulcer, increased protein breakdown resulting in muscle wasting and poor wound healing and redistribution of fat - Diurnal secretion pattern (i.e. occurring or active during the daytime rather than at night - peaks early in the morning) - Mobilizes fat for energy production

assessment findings Pheochromocytoma

- hypertension - Episodic Paroxysmal attacks: Severe headache, palpitations, tachycardia, visual disturbances, tremors, anxiety,, chest, abdominal pain dizziness, diaphoresis, nausea, etc. - Attacks increase in frequency - High risk of ventricular fibrillation (VF), heart failure, stroke and even death

Epinephrine

- secreted by the adrenal medulla - increases HR, BP, respiratory rate, muscle strength, blood sugar, bronchodilation, and mental alertness. - Reduces the amount of blood going to the skin and increase blood flow to the major organs, the such as the brain, heart, GI system, and kidneys

causes of primary hypothyroidism

- thyroid can't produce amount of hormone pituitary calls for - Iodine deficiency - Auto immune Hashimoto's thyroiditis - The most common cause of inadequate formation of the gland hypothyroidism - caused by the inflammation of the thyroid gland

causes of secondary hypothyroidism

- thyroid isn't being stimulated by pituitary to produce hormones - Thyroidectomy or irradiation of the thyroid gland - T4 synthesis defect

cardiac s&s of hypothyroidism

-Dyspnea on exertion and poor exercise tolerance - In people who also have heart disease dyspnea may be due to worsening heart failure -Bradycardia - heart rate is modulated by thyroid hormone with hypothyroidism the heart rate is typically 10 - 20 beats per minute slower than normal - Arteries are stiffer in hypothyroidism - causes the diastolic blood pressure to rise - Diastolic hypertension - one might think that, because a lack of thyroid hormone slows down the metabolism, people with hypothyroidism might suffer from hypotension - usually the opposite is true - Worsening of heart failure or the new onset of heart failure - Edema - can occur as a result of worsening heart failure - In addition, hypothyroidism itself can produce a type of edema called myxedema - Worsening of coronary artery disease (CAD) - The increase in LDL cholesterol (bad cholesterol) and in C-reactive protein seen with hypothyroidism can accelerate any underlying CAD hypothyroidism and suppressing nontoxic goiters

treatment for thyroid storm

-High doses of thioamides -Replace fluids -Reduce fever (no aspirin - it displaces the thyroid hormone from binding proteins; as a result, worsens the hypermetabolism) -Corticosteroids - inhibit peripheral conversion of T4 into T3 and have been shown to improve outcomes in patients with thyroid storm. - Propanolol ( beta blocker) - lowers the heart rate; hold for bradycardia

Pheochromocytoma

. Catecholamine secreting tumor -excess epinephrine and norepinephrine . Tumor is located in the medulla, abdominal cavity, or the sympathetic nervous system . Usually benign . Mostly seen in adults 40-60 years of age . Hypertensive child needs to be screened for pheochromocytoma

Which important instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach a client?

1. "Take the drug on an empty stomach." The nurse should instruct the client to take levothyroxine on an empty stomach (to promote regular absorption) in the morning (to help prevent insomnia and to mimic normal hormone release).

A client with Hashimoto's thyroiditis and a history of two myocardial infarctions and coronary artery disease is to receive levothyroxine (Synthroid). Because of the client's cardiac history, the nurse would expect that the client's initial dose for the thyroid replacement would be: 1. 25 g/day, initially. 2. 100 g/day, initially. 3. delayed until after thyroid surgery. 4. initiated before thyroid surgery.

1. 25 g/day, initially. Elderly clients and clients with cardiac disease should begin with low-dose levothyroxine increased at 2- to 4-week intervals until 100 g/day is reached. This slow titration prevents further cardiac stress. Younger clients would be started on the usual maintenance dose of 100 g/day. Clients with Hashimoto's thyroiditis don't require surgical intervention.

Before discharge, what should a client with Addison's disease be instructed to do when exposed to periods of stress? 1. Administer hydrocortisone I.M. 2. Drink 8 oz of fluids. 3. Perform capillary blood glucose monitoring four times daily. 4. Continue to take his usual dose of hydrocortisone.

1. Administer hydrocortisone I.M. Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. It's important to keep well hydrated during stress, but the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.

A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem? 1. Depression 2. Neuropathy 3. Hypoglycemia 4. Hyperthyroidism

1. Depression Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.

The nurse is caring for a client in acute addisonian crisis. Which laboratory data would the nurse expect to find? 1. Hyperkalemia 2. Reduced blood urea nitrogen (BUN) 3. Hypernatremia 4. Hyperglycemia

1. Hyperkalemia In adrenal insufficiency, the client has hyperkalemia due to reduced aldosterone secretion. BUN increases as the glomerular filtration rate is reduced. Hyponatremia is caused by reduced aldosterone secretion. Reduced cortisol secretion leads to impaired glyconeogenesis and a reduction of glycogen in the liver and muscle, causing hypoglycemia.

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? 1. Hypocalcemia 2. Hyponatremia 3. Hyperkalemia 4. Hypermagnesemia

1. Hypocalcemia Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery.

What does a positive Chvostek's sign indicate? 1. Hypocalcemia 2. Hyponatremia 3. Hypokalemia 4. Hypermagnesemia

1. Hypocalcemia Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. If the client's facial muscles twitch, it indicates hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping, muscle weakness, headache, and postural hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes, coma, or cardiac arrest.

The physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? 1. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test 2. A decreased TSH level 3. An increase in the TSH level after 30 minutes during the TSH stimulation test 4. Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay

1. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.

After undergoing a subtotal thyroidectomy, a client develops hypothyroidism. The physician prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent? 1. Primary hypothyroidism 2. Graves' disease 3. Thyrotoxicosis 4. Euthyroidism

1. Primary hypothyroidism Levothyroxine is the preferred agent to treat primary hypothyroidism and cretinism, although it also may be used to treat secondary hypothyroidism. It is contraindicated in Graves' disease and thyrotoxicosis because these conditions are forms of hyperthyroidism. Euthyroidism, a term used to describe normal thyroid function, wouldn't require any thyroid preparation.

A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? 1. Related to bone demineralization resulting in pathologic fractures 2. Related to exhaustion secondary to an accelerated metabolic rate 3. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces 4. Related to tetany secondary to a decreased serum calcium level

1. Related to bone demineralization resulting in pathologic fractures Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesn't accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn't associated with tetany.

Which nursing diagnosis is most appropriate for a client with Addison's disease? 1. Risk for infection 2. Excessive fluid volume 3. Urinary retention 4. Hypothermia

1. Risk for infection Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.

Parathyroid hormone (PTH) has which effects on the kidney? 1. Stimulation of calcium reabsorption and phosphate excretion 2. Stimulation of phosphate reabsorption and calcium excretion 3. Increased absorption of vitamin D and excretion of vitamin E 4. Increased absorption of vitamin E and excretion of vitamin D

1. Stimulation of calcium reabsorption and phosphate excretion PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

The nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? 1. Tetany 2. Hemorrhage 3. Thyroid storm 4. Laryngeal nerve damage

1. Tetany Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess: 1. Trousseau's sign. 2. Homans' sign. 3. Hegar's sign. 4. Goodell's sign.

1. Trousseau's sign. This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.

For a client with hyperthyroidism, treatment is most likely to include: 1. a thyroid hormone antagonist. 2. thyroid extract. 3. a synthetic thyroid hormone. 4. emollient lotions.

1. a thyroid hormone antagonist. Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.

When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of: 1. fresh fruits. 2. dairy products. 3. processed meats. 4. cereals and grains.

1. fresh fruits. Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit. The client should restrict consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium.

Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction would experience: 1. heat intolerance and systolic hypertension. 2. weight gain and heat intolerance. 3. diastolic hypertension and widened pulse pressure. 4. anorexia and hyperexcitability.

1. heat intolerance and systolic hypertension. An increased metabolic rate in a client with hyperthyroidism caused by excess serum thyroxine leads to systolic hypertension and heat intolerance. Weight loss — not gain — occurs due to the increased metabolic rate. Diastolic blood pressure decreases due to decreased peripheral resistance. Heat intolerance and widened pulse pressure can occur but systolic hypertension and diastolic hypertension don't. Clients with hyperthyroidism experience an increase in appetite — not anorexia.

For the first 72 hours after thyroidectomy surgery, the nurse would assess the client for Chvostek's sign and Trousseau's sign because they indicate: 1. hypocalcemia. 2. hypercalcemia. 3. hypokalemia. 4. hyperkalemia.

1. hypocalcemia. The client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.

Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia as indicated by: 1. muscle weakness. 2. tremors. 3. diaphoresis. 4. constipation.

1. muscle weakness. Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

In a 28-year-old female client who is being successfully treated for Cushing's syndrome, the nurse would expect a decline in: 1. serum glucose level. 2. hair loss. 3. bone mineralization. 4. menstrual flow.

1. serum glucose level. Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

A 56-year-old female client is being discharged after undergoing a thyroidectomy. Which discharge instructions would be appropriate for this client? 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, and dry skin, and report these changes to the physician." 4. "Recognize the signs of dehydration." 5. "Carry injectable dexamethasone at all times."

2. "Take thyroid replacement medication as ordered." 3. "Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin, and report these changes to the physician." After the removal of the thyroid gland, the client needs to take thyroid replacement medication. The client also needs to report such changes as lethargy, restlessness, cold sensitivity, and dry skin, which may indicate the need for a higher dosage of medication. The thyroid gland doesn't regulate blood glucose levels; therefore, signs and symptoms of hypoglycemia aren't relevant for this client. Dehydration is seen in diabetes insipidus. Injectable dexamethasone isn't needed for this client.

The nurse understands that for the parathyroid hormone to exert its effect, what must be present? 1. Decreased phosphate level 2. Adequate vitamin D level 3. Functioning thyroid gland 4. Increased calcium level

2. Adequate vitamin D level Adequate vitamin D must be present for parathyroid hormone to exert its effect — that is to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.

The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? 1. Pitting edema of the legs 2. An irregular apical pulse 3. Dry mucous membranes 4. Frequent urination

2. An irregular apical pulse Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

A middle-age female complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty". Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hr radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: 1. thyroiditis. 2. Graves' disease. 3. Hashimoto's thyroiditis. 4. multinodular goiter.

2. Graves' disease. Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-age females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, there is a low (≤2%) radioactive iodine uptake, and multinodular goiter will show an uptake in the high-normal range (3% to 10%).

A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. When he awoke this morning, his wife noticed that he acted confused and was extremely weak. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What would the nurse expect to administer by I.V. infusion? 1. Insulin 2. Hydrocortisone 3. Potassium 4. Hypotonic saline

2. Hydrocortisone Emergency treatment for acute adrenal insufficiency (Addisonian crisis) is I.V. infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until the client's blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.

Which condition would the nurse expect to find in a client diagnosed with hyperparathyroidism? 1. Hypocalcemia 2. Hypercalcemia 3. Hyperphosphatemia 4. Hypophosphaturia

2. Hypercalcemia Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hyperphosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.

The nurse should expect a client with hypothyroidism to report which health concern(s)? 1. Increased appetite and weight loss 2. Puffiness of the face and hands 3. Nervousness and tremors 4. Thyroid gland swelling

2. Puffiness of the face and hands Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? 1. Diabetic ketoacidosis 2. Thyroid crisis 3. Hypoglycemia 4. Tetany

2. Thyroid crisis Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

A client is being returned to the room after subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?

2. Tracheostomy set After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.

The nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?

2. Weight loss, nervousness, and tachycardia Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea.

A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by:

2. protruding eyes and a fixed stare. Exophthalmos is characterized by protruding eyes and a fixed stare.

A client with Addison's disease is scheduled for discharge after being hospitalized for an adrenal crisis. Which statements by the client would indicate that client teaching has been effective? 1. "I have to take my steroids for 10 days." 2. "I need to weigh myself daily to be sure I don't eat too many calories." 3. "I need to call my doctor to discuss my steroid needs before I have dental work." 4. "I will call the doctor if I suddenly feel profoundly weak or dizzy." 5. "If I feel like I have the flu, I'll carry on as usual because this is an expected response." 6. "I need to obtain and wear a Medic Alert bracelet."

3. "I need to call my doctor to discuss my steroid needs before I have dental work." 4. "I will call the doctor if I suddenly feel profoundly weak or dizzy." 6. "I need to obtain and wear a Medic Alert bracelet." Dental work can be a cause of physical stress; therefore, the client's physician needs to be informed about the dental work and an adjusted dosage of steroids may be necessary. Fatigue, weakness, and dizziness are symptoms of inadequate dosing of steroid therapy; the physician should be notified if these symptoms occur. A Medic Alert bracelet allows health care providers to access the client's history of Addison's disease if the client is unable to communicate this information. A client with Addison's disease doesn't produce enough steroids, so routine administration of steroids is a lifetime treatment. Daily weights should be monitored to monitor changes in fluid balance, not calorie intake. Influenza is an added physical stressor and the client may require an increased dosage of steroids. The client shouldn't "carry on as usual."

During the first 24 hours after a client is diagnosed with Addisonian crisis, which intervention should the nurse perform frequently? 1. Weigh the client. 2. Test urine for ketones. 3. Assess vital signs. 4. Administer oral hydrocortisone.

3. Assess vital signs. Because the client in Addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing the client's condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine for their presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency.

A client receiving thyroid replacement therapy develops the flu and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication will put the client at risk for developing which life-threatening complication? 1. Exophthalmos 2. Thyroid storm 3. Myxedema coma 4. Tibial myxedema

3. Myxedema coma Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos, protrusion of the eyeballs, is seen with hyperthyroidism. Thyroid storm is life-threatening but is caused by severe hyperthyroidism. Tibial myxedema, peripheral mucinous edema involving the lower leg, is associated with hypothyroidism but isn't life-threatening.

A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? 1. Dysuria 2. Leg cramps 3. Tachycardia 4. Blurred vision

3. Tachycardia Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. The other options aren't associated with levothyroxine.

Which of the following would the nurse expect to assess in an elderly client with Hashimoto's thyroiditis? 1. Weight loss, increased appetite, and hyperdefecation 2. Weight loss, increased urination, and increased thirst 3. Weight gain, decreased appetite, and constipation 4. Weight gain, increased urination, and purplish-red striae

3. Weight gain, decreased appetite, and constipation Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women over age 40. Weight gain, decreased appetite, constipation, lethargy, dry cool skin, brittle nails, coarse hair, muscle cramps, weakness, and sleep apnea are symptoms of Hashimoto's thyroiditis. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.

A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by:

3. a corticotropin-secreting pituitary adenoma. A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's syndrome in women ages 20 to 40. .

When caring for a client who's being treated for hyperthyroidism, it's important to:

3. balance the client's periods of activity and rest. A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest. Many clients with hyperthyroidism are hyperactive and complain of feeling very warm. Consequently, it's important to keep the environment cool and to teach the client how to manage his physical reactions to heat.

The nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find:

3. deposits of adipose tissue in the trunk and dorsocervical area. Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump).

When instructing the client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of: 1. restricting fluids. 2. restricting sodium. 3. forcing fluids. 4. restricting potassium.

3. forcing fluids. The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.

An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:

3. myxedema coma. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema.

A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of: 1. severe hypotension. 2. excessive thirst. 3. profound neuromuscular irritability. 4. acute gastritis.

3. profound neuromuscular irritability. Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism.

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?

4. "You must avoid hyperextending your neck after surgery." To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

A 68-year-old client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse would suspect which disorder? 1. Diabetes mellitus 2. Diabetes insipidus 3. Hypoparathyroidism 4. Hyperparathyroidism

4. Hyperparathyroidism Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercalciuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.

Which nursing diagnosis takes the highest priority for a client with hyperthyroidism?

4. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis. Options 2 and 3 may be appropriate for a client with hypothyroidism, which slows the metabolic rate.

Which of the following is the most critical intervention needed for a client with myxedema coma? 1. Administering an oral dose of levothyroxine (Synthroid) 2. Warming the client with a warming blanket 3. Measuring and recording accurate intake and output 4. Maintaining a patent airway

4. Maintaining a patent airway Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets would be appropriate. Thyroid replacement will be administered I.V. and although intake and output are very important, these aren't critical interventions at this time.

For a client with Graves' disease, which nursing intervention promotes comfort? 1. Restricting intake of oral fluids 2. Placing extra blankets on the client's bed 3. Limiting intake of high-carbohydrate foods 4. Maintaining room temperature in the low-normal range

4. Maintaining room temperature in the low-normal range Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.

The nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?

4. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.

The nursing care for the client in addisonian crisis should include which intervention? 1. Encouraging independence with activities of daily living (ADLs) 2. Allowing ambulation as tolerated 3. Offering extra blankets and raising the heat in the room to keep the client warm 4. Placing the client in a private room

4. Placing the client in a private room The client in addisonian crisis has a reduced ability to cope with stress due to an inability to produce corticosteroids. Compared to a multibed room, a private room is easier to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs to avoid stress as much as possible. Because extremes of temperature should be avoided, measures to raise the body temperature, such as extra blankets and turning up the heat, should be avoided.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? 1. Blood urea nitrogen (BUN) level of 12 mg/dl 2. Blood glucose level of 90 mg/dl 3. Serum sodium level of 134 mEq/L 4. Serum potassium level of 5.8 mEq/L

4. Serum potassium level of 5.8 mEq/L Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.

The nurse explains to a client with thyroid disease that the hypothyroid gland normally produces:

4. T3, T4, and calcitonin. The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. TSH is produced by the pituitary gland to regulate the thyroid gland. TRH is produced by the hypothalamus gland to regulate the pituitary gland.

The client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: 1. exophthalmos and conjunctival redness 2. flushed, warm, moist skin 3. systolic murmur at the left sternal border 4. decreased body temperature and cold intolerance

4. decreased body temperature and cold intolerance Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. The other options are typical findings in a client with hyperthyroidism.

Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse would expect the client's symptoms to subside: 1. in a few days. 2. in 3 to 4 months. 3. immediately. 4. in 1 to 2 weeks.

4. in 1 to 2 weeks. Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidism in the interim, clients are usually given a beta-adrenergic blocker such as propranolol.

The nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? 1. methimazole (Tapazole) 2. thyroid USP desiccated (Thyroid USP Enseals) 3. liothyronine (Cytomel) 4. levothyroxine (Synthroid)

4. levothyroxine (Synthroid) Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content gives it predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: 1. sodium. 2. potassium. 3. magnesium. 4. phosphorus.

4. phosphorus. PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

hematologic s&s hnypothyroid

A moderate anemia is usual and may be caused by lack of thyroxine - The blood film may show mild macrocytosis and acanthocytosis - There is also a reduced oxygen need and thus reduced erythropoietin secretion - Autoimmune thyroid disease, especially myxedema or Hashimoto's disease, is associated with pernicious anemia

*78 y/o hypotyhroid, lethargy, depression - what would you check?

AMS or CV function

causes of adrenocortical insufficiency

Adrenal cortex destruction possibly due to: -Tumors - Infection such as tuberculosis, histoplasmosis, etc. - Addison's disease -an auto immune disease (the most common cause) and is more common in women than in men - Could also be due to the inability to synthesize hormones (Congenital adrenal hyperplasia) -inherited genetic defect that limits production of one of the many enzymes the adrenal glands use to make cortisol

post op thyroidectomy

Airway clearance - laryngeal nerve damage, laryngospasm - requires an airway inserted - tracheotomy set is kept at bedside) - dyspnea - can also occur as a result of edema in the glottis or hematoma formation )surgical evacuation of the hematoma is required) - Bleeding - may be due to subcutaneous hemorrhage or a hematoma formation - (observe the sides and back of patient's neck plus the anterior dressing for bleeding) - monitor vital signs, c/o sensation of fullness or pressure at the incision site -Protect the incision - keep dressing intact - Risk of hypocalcemic tetany (The most common complication after total or near-total thyroidectomy secondary to hypoparathyroidism, which occurs in about a third of cases - When symptoms develop they can range from mild paresthesias to painful tetany and even life-threatening complications, such as laryngeal spasm or arrhythmia. - Symptomatic hypocalcemia is also the primary reason for a prolonged hospitalization after thyroidectomy. - A successful thyroid operation is dependent in part on preventing or effectively treating hypocalcemia-related symptoms: parathyroid trauma/removal - treat with calcium gluconate

Cushing's Disease

Due/secondary to ACTH excess/adrenocortical activity - Ectopic ACTH secretion by the lung or pancreatic tumors

thyroid nodules - hot-warm-cold

Hot nodules - hyperfunctioning of thyroid tissue - cancer in 5-9% - Warm nodules - moderate functioning of thyroid - cancer in 5-9% - Cold nodules - hypofunctioning of thyroid tissue - cancer in 15-20%

assessment findings for hypoparathyroidism

Hypocalcemia and tetany - Neurological symptoms such as stridor, tingling sensation, and spasms, seizures, Trusseau's sign (positive when carpopedal spasm is induced by occluding the blood flow to the arm for 30 minutes with a BP cuff - Autoimmune - occurs when the body tissues are attacked by its own immune system - Positive Chvostek's sign (when a sharp tapping over the facial nerve in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth - Cardiovascular: arrhythmias, prolonged QT interval, cardiac arrest - Calcifications: cataracts, soft tissues,malformations of the teeth, including weakened tooth enamel and misshapen roots of the teeth -Hypocalcemia, hyperphosphatemia

reproductive s&s hypothyroid

Hypothyroidism influences ovarian function by decreasing levels of sex-hormone-binding-globulin (SHBG) and increasing the secretion of prolactin - Prolactin, the hormone which stimulates milk production for breastfeeding, also affects ovulation and menstrual cycles. - Prolactin inhibits Follicle-Stimulating Hormone (FSH) and gonadotropin releasing hormone (GnRH) - With high levels of prolactin, which can be caused by hypothyroidism, ovulation is not triggered and a woman cannot get pregnant - In men, low FSH and GnRH caused by elevated levels of prolactin can prevent the maturation of sperm

Goitrogens

Inhibit T3 andT4 synthesis - soybeans, cabbage, strawberries, etc

Myxedema coma

Initially patient may show signs of depression, lethargy and diminished cognitive status -Respiratory drive depression resulting in alveolar hypoventilation, progressive carbon dioxide retention and coma

Adrenal Medulla

Inner layer of the adrenal gland, functions as part of the autonomic nervous system -often released into the bloodstream in response to stress or fright and prepare the body for "fight-or-flight"/produces "fight or flight" catecholamines -catecholamines are adrenaline (epinephrine), noradrenaline (norepinephrine), and dopamine.

Thyrotropin-releasing hormone (TRH) Test

Measures TSH before and after giving TSR Excessive increase in TSH - primary hypothyroidism

causes of hypoparathyroid

Most common cause is inadequate secretion of the parathyroid hormone - Could be due to the interruption of the blood supply or surgical removal of the parathyroid gland tissue during thyroidectomy, parathyroidectomy or radical neck resection - Idiopathic - spontaneously or from an unknown cause - Surgical removal may be another cause

*patient with severe high calcium - increased urine ca and BUN

NOT maintain seizure precautions

assessment findings for hyperpatathyroidism

PTH excess causes hypercalcemia and destruction of bones - Neurological irritation or depression - Cardiovascular: Arrythmias, hypertension, etc. - Gastrointestinal: Nausea, vomiting, constipation, decreased peristalsis

HYPERPARATHYROIDISM/ PARATHYROID HYPERFUNCTION

Primary: Tumor, often benign, most common in people between the age of 60-70 Secondary: Occurs in those who have chronic renal failure - Constant stimulation of the parathyroid - Also due to chronic hypocalcemia, malabsorption syndromes

myxedema

a severe form of hypothyroid disease where the brain is unable to control crucial processes like breathing - in some cases, myxedema is fatal

*hypothyroid patient has numbness and tingling - what is the nurse's priority action?

admin calcium gluconate

*MD must be informed when a patient with cushings develops

bilateral lung crackles

Thioamides

block synthesis of T3 and T4

thyroid hormones

calcitonin, T3, T4

*what diet should you provide a patient with hypoparathyroidism?

calcium and vitamin d supplements (not milk and milk products because they are high in phosphorous)

cardiac s&s hyperthyroid

cardiac effects may include a heart rate ranging from 90 to 160 bpm, atrial fibrillation may occur, cardiac decompensation e.g. heart failure is common especially in the elderly

norepinephrine

constricts all blood vessels to increase BP greatly

calcitonin

decrease serum calcium which inhibits bone reabsorption

GI s&s hypothyroid

decreases and slows down the movement in the GI tract - this often results in constipation - Other GI problems associated are irritable bowel syndrome (IBS)

*question to ask patient with hypoparathyroidism?

do you have bone pain?

respiratory s&s hyperthyroid

dyspnea due to oxygen demands/hypoxia

Goiter

enlargement of the thyroid - Occurs in both hyperthyroidism and hypothyroidism - Diffuse - enlarging the whole thyroid

Mineralocorticoids

exert their main effects on electrolyte metabolism (the "salt" hormones) aldosterone - essential to life - The release of aldosterone is also increased by hyperkalemia - Aldosterone is the long-term regulation of sodium balance - Increases retention of sodium and water by the kidneys - Stimulated by changes in serum sodium, sodium and the renin-angiotensin system - maintains blood volume and BP - Increases excretion of potassium

T3

fast and short acting

*signs to look for in person with thyroid dysfunction

fatigue after sleeping long periods

*how would you give instructions to patient diagnosed with hyperthyroidism

give written instructions

*priority patient with hypothyroidism

heart rate 48

*what to expect to see in a patient with cushings...

hypertension, peripheral edema, and petichiae

hematologic s&s hyperthyroid

hyperthyroidism emerged to have an increased risk of thrombotic events - A number of case reports have documented acute venous thrombosis complications in patients with overt hyperthyroidism, especially at cerebral sites - A small fall in hemoglobin is therefore usual in hyperthyroidism - may sometimes be sufficient to cause a mild degree of anemia

*RN would not administer morphine to patient w/...

hypothyroidism

GI s&s hyperthyroid

increased appetite and dietary intake, abdominal pain, changes in bowel function - diarrhea

neurological s&s hyperthyroid

it also stimulated the person becomes highly irritable, anxious and nervous

*s&s hypocalcemia

loss of sensation in hands/legs - involuntary muscle spasms?

PTH intact

measures the level of parathyroid hormone in the blood - This test is used to help identify hyperparathyroidism or to find the cause of abnormal calcium levels - 10-65 pg/ml

*patient with cushings - teach

moderate exercise

Hypercalcemia causes...

neuromuscular irritation

*patient with cushings

no strenuous exercise

*post partial thyroidectomy - nurse knows patient has airway clearance b/c

no tracheal stridor, speaks clearly, denies numbness & tingling

*patient with graves disease is receiving RAI therapy - I131 - should be informed?

not to expect relief from symptoms immediately

treatment for hyperthyroid

often consists of a combination of therapies including antithyroid agents, radioactive iodine (the most common treatment for Graves' disease) and surgery

Adrenal Cortex

outer layer of the gland and is necessary for life - Adrenocortical secretions make it possible for the body to adapt to stress of all kinds - ACTH maintains cortex function - Produces 3 types of steroid hormones which are glucocorticoids, mineralocorticoids, and androgens.

skeletal s&s hyperthyroid

premature osteoporosis and fractures

s&s of congenital hypothyroidism

puffy face, coarse facial features, dull look, thick protruding tongue, poor feeding, choking episodes, constipation or reduced stooling, jaundice prolonged, short stature, swollen, protuberant belly button, decreased activity, sleeps a lot, rarely cries or hoarse cry, dry brittle hair; low hairline, poor muscle tone, cool and pale skin, goiter, (enlarged thyroid), birth defects (eg, heart valve abnormality), poor weight gain due to poor appetite, poor growth, difficult breathing, slow pulse, swollen hands, feet and genitals

*what important vital sign should be reported immediately in a patient with hypothyroidism?

rapid irregular heart rate

*patient with graves given beta blockers because

reduces s&s

*hyperthyroid patient

report tachycardia

renal s&s hyperthyroid

results in increased GFR as well as increased renin - angiotensin -aldosterone activation

hair, skin, nails s&s hyperthyroid

skin is flushed, soft and may feel warm and moist and to the touch due to excessive perspiration; occasionally raised and thickened over the shins, back of feet The nails margins are irregular, may grow more rapidly and separate from the nail bed

T4

slow and long acting

*assess client following thyroidectomy

state name b/c checking for laryngeal nerve damage

*patient with cushings - what finding should be reported immediately?

temp of 101.6

Hypocalcemia causes...

tetany

*What do you want to monitor in a patient with addison's?

thready pulse

treatment for congenital hypothyroidism

treated with hormone replacement therapy e.g.,Levothroid, Levoxyl, Synthroid, Levothyroxine

*a patient with thyroid storm - the nurse should expect to admin

tylenol and steroids - never aspirin

*what indicates patient with DI or addison's needs further treatment?

weaning off vasopressin

Radioactive Iodine Uptake (RAIU)

- Measures the rate of iodine uptake by the thyroid gland - Patient is given a tracer dose of iodine 123 - Simple test and provides reliable results - patients with hyperthyroidism exhibit a very high uptake of iodine 123 and those with hypothyroidism exhibit a very low uptake of iodine 123

A client is being treated for hypothyroidism. The nurse knows that thyroid replacement therapy has been inadequate when she notes which findings? 1. Prolonged QT interval on electrocardiogram 2. Tachycardia 3. Low body temperature 4. Nervousness 5. Bradycardia 6. Dry mouth

1. Prolonged QT interval on electrocardiogram 3. Low body temperature 5. Bradycardia In hypothyroidism, the body is in a hypometabolic state. Therefore, a prolonged QT interval with bradycardia and subnormal body temperature would indicate that replacement therapy was inadequate. Tachycardia, nervousness, and dry mouth are symptoms of an excessive level of thyroid hormone; these findings would indicate that the client has received an excessive dose of thyroid hormone.

For a client in addisonian crisis, it would be very risky for a nurse to administer: 1. potassium chloride. 2. normal saline solution. 3. hydrocortisone. 4. fludrocortisone.

1. potassium chloride. Addisonian crisis results in hyperkalemia; therefore, administering potassium chloride is contraindicated. Because the client will be hyponatremic, normal saline solution is indicated. Hydrocortisone and fludrocortisone are both useful in replacing deficient adrenal cortex hormones.

The nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? 1. "I'll take my hydrocortisone in the late afternoon, before dinner." 2. "I'll take all of my hydrocortisone in the morning, right after I wake up." 3. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." 4. "I'll take the entire dose at bedtime."

3. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body's own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects.

A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease (COPD), the nurse formulates a nursing diagnosis of: 1. Risk for imbalanced fluid volume related to excessive sodium loss. 2. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. 3. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. 4. Decreased cardiac output related to hypotension secondary to Cushing's syndrome.

2. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss; along with immobility related to stroke, these factors increase this client's risk for impaired skin integrity. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention which, in turn, leads to edema and hypertension. Therefore, Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis.

The nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will prescribe daily supplements of calcium and: 1. folic acid. 2. vitamin D. 3. potassium. 4. iron.

2. vitamin D. Typically, clients with hypoparathyroidism are prescribed daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.

Which of the following instructions should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? 1. Keep an accurate record of intake and output. 2. Use nasal desmopressin acetate (DDAVP). 3. Be sure to get regular follow-up care. 4. Be sure to exercise to improve cardiovascular fitness.

3. Be sure to get regular follow-up care. Regular follow-up care for the client with Graves' disease is critical because most cases eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. While exercise to improve cardiovascular fitness is important, for this client the importance of regular follow-up is most critical.

A client with hyperthyroidism is about to receive radioactive iodine as an outpatient. What safety measures should the nurse teach the client to protect his family while he undergoes treatment? 1. Good hand washing 2. How to isolate himself in one room of the house 3. Use of disposable eating utensils 4. Not worrying about precautions

3. Use of disposable eating utensils The client with hyperthyroidism can receive radioactive iodine as an outpatient with some precautions, such as using disposable eating utensils, and avoiding kissing, sexual intercourse, and holding babies. Good hand washing is always necessary to prevent the spread of infection; however, it provides no protection against radioactive iodine therapy. Isolation isn't necessary, but radiation precautions are.

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of:

4. sodium and potassium abnormalities. In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.

*post thyroidectomy - patient develops stridor and right hand cramp - nurse expects to...

admin calcium gluconate

*addisons crisis patient admitted

administer IV NS

*important assessment question to ask a hypothyroid patient

do you feel fatigued even if you sleep a lot?

*patient receiving thyroid scan is afraid of being radioactive - I131 - appropriate response by nurse

this is a tracer dose - it wont harm you or others