Congenital hypothyroidism
After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question? "So, hypothyroidism can be only temporary, right?" "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?" "So, hypothyroidism can be treated by exposing our baby to a special light, right?"
"So, hypothyroidism can be treated by exposing our baby to a special light, right?" Explanation: Congenital hypothyroidism can be permanent or transient and may result from a defective thyroid gland or an enzymatic defect in thyroxine synthesis. Only the last question, which refers to phototherapy for physiologic jaundice, indicates that the parents need more information.
The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder? "When they get my son's thyroid levels normal, he won't be so tired." "My son's nervousness may be a symptom of his hypothyroidism." "Heat intolerance is a caused by low thyroid levels." "Most people with hypothyroidism have smooth, velvety skin."
"When they get my son's thyroid levels normal, he won't be so tired." Explanation: Tiredness, fatigue, constipation, cold intolerance and weight gain are all symptoms of hypothyroidism. Nervousness, anxiety, heat intolerance, weight loss and smooth velvety skin are all symptoms of hyperthyroidism.
Assessment of newborn reveals a large protruding tongue, slow reflexes, distended abdomen, poor feeding, hoarse cry, goiter and dry skin. Which of the following would the nurse suspect? A) Phenylketonuria B) Galactosemia C) Congenital hypothyroidism D) Maple syrup urine disease
C) Congenital hypothyroidism
What finding would the nurse expect to assess in a child with hypothyroidism? Nervousness Heat intolerance Smooth velvety skin Weight gain
Weight gain Explanation: Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.
A newborn is born with hypothyroidism. If it is not recognized and treated, what complication is likely? blindness muscle spasticity dehydration cognitive impairment
cognitive impairment Explanation: A newborn with congenital hypothyroidism is lethargic, hypotonic and irritable. Delayed growth is seen as well as decreased mental responsiveness. The newborn has an enlarged tongue and poor sucking ability. Without treatment with the thyroid hormone, the newborn will develop a cognitive impairment and failure to thrive. Blindness, muscle spasticity and dehydration are not symptoms or complications of the disease.
Assessment of a newborn reveals that the child has hypothyroidism. How does the nurse document this finding? congenital hypothyroidism acquired hypothyroidism secondary hypothyroidism autoimmune thyroiditis
congenital hypothyroidism Explanation: Congenital hypothyroidism is most commonly caused by defective embryonic development of the gland. Acquired hypothyroidism usually refers to thyroid deficiency that becomes evident after a period of apparently normal thyroid function. The most common cause of acquired hypothyroidism in iodine-sufficient regions of the world is lymphocytic thyroiditis (also called Hashimoto or autoimmune thyroiditis). Secondary hypothyroidism is a term that is not used when describing hypothyroidism.
Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? early identification promoting bonding allowing rooming in encouraging fluid intake
early identification Explanation: The most important nursing objective is early identification of the disorder. Nurses caring for neonates must be certain that screening is performed, especially in neonates who are preterm, discharged early, or born at home. Promoting bonding, allowing rooming-in, and encouraging fluid intake are all important but are less important than early identification.
The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family? how to recognize vitamin D toxicity how to maintain fluid intake regimens administering methimazole with meals reporting irritability or anxiety
reporting irritability or anxiety Explanation: Side effects of hypothyroidism are restlessness, inability to sleep, or irritability. These should be reported to the physician. Educating how to recognize vitamin D toxicity is necessary for a child with hypoparathyroidism. Teaching parents how to maintain fluid intake regimens is important for a child with diabetes insipidus. Teaching the child and parents to administer methimazole with meals is necessary for hyperthyroidism.
A 6-week-old infant has been diagnosed with congenital hypothyroidism. Once the level of medication has been determined, in order to maintain the proper dosing of thyroid hormone, the nurse instructs the parents to have the baby's levels tested how often during the first year? every 1 to 3 days every 1 to 3 weeks every 1 to 3 months every 3 to 6 months
every 1 to 3 months Explanation: Thyroid levels are measured at recommended intervals, such as every 2 weeks until the target range is reached on a stabilized dose of medication, then every 1 to 3 months until the child is 1 year old, every 2 to 3 months until the child is 3 years old, and becoming less frequent as the child gets older.
The nurse is assessing an 8-year-old boy who is performing academically at a second-grade level. The mother reports that the boy states feeling weak and tired and has had a weight increase of 6 pounds (13.2 kg) in 3 months. Which additional data would fit with a possible diagnosis of hypothyroidism? The child states that the exam room is cold. Oral cavity assessment shows two of the 6-year molars. The mother reports that the boy is always thirsty. The child has a faint rash on the trunk of the body.
The child states that the exam room is cold. Explanation: Cold intolerance, manifested by the fact that the child was uncomfortably cold in the exam room, is a sign of hypothyroidism. Delayed dentition, with only two of the four 6-year molars having erupted, is typical of growth hormone deficiency. Complaints of thirst may signal diabetes or diabetes insipidus. A rash can be varied disease processes but is not characteristic in hypothyroidism.
The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism? frequent diarrhea enlarged tongue tachycardia warm, moist skin
enlarged tongue Explanation: Observation of an enlarged tongue along with an enlarged posterior fontanel (fontanelle) and feeding difficulties are key findings for congenital hypothyroidism. The mother would report constipation rather than diarrhea. Auscultation would reveal bradycardia rather than tachycardia, and palpation would reveal cool, dry, and scaly skin.
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level Low T4 level and high TSH level Normal TSH level and high T4 level Normal T4 level and low TSH level
4. Normal saline infusionRationale:Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level decreases to an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.
