Endocrine System - (part 2 of 3)

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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