39 terms

Hypothyroidism

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Hypothyroidism key point:
inadequate amount thyroid hormones triiodothyronine (T3) and thyroxine (T4) result in decrease in metabolic rate
Primary hypothyroidism:
most common etiology - Disease or thyroid gland loss.
Secondary hypothyroidism:
failure of anterior pituitary gland to stimulate thyroid gland or failure of target tissue to respond to thyroid hormone
Tertiary hypothyroidism:
failure of hypothalamus to produce thyroid-releasing factor.
(by age of onset) Cretinism:
severe hypothyroidism in infants. Result in retardation of physical and/or mental growth.
(by age of onset) Juvenile hypothyroidism:
often caused by chronic autoimmune thyroiditis. Affects growth and sexual maturation. Reversible by treatment.
(by age of onset) adult
adult hypothyroidism
by gender
most prevalent in women (40 to 50 yrs old)
hypothyroidism diagnosis: T3 and T4
low
hypothyroidism diagnosis: ECG
sinus bradycardia
hypothyroidism diagnosis: serum cholesterol
elevated
hypothyroidism diagnosis: CBC
anemia
hypothyroidism EARLY symptoms:
fatigue - intolerance to cold - decreased bowel motility - WEIGHT GAIN - joint, muscle pain - thin hair - thin fingernails - pale skin - depression
hypothyroidism LATE symptoms:
slow thought & speech - thick skin - thin eyebrows - dry skin - swell hands & feet - decrease smell & taste - hoarse speech - abnormal menstruation - decrease libido
Nurs.interventions CAUTION meds:
CNS depressants are CONTRAINDICATED.
nurse intevention CAUTION heat:
external warming measures CONTRAINDICATED
most common medication
levothyroxine (synthroid)
cardiac risk if:
metabolic rate is increased too quickly (cardiac monitor at thyroid therapy beginning)
speed in treatment:
begin slow. is considered lifelong therapy.
overmedication result in:
hyperthyroidism
HYPERthyroidism signs & symptoms:
irritability, tremors, tachycardia, heat intolerance.
Nur. Intervention. Activity:
increase gradually w/frequent rest. Avoid fatigue and decrease myocardial oxygen demand.
Nur. intervention - legs:
apply antiembolism stocking, elevate them.
Nur. Intervention - respiratory:
encourage cough and deep breathing, prevent complications.
Nur. intervention - diet:
high bulk, low-calorie. Exercise to prevent constipation and promote weight loss. Laxatives and softeners PRN.
Nur. Intervention - skin:
turn and reposition q 2hr. Alcohol free products.
Nur. Intervention - temperature:
extra clothing and blankets. Warm liquids. Caution with external heat (vasodilation)
Myxedema coma
when hypothyroidism untreated or infection.
Myxedema coma signs & symptoms:
significantly depressed respirations, PaCO2 levels may rise. - decreased cardiac output - cerebral hypoxia - stupor - hypothermia - bradycardia - hypotension.
Myxedema coma - interventions (respiratory):
keep airway patency (ventilatory support if needed)
Myxedema coma - intervention (circulation) :
keep circulation through IV fluid replacement
Myxedema coma - intervention (tests) :
EKG monitor - ABGs (hypoxia, metabolic acidosis)
Myxedema coma - intervention (T) :
blankets - body temp.
Myxedema coma - intervention (Meds) :
levothyroxine (synthroid) large doses. cardiac monitor
Myxedema coma - intervention (fluids) :
weigh daily and I & O (urine output should increase and weight decrease)
Myxedema coma - intervention (glucose) :
Provide supplemental glucose as needed
Hypothyroidism in older adults - diagnosis:
undiagnosed hypothyroidism, thus untreated, can lead to serious problems with sedatives, opiates & anesthetics.
Hypothyroidism in older adults - treatment:
start much lower doses, prevent cardiac complications.
Hypothyroidism in older adults - polypharmacy:
several meds are affected by thyroid supplements.