Hypothyroidism key point:
inadequate amount thyroid hormones triiodothyronine (T3) and thyroxine (T4) result in decrease in metabolic rate
most common etiology - Disease or thyroid gland loss.
failure of anterior pituitary gland to stimulate thyroid gland or failure of target tissue to respond to thyroid hormone
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
most prevalent in women (40 to 50 yrs old)
hypothyroidism diagnosis: T3 and T4
hypothyroidism diagnosis: ECG
hypothyroidism diagnosis: serum cholesterol
hypothyroidism diagnosis: CBC
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
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 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)
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.
Endocrine Adult Health Deviations
CH40 - Care high risk newborn - test4
CH39 - Hemolytic disord. & cong. anomalies - test 4
CH38 - C/substance abuse - test4
Ch38-B neonatal infections
diabetes mellitus- insulins
ABGs Arterial Blood Gases