lOMoAR cPSD| 22896205
1
lOMoAR cPSD| 22896205
NURS 405A Exam 2 Study Guide – Med-Surg
Nursing Review | Pennsylvania State University
Resource
Care of the Patient with Endocrine Disorders
Endocrine glands
- Caring for the patient with selected disorders
o Thyroid
Goiter and thyroiditis
Hypo & Hyper Thyroidism o Parathyroid
Hypo & Hyper Parathyroidism can cause
pancreatitis o Adrenals
Cushing’s Syndrome & Addison’s Disease
Function of thyroid
- Regulates Metabolism
- Hormones T3 & T4 body converts iodine into these hormones
- Controlled by hypothalamus (TRH) & Pituitary (TSH)
- Hyper (thyrotoxicosis, hyperthyroidism) EUTHYROID Hypo (myxedema, coma) both ends of the spectrum are life
threatening
Diagnosis
o ECG, CxR
o TSH and free thyroxine (free T4)---TSH will be low or undetectable elevated T3 and T4 o Total T3 & T4
o Radioactive iodine uptake (RAIU) ----Differentiates Grave’s disease from other forms of thyroiditis
pg. 1
, lOMoAR cPSD| 22896205
2
o
Etiology of Hyperthyroidism
- Most common form: Graves’ disease
- Other causes o Toxic nodular goiter o
Thyroiditis
o Excess iodine intake: Eating too much
salt, seafood
o Pituitary tumors o Thyroid cancer
Etiology and Pathophysiology of Graves Disease
- Graves’ disease is an autoimmune disease of
unknown etiology characterized by… o Diffuse
thyroid enlargement and o Excessive thyroid
hormone secretion.
- Accounts for up to 80% of the cases ofhyperthyroidism.
- Women are five times more likely than men to develop Graves’ disease.
- Precipitating factors interact with genetic factors
- Cigarette smoking increases the risk of Graves' disease
Treatment
- Antithyroid medications Radioactive Iodine Therapy
(RAI-Ablation) Surger
- Antithyroid drugs o Propylthiouracil (PTU) and
methimazole (Tapazole)
Inhibit synthesis of thyroid hormone
Improvement in 1 to 2 weeks
Good results in 4 to 8 weeks
Therapy for 6 to 15 months
Remission happens in 20-40% of patients so can be lifelong therapy o Potassium iodine (SSKI)
and Lugol’s solution
Inhibit synthesis of T3 and T4 and block their release into circulation
Decreases vascularity of thyroid gland (making surgery easier)
Maximal effect within 1 to 2 weeks (10-14 days before surgery)
Used before surgery and to treat crisis
Beta-adrenergic blockers
Symptomatic relief of thyrotoxicosis
Block effects of sympathetic nervous stimulation
Propranolol (Inderal)
Atenolol (Tenormin)
pg. 2
, lOMoAR cPSD| 22896205
3
- Radioactive Iodine Therapy (RAI) o Treatment of choice
for most nonpregnant adults o RAI damages or destroys
thyroid tissue o RAI has a delayed response 2-3months
o Treated with antithyroid drugs and propranolol before and during the first 3 months of RAI o High incidence of
posttreatment hypothyroidism (80% of adequately treated persons) o Given on outpatient basis, pregnancy test
before beginning RAI o Patient teaching
Oral care for thyroiditis/parotiditis
• Ice chips, salt water gargle, Magic mouthwash (sometimes swallow, sometimes rinse and spit)
Radiation precautions
Symptoms of hypothyroidism
- Surgical o Indications
Large goiter causing tracheal compression
Unresponsive to antithyroid therapy
Thyroid cancer
Not a candidate for RAI o More rapid reduction in T3 and T4 levels
o Subtotal thyroidectomy – removal of 90% of gland
Preferred surgical procedure
Involves removal of 90% of thyroid
Can be done endoscopically o Endoscopic thyroidectomy is a minimally invasive procedure
• Endoscopic thyroidectomy is an appropriate procedure for patients with small nodules (less than
3 cm) in whom there is no evidence of malignancy
• Advantages of endoscopic thyroidectomy over open thyroidectomy include less scarring, less
pain, and a faster return to normal activity.
Nursing Process Map - Nursing diagnosis o Activity intolerance related to thyroidectomy as evidenced by patient report
of feeling of fatigue, patient will ambulate as tolerated 2x before end of shift
o Pain
o Imbalanced nutrition
- Planning
o Goals: experience relief of symptoms, have no serious complications related to the disease or treatment, maintain
nutritional balance, cooperate w/ the therapeutic plan
- Thyroid Storm (aka thyrotoxicosis) o This is a life
threatening emergency and patients will be treated in an
ICU setting
Assess, get vital signs, listen to the heart
Apply oxygen & call rapid response team
Chest pain + A-Fib = rapid response
Heart rhythm has changed but also complaining of chest pain
pg. 3
, lOMoAR cPSD| 22896205
4
o
o Severe and rare, increased risk after total thyroidectomy due to release of hormones
o Severe tachy, heart issues, continuous cardiac monitoring, avoid aspirin because it releases T4, glucocorticoids
given, for eye discomfort artificial tears, restrict salt, elevate head, tape eyes shut - Pre-op Care :
o Administer medications to achieve Euthyroidism (normally functioning thyroid)
Explain procedure, hoarseness & sore throat, give needed meds, high protein high carb diet
Half is considered a lobectomy and can keep 2 parathyroid (usually we
have 4)
Subtotal thyroidectomy will be able to leave one parathyroid maybe 2 (if
the surgeon is awesome)
There will be a transverse incision to perform surgery, small scar on base
of neck
Nursing Process Map - Implementation (post-op care) o After
surgery, what equipment is imperative for the room?
Oxygen, suction tubing, tracheostomy set o Monitoring
Hemorrhage, infection, laryngeal nerve damage
Hypocalcemia (due to the parathyroid hormone)
o MAINTAIN AIRWAY
- Discharge instructions o Regular follow up care
o Complete thyroidectomy: Teach symptoms of hypothyroidism o Need for lifelong thyroid hormone replacement
- Evaluation o Relief of symptoms
o No serious complications related to disease or treatment o Cooperate with therapeutic plan
Thyroid storm
- Increased risk for thyroid storm w/ total thyroidectomy
- Hyperthermia, chest pain, palpitations
- Maintain patent airway, cardiac monitoring, acetaminophen is given for fever, aspirin is contraindicated - Sponge baths
and ice packs for fever - Orders are as follows:
o TSH o Free T4
o Antithyroid antibodies (thyroid peroxidase
antibodies)
o CK, CBC with differential, lipid panel
Hypothyroidism
pg. 4
1
lOMoAR cPSD| 22896205
NURS 405A Exam 2 Study Guide – Med-Surg
Nursing Review | Pennsylvania State University
Resource
Care of the Patient with Endocrine Disorders
Endocrine glands
- Caring for the patient with selected disorders
o Thyroid
Goiter and thyroiditis
Hypo & Hyper Thyroidism o Parathyroid
Hypo & Hyper Parathyroidism can cause
pancreatitis o Adrenals
Cushing’s Syndrome & Addison’s Disease
Function of thyroid
- Regulates Metabolism
- Hormones T3 & T4 body converts iodine into these hormones
- Controlled by hypothalamus (TRH) & Pituitary (TSH)
- Hyper (thyrotoxicosis, hyperthyroidism) EUTHYROID Hypo (myxedema, coma) both ends of the spectrum are life
threatening
Diagnosis
o ECG, CxR
o TSH and free thyroxine (free T4)---TSH will be low or undetectable elevated T3 and T4 o Total T3 & T4
o Radioactive iodine uptake (RAIU) ----Differentiates Grave’s disease from other forms of thyroiditis
pg. 1
, lOMoAR cPSD| 22896205
2
o
Etiology of Hyperthyroidism
- Most common form: Graves’ disease
- Other causes o Toxic nodular goiter o
Thyroiditis
o Excess iodine intake: Eating too much
salt, seafood
o Pituitary tumors o Thyroid cancer
Etiology and Pathophysiology of Graves Disease
- Graves’ disease is an autoimmune disease of
unknown etiology characterized by… o Diffuse
thyroid enlargement and o Excessive thyroid
hormone secretion.
- Accounts for up to 80% of the cases ofhyperthyroidism.
- Women are five times more likely than men to develop Graves’ disease.
- Precipitating factors interact with genetic factors
- Cigarette smoking increases the risk of Graves' disease
Treatment
- Antithyroid medications Radioactive Iodine Therapy
(RAI-Ablation) Surger
- Antithyroid drugs o Propylthiouracil (PTU) and
methimazole (Tapazole)
Inhibit synthesis of thyroid hormone
Improvement in 1 to 2 weeks
Good results in 4 to 8 weeks
Therapy for 6 to 15 months
Remission happens in 20-40% of patients so can be lifelong therapy o Potassium iodine (SSKI)
and Lugol’s solution
Inhibit synthesis of T3 and T4 and block their release into circulation
Decreases vascularity of thyroid gland (making surgery easier)
Maximal effect within 1 to 2 weeks (10-14 days before surgery)
Used before surgery and to treat crisis
Beta-adrenergic blockers
Symptomatic relief of thyrotoxicosis
Block effects of sympathetic nervous stimulation
Propranolol (Inderal)
Atenolol (Tenormin)
pg. 2
, lOMoAR cPSD| 22896205
3
- Radioactive Iodine Therapy (RAI) o Treatment of choice
for most nonpregnant adults o RAI damages or destroys
thyroid tissue o RAI has a delayed response 2-3months
o Treated with antithyroid drugs and propranolol before and during the first 3 months of RAI o High incidence of
posttreatment hypothyroidism (80% of adequately treated persons) o Given on outpatient basis, pregnancy test
before beginning RAI o Patient teaching
Oral care for thyroiditis/parotiditis
• Ice chips, salt water gargle, Magic mouthwash (sometimes swallow, sometimes rinse and spit)
Radiation precautions
Symptoms of hypothyroidism
- Surgical o Indications
Large goiter causing tracheal compression
Unresponsive to antithyroid therapy
Thyroid cancer
Not a candidate for RAI o More rapid reduction in T3 and T4 levels
o Subtotal thyroidectomy – removal of 90% of gland
Preferred surgical procedure
Involves removal of 90% of thyroid
Can be done endoscopically o Endoscopic thyroidectomy is a minimally invasive procedure
• Endoscopic thyroidectomy is an appropriate procedure for patients with small nodules (less than
3 cm) in whom there is no evidence of malignancy
• Advantages of endoscopic thyroidectomy over open thyroidectomy include less scarring, less
pain, and a faster return to normal activity.
Nursing Process Map - Nursing diagnosis o Activity intolerance related to thyroidectomy as evidenced by patient report
of feeling of fatigue, patient will ambulate as tolerated 2x before end of shift
o Pain
o Imbalanced nutrition
- Planning
o Goals: experience relief of symptoms, have no serious complications related to the disease or treatment, maintain
nutritional balance, cooperate w/ the therapeutic plan
- Thyroid Storm (aka thyrotoxicosis) o This is a life
threatening emergency and patients will be treated in an
ICU setting
Assess, get vital signs, listen to the heart
Apply oxygen & call rapid response team
Chest pain + A-Fib = rapid response
Heart rhythm has changed but also complaining of chest pain
pg. 3
, lOMoAR cPSD| 22896205
4
o
o Severe and rare, increased risk after total thyroidectomy due to release of hormones
o Severe tachy, heart issues, continuous cardiac monitoring, avoid aspirin because it releases T4, glucocorticoids
given, for eye discomfort artificial tears, restrict salt, elevate head, tape eyes shut - Pre-op Care :
o Administer medications to achieve Euthyroidism (normally functioning thyroid)
Explain procedure, hoarseness & sore throat, give needed meds, high protein high carb diet
Half is considered a lobectomy and can keep 2 parathyroid (usually we
have 4)
Subtotal thyroidectomy will be able to leave one parathyroid maybe 2 (if
the surgeon is awesome)
There will be a transverse incision to perform surgery, small scar on base
of neck
Nursing Process Map - Implementation (post-op care) o After
surgery, what equipment is imperative for the room?
Oxygen, suction tubing, tracheostomy set o Monitoring
Hemorrhage, infection, laryngeal nerve damage
Hypocalcemia (due to the parathyroid hormone)
o MAINTAIN AIRWAY
- Discharge instructions o Regular follow up care
o Complete thyroidectomy: Teach symptoms of hypothyroidism o Need for lifelong thyroid hormone replacement
- Evaluation o Relief of symptoms
o No serious complications related to disease or treatment o Cooperate with therapeutic plan
Thyroid storm
- Increased risk for thyroid storm w/ total thyroidectomy
- Hyperthermia, chest pain, palpitations
- Maintain patent airway, cardiac monitoring, acetaminophen is given for fever, aspirin is contraindicated - Sponge baths
and ice packs for fever - Orders are as follows:
o TSH o Free T4
o Antithyroid antibodies (thyroid peroxidase
antibodies)
o CK, CBC with differential, lipid panel
Hypothyroidism
pg. 4
