ppt_Thyroid_disorders

ppt_Thyroid_disorders - Adult Health I Thyroid Disorders...

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Unformatted text preview: Adult Health I Thyroid Disorders Developed by C. McConnell RN MSN MSN Thyroid Disorders • Hyperthyroidism • Hypothyroidism S. Forehand RN MSN Hyperthyroidism (Thyroidtoxicosis) Definition: Definition: Hyperthyroidism Excessive secretion of T3 & T4 • Four to ten times more prevalent in women Affects metabolic processes in all body organs • Second only to Diabetes as the most occurring endocrine disease • Usually occurs in ages 30 - 50 Most Common Types • Graves’ Disease Graves’ • Multinodular goiter (toxic adenoma) Graves’ Disease • Pathophysiology – Thyroid stimulated by immunoglobins – Causes gland to enlarge and hypersecrete hormones 1 Graves’ Disease • Incidence – – – – – 20 to 40 years of age Women Heredity Stress Infection Signs and Symptoms • Neuromuscular – Fine Tremors – Nervousness – Hyperactive DTRs • Exophthalmos • Fine, soft, silky hair • Perioribital edema Signs and Symptoms Signs and Symptoms • Cardiac – Systolic hypertension – Tachycardia – Palpitations – Dysrhythmias – Atrial fibrillation – Angina, heart failure – Dyspnea Signs and Symptoms • GI – Increased appetite – Weight loss – Thirst – Hyperactive BS – Diarrhea Example of a Goiter • Other – – – – – Amenorrhea Increased libido Weakness Fatigue Smooth moist skin – Goiter – ↑ Temp – Insomnia 2 Proptosis and Goiter Diagnostics Increased T3, T4 Increased Decreased TSH Decreased No response to TRH No Thyroid Scan (RAI Uptake) Thyroid Increased uptake of iodine Increased Enlarged gland Enlarged Ultrasound Ultrasound Treatment of Hyperthyroidism • Medications – Antithyroid meds • Propylthioracil (PTU) • Tapazol (methimazole) Treatment of Hyperthyroidism • Medications Continued: – Beta Adrenergic Blockers • Inderal (Propranolol) – Iodine • Lugol’s Solution Lugol’ • SSKI • Radioactive Iodine Therapy Surgical Treatment of Hyperthyroidism • Procedure: thyroidectomy • Preoperatively – Euthyroid – Nutrition – Decrease stress – Teaching Postoperative Management Support head and neck Support Hemorrhage Hemorrhage Respiratory Obstruction Respiratory Humidified Air Humidified Oral/tracheal suctioning Oral/tracheal Voice checks every 1 to 2 hours Voice Eye Care Eye Home Care Home 3 Post Op Electrolytes • Monitor for Hypocalcemia – Tetany – Chvostek’s Sign Chvostek’ – Trousseau’s Sign Trousseau’ Nursing Diagnosis • RF Decreased Cardiac Output • Disturbed Sensory Perception; Visual • Imbalanced Nutrition; < body requirements • Disturbed Body Image Causes of hypothyroidism • Primary – – – – Defect in thyroid gland Congenital Post treatment of hyperthyroidism Thyroiditis • Secondary Complications of Hyperthyroidism • Thyroid Storm or Crisis – Acute exacerbation of S & S • • • • • • Heart failure Shock Hyperthermia Tachycardia, Hypertension Confusion Seizures … Coma Hypothyroidism • Severe state: myxedema • Usually seen in age 50+ but can happen at any age • Results from deficiency of thyroid hormones • Called “Cretinism” in children Cretinism” Diagnosis of Hypothyroidism Decreased T3 and T4 Decreased Increased TSH if cause is Increased thyroid Decreased TSH if cause is Decreased pituitary or hypothalamus – Deficiency in TSH – Peripheral resistance to thyroid hormones 4 Cardiovascular S&S Signs and Symptoms of Hypothyroidism Four Major Systems Usually Four Involved • • • • • • Cardiovascular Cardiovascular Gastrointestinal Gastrointestinal Reproductive Reproductive Hemopoietic Hemopoietic GI Signs and Symptoms • • • • Constipation Decreased Appetite Slight Weight Gain Thick Tongue Reproductive S & S • Decreased Libido • Altered Menses Other Signs and Symptoms Hemopoietic S & S • • • • Anemia Decreased Serum Iron Decreased Serum Folate Results in Increased Bruising Bradycardia Decreased Cardiac Output Chest Pain Hypotension Atherosclerosis Cardiomegaly • • • • • • • Fatigue, lethargy, weakness Intolerance to cold Joint pain Edema Depression Thick brittle nails Dry course hair 5 Treatment of Hypothyroidism Levothyroxine (Synthyroid) Levothyroxine Ú Low dose therapy with gradual increase Ú Evaluate patient response Ú Watch for CV adverse reactions Nursing Diagnoses • • • Decreased Cardiac Output Constipation RF Skin Integrity ÚPartial thyroidectomy ÚLarge goiter Patient Teaching Warm environment Skin Care High fiber diet Medication adherence 6 ...
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