Concentration Sleep patterns Mood Vision changes Joint pain Sexual dysfunction
o Changes in physical characteristics such as: Facial hair in women Moon face Buffalo hump Exophthalmos (abnormal protrusion of eyeball) Thinning of skin Increased size of hands/feet o It is important to document: The severity of these changes The length of time the patient has experienced these changes The way in which these changes have affected the patient’s ability to carry out activities of daily living The effect of the changes on the patient’s self-perception Family history o Cushing’s syndrome Diagnoses: Risk for injury r/t weakness Risk for infection r/t altered protein metabolism and inflammatory response Risk for activity intolerance Impaired skin integrity r/t edema, impaired healing, and thin and fragile skin Disturbed body image r/t altered physical appearance, impaired sexual functioning, and decreased activity level Ineffective coping r/t mood swings, irritability, and depression Priority nursing interventions and complications in caring for patients with endocrine disorders o Hypothyroidism GOALS: Reduce thyroid activity & decrease thyroglobulin production Reduce size of thyroid/ restore normal thyroid hormone levels Thyroid hormone replacement to prevent hypothyroidism o Surgery may be required Medication: Synthetic levothyroxine (Synthroid) o May increase O2 demand, chance for myocardial ischemia, monitor angina & dysrhythmias, D/C Synthroid temporarily o May cause glucose levels, insulin levels, oral medication doses may need to be adjusted COMPLICATIONS: Severe Hypothyroidism: Myxedema Coma o Myxedema coma is the MOST extreme form of hypothyroidism: Generally occurs in pts. >50 yrs old Unconscious and hypothermic Respiratory drive is decreased, CO 2 , narcosis, coma o Supportive therapy Maintain patent airway, gas exchange, oxygenation, vital signs ABG’s to assess CO 2 retention for respiratory acidosis Pulse oximetry Cautious administration of IV fluids (H2O intoxication) Thyroid hormone IV o Hyperthyroidsm GOALS: Reduce thyroid hyperactivity Thyroidectomy: part of thyroid is removed Antithyroid medications that interfere with synthesis of thyroid hormones o Propylthiouricil (Propacil, PTU) or Methimazole (Tapazole)
o May take weeks for therapy to be effective. o Watch for fever, rash, urticaria o Pharyngitis and fever or mouth ulcers: stop medication, notify MD immediately SSKI (Lugol’s solution): potassium iodide shrinks the size of the thyroid gland and decreasing the amount of thyroid hormones produced. o Give with milk or fruit juice through a straw to prevent staining of teeth. Administration of radioactive 123 I or 131 I which destroys the thyroid gland o May take 3-4 weeks for symptoms to decrease May take up to 1 year for thyroid replacement COMPLICATIONS: Thyroid Storm: Thyrotoxicosis o Severe form of hyperthyroidism o S/S: Anorexia, severe weight loss
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- Spring '14