Download - Thyroid and Parathyroid Glands
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Thyroid and Parathyroid Glands
NUR 111
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Functions of the Thyroid
Pg. 1450
Metabolic rate
Regulate protein, carbs and fat metabolism
Increase RBC production
Inc bone formation, decrease bone resorption of Ca+
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Regulation of Metabolism
Hormones T3 & T4 increase BMR
Secretion controlled by hypothalamic-pituitary-thyroid gland axis
TRH » TSH » T3 & T4 (neg feedback)
Protein and Iodine very important for T3 & T4 production
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Calcium and Phosphorus Balance
Calcitonin (thyrocalcitonin, or TCT)
Reduces bone resorption, lowers serum Ca+
Low serum Ca+ suppress TCT:
Elevated serum Ca+ trigger TCT
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Causes of Hyperthyroidism
Pg. 1482
Graves’ disease (Autoimmune)
Toxic multinodular goiter
Thyroid adenoma (benign tumor)
Pituitary hyperthyroidism
Excessive use of thyroid hormone
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Goiter and Exophthalmos in Graves' Disease
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Hyperthyroidism
More common in women
Lab assessment p.1485: T3, T4
TSH (Graves’)
Thyroid Scan (RAIU) = increased
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Nursing Diagnosis
Depends on condition of client Possible Dx. IncludeImbalanced nutrition: > body
requirementsFatigueAnxiety If large goiter present: what is priority???
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Interventions
Nonsurgical: monitor V/S, rest, cool environment
Medications: PTU (propylthiouracil), SSKI, beta blockers
Radioactive Iodine Therapy
Remember eye care
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Interventions
Surgical: total or subtotal thyroidectomy
Preop = antithyroid meds, SSKI
Postop = very important Monitor for Bleeding, respiratory
distress, tetany, weak voice, thyroid storm (p.1487)
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Causes of Hypothyroidism
Pg. 1489
Removal or destruction of thyroid
Autoimmune (Hashimoto’s Disease)
Iodine deficiency
Medications (ex.Lithium)
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Hypothyroidism
More common in womenLab assessment: T3, T4
TSH
Monitor for depression
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Nursing Diagnosis
Decreased cardiac output
Ineffective breathing pattern
Altered thought process
Constipation
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Interventions
Levothyroxine sodium (Synthroid)
Avoid sedatives & narcotics
Monitor vital signs
Monitor for S&S of hyperthyroidism
Family teaching re: mental status
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Myxedema Coma
Hypothyroid CrisisHypothyroid Crisis --> rare but serious
Etiology:Etiology: acute illness/ trauma * rapid withdrawal of thyroid meds.* rapid withdrawal of thyroid meds. use of sedatives / narcotics surgery exposure to cold
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Myxedema Coma
temp / BP
Na+
blood glucose
Lactic acidosis
Coma
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Collaborative Nursing Care
IVF
Airway
IV:SynthroidGlucose
Warming blanket
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Thyroiditis
Acute– Bacterial
Pain Temp. Malaise Dysphagia
– TX Antibiotics
Subacute– Viral
Temp. Chills Pain in jaw
and/or ear– TX
ASA and steroids
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Thyroid Cancer
Painless nodule in thyroid
Treatment :RAISurgery
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Parathyroid Glands:
4 in number
can be removed w/ thyroid during surgery
Parathyroid secretes: Parathyroid hormone (PTH)
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REMEMBER :
Thyroid -> Calcitonin -> decreases serum calcium
PTH - increases serum calcium
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Major Role: Regulate blood levels of calcium and phosphate
PTH acts on: GI tract Kidney Bones
If serum CA PTH secretion
PTH - activates Vit. D --Increase calcium absorption from g.i. tract
Parathyroid Glands:
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Remember:Thyroid also Remember:Thyroid also secretes Calcitoninsecretes Calcitonin
Calcitonin helps-->keep Ca in bonesmaintain balance of Ca and PhosphorusCalcium -- 8.8 - 10.5Calcium -- 8.8 - 10.5 Phosphorus - 3 - 4.5Phosphorus - 3 - 4.5
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HyperparathyroidismPathophysiology
PTH secretion = Ca+ PhPhosos increased reabsorption of calcium by
kidneys =increased excretion of Phosphateincreased excretion of PhosphateCausesCauses
tumorstumorshyperplasia of parathyroid glandhyperplasia of parathyroid gland
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Data Collection :
PTH renal calculi nephrocalcinosis bone decalcification
serum Ca GI: anorexia, N&V, epigastric pain, constipation, M/S: fatigue & lethargy [serum Ca] > 12 mg/dl = mental status
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Complications:Complications:
Renal Failure
Fractures
Collapse of vertebra
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Collaborative Management : focuses to decrease serum calcium
Diuretic & Fluid Therapy Lasix /0.9% Na Cl
Drug therapy Phosphates Calcitonin -miacalin spray Skel. Release Renal clearance
Calcium Chelators - binds with Ca. -< dec. Levels of free calcium
Parathyroidectomy
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Nursing Interventions :
Diuretic & Fluid Rx: Monitor:
cardiac function I & O renal status serum Ca
Calcium Chelator Rx: Monitor:
LFT, BUN & Creatinine, CBC
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Post - op careParathyroidectomy
Same as thyroidectomy
Monitor for *** Tetany *** Tetany continuous spasm spasm of hands / feet --->
convulsionsconvulsionscalcium levelsCalcium supplements ( Tums, Oscal )Maintain airway
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PathophysiologyHypoparathyroidism
PTH
Etiology (rare) thyroid / thyroid /
parathyroid parathyroid surgerysurgery
HypomagnesemiaHypomagnesemia IdiopathicIdiopathic
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Data CollectionHypoparathyroidism
TetanyTetany CheckCheck :
• Chvostek’sChvostek’s• Trousseau’sTrousseau’s• tinglingtingling• severe muscle crampingsevere muscle cramping• irritabilityirritability
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Collaborative management of care
IV calcium gluconate
Oscal
Vitamin D
High Calcium diet
Magnesium IM or IV