1 / 19

Nursing Care & Interventions for the Client with Disorders of the Thyroid Gland

Nursing Care & Interventions for the Client with Disorders of the Thyroid Gland. Keith Rischer RN, MA, CEN. 1. Today’s Objectives…. Compare and contrast pathophysiology & manifestations of thyroid/parathyroid gland dysfunction.

gil-kim
Download Presentation

Nursing Care & Interventions for the Client with Disorders of the Thyroid Gland

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Nursing Care & Interventions for the Client with Disorders of the Thyroid Gland Keith Rischer RN, MA, CEN 1

  2. Today’s Objectives… • Compare and contrast pathophysiology & manifestations of thyroid/parathyroid gland dysfunction. • Identify, nursing priorities, and client education associated with thyroid/parathyroid gland dysfunction. • Interpret abnormal laboratory test indicators of thyroid/parathyroid gland dysfunction. • Analyze assessment to determine nursing diagnoses and formulate a plan of care for clients with thyroid/parathyroid gland dysfunction. • Describe the mechanism of action, side effects and nursing interventions of pharmological management with thyroid/parathyroid gland dysfunction.

  3. Thyroid Glands:Patho • Thyroid gland • Thyroxin (T3) • Triiodothyronine (T4) • Functions • Controls metabolism of all cells • Regulate protein, CHO, fat metabolism • Exert chronotropic/inotropic cardiac effects

  4. Hyperthyroidism:Causes • Graves disease • Goiter • T3 Thyrotoxicosis • Thyroid cancer • Tumors in body 4

  5. Early Visual changes Blurred Double vision Photophobia Heat intolerance/diaphoresis Weakness, fatigue Other exopthalmos Tachycardia or systolic hypertension Agitation, tremors, anxiety Palpitations Increased libido, amenorhea Restlessness, confusion, psychosis seizures Hyperthroidism: Assessment chart 67-1 p.1482 5

  6. Hyperthyroidism:Diagnostic Tests • Serum thyronine (T4) • Serum Triodothyronine (T3) • Thyroid stimulating hormone (TSH) • low in Graves • high in secondary (due to pituitary disorder) • Thyroid scan • increase radioactive iodine uptake • Ultrasound • ECG 6

  7. Nursing Diagnostic Priorities • Imbalanced nutrition…less than body requires • High in calories, proteins, and carbohydrates with supplemental feedings • Hyperthermia r/t increased metabolic rate • Bedding change frequently (diaphoresis) • Sponge baths • Cool environment • Fatigue r/t sleep deprivation • Encourage rest – fatigue • Keep environment quiet • Deficient knowledge • Exopthalmos

  8. Thyroid Crisis/Storm • Patho • Uncontrolled hyperthyroidism • Excess thyroid hormone release • Physical assessment • Extreme temperature • Hypertension • Tachycardia • Treatment • Inderal • Closely monitor VS-rhythm-temp • Fever reduction 8

  9. Hyperthyroidism:Medical Management • Antithyroid medications • Propylthiouracal (PTU) • block synthesis of thyroid hormone • Iodine (SSKI) • reduce vascularity of thyroid gland • Beta blockers • Radioactive iodine therapy • To ablate thyroid to make the pt become hypothyroid; • Taken orally • Relief of symptoms may take 6-8 weeks 9

  10. Hyperthyroidism:Surgical Management • Preop care • Post op care • ABC’s • Humidified O2 • Support of neck with movement & coughing • Semi-Fowlers position • Incisional care • Postoperative complications • Hemorrhage • Respiratory distress • Stridor • Tracheotomy equipment readily available • Laryngeal nerve damage • Hoarseness/weak voice 10

  11. Hypothyroidism • Patho • Decreased metabolism • Myxedema coma • Cellular edema • Generalized NP edema…eyes, hands, feet, tongue • Causes • Thyroid surgery/radioactive iodine treatment • Iodide deficiency 11

  12. Hypothyroidism: Assessment chart 67-5 p.1488 • Change in sleep habits • more lethargic • Decreased libido • Generalized weakness • Muscles aches • Cold intolerance • Constipation 12

  13. Myxedema Coma • Those at highest risk • Surgery • Chemo • Withdrawal thyroid meds • Assessment • Respiratory failure • Hypotension • Labs • Emergency care • ABC’s • Replace fluids • Administering meds. Steroids, IV glucose, Levothyroxine sodium (thyroid) • Monitor Temp. & BP frequently 13

  14. Hypothyroidism: Diagnostic Tests • Laboratory studies • Serum T3 • Serum T4 • TSH • high in primary • Low in secondary Treat with Lifelong thyroid replacement • Levothyroxine (Synthroid) • Assess thyroid levels. May start low to avoid cardiac problems 14

  15. Nursing Diagnostic Priorities • Decrease cardiac output • Assess for bradycardia, dysrhythmias • O2 if needed • Ineffective Breathing pattern • care when giving sedation • Disturbed thought processes • assess lethargy, memory deficit, poor attention span, difficulty communicating • Constipation • Deficient knowledge 15

  16. Hyperparathyroidism • Parathyroid glands • Regulate calcium and phosphate balance • Labs • Hypercalcemia and hypophosphatemia • Causes • Tumor • Chronic renal failure • Vit. D deficiency • Neck trauma or radiation 16

  17. Hyperparathyroidism: Assessment • Bone fractures from demineralization from bones • Recent weight loss • Arthritis • Psychological distress • History of Radiation to neck • GI • N/V, diarrhea, constipation • Renal stones 17

  18. Hyperparathyroidism: Medical Management • Diet • restrict Calcium…esp milk products • Medications • Lasix • Increased excretion of calcium • Phosphates • Inhibits bone resorption and interferes with calcium absorption • Calcitonin • Use to decrease skeletal calcium release • Hyperparathyroidectomy • Same 18

  19. Hyperparathyroidism: Nursing Interventions • Hydration • (strict I & O) • IV saline in large amounts and lasix to excrete calcium • Assess for Congestive heart failure R/T fluid overload • Cardiac monitoring • Serum Calcium levels need to be done frequently • Educate client to report N/V, palpations, numbness • Care to reduce fractures – lift gently • Ambulation helps prevent demineralization • Observe for renal calculi 19

More Related