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Hypothyroidism. By: Michelle Russell. Objectives. To understand hypothyroidism and how it effects the body Causes Signs/ symptoms Become familiar with current treatment and nursing interventions Develop appropriate nursing diagnoses. What is Hypothyroidism?.

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Hypothyroidism


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    1. Hypothyroidism By: Michelle Russell

    2. Objectives • To understand hypothyroidism and how it effects the body • Causes • Signs/ symptoms • Become familiar with current treatment and nursing interventions • Develop appropriate nursing diagnoses

    3. What is Hypothyroidism? • Occurs when the thyroid gland doesn’t produce enough thyroid hormone (T-3, T-4) • State of metabolic slow down

    4. Pathophysiology Thyroxine(T-4) &Ttriiodothyronine(T-3) T-4 converts into T-3

    5. Primary causes • Hashimoto’s disease • Autoimmune disorder usually with a genetic component • Antibodies are attacking the thyroid gland • 80% of all cases- most common cause • Other- cancer, nodules, infection, pregnancy, congenital disease (1 in 3,000 babies), thyroidectomy

    6. Other causes • secondary (5% of cases) • Failure of the Pituitary gland to produce enough TSH • Tertiary • Failure of the Hypothalamus to make TRH • BOTH are usually caused by tumors and are rare

    7. Iodine deficiency- cause • Iodine is needed to synthesize T4 and T3 • Iodine deficiency is most common cause in developing countries • Its not a problem in the U.S. because it is included in our salt! • But stay aware…

    8. A visual recap OVERVIEW: Pathophysiology and Causes

    9. Epidemiology • Most common in women • between 30-50 years of age • Approximately 10% of ALL adults have evidence of Hashimoto’s disease • Hashimoto’s is more prevalent in white females • 20% of cases are inherited with a autosomal recessive pattern

    10. Signs and Symptoms Most common Severe Dryness and thickening of skin Slowed speech Altered menstrual cycle Puffiness in face, hands, feet Decrease capacity to taste or smell Jaundice Increase in tongue size • Tiredness and weakness-feeling "run down" • Weight gain or difficulty losing weight • Constipation • Depression • Thinning or brittleness of the hair or nails • Cold intolerance • Sleepiness • Memory loss • Decreased libido • Muscle aches and pains • Hoarse voice

    11. Complications • Goiter • Enlargement of the thyroid gland • Thyroid cancer and nodules • Heart disorders • Higher risk for developing heart disease, atherosclerosis, heart attack, and stroke • Infertility • Affect ovulation and decrease chances of conceiving • Mental status • Depression- usually when left untreated • May lead to dementia

    12. Example Goiter

    13. Myxedema • Rare and life threatening (50% mortality rate) • May cause a coma • Not enough thyroid hormone, your body cannot utilize glucose • Symptoms • Similar to hypothyroidism but EXTREME • Edema- swelling around the eyes, body and thickening of the tongue (heavy mushy skin) • Triggors- infections, stroke, trauma, heart failure, GI bleeding, hypothermia

    14. Example Myxedema

    15. Diagnostic testing • Blood test: TSH, T3, T4 • Thyroid antibody test to detect Hashimoto’s: TgAB • Ultrasound: • Detect nodules, tumors, heterogeneous appearance

    16. Patient Relevance • 51 years old • Presenting problems: • Stress- new job, different state, cultural differences, newly-wed, small income • Started developing symptoms which she contributed to stress • Life gradually settled, but symptoms did not disappear • Symptoms: • Cognitive- concentration, memory, focusing difficulties, tiredness, fatigue • Goiter • Diagnosis: Hashimoto’s Thyroiditis • Treatment: Armour Thyroid

    17. Subjective information • “I am usually very tired even after getting up in the morning”. • “Trying to stay awake during lectures, meetings, and movies is very difficult”. • “I am very busy/active while teaching, and I have no problem staying awake. But once my kids go to bed I have difficulty concentrating, staying awake, and getting paperwork done”.

    18. Nursing Interventions/ Assessment • Give Synthroid (Levothyroxine) at least 30 min. before breakfast! • Typically done on night shift as a 6am med. • Physical exam • Palpate thyroid gland • Assess for paleness, puffiness or lack of facial expression • Skin & hair may be dry • Monitor vitals/ Labs • Slowed HR and RR; EKG may eventually be done • Patient education

    19. Outpatient thyroid surgery: Should patients bedischarged on the day of their procedures? Article 1 • Yes, with appropriate Interventions… • Nursing Interventions • Patient education • Verbal and written instructions • Signs and symptoms of complications • Counseling with pamphlet • Follow up telephone call the next day from the Nurse • Thyroidectomies- prescription for calcium replacement to prevent Hypocalcemia • Follow up visit two weeks after surgery • 99.6% of patients were discharged as planned with only 1.7% readmitted

    20. Assessment and Management of Patients With Hypothyroidism Article 2 • Nursing Interventions: • Start with comprehensive history- Symptoms • Be aware of Hypothyroid symptoms in order to formulate questions • Underactive Thyroid-Dependent Quality of Life Questionnaire (ThyDQoL) • Pregnancy- *** Need to have an increase in medication dose • Myxedema- IV bolus T3 Q8H

    21. Are there gaps between research and practice? • Absolutely! • Not enough patient education • Never a thorough assessment • Synthroid is sometimes not given enough time before breakfast • CAUSES- Nurse shortage and too many patients for one Nurse to care for

    22. Prognosis • Generally pretty well if continue to have follow up visits, frequent monitoring, and medication compliance • Patient from the article: • She continues to experience symptoms • But they have gotten better since she started supplementation • But has learned to manage/ cope with them

    23. Nursing Diagnosis • Activity intolerance R/T disease status AEB Verbalization of lack of energy, tiredness, and weakness • Others: • Constipation • Low self esteem • Fatigue

    24. Conclusion • This is a common condition • Understand the signs/ symptoms of hypothyroidism • Such as cold intolerance, weight gain, tiredness, memory loss and depression • Slowed HR and RR • Causes: Hashimoto Thyroiditis is most common • Patient education about the illness is needed/ importance of medication compliance

    25. Works Cited • Berber, E., & Rehan, K. (2011, January 18). endocrineweb. Retrieved from http://www.endocrineweb.com/conditions/hypothyroidism/complications- hypothyroidism • Carson, M. (2009). Assessment and management of patients with hypothyroidism. Learning Zone, 28(18), 51-55. Retrieved from http://web.ebscohost.com.ezproxy.hsc.usf.edu/ehost/pdfviewer/pdfviewer?vid=21&hid=1 22&sid=8584a050-a8ed-4ac9-b7a7-a1f8e0e5960f%40sessionmgr13 • Living with hashimoto's disease. (2009, January 12). Retrieved from http://vitamvas.tripod.com/thyroid.html • Mathur, R. (2011). Medicine.net. Retrieved from http://www.medicinenet.com/myxedema_coma /article.htm • Mayo Clinic Staff. (2010, June 12). Hypothyroidism underactive thyroid. Retrieved from http://www.mayoclinic.com/health/hypothyroidism/DS00353/DSECTION=symptoms • Medicine.net. (n.d.). medicinenet.com. Retrieved from http://www.medicinenet.com/hashimotos_thyroiditis/article.htm • Trottier, D. C., Barron, P., Moonje, V., & Tadros, S. (2009). Outpatient thyroid surgery: Should patients be discharged on the day of their procedures?. Research, 52(3), 21-25. Retrieved from http://web.ebscohost.com.ezproxy.hsc.usf.edu/ehost/pdfviewer/pdfviewer?vid=18&hid=1 22&sid=8584a050-a8ed-4ac9-b7a7-a1f8e0e5960f@sessionmgr13 • WebMD. (2010, June). Webmd. Retrieved from http://www.webmd.com/a-to-z- guides/thyroid- hormone-tests

    26. Questions?