Hypothyroidism
A primary hypothyroidism client has which characteristic TSH and T4 pattern?
TSH elevated and T4 decreased.
What TSH level threshold is listed in the notes for hyperthyroidism?
Less than 0.4 mIU/mL.
The Graves' client has BP 162/68. Calculate pulse pressure.
94 mm Hg.
What is the purpose of levothyroxine?
Synthetic thyroid hormone replacement for hypothyroidism.
Where does gas exchange occur?
Alveoli
Name four manifestations of myxedema coma.
Hypothermia, bradycardia, hypotension, hypoventilation, mental status changes, hyponatremia, hypoglycemia, or non-pitting edema (any four).
Name four letters from the THYROIDISM mnemonic and their manifestations.
T—tremor; H—heart rate up; D—diarrhea; I—heat intolerance; S—sweating; M—muscle wasting.
Interpret TSH <0.01, T3 21.6, and T4 58.3.
Markedly low TSH with elevated T3 and T4, supporting hyperthyroidism
Name two major adverse effect categories associated with methimazole and PTU.
Low granulocyte count and liver toxicity/damage; both can also cause hypothyroidism
What two gases move across the alveolar-capillary membrane, and in which direction?
Oxygen moves into the blood; carbon dioxide moves out.
A client takes levothyroxine with breakfast. What timing should the nurse teach instead?
One hour before a meal or three hours after a meal.
What three thyroid laboratory changes support hyperthyroidism?
Decreased TSH, increased T3, increased T4.
Name the three priority problems in the unfolding case
Decreased cardiac output related to AFib/tachycardia; hypermetabolic state with risk of thyroid storm and imbalanced nutrition; risk of corneal injury.
What two assessments are required before metoprolol in the Graves' case?
Apical pulse and blood pressure
Name the four lower respiratory structures listed in the notes.
Tracheal bifurcation, bronchi, bronchioles, and alveoli.
A client with severe hypothyroidism has HR 40, hypothermia, hypotension, and declining consciousness. What is the emergency and the first physiologic priority?
Myxedema coma; prioritize airway and ventilation, with urgent cardiovascular and temperature support.
A hyperthyroid client develops tachycardia, AFib, and worsening cardiovascular status. What is the priority nursing concern?
Hemodynamic instability/decreased cardiac output; stabilize cardiac status and monitor rhythm.
The client's HR is 74 regular, BP 132/62, and telemetry shows sinus rhythm on day 3, but thyroid levels remain elevated. How are outcomes evaluated?
Partially met: cardiac status improved, but thyroid hormone levels remain elevated and need continued monitoring.
A client with Graves' disease has dry eyes and exophthalmos. Name three eye-care interventions.
Lubricating/saline eye drops, prescribed anti-inflammatory eye drops, sunglasses, elevated HOB, and reporting pain or vision changes (any three).
Trace the pathway from the upper respiratory tract through the site of gas exchange.
Nasopharynx → oropharynx → laryngopharynx → epiglottis → tracheal bifurcation → bronchi → bronchioles → alveoli.
Compare worldwide and U.S. leading causes of hypothyroidism.
Worldwide: iodine deficiency. U.S.: autoimmune disorders, most commonly Hashimoto's disease.
Explain why a client with Graves' disease may need telemetry, beta-blockers, and eye care simultaneously.
Telemetry monitors AFib and dysrhythmias; beta-blockers control heart rate and symptoms; eye care protects against corneal injury from exophthalmos.
The client taking methimazole reports fever, sore throat, and dark urine. Identify the medication complications and nursing response.
Possible granulocyte suppression and liver toxicity. Promptly notify the provider and evaluate CBC and LFTs.
Which labs should be monitored during antithyroid medication therapy, and why?
CBC for granulocyte suppression and LFTs for liver toxicity or damage.
A student says the lower respiratory tract begins at the nasopharynx and gas exchange occurs in the bronchi. Identify both errors.
The lower respiratory tract begins at the bifurcation of the trachea, and gas exchange occurs in the alveoli.