Hyperthyroid
These are the laboratory findings for someone with hyperthyroidism.
What is Decreased TSH, Increased T4, and Increased BMR
The nurse expects to find this laboratory finding for a patient with primary hypothyroid.
What are elevated TSH and decreased T4
These are the three types of Diabetes Insipidus.
Explain the three differences.
What is Central (neurogenic), Nephrogenic, and Primary DI.
Central- Interference with ADH synthesis, transport or release (Brain Tumor, head injury, CNS infection)
Nephrogenic- Inadequate renal response to ADH despite adequate ADH (Drug therapy, lithium, renal damage)
Primary- Excess water intake ( structural lesion in the thirst center or psychologic disorder)
Name three causes of SIADH.
What are Cancer, CNS Disorders, Drug Therapy, Miscellaneous Conditions?
These are the major post-op complications associated with a subtotal thyroidectomy.
How would a prudent nurse assess for these complications?
What are:
Hypothyroidism
Hypoparathyroidism and hypocalcemia
Hemorrhage
Hematoma
Laryngeal nerve damage
Thyrotoxicosis
Infection
Name three clinical manifestations of hyperthyroidism on the cardiovascular, GI, musculoskeletal systems, and nervous. (Three for each system)
What are: Increased BP, CO, Pulse, angina, palpitations, systolic murmurs, dysrhythmias, Increased thirst, appetite, peristalsis, diarrhea, increased bowel sounds, hepatomegaly, splenomegaly. Fatigue, weakness, muscle wasting, dependent edema, osteoporosis, inability to concentrate, nervousness, fine tremor, restlessness, insomnia, rapid speech
These are some of the most important patient and caregiver teachings about hypothyroidism.
Lifelong therapy
take in the morning before food
regular follow-up appointments and monitoring of hormone levels
when to contact the doctor
These are the clinical manifestations of DI.
What is polyuria, polydipsia, low specific gravity, hypernatremia
Serum osmolality, much lower than urine osmolality, shows this
SIADH
Serum osmolality, much lower than urine osmolality, shows the body is inappropriately excreting concentrated urine in the presence of dilute serum.
A nurse would advise a patient with Addison disease to do this while training for a triathlon?
What is increase the dosage of corticosteroids.
Name three types of drugs to treat hyperthyroidism and include MOA.
Beta Blockers (Propanolol)- block the effects of sympathetic nervous stimulation to produce symptom relief (decrease tachycardia, nervousness, irritability, and tremors)
Iodine- (SSKI & Lugol Solution)- iodine inhibits T3 and T4 synthesis and blocks the release of these hormones into circulation.
Antithyroid-( Pylthioyracil & Methimazole (Tapazole)- Inhibit thyroid hormone synthesis
Name three clinical manifestations of hypothyroidism on the reproductive system, GI, integumentary, and nervous systems. (Three for each system)
What are: amenorrhea or prolonged menstrual periods, infertility, decreased libido, decreased appetite, weight gain, N/V, constipation, celiac disease, dry, thick, cold skin, poor turgor of mucosa, puffy face, pallor, decreased sweating, periorbital edema, apathy, lethargy, slow/slurred speech, anxiety, depression, slowed mental processes
This is how DI is diagnosed.
What is water deprivation test and the measure of ADH after administration of desmopressin ( distinguishes central from nephrogenic)
These two medications are used to treat euvolemic hyponatremia in hospitalized SIADH patients.
Provide the MOA for these medications
What are Conivaptan(Vaprisol) & Tolvaptan (Samsca)
Vassopressor receptor antagonist block the activity of ADH.
What is a daily urine sample?
They should be taken in the morning.
This drug is usually given to women during their first trimester pregnancy
What is Propulthiouracil
These two autoimmune disorders cause the destruction of the thyroid gland.
What is Hashimoto thyroiditis and Graves Disease.
Name major complications of DI
What is hypovolemia, hypotension, tachycardia ( hypovolemic shock)
What is sodium?
Hypertonic solutions should always be placed on a pump.
This non-pharmacological intervention would be taken to provide relief to a patient who experiences a severe headache after a hypophysectomy.
What is elevate the head of the bed to a 30- degree angle?
Rationale: Elevating the head of the bed to a 30-degree angle alleviated pressure on the sella turcica, thereby relieving the headache. P.1325
A patient presenting to the ED with delirium, temperature of 104 F, HR of 135bpm, and signs of heart failure s/p MVC 1 day ago and a history of hyperthyroidism may be exhibiting signs and symptoms of this.
Name some nursing interventions for this patient
What is acute Thyrotoxicosis:
A progression of hypothyroidism that requires acute (Immediate) interventions.
Name some nursing interventions for this state.
What is Myxedema Coma
cardiac monitoring
respiratory support/monitoring
monitor core temperature
Medication administration as prescribed
The nurse anticipated that this medication will be prescribed when a low-sodium diet and thiazide drugs have not been effective in treating Diabetes Insipidus.
What is Indomethacin?
Indomethacin, a NSAID, helpd to increase renal responsiveness to ADH. p1328
This is the cause the features of SIADH.
What is ADH increases the permeability of the renal distal tubule and collecting duct of the kidney, which leads to the reabsorption of water into the circulation. Extracellular fluid volume expands, plasma osmolality declines, GFR increases, and sodium levels decline (dilutional hyponatremia)?
p.1326
These are pharmacologic and non-pharmacologic nursing care for a patient with SIADH.
What is monitor I&Os, vital signs, daily weights, monitor signs of hyponatremia (Lab values, n/v, H/A, decreased neuro function), keeping HOB flat, no more than 10 degrees and fluid restriction (800-1000ml/day) Administer medications as prescribed- Diuretics, electrolyte supplements, Demeclocycline, Vaprisol