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Nursing Care & Interventions for the Client with Disorders of the Thyroid Gland Keith Rischer RN, MA, CEN 1 1 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. 2 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 3 Hyperthyroidism:Causes Graves disease Goiter T3 Thyrotoxicosis Thyroid cancer Tumors in body 4 4 Hyperthroidism: Assessment chart 67-1 p.1482 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 5 5 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 6 Nursing Diagnostic Priorities Imbalanced nutrition…less than body requires • Hyperthermia r/t increased metabolic rate • • • • Bedding change frequently (diaphoresis) Sponge baths Cool environment Fatigue r/t sleep deprivation • High in calories, proteins, and carbohydrates with supplemental feedings Encourage rest – fatigue Keep environment quiet Deficient knowledge Exopthalmos 7 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 8 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 9 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 Stridor Tracheotomy equipment readily available •Laryngeal distress nerve damage Hoarseness/weak voice 10 10 Hypothyroidism Patho • • Decreased metabolism Myxedema coma Cellular edema – Generalized NP edema…eyes, hands, feet, tongue Causes • • Thyroid surgery/radioactive iodine treatment Iodide deficiency 11 11 Hypothyroidism: Assessment Change • chart 67-5 p.1488 in sleep habits more lethargic Decreased libido Generalized weakness Muscles aches Cold intolerance Constipation 12 12 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 13 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 14 Nursing Diagnostic Priorities 1. 2. 3. 4. 5. 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 15 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 16 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 17 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 18 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 19