Ch_50_Hypothyroid
Transcript of Ch_50_Hypothyroid
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Focus on Hypothyroidism
(Relates to Chapter 50,
Nursing Management: Endocrine Problems,in the textbook)
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Hypothyroidism
One of the most common medical
disorders in the United States
Affects 10% of women and 3% of men over 65 years of age
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Etiology and Pathophysiology
Results from insufficient circulating
thyroid hormone
Result of a variety of abnormalities
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Etiology and Pathophysiology (Contd)
Can be primary or secondary Primary
Related to destruction of thyroid tissue ordefective hormone synthesis
Secondary Related to pituitary disease with TSH
secretion or hypothalamic dysfunction
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Etiology and Pathophysiology (Contd)
May be transient, related to
thyroiditis, or from discontinuing
thyroid hormone therapy
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Etiology and Pathophysiology (Contd)
Iodine deficiency Most common cause worldwide and
most prevalent in iodine-deficientareas
In places where iodine intake is
adequate, the primary cause is
atrophy of the gland
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Etiology and Pathophysiology (Contd)
Atrophy is the end result of
Hashimotos thyroiditis and Graves
disease These autoimmune diseases destroy
the thyroid gland
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Etiology and Pathophysiology (Contd)
May also develop because of
treatment for hyperthyroidism
Amiodarone and lithium canproduce hypothyroidism
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Etiology and Pathophysiology (Contd)
Cretinism is caused by thyroid
hormone deficiencies during fetal or
neonatal life All infants are screened at birth for
thyroid function
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Clinical Manifestations
Vary depending on Severity
Duration Age of onset
Systemic effects characterized by
slowing of body processes
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Clinical Manifestations (Contd)
Ranges from no symptoms to classic
symptoms, and physical changes
easily detected on examination
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Clinical Manifestations (Contd)
Onset of symptoms may occur over
months to years
Unless occurs after thyroidectomy,thyroid ablation, treatment with
antithyroid drugs
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Clinical Manifestations (Contd)
Cardiovascular system Cardiac output
Cardiac contractility
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Clinical Manifestations (Contd)
Respiratory system Low exercise tolerance
Shortness of breath on exertion
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Clinical Manifestations (Contd)
Neurologic system Fatigued and lethargic
Personality and mood changes Impaired memory, slowed speech,
decreased initiative, and somnolence
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Clinical Manifestations (Contd)
Gastrointestinal system Motility
Achlorhydria common Constipation
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Clinical Manifestations (Contd)
Integumentary system Cold intolerance
Hair loss Dry/coarse skin
Brittle nails
Hoarseness
Muscle weakness and swelling Weight gain
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Clinical Manifestations (Contd)
Integumentary system (contd) Muscle weakness and swelling
Weight gain Reproductive system
Menorrhagia
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Clinical Manifestations (Contd)
Those with severe, longstanding
hypothyroidism may display
myxedema Accumulation of hydrophilic
mucopolysaccharides in the dermisand other tissues
Causes puffiness, periorbital edema,
masklike effect
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Common Features of Myxedema
Fig. 50-9
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Complications
Mental sluggishness
Drowsiness
Lethargy progressing gradually orsuddenly to impairment of
consciousness or coma
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Complications (Contd)
Myxedema coma Medical emergency
Can be precipitated by infection,drugs, cold, or trauma
Characterized by subnormal
temperature, hypotension, and
hypoventilation
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Complications (Contd)
Myxedema coma (contd)Vital functions must be supported
IVthyroid hormone replacementadministered
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Diagnostic Studies
History and physical examination
Laboratory tests
Serum TSH Determines cause of hypothyroidism
Free T4 Serum T3
Serum T4
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Diagnostic Studies (Contd)
Laboratory tests (contd)Other abnormal findings are
cholesterol and triglycerides,anemia, and creatine kinase
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Diagnostic Studies (Contd)
TRH stimulation test in TSH after TRH injection suggests
hypothalamic dysfunction No change after TRH injection
suggests anterior pituitary dysfunction
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Collaborative Care
Restoration of euthyroid state as
safely and rapidly as possible
Low-calorie diet
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Collaborative Care (Contd)
Drug therapy Levothyroxine (Synthroid)
Must take regularly Monitor for angina and cardiac
dysrhythmias
Monitor thyroid hormone levels and
adjust (as needed) Patient/family teaching
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Nursing Management
Nursing Assessment
Health history Weight gain Mental changes Fatigue Slowed/slurred speech Cold intolerance Skin changes
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Nursing Management
Nursing Assessment (Contd)
Health history (contd) Constipation
Dyspnea Recent introduction of iodine
medications
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Nursing Management
Nursing Assessment (Contd)
Physical examination Bradycardia
Distended abdomen Dry, thick, cold skin
Thick, brittle nails
Paresthesias
Muscular aches and pains
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Nursing Management
Nursing Diagnoses
Imbalanced nutrition: More than
body requirements
Activity intolerance
Disturbed thought processes
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Nursing Management
Pl anning
Experience relief of symptoms
Maintain a euthyroid state
Maintain a positive self-image
Comply with lifelong thyroid
replacement therapy
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Nursing Management
Nursing Impl ementation
Health Promotion No consensus for thyroid function
screening
High-risk populations screened forsubclinical thyroid disease Family history of thyroid disease, history
of neck radiation, women over 50 years of age, and postpartum
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Nursing Management
Nursing Impl ementation (Contd)
Acute Intervention Most individuals do not require acute
nursing care Managed on outpatient basis
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Nursing Management
Nursing Impl ementation (Contd)
Acute Intervention (contd) Individuals with myxedema coma
require acute nursing care Mechanical respiratory support Cardiac monitoring IV thyroid hormone replacement
If hyponatremic, hypertonic saline may beadministered Monitor core temperature
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Nursing Management
Nursing Impl ementation (Contd)
Acute Intervention (contd) Individuals with myxedema coma
(contd) Vitals Weight I&O
Visible edema
Cardiovascular response to hormone Energy level Mental alertness
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Nursing Management
Nursing Impl ementation (Contd)
Ambulatory and Home Care Explain nature of thyroid hormone
deficiency and self-care practices to
prevent complications Patient and family must understand
replacement therapy and that it is lifelong
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Nursing Management
Nursing Impl ementation (Contd)
Ambulatory and Home Care (contd) Teach measures to prevent skin
breakdown
Emphasize need for warmenvironment
Caution patient to avoid sedatives or
use lowest dose possible
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Nursing Management
Nursing Impl ementation (Contd)
Ambulatory and Home Care (contd) Discuss measures to minimize
constipation Avoid enemas because of vagal
stimulation in cardiac patient
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Nursing Management
Nursing Impl ementation (Contd)
Ambulatory and Home Care (contd) Teach patient to notify physician
immediately if signs of overdose
appear Orthopnea, dyspnea, rapid pulse,
palpitations, nervousness, insomnia
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Nursing Management
Nursing Impl ementation (Contd)
Ambulatory and Home Care (contd) Patient with diabetes should test
capillary blood glucose at least daily as
return to euthyroid state frequently
insulin requirements
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Nursing Management
Nursing Impl ementation (Contd)
Ambulatory and Home Care (contd) Thyroid preparations potentiate the
effects of some common drug groups Teach patient toxic signs and symptoms
of these drugs Anticoagulants Digitalis compounds
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Nursing Management
Nursing Impl ementation (Contd)
Ambulatory and Home Care (contd) Provide handouts for patients and
family members with verbal
instructions
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Nursing Management
Ev al uation
Expected outcomes Have relief from symptoms
Maintain euthyroid state as evidenced
by normal thyroid hormone and TSHlevels
Adhere to lifelong therapy
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Case Study
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Case Study
38-year-old female enters a
community outpatient clinic
She is complaining of overwhelming
fatigue that is not relieved by rest
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Case Study (Contd)
She is attending graduate school
and is very sedentary
She is so exhausted she has
difficulty waking for classes and
trouble concentrating whenstudying
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Case Study (Contd)
Her face is puffy and her skin is dry
and pale
She is dressed inappropriately for
warm weather
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Case Study (Contd)
She also complains of generalized
body aches and pains with frequent
muscle cramps and constipation
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Case Study (Contd)
Vital signs BP 142/84 mm Hg
Heart rate 52 beats/min
Respiratory rate 12 breaths/min
Temperature 96.8° F
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Discussion Questions
1. What are some possible causes of
her symptoms?
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Discussion Questions (Contd)
2. No obvious irregularities are found
in her cardiopulmonary
assessment. Her TSH levels comeback 20.9 IU/L. She is diagnosed
with hypothyroidism. What can
you tell her about the treatmentand follow-up?
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Discussion Questions (Contd)
3.What teaching will you need to do
with her before she leaves the
clinic?