Nursing Care & Interventions for the Client with Disorders of the Thyroid Gland

1. Nursing Care & Interventions for the Client with Disorders of the Thyroid Gland Keith Rischer RN, MA, CEN 1

2. 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.

3. 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

4. Hyperthyroidism:Causes • Graves disease • Goiter • T3 Thyrotoxicosis • Thyroid cancer • Tumors in body 4

5. 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 Hyperthroidism: Assessment chart 67-1 p.1482 5

6. 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

7. Nursing Diagnostic Priorities • Imbalanced nutrition…less than body requires • High in calories, proteins, and carbohydrates with supplemental feedings • Hyperthermia r/t increased metabolic rate • Bedding change frequently (diaphoresis) • Sponge baths • Cool environment • Fatigue r/t sleep deprivation • Encourage rest – fatigue • Keep environment quiet • Deficient knowledge • Exopthalmos

8. 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

9. 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

10. 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 distress • Stridor • Tracheotomy equipment readily available • Laryngeal nerve damage • Hoarseness/weak voice 10

11. Hypothyroidism • Patho • Decreased metabolism • Myxedema coma • Cellular edema • Generalized NP edema…eyes, hands, feet, tongue • Causes • Thyroid surgery/radioactive iodine treatment • Iodide deficiency 11

12. Hypothyroidism: Assessment chart 67-5 p.1488 • Change in sleep habits • more lethargic • Decreased libido • Generalized weakness • Muscles aches • Cold intolerance • Constipation 12

13. 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

14. 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

15. Nursing Diagnostic Priorities • 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

16. 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

17. 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

18. 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

19. 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