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Thyroid and Parathyroid Glands

Thyroid and Parathyroid Glands. NUR 111. Functions of the Thyroid. Pg. 1450 Metabolic rate Regulate protein, carbs and fat metabolism Increase RBC production Inc bone formation, decrease bone resorption of Ca +. Regulation of Metabolism. Hormones T 3 & T4 increase BMR

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Thyroid and Parathyroid Glands

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  1. Thyroid and Parathyroid Glands NUR 111

  2. Functions of the Thyroid • Pg. 1450 • Metabolic rate • Regulate protein, carbs and fat metabolism • Increase RBC production • Inc bone formation, decrease bone resorption of Ca+

  3. Regulation of Metabolism • Hormones T3 & T4 increase BMR • Secretion controlled by hypothalamic-pituitary-thyroid gland axis • TRH » TSH » T3 & T4 (neg feedback) • Protein and Iodine very important for T3 & T4 production

  4. Calcium and Phosphorus Balance • Calcitonin (thyrocalcitonin, or TCT) • Reduces bone resorption, lowers serum Ca+ • Low serum Ca+ suppress TCT: • Elevated serum Ca+ trigger TCT

  5. Causes of Hyperthyroidism • Pg. 1482 • Graves’ disease (Autoimmune) • Toxic multinodular goiter • Thyroid adenoma (benign tumor) • Pituitary hyperthyroidism • Excessive use of thyroid hormone

  6. Goiter and Exophthalmos in Graves' Disease

  7. Hyperthyroidism • More common in women • Lab assessment p.1485: T3, T4 •  TSH (Graves’) • Thyroid Scan (RAIU) = increased

  8. Nursing Diagnosis • Depends on condition of client  • Possible Dx. Include • Imbalanced nutrition: > body requirements • Fatigue • Anxiety • If large goiter present: what is priority???

  9. Interventions • Nonsurgical: monitor V/S, rest, cool environment • Medications: PTU (propylthiouracil), SSKI, beta blockers • Radioactive Iodine Therapy • Remember eye care

  10. Interventions • Surgical: total or subtotal thyroidectomy • Preop = antithyroid meds, SSKI • Postop = very important • Monitor for Bleeding, respiratory distress, tetany, weak voice, thyroid storm (p.1487)

  11. Causes of Hypothyroidism • Pg. 1489 • Removal or destruction of thyroid • Autoimmune (Hashimoto’s Disease) • Iodine deficiency • Medications (ex.Lithium)

  12. Hypothyroidism • More common in women • Lab assessment:  T3, T4 •  TSH • Monitor for depression

  13. Nursing Diagnosis • Decreased cardiac output • Ineffective breathing pattern • Altered thought process • Constipation

  14. Interventions • Levothyroxine sodium (Synthroid) • Avoid sedatives & narcotics • Monitor vital signs • Monitor for S&S of hyperthyroidism • Family teaching re: mental status

  15. Myxedema Coma • Hypothyroid Crisis --> rare but serious • Etiology: • acute illness/ trauma • * rapid withdrawal of thyroid meds. • use of sedatives / narcotics • surgery • exposure to cold

  16. Myxedema Coma •  temp / BP •  Na+ •  blood glucose • Lactic acidosis • Coma

  17. Collaborative Nursing Care • IVF • Airway • IV: • Synthroid • Glucose Warming blanket

  18. Acute Bacterial Pain  Temp. Malaise Dysphagia TX Antibiotics Subacute Viral  Temp. Chills Pain in jaw and/or ear TX ASA and steroids Thyroiditis

  19. Thyroid Cancer • Painless nodule in thyroid • Treatment : • RAI • Surgery

  20. Parathyroid Glands: • 4 in number • can be removed w/ thyroid during surgery • Parathyroid secretes: • Parathyroid hormone (PTH)

  21. REMEMBER : Thyroid -> Calcitonin -> decreases serum calcium PTH - increases serum calcium

  22. Parathyroid Glands: • Major Role: • Regulate blood levels of calcium and phosphate • PTH acts on: • GI tract • Kidney • Bones • If serum CA   PTH secretion • PTH - activates Vit. D --Increase calcium absorption from g.i. tract

  23. Remember:Thyroid also secretes Calcitonin • Calcitonin helps--> • keep Ca in bones • maintain balance of Ca and Phosphorus Calcium -- 8.8 - 10.5 • Phosphorus - 3 - 4.5

  24. HyperparathyroidismPathophysiology • PTH secretion = Ca+Phos • increased reabsorption of calcium by kidneys = • increased excretion of Phosphate • Causes • tumors • hyperplasia of parathyroid gland

  25. Data Collection : •  PTH • renal calculi • nephrocalcinosis • bone decalcification •  serum Ca • GI: anorexia, N&V, epigastric pain, constipation, • M/S: fatigue & lethargy • [serum Ca] > 12 mg/dl =  mental status

  26. Complications: • Renal Failure • Fractures • Collapse of vertebra

  27. Collaborative Management :focuses to decrease serum calcium • Diuretic & Fluid Therapy • Lasix /0.9% Na Cl • Drug therapy • Phosphates • Calcitonin -miacalin spray Skel. Release Renal clearance • Calcium Chelators - binds with Ca. -< dec. Levels of free calcium • Parathyroidectomy

  28. Nursing Interventions : • Diuretic & Fluid Rx: • Monitor: • cardiac function • I & O • renal status • serum Ca • Calcium Chelator Rx: • Monitor: • LFT, BUN & Creatinine, CBC

  29. Post - op careParathyroidectomy • Same as thyroidectomy • Monitor for *** Tetany • continuous spasm of hands / feet ---> convulsions • calcium levels • Calcium supplements ( Tums, Oscal ) • Maintain airway

  30. PathophysiologyHypoparathyroidism • PTH • Etiology (rare) • thyroid / parathyroid surgery • Hypomagnesemia • Idiopathic

  31. Data CollectionHypoparathyroidism • Tetany • Check : • Chvostek’s • Trousseau’s • tingling • severe muscle cramping • irritability

  32. Collaborative management of care • IV calcium gluconate • Oscal • Vitamin D • High Calcium diet • Magnesium IM or IV

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