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Wednesday, November 21, 2012

MS: Hypothyroidism vs Hyperthyroidism





HYPOTHYROIDISM
HYPERTHYROIDISM
Decreased T3 and T4
Increased T3 and T4
Early Signs
1.        Weakness and fatigue
2.        Loss of appetite but (+) weight gain d/t increased lipolysis
3.        Dry skin
4.        Cold intolerance
5.        Constipation
6.        Menorrhagia
Late Signs
1.        Brittleness of hair
2.        Non-pitting edema
3.        Hoarseness of voice
4.        Decreased libido
5.        Decreased vs
6.        Cns changes
a.         Lethargy
b.        Memory impairment
c.         Psychosis
1.        Hyperphagia – increased appetite
2.        (+) weight loss d/t increased metabolism
3.        heat intolerance
4.        moist skin
5.        diarrhea
6.        increased VS
7.        CNS changes
a.         Irritability
b.        agitation
c.         Tremors
d.        Restlessness
e.         Insomnia
f.          Hallucinations
8.        Goiter
9.        Exophthalmos
10.     Amenorrhea
1.        Monitor STRICTLY VS, IO to determine presence of MYXEDEMA COMA a complication of severe hypothyroidism characterized by:
a.         Severe hypotension
b.        Bradycardia
c.         Bradypnea
d.        Hypoventilation
e.         Hypoglycemia
f.          Hyponatremia
g.         Hypothermia
2.        Administer isotonic fluids as ordered
3.        Administer medications as ordered – thyroid hormones or agents (may cause insomnia and heat intolerance)
4.        Provide dietary intake low in calories to prevent weight gain
5.        Institute meticulous skin care
6.        Provide comfortable and warm environment
7.        Forced fluids

1.        Monitor VS and IO strictly to determine presence of THYROID STORM/Crisis
2.        Administer medications as ordered
a.         Anti-Thyroid Agents: PTU à toxic effects is agranulocytosisà fever and chills, sore throat (throat CS pls!), leukocytosis (CBC pls!)
b.        Methimazole (Tapazole)
3.        High calorie diet to correct weight loss
4.        Provide comfortable and cool environment
5.        Institute meticulous skin care
6.        Maintain side rails
7.        Bilateral eye patch to prevent drying of eyes
8.        Assist in surgical procedure: subtotal thyroidectomy

PRE-OP
Administer lugol’s solutions/ SSRI to promote decreased vasculature  and promote atrophy of the thyroid gland to prevent/minimize bleeding and hemorrhage

POST-OP
WOF signs of THYROID STORM à agitation, hyper-thermia, HPN. If (+) thyroid storm: administer anti-pyretics and beta-blockers; VS, IO and NVS strictly, siderails up, provide hypothermic blanket

WOF: inadvertent or accidental removal of parathyroid gland à hypocalcemia or tetany [(+) trousseu’s signs, (+) chvostek’s Give Ca Gluc slowly to prevent arrhythmia and arrest

WOF accidental laryngeal nerve damage à hoarness of voice à instruct client to talk immediately post-op à if (+) notify MD

WOF signs of bleeding à (+) feeling of fullness at incision site, (+) soiled dressings at back or nape area, notify MD

WOF signs of laryngeal spasm à DOB and SOB à prep trache set

9.        Hormonal Replacement therapy for life
10.     importance of FFup care
11.     wearing of medic-alert bracelet
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