HYPOTHYROIDISM
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HYPERTHYROIDISM
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Decreased T3 and T4
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Increased T3 and T4
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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
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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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