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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 - PowerPoint PPT Presentation
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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 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
Calcium and Phosphorus Balance
Calcitonin (thyrocalcitonin, or TCT)
Reduces bone resorption, lowers serum Ca+
Low serum Ca+ suppress TCT:
Elevated serum Ca+ trigger TCT
Causes of Hyperthyroidism
Pg. 1482
Graves’ disease (Autoimmune)
Toxic multinodular goiter
Thyroid adenoma (benign tumor)
Pituitary hyperthyroidism
Excessive use of thyroid hormone
Goiter and Exophthalmos in Graves' Disease
Hyperthyroidism
More common in women
Lab assessment p.1485: T3, T4
TSH (Graves’)
Thyroid Scan (RAIU) = increased
Nursing Diagnosis
Depends on condition of client Possible Dx. IncludeImbalanced nutrition: > body
requirementsFatigueAnxiety If large goiter present: what is priority???
Interventions
Nonsurgical: monitor V/S, rest, cool environment
Medications: PTU (propylthiouracil), SSKI, beta blockers
Radioactive Iodine Therapy
Remember eye care
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)
Causes of Hypothyroidism
Pg. 1489
Removal or destruction of thyroid
Autoimmune (Hashimoto’s Disease)
Iodine deficiency
Medications (ex.Lithium)
Hypothyroidism
More common in womenLab assessment: T3, T4
TSH
Monitor for depression
Nursing Diagnosis
Decreased cardiac output
Ineffective breathing pattern
Altered thought process
Constipation
Interventions
Levothyroxine sodium (Synthroid)
Avoid sedatives & narcotics
Monitor vital signs
Monitor for S&S of hyperthyroidism
Family teaching re: mental status
Myxedema Coma
Hypothyroid CrisisHypothyroid Crisis --> rare but serious
Etiology:Etiology: acute illness/ trauma * rapid withdrawal of thyroid meds.* rapid withdrawal of thyroid meds. use of sedatives / narcotics surgery exposure to cold
Myxedema Coma
temp / BP
Na+
blood glucose
Lactic acidosis
Coma
Collaborative Nursing Care
IVF
Airway
IV:SynthroidGlucose
Warming blanket
Thyroiditis
Acute– Bacterial
Pain Temp. Malaise Dysphagia
– TX Antibiotics
Subacute– Viral
Temp. Chills Pain in jaw
and/or ear– TX
ASA and steroids
Thyroid Cancer
Painless nodule in thyroid
Treatment :RAISurgery
Parathyroid Glands:
4 in number
can be removed w/ thyroid during surgery
Parathyroid secretes: Parathyroid hormone (PTH)
REMEMBER :
Thyroid -> Calcitonin -> decreases serum calcium
PTH - increases serum calcium
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
Parathyroid Glands:
Remember:Thyroid also Remember:Thyroid also secretes Calcitoninsecretes Calcitonin
Calcitonin helps-->keep Ca in bonesmaintain balance of Ca and PhosphorusCalcium -- 8.8 - 10.5Calcium -- 8.8 - 10.5 Phosphorus - 3 - 4.5Phosphorus - 3 - 4.5
HyperparathyroidismPathophysiology
PTH secretion = Ca+ PhPhosos increased reabsorption of calcium by
kidneys =increased excretion of Phosphateincreased excretion of PhosphateCausesCauses
tumorstumorshyperplasia of parathyroid glandhyperplasia of parathyroid gland
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
Complications:Complications:
Renal Failure
Fractures
Collapse of vertebra
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
Nursing Interventions :
Diuretic & Fluid Rx: Monitor:
cardiac function I & O renal status serum Ca
Calcium Chelator Rx: Monitor:
LFT, BUN & Creatinine, CBC
Post - op careParathyroidectomy
Same as thyroidectomy
Monitor for *** Tetany *** Tetany continuous spasm spasm of hands / feet --->
convulsionsconvulsionscalcium levelsCalcium supplements ( Tums, Oscal )Maintain airway
PathophysiologyHypoparathyroidism
PTH
Etiology (rare) thyroid / thyroid /
parathyroid parathyroid surgerysurgery
HypomagnesemiaHypomagnesemia IdiopathicIdiopathic
Data CollectionHypoparathyroidism
TetanyTetany CheckCheck :
• Chvostek’sChvostek’s• Trousseau’sTrousseau’s• tinglingtingling• severe muscle crampingsevere muscle cramping• irritabilityirritability
Collaborative management of care
IV calcium gluconate
Oscal
Vitamin D
High Calcium diet
Magnesium IM or IV