1. Care of Patients with Problems of the Thyroid and Parathyroid Glands
Chapter 66
Care of Patients with Problems of the Thyroid and Parathyroid Glands

2. Hyperthyroidism Thyrotoxicosis
Graves’ disease is the most frequent cause; usually has goiter, exophthalmos, pretibial myxedema
Assessment
History
Physical assessment
Clinical manifestations
Psychosocial assessment

3. Exophthalmos

4. Goiter

5. Laboratory Tests T3, T4, T3RU, TSH, TSH-RAb Thyroid scan
Ultrasonography
ECG

6. Nonsurgical Management
Monitoring
Reducing stimulation
Promoting comfort
Drug therapy—antithyroid drugs, iodine preparations, lithium, beta-adrenergic blocking drugs

7. Surgical Management Total thyroidectomy, subtotal thyroidectomy
Postoperative complications:
Hemorrhage
Respiratory distress
Hypocalcemia and tetany
Laryngeal nerve damage
Thyroid storm or thyroid crisis
Eye and vision problems of Graves’ disease

8. Hypothyroidism
Decreased metabolism from low levels of thyroid hormones
Myxedema
Myxedema coma

9. Myxedema

10. Hypothyroidism: Assessment
History
Physical assessment
Clinical manifestations
Psychosocial assessment
Laboratory assessment

11. Hypothyroidism: Community-Based Care
Home care management
Health teaching
Health care resources

12. Thyroiditis Inflammation of the thyroid gland
Three types of thyroiditis—acute; subacute (granulomatous); and chronic (Hashimoto’s disease), the most common type
Nonsurgical management, drug therapy
Surgical management

13. Thyroid Cancer Papillary, follicular, medullary, and anaplastic
Collaborative management
Surgery

14. Hyperparathyroidism Parathyroid glands—calcium and phosphate balance
Hypercalcemia and hypophosphatemia

15. Hyperparathyroidism: Nonsurgical Management
Diuretic and hydration therapies
Monitoring
Preventing injury
Drug therapy

16. Hyperparathyroidism: Surgical Management
Parathyroidectomy

17. Hyperparathyroidism: Surgical Management (Cont’d)
Postoperative care includes:
Observe for respiratory distress.
Keep emergency equipment at bedside.
Hypocalcemic crisis can occur.
Recurrent laryngeal nerve damage can occur.

18. Hypoparathyroidism Decreased function of the parathyroid gland
Iatrogenic hypoparathyroidism
Idiopathic hypoparathyroidism
Hypomagnesemia
Interventions—correcting hypocalcemia, vitamin D deficiency, and hypomagnesemia

19. Care of Patients with Problems of the Thyroid and Parathyroid Glands
Chapter 66
Care of Patients with Problems of the Thyroid and Parathyroid Glands
NCLEX TIME

20. Question 1
What is an appropriate expected outcome for the 35-year-old female patient who is undergoing treatment with radioactive iodine therapy?
Complete cure of all symptoms of hyperthyroidism within 2 weeks after therapy
Discontinuation of drug therapy for hyperthyroidism after completing therapy
Observation of required radiation precautions
Regular monitoring for thyroid function changes after therapy
Answer: D
Rationale: Because the thyroid gland stores thyroid hormones to some degree, the patient may not have complete symptom relief until 6 to 8 weeks after radioactive iodine (RAI) therapy. Additional drug therapy for hyperthyroidism is still needed during the first few weeks after RAI treatment. The radiation dose is low enough that radiation precautions are not needed. All patients who have undergone RAI therapy should be monitored regularly for changes in thyroid function.

21. Question 2
What parameter should be critically evaluated when providing care to a patient with Graves’ disease?
Irregular heart rate and rhythm
Elevated blood pressure
Elevated temperature
Change in respiratory rate
Answer: C
Rationale: Increases in temperature may indicate a rapid worsening of the patient’s condition and the onset of “thyroid storm.” Further evaluation of cardiovascular status is warranted.

22. Question 3
What is a priority intervention for an older female patient with a history of hyperparathyroidism?
Encourage small frequent meals.
Implement fall precautions.
Provide pain medications as prescribed.
Encourage fluid hydration by mouth.
Answer: B
Rationale: Manifestations of hyperparathyroidism may present as bone lesions, pathologic fractures, bone cysts, and osteoporosis. Preventing falls is a priority nursing intervention. Fluid hydration may be used to treat hypercalcemia. Small frequent meals can assist with nutritional need.

23. Question 4
How many times more often than men are women affected with hypothyroidism?
2 to 3 times more
4 to 5 times more
6 to 7 times more
7 to 10 times more
Answer: D
Rationale: Women are affected 7 to 10 times more often than men.

24. Question 5
When formulating the postoperative plan of care for a patient who is scheduled to have a thyroidectomy, the nurse should plan to
Avoid extending the patient’s neck.
Avoid humidification of the air.
Assess the patient’s voice once per shift .
Avoid using pillows or sandbags to support the patient’s head and neck.
Answer: A
Rationale: The nurse should avoid extending the patient’s neck to decrease tension on the suture line. The air in the patient’s room should be humidified to promote easier respirations and thin respiratory secretions. The patient’s voice should be assessed for changes every 2 hours. Sandbags or pillows should be used to support the patient’s head or neck, and the patient should be placed in a semi-Fowler’s position.