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

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

Exophthalmos

Goiter

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

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

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

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

Myxedema

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

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

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

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

Hyperparathyroidism Parathyroid glands—calcium and phosphate balance Hypercalcemia and hypophosphatemia

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

Hyperparathyroidism: Surgical Management Parathyroidectomy

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.

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

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

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.

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.

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.

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.

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.