Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

 Body systems affected by the thyroid gland  Hypersecretion effects vs. hyposecretion effects

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Thyrotoxicosis  Graves’ disease: goiter, exophthalmos, pretibial myxedema  Assessment  History  Physical assessment  Clinical manifestations  Psychosocial assessment

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

 T 3, T 4, T 3 RU, TSH, TSH-RAb  Thyroid scan  Ultrasonography  ECG

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Monitoring  Reducing stimulation  Promoting comfort  Drug therapy (antithyroid drugs, iodine preparations, lithium, beta-adrenergic blocking drugs)

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Total or 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

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Hoarseness or stridor  Suture line pressure  Hypocalcemia and tetany  Thyroid storm

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Causes  Differentiating: aging vs. hypothyroidism  Decreased metabolism from low thyroid hormone levels  Myxedema  Myxedema coma

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

 History  Physical assessment  Clinical manifestations  Psychosocial assessment  Laboratory assessment

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Inflammation of thyroid gland  Three types—acute; subacute (granulomatous); chronic (Hashimoto’s disease—most common type)  Thyroiditis vs. hyperthyroidism, hypothyroidism  Nonsurgical management, drug therapy  Surgical management

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Four types:  Papillary  Follicular  Medullary  Anaplastic  Collaborative management  Surgery

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Parathyroid glands—calcium and phosphate balance  Hypercalcemia and hypophosphatemia  Nonsurgical vs. surgical management

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Decreased function of parathyroid gland  Iatrogenic  Idiopathic  Hypomagnesemia  Interventions—correcting hypocalcemia, vitamin D deficiency, hypomagnesemia

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A 45-year-old woman who is seeing her health care provider states that she is tired all the time and has muscle aches and pains. Assessment reveals a heart rate of 56/min and a BP of 96/58. She has non-pitting edema of her face, especially around her eyes, and in her hands and feet. Her health history includes radioactive iodine (RAI) for hyperthyroidism. What diagnosis does the nurse expect for this patient?

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The provider orders laboratory work that includes thyroid function tests. Which results does the nurse expect to see? A. Increased T 3 and T 4 levels B. Decreased TSH level C. Decreased T 3 and T 4 levels D. Normal T 3 and T 4 levels

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Which statement by the patient indicates the need for additional teaching about her condition? A. “When I go home I should check my heart rate and BP every day.” B. “I will call my provider if I notice any change in level of consciousness.” C. “I will be sure to include fiber in my diet and drink plenty of water.” D. “When I am feeling better in a few months I will no longer need to take the Synthroid pills.”

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The patient is preparing to go home. What important teaching points should the nurse include? (Select all that apply.) A.“Report any difficulty with orientation to time, place, or person.” B.“Note how many hours you sleep in a 24-hr period.” C.“Be sure that you take your medication every day at the same time.” D.“Your diet should be low-fiber, but with plenty of fluids.” E.“Call the provider if you develop an unsteady gait or tremors in your hands.”

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. What parameter should be critically evaluated when providing care to a patient with Graves’ disease? A. Irregular heart rate and rhythm B. Elevated blood pressure C. Elevated temperature D. Change in respiratory rate

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. What is a priority intervention for an older female patient with a history of hyperparathyroidism? A. Encourage small frequent meals. B. Implement fall precautions. C. Provide pain medications as prescribed. D. Encourage oral fluid hydration.

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A postoperative plan of care for a patient after a total thyroidectomy should include which intervention? A. Avoiding extending the patient’s neck B. Administering oxygen via nasal cannula as needed C. Assessing the patient’s voice once per shift D. Encouraging the patient to be out of bed in a chair