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Chapter 66

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

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Chapter 66

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  1. 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, vitaminDdeficiency, and hypomagnesemia

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

  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

  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

  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.

  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

  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.

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