endocrine handout: thyroid & parathyroid - …home.portervillecollege.edu/ekeele/endocrine/5...

31
Endocrine Handout 5 Thyroid & Parathyroid Glands I. Reading Assignment: Brunner & Suddarth’s Textbook of Medical- Surgical Nursing, A. Chapter 42, Pages 1448 - 1473 II. Student Learning Outcomes A. The student will be able to describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following 1. Graves’s disease 2. Throiditis 3. Hashimoto’s thyroiditis 4. Hypothyroidism 5. Thyroid neoplasm 6. Hyperparathyroidism 7. Hypoarathyroidism 8. Thyrotoxic crises 9. Myxedema B. The student will be able to discuss medical terms commonly used in the endocrine system C. The student will be able to review and identify anatomy and physiology of the endocrine system D. The student will be able to identify components of a complete endocrine physical assessment E. The student will be able to discuss nursing management and patient education in the pre and post operative care of patients undergoing the following surgeries 1. Thyroidectomy F. The student will be able to identify the clinical significance and related nursing responsibilities of the following test and procedures used for diagnostic assessment of the patient with an endocrine disorder 1. Thyroid scan 2. Thyroid ultrasonography 3. Thyroid biopsy 4. Thyroxine serum (T4) 5. Triodothyronine serum (T3) Endocrine Handout 5 8/15/2022 1

Upload: voduong

Post on 11-Jul-2018

229 views

Category:

Documents


1 download

TRANSCRIPT

Page 1: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

Endocrine Handout 5Thyroid & Parathyroid Glands

I. Reading Assignment: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing,

A. Chapter 42, Pages 1448 - 1473

II. Student Learning OutcomesA. The student will be able to describe etiology, pathophysiology, clinical manifestations,

nursing management and patient education for the following1. Graves’s disease2. Throiditis3. Hashimoto’s thyroiditis4. Hypothyroidism5. Thyroid neoplasm6. Hyperparathyroidism7. Hypoarathyroidism8. Thyrotoxic crises9. Myxedema

B. The student will be able to discuss medical terms commonly used in the endocrine systemC. The student will be able to review and identify anatomy and physiology of the endocrine

systemD. The student will be able to identify components of a complete endocrine physical

assessmentE. The student will be able to discuss nursing management and patient education in the pre

and post operative care of patients undergoing the following surgeries1. Thyroidectomy

F. The student will be able to identify the clinical significance and related nursing responsibilities of the following test and procedures used for diagnostic assessment of the patient with an endocrine disorder

1. Thyroid scan2. Thyroid ultrasonography3. Thyroid biopsy4. Thyroxine serum (T4)5. Triodothyronine serum (T3)6. Thyroid – stimulating hormone assay (TSH)7. Radioactive iodine uptake8. Parathyroid function test

III. ThyroidA. Description

1. _________________ shaped

2. Two _______________ connected by an ____________________

3. Straddles the ____________________

4. __________________ endocrine gland

B. Function

Endocrine Handout 55/9/2023

1

Page 2: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

1. Produce _________________ __________________ (TH)

a. Vital for ___________________ & _______________________

2. _________________ storage

a. Essential for T3/T4 _______________________C. Hormones

Hormone Function Stimulated by…

Thyroixine (T4) &

Triiodothyronine (T3)

_______Metabolic rate

_______Protein synthesis

Calcitonin ___Blood___________ concentration

Decreases the reabsorption of

__________ & ____________ from

___________ to ________

Endocrine Handout 55/9/2023

2

Page 3: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

D. Hormone Loop

1. ____________ metabolic rate

2. Detection by the _______________________

3. Stimulates the _______________________________

4. Secretes _____________________

5. Blood stream target organ Thyroid

6. Stimulates the thyroid to _________________________________

7. Blood stream target organ Adrenal medulla

8. Secretes ____________________ & ______________________

9. ____________ metabolic rate

II. Thyroid disorders

A. World-wide

1. _________________ deficiency

B. United States

1. _____________________ disease

III. Hyperthyroidism

A. Definition

1.

B. Pathophysiology

1. Primary hyperthyroidism

a. Problem with the __________________ ___________________

2. Secondary

a. Problem with the _______________________ _______________

b. Pituitary _______________ ____________________

c. __________________ __________________ _______________

C. Etiology

1. Auto-immune

2. AKA:

a.

3. Female _________ Male

4. Age

D. Signs and Symptoms

Endocrine Handout 55/9/2023

3

Page 4: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

Neurological

Affect

Cardiovascular

Gastrointestinal

Muscle/skeletal

Skin

1. Exophthalmos

a.

b. Characteristic ______________________

2. Goiter

a.

b. D/T ____________________

3. Oncholysis

a.

b.

4. Gynecomastia

a. Abnormal enlargement of the ____________________

b. Female / Male

Endocrine Handout 55/9/2023

4

Page 5: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

5. Elderly

a. ____________ failure

b. _________________

c. Apathy

d. _________________

E. Hormone Review

1. T3/T4

2. _____________

3. _____________

4. _____________

5. T3/T4

6. T3/T4

7. _____________

8. _____________

9. _____________

10. T3/T4

F. Diagnostic tests

1. By definition hyperthyroidism means _________________

2. By definition primary hyperthyroidism means what?

________________________

3. In primary hyperthyroidism, is the pituitary gland working correctly?

4. If the pituitary gland is working correctly and there is an T3/T4 level,

what will the pituitary gland do with the TSH level?

5. By definition secondary hyperthyroidism means what? a.

Primary Hyperthyroidism Secondary Hyperthyroidism

T3 & T4

TSH

Endocrine Handout 55/9/2023

5

Page 6: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

G. Medical Treatment

1. Meds first

a. Goal __________________

2. Antithyroid therapy

a. Propylthoiracil (PTU)

b. Methimazole (Tapazole)

a. Action

3. Propranolol hydrochloride (Inderal)

a. Classification

b. Action

c. Warning

4. Meds alone sometimes work if not

a.

b. Ca of Thryoid

a.

5. Euthyroid State ______________ surgery

a.

6. Iodine before surgery

a. Potassium Iodide Saturated Solution (SSKI)

b. ______________________________ of the thyroid

c. ________ risk of post –op _________________________

7. Radioactive Iodine

a.

b. Used instead of ______________________ treatment

c. Stop anti-thyroid meds _________________________

d. ___________ dose

e. S&S decrease in about ___________________________ but full affect is

not known until _____________________________

f. Safety

a. No __________________________

b. Watch __________________________________

c. Avoid __________________ for 7 days

Endocrine Handout 55/9/2023

6

Page 7: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

H. Diet

1. Calories

a.

2. Fluids

a.

3. Na+

a.

4. Fiber

a.

5. Caffeine

a.

I. Nursing Management hyperthyroidism

1. Assessment

a. _____________________

b. _______________ sounds

c. Anxiety level

d. ________________

e. Bowel function

f. _____________ palpate the goiter

2. Nursing Diagnosis

a. Risk of _______________________

a.

b. ___________ thermia

c. Diarrhea

d. Alt __________________

e. Sleep pattern disturbance

f. Anxiety

3. Exophthalmos

a. ___________________ eyes

b. _____________ closed

c. ______________ glasses

d. _______________ diet

Endocrine Handout 55/9/2023

7

Page 8: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

e. HOB _______________

J. Thyrotoxicosis: AKA ___________________________________

1. Definition

a. _________________ __________thyroid state

2. Etiology/Pathophysiology

a. Stress

b. Post ________________ surgery

c.

3. Signs & symptoms

a. ____TH ____ adrenergic activity __ epinephrine

b. Pulse _________

c. Temperature

d. BP

e. Depression

f. Activity

g. Delirium

h. SOB

i. Coma

j. Death

a.

b. 2nd __________________________

4. Treatment

a. Fever

a. Tylenol/Acetaminophen

b. Not: __________________

b. For pulse / BP

a. Propranolol / Inderal

b.

c. If SOB

a. ______________

b. HOB ___________

Endocrine Handout 55/9/2023

8

Page 9: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

IV. HypothyroidismA. Definition

B. Pathophysiology

1. Primary hypothyroidism

2. Secondary hypothyroidism

C. Etiology

1. Primary

a. _____________________

b. ______________ deficiency

c. _______________________

d. Thyroidectomy

2. Secondary

a. ______________________ or ________________ changes

D. Signs and Symptoms

1. THINK _____________________

Neurological

Affect

Cardiovascular

Gastrointestinal

Muscle/skeletal

Skin

E. Cretinism

1. _________________ in the US

2. ___________________ condition d/t ________________ physical and

mental _____________________

Endocrine Handout 55/9/2023

9

Page 10: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

F. Hashimoto’s thyroiditis

1. Most common cause of ________________ hypothyroidism

2. _______________________ disease

3. Female _________ Male

4. Age:

G. Diagnostic Tests

1. By definition hypothyroidism means? _______________

2. By definition primary hypothyroidism means what?

3. In primary hypothyroidism is the pituitary working correctly?

4. If the pituitary gland is working correctly & there is a T3/T4, what will

the Pituitary gland do with the TSH level?

5. By definitions secondary hypothyroidism means what? a.

Primary HypothyroidismSecondary Hypothyroidism

T3/T4

TSH

H. Medical Treatment

1. Pharmacology

a. Thyroid (Armout Thyroid)

a.

b. Levothyroxine sodium (Levothroid, Synthroid)

a.

c. Time of dose _______________________

d. Monitor _______________________ system

e. Gradually __________ meds

a. Take ______________ to know full affect of dose

f. _____________blood level monitoring

g. Know __________________and report

Endocrine Handout 55/9/2023

10

Page 11: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

2. Diet

a. Fiber

b. Protein

c. Calories

d. Avoid foods high in _________________

a.

b.

c.

d.

e.

f.

g.

I. Nursing Management

1. Rest

2. Skin

3. Diet

V. Severe Hypothyroid State

A. Myxedema

1. Definition

a. _____________hypothyroidism

2. Etiology

a. Iodine

b. Atrophy

c. Surgery

d. Destruction of thyroid by ________________

3. Characteristics

a. Growing ________________ and _________________of skin

b. Dry, waxy ________________ (non-pitting)

c. Abnormal deposits of ______________in the skin

d. Distinctive ________________ changes

Endocrine Handout 55/9/2023

11

Page 12: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

B. Myxedema Coma

1. _________________rate drops so low _______________ threatening

a. Temperature

b. Respirations

c. Blood pressure

d. Glucose level

e. Mental functioning

f. Death 2nd _________________________________

VI. Goiters

A. Definition

1.

B. Pathophysiology

1. What hormone causes the thyroid to grow?

2. What hormonal change causes goiter?

3. _______________level goiters

C. Etiology

1. Low __________

2. Deficiency of __________________

3. Pregnancy

D. Endemic Goiter

1. Caused by _______________________ factors

a. i.e.

E. Are goiters associated with Hyperthyroidism, Hypothyroidism or Euthyroid state?

F. Goitrogens

1. __________________ thyroid function

a.

b.

c.

d.

e.

f.

g.

Endocrine Handout 55/9/2023

12

Page 13: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

G. S&S of a goiter

1. ___________________ thyroid

H. Complications

1. May interfere with

a.

b.

I. Nursing Management of Goiters

1. Diet

a. Limit _________________________

2. Assess

a.

b.

3. Palpate?

Quick Quiz: Thyroid Disorders

Label each of the following symptoms as associated with hyper or hypo thyroidism:

1. _________ Bradycardia

2. _________ Lethargy

3. _________ Restlessness

4. _________ Frequent stools

5. _________ Hypercholesterolemia

6. _________ Dry hair

7. _________ Tremor

8. _________Insomnia

9. _________ Mental dullness, confusion

10. _________Weight loss

11. _________ Decreased appetite

Endocrine Handout 55/9/2023

13

Page 14: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

VII. Cancer of the Thyroid

A. Etiology

1.

2. Female _________ Male

3. Thyroid _____________________

4. Radiation

5. _________________ deficiency

B. Signs & symptoms

1. 1st sign:

a.

b.

c.

2. Difficulty ____________________________

3. Difficulty ____________________________

4. Changes in ___________________________

5. Lab values ___________________________

C. Diagnostic tests

1. ______________________________ = Shows a “cold” nodule

a. Area that did not __________________________________

b. Indicates _______________

2. Biopsy

D. Medical treatment

1. Thyroidectomy

a. __________________________ or

b. ___________________________

VIII. Thyroidectomy

A. Pre-op

1. ________________ state

2. Verify ________________________

B. Post-op

1. Vital signs

a. Drop in BP + Tachycardia = _______________________

Endocrine Handout 55/9/2023

14

Page 15: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

b. pulse + Fever + BP = ________________________

2. Check for hemorrhage

a.

3. Check for S&S of ________________ or _______________

4. Check _______________________

5. Position:

6. Activity level:

7. Monitor for _______________

a.

8. _______________________ at the bed side

9. Diet changes (if due to hyperthyroidism)

C. Complications

1. Thyrotoxic Crisis

a. D/T manipulation of __________________ during surgery

______________________________

2. Tetany

a. Continuous __________________ spasm of a muscle

b. Caused by ___________________________________

c. Characterized by

a. Finger and perioral area

b. ________________ spasms

c. _____________________

d. Etiology

a. D/T ______________________________________

e. Treatment

a. IV _______________________________

b. Breath into a paper bag ___________________ ____________________

in the blood

IX. ParathyroidA. Description

1. ________ parathyroid glands

2. Behind _________________________

Endocrine Handout 55/9/2023

15

Page 16: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

B. Function of the Parathyroid

1. Secrete ___________ C. Hormone

Hormone Function Stimulated by…

PTH Increase reabsorption of __________ &

______________ from the bone to the

blood

_____ absorption by small ___________

________ absorption by ___________

Increases _____________________

Antagonist to _________________

It is the most important regulator of

______________________

D. Why do we need Calcium

1. _________

2. ____________

3. Blood __________________

4. Transmission of __________________ impulses

5. Muscle ____________________ & ______________________

6. Normal ___________________

X. HyperparathyroidismA. Pathophysiology

1. __________ parathyroid activity

2. ___________ PTH

3. ____________ blood Ca. levels

4. ____________________

5.

B. Etiology

1. Hyperplasia or benign tumor

2.

Endocrine Handout 55/9/2023

16

Page 17: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

C. Signs and symptoms

1. D/t ____________in serum __________________ levels

2.

3.

4.

5.

6. N/V ____________________

7. ____________________ AKA __________________________

8. Cardiac _________________ ________________________

9. Peptic ______________

10. Pathological ______________________

a. _____________ pain

b. _____________ pain / tenderness

11. Coma

D. Diagnostic tests

1. Lab

2. X-ray

E. Medical management

1. Goal =

2. _________ fluids

3. Lasix

a.

4. Pamidronate (Aredia)

a. Calcitonin

b.

F. Surgical Management

1. If severe ____________

2.

3. Post-op

a. Bone pain ________________________

b. Renal damage _____________________

XI. Hypoparathyroid

Endocrine Handout 55/9/2023

17

Page 18: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

A. Pathophysiology

1. A decrease in PTH

2. __________________ blood reabsorption of ____________ from the

_____________

3. _______________ Ca level

4. AKA: ______________________

B. Etiology

1. Heredity

2. _______________________

C. Signs & Symptoms

1. Neuromusclar ___________________

2. Acute ___________________

a. _________________ of fingers

b. __________________ spasms

c. ________________________

d. + __________________________ sign

a. Tap ___________ nerve

b. ______________________

e. + __________________________ sign

a. Occlusion of ____________ artery x 3 min

b. ______________ spasm

3. Chronic S&S

a. ___________________

b. Muscle Spasms

c. _____________________ in the eyes or brain

d. _____________________________

e. Laryngospasms

a. Obstruction of the ____________________

D. Diagnostic Tests

1. Chvostek’s sign

2. Trousseau’s sign

3. Labs

Endocrine Handout 55/9/2023

18

Page 19: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

a.

b.

E. Medial-surgical management

1. IV calcium gluconate

2. Breathing into a paper bag ______________ ____________

3. Diet

a.

b.

4. Vitamin

5. ___________________ diuretics

F. Nursing management

1. Monitory closely for S&S of ___________________

2. Monitor for ____________________

Case

Endocrine Handout 55/9/2023

19

Case Study: Sally is a 43-year-old office worker admitted to the hospital with a high fever. While collecting data for her history and find that she has recently lost her job because of inability to handle job stress. She has also had recent weight loss, fatigue, insomnia, palpitations, and heat intolerance. After an endocrine workup, her physician diagnoses Grave’s disease. A subtotal Thyroidectomy is scheduled for 2 months later, and she is started on Propylthiouracil and Propranolol (Inderal).

1. Why is Sally having palpitations? (Which other hormones might be involved?)

2. Why does Sally have a fever?

3. Why is surgery delayed for 2 months?

4. How will the Propranolol help?

5. Why was the Propylthioracil ordered?

6. What is the advantage of a subtotal over a total Thyroidectomy?

7. What will you teach Sally before the surgery?

8. Why should a tracheostomy set be at the bedside after surgery?

9. Sally develops tingling in her fingers and toes after surgery. What do you

suspect? What is the cause?

10. How will Sally’s dietary needs change after surgery?

Page 20: Endocrine handout: Thyroid & Parathyroid - …home.portervillecollege.edu/eKeele/Endocrine/5 Endocrine... · Web viewEndocrine Handout 5 Thyroid & Parathyroid Glands Reading Assignment:

Questions:

1. Where are the parathyroid glands located?

2. How many parathyroid glands do most people have?

3. What hormone(s) does the parathyroid gland secrete?

4. The Parathyroid hormones regulate the blood levels of what two elements?

5. What three diagnostic tests can be performed to test parathyroid function?

6. Name 3 medications that decrease serum Calcium levels

7. What are normal serum calcium levels?

8. How can hyperparathyroidism be treated surgically?

9. What medications are used to treat hypercalcemia?

10. Hyperparathyroidism leads to _______ serum calcium levels

11. Describe Chvosteks and Trousseau’s sign and what they indicate

12. Name 5 foods high in calcium

13. Define primary and secondary hyperthyroidism

14. Be able to complete the following

PTH S&S Dx Tx Rx Severe Nursing LabsHyperParathyroidism

HypoParathyroidism

Endocrine Handout 55/9/2023

20