Question

Med Surge Ch49

1. Describe the pathophysiology signs and symptoms complications and treatment of hyperthyroidism , hypoparathyroidsim.

2. Assist in the development of nursing care plans for patients with disorders of the thyroid or parathyroid glands.

Answer 1

SIGN AND SYMPTOMS

Increased appetite

Nervousness

Restlessness

Inability to concentrate

Weakness

Irregular heart beat

Difficulty sleeping

Fine , brittle hair

Itching

Hair loss

Tremor

Nausea and vomiting

Weight loss

Breast development

Dizziness

Shortness of Breathing

Loss of consciousness

Exophthalmos

Goiter

Muscle weakness

Emotional liability

COMPLICATIONS

immediate complications

Hemorrhage

Infection

Recurrent laryngeal nerve palsy

Thyroid crisis or Strom

Respiratory obstruction

Parathyroid insufficiency pr tetany

Late complications

Thyroid insufficiency

Recurrent thyrotoxicosis

Progressive exophthalmos

Hypertrophic scar or keloid  

TREATMENT

1. Antithyroid drugs ,betablocker

Radioactive iodine (I 131)

2. surgery

The objective of pharmacotherapy is to inhibit hormone synthesis or release and . reduce the amount of thyroid tissue

antithyroid drugs : prothiouracil , methimazole until patient is euthyroid.

Maintainance dose is established ,followed by gradual withdrawal of medication over next several months.

ADJUNCTIVE THERAPY: potassium iodide , Lugol's solutions , Saturated solutions of potassium iodide.

B - adrenergic agents , propranolol is most common prescribed , dose 20-40 mg four times daily.

RADIOACTIVE IODINE

Iodide blocks the conversion T4 to T3 and inhibit hormone releas.

SURGICAL TREATMENT

Surgical intervention removes about 5/6 of thyroid tissue.

Surgery performed when thyroid function has returned to normal 4 to 6 weeks) .

Before surgery Patient is given propylthiouracil until sign of hypothyroidism has disappeared

Iodide. Is given to reduce the size of thyroid and vascularity and blood loss.

HYPOPARATHYRODISM

HYPOPARATHYRODISM occur due to hypo - secretions of PTH. By .Parathyroid glands characterized by decreas in calcium level and hyperphosphetemia.

PATHOPHYSIOLOGY

1. due to etiological cause ( injury to parathyroid gland , iodine treatment for hyperthyroidism.)

2. Decrease in gland function

3. Resistance to PTH action

4. Inadequate PTH secretions. And increased .re absorption of calcium in GI tract .

5. Blood calcium. Fall to low level.

6. Muscular hyper irritability

7. Uncontrolled spasms ,hypo calcemic tetany.

SIGN AND SYMPTOMS

muscle Cramps or spams in legs , feet ,lower back , face abdomen.

Tingling In finger ., Toes or lips

Anxiety and depression

Heart failure

An irregular heart beat

Low blood pressure

Seizure

Cold intolerance

Dry

Hair , rough pale skin, Hair loss

- Positive Trousseau's sign , positive chevostek sign

Dysphagia

Photophobia

Cardiac dysrhythmia

Convulsion

COMPLICATIONS

- Acute airway obstruction

- CV failure

- Mental disorders

- .Sub capsular cataract

-. Shortening .of fingers and toes

-. Below .Normal temperature

- Decreased breathing

- Low blood pressure

- low blood sugar

-. Unresponsiveness

- Low calcium level can leads : cataract , dental problems , tremors , .Hair loss , Brittle nails.

TREATMENT :

1. Serum calcium level raised to 9-10mg /dl.

2.When hypocalcemia and tetany occur after thyroidectomy IV calcium gluconate, sedative may be administered, paraentral parathormon may be given .

3. Neuromuscular irritability reduced by environment that is free from noise , drafts bright light or sudden movement.

4. Tracheostomy , mechanical ventilation and bronchodilating medication may become necessary if patient develop respiratory distress.

5. High calcium diet and low phosphorus, patient should avoid milk , egg products, spinach .

6.Oral calcium tablet and vitamin D preparation and aluminium hydroxide or Aluminium carbonate given.

Que 2. NURSING DIAGNOSIS FOR THYROID DISORDERS

1.Activity intolerance related to fatigue and depressive cognitive process

2. Risk for imbalanced body temperature Relate to cold intolerance.

3. Constipation related to depressed gastrointestinal .Function.

4. Ineffective breathing pattern related to depressed ventilation.

5. Disturbed thought process related to depressed metabolism and CardioVascular and respiratory status.

6. Risk for decreased cardiac output related to .Uncontrolled HYPERTHYROIDISM , hypermetabolic state.

7 . fatigue related to hypermetabolic state.

8. Risk for altered thought process related to increase in CNS stimulation.

9.anxity related to pseudocatecholamine effect of thyroid hormone.

10. Risk for imablanced nutrition : less than body requirements related to nausea , vomiting .

NURSING DIAGNOSIS FOR PARATHYROID DISORDERS

HYPOPARATHYRODISM :

A) Ineffective airway clearance related to laryngeal muscle spasm.

B) Risk for injury related to tetany .

C) Acute Confusion related to parathyroid disorders.

D) activity intolerance related to weakness and apathy.

E) nutrition less than body ( calcium level) related to inadequate calcium diet or intake.

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