HESI MED SURG STUDY GUIDE

Grave's Disease - Thought to be an autoimmune process; diagnosis is made on the basis of serum
hormone levels

Common treatment for hyperthyroidism - Thyroid ablation by medication, radiation, thyroidectomy,

adenectomy of portion of the anterior pituitary where TSH- producing tumor is located

Nursing assessment for hyperthyroidism - Enlarged thyroid gland, weight loss, increased appetite,
diarrhea, heat intolerance, tachycardia, palpitations, increased BP, diaphoresis, wet or moist skin,
nervousness, insomnia, exophthalmost, T3>220, T4>12, low level of TSH, radioactive iodine uptake and
thyroid scan indicate the presence of a goiter.

Nursing plans and interventions for hyperthyroidism - Calm, restful atmosphere; signs of thyroid storm;
high calorie, high protein, low caffeine diet; eye care for expohthalmost; treat hyperthyroidism

Thyroid storm - Life threatening event that occurs with uncontrolled hyperthyroidism due to graves
disease; fever, tachycardia, agitation, anxiety and hypertension; maintain patent airway and adequate
aeration

Thyroid ablation - Propylthiouracil and methimazole act by blocking synthesis of T3 and T4; doses is
based on body weight and is given over several months; take medications exactly as prescribed

Radiation - Iodine 131 is given to destroy thyroid cells and is very irritating to the GI tract; place client on
radiation precautions

Postoperative thyroidectomy - Be prepared for the possibility of laryngeal edema. Put oxygen and a
suction machine; Ca++ gluconate should be easily accessible

Thyroidectomy - Check frequently for bleeding; support the neck when moving the client; laryngeal
edema damage by watching for hoarseness or inability to speak clearly; keep any drainage devices
compressed and empty

Adenectomy - TSH-secreting pituitary tumors are resected using a transnasal approach

Normal serum calcium levels - 9.0 to 10.5 mEq/L; the best indicator of parathyroid problems is a decrease
in the client's calcium compared to the preoperative value

Chance of tetany - The chance for this increases when two or more of the parathyroid glands have been
removed. Monitor serum calcium levels; check for tingling of toes and fingers and around the mouth;
check for chvostek's sign; check for trousseau's sign

Chvostek's sign - Twitching of lip after a tap over the parotid gland

Trousseau's sign - Carpopedal spasm after BP cuff is inflated above systolic pressure

Hypothyroidism - Hypofunction of the thyroid gland, with resulting insufficiency of thyroid hormone;
Hasimoto Disease, Myxedema

Myxedema Coma - Can be precipitated by an acute illness, withdrawal of thyroid medication, anesthesia,
use of sedatives, or hypoventilation (with the potential for respiratory acidosis and carbon dioxide