Dosdos, Bianca Mikaela F.

DIABETES

Block CCC 21. C

2nd Appraisal Exam 22. A

23. B

PARATHYROID DISORDERS 24. C

1. D 25. B, E, F

2. D 26. A, B, D

3. C 27. B, D

4. B 28. B.

5. B 29. C.

6. B 30. A.

7. C 31. C

8. A 32. A.

9. A,C,D,E 33. D.

10. A,B,F,G 34. A

11. A. 35. A

12. B. 36. D

13. A 37. D.

14. C 38. B

15. A 39. B

16. A 40. D.

17. B 41. B

18. A 42. A, C, D

19. C 43. C

20. B,C,D 44. B

45. D 20%. Thyroid storm is most commonly

46. A seen in the context of underlying Graves'

47. B, C, E hyperthyroidism but can complicate

48. B thyrotoxicosis of any aetiology. Clinical

49. B features represent manifestations of

50. A organ decompensation, with fever seen

51. D almost universally. Management is

52. ABFG supportive with cooling and fluids,

53. C alongside measures taken to reduce

54. D thyroid hormone synthesis, hormone

55. B release and inhibition of the peripheral

56. C effects of excessive thyroid hormone. In

57. C addition, the management of thyroid

58. B storm should not disregard the search

59. D, E and appropriate treatment of any

60. B precipitating factors.

ESSAY Immediate objectives are

A. reduction of body temperature and heart

Thyroid storm (also known as rate and prevention of vascular collapse.

thyroid or thyrotoxic crisis) is an Measures to accomplish these objectives

uncommon condition reflecting an in objectives include:

extreme physiological state within the  A hypothermia mattress or blanket,

spectrum of thyrotoxicosis. The ice packs, a cool environment,

condition is rare, however, mortality hydrocortisone, and acetaminophen

rates are high and may approach 10– (Tylenol).

 Salicylates (e.g., aspirin) are not fibrillation, dysrhythmias, and heart

used because they displace thyroid 45 failure, sympatholytic agents

hormone from binding proteins and may be given. Propranolol,

worsen the hypermetabolism. combined with digitalis, has been

 Humidified oxygen is given to effective in reducing severe cardiac

improve tissue oxygenation and symptoms.

meet the high metabolic demands. i. Administer dextrose-containing

Arterial blood gas levels or pulse intravenous fluids as ordered to correct

oximetry may be used to monitor fluid and glucose deficits.

respiratory status. ii. Carefully assess the patient for

 IV fluids containing dextrose are heart failure or pulmonary edema.

given to replace liver glycogen iii. Dopamine may be used to

stores that have been decreased in support blood pressure.

the patient who is hyperthyroid. iv. Provide supplemental oxygen as

 Propylthiouracil (PTU) or ordered to help meet increased

methimazole is given to impede metabolic demands.

formation of thyroid hormone and v. Once the patient is

block conversion of T4 to T3, the hemodynamically stable, provide

more active form of thyroid pulmonary hygiene to reduce pulmonary

hormone. complications.

 Hydrocortisone is prescribed to vi. If the patient is in heart failure,

treat shock or adrenal insufficiency. typical pharmacologic agents for

 Iodine is given to decrease output treatment of heart failure may also be

of T4 from the thyroid gland. For indicated.

cardiac problems such as atrial

vii. Reduce oxygen demands by approximately 4 to 6 weeks. After the

decreasing anxiety, reduce fever, dose is stabilized, patients can be

decrease pain, and limit visitors if monitored with laboratory measurement

necessary. of TSH annually.

viii. Anticipate aggressive treatment - Levothyroxine sodium a synthetic

of precipitating factor. thyroid hormone replacement is used to

ix. Institute pressure ulcer strategies. returns the patient to the euthyroid

B. (normal) state. Dosage is 1.5–2.5

Nursing Interventions mcg/kg PO daily; (use lowest dose

1. Monitor vital signs, including heart possible because over-replacement of

rate and rhythm. thyroid can cause bone loss or

2. Administer thyroid replacement, cardiovascular complications).

levothyroxine sodium (Synthroid) is 3. Instruct the client about thyroid

most commonly prescribed. replacement therapy.

- Treatment consists of replacing the 4. Instruct the client in low-calorie, low-

deficient hormone with synthetic thyroid cholesterol, low-saturated-fate diet.

hormone; low doses are initially used, 5. Assess the client for constipation;

and the dose is increased every 1 to 2 provide roughage and fluids to prevent

months based on the clinical response constipation.

and serial laboratory measurements that 6. Provide a warm environment for the

show normalization of thyroid- client.

stimulating hormone (TSH) levels in 7. Avoid sedatives and narcotics because

primary hypothyroidism. The patient of increase sensitivity to these

begins to experience clinical benefits in medications.

3 to 5 days, which level off after

8. Monitor for overdose of thyroid function and that the medications may

medications, characterized by lead to hyperthyroidism despite the

tachycardia, restlessness,, nervousness, patient’s underlying hypothyroidism.

and insomnia. 2. Teach the patient about the thyroid

9. Instruct the client to report episodes gland and hypothyroidism, as well as

of chest pain immediately. complications such as heart disease and

10. Document the following: edema. Teach the patient that new

a. Physical findings: Cardiovascular cardiac or hyperthyroidism symptoms

status, bowel activity, edema, condition need to be reported immediately.

of skin, and activity tolerance Explain that the caloric and fiber

b. Response to medications, skin care requirements vary. The patient should

regimen, nutrition report any abnormal weight gain or loss

c. Psychosocial response to changes in or change in bowel elimination.

bodily function, including mental acuity

Health teaching:

1. Explain all medications, including

dosage, potential side effects, and drug

interactions. Instruct the patient to check

the pulse at least twice a week and to

stop the thyroid supplement and notify

the physician if the pulse is greater than

100. Explain that the healthcare

professional should be notified about the

condition. Explain that ongoing medical

assessment is required to check thyroid