Professional Documents
Culture Documents
Presented by :
Dr. Nagla
Hamdi
Objectives
l On completion of this lecture, the learner
will be able to:
l Describe nursing management of patient with thyroid disorders
l •Compare and contrast with thyroid disorders regard to cause, assessment
findings, management and the significance of preventive health care.
l •Use the nursing process as a framework for care of patients with thyroid
storm
l •Identify the clinical significance and related nursing implications of the
various tests and procedures used for diagnostic assessment.
l •Demonstrate appropriate documentation and reporting thyroid disorders .
Thyroid Gland
3
Thyroid Function and Dysfunction
4
Thyroid Hormone
l The two separate hormones, thyroxine (T4) and
triiodothyronine (T3) are produced by the thyroid gland and
that make up thyroid hormone, are amino acids that regulate
the cellular metabolic activity. They influence cell replication,
are important in brain development, and necessary for normal
growth.
6
Thyroid Function Tests
9
Hypothyroidism
l Suboptimal levels of thyroid hormone.
l Thyroid deficiency can affect all body functions.
Causes of Hypothyroidism
l 1-Atrophy of thyroid gland.
l 2-Therapy for hyperthyroidism:
3- Radioactive iodine (131I)
4- Thyroidectomy
l 5- Medications.
– Lithium (controversal), iodine rich compounds
(amiodarone), and antithyroid drugs (propylthiouracil).
l 6- Radiation to head and neck.
10
Pathophysiology of Hypothyroidism
l Types:
l 1- Central hypothyroidism causes thyroid dysfunction due to
failure of the pituitary gland, or hypothalamus, or both.
l 2- Secondary hypothyroidism is caused by a thyroid disorder.
11
no 80
Clinical Manifestations of Hypothyroidism
1. Early symptoms are nonspecific.
2. Extreme fatigue.
3. Hair loss, brittle nails, dry skin, and numbness and tingling of
the fingers may occur.
4. Voice may become husky [hoarse and dry].
5. Menstrual disturbances & loss of libido.
- In severe hypothyroidism:
1. Hypothermia & bradycardia.
2. Weight gain even without ↑ in food intake.
3. Thick skin, thin hair that falls out.
4. Expressionless and masklike face.
Continued…
12
5. Subdued emotional responses, and dull mental processes.
6. Slow speech and enlarged tongue. É
7. Constipation. JW l
13
Autoimmune hypothyroidism
Sequential changes in physical appearance in a young
girl who presented at 15 years of age with amenorrhea
and hyperprolactinemia secondary to severe
hypothyroidism. Note her poor linear growth since at
least 11 years of age.
Autoimmune Hypothyroidism
l The aim of medical management is to:
– restore a normal metabolic state by replacing the missing
hormone.
Pharmacologic Therapy
– Synthetic levothyroxine (Synthroid or Levothroid) is the
preferred preparation for treating hypothyroidism .
18
Nursing Management
Modifying Activity
l The patient experiences decreased energy and lethargy. As a
result, the risk for complications from immobility increases.
l The patient has decreased ability to exercise and participate in
activities due to changes in cardiovascular and pulmonary
status.
l The nurse’s role is to assist with care and hygiene while
encouraging the patient to participate in activities as tolerated
to prevent the complications of immobility.
Continued….
19
Monitoring Physical Status
20
Promoting Physical Comfort
21
Providing Emotional Support
l The nurse informs the patient and family that the symptoms and
inability to recognize them are common but treatment is
successful and symptoms are reversible.
22
Promoting Home and Community-Based Care
23
Nursing Care
24
Management of Hypothyroidism
l Start patient on L-thyroxine (levothyroxine) 0.05-0.1mg.
l L-thyroxine treats the hypothyroidism .
l If patient is elderly or has HD start 0.025mg.
l Check TSH level after 4-6 weeks to adjust the dose of L-
thyroxine.
l In case of secondary hypothyroidism monitor FT4 instead
of TSH.
Myxedema Coma
l Medical emergency, end stage of untreated hypothyroidism.
l Clinical features:
– Eye features: Classes 0-6, scale.
l Class 0: No signs or symptoms
– Heat intolerance
l CHF, dyspnea, angina
– Gastrointestinal:
HIM
l Weight loss, happetite
l Diarrhea
– Reproductive:
l amenorrhea, oligo- menorrhea, infertility
l Gynecomastia
– Bone:
l Osteoporosis
Class G
Assessment and Diagnostic Findings
l Enlarged thyroid.
37
Treatment of Grave’s Disease
l A. Medical therapy:
39
Nursing Diagnoses
l Imbalanced nutrition, less than body requirements, related to
exaggerated metabolic rate, excessive appetite, and increased
gastrointestinal activity.
l Ineffective coping related to irritability, hyperexcitability,
apprehension, and emotional instability.
l Low self-esteem related to changes in appearance, excessive
appetite, and weight loss.
l Altered body temperature.
40
Planning and Goals
l Improved nutritional status.
l Improved coping ability.
l Improved self-esteem.
l Maintenance of normal body temperature.
l Absence of complications.
41
Nursing Interventions
SI is I 1- Improving Nutritional Status
42
2- Enhancing Coping Measures
43
3- Improving Self-esteem
44
4- Maintaining Normal Body Temperature
45
Teaching Patients Self-Care
46
Evaluation
Expected Patient Outcomes
47
1
Thyroid storm (Thyrotoxic crisis)
l Usually occurs in a severely hyperthyroid patient caused by a
precipitating event such as:
– Infection
– Surgical stress
– Stopping antithyroid medication in Graves’ disease
l Clinical clues
– feverà hyperthermia
– marked anxiety or agitationà coma
– Anorexia
– tachycardiaà tachyarrhythmias
– pulmonary edema/cardiac failure
– hypotensionà shock
– confusion
Thyroid storm management
l Initiate prompt therapy after free T4, free T3, and TSH drawn
without waiting for laboratory confirmation.
l Therapy
l 1. General measures:
l Fluids, electrolytes should be used as indicated
l A cooling blanket and acetaminophen can be
used to treat the pyrexia.
Thank
you
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