Grave’s Disease NCLEX Review

Grave’s disease NCLEX review notes for students who are prepping to
take the NCLEX exam. The endocrine system is made-up of many
disorders, such as Grave’s disease which is a cause of hyperthyroidism.

This NCLEX review is part of an endocrine series of thyroid disorders.

As a student prepping for NCLEX, it is very important you know the

details of Grave’s disease and how to care for a patient experiencing
this condition.

As the nurse taking care of the patient in Grave’s disease it is important

you understand the signs and symptoms, pathophysiology, causes,
nursing interventions, and medical treatments.

Don’t forget to take the quiz on Grave’s disease.

In this NCLEX review, you will learn the following:

-Pathophysiology of the Grave’s disease

-Signs and symptoms of Grave’s disease
-Causes of Grave’s disease
-Nursing Interventions
-Medications for Grave’s disease
-Treatments

Lecture on Grave’s Disease

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 Grave’s Disease
Definition: Most common cause of hyperthyroidism that is caused by
an autoimmune condition. The patient will have excessive thyroid
hormone secretion (T3 and T4) by the thyroid gland.

Cause: the body is producing an antibody called TSI (thyroid

stimulating immunoglobulin) that is producing the same effects on the
body as TSH (thyroid stimulating hormone). TSH release causes the
thyroid gland to secrete T3 and T4.

Negative feedback system of thyroid hormone

release:

Hypothalamus->TRH (thyrotropin releasing hormone)->Anterior

pituitary gland—>TSH—>stimulates the thyroid gland to secrete ->T3
and T4

T3 and T4: play a huge role on body metabolism, increases body

temperature, sympathetic nervous system (increase heart rate, blood
pressure, alertness), how fast the body digests food etc.
:
 Signs and Symptoms of Grave’s Disease
Typical signs and symptoms of HYPERTHYROIDISM but there are
UNIQUE signs and symptoms:

Weight loss (burning calories increased)

Heat intolerance (feel extremely hot…sweaty)
Tachycardia (sympathetic system in overdrive)
Hypertension (sympathetic system in overdrive)
Diarrhea (GI system working harder and faster)
Irritable
Smooth skin/hair (increase blood flow)

UNIQUE S&S:

Ophthalmopathy: protruding eye balls

Goiter: overstimulation of the thyroid gland which causes it to
swell
Pretibial Myxedema: red, swelling on the skin, lower legs, and
feet that has an orange peel texture…can advance to face, chest,
arms

Nursing Interventions for Grave’s Disease

Monitor HR, BP, EKG, weight (at risk for weight loss and will need a
high calorie diet)
Keep patient in a cool, quiet environment

Pharmacology Management:

Antithyroid medication: stop the thyroid from synthesizing t3 and t4,

:
 doesn’t damage thyroid gland like radioactive iodine therapy

Tapazole “Methimazole” (most common…fewer side effect)

common treatment for Grave’s Disease
PTU “Propylthiouracil” (safer during first trimester of
pregnancy)….liver failure

Other side effects for both medications: agranulocytosis and aplastic

anemia

Patient education for Antithyroid medications:

Never stop taking abruptly (takes a while before the patient starts
seeing results)
Take at same time every day
Signs and symptoms of thyroid storm
Avoid iodine rich foods (sea foods like seaweed, dairy eggs) or
supplements with iodine
No Aspirin or Salicylates (increases thyroid hormone)
Signs and symptoms of hypothyroidism (toxicity)

Beta Blockers:

Inderal: prevents the hyperthyroidism effects on the body by

blocking peripheral conversion of T3 and T4. This medication will
help decrease heart rate, blood pressure, and decrease heat
intolerance (not for people with asthma or history of
bronchospasm…watch in diabetics…. can mask signs and
symptoms of hypoglycemia).

Treatments for Grave’s Disease

:
 Radioactive iodine: destroys the thyroid gland overtime and is a
permanent cure compared to medications….not for pregnant or nursing
women

Side Effects: Iodism- taste changes “metal taste”, nausea, and

swollen saliva glands

Surgical Treatment: Thyroidectomy (removal of the thyroid gland)

Watch for thyroid storm due to the manipulation of the gland

causing extra T3 and T4 to leak into the body….prevent by
prepping with medications of: antithyroid meds, sodium iodide
solution, beta blocker, glucocorticoids
Educate about post-opt care: coughing and deep breathing and
splinting neck when coughing
Monitor for parathyroid destruction problems (common when a
thyroid procedure is performed due to the close proximity of the
parathyroid to the thyroid gland)…watch calcium levels
“hypocalcemia”…parathyroid is responsible for calcium regulation.
Watch for respiratory distress due to the nature of the surgical
site…keep patient in semi-fowler’s to help with swelling and
drainage at the site and keep at the bedside a trach kit, oxygen,
and suction.

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