NUR258 Exam 2 Modules 4, 5, 6 Questions With Complete
Solutions
How do we know if levels are high or low? Cause?
PRIMARY:
Cause: thyroid gland
T3 and T4: Low, because the thyroid gland is underactive.
TSH: High, because the pituitary gland is working to stimulate
the thyroid to produce more T3 and T4. The pituitary senses that
there is not enough thyroid hormone and secretes more TSH in
an attempt to get the thyroid to respond.
SECONDARY:
Cause: pituitary gland
T3 and T4: Low, because the thyroid isn't being properly
stimulated by TSH.
TSH: Low (or inappropriately normal), because the pituitary
gland is not producing enough TSH to signal the thyroid to
make more hormones.
hypothyroidism manifestations
slow and sluggish
- decrease in metabolism
- fatigue and lethargy
- weight gain with NO increased caloric intake
,- cold intolerance
- dry skin, brittle hair
- large tongue: risk for airway, aspiration precautions, monitor
swallowing, swallowing eval. (TSH high, T3 and T4 low)
- bradycardia
- hypotension
- menorrhagia: period heavy, light, absent
- constipation (tx stool softeners)
- goiter
hypothyroidism pharmacotherapy
○ Drug of choice: levothyroxine
□ Toxic effect: hyperthyroidism
□ Monitor levels of TSH
□ Risk of Thyroid storm (hyperthyroidism complication)
Why? (overdose)
○ Teaching
- Take in the morning on an empty stomach
- Dose started low and slowly titrated until desired levels of
serum TSH
- Treatment lifelong
hypothyroidism nursing priorities
,○ Monitor vital signs, HR and BP increasing/normalizing (low
bp = fluids, bradycardia = atropine)
○ Improved mood, weight loss, energized, not freezing
(stabilizing)
○ Encourage a balanced diet rich in fiber to prevent
constipation.
○ Address cold intolerance.
○ Medication compliance
myxedema coma
Severe hypothyroidism
○ Causes
- Undiagnosed hypothyroidism
- Levothyroxine noncompliance
- Stressors like acute illness or surgery
myxedema coma manifestations
Depression, diminished cognitive status, lethargy (may progress
to stupor, reduced LOC, coma)
- hypoventilation
- hyponatremia
- hypoglycemia
- hypothermia
- bradycardia
- hypotension
, THINK LOW LOW LOW
Myxedema LOWMA
myxedema coma nursing management
○ Hypoventilation progressing to respiratory failure: prevent
from aspirating, choking on there own secretion, ABC's, good
oxygenation
○ Hyponatremia
○ Hypoglycemia: glucagon
○ Hypothermia: keeping them warm, blankets
○ Bradycardia & hypotension – May progress to circulatory
collapse, BP so low: need fluids, vasopressors (atropine),
levothyroxine
hyperthyroidism
Primary:
- most common
- Graves disease
- women
- toxic multinodular goiter
-TSH low, T3 and T4 high
Excessive ingestion of thyroid hormone levothyroxine
Why are levels high or low?
Solutions
How do we know if levels are high or low? Cause?
PRIMARY:
Cause: thyroid gland
T3 and T4: Low, because the thyroid gland is underactive.
TSH: High, because the pituitary gland is working to stimulate
the thyroid to produce more T3 and T4. The pituitary senses that
there is not enough thyroid hormone and secretes more TSH in
an attempt to get the thyroid to respond.
SECONDARY:
Cause: pituitary gland
T3 and T4: Low, because the thyroid isn't being properly
stimulated by TSH.
TSH: Low (or inappropriately normal), because the pituitary
gland is not producing enough TSH to signal the thyroid to
make more hormones.
hypothyroidism manifestations
slow and sluggish
- decrease in metabolism
- fatigue and lethargy
- weight gain with NO increased caloric intake
,- cold intolerance
- dry skin, brittle hair
- large tongue: risk for airway, aspiration precautions, monitor
swallowing, swallowing eval. (TSH high, T3 and T4 low)
- bradycardia
- hypotension
- menorrhagia: period heavy, light, absent
- constipation (tx stool softeners)
- goiter
hypothyroidism pharmacotherapy
○ Drug of choice: levothyroxine
□ Toxic effect: hyperthyroidism
□ Monitor levels of TSH
□ Risk of Thyroid storm (hyperthyroidism complication)
Why? (overdose)
○ Teaching
- Take in the morning on an empty stomach
- Dose started low and slowly titrated until desired levels of
serum TSH
- Treatment lifelong
hypothyroidism nursing priorities
,○ Monitor vital signs, HR and BP increasing/normalizing (low
bp = fluids, bradycardia = atropine)
○ Improved mood, weight loss, energized, not freezing
(stabilizing)
○ Encourage a balanced diet rich in fiber to prevent
constipation.
○ Address cold intolerance.
○ Medication compliance
myxedema coma
Severe hypothyroidism
○ Causes
- Undiagnosed hypothyroidism
- Levothyroxine noncompliance
- Stressors like acute illness or surgery
myxedema coma manifestations
Depression, diminished cognitive status, lethargy (may progress
to stupor, reduced LOC, coma)
- hypoventilation
- hyponatremia
- hypoglycemia
- hypothermia
- bradycardia
- hypotension
, THINK LOW LOW LOW
Myxedema LOWMA
myxedema coma nursing management
○ Hypoventilation progressing to respiratory failure: prevent
from aspirating, choking on there own secretion, ABC's, good
oxygenation
○ Hyponatremia
○ Hypoglycemia: glucagon
○ Hypothermia: keeping them warm, blankets
○ Bradycardia & hypotension – May progress to circulatory
collapse, BP so low: need fluids, vasopressors (atropine),
levothyroxine
hyperthyroidism
Primary:
- most common
- Graves disease
- women
- toxic multinodular goiter
-TSH low, T3 and T4 high
Excessive ingestion of thyroid hormone levothyroxine
Why are levels high or low?
