NSG 3800 EXAM 4 STUDY GUIDE
Unit 9 Med-Surg
Hypothyroid pg. 1513
Signs and symptoms:
Extreme Fatigue
Weight Gain
Cold Intolerance
Brittle Nails
Dry Skin
Constipation: fiber, fluids, ambulation
Lifespan variances: Menorrhagia (excessive vaginal bleeding), Myxedema Coma (Severe
Cases)
Diagnosis
•Elevated TSH
•Fine needle aspiration
•Radioactive iodine uptake test: meds that alter test (amiodarone, aspirin, Tagamet
(GERD), valium, Lasix, lithium, phenytoin, propranolol)
•Low T3
•Low T4
•Causes of Hypothyroidism Chart 52-3 pg. 1514
•Autoimmune
•Thyroid gland can atrophy overtime (with age)
•Meds (lithium, iodine compounds, anti-thyroid meds)
•Radiation
Medical management: hypothyroidism
•Thyroid Replacement (Levothyroxine Sodium or Synthroid)
•High-dose glucocorticoids (hydrocortisone) every 8 to 12 hours for 24 hours followed by
low-dose therapy
•If showing signs of Myxedema Coma, then switch to Synthroid
•Take meds at same time each day
•Avoid calcium consumption w/in 3 hours of taking meds
•Monitor for cardiac issues due to high cholesterol
•Meds don’t absorb as well w/ mag containing antacids, decreases effects of digoxin, if pt
is on anticoagulants pt may need to decrease dose when starting levothyroxine b/c they
are at an increased risk for bleeding w/ levothyroxine.
Nursing Management: hypothyroidism
•Physical Assessment
•Pt teaching
•Prevention of complications (myxedema coma)
•Patients with hypothyroidism need to be monitored closely if ever given analgesics,
sedatives, or anesthetic agents because the effects are prolonged
•Older patients are at increased risk because of age-related changes in liver and renal
function
, •Oral and written instructions need to be given to the patient and family regarding self-
care
•correct med admin “take first thing in the morning with a full glass of water”
•continue taking even if symptoms improve
•when to call the doctor
•importance of diet and nutrition to promote weight loss and normal bowel patterns
•Monitor bowel function give Metamucil for constipation, watch for constipation,
encourage exercise, monitor pts temp, give them extra blanket b/c of cold intolerance.
•Can go into coma if not taking their meds.
Geriatric Considerations: Hypothyroidism pg. 1518
•Subclinical disease common in older women and commonly mistaken for other medical
condition
•Treatment must be started at low dose and increased gradually to prevent serious
cardiac side effects
•Myxedema and myxedema coma occur almost exclusively in patients over 50
•Require close lab follow-up due to poor adherence to therapy
•Nurse must monitor for s/s of ACS, which can occur in response to therapy in patients
w/ severe, long-standing hypothyroidism or myxedema coma, especially during the early
phases of tx. ACS must be aggressively treated at once to avoid morbid complications
such as a MI.
•There is a correlation between hypothyroidism and pts having elevated serum
cholesterol levels. (at risk for blockages)
Myxedema coma: pg. 1514. (a rare complication of hypothyroidism)
•Rare life-threatening condition. It is a state of severe hypothyroidism in which the
patient is hypothermic and unconscious
•This can occur with undiagnosed hypothyroidism and may be precipitated by infection,
or use of sedatives or opioid analgesic agents
•This can also occur if patients forget the take their thyroid replacement meds
•Meds given for Myxedema coma: IV admin of T3 and T4, levothyroxine
Signs and Symptoms Myxedema:
•Decreased level of consciousness
•Low blood pressure
•Low pulse
•May need ventilatory support for respiratory depression
Medical management: myxedema Coma
•Thyroid Replacement (Levothyroxine Sodium)
•IV thyroid replacement (thyroxine) with extreme caution to prevent cardiac events
•Thyroid replacement (Levothyroxine Sodium) for maintenance
•Meds are given to the pt w/ hypothyroidism w/ extreme caution b/c of the potential
for altered metabolism and excretion, as well as depressed metabolic rate and resp
status
Nursing management: myxedema Coma
•Chart 52-5 pg. 1518!!!
•Nursing care: education about meds, exercise
, •Patient Teaching (Nutrition, Medication, Activity, Self-Care) prior to discharge
•Physical Assessment
•Prevention of Complications (Cardiac, Immobility)
Hyperthyroidism pg. 1519
•Signs and Symptoms
•Nervousness
•Weight Loss
•Heat Intolerance
•Exophthalmos
•Dysrhythmias
•Thyroid Storm (Severe Cases)
•It can appear after emotional shock, stress, or an infection
•The presenting symptom often being nervousness, They are emotionally
hyperexcitable, irritable, apprehensive
•Cannot sit quietly. Everything is sped up!
•The most common cause of hyperthyroidism is an autoimmune disorder called Graves
disease.
•Dysrhythmias: palpitations, rapid pulse both with activity and rest, can go into atrial
fibrillation, myocardial hypertrophy, heart failure
•Exophthalmos one or both eyes abnormally protruding. Even with treatment, the eye
ball changes are not always reversible
•Weight loss even with increased appetite and dietary intake
Diagnosis: hyperthyroidism
•Enlarged Thyroid Gland (Goiter)
•Bruit of Thyroid Arteries, Thrill of Thyroid Arteries
•Decreased TSH, Increased T3 and T4
•Increased Radioactive Iodine Uptake when labs are drawn
•It is soft and may pulsate, a thrill being palpated and a bruit can be heard over the
thyroid arteries
•This is indicative of greatly increased blood flow through the thyroid gland
Medical management: hyperthyroidism
•Irradiation of Thyroid
•Thyroidectomy
•Will be on levothyroxine
•Antithyroid (Methimazole, Propylthiouracil)
•Thyroid Replacement (Levothyroxine Sodium)
•The use of radioactive iodine is the most common form of treatment for Graves disease
in North America
•Radioactive iodine, or RAI, is given as a pill, to treat hyperthyroidism by gradually
shrinking your thyroid—ultimately destroying the gland.
•Unlike antithyroid medications, radioactive iodine is a permanent and more reliable cure
for hyperthyroidism.
, •All medical management share the same complications: relapse or recurrent
hyperthyroidism and permanent hypothyroidism
Nursing management: hyperthyroidism
•Physical Assessment
•Patient Teaching (Medication, Nutrition, Activity, Self – Care, Coping Mechanisms,
Maintaining Normal Body Temperature)
•Prevention of Complications (Thyroid Storm)
•Post – Op Care for Thyroidectomy (look for s/s of hypothyroidism)
•Can have lots of diarrhea, worry about dehydration. Food goes through them very quick.
Avoid stimulants, alcohol, and highly seasoned foods.
•High calorie, high protein, quiet atmosphere when they’re eating.
•Short education sessions b/c of limited attention span. Can’t expect them to sit still long.
Keep room and bath cool. They have heat intolerance. May need oxygen to help w/
profusion.
Geriatric Considerations: hyperthyroidism
•Not common in this group
•Symptoms may be vague and atypical
•Symptoms may be attributed to other factors
•TSH, FT3 and FT4 should be checked
•Treatment is (Antithyroid) Radioactive Iodine Unless Airway is Affected
•Beta Blockers (Propranolol) will be used prior to Radioactive Iodine if Pre-existing
Cardiac Conditions and may be used to Decrease Neurologic and Cardiovascular
Symptoms
•Other Medication Doses May Need to Be Altered Due to Condition
Thyroid Storm with hyperthyroidism pg. 1520
•Signs and Symptoms
•Fever >101.3
•Pulse >130 bpm
•Chest Pain, Palpitations, Dyspnea
•Weight loss, Diarrhea, Abdominal Pain
•Altered Mental State (Delirium, Psychosis, Somnolence, Coma)
•Abrupt onset and is fatal!! Seek tx ASAP!
•They will go into thyroid storm if not taking meds!!!
Precipitating Factors of thyroid storm:
•Untreated Hyperthyroidism
•Extreme Stress
•Antithyroid Medication
•Digitalis Toxicity
•DKA
•Insulin Reaction
•Vigorous palpitation of thyroid
•Abrupt withdrawal of anti-thyroid meds
•Injury
Unit 9 Med-Surg
Hypothyroid pg. 1513
Signs and symptoms:
Extreme Fatigue
Weight Gain
Cold Intolerance
Brittle Nails
Dry Skin
Constipation: fiber, fluids, ambulation
Lifespan variances: Menorrhagia (excessive vaginal bleeding), Myxedema Coma (Severe
Cases)
Diagnosis
•Elevated TSH
•Fine needle aspiration
•Radioactive iodine uptake test: meds that alter test (amiodarone, aspirin, Tagamet
(GERD), valium, Lasix, lithium, phenytoin, propranolol)
•Low T3
•Low T4
•Causes of Hypothyroidism Chart 52-3 pg. 1514
•Autoimmune
•Thyroid gland can atrophy overtime (with age)
•Meds (lithium, iodine compounds, anti-thyroid meds)
•Radiation
Medical management: hypothyroidism
•Thyroid Replacement (Levothyroxine Sodium or Synthroid)
•High-dose glucocorticoids (hydrocortisone) every 8 to 12 hours for 24 hours followed by
low-dose therapy
•If showing signs of Myxedema Coma, then switch to Synthroid
•Take meds at same time each day
•Avoid calcium consumption w/in 3 hours of taking meds
•Monitor for cardiac issues due to high cholesterol
•Meds don’t absorb as well w/ mag containing antacids, decreases effects of digoxin, if pt
is on anticoagulants pt may need to decrease dose when starting levothyroxine b/c they
are at an increased risk for bleeding w/ levothyroxine.
Nursing Management: hypothyroidism
•Physical Assessment
•Pt teaching
•Prevention of complications (myxedema coma)
•Patients with hypothyroidism need to be monitored closely if ever given analgesics,
sedatives, or anesthetic agents because the effects are prolonged
•Older patients are at increased risk because of age-related changes in liver and renal
function
, •Oral and written instructions need to be given to the patient and family regarding self-
care
•correct med admin “take first thing in the morning with a full glass of water”
•continue taking even if symptoms improve
•when to call the doctor
•importance of diet and nutrition to promote weight loss and normal bowel patterns
•Monitor bowel function give Metamucil for constipation, watch for constipation,
encourage exercise, monitor pts temp, give them extra blanket b/c of cold intolerance.
•Can go into coma if not taking their meds.
Geriatric Considerations: Hypothyroidism pg. 1518
•Subclinical disease common in older women and commonly mistaken for other medical
condition
•Treatment must be started at low dose and increased gradually to prevent serious
cardiac side effects
•Myxedema and myxedema coma occur almost exclusively in patients over 50
•Require close lab follow-up due to poor adherence to therapy
•Nurse must monitor for s/s of ACS, which can occur in response to therapy in patients
w/ severe, long-standing hypothyroidism or myxedema coma, especially during the early
phases of tx. ACS must be aggressively treated at once to avoid morbid complications
such as a MI.
•There is a correlation between hypothyroidism and pts having elevated serum
cholesterol levels. (at risk for blockages)
Myxedema coma: pg. 1514. (a rare complication of hypothyroidism)
•Rare life-threatening condition. It is a state of severe hypothyroidism in which the
patient is hypothermic and unconscious
•This can occur with undiagnosed hypothyroidism and may be precipitated by infection,
or use of sedatives or opioid analgesic agents
•This can also occur if patients forget the take their thyroid replacement meds
•Meds given for Myxedema coma: IV admin of T3 and T4, levothyroxine
Signs and Symptoms Myxedema:
•Decreased level of consciousness
•Low blood pressure
•Low pulse
•May need ventilatory support for respiratory depression
Medical management: myxedema Coma
•Thyroid Replacement (Levothyroxine Sodium)
•IV thyroid replacement (thyroxine) with extreme caution to prevent cardiac events
•Thyroid replacement (Levothyroxine Sodium) for maintenance
•Meds are given to the pt w/ hypothyroidism w/ extreme caution b/c of the potential
for altered metabolism and excretion, as well as depressed metabolic rate and resp
status
Nursing management: myxedema Coma
•Chart 52-5 pg. 1518!!!
•Nursing care: education about meds, exercise
, •Patient Teaching (Nutrition, Medication, Activity, Self-Care) prior to discharge
•Physical Assessment
•Prevention of Complications (Cardiac, Immobility)
Hyperthyroidism pg. 1519
•Signs and Symptoms
•Nervousness
•Weight Loss
•Heat Intolerance
•Exophthalmos
•Dysrhythmias
•Thyroid Storm (Severe Cases)
•It can appear after emotional shock, stress, or an infection
•The presenting symptom often being nervousness, They are emotionally
hyperexcitable, irritable, apprehensive
•Cannot sit quietly. Everything is sped up!
•The most common cause of hyperthyroidism is an autoimmune disorder called Graves
disease.
•Dysrhythmias: palpitations, rapid pulse both with activity and rest, can go into atrial
fibrillation, myocardial hypertrophy, heart failure
•Exophthalmos one or both eyes abnormally protruding. Even with treatment, the eye
ball changes are not always reversible
•Weight loss even with increased appetite and dietary intake
Diagnosis: hyperthyroidism
•Enlarged Thyroid Gland (Goiter)
•Bruit of Thyroid Arteries, Thrill of Thyroid Arteries
•Decreased TSH, Increased T3 and T4
•Increased Radioactive Iodine Uptake when labs are drawn
•It is soft and may pulsate, a thrill being palpated and a bruit can be heard over the
thyroid arteries
•This is indicative of greatly increased blood flow through the thyroid gland
Medical management: hyperthyroidism
•Irradiation of Thyroid
•Thyroidectomy
•Will be on levothyroxine
•Antithyroid (Methimazole, Propylthiouracil)
•Thyroid Replacement (Levothyroxine Sodium)
•The use of radioactive iodine is the most common form of treatment for Graves disease
in North America
•Radioactive iodine, or RAI, is given as a pill, to treat hyperthyroidism by gradually
shrinking your thyroid—ultimately destroying the gland.
•Unlike antithyroid medications, radioactive iodine is a permanent and more reliable cure
for hyperthyroidism.
, •All medical management share the same complications: relapse or recurrent
hyperthyroidism and permanent hypothyroidism
Nursing management: hyperthyroidism
•Physical Assessment
•Patient Teaching (Medication, Nutrition, Activity, Self – Care, Coping Mechanisms,
Maintaining Normal Body Temperature)
•Prevention of Complications (Thyroid Storm)
•Post – Op Care for Thyroidectomy (look for s/s of hypothyroidism)
•Can have lots of diarrhea, worry about dehydration. Food goes through them very quick.
Avoid stimulants, alcohol, and highly seasoned foods.
•High calorie, high protein, quiet atmosphere when they’re eating.
•Short education sessions b/c of limited attention span. Can’t expect them to sit still long.
Keep room and bath cool. They have heat intolerance. May need oxygen to help w/
profusion.
Geriatric Considerations: hyperthyroidism
•Not common in this group
•Symptoms may be vague and atypical
•Symptoms may be attributed to other factors
•TSH, FT3 and FT4 should be checked
•Treatment is (Antithyroid) Radioactive Iodine Unless Airway is Affected
•Beta Blockers (Propranolol) will be used prior to Radioactive Iodine if Pre-existing
Cardiac Conditions and may be used to Decrease Neurologic and Cardiovascular
Symptoms
•Other Medication Doses May Need to Be Altered Due to Condition
Thyroid Storm with hyperthyroidism pg. 1520
•Signs and Symptoms
•Fever >101.3
•Pulse >130 bpm
•Chest Pain, Palpitations, Dyspnea
•Weight loss, Diarrhea, Abdominal Pain
•Altered Mental State (Delirium, Psychosis, Somnolence, Coma)
•Abrupt onset and is fatal!! Seek tx ASAP!
•They will go into thyroid storm if not taking meds!!!
Precipitating Factors of thyroid storm:
•Untreated Hyperthyroidism
•Extreme Stress
•Antithyroid Medication
•Digitalis Toxicity
•DKA
•Insulin Reaction
•Vigorous palpitation of thyroid
•Abrupt withdrawal of anti-thyroid meds
•Injury
