Chapter 66
Care of Patients withProblems of the Thyroidand Parathyroid Glands
Hyperthyroidism
•Thyrotoxicosis
•Graves’ disease is the most frequentcause; usually has goiter, exophthalmos,pretibial myxedema
•Assessment
•History
•Physical assessment
•Clinical manifestations
•Psychosocial assessment
Exophthalmos
Goiter
Laboratory Tests
•T3, T4, T3RU, TSH, TSH-RAb
•Thyroid scan
•Ultrasonography
•ECG
Nonsurgical Management
•Monitoring
•Reducing stimulation
•Promoting comfort
•Drug therapy—antithyroid drugs, iodinepreparations, lithium, beta-adrenergicblocking drugs
Surgical Management
•Total thyroidectomy, subtotalthyroidectomy
•Postoperative complications:
•Hemorrhage
•Respiratory distress
•Hypocalcemia and tetany
•Laryngeal nerve damage
•Thyroid storm or thyroid crisis
•Eye and vision problems of Graves’disease
Hypothyroidism
•Decreased metabolism from low levels ofthyroid hormones
•Myxedema
•Myxedema coma
Myxedema
Hypothyroidism: Assessment
•History
•Physical assessment
•Clinical manifestations
•Psychosocial assessment
•Laboratory assessment
Hypothyroidism: Community-Based Care
•Home care management
•Health teaching
•Health care resources
Thyroiditis
•Inflammation of the thyroid gland
•Three types of thyroiditis—acute; subacute(granulomatous); and chronic(Hashimoto’s disease), the most commontype
•Nonsurgical management, drug therapy
•Surgical management
Thyroid Cancer
•Papillary, follicular, medullary, andanaplastic
•Collaborative management
•Surgery
Hyperparathyroidism
•Parathyroid glands—calcium andphosphate balance
•Hypercalcemia and hypophosphatemia
Hyperparathyroidism: NonsurgicalManagement
•Diuretic and hydration therapies
•Monitoring
•Preventing injury
•Drug therapy
Hyperparathyroidism: SurgicalManagement
•Parathyroidectomy
Hyperparathyroidism: SurgicalManagement (Cont’d)
•Postoperative care includes:
•Observe for respiratory distress.
•Keep emergency equipment at bedside.
•Hypocalcemic crisis can occur.
•Recurrent laryngeal nerve damage canoccur.
Hypoparathyroidism
•Decreased function of the parathyroidgland
•Iatrogenic hypoparathyroidism
•Idiopathic hypoparathyroidism
•Hypomagnesemia
•Interventions—correcting hypocalcemia,vitamin D deficiency, andhypomagnesemia
Chapter 66
Care of Patients with Problems of theThyroid and Parathyroid Glands
NCLEXTIME
Question 1
What is an appropriate expected outcome forthe 35-year-old female patient who isundergoing treatment with radioactiveiodine therapy?
A.Complete cure of all symptoms ofhyperthyroidism within 2 weeks aftertherapy
B.Discontinuation of drug therapy forhyperthyroidism after completing therapy
C.Observation of required radiationprecautions
D.Regular monitoring for thyroid functionchanges after therapy
Question 2
What parameter should be criticallyevaluated when providing care to apatient with Graves’ disease?
A.Irregular heart rate and rhythm
B.Elevated blood pressure
C.Elevated temperature
D.Change in respiratory rate
Question 3
What is a priority intervention for an olderfemale patient with a history ofhyperparathyroidism?
A.Encourage small frequent meals.
B.Implement fall precautions.
C.Provide pain medications as prescribed.
D.Encourage fluid hydration by mouth.
Question 4
How many times more often than men arewomen affected with hypothyroidism?
A.2 to 3 times more
B.4 to 5 times more
C.6 to 7 times more
D.7 to 10 times more
Question 5
When formulating the postoperative plan ofcare for a patient who is scheduled tohave a thyroidectomy, the nurse shouldplan to
A.Avoid extending the patient’s neck.
B.Avoid humidification of the air.
C.Assess the patient’s voice once per shift .
D.Avoid using pillows or sandbags tosupport the patient’s head and neck.