Thyroid Disorders Overview
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Questions and Answers

What are the classic symptoms of hypermetabolism?

Weight loss, increased heart rate, increased blood pressure, hyperpersonality, heat intolerance, and exophthalmos.

What precautions should be taken after a patient undergoes radioactive iodine treatment for hyperthyroidism?

The patient must flush three times after urinating, call the hazmat team if urine spills, and needs a private room for the first 24 hours with visitor restrictions.

What is the significance of a total thyroidectomy in terms of hormone replacement?

A total thyroidectomy requires lifelong hormone replacement and puts the patient at risk for hypocalcemia due to possible damage to the parathyroid glands.

What are the symptoms associated with hypocalcemia?

<p>Paresthesia, tetany, twitching, spasm, clonus, seizure, jitteriness, tremor, and positive Chvostek and Trousseau signs.</p> Signup and view all the answers

What is the immediate treatment for a thyroid storm?

<p>Lower body temperature using ice packs and cooling blankets while providing oxygen per mask at 10L.</p> Signup and view all the answers

What are the potential risks during the first 12 hours after a total thyroidectomy?

<p>The risks include bleeding, respiratory distress, and hypocalcemia, which are similar for both total and subtotal thyroidectomies.</p> Signup and view all the answers

What is PTU’s primary use in treating hyperthyroidism?

<p>PTU, or Propylthiouracil, is primarily used to suppress thyroid function in patients with cancer and can cause immunosuppression.</p> Signup and view all the answers

What is the difference between a total and subtotal thyroidectomy regarding hormone replacement?

<p>A total thyroidectomy requires lifelong hormone replacement, whereas a subtotal thyroidectomy may not.</p> Signup and view all the answers

What are some examples of verbal toys for infants age 9 months and older?

<p>Examples include Tickle Me Elmo, Woody Cowboy, See and Say-Barnyard Friends, and talking books.</p> Signup and view all the answers

What type of play do toddlers typically engage in, and what are their best toys?

<p>Toddlers engage in parallel play and benefit from push/pull toys like lawn mowers and wagons.</p> Signup and view all the answers

What are the key developmental skills that preschoolers aged 3 to 6 years work on?

<p>Preschoolers develop fine motor skills and balance through activities like writing, drawing, and dancing.</p> Signup and view all the answers

Identify the three characteristics that define play for school-age children from 7 to 11 years.

<p>The three Cs are Creative, Collective, and Competitive.</p> Signup and view all the answers

How does peer group association impact play for adolescents aged 12 to 18 years?

<p>Peer group association allows adolescents to engage more socially and share experiences in their play.</p> Signup and view all the answers

What restrictions should be followed for a patient who has recently undergone laminectomy?

<p>Such patients should avoid lifting over 5 lbs, driving for 6 weeks, and bending at the waist.</p> Signup and view all the answers

What types of toys are beneficial for encouraging cooperative play in preschoolers?

<p>Imaginative toys such as role-play sets encourage cooperative play among preschoolers.</p> Signup and view all the answers

In what ways do toddlers develop gross motor skills?

<p>Toddlers develop gross motor skills through activities like running and jumping.</p> Signup and view all the answers

What is the primary concern in the first 12 to 48 hours post-thyroid surgery?

<p>The primary concern is tetany due to low calcium levels.</p> Signup and view all the answers

Why should Synthroid not be withheld before surgery?

<p>Holding Synthroid may exacerbate the suppressive effects of anesthesia during surgery.</p> Signup and view all the answers

What characterizes myxedema coma?

<p>Myxedema coma is characterized by severe hypothyroidism leading to decreased mental status and hypothermia.</p> Signup and view all the answers

Why are patients with Addison disease at risk under stress?

<p>They cannot adapt to stress, which can lead to shock or hypoglycemic episodes.</p> Signup and view all the answers

What are common symptoms associated with Cushing's syndrome?

<p>Common symptoms include moon face, truncal obesity, and high serum glucose levels.</p> Signup and view all the answers

What nursing action should be taken when a patient is on Solu-Medrol?

<p>Perform Accu-Checks every 6 hours to monitor blood glucose levels.</p> Signup and view all the answers

What does the stress response aim to maintain?

<p>It aims to maintain normal blood pressure and adequate glucose levels.</p> Signup and view all the answers

What can happen if a patient with Addison’s disease undergoes a bilateral adrenalectomy?

<p>The patient will develop Addison disease and require steroid replacement therapy.</p> Signup and view all the answers

Why are hard plastic toys preferable for immunosuppressed children?

<p>They can be easily disinfected, reducing the risk of infection.</p> Signup and view all the answers

What is the best toy for infants aged 0 to 6 months?

<p>A musical mobile is the best choice for this age group.</p> Signup and view all the answers

What should be avoided for children over 6 months due to safety concerns?

<p>Musical mobiles should be avoided after 6 months to prevent strangulation.</p> Signup and view all the answers

What does the concept of object permanence signify for children aged 6 to 9 months?

<p>It signifies that the child understands that objects still exist even when they cannot see them.</p> Signup and view all the answers

What medication is commonly prescribed for hypothyroidism?

<p>Levothyroxine (Synthroid) is the medication prescribed.</p> Signup and view all the answers

What are some physical characteristics seen in a patient with Cushing’s syndrome?

<p>Physical characteristics include hirsutism, muscle atrophy, and easy bruising.</p> Signup and view all the answers

Flashcards

Hyperthyroidism

An overactive thyroid gland results in increased metabolism, leading to symptoms like weight loss, increased heart rate and blood pressure, hyperactivity, heat intolerance, and bulging eyes (exophthalmos).

Hypothyroidism

A condition where the thyroid gland is underactive, leading to a slowed metabolism, fatigue, weight gain, cold intolerance, and slowed heart rate.

Cushing Syndrome

A condition where the adrenal glands produce too much cortisol, leading to symptoms like weight gain, high blood pressure, high blood sugar, muscle weakness, and mood changes.

Addison Disease

A disorder where the adrenal glands do not produce enough cortisol, leading to symptoms like weakness, fatigue, weight loss, low blood pressure, and low blood sugar.

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Subtotal Thyroidectomy

Surgical removal of a portion of the thyroid gland.

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Total Thyroidectomy

Surgical removal of the entire thyroid gland.

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Thyroid Storm

A life-threatening condition characterized by a rapid rise in body temperature, heart rate, and blood pressure, often triggered by stress or infection in individuals with hyperthyroidism.

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Laminectomy

A surgical procedure to remove a portion of the vertebral bone (backbone) to relieve pressure on the spinal nerves.

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Purposeful Play

Play that involves using objects to build, sort, stack, make, or construct. It requires a higher level of cognitive development and typically emerges around 9 months of age.

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Gross Motor Play

Play that involves gross motor skills like running, jumping, and pushing/pulling objects. This is typical for toddlers between 1 and 3 years old.

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Parallel Play

Play where children play alongside each other without direct interaction or cooperation. This is common in toddlers due to their egocentrism.

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Fine Motor Play

Play that involves fine motor skills such as writing, drawing, using scissors, and manipulating small objects. This is typical for preschoolers between 3 and 6 years old.

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Cooperative Play

Play that involves working together and cooperating with others. This is common in preschoolers as they develop social skills.

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School Age Play

Play that is characterized by creativity, collaboration, and competition. This is typical for children between 7 and 11 years old.

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Laminectomy Restrictions

A set of permanent restrictions for laminectomy patients. They should never lift heavy objects by bending at the waist, avoid lifting over their head, and refrain from engaging in activities that put excessive strain on the spine.

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Myxedema Coma

A medical emergency that occurs when someone with severe hypothyroidism experiences a decrease in mental status, low body temperature, and slowed organ function.

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Myxedema

A condition where a patient with severe hypothyroidism presents with changes to their skin.

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Stress Response

The body's natural response to stress, ensuring adequate blood pressure and glucose levels.

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Addisonian Crisis

A medical emergency in patients with Addison's disease, characterized by shock and low blood sugar levels due to the inability to respond to stress.

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Hypometabolism

A state of low metabolism caused by an underactive thyroid.

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Glucocorticoids

A class of medications that end in '-SONE,' used to treat conditions like Addison's disease and inflammation.

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Striae

A common side effect of steroid medications, appearing as stretch marks.

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Hirsutism

A common side effect of steroid medications, causing increased hair growth, particularly in the face.

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Fomite

A non-living object that can harbor microorganisms, like stuffed animals

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Study Notes

Thyroid Disorders

  • Hyperthyroidism (Hypermetabolism): Characterized by increased metabolic rate.

    • Symptoms: Weight loss, elevated heart rate (HR) and blood pressure (BP), hyperactivity, heat intolerance, and bulging eyes (exophthalmos).
    • Causes: Often associated with Graves' disease.
    • Treatment:
      • Radioactive iodine: Destroys thyroid tissue, requires patient to flush three times after urination, and be in a private room for the first 24 hours. Visitors restricted for the first 24 hours at home also.
      • Propylthiouracil (PTU): Suppresses thyroid hormone production. Monitor white blood cell (WBC) count due to immunosuppressant effects.
      • Thyroidectomy: Surgical removal of the thyroid. Differentiate between total (lifelong hormone replacement, risk of hypocalcemia) and subtotal (may need initial supplementation, risk of thyroid storm).

  • Hypothyroidism (Hypometabolism): Characterized by decreased metabolic rate.

    • Symptoms: Weight gain, decreased heart rate and blood pressure, lethargy, and cold intolerance, Academically challenged, potentially flat personality .
      • Severe hypothyroidism: Myxedema, displaying skin involvement, potentially progressing to myxedema coma leading to decreased mental status, hypothermia, and slowing of organ function. medical emerency.
    • Treatment: Levothyroxine (Synthroid) taken in the morning on an empty stomach with water.
    • Pre-op considerations -Avoid sedation. -Clarify NPO orders if on Synthroid, the patient must take their thyroid medication before surgery.

Adrenal Cortex Diseases

  • Addison Disease (Hypoadrenalism): Under-secretion of adrenal cortex hormones.

    • Symptoms: Hyperpigmentation (tanning), inability to adapt to stress.
    • Crisis: Under stress, patients can go into shock and hypoglycemic episode (Addisonian crisis).
    • Treatment: Steroid replacement with glucocorticoid drugs (e.g., prednisone, methylprednisone).
    • Purpose of stress response: Maintenance of normal blood pressure and adequate glucose levels.

  • Cushing's Syndrome: Over-secretion of adrenal cortex hormones.

    • Symptoms: "Cushingoid" appearance: Moon face, truncal obesity, thin extremities, hirsutism, gynecomastia, buffalo hump, stretch marks, water retention (high Na+, low K+), high serum glucose (requiring frequent blood glucose checks), easy bruising, and irritability or depression. Immunosuppression possible.
    • Treatment: Adrenalectomy (surgical removal).
      • Bilateral adrenalectomy leads to Addison's disease and requires hormone replacement therapy. Treatment takes a year or so after titration for the patient to return to normal.

Toys

  • Safety: Consider size (avoid small toys for children under 4), age appropriateness (according to Piaget's stages), and feasibility.
    • Avoid metal or dye-cast toys, especially when oxygen is in use.
    • Hard plastic is a safe choice for disinfectability.
  • Age-appropriate toys:
    • Infants (0-6 months): Musical mobiles, large soft toys. Musical mobiles should be avoided past 6 months of age due to strangulation risk.
    • 6-9 months: Cover/uncover toys (e.g., Jack-in-the-box, peek-a-boo).
    • 9-12 months: Speaking or verbal toys.
    • 1-3 years (toddlers): Gross motor toys (e.g., push/pull toys).
    • 3-6 years (preschoolers): Fine motor toys, and cooperative and imaginative play.
    • 7-11 years (school-age): Creative, collective (e.g., trading cards, toys), and competitive toys.
    • 12-18 years (adolescents): Peer-group oriented. Important considerations to note when evaluating adolescents for surgical recovery.

Laminectomy

  • Post-op considerations:
    • Never lift by bending at the waist. Use knees for lifting.
    • Never lift anything over the head.
    • Avoid horseback riding, off-trail biking, and jerky amusement park rides.
  • Important note: Laminectomy information is valuable in answering spinal cord questions. Focus on the location-specific restrictions.

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Description

This quiz covers key aspects of thyroid disorders, including hyperthyroidism and hypothyroidism. You will explore their symptoms, causes, and treatment options, such as medication and surgery. Test your knowledge on managing these conditions and their physiological impacts.

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