Assessment and Management of Patients With Endocrine Disorders PDF

Assessment and Management of Patients With Endocrine Disorders by adult nursing team  Outcomes 1. Compare hyper/hypothyroidism in terms of their causes, clinical manifestations, management, and nursing interventions. 2. Use the nursing process as a framework for care of patients with...

Assessment and Management of Patients With Endocrine Disorders by adult nursing team  Outcomes 1. Compare hyper/hypothyroidism in terms of their causes, clinical manifestations, management, and nursing interventions. 2. Use the nursing process as a framework for care of patients with hyper/hypothyroidism. 3. Develop a plan of nursing care for the patient undergoing thyroidectomy. Copyright © 2018 Wolters Kluwer · All Rights Reserved Introduction  Thyroid disorders: o Hypothyroidism o Nontoxic goitre o Hyperthyroidism and o Thyroid nodules & thyroid thyrotoxicosis cancer  Graves’ disease  Benign thyroid nodules  Thyroiditis  Thyroid cancer  Toxic adenoma  Papillary carcinoma  Follicular carcinoma  Toxic multinodular goitre  Medullary carcinoma  Thyrotoxicosis factitia  Anaplastic carcinoma  Lymphoma  Struma ovarii  Cancer metastatic to the  Hydatidiform mole thyroid  TSH-secreting pituitary adenoma Copyright © 2018 Wolters Kluwer · All Rights Reserved  Key term  Euthyroid: state of normal thyroid hormone production  Exophthalmos: abnormal protrusion of one or both eyeballs  Goiter: enlargement of the thyroid gland  Graves disease: a form of hyperthyroidism; characterized by a diffuse goiter and exophthalmos  Myxedema: severe hypothyroidism; can be with or without coma Copyright © 2018 Wolters Kluwer · All Rights Reserved Endocrine System  Plays vital role in orchestrating cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions  Negative feedback mechanism  Hormones: refer to Table 52-1 o Amines and amino acids o Peptide (protein): act on cell surface o Steroid: act inside the cell o Fatty acid derivative Copyright © 2018 Wolters Kluwer · All Rights Reserved Major Hormone-Secreting Glands Copyright © 2018 Wolters Kluwer · All Rights Reserved Pituitary Gland: Hypophysis  Posterior  Anterior o ADH, vasopressin o FSH, LH, prolactin, o Oxytocin ACTH, TSH, GH  Hyper: Cushing syndrome,  Hyper: syndrome of gigantism, acromegaly inappropriate antidiuretic hormone (SIADH)  Hypo: dwarfism,  Hypo: diabetes insipidus (DI) panhypopituitarism  Tumors: 95% benign  Surgery: hypophysectomy Copyright © 2018 Wolters Kluwer · All Rights Reserved Pituitary Gland and Hormones Secreted Copyright © 2018 Wolters Kluwer · All Rights Reserved Thyroid  Thyroid hormones: T3, T4, calcitonin  Iodine is contained in thyroid hormone  TSH from the anterior pituitary controls the release of thyroid hormone  Controls cellular metabolic activity  T3 is more potent and rapid-acting than T4  Calcitonin is secreted in response to high plasma calcium level and increases calcium deposit in bone Copyright © 2018 Wolters Kluwer · All Rights Reserved Thyroid Gland Copyright © 2018 Wolters Kluwer · All Rights Reserved Hypothalamic–Pituitary–Thyroid Axis Copyright © 2018 Wolters Kluwer · All Rights Reserved Thyroid Diagnostic Tests  TSH  Fine-needle biopsy  Serum-free T4  Thyroid scan, radioscan, or  T3 and T4 scintiscan  Serum thyroglobulin  T3 resin uptake  Refer to Chart 52-2 for  Thyroid antibodies medications that can alter test  Radioactive iodine uptake results Copyright © 2018 Wolters Kluwer · All Rights Reserved  Outcomes 1. Compare hyper/hypothyroidism in terms of their causes, clinical manifestations, management, and nursing interventions. 2. Use the nursing process as a framework for care of patients with hyper/hypothyroidism. 3. Develop a plan of nursing care for the patient undergoing thyroidectomy. Copyright © 2018 Wolters Kluwer · All Rights Reserved  Hyperthyroidism  Its a common endocrine disorder, resulting from an excessive synthesis and secretion of endogenous or exogenous thyroid hormones.  Causes: o Graves disease (most common) o Toxic multinodular goiter o Toxic adenoma. o Excessive ingestion of thyroid hormone. o Autoimmune disorder  Affects women eight times more than men Copyright © 2018 Wolters Kluwer · All Rights Reserved  Clinical manifestations  Nervousness; (emotionally hyperexcitable, irritable, and apprehensive, cannot sit quietly  Rapid pulse and palpitation.  Heat intolerance and Tremors  Skin flushed, warm, soft, and moist  Exophthalmos  Increased appetite , Weight loss  Elevated systolic BP and Cardiac dysrhythmiastime Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved  Management of Hyperthyroidism  Antithyroid agents such as Propylthiouracil and Methimazole  Radioactive iodine (131I therapy). Refer to Table 52-3  Adjunctive therapy for symptomatic relief such as o Sodium or potassium iodine solutions o Dexamethasone o Beta-blockers  Surgery; Thyroidectomy Copyright © 2018 Wolters Kluwer · All Rights Reserved Question #1 Which of the following medication blocks synthesis of thyroid hormone? A. Dexamethasone B. Methimazole C. Potassium iodide D. Sodium iodide Copyright © 2018 Wolters Kluwer · All Rights Reserved  Thyroidectomy  Treatment of choice for thyroid cancer  Preoperative goals: reduction of stress and anxiety to avoid precipitation of thyroid storm  Preoperative education: o Dietary guidance to meet patient’s metabolic needs, avoidance of caffeinated beverages and other stimulants o Explanation of tests and procedures, and head and neck support used after surgery Copyright © 2018 Wolters Kluwer · All Rights Reserved  Postoperative Care:  Monitor respirations; potential airway impairment (tracheostomy set beside the patient).  Monitor for potential bleeding and hematoma formation; check posterior dressing  Assess pain and provide pain relief measures  Semi-Fowler position, support head and neck  Assess voice, discourage talking  Potential hypocalcaemia related to injury or removal of parathyroid glands; refer to Chart 52-6  More details about NURSING PROCESS ; PP 4017 Copyright © 2018 Wolters Kluwer · All Rights Reserved These signs can occur after thyroidectomy Copyright © 2018 Wolters Kluwer · All Rights Reserved  Hypothyroidism  Hypothyroidism results from suboptimal levels of thyroid hormone.  Thyroid deficiency can affect all body functions and can range from mild, subclinical forms to myxedema  Hypothyroidism affects women five to eight times more frequently than men and occurs most often between 40 and 70 years of age  Hashimoto disease (autoimmune thyroiditis) most common  Post radioiodine or antithyroid medications or thyroidectomy  Other causes of hypothyroidism are presented in Chart 52-3 and Chart 52-3. Copyright © 2018 Wolters Kluwer · All Rights Reserved  Clinical Manifestations  Extreme fatigue  Reports of hair loss, brittle nails, and dry skin  Numbness and tingling of the fingers.  Voice may become husky, and hoarse  Menstrual disturbances such as menorrhagia or amenorrhea occur, in addition to loss of libido.  Severe hypothyroidism results in a subnormal body temperature and pulse rate  Weight gain  The skin becomes thickened because of an accumulation of mucopolysaccharides in the subcutaneous tissues.  Myxedema coma is life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved  Medical Management  The objectives o To restore a normal metabolic state by replacing the missing hormone o Prevention of disease progression and complications  Synthetic levothyroxine (Synthroid or Levothroid).  Note : Angina or dysrhythmias can occur when thyroid replacement is initiated because thyroid hormones enhance the cardiovascular effects of catecholamines. Copyright © 2018 Wolters Kluwer · All Rights Reserved  Management of Hypothyroidism  Start patient on L-thyroxine 0.05-0.1mg PO OD. L-thyroxine treats the hypothyroidism and leads to regression of goiter.  If patient is elderly or has IHD start 0.025mg PO OD.  Check TSH level after 4-6 weeks to adjust the dose of L-thyroxine.  In case of secondary hypothyroidism monitor T4 instead of TSH.  Hypothyroidism during pregnancy: o Check TFT every month. L-thyroxine dose requirement tends to go up as the pregnancy progresses. Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved  Supportive Therapy;  Oxygen saturation levels should be monitored using pulse oximetry.  Fluids are given cautiously because of the danger of water intoxication.  If myxedema has progressed to myxedema coma may occur Copyright © 2018 Wolters Kluwer · All Rights Reserved  Nursing care of the patient with hypothyroidism and myxedema is summarized in the plan of nursing care in Chart 52-4. Copyright © 2018 Wolters Kluwer · All Rights Reserved