Endocrine Drugs Quizzes Nclex Style
Hyperthyroidism vs. Hypothyroidism
The thyroid gland plays key function in the endocrine system as it manages a multifariousness of pathways was significant clinical implications. Generally, the thyroid gland and the hormones involved are associated with the regulation of metabolism. Hyperthyroidism can be attributed with an increased metabolism while the opposite is true for hypothyroidism.
The pathway originates in the hypothalamus where it secretes thyroid releasing hormone (TRH) – thereby triggering thyroid stimulating hormone (TSH) – ultimately leading to the production of two hormones. T4 is the start hormone produced and T3 is the second 1 which is too known as the active thyroid hormone. TSH also stimulates the release of calcitonin which causes the removal of calcium from the claret into the bones. It is also important to note that iodine is a fundamental component in thyroid hormone production.
Hyperthyroidism:
Signs and Symptoms – Hyperthyroidism
Hyperthyroidism tin can be caused by several factors including excessive iodine intake via diet, Graves' disease, and potentially thyroid replacement overdose (levothyroxine overdose). Hyperthyroidism tin be attributed largely to characteristics that reflect increased metabolism suggesting increased free energy. A clinical manifestation of hyperthyroidism is chosen a thyroid storm where as well much thyroid hormone is released into the organisation. A client with thyroids storm will present with marked agitation, defoliation, and restlessness.
In addition, these clients may experience increased temperature, tachycardia (Hr > 100 bpm), heart palpitations, and hypertension. Physically clients suffering from hyperthyroidism may exhibit grape optics (exophthalmos) where the eyes announced to bulge outwards. They may also develop a goiter which is an aberrant enlargement of the thyroid gland. Other manifestations may exist weight loss as the client's metabolism becomes ramped upwardly as well as diarrhea as the digestive tract becomes sped up.
Nursing Interventions and Pharmacology – Hyperthyroidism
In that location are a diversity of interventions that can be made on the behalf of clients experiencing hyperthyroidism. A key one to make is to eliminate the cause whether it is reducing the dose of thyroid replacement therapy or dietary iodine reduction. As a result of increased metabolism these clients may require increased caloric intake high in proteins and carbs depending on their baseline weight. They may need to consume frequent meals and snacks up to 6-8 times per twenty-four hour period. Due to other effects such as diarrhea in these clients it is advised that they avoid caffeine, high fiber foods, and spicy foods as well.
In that location are several pharmacological interventions that clients with hyperthyroidism may benefit from. A usually prescribed medication for this status is methimazole. Methimazole works by inhibiting the synthesis of thyroid hormone. It is important to know that methimazole is not safe for pregnant women where other treatments may exist. PTU or propylthiouracil too works to inhibit the production of thyroid hormone similar methimazole simply through unlike mechanisms. This medication is safe for pregnancy but may crusade side effects such equally fever or sore throat.
Clients may be required to remove the thyroid gland which can be achieved by 2 different modalities. The first begins by providing clients potassium iodide which acts to shrink the thyroid gland in preparation for thyroidectomy (surgical removal of the gland). Potassium iodide may stain the customer's teeth and should not be taken with methimazole or PTU. During the removal of the thyroid gland the hormones may dump into the client's arrangement which can cause a thyroid tempest, so monitoring is a key intervention for these clients.
It is likewise of import to note that sharp discontinuation of thyroid hormone production can cause a Myxedema blackout which can be life threatening. An endotracheal tube should be at the client's bedside to intervene in the presence of astringent respiratory depression. Calcium levels should also exist monitored in the effect of hypocalcemia (Ca++ < 8.6 mEq/L). Hypocalcemia may present with Chvostek's sign which is the twitching of facial muscles or Trousseau's sign which are carpopedal spasms which occurs later inflating a blood pressure cuff for 3 minutes.
Another thyroid removal method involves the destruction of the thyroid gland by administering radioactive iodine besides known every bit radioactive iodine uptake (RAIU). RAIU destroys the thyroid gland in the same way radiation would. This should only be used in clients who are not pregnant and so women should have a negative effect before starting. These clients should not be given sedatives or anesthesia and should not be wearing jewelry around the neck or dentures. They should hold antithyroid medications 5-7 days prior to the procedure to forestall acute hypothyroidism. Lastly, these clients should avoid other people especially significant women every bit the isotope can damage their thyroid gland also. They may fifty-fifty be advised to employ split up restrooms and flush multiple times to foreclose any further issues.
The last consideration to go along in mind for handling of hyperthyroid clients is that their middle rate may be dangerously elevated. They can be treated with a beta blocker to reduce their center charge per unit. Examples of beta blockers includes atenolol, propranolol, and metoprolol. All beta blockers end with the suffix "prolol" which can aid in memorization of the various treatments.
Hypothyroidism:
Signs and Symptoms
Hypothyroidism is a much more prevalent disorder which tin can be caused by depression dietary iodine, Hashimoto's disease, a pituitary tumor, and naturally due to the removal of the thyroid gland. Some other potential crusade is abrupt discontinuation of thyroid replacement therapy (e.g. levothyroxine). Some classic signs and symptoms includes reduced energy, weight proceeds, slowed mental status and depression. Weight proceeds is due to both water retention and reduced energy output since the client's metabolism is depression. Other symptoms can include pilus loss (baldness), constipation, dry skin turgor, reduced sexual appetite and irregular and slowed menstrual cycles (amenorrhea).
Clinically these clients may exhibit bradycardia (HR < threescore bpm), reduced blood pressure, reduced temperature and common cold intolerance, and a reduced respiratory charge per unit. A primal manifestation of this respiratory low is known as a Myxedema coma where the client's breathing becomes drastically inhibited potentially leading to death.
Nursing Interventions and Pharmacology
Clients with hypothyroidism may demand to be managed according to their reduced metabolic charge per unit. The implication is that they should reduce their caloric load as well as cholesterol and saturated fats. They should be advised to residuum oftentimes equally well as avoid CNS depressants (east.g. opioids, benzos, muscle relaxants, EtOH).
Pharmacological intervention for hypothyroidism are relatively straight forward every bit the hormone simply need to get replaced. The most common medication used for this condition is levothyroxine which is simply a synthetic course of T4. Another thyroid supplement is armor thyroid which replaces both T3 and T4. Clients on these medications should be counseled on taking it in the early morning on an empty breadbasket (30-60 minutes before breakfast). Levothyroxine takes several weeks (3-four weeks) to achieve relief in clients. Clients volition have to be on thyroid replacement chronically for the rest of their lives – which may take fourth dimension for the medico to determine the optimal dosage. Levothyroxine and other replacement hormones should not be stopped abruptly which could pb to events like a Myxedema coma.
Determination
The endocrine organization is a circuitous web of pathways that has been the target of numerous interventions over the last few decades. There are many debilitating diseases that can affect clients ranging from steroid production to metabolic efficiency. The physical and clinical manifestations of these disorders are numerous yet often easy to distinguish. For this reason, it is imperative to sympathise these diseases well when preparing for the NCLEX® examination.
Source: https://simplenursing.com/endocrine-disorders-nclex-review/
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