ENDOCRINE CONDITION Who is at risk? Signs/Symptoms Lab/Diagnostics Nursing Management Hyperthyroid Family history of Tachycardia, a-fib Serum antibodies Tapazole, PTU thyroid/AI disease Tremors Decreased TSH Beta-blockers Primary vs secondary Recent pregnancy Goiter Increased T3 & T4 131I Excess iodine Warm, moist skin Uptake/suppression Thyroidectomy Graves, goiter, Meds (amioadarone) Hair falls out Thyroid storm amiodarone-induced Assess for fever, Irritability diaphoresis, S/S Heat intolerance Antithyroid drugs Hyperactiviy Hormones Weight loss Post-op Diarrhea Respiratory distress Proptosis/exophthalmos Hemorrhage Hypocalcemia Thyroid storm Hypothyroid Family history of thyroid Dry skin T4 and TSH Levothyroxine (1º) (Myxedema) disease Cold extremities Antibodies (Hashimoto) TSH stimulation (2º) History of autoimmune Hair breakage, dry hair Myxedema crisis Primary vs secondary disease (women) Cardiac – IV fluids Bradycardia Aging Neuro Peripheral edema Hashimoto – hyper Respiratory – monitor; Inadequate dietary iodine Delayed DTR relaxation then hypo ventilator Previous tx for Carpal tunnel Rewarm hyperthyroidism Tiredness Amenorrhea Weakness Cold intolerance Difficulty concentrating Weight gain Constipation Hoarse voice Hypoparathyroid Family hx, heredity Hypocalcemia Ca and P levels Ca, calcitrol, vit. D Neck sx/radiation Hyperphosphatemia Ca: decreased Fall and fracture prevention Comorbidity Numbness, tingling P: increased Muscle cramps Chvostek’s Trousseau’s Hyperparathyroid Menopause Bone fx/weakness Increased PTH Parathyroidectomy + Ca supplements (1500-2000 Prolonged Ca/vit. D Oliguria, kidney stones, Ca: increased Primary: gland mg/day) deficiency acidosis Bone density test = enlargement; hyper-Ca Hemorrhage Neoplasm Weakness, fatigue, Osteopenia: weak bones
ENDOCRINE CONDITION Who is at risk? Signs/Symptoms Lab/Diagnostics Nursing Management Hyperthyroid Primary vs secondary Graves, goiter, amiodarone-induced Family history of thyroid/AI disease Recent pregnancy Excess iodine Meds (amioadarone) Tachycardia, a-fib Tremors Goiter Warm, moist skin Hair falls out Irritability Heat intolerance Hyperactiviy Weight loss Diarrhea Proptosis/exophthalmos Serum antibodies Decreased TSH Increased T3 & T4 Uptake/suppression Tapazole, PTU Beta-blockers 131I Thyroidectomy Thyroid storm Assess for fever, diaphoresis, S/S Antithyroid drugs Hormones Post-op Respiratory distress Hemorrhage Hypocalcemia Thyroid storm Hypothyroid (Myxedema) Primary vs secondary Hashimoto – hyper then hypo Family history of thyroid disease History of autoimmune disease (women) Aging Inadequate dietary iodine Previous tx for hyperthyroidism Dry skin Cold extremities Hair breakage, dry hair Bradycardia Peripheral edema Delayed DTR relaxation Carpal tunnel Tiredness Amenorrhea Weakness Cold intolerance Difficulty concentrating Weight gain Constipation Hoarse voice T4 and TSH Antibodies (Hashimoto) Levothyroxine (1º) TSH stimulation (2º) Myxedema crisis Cardiac – IV fluids Neuro Respiratory – monitor; ventilator Rewarm Hypoparathyroid Family hx, heredity Neck sx/radiation Comorbidity Hypocalcemia Hyperphosphatemia Numbness, tingling Muscle cramps Chvostek’s Trousseau’s Ca and P levels Ca: decreased P: increased Ca, calcitrol, vit. D Fall and fracture prevention Hyperparathyroid Primary: gland enlargement; hyper-Ca Menopause Prolonged Ca/vit. D deficiency Neoplasm Bone fx/weakness Oliguria, kidney stones, acidosis Weakness, fatigue, Increased PTH Ca: increased Bone density test = Osteopenia: weak bones Parathyroidectomy + Ca supplements (1500-2000 mg/day) Hemorrhage
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