Hypothyroidism and Myxedema: Scenario: A 46 y/o client visits the outpatient clinic for symptoms of fatigue, cold intolerance,

dry scaly skin, hoarseness, weight gain, and fluid retention. Based on her symptoms, thyroid studies are performed and reveal an elevated thyroid stimulating hormone (TSH) and decreased T3 and T4 levels. The client is placed on levothyroxine (Synthroid) 0.1 mg by mouth daily and instructed to return to the clinic in 1 month. 1. What is the significance of the clients laboratory findings? 2. What does the client need to be taught about her condition and the prescribed medication? 3. The client feels that she is not losing weight, so she doubles her dose. What are the potential risks of too much thyroid replacement hormone? Hypothyroidism and Thyroid Storm 1. What is the usual treatment for thyroidism? 2. What did the primary care provider place the client on metoprolol? 3. A potential complication of hyperthyroidism is thyroid storm. What signs and symptoms correspond with thyroid storm and what would the nursing management include? 4. Identify which symptoms correspond with hyperthyroidism (>) and which ones correspond with hypothyroidism (<). ________ Dry Skin ________ Constipation ________ Palpitations ________ Weight Gain ________ Excess perspiration ________ Insomnia ________ Increased blood pressure ___________ Heat Intolerance ___________ Exophthalmos ___________ Weight loss ___________ Cold Intolerance ___________ Low blood pressure

___________ Bradycardia

Thyroidectomy: Application Exercises: Scenario: A 25 year old female client is being admitted to the postanesthesia care unit (PACU) following a thyroidectomy for hyperthyroidism. The client underwent 3 months of preoperative treatment with antithyroid medications and iodine preparations to establish a euthyroid status prior to her surgery. At the clients bedside, the nurse has placed a tracheostomy set, an endotracheal tube, a laryngoscope, a suction equipment. There are ampoules of calcium gluconate on hand. The nurse places the client in a semi fowlers position and is supporting her head and neck with pillows and sandbags. The client frequently checks the clients vital signs and assesses her suture line for strain or bleeding. Once the immediate postoperative period has passed, the client will be transferred to the surgical floor where she will recuperate and learn about lifelong thyroid replacement therapy. 1. Define Euthyroid State. 2. Why is it important for the client to be Euthyroid prior to thyroidectomy? 3. Why is it mandatory to have emergency equipment and ampoules of calcium gluconate on hand following thyroidectomy? 4. Why is it important to support the clients head and neck with sandbags and pillows? 5. Which of the following client interventions, following a thyroidectomy, could the registered nurse delegate to a nursing aide? PLEASE Rationalize your answer. A. Assess clients pain level. B. Monitor and document vital signs. C. Check incision for evidence of bleeding and replace dressing as needed. D. Administer calcium gluconate, if tetany develops.

Instructions: 1. Deadline: Tuesday (Maam Melchie Is afternoon duty in ER-LMC. 2. Staple your work and must have a clean output. 3. MORE TAKE HOME Exam to be pass on Thursday. Please check your CLASS FB ACCOUNT!