Which intervention is the most critical for a client with myxedema coma?
Maintenance of adequate airway is crucial, since most patients have depressed mental status along with respiratory failure. Mechanical ventilation is commonly required during the first 36-48 hours, but some patients require prolonged respiratory support for as long as 2-3 weeks.
What assessment should the nurse implement prior to the administration of levothyroxine?
Assessment. When administering thyroid replacement medications, the nurse should plan to monitor TSH levels before and during therapy for effectiveness. Drug interactions may occur with several other medications, so review drug labeling information carefully before administering.
What myxedema means?
Myxedema is a term generally used to denote severe hypothyroidism. Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism and occasionally hyperthyroidism.
What is thyrotoxicosis disease?
Thyrotoxicosis is a condition in which you have too much thyroid hormone in your body. Your thyroid — the butterfly-shaped gland in the front of your neck — makes and releases two hormones: triiodothyronine (also called T3) and thyroxine (also called T4). Together, they are referred to as thyroid hormones.
What is the nursing intervention for levothyroxine?
Nursing considerations Levothyroxine should be taken on an empty stomach with water, at least 1 hour before eating. Even coffee has been shown to interfere with the absorption of T4. And levothyroxine is incompatible with many other medications, so it should be taken alone.
What should I monitor with levothyroxine?
Response to thyroxine (levothyroxine sodium) is best monitored biochemically. Thyroid function should be assessed every 6-8 weeks until the patient is euthyroid and then rechecked annunally, aiming to maintain T4 and TSH within the normal range (1).
When is hypothyroidism an emergency?
When to Seek Medical Care. People who have hypothyroidism and develop fever, changes in behavior or mental status, slowness of breath, or increased swelling of the hands and feet should be taken to an emergency department.
What is the treatment for myxedema?
The most important elements in treatment of myxedema coma are early recognition, presumptive thyroid hormone replacement, hydrocortisone and appropriate supportive care.
What is the difference between hypothyroidism and myxedema?
Myxedema is another term for severely advanced hypothyroidism. It's a condition that occurs when your body doesn't produce enough thyroid hormone. The thyroid is a small gland that sits right at the front of your neck. It releases hormones that help your body regulate energy and control a wide variety of functions.
How is a thyrotoxic crisis treated?
Treatment / ManagementTreatment of thyroid storm consists of supportive measures like intravenous (IV) fluids, oxygen, cooling blankets, acetaminophen, as well as specific measures to treat hyperthyroidism. ... After initial supportive measures, a beta-blocker should be started for any case of suspected thyroid storm.More items...•
Is hyperthyroidism an emergency?
Hyperthyroidism can also cause atrial fibrillation, a dangerous arrhythmia (irregular heartbeat) that can lead to stroke, as well as congestive heart failure. Untreated thyroid disorders take a heavy toll on your body, and can develop into medical emergencies if not treated.
What is the best treatment for hyperthyroidism?
Hyperthyroidism treatmentRadioactive iodine. You take a pill or liquid by mouth. ... Anti-thyroid medicine. These drugs tell your thyroid to produce fewer hormones. ... Surgery. A thyroidectomy is when the doctor removes most of your thyroid gland. ... Beta blockers. These drugs slow your heart rate and reduce tremors and anxiety.
Why is tetany a symptom of a serious condition?
Problems with your thyroid or pancreas can create low calcium levels, which may cause tetany. Pregnancy, breastfeeding, malnutrition, vitamin D deficiency, and some medications may also cause hypocalcemia, leading to tetany. In some cases, tetany may be a symptom of a serious or life-threatening condition. Seek immediate medical care (call 911) ...
What other symptoms might occur with tetany?
Tetany may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the muscles may also involve other body systems.
What is tetany?
Tetany is a symptom characterized by muscle cramps, spasms or tremors. These repetitive actions of the muscles happen when your muscle contracts uncontrollably. Tetany may occur in any muscle in your body, such as those in your face, fingers or calves. The muscle cramping associated with tetany can be long lasting and painful.
What causes tetany?
A common cause of tetany is very low levels of calcium in the body. The medical term for low calcium is hypocalcemia. There are many causes of hypocalcemia that can lead to tetany.
Why does tetany hurt?
The muscle cramping associated with tetany can be long lasting and painful. A common cause of tetany is very low levels of calcium in the body. The medical term for low calcium is hypocalcemia. There are many causes of hypocalcemia that can lead to tetany, and these different causes can vary widely in severity.
What to do if you have a slurred speech?
Seek immediate medical care (call 911) if you, or someone you are with, have slurred speech and other serious symptoms, such as changes in consciousness, vomiting, severe headache, and changes in mood, personality and behavior. If your tetany is persistent or causes you concern, seek prompt medical care .
Is tetany a life threatening condition?
In some cases, tetany may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:
How long does it take for tetany to occur?
An early sign of tetany is numbness & tingling of the fingers & toes & in the circumoral region. Tetany may occur from 1-7 days postoperatively. late signs & symptoms of tetany include seizures, contraction of the glottis, & respiratory obstruction.
What is PTU in nursing?
Propylthiouracil (PTU) is prescribed for a client w/ Graves' disease. Which symptom should the nurse teach the client to report?
What are the adverse effects of PTU?
A; the most serious adverse effect of PTU are leukopenia & agranulocytosis, which usually occur within the first 3 months of treatment. The; client should be taught to promptly report to HCP s&s of infection, such as sore throat & fever. Clients having a sore throat & fever should have immediate WBC count & differential performed & the drug must be withheld until the results are obtained. Painful menstruation, constipation, & increased urine output are not associate w/ PTU therapy.
What is a 34 year old female diagnosed with?
A 34-yr old female is diagnosed w/ hypothyroidism. What information should the nurse obtain from conducting a focused assessment? Select all that apply
What is empowerment in healthcare?
C; empowerment is an approach to clinical practice that emphasizes helping people discover & use their innate abilities to gain mastery over their own condition. Empowerment means that individuals w/ a health problem have the tools, such as knowledge, control, resources, & experience, to implement & evaluate their self-management practices.
What is the treatment for tetany?
The client with tetany is suffering from hypocalcemia, which is treated by administering an intravenous preparation of calcium, such as calcium gluconate or calcium chloride. Oral calcium is then necessary until parathyroid function returns. Sodium phosphate is a laxative. Echothiopate iodide is an eye preparation used as miotic for antiglaucoma effect. Sodium bicarbonate is a potent systemic antacid.
How to know if you have tetany after thyroidectomy?
Tetany may occur after thyroidectomy if the parathyroid glands are accidentally injured or removed during surgery. This would cause a disturbance in serum calcium levels. An early sign of tetany is numbness and tingling of the fingers or toes and in the circumoral region. Tetany may occur from 1 to 7 days postoperatively. Late signs of tetany include seizures, contraction of the glottis, and respiratory obstruction. Pains in the joints of the hands and feet are not early symptoms of tetany. Bleeding on the back of the dressing is related to possible incisional complications. Tension on the suture line may indicate swelling, infection, or internal bleeding, but it is not related to tetany.
What is the name of the medication that relieves stress?
occurs with exercise or emotinal stress and is relieved by rest or nitroglycerin (Nitrostat)
What is PTU in a drug?
6. 2. PTU is a prototype of thioamide antithyroid drugs. It inhibits production of thyroid hormones and peripheral conversion of T4 to the more active T3. A client taking this antithyroid drug should be able to sleep and rest well at night since the level of thyroid hormones is reduced in the blood. Excess energy throughout the day, loss of weight and perspiring through the day are symptoms of hyperthyroidism indicating the drug has not produced its outcome.
How to take SSKI?
11. 3. SSKI should be diluted well in milk, water, juice, or a carbonated beverage before administration to help disguise the strong, bitter taste. Also, this drug is irritating to mucosa if taken undiluted. The client should sip the diluted preparation through a drinking
What are the side effects of PTU?
4. 1. The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within the first 3 months of treatment. The client should be taught to promptly report to the health care provider signs and symptoms of infection, such as a sore throat and fever. Clients having a sore throat and fever should have an immediate white blood cell count and differential performed, and the drug must be withheld until the results are obtained. Painful menstruation, constipation, and increased urine
Why is SSKI used before thyroidectomy?
10. 2. SSKI is frequently administered before a thyroidectomy because it helps decrease the vascularity of the thyroid gland. A highly vascular thyroid gland is very friable, a condition that presents a hazard during surgery. Preparation of the client for surgery includes depleting the gland of thyroid hormone and decreasing vascularity. SSKI does not decrease the progression of exophthalmos, and it does not decrease the body's ability to store thyroxine or increase the body's ability to excrete thyroxine.
How long does it take for tetany to occur?
An early sign of tetany is numbness and tingling of the fingers or toes and in the circumoral region. Tetany may occur from 1 to 7 days postoperatively. Late signs and symptoms of tetany include seizures, contraction of the glottis, and respiratory obstruction. The nurse should notify the physician. Exercising the joints in the fingers and toes will not relieve the tetany. The client is not exhibiting signs of thrombophlebitis. There is no indication of nerve damage that would cause the client not to be able to speak.
How to treat thyrotoxicosis?
R: Treatment of mild ophthalmopathy that may accompany thyrotoxicosis includes measures such as wearing sunglasses to protect the eyes from corneal irritation. Treatment of ophthalmopathy should be performed in consultation with an ophthalmologist. Massaging the eyes will not help to protect the cornea. An ophthalmic anesthetic is used to examine and possibly treat a painful eye, not protect the cornea. Covering the eyes with moist gauze pads is not a satisfactory nursing measure to protect the eyes of a client with exophthalmos because treatment is not focused on moisture to the eye but rather on protecting the cornea and optic nerve. In exophthalmos, the retrobulbar connective tissues and extraocular muscle volume are expanded because of fluid retention. The pressure is also increased
What are the side effects of PTU?
R: The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within the first 3 months of treatment. The client should be taught to promptly report to the health care provider signs and symptoms of infection, such as a sore throat and fever. Clients having a sore throat and fever should have an immediate white blood cell count and differential performed, and the drug must be withheld until the results are obtained. Painful menstruation, constipation, and increased urine output are not associated with PTU therapy.
What equipment is needed for a tracheotomy?
A tracheostomy set, oxygen and suction equipment, and a suture removal set (for respiratory distress from hemorrhage ) make up the emergency equipment that should be readily available. Total parenteral nutrition is not anticipated for the client undergoing thyroidectomy. Intravenous infusion via a cutdown is not an expected possible treatment after thyroidectomy. Tube feedings are not anticipated emergency care.
Why is SSKI used before thyroidectomy?
R: SSKI is frequently administered before a thyroidectomy because it helps decrease the vascularity of the thyroid gland. A highly vascular thyroid gland is very friable, a condition that presents a hazard during surgery. Preparation of the client for surgery includes depleting the gland of thyroid hormone and decreasing vascularity. SSKI does not decrease the progression of exophthalmos, and it does not decrease the body's ability to store thyroxine or increase the body's ability to excrete thyroxine.
How is tetany treated?
Severe tetany generally requires urgent intravenous (IV) calcium replacement. It is important to check magnesium levels during calcium repletion, as magnesium deficiency is a common cause of treatment-resistant hypocalcemia. For the correction of mild hypocalcemia, oral calcium supplements , vitamin D supplementation , or magnesium tablets may be required to restore calcium levels. Once the acute episode has been resolved, future management should focus on addressing the underlying cause of tetany.
How to diagnose tetany?
A tetany diagnosis is usually confirmed by evidencing low calcium levels in the blood. In addition, blood levels of parathyroid hormone (PTH), vitamin D, magnesium, and phosphorus may help identify the underlying cause of tetany in an individual.
What is tetany?
Tetany is a symptom characterized by the involuntary contraction of muscles that leads to painful muscle cramps, spasms of the voice box (i.e., larynx ), and sensory disturbances. It is most commonly associated with low blood calcium levels, or hypocalcemia, although it can also appear with other metabolic irregularities.
What causes tetany?
Tetany is a classic sign of hypocalcemia, which refers to the presence of low calcium levels in the blood. Maintaining stable calcium levels is important for the adequate functioning of many cellular processes, such as neuronal activity, muscular contraction, hormone secretion, and blood coagulation. Blood calcium levels are regulated by the parathyroid hormone (PTH), which is released into the circulation when calcium levels are too low.
What are the symptoms of tetany?
Mild symptoms include numbness around the mouth, painful muscle cramps, and a burning or tingling sensation of the hands and feet, known as paresthesias. In severe cases, individuals may present with spasms of the voice box (i.e., laryngospasm), which can make breathing difficult and lead to high-pitched sounds while breathing (i.e., laryngeal stridor). Individuals with tetany may also experience vomiting, generalized muscle cramps, seizures, and decreased cardiac function, such as an irregular heart rhythm. Muscle cramps occur when a muscle contracts involuntarily and is not able to relax, leading to significant pain.
How is tetany diagnosed?
These symptoms can be recognized by assessing an individual’s sensory and motor functions in a thorough neurological examination. In some individuals, symptoms of tetany may not be as evident, and the diagnosis may require a high clinical suspicion. In some cases, other clinical signs, such as Trousseau’s sign, can be indicative of hypocalcemia -related tetany .
What supplements can be taken for tetany?
For the correction of mild hypocalcemia, oral calcium supplements, vitamin D supplementation, or magnesium tablets may be required to restore calcium levels. Once the acute episode has been resolved, future management should focus on addressing the underlying cause of tetany.