12 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
1
Slide 27
Anatomy and Physiology
• Small glands located on back of thyroid
• Occasionally found in the mediastinum as well
TALKING POINTS:
• Calcium is an essential component of strong bones and plays a vital role in the functions
of nerve and muscle cells.
• What is the role of PTH?
Slide 28
Nursing Assessment
• Health history
• Change in mental-emotional status, such as memory problems, irritability, or
personality changes
• Musculoskeletal problems, including weakness, skeletal pain, backache, and muscle
• Medications, including calcium and vitamin D supplements
Slide 29
Nursing Assessment (cont.)
• Physical examination
• Heart rate and rhythm, blood pressure, respiratory effort, muscle strength, muscle
twitching, and hair and skin texture
• Chvostek sign
TALKING POINTS:
• What does a positive Chvostek or Trousseau sign indicate?
2
Slide 30
Diagnostic Tests and Procedures
• Blood tests
• Calcium, phosphate, creatinine, uric acid, magnesium, alkaline phosphatase, and
PTH
• Parathyroid antibodies
• Radiographs
• Dental examination
• Electrocardiogram
_________________________________________________ Chapter 47 Thyroid and Parathyroid Disorders 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
3
Slide 31
Characteristics
• Secretion of excess parathormone (PTH)
• Causes
• Tumor (an adenoma); can be benign or malignant
• Vitamin D deficiencies, malabsorption, chronic renal failure, and elevated serum
phosphate
TALKING POINTS:
• People who receive a kidney transplant after having been on dialysis for a long time also
may have hyperparathyroidism.
• What complications may occur due to excess levels of PTH?
Slide 32
Signs and Symptoms
• Symptoms vague at first
• Weakness, lethargy, depression, anorexia, and constipation
• Other findings include mental and personality changes, cardiac dysrhythmias, weight loss,
and urinary calculi
Medical Diagnosis
• Elevated serum calcium and decreased serum phosphate
Slide 34
Medical Treatment
• Surgical intervention
• Parathyroidectomy
• Surgeon attempts to leave some parathyroid tissue to prevent hypoparathyroidism
• Sometimes patient’s normal parathyroid tissue is transplanted to muscle in
forearm or neck, to continue to secrete PTH
Slide 35
Medical Treatment (cont.)
• Drug therapy
• Sodium and phosphorus replacements
• Calcitonin (Calcimar), bisphosphonates (etidronate, pamidronate), and plicamycin
4
Slide 36
Assessment
• Monitor vital signs, urine output, weight, muscle strength, bowel elimination, and digestive
disturbances
14 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
Slide 37
Interventions
• Activity intolerance
• Risk for injury
• Impaired urinary elimination
• Constipation
• Disturbed thought processes
• Imbalanced nutrition: Less than body requirements
Slide 38
Postoperative Care
• Airway obstruction from accumulated fluid and blood in surgical site compressing the
trachea
• Monitor and document the respiratory rate and effort and the pulse rate
Slide 39
Postoperative Care (cont.)
• Airway obstruction related to severe hypocalcemia
• Be alert for tetany
Slide 40
Postoperative Care (cont.)
• Protect suture line from stress
• Show patient how to support the head when changing positions
• Inspect dressing and back of the neck for bleeding
• Elevate patient’s head to reduce swelling
TALKING POINTS:
• Where is the incision usually located?
3
Slide 41
Hypoparathyroidism
• Deficiency of parathormone (PTH)
• Uncommon condition
• From accidental removal of/damage to parathyroid glands during surgery
Slide 42
Hypoparathyroidism (cont.)
• Signs and symptoms
• Painful muscle cramps, fatigue and weakness, tingling and twitching of the face and
hands, mental and emotional changes, dry skin, and urinary frequency
• With severe hypocalcemia, difficulty breathing, convulsions, and cardiac dysrhythmias
_________________________________________________ Chapter 47 Thyroid and Parathyroid Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
Slide 43
Hypoparathyroidism (cont.)
• Medical diagnosis
• Low serum calcium, elevated serum phosphate, low urine calcium, and sometimes
low serum magnesium
• Chvostek sign and Trousseau sign
• Medical treatment
4
Slide 44
Hypoparathyroidism (cont.)
• Interventions
• Administer drugs as ordered
• If recent seizure activity or if patient shows severe neuromuscular irritability, follow
seizure precautions
• Pulse/blood pressure for dysrhythmias/heart failure
• Teach signs and symptoms of calcium imbalances, and provide instructions for self–
medication
Slide 45
Question 1
• Which of the following is not a symptom of hyperthyroidism?
A. Heart failure
B. Muscular weakness
C. Irregular heart rhythms
D. Weight gain
TALKING POINTS:
Slide 46
Question 2
• Which of the following is an incorrect statement about Graves disease/hyperthyroidism?
A. Graves disease is the most common type of hyperthyroidism.
B. Graves disease is thought to be an autoimmune disorder.
C. Graves disease develops most often in middle-aged women.
D. Some patients with Graves disease eventually develop hypothyroidism.
TALKING POINTS:
16 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
Activities
Classroom Choose from below to make 30 minutes
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss anatomy and physiology of the
thyroid gland and describe the role of the
thyroid gland in regulating metabolism and
growth and development.
PRACTICE
• Provide each student with an unlabeled copy
of Figure 47-1 with the labels written along
the side of the illustration. Have students
correctly label the anatomic structures in the
illustration.
DISCUSS
• Discuss the anatomy and physiology of the
parathyroid glands.
• Discuss nursing assessment of the thyroid
PRACTICE
• Divide the class into small groups. Have the
groups refer to Box 47-2. For the information
_________________________________________________ Chapter 47 Thyroid and Parathyroid Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
2
DISCUSS
• Discuss diagnostic tests and procedures.
For each laboratory study and uptake and
imaging procedure, discuss patient
preparation and postprocedure care.
PRACTICE
• Divide the class into groups, and assign
each group one or more laboratory and
diagnostic procedures for thyroid disorders.
its information sheet to the class.
DISCUSS
• Discuss diagnostic tests and procedures and
describe the blood and urine tests and the
skeletal radiographs used to diagnose
disorders of the parathyroid glands.
18 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
3
DISCUSS
• Discuss hyperthyroidism, including causes,
risk factors, signs and symptoms,
complications, medical diagnosis, and
medical and surgical treatment.
• Discuss hypothyroidism, including causes,
risk factors, signs and symptoms, medical
diagnosis, and complications.
• Discuss goiter, including causes, risk
factors, signs and symptoms, and treatment.
• Discuss thyroid cancer, including causes,
PRACTICE
• Divide the class into teams. Present the
students with symptoms of different thyroid
disorders, and have the teams identify the
disorder. The team with the most correct
answers is the winner. (Example: cold
intolerance = hypothyroidism, weight loss =
hyperthyroidism). After the game is
complete, have a class discussion about the
causes and treatments of each disorder.
_________________________________________________ Chapter 47 Thyroid and Parathyroid Disorders 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
4
DISCUSS
• Discuss nursing care of the patient with
hyperthyroidism.
• Discuss drug therapy for thyroid conditions.
• Discuss nursing care of the patient having a
thyroidectomy.
• Discuss nursing care of the patient with
hypothyroidism.
• Discuss the signs and symptoms of
hypothyroidism and hyperthyroidism.
Compare effects on the integumentary,
musculoskeletal, cardiovascular, respiratory,
PRACTICE
• Divide the class into groups, and have each
group identify five nursing interventions with
rationales for the following patient:
• A 30-year-old woman presents to the
clinic for a routine visit. The patient tells
the nurse that she has lost a great deal
of weight over the past month, even
though she has been eating constantly.
Her menstrual periods are irregular and
20 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
Critical Thinking Question
A 46-year-old woman is experiencing fatigue and weight gain despite decreased food intake.
Her hair is thinning and her skin is very dry. She reports that she has had mild swelling in
her legs. She also reports feeling irritable and depressed. Laboratory tests reveal a low
serum T4 level and an elevated serum TSH level. What is the likely diagnosis and what
information can the nurse provide to the patient about her condition?
Discussion Guidelines: This patient likely has hypothyroidism. Her symptoms are typical of
hypothyroidism—the weight gain may be a result of a slower metabolism because of the
Instructor Notes/Student Feedback
_________________________________________________ Chapter 47 Thyroid and Parathyroid Disorders 21
Introduction to Medical-Surgical Nursing, 6th ed.
47
Assessments for
Thyroid and Parathyroid Disorders
CHAPTER OBJECTIVES
Lesson 47.1:
2. Describe tests and procedures used to diagnose disorders of the thyroid and parathyroid glands and
nursing responsibilities relevant for each.
4. Assist in the development of nursing care plans for patients with disorders of the thyroid or
parathyroid glands, including assessment, nursing diagnoses, goals, interventions, and outcome
criteria.
Assessments by Lesson & Objective
Lesson 47.1
1
Study Guide
• Part IA: 4 (p. 313)
• Part IC: 1-5 (p. 314)
Evolve Instructor Resources
• Open Book Quiz: 1
2
Study Guide
• Part ID: 1-8 (p. 314)
Evolve Instructor Resources
• Test Bank: 1, 4, 5
Evolve Student Resources
• Prioritization: 4
3
Study Guide
• Part IA: 1-3, 5-11 (p. 313)
Evolve Instructor Resources
• Test Bank: 2, 6, 7, 9, 11, 13-16, 19-21, 24-26, 28, 29, 31
• Open Book Quiz: 2, 3, 6, 8-10
Evolve Student Resources
• NCLEX Review: 1, 2, 4, 5, 8, 9
• Prioritization: 1-3
22 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IIF: 7, 13 (pp. 315-316)
• Part IIIH: 1, 3, 5-7 (pp. 317-318)
• Part III I: 1-5 (p. 318)
Evolve Student Resources
• NCLEX Review: 3, 6, 7, 10
• Prioritization: 5
Instructor’s Notes/Student Feedback