Introduction to Medical-Surgical Nursing, 6th ed.
47
Lesson Plans for
Thyroid and Parathyroid Disorders
CHAPTER LESSON PLANS & 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.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to topics related to thyroid and parathyroid disorders.
• The anatomy and physiology of the thyroid and parathyroid glands, nursing assessment of the thyroid
and parathyroid glands, and diagnostic tests and procedures will be discussed.
2 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) The thyroid gland is located in the __________.
a) apex of the lung
b) brain
c) anterior neck
d) abdomen
2) Of the following information obtained during a health history, what would indicate a possible thyroid
problem?
a) Eats three well-balanced meals a day.
b) Has gained 15 pounds in the past 3 months.
c) Sleeps 8 hours a night.
d) Reports a regular menstrual cycle.
3) Why are vital signs important in assessing thyroid function?
a) It’s good practice.
b) Vital signs are part of the assessment.
c) The patient expects it.
d) Vital signs reflect the metabolic rate.
4) If a patient has hypothyroidism, what would the thyroid-stimulating hormone level be?
a) Increased
b) Decreased
c) Normal
d) Not used to evaluate hypothyroidism
5) The most visible sign of Graves disease is __________.
a) swelling of the neck
b) exophthalmus
c) weight loss
d) irritability
6) Facial edema that is associated with long-term untreated hypothyroidism is called __________.
a) cretinism
b) myxedema
c) tetany
d) thyroiditis
7) Thyroid storm is prevented by administering what medications before a thyroidectomy?
a) Thyroid replacement hormones
b) Thyroid-stimulating drugs
c) Can’t be prevented
d) Antithyroid drugs
8) Enlargement of the thyroid gland is called __________.
a) hypothyroidism
b) Graves disease
c) goiter
d) myxedema
9) What is the function of the parathyroid glands?
a) Regulate potassium levels.
b) Regulate sodium levels.
c) Regulate serum calcium levels.
d) Regulate the thyroid gland.
10) The most common cause of hyperparathyroidism is __________.
a) an adenoma
b) Wilson disease
c) accidental removal or damage of the parathyroid glands
d) hypothyroidism
_________________________________________________ Chapter 47 Thyroid and Parathyroid Disorders 3
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What is the purpose of the thyroid gland? Explain how the thyroid gland works.
Answer: The primary purpose of the thyroid gland is to regulate metabolism and growth and
Question: Why do thyroid disorders affect body weight? What effects do hypothyroidism and
hyperthyroidism have on weight?
4 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
Instructor Preparation
Textbook Objectives Covered
1. Identify nursing assessment data related to the functions of the thyroid and parathyroid glands.
3. Describe the pathophysiology, signs and symptoms, complications, and treatment of
hyperthyroidism, hypothyroidism, hyperparathyroidism, and hypoparathyroidism.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying thyroid and parathyroid disorders, including:
• Anatomy and physiology
Materials and Supplies
• computer and PowerPoint
projector
• unlabeled copies of Figure
47-7 (p. 1050)
Key Terms
• Chvostek sign (p. 1051)
• cretinism (p. 1045)
• tetany (p. 1044)
• thyroiditis (p. 1040)
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 1036-1037, 1050-1051)
REVIEW
• Figure 47-1: The thyroid gland (p. 1037)
• Figure 47-7: The parathyroid gland (p. 1050)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1 (p. 1056)
ANSWER – Study Guide
• Part IA: 4 (p. 313)
_________________________________________________ Chapter 47 Thyroid and Parathyroid Disorders 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
2
READ – Textbook (pp. 1037-1039)
ANSWER – Text
• Review Questions for the NCLEX Examination: 4, 7, 8 (pp. 1056-1057)
ANSWER – Study Guide
• Part ID: 1-8 (p. 314)
3
READ – Textbook (pp. 1038-1055)
REVIEW
• Figure 47-2: Exophthalmos (p. 1040)
• Table 47-2: Drug Therapy: Thyroid Conditions (p. 1041)
ANSWER – Text
• Review Questions for the NCLEX Examination: 2, 3, 5, 10 (pp. 1056-1057)
ANSWER – Study Guide
• Part IA: 1-3, 5-11 (p. 313)
4
READ – Textbook (pp. 1038-1055)
REVIEW
ANSWER – Text
• Review Questions for the NCLEX Examination: 6, 9 (pp. 1056-1057)
ANSWER – Study Guide
• Part IIF: 7, 13 (pp. 315-316)
6 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
Lecture Outline 20 minutes
Slide 1
Chapter 47
Thyroid and Parathyroid Disorders
1
Slide 2
The Thyroid Gland
• Anatomy and physiology
• Located in lower portion of the anterior neck
TALKING POINTS:
• When does the hypothalamus stimulate the pituitary gland to secrete thyroid-stimulating
hormone (TSH)?
Slide 3
Age-Related Changes in Thyroid Function
• Increased incidence of thyroid nodules
• Serum levels of T4 remain approximately the same in a healthy older person, but levels of
T3 often decline
• Incidence of hypothyroidism increases with age, especially among women
TALKING POINTS:
Slide 4
Assessment of the Thyroid Gland
• Health history
• Changes in energy level, sleep patterns, personality, mental function, emotional state
_________________________________________________ Chapter 47 Thyroid and Parathyroid Disorders 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
Slide 5
Assessment of the Thyroid Gland (cont.)
• Physical examination
• Vital signs and height and weight
• Facial expression and characteristics as well as mental alertness
• Inspect/palpate skin for moisture, temperature, texture
TALKING POINTS:
• Thyroid disorders may cause increased or decreased heart rate, respirations, blood
pressure, and temperature as well as irregular heart rhythms.
• What are the key components of the nursing assessment of a patient with a thyroid
disorder?
2
Assessment of the Thyroid Gland (cont.)
• Diagnostic tests and procedures
• Serum T3, free T4, T4, and TSH
TALKING POINTS:
• What is a contraindication for thyroid scanning?
3
Slide 7
Characteristics of Hyperthyroidism
• Abnormally increased synthesis and secretion of thyroid hormones
• Graves disease
Slide 8
Multinodular Goiter
• Often in women in their 60s and 70s
• Likely develop in people who have had goiter for a number of years
• Caused by small thyroid nodules that secrete excess thyroid hormone
8 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
Slide 9
Signs and Symptoms
• Weight loss and nervousness with a mild form
• In more severe cases
• Restlessness, irritable behavior, sleep disturbances, emotional lability, personality
changes, hair loss, and fatigue
Slide 10
Complications
• Thyrotoxicosis
• Excessive stimulation caused by elevated thyroid hormone levels that produce dangerous
tachycardia and hyperthermia
TALKING POINTS:
• What symptoms may be seen with thyrotoxicosis?
Medical Diagnosis
• Decreased TSH and elevated serum T4
Slide 12
Medical Treatment
• Drug therapy
• Antithyroid drugs
• Thionamides and iodides
• Radioactive iodine
TALKING POINTS:
• Antithyroid drugs block the synthesis, release, or activity of thyroid hormones.
• Radioactive iodine accumulates in the thyroid gland, where it causes destruction of thyroid
tissue.
• What side effects may occur with radioactive iodine treatment?
4
Slide 13
Care of the Nonsurgical Patient
• Assessment
• Activity tolerance, heat tolerance, bowel elimination pattern, appetite, weight changes,
and food intake
• Mental-emotional state, adaptation to the condition, and understanding of the
treatment
• Measure vital signs and height and weight
• Skin texture and edema
_________________________________________________ Chapter 47 Thyroid and Parathyroid Disorders 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
Care of the Nonsurgical Patient (cont.)
• Decreased cardiac output
• Disturbed sleep pattern
Slide 15
Care of the Patient Having a Thyroidectomy
• Assessment: preoperative
• Identify and address learning needs
• Teaching: primary preoperative nursing intervention
TALKING POINTS:
• What is the primary preoperative nursing intervention?
• What is the priority to assess and document after thyroidectomy?
Slide 16
Care of the Patient Having a Thyroidectomy (cont.)
• Interventions
• Ineffective airway clearance
• Decreased cardiac output
• Disturbed body image
• Acute pain
• Risk for infection
3
Hypothyroidism
• Inadequate secretion of thyroid hormones
• Cretinism
10 Chapter 47 Thyroid and Parathyroid Disorders _________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 47.1
Slide 18
• Defects in thyroid hormone synthesis
• Secondary
• What foods may act as goitrogens?
Cause and Risk Factors
• Primary
• Atrophy of the thyroid gland after years of Graves disease or thyroiditis
• Treatment for hyperthyroidism
• Dietary iodine deficiency
• High intake of goitrogens
TALKING POINTS:
Slide 19
Signs and Symptoms
• Swelling of the lips and eyelids
• Dry, thick skin
• Bruising
• Thin, coarse hair
• Hoarseness
• Generalized nonpitting edema
• Facial edema
• May seem slow, depressed, or apathetic
TALKING POINTS:
• What causes the patient with hypothyroidism to gain weight?
Slide 20
Medical Diagnosis
• Based on laboratory determination of free T4 and TSH
• Complications
• Myxedema coma
• Medical treatment
TALKING POINTS:
• Infection, trauma, excessive chilling, and some drugs (opioids, sedatives, tranquilizers)
4
Slide 21
Assessment
• VS, height and weight, activity and temperature tolerance, voice quality, bowel elimination
pattern, changes in weight and dietary intake
• Skin turgor, texture, and moisture
_________________________________________________ Chapter 47 Thyroid and Parathyroid Disorders 11
LESSON 47.1
Slide 22
Interventions
• Activity intolerance
• Imbalanced nutrition: More than body requirements
• Hypothermia
• Constipation
• Risk for impaired skin integrity
• Decreased cardiac output
• Disturbed thought processes
• Disturbed body image
• Self-care deficit
3
Slide 23
Simple Goiter
• Thyroid enlargement with normal hormone production
• Causes
Slide 24
Simple Goiter (cont.)
• Treatment
• If mild enlargement and normal hormones, no intervention
• Some patients need hormone replacement therapy
• Surgery indicated if pressure on the trachea or esophagus or if the condition is
disfiguring
Goiter
• Nodules
• Can be benign or malignant
Slide 26
Thyroid Cancer
• Uncommon
• Fatal in less than 1% of all cases
• Early stages: nodule that can be felt on thyroid
TALKING POINTS:
• Surgery may be followed with radioactive iodine treatment to destroy any remaining tissue