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Palpitations
Increased perspiration
Goiter
Hypertension
Lid lag
Atrial fibrillation
Do not breastfeed as RAI may be excreted through breast milk and could harm
the infant
Do not share utensils with others or use bare hands to handle food that is to be
served to others
Isolate personal laundry (eg, bed linens, towels, daily clothes) and wash it
separately
Use a separate toilet from the rest of the family and flush 2-3 times after each
use
Sleep in a separate bed from others and do not sit near others in an enclosed
area for a prolonged period of time (eg, train or flight travel)
radioactive iodine uptake (RAIU) test. measures the metabolic activity in the thyroid
gland in order to differentiate between the many types of thyroid disorders. For an
accurate measurement, medications affecting the thyroid should be held 7 days prior to
the test date and clients are NPO for 4 hours prior to iodine administration.
Premenopausal women must take a pregnancy test. Dentures, metal, and jewelry
should be removed.
Increased waist circumference: ≥40 in (102 cm) in men, ≥35 in (89 cm) in
women (abdominal obesity)
Triglyceride level: >150 mg/dL (1.7 mmol/L) or drug treatment for elevated
triglycerides
High-density lipoprotein (HDL) levels: <40 mg/dL (1.04 mmol/L) in men and <50
mg/dL (1.3 mmol/L) in women or drug treatment for low HDL-C
Fasting glucose levels: ≥100 mg/dL (5.6 mmol/L) or drug treatment for elevated
blood glucose (hyperglycemia)
Hypothyroidism
characterized by thyroid hormone deficit (low T3 and T4). TSH is elevated due to
compensatory increase from pituitary.
Symptoms of hypothyroidism may include fatigue, cold intolerance, constipation, dry
skin, and brittle hair/nails, weight gain skin is cool, pale, and rough (due to dryness),
irregular or prolonged menstrual periods
Common manifestations include the following:
2. Cool and pale skin due to decreased blood flow; hyperkeratosis results in dry and
rough skin
3. Brittle nails and hair; hair loss due to poor blood supply
Levothyroxine sodium
the first-line treatment for hypothyroidism during pregnancy to maintain adequate
levels of maternal thyroid hormones, which are critical for fetal brain development.
instruct the client to take levothyroxine in the morning on an empty stomach, at least 4
hours before or after taking a prenatal vitamin. Take separate from other medications
Symptoms of hypothyroidism typically begin to improve approximately 3-4 weeks after
initiating levothyroxine. Therapy should not be stopped, even if symptoms resolve.
A client's dose is adjusted based on serum TSH levels to prevent too much or too little
hormone. Clients must be taught to report signs of excess thyroid hormone such as
heart palpitations/tachycardia, weight loss, and insomnia
treatment is lifelong and be taught the signs of excess hormone (eg,
tachycardia/palpitations, weight loss, insomnia). The medication is best absorbed on an
empty stomach and is safe to take during pregnancy.
expected response includes improved well-being with elevated mood, higher energy
levels, and a heart rate that is within normal limits. The nurse should consult the health
care provider if the heart rate is >100/min, or if the client reports chest pain,
nervousness, or tremors; this may indicate that the dose is higher than necessary.
Pharmacological therapy manages the symptoms of hypothyroidism, but it takes up to 8
weeks after initiation to see the full therapeutic effect.
Exophthalmos
a complication of hyperthyroidism (hypermetabolic state due to thyroid hormone
overproduction) from Graves' disease. It is defined as a protrusion of the eyeballs
caused by increased orbital tissue (connective, adipose, muscular) expansion and can
be irreversible. The exposed cornea is at risk for dryness, injury, and infection.
Nursing care for a client with exophthalmos includes:
Maintaining the head of the bed in a raised position to facilitate fluid drainage
from the periorbital area
Using artificial tears or other similar products to moisten the eyes to prevent
corneal drying (causes abrasions/ulcers)
Taping the client’s eyelids shut during sleep if they do not close on their own
o Use dark glasses to decrease glare and prevent external irritants and
infection.
insulin pump
A client prescribed CSII is taught how to self-manage the insulin pump. Key points
include the importance of checking blood glucose levels at least 4 times a day, how to
administer a bolus dose at mealtime to cover carbohydrate intake, how to administer a
supplemental bolus dose to correct pre- and postprandial hyperglycemia, and the
importance of balancing diet and exercise to avoid excess weight gain.
Acanthosis nigricans
a skin condition that occurs with obesity and diabetes and appears as velvet-like patches
of darkened, thick skin. These areas typically occur around the back of the neck and in
the groin and armpits.
velvety light brownish to black skin thickening seen in the axillae, neck, or flexures and is
indicative of insulin resistance (diabetic dermopathy). Skin tags (acrochordons) are
commonly present on regions affected by acanthosis nigricans.
3. High-fiber foods (30-35 g of fiber per day), including whole grains, legumes,
fruits, vegetables, and low-fat dairy products
4. Use monounsaturated fats, limit use of saturated fat, and eliminate trans fatty
acids
Hyperparathyroidism
hypersecretion of parathyroid hormone causing bone breakdown that leads to
hypercalcemia. Clients with hyperparathyroidism exhibit manifestations of
hypercalcemia (eg, constipation, polyuria, muscle weakness, bone pain) and may
subsequently develop pathologic fractures, osteoporosis, and/or kidney stones.
Constipation Seizures
Bone pain
Muscle pain
Hypoglycemia
evidenced by low blood glucose <70 mg/dL
acute and potentially serious complication. Signs and symptoms include shakiness,
palpitations, anxiety/arousal, restlessness, diaphoresis, and pallor. neuroglycopenic
symptoms (confusion, seizures, coma) develop.
hypoglycemic reaction
A client who is alert enough to ingest food/liquids orally should be given 15grams of a
simple carbohydrate (eg, 1 tbs syrup or honey, 4 tsp jelly, 4-6 oz orange juice, or 8 oz
low-fat milk). Fingerstick blood glucose should be checked 10-15 minutes after. shows
no improvement, the simple carbohydrate can be readministered orally.
Dextrose (D50 IV push) aministered to hypoglycemic clients who are unable to ingest a
simple oral carbohydrate. These can cause rebound hypoglycemia by stimulating
additional insulin release from the body in response to increased serum glucose levels.
Stress-induced hyperglycemia
can occur in hospitalized clients in relation to surgery, trauma, acute illness, and
infection.
causes complications in the hospitalized client. To minimize complications, the
recommended target glucose range for critically ill clients is 140-180 mg/d. For non-
critically ill clients, <140 mg/dL fasting and <180 mg/d random blood glucose are
recommended.
Cushing syndrome
prolonged exposure to excess corticosteroids
Clinical manifestations: weight gain, truncal obesity, moon face, skin atrophy, easy
bruising, purple striae on the abdomen, muscle weakness, hypertension, and
hyperglycemia. Associated androgen excess can result in acne, hirsutism, and
menstrual irregularities.
Clinical features of Cushing syndrome include:
Skin manifestations such as easy bruising, purple striae, and skin atrophy
(topical preparations), which are a result of collagen loss.
Fat redistribution resulting in truncal obesity and moon like face; thin
extremities. Fat pads are seen on the neck and supraclavicular areas
In women, androgens are produced in the adrenal gland. Androgen excess from
adrenal gland stimulation can result in acne, hirsutism, and menstrual
irregularities (oligomenorrhea)
Acromegaly
an uncommon condition caused by growth hormone overproduction leading to
overgrowth of soft tissues of the face, hands, feet, and organs. The nurse should
monitor the client for signs and symptoms of acute complications (eg, heart failure) and
report findings to the health care provider
Instructions for diabetic foot care include:
1. Wash feet daily with warm water and mild soap; test water temperature with
thermometer beforehand. Gently pat feet dry, particularly between the toes. Use
lanolin to prevent dry and cracked skin, but do not apply between the toes.
2. Inspect for abrasions, cuts, or sores. Have others inspect the feet if eyesight is
poor.
3. To prevent injury, use cotton or lamb's wool to separate overlapping toes. Cut
toenails straight across and use a nail file to file along the curves of the toes.
Avoid going barefoot and wear sturdy leather shoes. Use mild foot powder to
absorb perspiration and wear clean, absorbent socks with seams aligned.
5. To improve circulation, do not sit with legs crossed or for extended periods, avoid
tight-fitting garments, and perform daily exercise.
acute pancreatitis
Supportive care for symptom relief and prevention of complications are the major goals
These strategies include:
1. NPO status - The client is maintained on NPO status as any ingestion of food
will stimulate the excretion of pancreatic enzymes. A nasogastric tube is used to
suction out gastric secretions; this will reduce nausea and lessen stimulation of
the pancreas as these juices will move to the duodenum.
4. maintain positions that flex the trunk and draw the knees up to the abdomen
(semi-Fowler's) to decrease tension on the abdomen. A side-lying position with
the head elevated to 45 degrees will help relieve the pain even better.
**Impairment to the autonomic nervous system caused by neuropathy can cause
symptoms such as postural hypotension and put the client at risk for falls.
**Hemoglobin A1C is a diagnostic test used to measure the percentage of glycosylated
hemoglobin in the blood over a period of 2-3 months. A normal hemoglobin A1C is 4%-
6% in clients without diabetes; the goal is to keep the level <7% in clients with diabetes.