Researched by: Shammah H.

Jaco BSN IV -B

Critical Care and Emergency Nursing / Myxedema coma

Myxedema coma
Posted by: Lhynnelli, RN
September 28, 2010

Myxedema coma is a life-threatening

condition in which patients with
Gastrointestinal
underlying thyroid dysfunction exhibit
exaggerated manifestations of  Decreased bowel sounds
hypothyroidism. Precipitating factors may
include (but are limited to) infection, Endocrine
trauma, surgery, heart failure, stroke, or
central nervous system depressants.  Thyroid maybe nonpalpable, enlarged, or
Hypothyroidism depresses metabolic nodular
rate, thus seriously affecting all body
Acute Care Patient Management
system.
NURSING DIAGNOSIS: Decreased cardiac
Signs And Symptoms output related to bradycardia and decreased
stroke volume.
 Hypothermia
 Hypoventilation Outcome Criteria
 Decreased mental function
 Fatigue  Patient alert and oriented
 Activity intolerance  BP 90 to 120 mm Hg
 Hyporeflexia  Mean arterial pressure 70 to 105 mm Hg
 Cardiac or respiratory failure  HR 60 to 100 beats/min
 Urine output 30 ml/hr
Physical Examination  Peripheral pulses palpable
Vital Signs Patient Monitoring

 BP: hypotension or hypertension 1. Continuously monitor ECG for

 HR: bradycardia dysrhythmias or profound bradycardia
 RR: bradypnea that can adversely affect cardiac output.
 Temperature: hypothermic <95° F (35° C) 2. Continuously monitor pulmonary artery
pressure, central venous pressure (if
Skin available) and blood pressure.
3. Monitor fluid volume status; measure
 Coarse and dry urine output hourly and determine fluid
 Possibly carotene color balance every 8 hours.
 Preorbital and facial edema

Neurologic

 Obtunded, coma or seizures

 Delayed reflexes

Patient Assessment
1. Assess cardiovascular status: note
quality of peripheral pulses and capillary
refill.
2. Observe for increase jugular vein
distention and pulsus paradoxus, which
may indicate pericardial effusion.
Source: http://nursingcrib.com/critical-care-and-emergency-nursing/myxedema-coma/
Diagnostic Assessment
1. Review thyroid studies as available.
2. Thyroid stimulating hormone should
decline within 24 hours of therapy and
should normalize after 7 days of therapy.
Patient Management
1. Administer intravenous fluids as ordered
to maintain BP >90 mm Hg; carefully
monitor for fluid overload and
development of heart failure.
2. Vasopressor agents may be used if
hypotension is refractory to volume
administration and if thyroid replacement
has not had time to act. Carefully monitor
the patient for lethal dysrhythmias.