Question

5. Medications for Hyperthyroidism. Fill in the Nursing Intervention for each side effect.

Medication	Side effects	Nursing Intervention
Radioactive Iodine	Radiation Sickness Bone Marrow Depression Hypothyroidism	a)
		b)
		c)
Propylthioracil (PTU)	Overmedication Agranulocytosis Hepatitis	a)
		b)
		c)

6. Which conditions are contraindicated with the two medications above and why?

7. Why do patients diagnosed with hyperthyroidism have surgery?

8. Why is eye care important for hyperthyroidism?

9. Where are the parathyroid and what condition may develop as a complication of thyroid removal surgery?

10. Medications for Hypothyroidism. Fill in the client education for each side effect.

Medication	Side Effects	Patient Education
Levothyroxine (Synthyroid)	Overmedication Tachycardia Heat Intolerance Weight loss Diaphoresis Anxiety

11. Give two contraindications for the medication listed above.

overactive thyroid gland

thyrotoxicosis crisis

      12. Give two medication interactions for Synthyroid and provide a rationale.

Answer 1

5. Hyperthyroidism

Hyperthyroidism is a condition characterized by excessive production of hormones by the thyroid.

Nursing intervention for the side effects of Radioactive iodine:

A) Radiation sickness

Any illness produced by ionizing radiation with symptoms ranging from nausea through to death. Patient who receive radioactive iodine may have the side effects of nausea, swelling and tenderness in neck, dry mouth and loss of taste, dry eyes or excessive tearing, swelling of salivary glands

Nursing intervention

a) Routine assessment for skin changes, mouth changes, fatigue, diarrhoea etc.

b) provide mouth care and bland rinses according to the oralcare protocol ( patient may have dry mouth due to decreased salivary production)

c) Provide the patient privacy by giving separate room and avoid stress. ( should keep distance from others specially children and pregnant women as there will be chances of exposure to radiation)

B) Bone marrow depression

It is characterised by decreased number of heamatopoetic cells in the bone marrow

a) Monitor for the signs of decreased White Blood cells (agranulocyotsis).

b) Frequent assessment of Patient and Monitor the signs of infections.

c) Minimize environmental contaminants to reduce opportunistic infections

C) Hypothyroidism

The disease state caused by decreased production of thyroid hormones by thyroid gland. It can occur as a complication of hyperthyroidism treatment.

Nursing interventions

a) Close monitoring of Patient after hypothyroidism treatment

b) Provide high calorie and high protein diet during Radioactive iodine( RAI) treatment.

c) If a patient develop Hypothyroidism as a side effect of RAI , administer hormone replacement therapy as per physicians order.

Propylthiouracil ( PTU): Nursing interventions for the side effects;

A) over medication :

Contact Poison Control Centre

emergency room admission

Provide symptomatic treatment ( vomiting, stomach pain, headache, fever, swelling of body parts)

B) agranulocytosis

a) Assess the patient for signs of agranulocytosis: fever and sore throat

b) Routine monitoring of White Blood cell count

c) temporary withdrawal of drug according to physician's order

d) Maintain a clean environment for patient

C) Hepatitis

a) Monitoring of liver function tests

b) Instruct the patient to report any symptom of hepatic disfunction such as pruritis and anorexia

c )Asess the patient regularly for right upper quadrant pain ( sign of liver disfunction) and report to doctor, obtain ALT and AST level ( Aspartate Aminotransferase)

Contra indications for;

Radioactive Iodine - Pregnancy and Lactation

RAI causes the destruction of fetus' thyroid gland and RAI can secrete through breast milk, both causes hypothyroidism in the baby.

Propylthyouracil- Patients who have hypersensitivity

It may cause serious allergic reactions

Pregnancy and lactation ( causes problems the fetus and hypothyroidism.

Patients with liver diseases ( causes hepatic failure)

Hyperthyroidism and surgery

Subtotal thyroidectomy or total thyroidectomy for hyperthyroidism : Sometimes hyperthyroidism may occur due to cancerous enlargement or tumours in thyroid gland , over active thyroid gland or due to goiter. Then doctors may suggest for thyroidectomy. Possible complications of hyperthyroidism treatment also may increase the need of surgery.

Eye care and hyperthyroidism

Hyperthyroidism may cause bulging of eyes ( exopthalmus), dry eyes or excessive tearing of eyes ( side effects of the drugs)

eye care: Eye drops to keep eyeballs moist

During bedtime, cover the eyes with clean gauze

To relieve swelling in the eyes, head end of the bed should be raised.

To prevent photosensitivity , provide eye shades