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Hypothyroidism (myxedema) Nursing Care Plan & Management
Medical & Surgical Nursing (Notes)

Hypothyroidism (myxedema) Nursing Care Plan & Management

Notes

Description
  1. Hypothyroidism is a hypothyroid state resulting from a hyposecretion of the thyroid hormones T4 and T3.
  2. Hypothyroidism is characterized by decreased rate of body metabolism.

Hypothyroidism

Causes
  • Hypothyroidism can be a primary disorder that results from disease in the thyroid gland itself or a secondary or tertiary disorder. In most cases, hypothyroidism occurs as a primary disorder and results from the loss of thyroid tissue, which leads to inadequate production of thyroid hormones (primary hypothyroidism). It is most frequently autoimmune in origin but can also be related to iodine deficiency.
  • Secondary hypothyroidism, which occurs in only 5% of cases, is caused by a failure of the pituitary gland to stimulate the thyroid gland or a failure of the target tissues to respond to the thyroid hormones. Tertiary hypothyroidism is caused by failure of the hypothalamus to produce thyroid-releasing factor.
  • The most common cause of goitrous hypothyroidism in North America is Hashimoto’s disease, which causes defective iodine binding and defective thyroid hormone production. Hashimoto’s disease is common in the same family and is considered an autoimmune disorder leading to chronic inflammation of the thyroid gland and hypothyroidism but can also lead to hyperthyroidism.

Hypothyroidism2

Risk Factors
  • Age over 50 years
  • Being female
Assessment
  1. Lethargy and fatigue
  2. Weakness, muscle aches, paresthesias
  3. Intolerance to cold
  4. Weight gain
  5. Dry skin and hair
  6. Loss of body hair
  7. Bradycardia
  8. Constipation
  9. Generalized puffiness and edema around the eyes and face.
  10. Forgetfulness and loss of memory
  11. Menstrual disturbances
  12. Cardiac enlargement, tendency to develop congestive heart failure.
Complications

Myxedema coma, the most severe form of hypothyroidism, is rare. It may be caused by an infection, illness, exposure to cold, or certain medications in people with untreated hypothyroidism.

Symptoms and signs of myxedema coma include:

  • Below normal temperature
  • Decreased breathing
  • Low blood pressure
  • Low blood sugar
  • Unresponsiveness
Primary Nursing Diagnosis
  • Activity intolerance related to weakness and apathy
Diagnostic Evaluation
  • Thyroid-stimulating hormone (TSH) assay result is >4.0 mU/L ( normal values: 0.5–1.5 mU/L). Normal value excludes primary hypothyroidism and a markedly elevated value confirms the diagnosis.
  • Thyroxine (T4) radioimmunoassay decreased (normal values: 5.0–12.0 μg/dL). Reflects underproduction of thyroid hormones; monitors response to therapy.
  • Tri-iodothyronine (T3) radioimmunoassay decreased (normal values: 80–230 ng/dL). Reflects underproduction of thyroid hormones.
  • Electrocardiogram (ECG) reveals low voltage, T wave abnormalities.
  • Other Tests: 24-hr radioactive iodine uptake; thyroid autoantibodies; antithyroglobulin
Medical Management
  • Most patients are diagnosed and treated on an outpatient basis. The goal of treatment is to return the patient to the euthyroid (normal) state and to prevent complications. The treatment of choice is to provide thyroid hormone supplements to correct hormonal deficiencies.
  • Treatment of the elderly patient is approached more cautiously because of higher risk for cardiac complications and toxic effects. The medication should not be given if the pulse rate is greater than 100. The treatment is considered to be life-long, requiring ongoing medical assessment of thyroid function.
  • Polypharmacy is a significant concern for the hypothyroid patient. Several classifications of drugs are affected by the addition of thyroid supplements, including beta blockers, oral anticoagulants, bronchodilators, digitalis preparations, tricyclic antidepressants, and cholesterol lowering agents.
  • Because significant cardiovascular disease often accompanies hypothyroidism, the patient is at risk for cardiac complications if the metabolic rate is increased too quickly. Therefore, the patient needs to be monitored for cardiovascular compromise (palpitations, chest pain, shortness of breath, rapid heart rate) during early thyroid therapy. The diet for the hypothyroid patient is generally low in calories, high in fiber, and high in protein. As the metabolic rate rises, the caloric content can be increased. The patient’s intolerance to cold may extend to cold foods,making meal planning more difficult.
Pharmacologic Highlights
  • Treatment consists of replacing the deficient hormone with synthetic thyroid hormone; low doses are initially used, and the dose is increased every 1 to 2 months based on the clinical response and serial laboratory measurements that show normalization of thyroid-stimulating hormone (TSH) levels in primary hypothyroidism. The patient begins to experience clinical benefits in 3 to 5 days, which level off after approximately 4 to 6 weeks. After the dose is stabilized, patients can be monitored with laboratory measurement of TSH annually.
  • Levothyroxine sodium a synthetic thyroid hormone replacement is used to returns the patient to the euthyroid (normal) state. Dosage is 1.5–2.5 mcg/kg PO daily; (use lowest dose possible because over-replacement of thyroid can cause bone loss or cardiovascular complications).
Nursing Interventions
  1. Monitor vital signs, including heart rate and rhythm.
  2. Administer thyroid replacement, levothyroxine sodium (Synthroid) is most commonly prescribed.
  3. Instruct the client about thyroid replacement therapy.
  4. Instruct the client in low-calorie, low-cholesterol, low-saturated-fate diet.
  5. Assess the client for constipation; provide roughage and fluids to prevent constipation.
  6. Provide a warm environment for the client.
  7. Avoid sedatives and narcotics because of increase sensitivity to these medications.
  8. Monitor for overdose of thyroid medications, characterized by tachycardia, restlessness,, nervousness, and insomnia.
  9. Instruct the client to report episodes of chest pain immediately.
Documentation Guidelines
  • Physical findings: Cardiovascular status, bowel activity, edema, condition of skin, and activity tolerance
  • Response to medications, skin care regimen, nutrition
  • Psychosocial response to changes in bodily function, including mental acuity
Discharge and Home Healthcare Guidelines
  • Explain all medications, including dosage, potential side effects, and drug interactions. Instruct the patient to check the pulse at least twice a week and to stop the thyroid supplement and notify the physician if the pulse is greater than 100. Explain that the healthcare professional should be notified about the condition. Explain that ongoing medical assessment is required to check thyroid function and that the medications may lead to hyperthyroidism despite the patient’s underlying hypothyroidism.
  • Teach the patient about the thyroid gland and hypothyroidism, as well as complications such as heart disease and edema. Teach the patient that new cardiac or hyperthyroidism symptoms need to be reported immediately. Explain that the caloric and fiber requirements vary. The patient should report any abnormal weight gain or loss or change in bowel elimination.

Exam

Welcome to your MSN Exam for Hypothyroidism! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

✔ Exam Details

  • Number of Questions: 30 items
  • Mode: Practice Mode

✔ Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

The key is to monitor the thyroid's uptake of iodine over a daily period. Consider a timeframe that balances efficient monitoring with practical intervals.

1 / 30

1. Nurse Adams is preparing a patient for a thyroid scan using radioactive iodine. She informs the patient about the schedule for follow-up tests after the iodine is administered. How frequently are these tests performed?

💡 Hint

Focus on the key intervention that can prevent complications associated with hypothyroidism.

2 / 30

2. Nurse Thompson is discussing a newborn's recent hypothyroidism diagnosis with the parents. She explains the importance of treatment and what they can expect moving forward. What should Nurse Thompson emphasize to the family?

💡 Hint

Think about the most commonly prescribed and widely accepted synthetic hormone replacement for hypothyroidism.

3 / 30

3. Nurse Samantha is reviewing treatment options for her patient recently diagnosed with hypothyroidism. She knows that despite the various thyroid hormone therapies available, the preferred treatment for most patients remains clear. Which therapy should Nurse Samantha recognize as the best option?

💡 Hint

One hormone is responsible for decreasing calcium levels in the blood, and the other works to increase it. Think of which hormone acts during calcium deficiency.

4 / 30

4. Nurse Jamie is reviewing the roles of calcitonin and parathormone with a colleague. She demonstrates a clear understanding when she explains that:

💡 Hint

Think about whether hormone replacement is something that can be stopped or is needed consistently for normal growth and development.

5 / 30

5. Nurse Megan is speaking with the parents of an infant diagnosed with congenital hypothyroidism after the physician has explained the need for medication. To reinforce the teaching, Nurse Megan tells the parents:

💡 Hint

This gland releases TSH in response to TRH and plays a central role in regulating thyroid function.

6 / 30

6. Nurse Alex is preparing a patient for a TRH stimulation test, explaining that the test helps evaluate both thyroid activity and the functioning of another critical gland. What other gland does this test assess?

💡 Hint

Think about the specific cell type within the thyroid that directly handles hormone production.

7 / 30

7. Nurse Reyes is educating a nursing student about the thyroid gland and its hormone production. She asks the student which type of cell is responsible for producing T3 and T4 hormones. What is the correct response?

💡 Hint

Consider how thyroid hormone therapy can affect the cardiovascular system, especially in older adults or those with pre-existing heart conditions.

8 / 30

8. Nurse Jenna is reviewing potential complications with a patient starting therapy for hypothyroidism. She informs the patient about the most serious risks associated with this treatment. Which complication should Nurse Jenna emphasize?

💡 Hint

Think about whether iodine promotes or inhibits thyroid hormone activity and how that would impact hyperthyroidism.

9 / 30

9. Nurse James is explaining iodine therapy to a patient with hyperthyroidism. He highlights the key role of iodine in treatment and its main function in managing thyroid hormone activity. Which of the following best describes iodine's primary action in therapy?

💡 Hint

Consider the safest and most practical method to maintain warmth throughout the day without relying on external devices.

10 / 30

10. Nurse Miller is caring for a client with hypothyroidism who often complains of feeling cold. To help the client manage this symptom, what should the nurse suggest to make her more comfortable?

💡 Hint

When the thyroid isn't responding effectively to high TSH, it usually signals a thyroid gland issue rather than a pituitary one.

11 / 30

11. Nurse Kelly is reviewing lab results for a patient showing an elevated TSH level and a low free T4 (FT4) level. Based on these findings, Nurse Kelly prepares to inform the patient about the diagnosis. What condition does this lab pattern suggest?

💡 Hint

Think about how this treatment targets the thyroid gland to control hormone overproduction long-term.

12 / 30

12. Nurse Taylor is educating Mrs. Lopez, a patient undergoing treatment for hyperthyroidism, about the role of radioactive iodine in her therapy. What is the primary function of radioactive iodine in this treatment?

💡 Hint

Think about which condition involves an underactive thyroid gland requiring hormone replacement therapy.

13 / 30

13. Nurse Ellis is reviewing the medication plan for a patient who developed hypothyroidism after a subtotal thyroidectomy. The physician has prescribed levothyroxine (Levothroid) to manage her condition. For which condition is this medication the most appropriate treatment?

💡 Hint

Think about symptoms related to a slowed metabolism and fluid retention commonly seen in hypothyroidism.

14 / 30

14. Nurse Evans is assessing a client with hypothyroidism. Which health concerns should the nurse expect the client to report?

💡 Hint

Consider the life-threatening complication of untreated or severe hypothyroidism that requires immediate medical attention.

15 / 30

15. Nurse Libby is assessing an incoherent female client with a history of hypothyroidism, presenting with hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema. Recognizing these signs as severe hypothyroidism, she prepares for emergency intervention to prevent which potential complication?

💡 Hint

In hyperthyroidism, the thyroid is overactive, leading to higher levels of thyroid hormones, while feedback reduces this stimulating hormone.

16 / 30

16. Nurse Laura receives lab results for a patient suspected of having hyperthyroidism. She reviews the thyroid hormone levels to confirm the diagnosis. Which of the following lab values would Nurse Laura most likely expect?

💡 Hint

Consider the life-threatening complication of hyperthyroidism that involves an extreme excess of thyroid hormones.

17 / 30

17. Jonas arrives at the emergency department with a heart rate of 150, a high fever of 104.5°F, and signs of confusion and anxiety. Nurse Parker suspects a serious condition related to his thyroid. What could be causing these symptoms?

💡 Hint

Consider the effects of excessive thyroid hormone replacement on heart rate and metabolism.

18 / 30

18. Nurse Hans is monitoring a female client with hypothyroidism who is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which of the following findings should be recognized as a potential adverse effect of the medication?

💡 Hint

Hypothyroidism generally slows down body processes, affecting energy levels, skin, and digestion. Think of symptoms that reflect reduced metabolic activity.

19 / 30

19. Nurse Rachel is discharging a patient who recently underwent thyroid surgery. She educates the patient on how to identify signs of surgically induced hypothyroidism. The nurse knows the patient understands the teaching when she says she will notify the doctor if she experiences:

💡 Hint

Consider how excessive levels of thyroid hormones affect the body’s metabolic rate.

20 / 30

20. Nurse Simmons is reviewing symptoms of thyrotoxicosis with her patient, Mr. Davies, who was recently diagnosed with hyperthyroidism. To help the patient understand the condition, she explains what occurs during thyrotoxicosis. How should Nurse Simmons describe it?

💡 Hint

Think about how a sluggish metabolism typically impacts body weight and other functions.

21 / 30

21. Nurse Carter is assessing a 57-year-old woman recently diagnosed with hypothyroidism. She recalls the common signs and symptoms of this condition. Which of the following should she expect?

💡 Hint

Think of the essential mineral required by the thyroid gland for synthesizing its primary hormones.

22 / 30

22. Nurse Patel is reviewing the process of thyroid hormone production with a group of nursing students. She asks them what tyrosine combines with to produce T3 and T4 hormones. What is the correct answer?

💡 Hint

Think about the most common autoimmune disease that results in underactive thyroid function.

23 / 30

23. Nurse Emily is educating a patient about the various causes of hypothyroidism. She explains that, in addition to iatrogenic causes and certain medications like amiodarone and lithium, there is an autoimmune condition that can also lead to hypothyroidism. What is this condition?

💡 Hint

Consider when thyroid hormone replacement is most effective, especially related to absorption and the body’s natural rhythm.

24 / 30

24. Nurse Sarah is educating a client newly diagnosed with hypothyroidism about starting levothyroxine (Synthroid) at 50 mcg per day. As part of the teaching plan, Nurse Sarah stresses which important point about this medication?

💡 Hint

Focus on the symptoms that are typically associated with an accelerated metabolism.

25 / 30

25. Nurse Angela is assessing a patient who reports feeling hot constantly, sweating, excessive thirst, and noticeable hair loss. Based on these symptoms, Nurse Angela suspects the following condition:

💡 Hint

In hypothyroidism, think about how the body responds when the thyroid isn't producing enough hormones, leading to higher stimulation from the pituitary.

26 / 30

26. Nurse Lisa is reviewing lab results for a patient suspected of having hypothyroidism. She examines the thyroid hormone levels to confirm the diagnosis. Which lab values would Nurse Lisa most likely expect?

💡 Hint

Focus on the body system most affected by a slowed heart rate and its potential complications.

27 / 30

27. Nurse Carla is assessing a 33-year-old mother of three who presents with a pulse of 52, significant weight gain of 30 pounds in the last four months, and is bundled up in two sweaters. Following a diagnosis of hypothyroidism, Nurse Carla prioritizes her care plan. What nursing diagnosis should take precedence?

💡 Hint

Consider the symptoms associated with a slowed metabolism that typically present in hypothyroidism.

28 / 30

28. Nurse Johnson is performing an initial assessment on a client who has been admitted with hypothyroidism. Which findings should she expect to observe during her assessment?

💡 Hint

Pregnancy increases the demand for thyroid hormones, especially in clients with hypothyroidism. Consider how the body's needs change during this time.

29 / 30

29. Nurse Karen is discussing medication management with a client who has hypothyroidism and is now pregnant. The client asks if she will still need to take her thyroid medication. Nurse Karen's response is guided by the understanding that:

💡 Hint

Focus on developmental milestones that should typically be reached by 3 months and may be delayed in infants with hypothyroidism.

30 / 30

30. Nurse Jenna is assessing a 3-month-old baby in the pediatric unit and is concerned about possible hypothyroidism based on the mother's report. Which statement from the mother might indicate delayed development associated with hypothyroidism?

Nursing Care Plan

Nursing Care Plan for Hypothyroidism

Nursing Diagnosis

Disturbed Sensory Perception (specify: visual)r/t the transmission of sensory impulses as a result of ophthalmopathy.

Goal
  • Patients did not experience a decrease in visual acuity worse and there is no trauma / injury to the eye.
Intervention
  • Instruct the patient when sleeping with head elevation position.
    • Rationale: To reduce trauma to the eye.
  • Wet the eye with sterile water.
    • Rationale: To provide comfort to the eye.
  • If the patient can not close their eyes tightly while sleeping , use a non- allergic plaster.
    • Rationale: Make it easy for the patient to sleep.
  • Give steroid medications as ordered. In severe cases, doctors usually prescribe medications such as steroids to reduce edema and diuretics.
    • Rationale: Reduce edema and fluid.
Nursing Diagnosis

Decreased cardiac output r / t changes in stroke volume.

Goal
  • to remain cardiovascular function optimally characterized by blood pressure, and heart rhythm within normal limits.
Intervention
  • Monitor blood pressure, heart rate and rhythm every 2 hours.
    • Rationale: To indicate the likelihood of cardiac hemodynamic disturbances such as hypotension, decreased urine output , and mental status changes.
  • Instruct the patient to notify the nurse immediately if the patient experiences chest pain.
    • Rationale: Because in patients with hypothyroidism can develop chronic arteriosclerosis.
  • Collaboration of drugs.
    • Rationale: To reduce the symptoms.
  • Teach the patient and family how to use drugs and the signs to look out for in case of hyperthyroidism due to excessive use of drugs.
    • Rationale: To identify drug reaction that is given to the patient.
Nursing Diagnosis

Imbalance nutrition less than body requirements r / t anorexia.

Goal
  • Nutrition can be met, with the following criteria: weight gain, good skin texture.
Intervention
  • Encourage increased fluid intake.
    • Rationale: To increase the intake of fluids in the body of the patient.
  • Give foods rich in fiber.
    • Rationale: To ensure adequate intake of nutrients in the body.
  • Teach the patient, about the kinds of foods that contain lots of water.
    • Rationale: In order for the patient to know about what foods are good to eat.
  • Collaboration with a nutritionist.
    • Rationale: For a given proper nutrition.
Nursing Diagnosis

Activity Intolerance r / t generalized weakness

Goal
  • Patients can rest.
Intervention
  • Set the time interval between rest and activity to improve exercise that can be tolerated.
    • Rationale: To improve resting and exercise that can be tolerated.
  • Help the patient self-care activities when the patient is in a state of fatigue.
    • Rationale: To prevent decubitus sores.
  • Give stimulation through conversation and activities that do not cause stress.
    • Rationale: Aiming to avoid any stress.
  • Monitor the patient’s response to increased activity.
    • Rationale: To determine the development of the activity in patients.

 

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