Chapter 18 | Endocrine Disorders 437
● A goiter may be present, along with exophthalmos (bulging of the eyes) ● Other symptoms may include physical restlessness, fatigue, tachycardia, high blood pressure, increased perspiration, increased appetite, weight loss, difficulty sleeping, tremor, heat intolerance, fine hair, systolic murmurs, absence of menses, and mood changes or irritability
● Parents should be encouraged to educate teachers and school personnel about the child’s physical and emotional instability during the treatment period. ● Emergency care involves teaching the patient/family signs and symptoms of thyroid storm and instructing them to bring the child to the hospital immediately if these symptoms occur. ● Stress the importance of a low-stress, low-pressure environ- ment during and after hospitalization and until the child’s symptoms of hyperthyroidism are decreasing.
CLINICAL JUDGMENT Laboratory Indicators for Hyperthyroidism When evaluating laboratory results for hyperthyroidism, the nurse will see the following laboratory indicators:
SAFE AND EFFECTIVE NURSING CARE: Understanding Medication
Serum T4 ↑ Serum T3 ↑ Serum TSH ↓ (may be undetectable)
Medications for Hyperthyroidism The most common medications used to treat hyperthyroid- ism are antithyroid medications and beta blocking agents. The antithyroid agents help to lower the level of T4 by blocking the synthesis of T4 and T3. Beta blocking agents do not decrease the amount of thyroid hormone, but provide comfort for the patient who is experiencing tachycardia, restlessness, and tremors. Side Effects of Antithyroid Medications Mild effects: skin rash, mild leucopenia, loss of taste, arthralgia, and skin discoloration Severe effects that can be fatal: agranulocytosis (as evi- denced by sore throat and high fever), symptoms similar to lupus, hepatitis, hepatic failure, and glomerulonephritis From Vallerand and Sanoski (2021).
Diagnostic Testing ● Serum T3, T4, TSH, and thyroid antibodies ● Thyroid ultrasound
Nursing Interventions ● Complete physical assessment, especially for children who are referred for symptoms of attention deficit-hyperactivity disorder (LaFranchi, 2021). ● A complete school history of performance and behavioral problems; history of sleep patterns and changes in mood. ● Menstruation cycle history in girls. ● Outpatient follow-up is recommended every 4 to 6 months until stabilized. ● The nurse must understand the administration, dosage, side effects, and nursing interventions of medications adminis- tered for hyperthyroidism. ● Radioactive iodine therapy may be indicated to decrease produc- tion of thyroid hormone; in this case, the nurse must be familiar with patient education and outcomes related to therapy. ● If surgery is indicated to remove an overactive nodule of the thyroid gland, the nurse must take precautions postoperative- ly to make sure the patient’s respiratory status is stable and the environment is quiet and calm. Assess the operative site for excessive edema or excessive bleeding. ● Patients who have a thyroidectomy will require lifelong thy- roid hormone replacement therapy to treat hypothyroidism. ● Emotional support should be provided to patients with hyperthyroidism and their families. Caregiver Education ● Patient/family education regarding the importance of medi- cation compliance, adverse reactions to medications, and follow-up care is essential. ● For patients who have had a thyroidectomy, teaching the im- portance of lifelong hormone replacement therapy is crucial.
HYPOPARATHYROIDISM
Hypoparathyroidism is rare in children. This condition is caused by inadequate production of PTH. In some cases, PTH is released from the parathyroid gland, but the kidneys or bones do not respond to it. PTH mediates the parathyroid glands to regulate homeostasis of calcium and phosphate concentrations in extracellular fluid through regulation of their absorption from the intestines, mobilization from the skeleton, and reabsorption from the kidneys. A delay in diagnosis of hypoparathyroidism may result in permanent brain dysfunction or death. Assessment Pediatric assessment for hypoparathyroidism should include the following measures. Clinical Presentation ● Vomiting; poor tooth development; headaches; confusion; seizures; and spasms of the face, hands, arms, and feet ● Infants may experience increased irritability, muscle rigidity, abdominal distention, and episodes of apnea or cyanosis
Powered by FlippingBook