Grave’s disease NCLEX review notes for students who are prepping to take the NCLEX exam. The endocrine system is made-up of many disorders, such as Grave’s disease which is a cause of hyperthyroidism.
This NCLEX review is part of an endocrine series of thyroid disorders.
As a student prepping for NCLEX, it is very important you know the details of Grave’s disease and how to care for a patient experiencing this condition.
As the nurse taking care of the patient in Grave’s disease it is important you understand the signs and symptoms, pathophysiology, causes, nursing interventions, and medical treatments.
Don’t forget to take the quiz on Grave’s disease.
In this NCLEX review, you will learn the following:
-Pathophysiology of the Grave’s disease
-Signs and symptoms of Grave’s disease
-Causes of Grave’s disease
-Medications for Grave’s disease
Lecture on Grave’s Disease
Definition: Most common cause of hyperthyroidism that is caused by an autoimmune condition. The patient will have excessive thyroid hormone secretion (T3 and T4) by the thyroid gland.
Cause: the body is producing an antibody called TSI (thyroid stimulating immunoglobulin) that is producing the same effects on the body as TSH (thyroid stimulating hormone). TSH release causes the thyroid gland to secrete T3 and T4.
Negative feedback system of thyroid hormone release:
Hypothalamus->TRH (thyrotropin releasing hormone)->Anterior pituitary gland—>TSH—>stimulates the thyroid gland to secrete ->T3 and T4
T3 and T4: play a huge role on body metabolism, increases body temperature, sympathetic nervous system (increase heart rate, blood pressure, alertness), how fast the body digests food etc.
Signs and Symptoms of Grave’s Disease
Typical signs and symptoms of HYPERTHYROIDISM but there are UNIQUE signs and symptoms:
- Weight loss (burning calories increased)
- Heat intolerance (feel extremely hot…sweaty)
- Tachycardia (sympathetic system in overdrive)
- Hypertension (sympathetic system in overdrive)
- Diarrhea (GI system working harder and faster)
- Smooth skin/hair (increase blood flow)
- Ophthalmopathy: protruding eye balls
- Goiter: overstimulation of the thyroid gland which causes it to swell
- Pretibial Myxedema: red, swelling on the skin, lower legs, and feet that has an orange peel texture…can advance to face, chest, arms
Nursing Interventions for Grave’s Disease
- Monitor HR, BP, EKG, weight (at risk for weight loss and will need a high calorie diet)
- Keep patient in a cool, quiet environment
Antithyroid medication: stop the thyroid from synthesizing t3 and t4, doesn’t damage thyroid gland like radioactive iodine therapy
- Tapazole “Methimazole” (most common…fewer side effect) common treatment for Grave’s Disease
- PTU “Propylthiouracil” (safer during first trimester of pregnancy)….liver failure
Other side effects for both medications: agranulocytosis and aplastic anemia
Patient education for Antithyroid medications:
- Never stop taking abruptly (takes a while before the patient starts seeing results)
- Take at same time every day
- Signs and symptoms of thyroid storm
- Avoid iodine rich foods (sea foods like seaweed, dairy eggs) or supplements with iodine
- No Aspirin or Salicylates (increases thyroid hormone)
- Signs and symptoms of hypothyroidism (toxicity)
- Inderal: prevents the hyperthyroidism effects on the body by blocking peripheral conversion of T3 and T4. This medication will help decrease heart rate, blood pressure, and decrease heat intolerance (not for people with asthma or history of bronchospasm…watch in diabetics…. can mask signs and symptoms of hypoglycemia).
Treatments for Grave’s Disease
Radioactive iodine: destroys the thyroid gland overtime and is a permanent cure compared to medications….not for pregnant or nursing women
- Side Effects: Iodism- taste changes “metal taste”, nausea, and swollen saliva glands
Surgical Treatment: Thyroidectomy (removal of the thyroid gland)
- Watch for thyroid storm due to the manipulation of the gland causing extra T3 and T4 to leak into the body….prevent by prepping with medications of: antithyroid meds, sodium iodide solution, beta blocker, glucocorticoids
- Educate about post-opt care: coughing and deep breathing and splinting neck when coughing
- Monitor for parathyroid destruction problems (common when a thyroid procedure is performed due to the close proximity of the parathyroid to the thyroid gland)…watch calcium levels “hypocalcemia”…parathyroid is responsible for calcium regulation.
- Watch for respiratory distress due to the nature of the surgical site…keep patient in semi-fowler’s to help with swelling and drainage at the site and keep at the bedside a trach kit, oxygen, and suction.
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