nursing.elitecme.com Page 31 Complete Your CE Test Online - Click Here Teach parents to monitor their child’s pulse rate and to report tachycardia immediately. Be sure to explain that the normal infant heart rate is about 120 beats per minute. Explain that positioning the baby on his/her side will help prevent airway obstruction, especially if the child’s tongue is unusually large. Tell the parents to keep the infant warm and to take steps to keep his/her skin moist[5] . Explain that the child will need to adhere to a long-long treatment plan with thyroid supplements. Stress the need for strict adherence to the prescribed medication regimen. Have the parents demonstrate their knowledge of administering medication by observing them give the child his/her medication. Assess their knowledge of medication overdose by having them list the signs of overdose such as tachycardia, sweating, fever, irritability, and insomnia. Emphasize that compliance with treatment is absolutely essential to prevent mental impairment, or if impairment has already occurred, to prevent further impairment[5,12] . Parents whose children are mentally impaired need support and understanding. Refer them to community resources and support groups. They need to be helped to focus on the child’s strengths and to participate in education programs that will help their children reach maximum potential[5] . Finally, when working with pregnant women, explain how important it is for them to have a diet that includes iodine-rich foods as part of efforts to reduce the risk of infantile cretinism[5] . Efforts to help the fetus grow and develop normally prior to birth can significantly reduce the risk for many disorders and diseases that affect newborns, infants, and children. Adult hypothyroidism Lauren is an RN who is pursuing a doctorate in nursing practice. As part of her work in endocrinology she has been asked to write a hypothetical clinical study of an adult with hypothyroidism. She would like to find something “different” to focus on as part of her research. Lauren decides to develop a case study based on the clinical presentation of an adult who has hypothyroidism caused by chronic autoimmune thyroiditis or Hashimoto’s disease. Hashimoto’s disease is not frequently discussed even though it is a common thyroid gland disorder and should provide Lauren the challenge she is looking for. Many endocrine orders are not especially prevalent (compared to other diseases and disorders) and may go unrecognized because of HCPs’ lack of knowledge or exposure to such disorders. Even diseases of the thyroid, that are, arguably, more easily recognized and prevalent, can go undetected for lengthy periods of time causing delays in treatment that can not only be frustrating for the patient, but, at times, dangerous as well. Incidence and etiology Hypothyroidism is more common in females than in males and in people with Down syndrome, and frequency increases with age. There has been a significant increase in incidence in the United States among persons aged 40 to 50[5,11] . There are two classifications of hypothyroidism: primary and secondary. Primary hypothyroidism is due to a disorder of the thyroid gland itself. Secondary hypothyroidism is the result of a failure to stimulate normal thyroid function[11] . EBP alert! There are a number of causes of hypothyroidism. Research has been able to identify the frequency of each cause. It is important that nurses know the various causes of the disease and the frequency of each. The most common cause of hypothyroidism is the primary form and is usually caused by, in order of frequency[6] : ● ● Autoimmune disease: Autoimmune disease hypothyroidism is also referred to as chronic thyroiditis or Hashimoto’s disease. It occurs at any age but is most often found in middle-aged women and in persons who have a family history of thyroid disease. Autoimmune hypothyroidism is caused by a reaction of the immune system against the body’s thyroid gland and affects between 0.1% and 5% of all adults in Western countries. In rare cases this disease is related to other endocrine disorders caused by the immune system such as adrenal insufficiency and type 1 diabetes. Hashimoto’s disease begins and progresses slowly, taking months or even years for a diagnosis to be made[13] . ● ● Use of radioactive iodine: The use of radioactive iodine to treat thyroid cancer, for example, may destroy healthy thyroid cells as well as malignant cells. This can lead to hypothyroidism[5,6] . ● ● Thyroidectomy: Thyroidectomy involves the surgical removal of part or all of the thyroid gland. It is performed as a treatment for thyroid cancer or goiter[5,6] . ● ● Diet that is deficient in iodine: The thyroid uses iodine to produce thyroid hormone. A diet that is deficient in iodine may interfere with the thyroid’s ability to produce adequate amounts of thyroid hormone[5,6,11] . ● ● Subacute thyroiditis: Subacute thyroiditis is a self-limiting, painful inflammation of the thyroid gland. It is most often associated with viral infections[6] . ● ● Lithium therapy: Lithium may decrease thyroid hormone levels [5,14] . ● ● Overtreatment with anti-thyroid drugs: Too large a dose of anti-thyroid drugs (used to treat hyperthyroidism) can lead to hypothyroidism[5,6] . Secondary hypothyroidism occurs as a result of insufficient secretion of TSH caused by disease or trauma of the pituitary gland[6] . Pathophysiology When the thyroid gland fails to produce adequate amounts of thyroid hormone, or when the thyroid is not adequately stimulated to produce thyroid hormone, there is a general reduction in the rate of all physical and mental processes. Cellular enzyme systems and oxidation are depressed. Cellular metabolic activity decreases, which reduces oxygen consumption. Thus, there is less oxidation of nutrients for energy and less body heat[6] . Hypothyroidism alert! Even though hypothyroidism is not an uncommon disorder, it can go unrecognized for long periods of time. This is because initial signs and symptoms can be vague and nonspecific, making recognition and diagnosis a challenge[5,6] . Complications There are a number of potential complications of hypothyroidism. These include[5,6] : ● ● Benign intracranial hypertension. ● ● Bleeding tendencies. ● ● Cardiovascular disease such as arteriosclerosis, impaired peripheral circulation, ischemic heart disease, heart failure, and cardiomegaly (enlarged heart). ● ● Carpal tunnel syndrome. ● ● Deafness. ● ● Fertility problems. ● ● GI problems such as achlorhydria (absence of hydrochloric acid), pernicious anemia, megacolon (abnormal dilation of the colon), and intestinal obstruction. ● ● Iron deficiency anemia. ● ● Psychiatric disturbances. The most serious and dramatic complication of hypothyroidism is myxedema coma, which commonly causes death. Myxedema coma usually progresses slowly. However, stressors such as infection, trauma, exposure to cold, or myocardial infarction can intensify hypothyroidism, causing myxedema coma to develop abruptly[5,6] .