-elevated serum calcium levels

-decrease phosphorus

-muscle weakness and atrophy

-low back pain

-prolong PR

-shortened QT

-constipation, anorexia, and nausea/vomiting

-renal stones

-high risk for injury: falls related to bone demineralization and calcium resorption

Nursing Actions:

Monitor for cardiovascular compromise, inform the client that fiber supplements, calcium, iron and antacids interfere with absorption

Client Education:

Tx begins slowly and the dosage will be increased every 2-3 weeks until the desired response is obtained, Monitor TSH levels, take medication on an empty stomach, monitor for and report manifestations of hyperthyroidism

Antidiuretic hormone: (ADH, or vasopressin) is a hormone that your hypothalamus makes and your pituitary gland stores and releases.

In most cases of diabetes insipidus, your hypothalamus isn’t making enough ADH, your pituitary gland isn’t releasing enough ADH or your kidneys aren’t properly using ADH. This causes frequent and excessive water loss through your urine.

Monitor for chest pain

Monitor the client's weight

Monitor Vital Signs

Provide extra clothing and blankets for clients who have decreased cold tolerance

-fatigue

-mental health issues (depression, anxiety, psychosis, irritability)

-loss of appetite, abdominal pain, N/V/D

-increased urination and frequency

-kidney stones

-sleeping problems

-headaches

Excess thyroid hormone exaggerates normal body functions.

Risk factors- female ages 30-5 0

Causes- Grave's disease, thyroiditis, toxic adenoma

Free T4 index, T4 (total) T3: Elevated

Thyroid-stimulating immunoglobulin: Elvated in Graves disease and normal in other types of hyperthyroidism

Thyrotropin receptor antibodies: Elevated in Graves Dease

Fludrocortisone acetate to replace aldosterone

Blood work to test for antidiuretic hormone levels and glucose levels

Urinalysis to test for ketones and osmolarity

MRI to visualize the hypothalamus and pituitary gland.

Vitals

Intake and output

BUN creatinine

Weight

skin turgor

                  excessive hair growth on the face, neck, chest , abdomen and thigh 

                    weight gain- face, chest, and stretch marks 

                     Body shape - buffalo hump 

T3 and T4: Decreased

TSH: Increased with primary hypothyroidism

Decreased or within the expected reference range in secondary Hypothyroidism

Blood Cholesterol: Increased

DIAGNOSTIC PROCEDURES

Thyroid Scan: Low uptake of the radioactive preparation

ECG: Sinus bradycardia and dysrhythmias

Beta-adrenergic blockers

Iodine solutions

Radioactive iodine (ablation) therapy

Thyroidectomy

UTI

BPH

Urinary Incontinence

chlorpropamide

Reduce the amount of salt and protein in diet

add more fruits and vegetables to prevent constipation

use alcohol free skin products to prevent drying out skin

provide skin and mouth care with soft brittle tooth brush

Monitor for dry cracked lips, weight loss, dizziness, and confusion for signs of dehydration and seek emergent medical attention.

-The RN should know that radioiodine therapy is contraindicated in pregnant clients

-The RN should monitor manifestations of Hypothyroidism such as ( Edema, intolerance to cold, Bradycardia, increase in weight, and depression )

Education

- The effects of therapy might not be evident for 6 to 8 weeks.

-Continue taking antithyroid medication as directed

-Stay at least 1 m away from pregnant individuals, infants, or small children for the first week after tx. Limit contact to no more than 1 hr daily.

-Report incisional drainage, swelling, or redness which can indicate infection (post op )

-Report fever, increased restlessness, palpitations, or chest pain.

1) Calcimimetics: cinacalcet (Sensipar): it mimics the action of calcium circulating in the blood, use to treat primary hyperparathyroidism

2) Hormone replacement therapy- helps maintain calcium level

3) Bisphosphonates: Prevent calcium loss from bones

Nursing Interventions:

Monitoring and managing electrolytes: Regularly check serum calcium & PTH levels.

Monitor for signs of bone demineralization or fractures.

Monitor for renal test & fluid status for nephrolithiasis and renal function

Patient Education:

Educate about disease management, lifestyle modification such as avoid drinking and smoking, medication adherence and avoid dehydration.

Skin/hair- skin can feel warm and smooth- fine brittle looking hair 

Eyes - Patient can present with a fixed gaze- staring - Bulging eyes 

Cardiovascular- Elevated heart rate 

Musculoskeletal- patient can present as being shaky- fine tremors 

GI- Increase bowel movements 

Nervous- increased reflex during testing- anxiety 

Thyroid- bruit hear on auscultation 

Grave’s disease (type of hyperthyroidism)

Anxiety disorders 

Surgery

Medications:

1) Calcimimetics: cinacalcet (Sensipar): it mimics the action of calcium circulating in the blood

2)  Hormone replacement therapy- helps maintain calcium level

3)  Bisphosphonates: Prevent calcium loss from bones

Nursing Interventions:

Monitor and manage electrolytes: serum calcium & PTH levels.

Dexa scan: Bone demineralization or fractures.

Monitor for renal test & fluid status for nephrolithiasis and renal function

Monitor heart for BP, MI & stroke

Patient Education:

Educate about lifestyle modification such as avoid drinking and smoking, medication adherence and avoid dehydration.