Hey guys, Nurse Mike here and welcome to SimpleNursing.com. Now before we get today's lecture started, please remember to access your free quiz and preview our cool nifty new study guides not here on YouTube. Click the link right up here at any time during this video.
Alright guys, let's begin. Alright guys, let's wrap up hyper versus hypothyroidism. Guys, the easiest way is to let the name help you.
So think thigh in thyroid is like a thigh master. You guys use a lot of energy. Since the thyroids create...
high energy and high metabolism for the body. So guys, in hyperthyroidism, think high energy and high metabolism. Now this is also called Graves'disease, so we call it Gaines'disease, high and hyper energy.
Now on the other side, for hypothyroidism, guys, we think low and slow energy. So start moving your thighs during the exam. For hyper, we have high energy, and for hypo, we have just this low and slow.
Alright guys, now a little bit of pathophysiology that the NCLEX expects you guys to know. But let's be honest, the NCLEX is never going to ask you a direct question about pathophysiology. So as you know, just like all endocrine hormones, it's a big game of telephone, or dominoes if you will. So the hypothalamus releases TRH, which then tells the anterior pituitary to release TSH, the thyroid stimulating hormone.
And can you guess what the thyroid stimulating hormone does? Well yes guys, it stimulates the thyroid. Oh, how stimulating. So once stimulated, the thyroid pops out three most important key players guys, our T3 and T4, which are basically our active thyroid hormones. And also calcitonin, which basically puts a ton of calcium into the bone.
So our memory trick is it tones down the calcium in the blood by putting a ton of calcium into the bone. So calcitonin, a ton in the bone. Now our thyroid hormones T3 and T4 are the main focus for our thyroid conditions. Hypo, we have low T3 and T4. And hyper, we have high T3 and T4.
And to make this, your body needs dietary iodine found in salt. So iodine deficiency is a major cause of that hypo, low thyroidism in developing countries. So what causes our high T3 and T4 in hyperthyroidism? Guys, the number one cause is our autoimmune disease we talked about, Graves'disease.
We think Gaines'disease in high thyroid. But also, too much iodine means too much thyroid hormone. And even treating hypothyroid conditions, guys, if we give those patients too much thyroid meds, like levothyroxine, which leaves too much thyroid hormones in the body, we can eventually cause a high T3. hyper condition so guys balancing these two conditions is kind of like a teeter-totter or basically like a seesaw Hyper will be the exact opposite than hypo So low t3 and t4 in our hypo comes from that autoimmune disease guys called Hashimoto's That low and slow thyroid now other causes are low iodine in the diet and a big one guys big test up here pituitary tumor and even anti-thyroid treatments like a thyroidectomy where we take out that thyroid gland and now the body can't produce any thyroid hormones at all. Now as far as diagnostic tests guys don't let the NCLEX trick you here.
So here's a tip always focus on T3 and T4 first. Guys don't even look at TSH initially. If T3 and T4 are high then it's hyper thigh and guys if it's low then it's hypo.
Now You don't have to memorize any of the values. The NCLEX will give you the ranges. After seeing T3 and T4, then we look at TSH.
TSH will always be the opposite of T3 and T4 here. TSH is just trying to slow the hyper and amp up the hypo. As far as signs and symptoms, it's super simple.
Everything in hyper will be high and hot, and everything in hypo is going to be the exact opposite. Low and slow. So for hyperthyroid, guys, that Graves disease, our Gaines disease, everything is super high.
We're going to be bouncing off the walls, super amped up, like you're on a bunch of energy drinks. And again, the priority is to monitor for this thyroid storm, aka thyroid toxicosis. Guys, this will kill the patient. Again, NCLEX key terms are agitation, confusion, and even restlessness.
Those are usually the first signs. coupled with extremely high temperatures over 105, high heart rate, and blood pressure. Now classic signs that will show up on Select All That Apply questions, guys, we use our two Gs for Graves'disease.
So the first G is for grape eyes. Now the NCLEX term is exophthalmos. Guys, these are big eyeballs that are popping out like big grapes.
So think exo and exophthalmos as eyes exiting the body. So typically we use an eye patch or even tape down the eyelids for sleeping guys. That's always on the NCLEX.
I know it's super weird, but always an NCLEX key term. And our second G is for golf balls in the throat, called a goiter. Guys, this will look like a big bullfrog-looking throat.
And now, everything else will be high. So we'll have high blood pressure, aka hypertension. Remember, over 140, the heart says, oh lordy.
We'll also see high heart rate, guys, known as tachycardia, over 100. Heart palpitations, we'll even see atrial fibrillation. Now we'll also see high weight loss. And guys, the NCLEX will try and trick you here.
No, we're not talking about weight gain. The biggest thing is weight loss. So we'll see skinny patients.
Since we have high energy burn, we burn a lot of high calories. Now with that, we'll have high hot temperature. Hot and sweaty skin, known as diaphoresis.
Guys, not dry skin, sweaty skin. Now this is also called heat intolerance. You will definitely see this on SATA NCLEX questions.
And the very last thing, we have a high GI, so we get diarrhea, not constipation. So guys, patients in hyper mode need a hyper diet with high calories. Also high protein and carbohydrates.
Now, big key word here, frequent meals and snacks, like six to eight per day. Huge NCLEX key term. And guys, we also do the three big no-no's for the NCLEX. No high fiber, we need low fiber, unless the patient's constipated. Also no caffeine, so no coffees, sodas, or teas.
And lastly, no spicy food. Okay, now on the other side in our hypo, our Hashimoto's, guys, everything is low and slow. So super depressed, fat, and lethargic.
So we get the exact opposite from hyper. Again, the extreme priority is the extreme low and slow, airway, breathing, and circulation. Now the key term is myoxidema coma, guys, extremely low respiratory rate. So we think respiratory failure.
Again, the priority is innovation supplies at the top. the bedside. NCLEX's keyword here is endotracheal inhibition set or tracheostomy setup.
So we're expecting extremely low BP aka hypotension, extremely low heart rate known as bradycardia, below 60 and even low temperature called cold intolerance. Now the NCLEX tip here is no electric blankets guys. This can actually harm the patient if they're not closely monitored.
Now two more NCLEX tips which are the biggest risk for myxedema coma usually after a thyroid removal like a thyroidectomy or abruptly stopping thyroid replacement hormones like levothyroxine usually those two lead to the myxedema coma the extreme low and slow now classic signs for our hypothyroidism guys everything's gonna be low and slow now these will show up on SATA select all the apply questions so guys just think everything's gonna be low and slow We have low energy, known as fatigue, weakness, muscle pains, and aches. Low metabolism, meaning we have weight gain and water gain. There'll be edema in the legs and even under the eyes. Now, the big key word here is not weight loss.
We have low energy, which means low calories burned. So, guys, we have weight gain here. We also have low digestion, called constipation, not diarrhea.
Low hair, or basically hair loss, called alopecia. Now guys, this is not hirsutism. Huge NCLEX tip, they're going to try and trick you.
Hirsutism is that hairy suit. We have hair loss here. We also have low mental status, or basically forgetfulness.
Low mood, known as depression, apathy or confusion. Low libido with low sex drive or infertile. And also slow, dry skin turgor. Huge NCLEX tip here guys. Not hot, not sweaty.
Hypo, we have that dry skin. Now, our last two NCLEX keywords for low and slow. This is what's called irregular menstruation, guys. We have no periods or basically a missed period.
For a no period, it's called amenorrhea. Just think amen, no period. For low but heavy periods, we call it hypermenorrhea.
Just think hypermenstruation, heavy bleeding. For diet and hypo, guys, we have low energy. So we need low calories, low cholesterol, low saturated fats. And since we have low energy, we need frequent rest periods, guys.
Huge NCLEX tip right there. Now guys, the most common NCLEX questions revolve around priority, or basically who dies first. And it's always the extreme conditions, guys. For example, you will get a question about a client in Hashimoto's with that low heart rate, less than 60. Or those low respirations, about 10, right?
So we're thinking here my exedema coma guys we put that innovation tray or the endotracheal setup near the bedside So on the other side of things you get a question about a client in Graves disease guys with high high heart rate like over 100 beats per minute or high blood pressure over 140 size delic and even high temperature like over 101 guys the biggest thing think Thyroid storm and the priority here is to monitor for agitation and confusion Now, pharmacology and surgery is always NCLEX favorites here, guys. Guys, grab your notes, grab your study guides that we provide. We're going to be covering only the highly tested NCLEX topics here.
So, meds for hypothyroidism. Guys, we only have one main drug that you need to know for the NCLEX and for your nursing exams. It's called levothyroxine, which leaves T3 and T4 in the body. So guys, think Levo, we give for hypothyroidism. Now our second memory trick for those SATA questions is just the acronym Levo.
L for lifelong drug, guys. We never stop taking this drug. These are what's known as forever medications.
And L for long, slow onset. Usually three to four weeks till we find relief. Now test questions love to ask, patient education on these two points.
So I'd write those down. E is for early morning and empty stomach. Always 30 to 60 minutes before breakfast. One time a day at the same time every day.
Guys, never at night. Levo is always in the morning when you levantate or basically get up. Now V is for very hyper, guys. We report signs and symptoms of hyperthyroidism.
Basically, high heart rate, high BP, high temperature. It could lead to an extreme condition known as our thyroid storm. So key words we're looking for are agitation and confusion, usually the early signs of a thyroid storm.
And lastly, oh is for oh, the baby's fine. So guys, it's pregnancy safe. Now the four most tested no-no's to help drive them to the point for the most tested points here, guys. No food. We take an hour before breakfast.
Key word here is empty stomach. No cure. This medication is a hormone replacement.
It will never cure. It will only treat. So yes, this is a forever drug. And no double dosing.
If you ever miss a dose, guys, take ASAP or as soon as possible. And lastly, never abruptly stop taking medications. Key word is abrupt stop. It can lead to an extreme hypo, low condition with low respiratory rate, low BP, and guys, that will kill your patient. Again, this is called my exedema coma.
Now, some common NCLEX questions that will try and trick you guys. It's going to give you SATA questions. For example, additional patient teaching is needed when the patient on Levo says it doesn't work after 18 days. Guys, teach it to slow onset, 3 to 4 weeks, like 21 days.
Now, the patient 30 weeks pregnant, guys, is that okay? Yes, it's baby safe. And my personal favorite. Patient states, I'm glad this med will finally cure me. Guys, no, there's no cure here.
And a little side note for hypo, since everything is low and slow. We avoid narcotics, or basically opioids, like Vicodin and other painkillers. And guys, we avoid benzos, which are sedatives.
These drugs can actually add to the low and slow, dropping us into low condition, that myoxidema coma. Okay, so now the pharmacology for hyperthyroidism, that Graves disease, or... our Gaines disease. Guys, think here.
The thyroid is super amped up and super high. So we need to slow down that thyroid, right? Or basically, we need to kill it. So the four drugs you need to know.
Methemazole, guys, is not baby safe, but its friend, PTU, propothiouracil, memory trick for PTU is puts the thyroid underground. This guy is baby safe, but we report fever and sore throat. Guys, these dudes stop the thyroid from making T3 and T4.
Basically, slow it down. Now, SSKI, or potassium iodide. Guys, the memory trick is SSK. S for shrinks the thyroid before thyroid removal, or basically, thyroidectomy. This is done to reduce the bleeding, a.k.a. reduce the vascularity.
S is for stains the teeth. So guys, drink it through a straw with some juice. And K is to keep it one hour apart from other anti-thyroid medications.
Lastly, since hyperthyroid, we have a hyper heart, we use beta blockers, which puts the breaks on the heart, slowing it down. Now, these guys end in LOL, like propanolol. So, think the double L's in LOL lowers the double heart vitals.
So, low blood pressure and low heart rate. Now, next up, guys, the most dangerous and consequently the most tested here. RAIU, radioactive iodine uptake, guys.
These are the big guns. It destroys the thyroid in like one dose. So we expect hypo, low signs and symptoms.
Basically, we're monitoring for extreme lows like respiratory failure. Now again, guys, it's very toxic, making the patient like radioactive. So some common NCLEX Select All the Apply questions always come from this section, guys. Write these down.
Before giving, we always ensure A pregnancy test is negative. We always remove neck jewelry and dentures. That one came up a lot in the NCLEX here. And five to seven days before giving this drug, we hold any anti-thyroid meds. And guys, yes, you're awake.
There's no anesthesia. There's no conscious sedation. So we're just NPO two to four hours before and one to two hours after, guys.
It's not 12 hours and it's not surgery. This is just a radioactive pill. One dose, one and done, lasts about 24 to 72 hours. And speaking of after we give it, guys, we avoid everyone up to seven days.
Now, most. Most quiz banks say about 1-3 days. Just avoid everyone.
No going around pregnant people, no crowds, not even the same restroom. We're flushing it three times. Not even the same food utensils. Not the same laundry as your family's separate laundry baskets.
No cuddling and not even kissing. If all else fails, we can do a good old-fashioned surgery known as a thyroidectomy. Now, a lot of NCLEX tips come from this section, so please write this down.
Since thyroidectomy are usually done for hyperthyroidism, it's kind of like removing a big glass of milk. Surgeons can accidentally like squeeze out a lot of thyroid hormones into the body, so guys we're monitoring for high extreme conditions after surgery, known as a thyroid storm. Okay now for the big NCLEX priorities, we have the ABCs of thyroidectomy. A is for airways, since surgery is done near the neck, guys we think airway. Huge NCLEX key terms here, write these down.
Laryngeal stridor, noisy breathing and even hoarseness or weak voice. Huge big NCLEX key terms there. These usually indicate an airway problem so the number one priority is endotracheal tube at bedside.
Now the NCLEX will call it different things like intubation supplies and even tracheostomy setup. So anything with the word trache in it guys, keep it at the bedside. Huge on the NCLEX. Now B is for breathing that is noisy like covered before. Laryngeal stridor.
So guys, we always monitor voice strength and quality. Now next, C is for circulation. Obviously, we just had the surgery. So guys, we're looking for bleeding, but specifically bleeding around the pillow and insertion site. Now big NCLEX key terms for positioning to prevent the bleeding, guys.
Write these down. We want a neutral head and neck alignment. This means not supine, big no-no guys. Head of the bed, 30 to 45 degrees, aka semi-fowlers. And lastly guys, big no for flexing.
This is a no-flex zone for sure. No extending the neck, huge and always on the NCLEX. Now our last C, which is another NCLEX favorite guys. Calcium that is low, below 8.6, known as hypocalcemia. Now guys, these numbers are based on NCLEX standards, so...
Your textbook and your school might differ. So, memory trick is if you remove the T, then you check the C. Or basically, if you remove the thyroid, then guys, check the calcium. Now, the first sign of low calcium, write this down, tingling and numbness or circumoral tingling around the mouth and even the fingers. And the two other keywords are T and C for low calcium.
So, trousseau's, which is basically that arm torque with the blood pressure cuff on. And shavastics, that cheeky smile with facial numbness. So guys, I call these the two dance moves of low calcium. So remember, if you remove the T, then check the C.
Alright guys, that wraps it up for hyper and hypothyroidism. Guys, don't forget to take your quiz to test your comprehension. Thanks for watching.
For our full video and new quiz bank, click right up here to access your free trial. And please consider subscribing to our YouTube channel. Last but not least, A big thanks to our team of experts helping us make these great videos. Alright guys, see you next time.