hey everyone it's sah register nurse rn.com and in this video I'm going to be going over Graves disease this video is part of an inlex review series on the endocrine system specifically the thyroid in the previous video I went over hypo and hyper thyroidism so if you're interested in those check those out and I've been covering all the complications that go along with this these disorders as well so what I'm going to do in this video is I'm going to hit on the causes the signs and symptoms and the nursing interventions of what you need to know about Graves disease and after you watch this video go to my website register nurse.com and take the free quiz that's going to test your knowledge on graves disease so let's get started first let's talk about the definition of graves disease what is this condition it is a common cause of hyperthyroidism due to an autoimmune condition so the body is causing an on itself and it will present with excessive thyroid hormone in the body first let's talk about the basics of the thyroid gland because in Graves disease there's some things going on and if you can understand the basics you can understand why this patient has these certain signs and symptoms and why we're providing these certain nursing interventions and giving them these certain medications so let's talk about where the thyroid gland is the thyroid gland is in where your trachea is your windpipe it's located right below the Linx where the laryng prominence is um the aka the Adam's apple on men and it's a butterfly shaped gland and it produces thyroid hormone what happens in the body you have a negative feedback loop and your hypothalamus anterior pituitary gland and your thyroid gland all work together so let's talk about this for a second what happens is that your hypothalamus releases TR which is thyron tropen releasing hormone whenever that releases your anterior pituitary gland picks that up and says hey I'm going to release TSH which is thyroid stimulating hormone and then this causes your thyroid gland to release thyroid hormone T3 and T4 now the issue with this condition is it's autoimmune so what happens is that the body starts secreting something called TSI which is thyroid stimulating imunoglobulin now your body looks at this as TSH the thyroid stimulating hormone so your body doesn't know the difference and it's being produced in excess so your body is producing TSI and whenever it produces that your thyroid starts producing lots of T3 and T4 so that is like the patho of what's going on in this condition remember TSI thyroid stimulating um immunoglobuline is being produced by your body and antibody and your body thinks it's TSH so it's causing that thyroid gland to Just Produce lots of T3 and T4 now what does T3 and T4 do why does it cause so much problems on our body when we have too much of it well let's look and see what it does normally normally it helps us burn calories um it determines how fast new cells replace dying cells how fast we digest our food um stimulates our sympathetic nervous system which is responsible for alertness or responses or reflexes increases body temperature or heart rate and um blood pressure helps in brain development especially in children and the TSH regulation regulates that hormone so whenever you have too much of it what's going to happen let's look at these signs and symptoms because we already talked about the cause the cause is the TSI being produced by the body and your body thinks it's TSH so what does it look like okay as a nurse you need to know these basic signs and symptoms in case you see them on an exam because with Graves disease there's some unique signs and symptoms that other disorders don't have have that are causes of hyperthyroidism okay so you're going to have those typical signs and symptoms of hyperthyroidism but like the weight loss the heat intolerance the weight loss again T3 and T4 helps you burn calories you're burning them at a rapid rate with Graves disease so you're going to have weight loss heat intolerance T3 and T4 increase your temperature so you're not going to be able to tolerate heat they're going to be sweaty um increase heart rate and blood pressure again your sympathetic nervous system is an overdrive so your heart's pumping fast your blood pressure pressures up diarrhea again remember it plays a role in how fast food goes through our intestines so we're not digesting all that nutrients it's going to come out watery irritable they're going to have smooth skin and hair due to that increased blood flow but the unique signs and symptoms that you want to um remember are the following they're going to have eye changes not all patients with grav disease but some of them will where they have the protruding eyeballs it's where the eyeballs are opened up really large and it looks like they have a surprise look on their face but it's constant they can also have a Gorder of the neck and the reason for this is due to overstimulation of the thyroid gland remember TSH all really TSI is producing causing the thyroids hormone thyroid gland to be producing T3 and T4 and it's constant so you're going to start getting swelling of the thyroid gland that will look like a Gorder also they can have pre-tibial miedema which is red swelling of the skin on the lower legs and the feet that have like this Orange Peel texture to it and this can progress to the face the chest and the arms so as a nurse what are you going to do for this patient nursing intervention wise one thing you want to do is you want to monitor their heart rate because they're going to be tacky monitor their blood pressure it's going to be high and monitor their weight cuz they're at risk for nutrient issues because they're burning calories really rapidly you want to make sure that they're on a high calorie diet getting the proper amount of calories keep the environment cool and quiet because this patient remember their sympathetic nervous system which is your fighter figh ORF flight response is an over job so they are stimulated they're irritable and they need a calm cool quiet environment next you're going to as a nurse you're going to be responsible for educating them about medications they're going to be started on the treatments treatments include radi radioactive iodine and thyroid ectomy and you're going to monitor for side effects um because of those medications which are anti-thyroid medications they may be started on beta blockers and you're also going to watch for thyroid storm we talked about that in uh the previous video where the thyroid storm is where they um it's either due to untreated or um they're not taking their medication properly and people with Graves disease can enter into thyroid storm and this is where you're you get severe um hypothermia their heart rate is increased tardia blood pressure and it's life-threatening to the point of death so if you don't know about that condition card should be popping up and you can access that video so first let's talk about the medications that these patients are started on okay so with Graves disease we have an elevated amount of thyroid hormon so what would be a goal what would we want to do to treat it the physicial is probably going to order anti-thyroid hormone which is going to help decrease thyroid hormones um most common that's usually prescribed by physicians it's called tapasol also known as methol it it tends to have fewer side effects than the other medication we'll go over here in a second however it cannot be used in the first trimester of pregnancy another drug is called PTU propy uracil and this if a woman is pregnant in her first trimester and she has this condition she'll be started on this because it's safe during the first trimester however um there is um problems with liver failure with this drug so watch liver enzymes another thing that you need to watch for with these antithyroid hormones not common side effects but it can happen especially what they love to ask you on test is a granulocytosis or thrombocytopenia so if you see those options that is a side effect of these medications now as a nurse You're always educating your patient about medications they're taking so what are some education pieces with the anti-thyroid hormone medicines um never stop taking these abruptly these medications can take some time to work so the patient may think I don't need this it's not even working I'm going to quit taking it so tell them takes a while to start working don't ever quit taking it because you can go into thyroid storm where you have untreated hyperthyroidism and you went into thyroid storm um take at the same time every day watch for those signs and symptoms of thyroid storm which is fever uh feeling really fast heart rate chest pain things like that uh avoid foods rich in iodine because remember the thyroid loves iodine because it helps them make T3 and T4 well if you're taking in a bunch of iodine you're going to be producing even more so watch foods that are like from the sea like kelp which is seaweed or um dairy products eggs things like that they're high in IOD no salicylates which is aspirin these increase thyroid hormones so don't take aspirin and watch for signs of toxicity we're giving them anti-thyroid hormone to decrease their thyroid hormone well sometimes you can decrease it so much that you send them into hypothyroidism and watch for signs and symptoms of that like bra cardia feeling cold all the time low blood pressure things like that with that now let's look at the treat treatment of with radioactive iodine and thyroidectomy another thing the patient could be started on medication wise are called beta blockers why beta blockers remember with this condition we have an tardia we have high blood pressure we have heat intolerance and what that does these will help prevent the effects of T3 and T4 on the body so um a popular one is indal so it'll decrease that heart rate um decrease that blood pressure help that patient with that heat intolerance however remember we talked about this in the hypertension video inlex review that whenever you get beta blockers remember they're not for patients who have a history of asthma or bronos spasms because it can exacerbate that make that come out again and you have to watch giving this medication beta blockers in patients who are diabetic because it can mask the typical signs and symptoms of hypoglycemia like the tacac cardia the sweating the things like that that normally come with that so want to educate your diabetic patient if they are started on this another treatment is radioactive iodine normally how this is given it's given in like a capsule patient swallows it the iodine remember thyroid loves iodine but this is special iodine it goes to the thyroid and what it does is it destroys the thyroid gland over time so go here destroy that however this is not for patients who are pregnant or nursing due to the radioactive material that beginning there are there may be some side effects with this they're usually mild however they can have iodism known as which can present as taste changes with a metal taste in the mouth nausea or swollen um saliva glands a surgical treatment for this um is a thyroid ectomy where they go in and remove the thyroid gland and um some things you need to watch out for this as the nurse whenever they remove a thyroid gland you want to monitor the patient for thyroid storm typically now this isn't as common patients entering into this because they're start on a lot of pre op meds and deing and after the procedure but thyroid storm because whenever they remove this Glam manipulate it it could cause a lot of T3 and T4 to leak into the body which will produce excessive amount of these hormones and um cause the patient to go into a life-threatening complication where they're going to go into hypothermia fast heart rate um could lead to of heart failure my cardal inunction things like that so monitor for that you also want to monitor if they've had a thyroid ectomy the calcium level why the calcium level remember in the thyroid gland are these little glands called parathyroid the parathyroid what is it do it regulates calcium so whenever they've went in here removed this thyroid gland they could have damaged the parathyroids and whenever you damage that you may have hypocalcemia so monitor the calcium level next monitor for respiratory distress because of the nature of the site it's going to be on the throat they could have excessive swelling they could have bleeding which could cause them to go in respiratory distress so you want to keep them in semi fallers position and keep a trait kit oxygen ins suction at bedside in case of emergency and also whenever the patient is coughing and deep breathing which is important to prevent pneumonia you want to teach them to splend their neck when they cough so they don't put extra pressure on that site so that is about grav disease now go take that free quiz on my website register narsari and.com and check out the other videos that are part of this series and thank you so much for watching and please consider subscribing to this YouTube channel