thyroid storm nursing Flashcards

What's on the cards

1. What is thyroid storm?
2. What other names are used for thyroid storm?
3. Roughly how deadly is thyroid storm even with modern treatment?
4. Is thyroid storm diagnosed mainly by lab values or by the clinical picture?
5. Should treatment of suspected thyroid storm wait until thyroid lab results return?
6. What thyroid function test pattern is usually seen in thyroid storm?
7. Does a patient need extremely high thyroid hormone levels to develop thyroid storm?
8. Does thyroid storm usually arise on its own, or does something set it off?
9. Which underlying thyroid disease most often leads to thyroid storm, and what other causes can?
10. Why is abruptly stopping antithyroid medicine a recognized trigger of thyroid storm?
11. How can surgery and anesthesia lead to thyroid storm, and how is that risk lowered before thyroid surgery?
12. Name acute illnesses that can precipitate thyroid storm.
13. Besides surgery and acute illness, what other events are listed as thyroid storm triggers?
14. Why should a nurse note recent iodinated contrast in a patient with hyperthyroidism?
15. Which medications are named as possible triggers of thyroid storm?
16. How common is thyroid storm among people hospitalized for hyperthyroidism?
17. What is the approximate male-to-female ratio and average age for thyroid storm?
18. Why does thyroid storm strain the heart?
19. What role does the sympathetic nervous system play in thyroid storm?
20. Which body systems are commonly involved in thyroid storm?
21. What fever range is a key presenting feature of thyroid storm, and what accompanies it?
22. What cardiovascular findings can occur in thyroid storm?
23. What central nervous system changes can thyroid storm cause?
24. What gastrointestinal problems can thyroid storm cause?
25. Besides thyroid tests, what other lab abnormalities may appear in thyroid storm?
26. Why can blood glucose run high during thyroid storm?
27. What is the Burch-Wartofsky Point Scale?
28. How does temperature score on the Burch-Wartofsky Point Scale?
29. How is CNS dysfunction scored on the Burch-Wartofsky Point Scale?
30. How are heart rate and atrial fibrillation scored on the Burch-Wartofsky Point Scale?
31. How are heart failure, GI dysfunction and a precipitating factor scored on the Burch-Wartofsky Point Scale?
32. How is a Burch-Wartofsky total score interpreted?
33. A patient with known hyperthyroidism and a urinary tract infection has a temperature of 103 °F, heart rate 135, and new delirium, with no heart failure, atrial fibrillation or GI signs. What is the Burch-Wartofsky score and what does it suggest?
34. An alert patient with hyperthyroidism has a temperature of 100 °F and heart rate 105, with no other scored findings and no identified trigger. What is the Burch-Wartofsky score and what does it suggest?
35. Under the Japanese Thyroid Association criteria, what lab finding is a prerequisite, and what fever and heart-rate thresholds are used?
36. Which tests besides labs help in the workup of thyroid storm, and why?
37. Where should a patient with thyroid storm be cared for, and with what monitoring?
38. What supportive measures are part of thyroid storm treatment?
39. Why is acetaminophen, not aspirin, the fever reducer used in thyroid storm?
40. In thyroid storm, which drug class controls the increased adrenergic tone?
41. In thyroid storm, which drug class reduces new thyroid hormone synthesis?
42. In thyroid storm, what therapy reduces the release of stored thyroid hormone?
43. Which therapies block the peripheral conversion of T4 to T3 in thyroid storm?
44. Which drug class reduces enterohepatic recycling of thyroid hormone?
45. After initial supportive measures, which drug should be started for any suspected thyroid storm, and what is a typical regimen?
46. What thionamide doses are used in thyroid storm?
47. Why is propylthiouracil favored over methimazole during the acute storm?
48. Which must be given first in thyroid storm: the thionamide or the iodine solution, and why?
49. When and how is SSKI given in thyroid storm?
50. Which glucocorticoid regimens are started in thyroid storm?
51. Why is methimazole often preferred over propylthiouracil once the acute phase passes?
52. How can antithyroid medicine be given to a patient in thyroid storm who cannot take it by mouth?
53. Which beta-blocker can be given in the ICU as a short-acting option in thyroid storm?
54. Which beta-blockers are chosen for a thyroid storm patient with reactive airway disease, and what if beta-blockers are contraindicated?
55. What is the plan if a patient in thyroid storm is allergic to thionamides?
56. What is the last-resort therapy for thyroid storm when all other measures fail?
57. Once a patient's condition improves after thyroid storm, how are the acute drugs adjusted?
58. What definitive treatment is recommended after recovery from thyroid storm, and what preparation does surgery need?
59. Why can thyroid storm be misdiagnosed, and which conditions can mimic it?
60. Why do patients taking antithyroid drugs need CBC monitoring, and what finding stops the drug?
61. Which antithyroid medicine side effect should a patient report to the doctor right away?
62. What are the usual causes of death in thyroid storm, and how fast do treated patients usually improve?
63. Which factors point to a poorer prognosis in thyroid storm?
64. Which complications can follow untreated thyroid storm?
65. What should patients with hyperthyroidism be taught about thyroid storm?
66. What should the nurse do when a patient being treated for thyroid storm has a change in hemodynamic status?
67. Besides controlling the thyroid hormone excess, what else must the care team look for in thyroid storm?
68. Which signs does MedlinePlus list for thyroid crisis, and where must patients be treated?
69. Which symptoms should prompt a person with hyperthyroidism to go to an emergency room or call 911?
70. What do beta-blockers do and not do for a patient with hyperthyroidism?
71. How do antithyroid medicines differ from beta-blockers in treating hyperthyroidism?
72. Which everyday hyperthyroidism symptoms form the baseline that a thyroid storm builds on?
73. Why can hyperthyroidism be missed in older adults?
74. Who is hyperthyroidism more common in?
75. Why is propylthiouracil often chosen for hyperthyroidism in the first 3 months of pregnancy?
76. Which complications should the nurse watch for after thyroidectomy?
77. What long-term medicine does a patient need after thyroidectomy?
78. A patient with Graves disease, a day after non-thyroid surgery, has a temperature of 104.5 °F, heavy sweating, heart rate 150 and new confusion. What is the first nursing action, and why?

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