Endocrine System Disorders Q 9

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Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

  

    A. Diabetic ketoacidosis

    B. Thyroid crisis

    C. Hypoglycemia

    D. Tetany

    

    

Correct Answer: B. Thyroid crisis

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Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Presentation of thyroid storm is an exaggerated manifestation of hyperthyroidism, with the presence of an acute precipitating factor. Fever, cardiovascular involvement (including tachycardia, heart failure, arrhythmia), central nervous system (CNS) manifestations, and gastrointestinal symptoms are common.

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Option A: Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia. The patient with diabetic ketoacidosis may present with a myriad of symptoms and physical exam findings. Patients may have symptoms of hyperglycemia like polyphagia, polyuria, or polydipsia. As patients become more volume-depleted, they may experience decreased urine output, dry mouth, or decreased sweating indicative of dehydration. They may complain of many other symptoms, including anorexia, nausea, vomiting, abdominal pain, and weight loss.

Option C: Hypoglycemia produces weakness, tremors, profuse perspiration, and hunger. Neurogenic signs and symptoms can either be adrenergic (tremor, palpitations, anxiety) or cholinergic (hunger, diaphoresis, paresthesias). Neurogenic symptoms and signs arise from sympathoadrenal involvement (either norepinephrine or acetylcholine release) in response to perceived hypoglycemia.

Option D: Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia. Generally induced by a rapid decline in serum ionized calcium; tetany is usually most dangerous and most commonly seen in the presence of respiratory alkalosis causing hypocalcemia.

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