The nurse is caring for a school-age child with hyperthyroidism (Graves’ disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply)

 

The correct answer is a. Vomiting, c. Tachycardia.

Choice A: Vomiting

Vomiting is a common symptom of thyroid storm. Thyroid storm is a life-threatening condition that occurs when the thyroid gland releases a large amount of thyroid hormone in a short period. This sudden surge in thyroid hormone can cause severe metabolic disturbances, leading to symptoms such as vomiting. Vomiting can result from the body’s attempt to cope with the excessive thyroid hormone levels, which can affect the gastrointestinal system.

Choice B: Constipation

Constipation is not typically associated with thyroid storm. In fact, hyperthyroidism, including thyroid storm, usually causes an increase in bowel movements or diarrhea due to the accelerated metabolism. Constipation is more commonly associated with hypothyroidism, where the thyroid gland is underactive and slows down bodily functions.

Choice C: Tachycardia

Tachycardia, or a rapid heart rate, is a hallmark symptom of thyroid storm. The excessive thyroid hormones increase the body’s metabolic rate, leading to an increased demand for oxygen and nutrients. To meet this demand, the heart rate increases significantly, often exceeding 140 beats per minute. This rapid heart rate can be dangerous and requires immediate medical attention.

Choice D: Hypotension

Hypotension, or low blood pressure, is not a typical symptom of thyroid storm. Instead, thyroid storm often causes hypertension (high blood pressure) due to the increased metabolic activity and the body’s heightened demand for oxygen and nutrients. The cardiovascular system responds by increasing blood pressure to ensure adequate blood flow to vital organs.

The correct answer is c. An excessive destruction of platelets.

Choice A: Diffuse fibrin deposition in the microvasculature

Diffuse fibrin deposition in the microvasculature is not characteristic of immune thrombocytopenia (ITP). This description is more aligned with disseminated intravascular coagulation (DIC), a condition where widespread clotting occurs within the blood vessels, leading to multiple organ damage.

Choice B: Deficiency in the production rate of globin chains

A deficiency in the production rate of globin chains is associated with thalassemia, a genetic blood disorder that affects the production of hemoglobin. This is not related to the pathology of immune thrombocytopenia.

Choice C: An excessive destruction of platelets

An excessive destruction of platelets is the hallmark of immune thrombocytopenia (ITP). In ITP, the immune system mistakenly targets and destroys platelets, which are essential for blood clotting. This leads to a low platelet count and an increased risk of bleeding.

Choice D: Bone marrow failure in which all elements are suppressed

Bone marrow failure in which all elements are suppressed is characteristic of aplastic anemia, a condition where the bone marrow fails to produce sufficient blood cells. This is not related to immune thrombocytopenia.