Hyperthyroidism

St. Dominic College of Arts and Sciences Emilio Aguinaldo Highway, Talaba IV, Bacoor, Cavite

College of Nursing

A Case Study

Hyperthyroidism “Touch my Neck” Presented by: Group 1 Agcaoili, Jenalyn Aranzaso, Christian Columna, Liezel Cueno, Caroline Hierco, Rica Bianca Legayada, Mary Jerah Manigsaca, Melizen Paraiso, Joanna Romeo, Norely Romero, Jelica Turla, Jordina

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CHAPTER I INTRODUCTION Hyperthyroidism, a term for overactive tissue within the thyroid gland, resulting in overproduction and thus an excess of circulating free thyroid hormones: thyroxine (T4), triiodothyronine (T3) or both. Thyroid hormone is important at a cellular level, affecting nearly every type of tissue in the body. It functions as a stimulus to metabolism, and is critical to normal function of the cell. Hyperthyroidism, considered as the second most common endocrine disorder. It results from an excessive output of thyroid hormones due to abnormal stimulation of the thyroid gland by circulating immunoglobulin. This disorder affects women eight times more frequently than men and peaks between the second and fourth decades of life. It generally occurs between 20 and 40 years old and is more common in females. Weight loss, exopthalmos (protrusion of the eyeballs), hypertension, and heat intolerance: these are some of the signs and symptoms of Hyperthyroidism. Neurological manifestations can include tremors, irritability and restlessness. Hyperthyroidism is the most common endocrine disorder that’s why we choose this as our case study because of its relevance to our concept about disturbance in metabolism and endocrine. Since metabolism is all the chemical and physical processes which occur in living organisms and that maintain life and growth, endocrine is specifically producing secretions that are distributed in the body by the blood stream. Like with our patient with hyperthyroidism, there is an excess T4 (thyroxine) and T3 (triiodothyronine) and decreased of TSH (Thyroid Stimulating Hormone) that affects his metabolism (Medical surgical Nursing; Joyce Young Johnson).

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BACKGROUND OF THE STUDY One of the cases that we handled in one of the tertiary hospital in Cavite, City is Hyperthyroidism. Hyperthyroidism is the second most common endocrine disorder that captured the interest of the researchers to further study the case (Medical Surgical Nursing; Joyce Young Johnson). Our patient is a 28 year old male and he is a navy. On the day of his admission, he experienced severe palpitation or tachycardia and he felt light headedness and loss his consciousness that’s prompted his admission in Cavite, City.

STATEMENT OF THE PROBLEM Major Problem: What nursing intervention can be formulated based on the identified problem? 1.) What is the demographic profile of the client? •

Age

•

Gender

•

Occupation

•

Socio – economic status

2.) What are the different assessment parameters of a patient with Hyperthyroidism? 3.) What are the different nursing diagnoses formulated based on the client’s situation? 4.) What are the nursing diagnoses that should be prioritize? 5.) What nursing intervention can be formulated based on the identified problem? 6.) What are the client’s responses based on the implemented nursing interventions?

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SIGNIFICANCE OF THE STUDY To client/his family This study is for the family to know and understand better the importance of seeking medical assistance. For them to understand further, the disease and be able to cope gradually with whatever changes that the patient will go through regarding his condition. To nursing service department This study will provide facts and nursing managements about this disease, which will be a great assistance for them to provide the students to have sufficient knowledge about the disease and how to deal with patients who are suffering from it. To nursing education This study will provide the information about hyperthyroidism because of the facts and managements regarding to this disease will be beneficial in teaching the students. To the students This study will serve as a reference for the nursing students about patients with hyperthyroidism. Also, for them to gain knowledge and be aware on how to give proper nursing managements to the client suffering to this condition. To the community health center and/or city health office This study will provide knowledge about this disease which will be helpful for the services of the community to educate those who are suffering from this condition, the family and other people who need the information about it. To the future researchers The result of this study will serve as a guide for future reference about future researches on the study of hyperthyroidism.

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SCOPE AND LIMITATION

The researchers had a total of five (5) interactions and/or equal to 4o hours and had a follow up home visit. This study covers only the information about hyperthyroidism that has relevance to our topic; disturbances in endocrine. This study is limited only to hyperthyroidism which is results from an excessive output of thyroid hormones such as T3 triidothyronini and T4 thyroxine, due to abnormal stimulation of the thyroid gland by circulating immunoglobulins that can be classified as an endocrine disorder. This study will not tackle any topic beyond the disease (hyperthyroidism).

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CHAPTER II REVIEW OF RELATED LITERATURE

FOREIGN: Hyperthyroidism

To be hyperthyroid, is to have an over-active thyroid gland. When the thyroid produces to much hormone, hyperthyroidism is the result.

Anxiety Symptoms in Hyperthyroidism Hyperthyroidism causes a sped-up metabolism and can cause the patient to feel hyper, edgy, nervous and anxious. While people with any thyroid disorder have potential to experience anxiety, those with hyperthyroidism are especially vulnerable to chronic and severe anxiety symptoms.

Hyperthyroid from Over-treated Hypothyroidism Patients being treated for hypothyroidism can at times be over-treated on their thyroid hormone medication and will cause them to experience hyperthyroidism. This is also referred to as thyrotoxicity and this article helps in recognizing this treatment condition.

Hyperthyroidism and Its Causes Hyperthyroidism is a condition of excess thyroid hormone. When hormone levels are too high,

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the resulting sped up metabolism in the body, causes hyperthyroid symptoms. This article further describes this over-active thyroid condition and the causes of it. Hypothyroid & Hyperthyroid at the Same Time Some patients with autoimmune hypothyroidism experience spells of hyperthyroidism (Hashitoxicosis). When this happens, their Doctor should test them for "TSI antibodies", which normally occur with Grave's Disease. If the antibodies are present, they may be a candidate for "block & replace" therapy.

Recognizing Graves' Disease - Hyperthyroidism Approximately 3 million Americans have Graves´ Disease and that number is greatly increased worldwide. This article gives the basic signs and symptoms for recognizing this common cause of hyperthyroidism.

Treatments for Graves' Disease - Hyperthyroidism This article looks at the different treatments for hyperthyroidism caused by Graves´ Disease, including a co-morbid condition called Thyroid Eye disease.

What is hyperthyroidism? Hyperthyroidism is a condition in which an overactive thyroid gland is producing an excessive amount of thyroid hormones that circulate in the blood. ("Hyper" means "over" in Greek). Thyrotoxicosis is a toxic condition that is caused by an excess of thyroid hormones from any cause. Thyrotoxicosis can be caused by an excessive intake of thyroid hormone or by overproduction of thyroid hormones by the thyroid gland. Because both physicians and patients

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often use these words interchangeably, we will take some liberty by using the term "hyperthyroidism" throughout this article. What are thyroid hormones? Thyroid hormones stimulate the metabolism of cells. They are produced by the thyroid gland. The thyroid gland is located in the lower part of the neck, below the Adam's apple. The gland wraps around the windpipe (trachea) and has a shape that is similar to a butterfly formed by two wings (lobes) and attached by a middle part (isthmus).

What causes hyperthyroidism? Some common causes of hyperthyroidism include:Graves' Disease,Functioning adenoma ("hot nodule") and Toxic Multinodular Goiter (TMNG) ,Excessive intake of thyroid hormones ,Abnormal secretion of TSH ,Thyroiditis (inflammation of the thyroid gland) ,Excessive iodine intake Graves' Disease -Graves' disease, which is caused by a generalized overactivity of the thyroid gland, is the most common cause of hyperthyroidism. In this condition, the thyroid gland usually is renegade, which means it has lost the ability to respond to the normal control by the pituitary gland via TSH. Graves' disease is hereditary and is up to five times more common among women than men. Graves' disease is thought to be an autoimmune disease, and antibodies that are characteristic of the illness may be found in the blood. These antibodies include thyroid stimulating immunoglobulin (TSI antibodies), thyroid peroxidase antibodies (TPO), and TSH receptor antibodies. The triggers for Grave's disease include:stress, smoking, radiation to the neck, medications, and infectious organisms such as viruses. Graves' disease can be diagnosed by a standard, nuclear medicine thyroid scan which shows diffusely increased

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uptake of a radioactively-labeled iodine. In addition, a blood test may reveal elevated TSI levels.Grave's disease may be associated with eye disease (Graves' ophthalmopathy) and skin lesions (dermopathy ). Ophthalmopathy can occur before, after, or at the same time as the hyperthyroidism. Early on, it may cause sensitivity to light and a feeling of "sand in the eyes." The eyes may protrude and double vision can occur. The degree of ophthalmopathy is worsened in those who smoke. The course of the eye disease is often independent of the thyroid disease, and steroid therapy may be necessary to control the inflammation that causes the ophthalmopathy. In addition, surgical intervention may be required. The skin condition (dermopathy) is rare and causes a painless, red , lumpy skin rash that appears on the front of the legs.

Hyperthyroidism: Overactivity of the Thyroid Gland Hyperthyroidism is a large topic so we split it into four manageable sized portions. This page introduces hyperthyroidism. Subsequent pages are listed at the bottom which address more specific details of making the diagnosis of hyperthyroidism, the causes of hypwerthyroidism, and different treatment options available for hyperthyroidism. In healthy people, the thyroid makes just the right amounts of two hormones, T4 and T3, which have important actions throughout the body. These hormones regulate many aspects of our metabolism, eventually affecting how many calories we burn, how warm we feel, and how much we weigh. In short, the thyroid "runs" our metabolism. These hormones also have direct effects on most organs, including the heart which beats faster and harder under the influence of thyroid hormones. Essentially all cells in the body will respond to increases in thyroid hormone with an increase in the rate at which they conduct their business. Hyperthyroidism is the

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medical term to describe the signs and symptoms associated with an over production of thyroid hormone. For an overview of how thyroid hormone is produced and how its production is regulated check out our thyroid hormone production page. Hyperthyroidism is a condition caused by the effects of too much thyroid hormone on tissues of the body. Although there are several different causes of hyperthyroidism, most of the symptoms that patients experience are the same regardless of the cause (see the list of symptoms below). Because the body's metabolism is increased, patients often feel hotter than those around them and can slowly lose weight even though they may be eating more. The weight issue is confusing sometimes since some patients actually gain weight because of an increase in their appetite. Patients with hyperthyroidism usually experience fatigue at the end of the day, but have trouble sleeping. Trembling of the hands and a hard or irregular heartbeat (called palpitations) may develop. These individuals may become irritable and easily upset. When hyperthyroidism is severe, patients can suffer shortness of breath, chest pain, and muscle weakness. Usually the symptoms of hyperthyroidism are so gradual in their onset that patients don't realize the symptoms until they become more severe. This means the symptoms may continue for weeks or months before patients fully realize that they are sick. In older people, some or all of the typical symptoms of hyperthyroidism may be absent, and the patient may just lose weight or become depressed.

The latest on Symptoms in Hyperthyroidism Hyperthyroidism can cause a wide variety of symptoms. Most people won’t have all of the characteristic symptoms. Instead, they’ll experience several predominant symptoms. These symptoms can change over time and they can vary in severity. For many years, typical

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symptoms of hyperthyroidism, such as excess sweating, muscle weakness, heat tolerance, fatigue, tremor, increased heart rate, anxiety and nervousness have been recognized.IN recent years, a number of other less typical symptoms, many of which occur outside of hyperthyroidism, have been found to occur as a result of hyperthyroidism. For instance, symptomsof headache, vomiting, high blood calcium and low potassiumhave been found to occur in hyperthyroidism, but sometime, because they are commonly seen in other conditions, the connectionto hyperthyroidism isn’t made. Similarly, hyperactivity in attention deficit disorders has been linked to excess thyroid hormone, but often, this connection isn’t considered. In hypokalemic periodic paralysis, patients with hyperthyroidism develop a low blood potassium, which can result in temporary paralysis. This condition was originally described in Asian men, but has since found in all races and in women although it occurs more often in men. The sudden drop in potassium typically occurs after exercise or following ingestionof high amounts of carbohydrates or sodium. Paralysis typically begins in the proximal muscles and is worst in the lower legs. Patients with hypokalemic paralysis may become paralyzed after sitting or lying down and may awaken from deep sleep unable to rise from bed. Beta-blockers improve this condition but complete resolution doesn’t occur until the thyroid hormone levels are lowered. Similarly, serum calcium levels may rise in hyperthyroidism, sometimes to a significant degree. This occurs as the hypermetabolic state causes increased withdrawal of calcium from bones. The sudden onset of hypercalcemia may cause appetite loss, usually in contrast to the usual increased appetite typically seen in hyperthyroidism. This can cause significant bone loss over time, particularly in women. With treatment for hyperthyroidism, this condition improves.

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Methimazole vs. Propylthiouracil for Hyperthyroidism Methimazole was superior overall, and lower doses seemed sufficient for patients with mild-tomoderate hyperthyroidism. Both methimazole and propylthiouracil (PTU) are used to treat hyperthyroidism. To compare these drugs, Japanese researchers randomized 396 patients with Graves hyperthyroidism to receive 15 mg of methimazole once daily, 30 mg of methimazole daily (given as 15 mg twice daily), or 100 mg of PTU three times daily. At each of three time points (4, 8, and 12 weeks), the proportion of patients with normalized free thyroxine (T4) levels was higher in the 30-mg methimazole group than in the other two groups. The differences were of borderline statistical significance at 4 and 8 weeks but significant at 12 weeks (normal free T4 achieved in 97%, 86%, and 78% of patients in the 30mg methimazole, 15-mg methimazole, and PTU groups, respectively). In patients with mild or moderate hyperthyroidism, normal free T4 was achieved at similar rates in the three groups. However, in patients with severe hyperthyroidism (i.e., free T4 7 ng/dL), higher-dose methimazole was more effective than lower-dose methimazole or PTU. Transaminase elevations and leukopenia occurred less commonly with both doses of methimazole than with PTU. Rash was less common with lower-dose methimazole than with higher-dose methimazole or PTU.

Age and Gender Predict the Outcome of Treatment for Graves’ Hyperthyroidism The response to treatment in Graves’ hyperthyroidism is unpredictable, and factors postulated to

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predict outcome have not generally proved clinically useful or been widely adopted in clinical practice. We audited outcome in 536 patients with Graves’ hyperthyroidism presenting consecutively to determine whether simple clinical features predict disease presentation and response to treatment. At presentation males had slightly more severe biochemical hyperthyroidism [free T4: males, 64.3 ± 3.0 pmol/L (mean ± SE); females, 61.3 ± 1.7 (P = 0.45); free T3: males, 24.3 ± 1.5 pmol/L; females, 21.0 ± 0.6, (P = 0.04)]. Patients less than 40 yr at diagnosis had more severe hyperthyroidism than patients more than 40 yr old [free T4: <40 yr, 64.3 ± 2.0; >40 yr, 56.7 ± 2.3 (P = 0.02); free T3: <40 yr, 22.8 ± 0.8; >40 yr, 19.0 ± 0.9 (P = 0.003)]. Males had a lower remission rate than females after a course of antithyroid medication [19.6% vs. 40%; odds ratio, 0.37; 95% confidence interval (CI), 0.17–0.79; P < 0.01]. Similarly, patients aged less than 40 yr had a lower remission rate than older patients (32.6% vs. 47.8%; odds ratio, 0.53; 95% CI, 0.32–0.87; P = 0.01). One dose of radioiodine cured hyperthyroidism in fewer males than females (47% vs. 74%; P < 0.0001). Logistic regression analysis demonstrated male sex (odds ratio, 2.80; 95% CI, 1.31–5.98; P = 0.008), serum free T4 concentration at diagnosis (odds ratio, 1.02; 95% CI, 1.0–1.04; P = 0.01), and dose of radioiodine administered (odds ratio, 0.99; 95% CI, 0.99–1.00; P = 0.001) were contributing factors associated with failure to respond to a single dose of radioiodine. As males and younger patients are more likely to fail to respond to medical treatment, and male patients are likewise less likely to respond to a single dose of radioiodine, we suggest that those groups with low remission rates should be offered definitive treatment with radioiodine or surgery soon after presentation and that the value of higher initial doses of radioiodine in males be evaluated

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LOCAL: PSEM battles goiter and other thyroid diseases in RP EXCESSIVE weight loss or weight gain may be an indication of trouble in the thyroid glands according to Dr. Gabriel Jasul Jr., director and chairman of the Committee on Advocacy of the Philippine Society of Endocrinology and Metabolism (PSEM). Jasul said that hyperthyroidism, hypothyroidism and goiter are among the leading thyroid disorders. The doctor gave a primer entitled “PSEM and the Public: Working Together to Fight Goiter,” at the press conference held at the Heritage Hotel in Pasay City on January 17. Diseases of the thyroid glands could manifest in a plethora of symptoms besides the usual lump in the neck, related Jasul. The doctor explained that hyperthyroidism is a condition where the thyroid glands are diffusely enlarged; its signs may include weight loss, rapid heartbeat, palpitations, nervousness, irritability shakiness, intolerance to heat, diarrhea, inability to sleep, muscle weakness, fatigue, increased sweating and shorter menstrual flow in women. Hypothyroidism is the inability of the thyroid glands to produce adequate amounts of thyroid hormones causing the body to slow down. A person with hypothyroidism may display the following symptoms: weight gain, intolerance to cold, constipation, low infertility, depression, sleepiness, forgetfulness, puffy face, falling hair, muscle weakness, fatigue, dry skin and longer and heavier menstrual period. Jasul emphasized in his lecture that goiter is still prevalent among Filipinos. Commonly known as bosyo, goiter is the general term for the enlargement of the thyroid gland in the neck. In the Philippines, its frequency is high among women within the reproductive age of 13 to 20 years old. The disease also afflicts 5 percent of the school children in the country due to iron deficiency.

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PSEM president Dr. Rosa Allyn Sy stressed the role of endocrinology in the management of goiter and other thyroid diseases. Endocrinology is the study of the endocrine system and its specific secretions called \o “Hormone” hormones. Hormones are messenger molecules essential in cell-to-cell communication. In the Philippines, an endocrinologist is either an internist or a pediatrician who has completed two years of study in an accredited fellowship training program in endocrinology. Endocrinology as a discipline is crucial in the management and treatment of diabetes, thyroid disorders, obesity, dyslipidemia, osteoporosis and other metabolic problems. The PSEM has just over 120 endocrinologists on its roster nationwide. PSEM vice president Dr. Josephine Carlos-Raboca and director Dr. Leilani B. Mercado-Asis said that their organization is actively involved in advocacy campaigns on the prevention and treatment of goiter and other thyroid diseases.

Philippine Thyroid Association’s Thyroid Expo kicks off Medicine Week During the recent celebration of Medicine Week, the Philippine Thyroid Association (PTA) held its very first Thyroid Expo as part of its advocacy to educate lay people. In an effort to educate the public and generate awareness on thyroid problems, lectures on hyperthyroidism (overactive thyroid), hypothyroidism (under-active thyroid) and goiter were conducted through the support of pharmaceutical companies, including Pharmalink, providers of widely prescribed hyperthyroidism medicine methimazole. “That’s why we chose to hold the lectures here in a mall, where we are able to offer free thyroid tests to the public at Clinica Manila for those who could not afford the test,” explains Dr. Roy J. Cuison, endocrinologist and current PTA president. “Just like diabetes, many people with thyroid problems are unaware of their condition until it becomes serious and entrenched. But

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unlike diabetes, there is still a very low awareness for thyroid diseases. That’s why the declaration of the third week of January as Goiter Awareness Week is very important to us,” says Cuison. For hypothyroidism, common symptoms are fatigue, weight gain, constipation, fuzzy thinking, low blood pressure, fluid retention, depression, body pain, slow reflexes, among others. For hyperthyroidism, symptoms include anxiety, insomnia, rapid weight loss, diarrhea, fast heart rate, high blood pressure, eye sensitivity/bulging and vision disturbances, and many other concerns. For certain thyroid problems, more women are afflicted than men. At greater risk are women who have family members (mothers, sisters, or cousins) who have had thyroid problems. It also tends to surface after a woman’s first pregnancy. “If you are a woman and thyroid problems have been found in your family, it would be best to have your thyroid checked,” recommends Dr. Cuison. “Thyroid hormones are partly responsible for brain development, that’s why pregnant women should have a thyroid test while newborns can undergo neonatal screening to detect potential thyroid problems.” “When treating thyroid problems, we use a comprehensive multi-specialty and multi-discipline approach. Most thyroid problem cases can be managed medically, which means they can be given tablets. However, for problems discovered much later, there is another modality — surgical intervention. Another modality that can be used is called radioactive iodine,” explains Cuison. To improve the awareness and treatment of thyroid problems, Dr. Cuison urges all physicians to cooperate with the PTA by disseminating information to their patients about thyroid problems and the need for early detection and treatment.

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Goiter still rampant among Filipinos Goiter prevalence in the Philippines is still high compared to other Asian countries, with the greatest frequency among pregnant women between 13 to 20 years old. This was revealed by officials of the Philippine Society of Endocrinology and Metabolism during a press conference dubbed PSEM and the Public: Working Together to Fight Goiter held recently at The Heritage Hotel in Pasay City. Goiter or the enlargement of the thyroid gland just below the Adam’s apple – is also prevalent in five percent of the schoolchildren. The disease is most commonly caused by iodine deficiency. PSEM director and committee on advocacy chair Dr. Gabriel Jasul, Jr. also provided an overview of the diseases of the thyroid gland which include goiter, hypothyroidism and hyperthyroidism. PSEM president Dr. Rosa Allyn Sy, on the other hand, stressed the role of endocrinology in the management and treatment of these thyroid disorders. PSEM vice-president Dr. Josephine Carlos-Raboca and director Dr. Leilani B. Mercado-Asis, also presented their advocacy campaigns on the awareness, prevention and treatment of goiter. As mandated by Proclamation No. 1188 recently signed by President Gloria Macapagal-Arroyo, Goiter Awareness Week will be commemorated every fourth week of January.

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Goiter Awareness Week brings to fore importance of ASIN Law implementation TACLOBAN CITY, Jan. 7 (PNA) -- The Goiter Awareness Week is celebrated on the fourth week of January, thanks to President Gloria Macapagal Arroyo who, through Proclamation No. 1188 in 2007, declared the fourth week of January as Goiter Awareness Week. In signing the Proclamation, President Arroyo stressed the need to promote a sustained information and education of the population on the prevention of goiter and other thyroid disorders. The Department of Health (DOH) has been designated as the lead agency in conducting information dissemination, education and training, research and preventive measures like the use of iodized salt to prevent goiter. There is a need for the various stakeholders to work together to fight goiter through concerted efforts in raising awareness against goiter and to stress the importance of preventing this formidable disease which affects women under reproductive age and school children aged seven years old onwards. It has always been said that a goiter maybe a temporary problem that will remedy itself overtime without medical intervention or it could be a symptom of another, possibly severe thyroid condition that requires urgent medical attention. Goiter or the enlargement of the thyroid gland is considered prevalent in the Philippines. This disease in thyroid glands is classified as an endemic, meaning present continuously in a community, or sporadic goiter. Based on the studies on urinary iodine levels conducted by the Department of Health, most goiter cases are found in the mountainous provinces and other remote areas of the country, where children and pregnant women are mostly affected. 18

Synthesis In this article they discuss about what is hyperthyroidism,how it diagnose,what causes this disease,symptoms,and treatments.hyperthyroidism is a condition in which an overactive thyroid gland, an excessesive amount of thyroid hormones that circulate in the blood. Some common causes of hyperthyroidism includes grave’s disease which is said to be the most common cause of hyperthyroidism and it is thought to be a autoimmune disease and antibodies that are characteristics of the illness may found in the blood,and what triggers for grave’s disease are stress,smoking,radiation to the neck,medication,and infection organism such as viruses, ,functioning adenoma and toxic goiter, excessive intake of thyroid hormones,abnormal secretion of thyroid-stimulating hormone,thyroiditis and excessive iodine intake. Various symptoms manifest in this disease such as excessive sweating, heat tolerance, increase bowel movement, tremor, nervouseness, agitation, rapid heart rate, weight loss, fatigue, decrease concentration, irregular and scant menstrual flow for female.

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There are various ways to diagnosed hyperthyroidism some of this diagnostic test is blood test to test the level of thyroid-stimulating hormone, because decrease TSH means that there is elevation either in thyroxine or/and triiodothyroxine. Hyperthyroidism is treated in many ways such as treating the symptoms itself using medication like beta- blockers, using antithyroid drugs, radioactive iodine theraphy which give orally on a one-time basis to ablate a hyperactive gland, and surgery which is the partial removal of thyroid gland.

ANATOMY AND PHYSIOLOGY Thyroid Gland The thyroid is one of the largest endocrine glands in the body. This gland is found in the neck inferior to (below) the thyroid cartilage (also known as the Adam's apple in men) and at approximately the same level as the cricoid cartilage. The thyroid controls how quickly the body burns energy, makes proteins, and how sensitive the body should be to other hormones. The thyroid participates in these processes by producing thyroid hormones, principally thyroxine (T4) and triiodothyronine (T3). These hormones regulate the rate of metabolism and affect the growth and rate of function of many other systems in the body. Iodine is an essential component of both T3 and T4. The thyroid also produces the hormone calcitonin, which plays a role in calcium homeostasis. The thyroid is controlled by the hypothalamus and pituitary. The gland gets its name from the Greek word for "shield", after the shape of the related thyroid cartilage.

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Hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) are the most common problems of the thyroid gland.

Anatomy The thyroid gland is butterfly-shaped organ and is composed of two cone-like lobes or wings: lobus dexter (right lobe) and lobus sinister (left lobe), connected with the isthmus. The organ is situated on the anterior side of the neck, lying against and around the larynx and trachea, reaching posteriorly the oesophagus and carotid sheath. It starts cranially at the oblique line on the thyroid cartilage (just below the laryngeal prominence or Adam's apple) and extends inferiorly to the fourth to sixth tracheal ring. It is difficult to demarcate the gland's upper and lower border with vertebral levels as it moves position in relation to these during swallowing. The thyroid gland is covered by a fibrous sheath, the capsula glandulae thyroidea, composed of an internal and external layer. The external layer is anteriorly continuous with the lamina pretrachealis fasciae cervicalis and posteriorolaterally continuous with the carotid sheath. The gland is covered anteriorly with infrahyoid muscles and laterally with the sternocleidomastoid muscle. Posteriorly, the gland is fixed to the cricoid and tracheal cartilage and cricopharyngeus muscle by a thickening of the fascia to form the posterior suspensory ligament of Berry. In variable extent, Zuckerkandl's tubercle, a pyramidal extension of the thyroid lobe, is present at the most posterior side of the lobe. In this region the recurrent laryngeal nerve and the inferior thyroid artery pass next to or in the ligament and tubercle. Between the two layers of the capsule and on the posterior side of the lobes there are on each side two parathyroid glands.

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The thyroid isthmus is variable in presence and size, and can encompass a cranially extending pyramid lobe (lobus pyramidalis or processus pyramidalis), remnant of the thyroglossal duct. The thyroid is one of the larger endocrine glands, weighing 2-3 grams in neonates and 18-60 grams in adults, and is increased in pregnancy

The thyroid is supplied with arterial blood from the superior thyroid artery, a branch of the external carotid artery, and the inferior thyroid artery, a branch of the thyrocervical trunk, and sometimes by the thyroid ima artery, branching directly from the aortic arch. The venous blood is drained via superior thyroid veins, draining in the internal jugular vein, and via inferior thyroid veins, draining via the plexus thyroideus impar in the left brachiocephalic vein. Lymphatic drainage passes frequently the lateral deep cervical lymph nodes and the pre- and parathracheal lymph nodes. The gland is supplied by sympathetic nerve input from the superior cervical ganglion and the cervicothoracic ganglion of the sympathetic trunk, and by parasympathetic nerve input from the superior laryngeal nerve and the recurrent laryngeal nerve..

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Physiology The primary function of the thyroid is production of the hormones thyroxine (T4), triiodothyronine (T3), and calcitonin. Up to 80% of the T4 is converted to T3 by peripheral organs such as the liver, kidney and spleen. T3 is about ten times more active than T4. T3 and T4 production and action Thyroxine (T4) is synthesised by the follicular cells from free tyrosine and on the tyrosine residues of the protein called thyroglobulin (TG). Iodine is captured with the "iodine trap" by the hydrogen peroxide generated by the enzyme thyroid peroxidase (TPO) and linked to the 3' and 5' sites of the benzene ring of the tyrosine residues on TG, and on free tyrosine. Upon stimulation by the thyroid-stimulating hormone (TSH), the follicular cells reabsorb TG and proteolytically cleave the iodinated tyrosines from TG, forming T4 and T3 (in T3, one iodine is absent compared to T4), and releasing them into the blood. Deiodinase enzymes convert T4 to T3. Thyroid hormone that is secreted from the gland is about 90% T4 and about 10% T3. Cells of the brain are a major target for the thyroid hormones T3 and T4. Thyroid hormones play a particularly crucial role in brain maturation during fetal development. A transport protein (OATP1C1) has been identified that seems to be important for T4 transport across the blood brain barrier. A second transport protein (MCT8) is important for T3 transport across brain cell membranes. In the blood, T4 and T3 are partially bound to thyroxine-binding globulin, transthyretin and albumin. Only a very small fraction of the circulating hormone is free (unbound) - T4 0.03% and T3 0.3%. Only the free fraction has hormonal activity. As with the steroid hormones and retinoic acid, thyroid hormones cross the cell membrane and bind to intracellular receptors

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(α1, α2, β1 and β2), which act alone, in pairs or together with the retinoid X-receptor as transcription factors to modulate DNA transcription.

T3 and T4 regulation The production of thyroxine and triiodothyronine is regulated by thyroid-stimulating hormone (TSH), released by the anterior pituitary (that is in turn released as a result of TRH release by the hypothalamus). The thyroid and thyrotropes form a negative feedback loop: TSH production is suppressed when the T4 levels are high, and vice versa. The TSH production itself is modulated by thyrotropin-releasing hormone (TRH), which is produced by the hypothalamus and secreted at an increased rate in situations such as cold (in which an accelerated metabolism would generate more heat). TSH production is blunted by somatostatin (SRIH), rising levels of glucocorticoids and sex hormones (estrogen and testosterone), and excessively high blood iodide concentration. Calcitonin An additional hormone produced by the thyroid contributes to the regulation of blood calcium levels. Parafollicular cells produce calcitonin in response to hypercalcemia. Calcitonin stimulates movement of calcium into bone, in opposition to the effects of parathyroid hormone (PTH). However, calcitonin seems far less essential than PTH, as calcium metabolism remains clinically normal after removal of the thyroid, but not the parathyroids.

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PATHOPHYSIOLOGY HYPERTHYROIDISM Modifiable

Non-modifiable

Diet Lifestyle

Age • •

Heavy drinker Navy

Occupation

Gender

Health History

Increase TSH stimulation to the Pituitary Gland

Stimulation of Thyroid Hormone

Weight Loss Enlarge Thyroid Exopthalmos Physical gland Eyes

RespiraHR tory System RR CV BP

Appetite Nutrition

Increase in T3 and T4 Restless Anxiety MusculoHormonal Imbalance skeletal PsychoFine Insomnia Multi-system System Tremors Changes logical

Sweating 25 Heat InteguNeuroIrritability Intolerance mentary logical

CHAPTER III RESEARCH METHODOLOGY

Research Design The descriptive method of research was utilized in this study, because it is concerned with the existing condition, it’s meaning, significance and then making adequate and accurate interpretations of the data gathered. This study contains only the facts about the disease of Hyperthyroidism and the important information about the patient. The researchers use this kind of study to add further knowledge to everyone about this disease.

Research Environment The researchers conducted this study at the medical ward on one of the Tertiary Hospital in Cavite City.

The institution has a 100-bed capacity catering various services like;

Rehabilitation Medicine, Physical Therapy, ICU, Delivery Room, Operating Room and Emergency Room.

Research Respondent The research respondent’s were the patient with hyperthyroidism and her mother as well. They are presently residing at Bacoor, Cavite.

Research Instrument The researchers made use of the following sources of information to gather all the necessary data needed in conducting this study.

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•

Interview The researchers made an initial interview with the patient and his mother to

provide additional information about the past health and family history. It was done on one of the tertiary hospital in Cavite City last December 3, 2008. •

Physical Assessment The researchers performed cephalocaudal assessment to distinguish any

manifestation or any abnormalities on the patient that can be used as a baseline data in formulating the necessary care plan for him. •

Review of Records The researchers reviewed the secondary sources of data such as the patient’s

chart to further add some details about the patient and his condition, and helped the researchers to render the necessary care.

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CHAPTER IV PRESENTATION AND ANALIZATION OF DATA

DEMOGRAPHIC PROFILE Patient’s name: Mr. Bean Age: 28 yrs old Gender: Male Address: Habay Bacoor, Cavite Educational Attainment: College Graduate ( Nautical Engineering) Employment: Navy History of Present illness: Few months PTA the pt increased his appetite but he didn’t gain weight instead he lost some weight. He usually had an insomnia and restless on the rest of the day. He also experienced occasionally palpitation and fine tremors. Few days PTA the pt vomits all the foods he ate and experiencing fine tremors in his extremities. On the day of his admission he experience severe palpitation/ tachycardia and he felt lightheadedness and loss his consciousness that’s prompted his admission in one of the Tertiary Hospital in Cavite City.

History of Past Medical History The patient was a fully immunized child except measles and chickenpox and no allergy in any medicines.

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Patient had a primary KOCH’s during his childhood years but treated at 7 years old. The patient had different diseases during his childhood he had measles and chickenpox which prompted his several admissions to hospital.

Family History of

Mother Side: Hypertension and Diabetes Mellitus Father Side: Hypertension

Personal/ Social History He usually had sedentary lifestyle. He likes to eat cabbage very often and he did’t usually eat fish. He is an heavy alcohol drinker since he was in high school. He can drink up to 2 long necks of hard drinks like emperador.

Patient Clinical Record Final Diagnosis: Hyperthyroidism Chief Complain: Loss of consciousness Reason for Admission: For evaluation and management Date of Admission: November 20, 2008 Weight: BEFORE 60 kg

Height: 5’ 6”

AFTER 52 kg BMI= wt. in kg/ (ht. in m)²

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General survey Receive patient alert, conscious, restless and coherent.

Review of System and Physical Examination

Dec. 3, 2008 Pulse: 120 bpm BP: 140/90 mmHg Temp: 36.5 ˚C RR: 27 cpm Physical Assessment SKIN HAIR Areas to assess Characteristics

Findings Resilient, silky hair

SCALP Areas to assess

Findings

Characteristics

Shiny and smooth without lesions, masses or

Deformities

mumps No trauma deformities

Redness or scaliness

No redness or scaliness

SKULL

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Areas to assess

Findings

Characteristics

Rounded and smooth skull contour without

Symmetry of facial features and movement

any sings of enlargement. Symmetrical in facial features and movement

EYES Areas to assess Characteristics

Findings Pink conjunctiva, anicteric sclera

Symmetry of eye features and movement

Bilateral Exopthalmus; [+] PERRLA

NECK Areas to assess Symmetry

Findings Enlarged and palpable mass on anterior portion of the neck

Thyroid gland

Presence of mass during palpitation

Nails Areas to assess Capillary refill

Findings [-] slow capillary refill, [-] crushing pain

LUNGS Areas to assess Characteristics

Findings [-] wheezes, [-] masses, [-] cough.

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Musculoskeletal Areas to assess Characteristics

Findings Fine tremors

Neurologic Areas to assess Characteristics

Findings Irritable and restless

ABDOMEN Areas to assess Characteristics

Findings [+] symmetrical, [-] bruit sound, [-] pain.

After physical assessment there was no abnormalities expect for resilient and silky hair, bilateral exopthalmus of his eyes, excessive sweating of his skin, enlarged and palpable mass on the anterior portion of the neck, fine tremors, irritable and restless.

Diagnostic Test Results Date: November 29, 2008 Examination/s Requested T3 T4 TSH

Results 7.98 33.81 0.04

Normal Values 2.2-6.8 pmol/L 10.3-25.74 pmol/L 0.3-5.0Uiu/ML

Interpretation Increased Increased Decreased

Date: December 9, 2008

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Examination/s Requested T3 T4 TSH

Results 7.7 29.8 0.1

Normal Values 2.2-6.8 pmol/L 10.3-25.74 pmol/L 0.3-5.0Uiu/ML

Interpretation Increased Increased Decreased

Results 7 26 0.2

Normal Values 2.2-6.8 pmol/L 10.3-25.74 pmol/L 0.3-5.0Uiu/ML

Interpretation Increased Increased Decreased

Date: January 15, 2009 Examination/s Requested T3 T4 TSH Interpretation The diagnostic result was increased T3 AND T4 this result indicate that the patient has a hyperthyroidism. TSH is low it also an indicative of hyperthyroidism.

CHAPTER V CONCLUSION AND RECOMMENDATION

CONCLUSION This case study will help significant individuals to better understand Hyperthyroidism. How it will affect the normal process of the endocrine system to individual and what are several changes it can bring to all people’s having this disease? Based on the case presented, with the support of literatures and research study on Hyperthyroidism, the researchers firmly believe on the following concepts. An effective and comprehensive nursing management should be formulated and implemented in both clinical and home setting; in order to provide an optimum care for the people with Hyperthyroidism. A proper health teaching is an important tool for nurse’s and its

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primary responsibility should always be prioritize and should be given an emphasis for its management. There are treatments for Hypertyroidism the Antithyroid medication and radioactive iodine are the ones doctors use most often. In rare cases, surgery may be done. Even if your symptoms are not bothering you, you still need treatment, because hyperthyroidism can lead to more serious problems.

RECOMMENDATION The research study brought about a great deal, gives some additional information in enhancing nursing care practice and deep responsibility with regards to our nursing practice. For this reasons, this case study recommend the following concepts which may be consider vital in the care management of Hyperthyroidism in general for all aspects of people’s. For client and family, to be able for them to understand the disease and to know what are the factors they need to consider for seeking some medical assistance for the patient suffering from Hyperthyroidism. For nursing service department, this study will provide them to have idea and sufficient knowledge about this kind of disease that the patient was suffering. For nursing education and students, this study will provide some important information about Hyperthyroidism and this research study will serve as references for the nursing student to be guided and to have an idea on how to provide a proper nursing care management for the client having this kind of disease.

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For the community health center and city health office, which will benefit to this study to provide some information and idea about this disease and will serves as a references that will help for them to have knowledge about this kind of disease. For the future researchers, it will be beneficial to have knowledge regarding to the Hyperthyroidism; is a condition in which there is overproduction of thyroid hormone by the thyroid gland, causing the levels of thyroid hormone in the blood to be too high. It is also necessary to have a background regarding to this kind of disease which is very difficult to have and we should familiarize ourselves on the signs and symptoms of this kind of disease. We should support our nursing management with vital health teaching by spreading basic necessary information regarding predisposing factors that can lead of having Hyperthyroidism.

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CONCEPT MAP

1.) Increase cardiac workload related to hypermetabolic state

6.) Disturbed body image related to disease process (hyperthyroidism)

5.) Disturbed sleep pattern related to daytime activity pattern

Patient’s name: Mr. Bean Age: 28 yrs old Gender: Male Increased appetite Heat tolerance Fatigue Anxiety Insomnia Bilateral exopthalmos Weight loss Restless Tremors (fine) Increase sweating Irritability Silky resilient hair Vital signs: PR: 120 bpm BP: 140/90 mmHg Temp: 36.5 °C RR: 27 cpm

2.) Imbalanced nutrition: less than body requirements related to hyper metabolic state secondary to excessive

3.) Anxiety (mild) related to increased stimulation secondary to excessive thyroid hormone secretion

4.) Fatigue related to increased energy requirements secondary to hypermetabolic state

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Interpretation of Concept Map 1.) The first priority nursing diagnosis is cardiac output; risk for decrease. Because of the heart inadequately pump blood to meet metabolic demands of the body. It should be prioritized based on the ABC principle (Airway, Breathing and Circulation). The heart inadequately pumped blood it results to inadequate oxygenation of the body. Which manifest the patient to restlessness, irritability, fatigue and with vital signs of BP 140/90 mmHg, PR 120 bpm and RR 27 cpm. Appropriate nursing interventions should be done for the patient to have adequate cardiac output (Blood pressure, pulse rate and respiratory rate) within normal parameters.

2.) The second priority nursing is imbalanced nutrition: less than body requirements. Because the patients body is having intake of nutrients insufficient to meet the metabolic needs of the body; which is cause by hyper metabolic state secondary to excessive thyroid hormone secretion. Nursing interventions needs to be formulated for the patient, to be able to consume adequate nourishment needed by the body based to patient’s weight age and height.

3.) The third priority nursing diagnosis is anxiety. Patient is irritable, has insomnia, intolerance to heat, restless, fatigue, has fine tremors, increased sweating, and has a respiratory rate of 27 cpm. Anxiety is an alerting signal that warns of impending danger and because of the formulated nursing interventions the patient will be able to take the verbalized feeling of anxiety and measures to deal with it.

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4.) The fourth priority nursing diagnosis is fatigue. Based on the assessment done the patient is manifesting fine tremors, anxiety, increased sweating and verbalizing lack of energy with vital signs of pulse rate 129 bpm, blood pressure 140/90 mmHg and respiratory rate 27 cpm. Appropriate nursing interventions are necessary to increase energy and improved well-being of the patient. Because fatigue is an overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work at usual level.

5.) The fifth priority nursing diagnosis is disturbed sleep pattern. Patient is verbally complaining of difficulty falling asleep and based on the assessment done he is irritable, have fine tremors and unilateral exopthalmos. Time- limited disruption of sleep this is what the patient experiencing. Which can affect the recovery of the patient that is, why necessary nursing interventions should be done.

6.) The last priority nursing diagnosis disturbed body image. Disturbed body image means confusion in mental picture of one’s physical self. The patient is manifesting weight loss, unilateral exopthalmos, silky resilient hair and he is shy at first. That’s why necessary nursing interventions should be done for the patient to accept the change or loss and change in his lifestyle.

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Assessment Subjective: “ madali nga ako mapagod” as verbalized by the patient Objective: -

Restless Irritability fatigue

Vital Signs: -

BP: 140/90 mmHg PR: 120 bpm RR: 27 cpm

Nursing Diagnosis

Planning

Intervention

Increased cardiac workload related to hypermetabolic as evidenced by increase blood pressure, pulse rate and respiratory rate

At 4 hours of nursing intervention the patient will be able to maintain adequate cardiac output as evidence by stable vital signs as follows blood pressure (from 140/90 to 120/80) , pulse rate (120- 60100 bpm) and respiratory rate (2720bpm).

Independent: • Monitor vital signs especially blood pressure •

Place the client in semi-Fowler’s position or position of comfort • Provide restful environment Dependent: • Maintain adequate nutrition and fluid balance as ordered by the physician ( low iodine and low root crops foods) Collaborative: • Administer Beta Blockers (Propanolol) Inderal as ordered).

Rationale

•

• •

•

•

Evaluation

After 4 hours of rendering nursing May indicate intervention the compensatory changes in stroke patient was able to maintain volume Elevating the head adequate cardiac output as may decrease cardiac work load evidence by stable vital signs Rest periods as follows blood decrease oxygen pressure (120/80) consumption , pulse rate (110 bpm) and To provide proper respiratory rate nourishment to (24bpm) the patient

Decreases heart rate/ cardiac work by blocking conversion of T3 to T4.

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Assessment

Nursing Diagnosis

Planning

Imbalanced nutrition: less than body requirements related to hyper metabolic state secondary to excessive thyroid hormone secretion as evidenced by weight loss, restlessness and irritability.

At 4 hours of nursing intervention the patient will be able to consume adequate nourishment.

Intervention

Rationale

Evaluation

Independent: Subjective: “Pumayat talaga ako, maski malakas ako kumain, ganito siguro talaga pag may goiter” as verbalized by the patient Objective: -

Increased appetite Weight loss

(Weight before: 60 kg) (Weight now: 52 kg) -

•

•

•

Restless Irritability

•

Provided good oral hygiene before and after meals Monitor food intake

•

To enhance client’s appetite and ability to eat

•

Encourage patient to eat and increase meals and snaks with high calorie that are easily digested Instruct the patient to avoid foods that increased peristalsis (eg.

•

Continued weight loss in face of adequate caloric intake may indicate failure of anti- thyroid therapy. Keeping enough caloric intake aids in hypermetabolic state

•

After 4 hours of rendering nursing intervention the patient was able to consume adequate nourishment.

It is increased GI motility may result in diarrhea and impair absorption of

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•

Tea. Coffee, fibrous and highly seasoned foods) and fluids that causes diarrhea (eg. Apple/ prune juice). Provide relaxing and pleasant environment

needed nutrients

•

To enhance the intake ability

•

To provide patient the appropriate diet.

•

To meet energy requirements

Dependent: •

Determine healthy body weight for age and height

Collaborative: •

Administer medication indicated ( vitamin B complex)

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Assessment

Nursing Diagnosis

Planning

Intervention

Rationale

Evaluation

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Independent: Subjective: “ naiinip na ako dito” as verbalized by the patient

Anxiety (mild) related to increased stimulation secondary to Objective: excessive thyroid hormone - Irritability secretion as - Restless evidenced by - Fatigue irritability, - Tremors (fine) insomnia, - Increased restlessness, sweating tremors( fine), - Increased increased respiration sweating, and (RR 27 cpm) increased respiration

At 8hours of nursing intervention the patient will be able to verbalize feelings of anxiety

•

Observe behavior indicative of level of anxiety

•

Establish therapeutic relationship

•

Stay with patient, maintaining calm manner.

•

Speak in brief statements, using simple words.

•

Provide comfort measures (putting up the bed siderails and don’t leave the client alone at

•

Mild anxiety is manifested by irritability and insomnia

•

To have an open communication

•

To establish rapport.

•

Attention span may be shortened, concentration reduced, limiting ability to assimilate information.

•

To promote clients safety.

•

To know the

After 8 hours of rendering nursing intervention the patient was able to verbalized feelings of anxiety

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bedside) •

Encourage client to express feelings

•

Provide accurate information about the situation

Dependent: •

Review coping strategies or mechanism

coping strategy of the client •

Helps the patient to know the reality

•

To determine those that might be helpful to the current situation of the patient

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Assessment Subjective: “eto madali ako mapagod” as verbalized by the patient Objective: -

Tremors (fine) Heat intolerance Restless Increased sweating

Nursing Diagnosis

Planning

Fatigue related to hypermetabolic state with increases energy requirements as evidenced by fine tremors, anxiety, incresed sweating with vital signs of pulse rate 120 bpm, blood pressure of 140,90 mmHg and respiratory rate of 27 cpm

At 8 hours of nursing intervention the patient will be able to verbalize increased energy and improve wellbeing

Intervention

Rationale

Independent: •

•

•

•

After 8 hours of rendering To note if there nursing is tachycardia intervention the or incresed in patient was able pulse rate to verbalized Reduces stimuli increased energy that may and improved aggravate hyperactivity or well-being to relief fatigue

•

Provide quiet environment

•

Encourage patient to restrict activity and rest as much as possible

•

Helps to counteract effects of increased metabolism

•

Provide diversional activities (e.g reading, radio, television)

•

May reduce anxiety

•

To know what are the needs of the patient

Vital signs: PR: 120 bpm BP: 140/90 mmHg RR: 27 cpm

Monitor vital signs (especially pulse rate)

Evaluate need for assistance or assistive devices

Evaluation

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•

Assist with self care needs; keep bed in low position and travel ways clear of furniture

•

For easy access and to avoid accidents

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Assessment Subjective: “Hindi ako masyado nakatulog kagabi, kumakabog yung dibdib ko” as verbalized by the patient Objective: -

Irritability fatigue tremors (fine) Presence of eyebags on. Frequent yawning.

Nursing Diagnosis Disturbed sleep pattern related to daytime activity pattern as evidenced by irritability tremors (fine) Presence of eye bags. Frequent yawning.

Planning

Intervention

Long Term: Independent: After 24 hours of nursing • Provided quiet intervention environment and the patient comfort measures will be able to (e.g backrub, identify the washing hands and different face, cleaning and measures how straitening sheets) to obtain a in preparation to normal sleep. sleeping pattern • Recommended evidenced by limiting intake of non- irritable, chocolate and relax, and caffeine/alcoholic absence of beverages esp. prior eye bags, and to bedtime no frequent yawning. •

Encourage the client to develop a bedtime ritual that includes quiet activities such as reading pocketbooks or

Rationale

•

To enhance client ability to fall asleep.

•

Caffeine increases awaking time during the night. A full stomach interferes with sleep

•

Effective in inducing and maintaining sleep

Evaluation Long Term: After 24 hours of rendering nursing intervention the patient was be able to obtained the different measures of an 8 hours normal sleeping pattern as evidenced by (-) irritability, relax, and minimal yawning.

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watching television Dependent: •

Obtain history including bed time routines

•

To monitor clients sleeping pattern.

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Assessment

Nursing Diagnosis

Subjective: “Para nga ko si Garfield yung dalawa kong mata, ang laki.” As verbalized by the patient Objective: -

Bilateral exopthalmos Silky resilient hair Shy at first Weight loss

Disturbed body image related to disease process (hyperthyroidis m) as evidence by, bilateral exopthalmos.

Planning Long Term: After 2 days of nursing intervention the patient will be able to demonstrate acceptance of self image as evidence by interact with the nurse on duty, and student nurses

Intervention

Rationale

Independent: •

Encourage client to make own decisions and accept both inadequacies and strengths

•

For support to patient about his illness

•

Assess for and promote good nutrition and sleep patterns

•

Good nutrition and sleep patters promote faster healing and better coping

•

Acknowledge coping mechanisms as a normal feelings when adjusting to changes in body and lifestyle

•

Assist the client to coping to renewed sense of well-being & increases trust between the nurse and patient.

•

Encourage client to verbalize feelings

•

To enhance coping or handling his situation

(Weight before: 60 kg) (Weight now: 52 kg)

Evaluation Long Term: After 2 days of rendering nursing intervention the patient was able to accept self image as evidenced by interaction with the student nurses

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Dependent: •

•

Encourage significant other to offer support Alert staff or significant others to monitor facial expressions and nonverbal behaviors

•

Social support enhances both emotional and physical health

•

To have acceptance and not embarrassed the patient when his appearance is affected

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DRUG STUDY Name

Mode of Action

Indications

Contraindication s

Generic Name: methimazole Brand Name: Tapazole 10 mg Dose: 10 mg Route: PO Frequency: q6

Increases metabolic rate, cardiac output and protein synthesis. Useful for treating thyrotoxic crisis and in preparation for subtotal thyroidectomy.

For treating Hyperthyroidism

Thyrotoxicosis, myocardial infarction and severe renal disease

Adverse Effects Side effects: Nausea and vomiting, diarrhea, cramps, tremors, nervousness, insomnia, headache and weight loss Adverse Effects: Tachycardia, hypertension and palpitations

Nursing Interventions  Instruct patient to take the drug with meals to decrease gastrointestinal symptoms  Advise patient about the effects of iodine and its presence in iodized salt, shellfish and OTC cough medicines  Emphasize the importance of drug compliance; abruptly stopping the antithyroid drug could bring on a thyroid crisis  Teach patient the

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signs and symptoms of hypothyroidism: lethargy, puffy eyelids and face, thick tongue, slow speech with hoarseness, lack of perspiration and slow pulse. Hypothyroidism may result to treatment of Hyperthyroidism

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Name

Generic Name: propanolol Hcl Brand Name: Inderal 20 mg Dose: 20 mg Route: PO Frequency: OD

Mode of Action Selectively blocks beta  adrenergic receptor sites, decreases sympathetic outflow to the periphery, suppresses renninangiotensinaldosterone system

Indications

To control hypertension and management for thyrotoxicosis

Contraindications

Second and Third degree heart block, cardiogenic shock, CHF, sinus bradycardia Caution: Hepatic, renal or thyroid dysfunction; asthma; peripheral vascular disease; type 1 diabetes mellitus

Adverse Effects

Side Effects: Bradycardia, thrombocytopenia, drowsiness, dry mouth and dizziness Adverse Effects: Complete heart block, bronchospasm, agranulocytosis

Nursing Interventions  Monitor vital signs especially blood pressure and pulse  Instruct patient to comply with drug regimen: abrupt discontinuation of antihypertensive drug may cause rebound hypertension  Advise patient that antihypertensives may cause dizziness resulting from orthostatic hypotension. Instruct patient to remain in a sitting position for several minutes before standing  Encourage patient to

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increase fluid intake Instruct client to avoid excessive intake of alcoholic beverages. Alcohol can cause vitamin B complex deficiencies

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Name

Generic Name: Vitamin B Complex Brand Name: Nevramin Route: PO Frequency: OD

Mode of Action Water- soluble vitamins are not stored in the body and are readily excreted in the urine. Protein binding of water – soluble vitamins is minimal.

Indications

To treat peripheral neuritis, essential for building block of nucleic acids, red blood cell formation and synthesis of hemoglobin

Contraindications

Patient with liver dysfunction

Adverse Effects GI irritation and vasodilation, resulting in flushing sensation

Nursing Interventions  Instruct client to take the prescribed amount of drug.  Advise client to check the expiration dates on vitamin containers before purchasing and taking them. Potency of the vitamin is reduced after the expiration date.  Advise client to eat a well-balanced diet that includes the recommended amounts and types of food detailed in the food pyramid  Encourage patient to eat foods high in

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Vitamin B such as grains, cereal, bread and meats  Instruct client to avoid excessive intake of alcoholic beverages. Alcohol can cause vitamin B complex deficiencies

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BIBLIOGRAPHY Book: Nurse’s Pocket Guide (10th edition) by Marilyn E. Doenges and Alice C. Murr Medical Surgical Nursing (11th edition) by Joyce Young Johnson Davis’s Drug Guide for Nurses (10th edition) by Judith Hopfer Deglin

Web/internet: http://dine.racoma.com.ph/health/take-charge-of-your-health/ http://www.medicinenet.com/hyperthyroidism/index.htm http://general-medicine.jwatch.org/cgi/content/full/2007/619/1 http://jcem.endojournals.org/cgi/content/abstract/85/3/1038 http://www.tribune.net.ph/life/20081117lif5.html http://www.malaya.com.ph/feb17/livi1.htm http://positivenewsmedia.net/am2/publish/Health_21/Goiter_Awareness_Week_brings_to_fore _importance_of_ASIN_Law_implementation.shtml http://www.manilastandardtoday.com/?page=goodLife02_sept19_2006

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