Nursing Care Plan for Hyperthyroidism

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HYPERTHYROIDISM (THYROTO

HYPERTHYROIDISM (THYROTOXICOSIS, GR

XICOSIS, GRA

AVES’ DISEASE)

VES’ DISEASE)

Hyperthyroidism

Hyperthyroidism is a metabolic imbalance that results from overproduction of the thyroid hormones triiodothyronine (Tis a metabolic imbalance that results from overproduction of the thyroid hormones triiodothyronine (T₃₃) and) and thyroxine (T

thyroxine (T₄₄). The most common form is Graves’ disease, but other forms of hyperthyroidism include toxic adenoma, TSH-). The most common form is Graves’ disease, but other forms of hyperthyroidism include toxic adenoma, TSH-secreting pituitary tumor, subacute or silent thyroiditis, and some forms

secreting pituitary tumor, subacute or silent thyroiditis, and some forms of thyroid cancer.of thyroid cancer. Thyroid storm

Thyroid storm is a is a rarely encourarely encounterentered d manimanifestafestation of tion of hyperhyperthyrothyroidisidism m that can that can be precipitbe precipitated by ated by such events as such events as thyrothyroidid ablation (surgical or radioiodine),

ablation (surgical or radioiodine), medication overdosage, and medication overdosage, and trauma. This condition constitutes a trauma. This condition constitutes a medical emergencymedical emergency..

CARE SETTING

Most people with classic h

Most people with classic h yperthyroidism rarely need hospitalization. Critically ill patients, those with extreme manifestations of yperthyroidism rarely need hospitalization. Critically ill patients, those with extreme manifestations of thyrotoxicosis plus a significant concurrent illness, require inpatient acute care

thyrotoxicosis plus a significant concurrent illness, require inpatient acute care on a medical unit.on a medical unit.

RELATED CONCERNS

Heart failure: chronic

Heart failure: chronic Psychosocial aspects of care Psychosocial aspects of care Thyroidectomy

Thyroidectomy

Patient Assessment Database

Data depend on the severity/duration of hormone imbalance and involvement of other organs. Data depend on the severity/duration of hormone imbalance and involvement of other organs.

ACTIVITY/REST

May report:

May report: Nervousness, increased Nervousness, increased irritabilityirritability, inso, inso mniamnia Muscle weakness, incoordination

Muscle weakness, incoordination Extreme fatigue

Extreme fatigue May exhibit:

May exhibit: Muscle atrophyMuscle atrophy

CIRCULATION

May report:

May report: PalpitationsPalpitations

Chest pain (angina) Chest pain (angina) May exhibit:

May exhibit: Dysrhythmias (atrial fibrillation); gallop rhythm, murmursDysrhythmias (atrial fibrillation); gallop rhythm, murmurs Elevated BP with widened pulse pressure

Elevated BP with widened pulse pressure Tachycardia at rest

Tachycardia at rest

Circulatory collapse, shock (thyrotoxic crisis) Circulatory collapse, shock (thyrotoxic crisis)

ELIMINATION

May report:

May report: Urinating in large amountsUrinating in large amounts Stool changes; diarrhea Stool changes; diarrhea

EGO INTEGRITY

May report:

May report: Recent stressful experience, e.g., Recent stressful experience, e.g., emotional/physicaemotional/physicall May exhibit:

May exhibit: Emotional lability (mild euphoria to Emotional lability (mild euphoria to delirium); anxiety/depressiondelirium); anxiety/depression

FOOD/FLUID

May report:

May report: Recent/sudden weight lossRecent/sudden weight loss

Increased appetite; large meals, frequent meals; Increased appetite; large meals, frequent meals; thirstthirst Nausea/vomiting

Nausea/vomiting May exhibit:

May exhibit: Enlarged thyroid; goiter Enlarged thyroid; goiter

Nonpitting edema, especially in pretibial area Nonpitting edema, especially in pretibial area

NEUROSENSORY

May exhibit:

May exhibit: Rapid and hoarse speechRapid and hoarse speech Ment

Mental al statstatus us and and behavibehavior or altealteratirations, ons, e.g.e.g., , confusiconfusion, on, disoridisorientatentation, ion, nervousnervousness, ness, irritirritabilabilityity,, delirium, frank psychosis, stupor, coma

delirium, frank psychosis, stupor, coma

Fine tremor in hands; purposeless, quick, jerky movements of bod Fine tremor in hands; purposeless, quick, jerky movements of bod y partsy parts Hyperactive DTRs

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Paralysis (thyrotoxic hypokalemia) Paralysis (thyrotoxic hypokalemia)

PAIN/DISCOMFORT

May report:

May report: Orbital pain, photophobia (eye movement)Orbital pain, photophobia (eye movement)

RESPIRATION

May report:

May report: Difficulty breathingDifficulty breathing May exhibit:

May exhibit: Increased respiratory rate, tachypneaIncreased respiratory rate, tachypnea

Breath sounds: Crackles, wheezes (pulmonary edema associated with thyrotoxic crisis) Breath sounds: Crackles, wheezes (pulmonary edema associated with thyrotoxic crisis)

SAFETY

May report:

May report: Heat intolerance, excessive sweatingHeat intolerance, excessive sweating Allergy to iodine (may be used in testing) Allergy to iodine (may be used in testing) May exhibit:

May exhibit: Elevated temperature (above 100°Elevated temperature (above 100°F), diaphoresisF), diaphoresis Skin smooth, warm, and

Skin smooth, warm, and flushed; hair fine, silky, straightflushed; hair fine, silky, straight Exophthalmos, lid retraction; conjunctival irritation, tearing Exophthalmos, lid retraction; conjunctival irritation, tearing Pruritic, erythematous lesions (often in pretibial area) that

Pruritic, erythematous lesions (often in pretibial area) that become brawnybecome brawny

SEXUALITY

May report:

May report: Decreased libidoDecreased libido

Hypomenorrhea, amenorrhea Hypomenorrhea, amenorrhea Impotence Impotence

TEACHING/LEARNING

May report:

May report: Family history of thyroid problemsFamily history of thyroid problems

History of hypothyroidism, thyroid hormone

History of hypothyroidism, thyroid hormone replacement therapy or antithyroid therapyreplacement therapy or antithyroid therapy, premature, premature withdrawal of antithyroid drugs, recent partial thyroidectomy

withdrawal of antithyroid drugs, recent partial thyroidectomy History of insulin-induced hypoglycemia, cardiac disorders or

History of insulin-induced hypoglycemia, cardiac disorders or surgerysurgery, recent illness (pneumonia),, recent illness (pneumonia), trauma; x-ray contrast studies

trauma; x-ray contrast studies Discharge plan

Discharge plan DRG projected mean length of inpatient stay: 4.3 daysDRG projected mean length of inpatient stay: 4.3 days

considerations:

considerations: May require assistance with treatment May require assistance with treatment regimen, self-care activities, homemaker/maintenancregimen, self-care activities, homemaker/maintenance taskse tasks

Refer to section at

Refer to section at end of end of plan for postdischarge considerationsplan for postdischarge considerations..

DIAGNOSTIC STUDIES

Radioactive iodine

Radioactive iodine (( RAI RAI )) uptake test:uptake test:High in Graves’ disease and toxic noduHigh in Graves’ disease and toxic nodu lar goiter; low in thlar goiter; low in th yroiditis.yroiditis.

Serum T

Serum T ₄₄and T and T ₃₃::Increased in hyperthyroidism. Normal TIncreased in hyperthyroidism. Normal T₄₄with elevated Twith elevated T₃₃indicates thyrotoxicosis.indicates thyrotoxicosis.

Thyroid-sti

Thyroid-stimulating mulating hormonehormone ((TSH TSH ):):Suppressed (except when etiology is Suppressed (except when etiology is a TSH-secreting pituitary tumor or pituitary resistanta TSH-secreting pituitary tumor or pituitary resistant to thyroid hormone). Does not respond

to thyroid hormone). Does not respond to thyrotropin-releasing hormone (TRH).to thyrotropin-releasing hormone (TRH).

Thyroglobulin:

Thyroglobulin: Increased.Increased.

TRH stimulation:

TRH stimulation:Hyperthyroidism is indicated if TSH fails to Hyperthyroidism is indicated if TSH fails to rise after administration of TRH.rise after administration of TRH.

Thyroid T

Thyroid T ₃₃uptake:uptake:Normal to high.Normal to high.

Protein-boun

Protein-bound d iodine:iodine: Increased.Increased.

Serum glucose:

Serum glucose: Elevated (related to adrenal involvement).Elevated (related to adrenal involvement).

Plasma cortisol:

Plasma cortisol:Low levels (less adrenal reserve).Low levels (less adrenal reserve).

Alkaline phosphatase and serum calcium:

Alkaline phosphatase and serum calcium:Increased.Increased.

Liver function tests:

Liver function tests: Abnormal.Abnormal.

Electrolytes:

Electrolytes: Hyponatremia may reflect adrenal response or dilutional effect in fluid replacement therapy. Hypokalemia occursHyponatremia may reflect adrenal response or dilutional effect in fluid replacement therapy. Hypokalemia occurs because of GI losses and diuresis.

because of GI losses and diuresis.

Serum

Serum catecholacatecholamines:mines: Decreased.Decreased.

Urine creatinine:

Urine creatinine:Increased.Increased.

ECG:

ECG:Atrial fibrillations; shorter systole time; cardiomegaly, heart enlarged with fibrosis and necrosis (late signs or in elderlyAtrial fibrillations; shorter systole time; cardiomegaly, heart enlarged with fibrosis and necrosis (late signs or in elderly with masked h

with masked h yperthyroidismyperthyroidism).).

Needle or open biopsy:

Needle or open biopsy:May be done to determine cause of hyperthyroidism, differentiate cysts or tumors, diagnose enlargementMay be done to determine cause of hyperthyroidism, differentiate cysts or tumors, diagnose enlargement of thyroid gland.

of thyroid gland.

Thyroid scan:

Thyroid scan:DifferentiateDifferentiates between Graves’ disease and Plummer’s disease, both of s between Graves’ disease and Plummer’s disease, both of which result in hwhich result in h yperthyroidism.yperthyroidism.

NURSING PRIORITIES

1.

1. ReducReduce metabole metabolic demands and support cardiic demands and support cardiovascuovascular functilar function.on. 2.

2. Provide Provide psycpsychologichological al supportsupport.. 3.

3. PrePrevenvent t comcompliplicatcationions.s. 4.

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DISCHARGE GOALS

1.

1. HomeHomeostostasiasis s achachievieved.ed. 2.

2. PatiPatient effecent effectiveltively dealing with currey dealing with current situatint situation.on. 3.

3. ComplComplicatications preveions prevented/nted/minimminimized.ized. 4.

4. Disease Disease process/prognosis process/prognosis and and therapeutic therapeutic regimen regimen understood.understood. 5.

5. Plan in plPlan in place to meace to meet neeet needs afteds after dischar discharge.rge.

NURSING DIAGNOSIS: Cardiac Output, risk for decreased NURSING DIAGNOSIS: Cardiac Output, risk for decreased Risk factors may include

Risk factors may include

Uncontrolled hyperthyroidism, hypermetabolic state Uncontrolled hyperthyroidism, hypermetabolic state Increasing cardiac workload

Increasing cardiac workload Changes in venous

Changes in venous return and systemic vascular resistancereturn and systemic vascular resistance Alterations in rate, rhythm, conduction

Alterations in rate, rhythm, conduction Possibly evidenced by

Possibly evidenced by [Not applicable; presence of signs

[Not applicable; presence of signs and symptoms establishes anand symptoms establishes an actual actual diagnosis.]diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Circulatory Status (NOC)

Circulatory Status (NOC)

Maintain adequate cardiac output for tissue needs

Maintain adequate cardiac output for tissue needs as evidenced by stable vital signs, as evidenced by stable vital signs, palpable peripheral pulses,palpable peripheral pulses, good capillary refill, usual mentation, and absence o

good capillary refill, usual mentation, and absence o f dysrhythmias.f dysrhythmias.

ACTIONS/INTERVENTIONS

Hemodynamic Regulation (NIC) Hemodynamic Regulation (NIC)

Independent

Monitor BP lying, sitting, and standing, if

Monitor BP lying, sitting, and standing, if able. Noteable. Note widened pulse pressure.

widened pulse pressure.

Monitor central venous pressure (CVP),

Monitor central venous pressure (CVP), if available.if available.

Investigate reports of chest pain/angina. Investigate reports of chest pain/angina.

Assess pulse/heart rate while patient is sleeping. Assess pulse/heart rate while patient is sleeping.

RATIONALE

General/orthostatic hypotension may occur as a result General/orthostatic hypotension may occur as a result of of excessive peripheral vasodilation and

excessive peripheral vasodilation and decreaseddecreased circulating volume. Widened pulse pressure circulating volume. Widened pulse pressure reflectsreflects compensatory increase in stroke volume and

compensatory increase in stroke volume and decreaseddecreased systemic vascular resistance (SVR).

systemic vascular resistance (SVR).

Provides more direct measure of circulating volume and Provides more direct measure of circulating volume and cardiac function.

cardiac function.

May reflect increased myocardial oxygen May reflect increased myocardial oxygen demands/ischemia.

demands/ischemia. Provides a more

Provides a more accurate assessment of tachycardia.accurate assessment of tachycardia.

ACTIONS/INTERVENTIONS

Independent

Auscultate heart sounds, noting extra heart sounds, Auscultate heart sounds, noting extra heart sounds, development of gallops and systolic murmurs. development of gallops and systolic murmurs.

Monitor ECG, noting rate/rhythm. Document Monitor ECG, noting rate/rhythm. Document dysrhythmias.

dysrhythmias.

RATIONALE

Prominent S

Prominent S₁₁and murmurs are associated with forcefuland murmurs are associated with forceful cardiac output of h

cardiac output of h ypermetabolic stateypermetabolic state; development of S; development of S₃₃ may warn of impending cardiac failure.

may warn of impending cardiac failure. Ta

Tachycardia (greater than nochycardia (greater than no rmally expected withrmally expected with fever/increased circulatory demand) may reflect d fever/increased circulatory demand) may reflect d irectirect myocardialstimula

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Auscultate breath sounds, noting adventitious sounds Auscultate breath sounds, noting adventitious sounds (e.g., crackles).

(e.g., crackles).

Monitor temperature; provide cool environment, limit bed Monitor temperature; provide cool environment, limit bed linens/clothes, administe

linens/clothes, administer tepid sponge r tepid sponge baths.baths.

Observe signs/symptoms of severe thirst, dry mucous Observe signs/symptoms of severe thirst, dry mucous membranes, weak/thready pulse, poor capillary refill, membranes, weak/thready pulse, poor capillary refill, decreased urinary output, and h

decreased urinary output, and h ypotension.ypotension. Record I&O. Note

Record I&O. Note urine specific gravity.urine specific gravity.

Weigh daily. Encourage chair rest/bedrest; limit Weigh daily. Encourage chair rest/bedrest; limit nonessential activity.

nonessential activity. Note history of

Note history of asthma/bronchoconstrictasthma/bronchoconstrictive disease, sinusive disease, sinus bradycardia/heart blocks, advanced HF, or current

bradycardia/heart blocks, advanced HF, or current pregnancy.

pregnancy.

Observe for adverse side

Observe for adverse side effects of adrenergic antagonists,effects of adrenergic antagonists, e.g., severe decrease in pulse, BP; signs of vascular e.g., severe decrease in pulse, BP; signs of vascular congestion/HF; cardiac arrest.

congestion/HF; cardiac arrest.

Collaborative

Administer IV fluids as indicated. Administer IV fluids as indicated.

Administer medications as indicated: Administer medications as indicated:

[beta]-blockers, e.g., propranolol (Inderal), atenolol [beta]-blockers, e.g., propranolol (Inderal), atenolol (Te

(Tenormin), nadolol normin), nadolol (Corgard), pindolol (Visken);(Corgard), pindolol (Visken);

often occur and

often occur and may compromise cardiac function/output.may compromise cardiac function/output. Early sign of pulmonary congestion, reflecting developing Early sign of pulmonary congestion, reflecting developing cardiac failure.

cardiac failure.

Fever (may exceed 104°F) may occur as a result of Fever (may exceed 104°F) may occur as a result of excessive hormone levels and can aggravate excessive hormone levels and can aggravate diuresis/dehydration and cause increased peripheral diuresis/dehydration and cause increased peripheral vasodilation, venous pooling, and hypotension. vasodilation, venous pooling, and hypotension.

Rapid dehydration can occur, which reduces circulating Rapid dehydration can occur, which reduces circulating volume and compromises cardiac output.

volume and compromises cardiac output.

Significant fluid losses (through vomiting, diarrhea, Significant fluid losses (through vomiting, diarrhea, diuresis, diaphoresis) can lead to profound dehydration, diuresis, diaphoresis) can lead to profound dehydration, concentrated urine, and weight loss.

concentrated urine, and weight loss.

Activity increases metabolic/circulatory demands, which Activity increases metabolic/circulatory demands, which may potentiate cardiac failure.

may potentiate cardiac failure.

Presence/potential recurrence of these conditions Presence/potential recurrence of these conditions affectsaffects choice of therapy; e.g., use of [beta]-adrenergic blocking choice of therapy; e.g., use of [beta]-adrenergic blocking agents is contraindicated.

agents is contraindicated. Indicates need for

Indicates need for reduction/discontinuatreduction/discontinuation of ion of therapytherapy..

Rapid fluid replacement may be necessary to

Rapid fluid replacement may be necessary to improveimprove circulating volume but must be balanced against signs of circulating volume but must be balanced against signs of cardiac failure/need for inotropic support.

cardiac failure/need for inotropic support.

Given to control

Given to control thyrotoxic effects of tachycardia,thyrotoxic effects of tachycardia, tremors, and nervousness and is first drug

tremors, and nervousness and is first drug of choice for of choice for acute storm. Decreases heart rate/cardiac work by acute storm. Decreases heart rate/cardiac work by blocking [beta]-adrenergic receptor sites and blocking blocking [beta]-adrenergic receptor sites and blocking

conversion of T

conversion of T44to Tto T33.. Note: Note: If severe bradycardiaIf severe bradycardia develops, atropine may be required.

develops, atropine may be required.

ACTIONS/INTERVENTIONS

Collaborative

Thyroid hormone antagonists, e.g., Thyroid hormone antagonists, e.g., propylthiouracil(PTU), methimazole

propylthiouracil(PTU), methimazole (Tapaz(Tapazole);ole);

Strong iodine solution (Lugol’s solution) or Strong iodine solution (Lugol’s solution) or supersaturated potassium iodide (SSKI) PO; supersaturated potassium iodide (SSKI) PO;

RATIONALE

Blocks thyroid hormone synthesis and inhibits peripheral Blocks thyroid hormone synthesis and inhibits peripheral conversion of T

conversion of T₄₄to Tto T₃₃. May be definitive treatment or . May be definitive treatment or used to prepare patient for surgery; but effect is slow and used to prepare patient for surgery; but effect is slow and so may not relieve thyroid storm.

so may not relieve thyroid storm. Note: Note: Once PTUOnce PTU therapy is begun, abrupt

therapy is begun, abrupt withdrawal may precipitatewithdrawal may precipitate thyroid crisis.

thyroid crisis.

Acts to prevent release of thyroid hormone into Acts to prevent release of thyroid hormone into

circulation by increasing the amount of thyroid hormone circulation by increasing the amount of thyroid hormone stored within the gland. May interfere with RAI treatment stored within the gland. May interfere with RAI treatment

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RAI (Na

RAI (Na131131_{I or Na}_{I or Na}125125_{I) following NRC regulations for}_{I) following NRC regulations for} radiopharmaceutical;

radiopharmaceutical;

Corticosteroids, e.g., dexamethasone (Decadron); Corticosteroids, e.g., dexamethasone (Decadron);

Digoxin (Lanoxin); Digoxin (Lanoxin);

Furosemide (Lasix); Furosemide (Lasix);

Potassium (KCl,

Potassium (KCl, K-LyteK-Lyte););

Acetaminophen

Acetaminophen (Ty(Tylenol);lenol);

and may exacerbate the disease in some people. May be and may exacerbate the disease in some people. May be used as surgical preparation to

used as surgical preparation to decrease size anddecrease size and vascularity of the gland or to treat thyroid storm. vascularity of the gland or to treat thyroid storm. Note: Note: Should be started 1–3 hr

Should be started 1–3 hr after initiation of antithyroidafter initiation of antithyroid drug therapy to minimize hormone formation from the drug therapy to minimize hormone formation from the iodine.

iodine.

Radioactive iodine therapy is the treatment of

Radioactive iodine therapy is the treatment of choice for choice for almost all patients with

almost all patients with Graves’ disease because itGraves’ disease because it destroys abnormally functioning gland tissue. Peak destroys abnormally functioning gland tissue. Peak resultsresults take 6–12 wk

take 6–12 wk (several treatments may be necessary);(several treatments may be necessary); however, a single dose controls hyperthyroidism in about however, a single dose controls hyperthyroidism in about 90% of patients.

90% of patients. Note: Note: This therapy is This therapy is contraindicatedcontraindicated during pregnancy. Also people preparing or administering during pregnancy. Also people preparing or administering the dose must have their own th

the dose must have their own th yroid burden measured,yroid burden measured, and contaminated supplies and equipment must be and contaminated supplies and equipment must be monitored and stored

monitored and stored until decayed.until decayed.

Provides glucocorticol support. Decreases hyperthermia; Provides glucocorticol support. Decreases hyperthermia; relieves relative adrenal insufficiency; inhibits calcium relieves relative adrenal insufficiency; inhibits calcium absorption; and reduces peripheral conversion of T absorption; and reduces peripheral conversion of T₃₃fromfrom T

T₄₄.. Note: Note: May be given before thyroidectomy andMay be given before thyroidectomy and discontinued after

discontinued after surgerysurgery..

Digitalization may be required in patients with HF before Digitalization may be required in patients with HF before [beta]-adrenergic blocking therapy can be

[beta]-adrenergic blocking therapy can be considered/safely intiated.

considered/safely intiated.

Diuresis may be necessary if HF occurs.

Diuresis may be necessary if HF occurs. Note: Note: It also mayIt also may be effective in reducing calcium level if

be effective in reducing calcium level if neuromuscular neuromuscular function is impaired.

function is impaired. Increased losses of K

Increased losses of K ++_{through intestinal/renal routes may}_{through intestinal/renal routes may} result in dysrhythmias if not

result in dysrhythmias if not corrected.corrected.

Drug of choice to reduce temperature and associated Drug of choice to reduce temperature and associated metabolic demands. Aspirin is contraindicated because it metabolic demands. Aspirin is contraindicated because it actually increases level of circulating thyroid hormones actually increases level of circulating thyroid hormones by blocking binding of T

by blocking binding of T₃₃and Tand T₄₄with thyroid-bindingwith thyroid-binding proteins.

proteins.

ACTIONS/INTERVENTIONS

Collaborative

Sedative, barbiturates; Sedative, barbiturates; Muscle relaxants. Muscle relaxants.

Monitor laboratory/diagnostic studies, as indicated, e.g.: Monitor laboratory/diagnostic studies, as indicated, e.g.:

Serum potassium; Serum potassium;

RATIONALE

Promotes rest, thereby reducing metabolic Promotes rest, thereby reducing metabolic demands/cardiac workload.

demands/cardiac workload.

Reduces shivering associated with hyperthermia, which Reduces shivering associated with hyperthermia, which can further increase metabolic demands.

can further increase metabolic demands.

Hypokalemia resulting from

Hypokalemia resulting from intestinal losses, alteredintestinal losses, altered intake, or diuretic therapy may cause

intake, or diuretic therapy may cause dysrhythmias anddysrhythmias and compromise cardiac function/output.

compromise cardiac function/output. Note: Note: In theIn the presence of thyrotoxic paralysis (primarily occurring in presence of thyrotoxic paralysis (primarily occurring in

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Serum calcium; Serum calcium; Sputum culture; Sputum culture; Serial ECGs; Serial ECGs; Chest x-rays. Chest x-rays. Provide supplemental O

Provide supplemental O22as indicated.as indicated.

Provide hypothermia blanket as indicated. Provide hypothermia blanket as indicated.

Administer transfusions; assist with

Administer transfusions; assist with plasmapheresis,plasmapheresis, hemoperfusion, dialysis.

hemoperfusion, dialysis. Prepare for surgery. Prepare for surgery.

Asian men), close monitoring and cautious replacement Asian men), close monitoring and cautious replacement are indicated because rebound h

are indicated because rebound h yperkalemia can occur asyperkalemia can occur as condition abates releasing potassium from the

condition abates releasing potassium from the cells.cells. Elevation may alter cardiac contractility.

Elevation may alter cardiac contractility. Pulmonary infection is most frequent

Pulmonary infection is most frequent precipitating factor precipitating factor of crisis.

of crisis.

May demonstrate effects of

May demonstrate effects of electrolyte imbalance or electrolyte imbalance or ischemic changes reflecting inadequate myocardial ischemic changes reflecting inadequate myocardial oxygen supply in presence of increased metabolic oxygen supply in presence of increased metabolic demands.

demands.

Cardiac enlargement may occur in response to

Cardiac enlargement may occur in response to increasedincreased circulatory demands. Pulmonary congestion may be noted circulatory demands. Pulmonary congestion may be noted with cardiac decompensation.

with cardiac decompensation. May be necessary to support

May be necessary to support increased metabolicincreased metabolic demands/O

demands/O₂₂consumption.consumption.

Occasionally used to lower uncontrolled h

Occasionally used to lower uncontrolled h yperthermiayperthermia (104°F and higher) to

(104°F and higher) to reduce metabolic demands/Oreduce metabolic demands/O22 consumption and cardiac workload.

consumption and cardiac workload.

May be done to achieve rapid depletion of extrathyroidal May be done to achieve rapid depletion of extrathyroidal hormone pool in

hormone pool in desperately ill/comatdesperately ill/comatose patient.ose patient. Subtotal thyroidectomy (removal of five-sixths of the Subtotal thyroidectomy (removal of five-sixths of the gland) may be treatment of choice for hyperthyroidism gland) may be treatment of choice for hyperthyroidism once euthyroid state is achieved.

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NURSING DIAGNOSIS: Fatigue NURSING DIAGNOSIS: Fatigue May be related to

May be related to

Hypermetabolic state with increased energy requirements Hypermetabolic state with increased energy requirements Irritability of central nervous system (CNS); altered bod

Irritability of central nervous system (CNS); altered bod y chemistryy chemistry Possibly evidenced by

Possibly evidenced by V

Verbalization of overwhelming lack of erbalization of overwhelming lack of energy to maintain usual routine, decreased performanceenergy to maintain usual routine, decreased performance Emotional lability/irritabili

Emotional lability/irritability; nervousness, ty; nervousness, tensiontension Jittery behavior

Jittery behavior

Impaired ability to concentrate Impaired ability to concentrate

DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Endurance (NOC)

Endurance (NOC)

Verbalize increase in level of energy. Verbalize increase in level of energy. Display improved ability to

Display improved ability to participate in desired activities.participate in desired activities.

ACTIONS/INTERVENTIONS

Energy Management (NIC) Energy Management (NIC)

Independent

Monitor vital signs, noting pulse rate at rest and when Monitor vital signs, noting pulse rate at rest and when active.

active.

Note development of tachypnea, dyspnea, pallor, and Note development of tachypnea, dyspnea, pallor, and

cyanosis. cyanosis.

Provide for quiet environment; cool room, decreased Provide for quiet environment; cool room, decreased sensory stimuli, soothing colors, quiet music.

sensory stimuli, soothing colors, quiet music.

Encourage patient to restrict activity and rest in bed as Encourage patient to restrict activity and rest in bed as much as possible.

much as possible.

Provide comfort measures, e.g., judicious touch/massage, Provide comfort measures, e.g., judicious touch/massage, cool showers.

cool showers.

Provide for diversional activities that are calming, Provide for diversional activities that are calming, e.g.,e.g., reading, radio, television.

reading, radio, television.

Avoid topics that irritate or upset patient. Discuss ways to Avoid topics that irritate or upset patient. Discuss ways to respond to these feelings.

respond to these feelings.

Discuss with SO reasons for fatigue and emotional Discuss with SO reasons for fatigue and emotional lability.

lability.

RATIONALE

Pulse is typically elevated and, even at

Pulse is typically elevated and, even at rest, tachycardiarest, tachycardia (up to 160

(up to 160 beats/min) may be noted.beats/min) may be noted. O

O₂₂demand and consumption are increased indemand and consumption are increased in hypermetabolic state, potentiati

hypermetabolic state, potentiating risk ng risk of hypoxia withof hypoxia with activity.

activity.

Reduces stimuli that may aggravate agitation, Reduces stimuli that may aggravate agitation, hyperactivity

hyperactivity, , and and insomnia.insomnia. Helps counteract effects of

Helps counteract effects of increased metabolism.increased metabolism.

May decrease nervous

May decrease nervous energyenergy, promoting , promoting relaxation.relaxation.

Allows for use of n

Allows for use of n ervous energy in a constructiveervous energy in a constructive manner and

manner and may reduce anxiety.may reduce anxiety.

Increased irritability of the CNS may cause patient to be Increased irritability of the CNS may cause patient to be easily excited, agitated, and prone to emotional outbursts. easily excited, agitated, and prone to emotional outbursts. Understanding that the behavior is physically based may Understanding that the behavior is physically based may enhance coping with current situation and encourage SO enhance coping with current situation and encourage SO to respond positively and provide support

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ACTIONS/INTERVENTIONS

Collaborative

Sedatives, e.g., phenobarbital (Luminal); antianxiety Sedatives, e.g., phenobarbital (Luminal); antianxiety agents, e.g., chlordiazepoxide (Librium).

agents, e.g., chlordiazepoxide (Librium).

RATIONALE

Combats nervousness, hyperactivity

Combats nervousness, hyperactivity, and , and insomnia.insomnia.

NURSING DIAGNOSIS: Nutrition imbalanced

NURSING DIAGNOSIS: Nutrition imbalanced, risk for less , risk for less than body requirementsthan body requirements Risk factors may include

Increased metabolism (increased appetite/int

Increased metabolism (increased appetite/intake with loss ake with loss of weight)of weight) Nausea/vomiting, diarrhea

Nausea/vomiting, diarrhea Relative insulin

Relative insulin insufficiencyinsufficiency; ; hyperglycemiahyperglycemia Possibly evidenced by

[Not applicable; presence of signs and symptoms establishes anand symptoms establishes an actual actual diagnosis.]diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Nutritional Status (NOC)

Nutritional Status (NOC)

Demonstrate stable weight with normal laboratory values and be free of signs of

Demonstrate stable weight with normal laboratory values and be free of signs of malnutrition.malnutrition.

ACTIONS/INTERVENTIONS

Independent

Monitor daily food intake. Weigh daily and report losses. Monitor daily food intake. Weigh daily and report losses.

Encourage patient to eat and increase number of meals Encourage patient to eat and increase number of meals and snacks, using high-calorie foods that are easily and snacks, using high-calorie foods that are easily digested.

digested.

Avoid foods that increase peristalsis (e.g.,

Avoid foods that increase peristalsis (e.g., tea, coffee,tea, coffee, fibrous and highly seasoned foods) and

fibrous and highly seasoned foods) and fluids that causefluids that cause diarrhea (e.g., apple/prune juice).

diarrhea (e.g., apple/prune juice).

Collaborative

Consult with dietitian to provide diet high in calories, Consult with dietitian to provide diet high in calories, protein, carbohydrates, and vitamins.

protein, carbohydrates, and vitamins. Administer medications as indicated: Administer medications as indicated:

Glucose, vitamin B complex; Glucose, vitamin B complex;

Insulin (small doses). Insulin (small doses).

RATIONALE

Continued weight loss in face of adequate caloric intake Continued weight loss in face of adequate caloric intake may indicate failure of

may indicate failure of antithyroid therapyantithyroid therapy.. Aids in keeping caloric intake high enough to

Aids in keeping caloric intake high enough to keep upkeep up with rapid expenditure of calories caused by

with rapid expenditure of calories caused by hypermetabolic state.

hypermetabolic state.

Increased motility of GI tract may result in diarrhea and Increased motility of GI tract may result in diarrhea and impair absorption of needed nutrients.

impair absorption of needed nutrients.

May need assistance to ensure adequate intake May need assistance to ensure adequate intake of of nutrients, identify appropriate supplements. nutrients, identify appropriate supplements.

Given to meet energy requirements and prevent or correct Given to meet energy requirements and prevent or correct hypoglycemia.

hypoglycemia.

Aids in controlling serum glucose if elevated. Aids in controlling serum glucose if elevated.

NURSING DIAGNOSIS: Anxiety [specify level] NURSING DIAGNOSIS: Anxiety [specify level]

(9)

May be related to May be related to

Physiological factors: hypermetabolic state (CNS stimulation), pseudocatecholamine effect of

Physiological factors: hypermetabolic state (CNS stimulation), pseudocatecholamine effect of thyroid hormonesthyroid hormones Possibly evidenced by

Possibly evidenced by

Increased feelings of apprehension, shakiness, loss of control, panic Increased feelings of apprehension, shakiness, loss of control, panic Changes in cognition, distortion o

Changes in cognition, distortion o f environmental stimulif environmental stimuli Extraneous movements, restlessness, tremors

Extraneous movements, restlessness, tremors

DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Anxiety Control (NOC)

Anxiety Control (NOC) Appear relaxed.

Appear relaxed.

Report anxiety reduced to a

Report anxiety reduced to a manageable level.manageable level. Identify healthy ways to deal with

Identify healthy ways to deal with feelings.feelings.

ACTIONS/INTERVENTIONS

Anxiety Reduction (NIC) Anxiety Reduction (NIC)

Independent

Observe behavior indicative of

Observe behavior indicative of level of anxietylevel of anxiety..

Monitor physical responses, noting palpitations, repetitive Monitor physical responses, noting palpitations, repetitive movements, hyperventilation, insomnia.

movements, hyperventilation, insomnia.

Stay with patient, maintaining calm

Stay with patient, maintaining calm mannermanner.. Acknowledge fear and allow

Acknowledge fear and allow patient’patient’s behavior to bs behavior to b elongelong to patient.

to patient.

Describe/explai

Describe/explain procedures, surroundn procedures, surround ing environment, or ing environment, or sounds that may be heard by patient.

sounds that may be heard by patient.

Speak in brief statements, using simple words. Speak in brief statements, using simple words.

Reduce external stimuli: Place in quiet room; pro Reduce external stimuli: Place in quiet room; pro videvide soft, soothing music; reduce bright lights; reduce number soft, soothing music; reduce bright lights; reduce number of persons contacting

of persons contacting patient.patient. Discuss with patient/SO reasons for

Discuss with patient/SO reasons for emotionalemotional lability/psy

lability/psychotic reaction. (Refer to chotic reaction. (Refer to ND: ThoughtND: Thought Processes, risk for disturbed, following.)

Processes, risk for disturbed, following.)

Reinforce expectation that emotional control should Reinforce expectation that emotional control should return as drug therapy progresses.

return as drug therapy progresses.

RATIONALE

Mild anxiety may be displayed by

Mild anxiety may be displayed by irritability andirritability and insomnia. Severe anxiety progressing to panic state may insomnia. Severe anxiety progressing to panic state may produce feelings of impending doom, terror, inability to produce feelings of impending doom, terror, inability to

speak or move, shouting/swearing. speak or move, shouting/swearing. Increased number of

Increased number of [beta]-adrenergic receptor sites,[beta]-adrenergic receptor sites, coupled with effects of excess thyroid hormones, coupled with effects of excess thyroid hormones, produces clinical manifestations of

produces clinical manifestations of catecholamine excesscatecholamine excess even when normal levels of norepinephrine/epinephrine even when normal levels of norepinephrine/epinephrine exist.

exist.

Affirms to patient/SO that although patient feels out of Affirms to patient/SO that although patient feels out of control, environment is

control, environment is safe. Asafe. Avoiding personal responsesvoiding personal responses to inappropriate remarks or actions prevents

to inappropriate remarks or actions prevents conflicts/overreacti

conflicts/overreaction to on to stressful situation.stressful situation. Provides accurate information, which reduces Provides accurate information, which reduces distortions/misinterpreta

distortions/misinterpretations that can tions that can contribute tocontribute to anxiety/fear reactions.

anxiety/fear reactions. Attention span may be

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

limiting ability to assimilate information.

Creates a therapeutic environment; shows recognition that Creates a therapeutic environment; shows recognition that unit activity/personnel may

unit activity/personnel may increase patient’s anxietyincrease patient’s anxiety..

Understanding that behavior is

Understanding that behavior is physically based enhancesphysically based enhances acceptance of situation and encourages different

acceptance of situation and encourages different responses/approaches.

responses/approaches.

Provides information and reassures patient that the Provides information and reassures patient that the situation is temporary and will improv

situation is temporary and will improv e with treatment.e with treatment.

A

(10)

Anxiety Reduction (NIC) Anxiety Reduction (NIC)

Collaborative

Administer antianxiety agents or sedatives and monitor Administer antianxiety agents or sedatives and monitor effects.

effects.

Refer to support systems as needed, e.g., counseling, Refer to support systems as needed, e.g., counseling, social services, pastoral care.

social services, pastoral care.

May be used in conjuction with medical regimen to May be used in conjuction with medical regimen to reduce effects of hyperthyroid secretion.

reduce effects of hyperthyroid secretion.

Ongoing therapy support may be desired/required by Ongoing therapy support may be desired/required by patient/SO if crisis precipitates lifestyle alterations. patient/SO if crisis precipitates lifestyle alterations.

NURSING DIAGNOSIS: Thought Processes, risk for

NURSING DIAGNOSIS: Thought Processes, risk for disturbeddisturbed Risk factors may include

Physiological changes: increased CNS

Physiological changes: increased CNS stimulation/accstimulation/accelerated mental activityelerated mental activity Altered sleep patterns

Altered sleep patterns Possibly evidenced by Possibly evidenced by [Not applicable; presence of signs

[Not applicable; presence of signs and symptoms establishes anand symptoms establishes an actual actual diagnosis.]diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Distorted Thought Control (NOC)

Distorted Thought Control (NOC) Maintain usual reality orientation. Maintain usual reality orientation.

Recognize changes in thinking/behavior and causative factors. Recognize changes in thinking/behavior and causative factors.

ACTIONS/INTERVENTIONS

Delirium Management (NIC) Delirium Management (NIC)

Independent

Assess thinking processes, e.g

Assess thinking processes, e.g ., memory, attention span,., memory, attention span, orientation to

orientation to person/place/timperson/place/time.e. Note changes in behavior. Note changes in behavior.

Assess level of

Assess level of anxietyanxiety. (Refer . (Refer to ND: Anxiety)to ND: Anxiety)

Provide quiet environment; decreased stimuli, cool room, Provide quiet environment; decreased stimuli, cool room, dim lights. Limit procedures/personnel.

dim lights. Limit procedures/personnel.

Reorient to person/place/time as indicated. Reorient to person/place/time as indicated.

Present reality concisely and briefly without challenging Present reality concisely and briefly without challenging illogical thinking.

illogical thinking.

RATIONALE

Determines extent of interference with sensory Determines extent of interference with sensory processing.

processing. May be h

May be h ypervigilant, restless, extremely sensitive, or ypervigilant, restless, extremely sensitive, or crying or may develop frank psychosis.

crying or may develop frank psychosis. Anxiety may alter thought processes. Anxiety may alter thought processes. Reduction of external stimuli may decrease Reduction of external stimuli may decrease hyperactivity/re

hyperactivity/reflexia, flexia, CNS CNS irritabilityirritability, , auditory/visualauditory/visual hallucinations.

hallucinations.

Helps establish and maintain awareness of Helps establish and maintain awareness of reality/environment.

reality/environment. Limits defensive reaction. Limits defensive reaction.

ACTIONS/INTERVENTIONS

Delirium Management (NIC) Delirium Management (NIC)

Independent

Provide clock, calendar, room with outside window; Provide clock, calendar, room with outside window; alter alter level of lighting to

level of lighting to simulate day/night.simulate day/night.

RATIONALE

Promotes continual orientation cues to assist p

Promotes continual orientation cues to assist p atient inatient in maintaining sense o

(11)

Encourage visits by family/SO. Provide support as Encourage visits by family/SO. Provide support as needed.

needed.

Provide safety measures, e.g., padded side

Provide safety measures, e.g., padded side rails, closerails, close supervision, or soft

supervision, or soft restraints as last resort as necessary.restraints as last resort as necessary.

Collaborative

Administer medication as indicated, e.g., Administer medication as indicated, e.g., sedatives/antianxi

sedatives/antianxiety aety a gents/antipsygents/antipsychotic chotic drugs.drugs.

Aids in maintaining socialization and orientation. Aids in maintaining socialization and orientation. Note: Note: Patient’

Patient’s agitation/psychotic behavior s agitation/psychotic behavior may precipitatemay precipitate family quarrels/conflicts.

family quarrels/conflicts.

Prevents injury to patient who may be Prevents injury to patient who may be hallucinating/disoriented.

hallucinating/disoriented.

Promotes relaxation, reduces

Promotes relaxation, reduces CNS hyperactivity/agitatiCNS hyperactivity/agitationon to enhance

to enhance thinking ability.thinking ability.

NURSING DIAGNOSIS: Tissue Integrity, risk for

NURSING DIAGNOSIS: Tissue Integrity, risk for impairedimpaired Risk factors may include

Alterations of protective mechanisms of eye: impaired closure

Alterations of protective mechanisms of eye: impaired closure of eyelid/exophthalmosof eyelid/exophthalmos Possibly evidenced by

[Not applicable; presence of signs and symptoms establishes anand symptoms establishes an actual actual diagnosis.]diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Tissue Integrity: Skin & Mucous Membranes (NOC)

Tissue Integrity: Skin & Mucous Membranes (NOC) Maintain moist eye membranes, free of u

Maintain moist eye membranes, free of u lcerations.lcerations. Risk Control (NOC)

Risk Control (NOC)

Identify measures to provide protection for eyes and prevent complications. Identify measures to provide protection for eyes and prevent complications.

ACTIONS/INTERVENTIONS

Surveillance (NIC) Surveillance (NIC)

Independent

Encourage use of dark glasses when awake and

Encourage use of dark glasses when awake and taping thetaping the eyelids shut during sleep as needed.

eyelids shut during sleep as needed.

Elevate the head of the bed and restrict salt intake if Elevate the head of the bed and restrict salt intake if indicated.

indicated.

Instruct patient in extraocular muscle exercises if Instruct patient in extraocular muscle exercises if appropriate.

appropriate.

RATIONALE

Protects exposed cornea if patient is unable to close Protects exposed cornea if patient is unable to close eyelids completely because of edema/fibrosis of fat pads. eyelids completely because of edema/fibrosis of fat pads. Decreases tissue edema when appropriate, e.g., HF, which Decreases tissue edema when appropriate, e.g., HF, which can aggravate existing exophthalmos.

can aggravate existing exophthalmos.

Improves circulation and maintains mobility of Improves circulation and maintains mobility of thethe eyelids. eyelids.

ACTIONS/INTERVENTIONS

Surveillance (NIC) Surveillance (NIC)

Independent

Provide opportunity for patient to discuss feelings about Provide opportunity for patient to discuss feelings about altered appearance and measures to enhance self-image. altered appearance and measures to enhance self-image.

RATIONALE

Protruding eyes may be

Protruding eyes may be viewed as unattractive.viewed as unattractive. Appearance can be enhanced with proper use of

Appearance can be enhanced with proper use of makeup,makeup, overall grooming, and use of

(12)

Collaborative

Methylcellul

Methylcellulose ose drops;drops;

Adrenocorticotropic hormone (ACTH), prednisone; Adrenocorticotropic hormone (ACTH), prednisone;

Antithyroid drugs; Antithyroid drugs;

Diuretics. Diuretics.

Prepare for surgery as

Prepare for surgery as indicated.indicated.

Lubricates the eyes, reducing risk of lesion formation. Lubricates the eyes, reducing risk of lesion formation. Given to decrease rapidly progressive and marked Given to decrease rapidly progressive and marked inflammation.

inflammation.

May decrease signs/symptoms or prevent worsening of May decrease signs/symptoms or prevent worsening of the condition.

the condition.

Can decrease edema in mild

Can decrease edema in mild involvement.involvement.

Eyelids may need to be sutured shut temporarily to Eyelids may need to be sutured shut temporarily to protect the corneas until edema resolves (rare) or protect the corneas until edema resolves (rare) or

increasing space within sinus cavity and

increasing space within sinus cavity and adjustingadjusting musculature may return eye to a more normal position. musculature may return eye to a more normal position.

NURSING DIAGNOSIS: Knowledge, deficient [Learning Need]

NURSING DIAGNOSIS: Knowledge, deficient [Learning Need] regarding condition, prognosis,regarding condition, prognosis, treatment, self-care, and discharge needs

treatment, self-care, and discharge needs May be related to

May be related to Lack of exposure/recall Lack of exposure/recall Information

Information misinterpretatmisinterpretationion

Unfamiliarity with information resources Unfamiliarity with information resources Possibly evidenced by

Possibly evidenced by

Questions, request for information, statement of

Questions, request for information, statement of misconceptionmisconception Inaccurate follow-through of instructions/development of p

Inaccurate follow-through of instructions/development of p reventable complicatireventable complicationsons DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:

DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Knowledge: Illness Care (NOC)

Knowledge: Illness Care (NOC) V

Verbalize understanding of erbalize understanding of disease process and disease process and potential complications.potential complications. Identify relationship of signs/symptoms to the

Identify relationship of signs/symptoms to the disease process and correlate symptoms with causative fdisease process and correlate symptoms with causative f actors.actors. V

Verbalize understanding of erbalize understanding of therapeutic needs.therapeutic needs. Initiate necessary lifestyle changes and

(13)

ACTIONS/INTERVENTIONS

T

Teaching: Disease eaching: Disease Process (NIC)Process (NIC)

Independent

Review disease process and future

Review disease process and future expectations.expectations.

Provide information appropriate to individual

Provide information appropriate to individual situation.situation.

Identify stressors and discuss precipitators to Identify stressors and discuss precipitators to thyroidthyroid crises, e.g., personal/social and job concerns, infection, crises, e.g., personal/social and job concerns, infection, pregnancy.

pregnancy.

Provide information about signs/symptoms of Provide information about signs/symptoms of

hypothyroidism and the need for continuing follow-up hypothyroidism and the need for continuing follow-up care.

care.

Discuss drug therapy, including need for adhering to Discuss drug therapy, including need for adhering to regimen, and expected therapeutic and side effects. regimen, and expected therapeutic and side effects.

Identify signs/symptoms requiring medical evaluation, Identify signs/symptoms requiring medical evaluation, e.g., fever, sore throat, and skin

e.g., fever, sore throat, and skin eruptions.eruptions.

Explain need to check

Explain need to check with physician/pharmacist beforewith physician/pharmacist before taking other prescribed or OTC drugs.

taking other prescribed or OTC drugs.

Emphasize importance of planned rest periods. Emphasize importance of planned rest periods.

Review need for nutritious diet and periodic review of Review need for nutritious diet and periodic review of nutrient needs; avoid caffeine, red/yellow food d nutrient needs; avoid caffeine, red/yellow food d yes,yes, artificial preservatives.

artificial preservatives.

Stress necessity of continued medical follow-up. Stress necessity of continued medical follow-up.

RATIONALE

Provides knowledge base from which patient can make Provides knowledge base from which patient can make informed choices.

informed choices.

Severity of condition, cause, age, and concurrent Severity of condition, cause, age, and concurrent complications determine course of treatment. complications determine course of treatment.

Psychogenic factors are often of prime importance in the Psychogenic factors are often of prime importance in the occurrence/exacerbat

occurrence/exacerbation of ion of this disease.this disease.

Patient who has been treated for hyperthyroidism needs to Patient who has been treated for hyperthyroidism needs to be aware of possible development of hypothyroidism, be aware of possible development of hypothyroidism,

which can occur immediately after treatment or as long as which can occur immediately after treatment or as long as 5 yr later.

5 yr later.

Antithyroid medication (either as primary therapy or Antithyroid medication (either as primary therapy or inin preparation for thyroidectomy) requires adherence to a preparation for thyroidectomy) requires adherence to a

medical regimen over an extended period to inhibit medical regimen over an extended period to inhibit hormone production. Agranulocytosis is the most serious hormone production. Agranulocytosis is the most serious side effect that can occur, and alternative drugs

side effect that can occur, and alternative drugs may bemay be given if problems arise.

given if problems arise.

Early identification of toxic reactions (thiourea therapy) Early identification of toxic reactions (thiourea therapy) and prompt intervention are important in preventing and prompt intervention are important in preventing development of agranulocytosis.

development of agranulocytosis.

Antithyroid medications can affect or be

Antithyroid medications can affect or be affected byaffected by numerous other medications, requiring monitoring of numerous other medications, requiring monitoring of medication levels, side effects, and

medication levels, side effects, and interactions.interactions.

Prevents undue fatigue; reduces metabolic demands. As Prevents undue fatigue; reduces metabolic demands. As euthyroid state is achieved, stamina and activity level will euthyroid state is achieved, stamina and activity level will increase.

increase.

Provides adequate nutrients to support

Provides adequate nutrients to support hypermetabolichypermetabolic state. A hormonal imbalance is corrected, diet will need to state. A hormonal imbalance is corrected, diet will need to be readjusted to prevent

be readjusted to prevent excessive weight gain. Irritantsexcessive weight gain. Irritants and stimulants should be limited to avoid cumulative and stimulants should be limited to avoid cumulative systemic effects.

systemic effects.

Necessary for monitoring effectiveness of therapy and Necessary for monitoring effectiveness of therapy and prevention of

prevention of potentially fatal complications.potentially fatal complications.

POTENTIAL CONSIDERA

POTENTIAL CONSIDERATIONS following acute TIONS following acute hospitalization (dependent on patient’s age, hospitalization (dependent on patient’s age, physicalphysical condition/pr

condition/presence of esence of complicationcomplications, personal s, personal resources, and resources, and life responsibilities)life responsibilities) Fatigue—hypermeta

Fatigue—hypermetabolic state diminishing bodbolic state diminishing bod y energy reserves, prolonged y energy reserves, prolonged recoveryrecovery.. Nutrition: imbalanced, risk for more