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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 thyro-

toxicity 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-to-

moderate 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 30-

mg 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 (over-

active 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.

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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

23
(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.

24
PATHOPHYSIOLOGY

HYPERTHYROIDISM

Modifiable
Non-modifiable

Diet Age
• Heavy drinker
Lifestyle Gender
• Navy

Occupation Health History

Increase TSH stimulation to the


Pituitary Gland

Stimulation of Thyroid
Hormone

Increase in T3 and T4
Weight
Loss Restless Sweating
Enlarge Respira- Musculo- Anxiety 25
HR Appetite Hormonal Imbalance Heat
Thyroid tory skeletal
Fine Psycho- Integu- Neuro-
Exopthalmos
Physical
gland
Eyes System
RR Nutrition Multi-system
System Insomnia
Tremors Changes logical Intolerance
mentary Irritability
logical
CV
BP
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.

26
• 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.

27
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.

28
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

29
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 Findings

Characteristics Resilient, silky hair

SCALP

Areas to assess Findings

Characteristics Shiny and smooth without lesions, masses or

mumps
Deformities No trauma deformities

Redness or scaliness No redness or scaliness

SKULL

30
Areas to assess Findings

Characteristics Rounded and smooth skull contour without

any sings of enlargement.


Symmetry of facial features and movement Symmetrical in facial features and movement

EYES

Areas to assess Findings


Characteristics Pink conjunctiva, anicteric sclera

Symmetry of eye features and movement Bilateral Exopthalmus; [+] PERRLA

NECK

Areas to assess Findings


Symmetry Enlarged and palpable mass on anterior

portion of the neck

Thyroid gland Presence of mass during palpitation

Nails

Areas to assess Findings


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

LUNGS

Areas to assess Findings


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

31
Musculoskeletal

Areas to assess Findings


Characteristics Fine tremors

Neurologic

Areas to assess Findings


Characteristics Irritable and restless

ABDOMEN

Areas to assess Findings


Characteristics [+] 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 Results Normal Values Interpretation


T3 7.98 2.2-6.8 pmol/L Increased
T4 33.81 10.3-25.74 pmol/L Increased
TSH 0.04 0.3-5.0Uiu/ML Decreased

Date: December 9, 2008

32
Examination/s Requested Results Normal Values Interpretation
T3 7.7 2.2-6.8 pmol/L Increased
T4 29.8 10.3-25.74 pmol/L Increased
TSH 0.1 0.3-5.0Uiu/ML Decreased

Date: January 15, 2009

Examination/s Requested Results Normal Values Interpretation


T3 7 2.2-6.8 pmol/L Increased
T4 26 10.3-25.74 pmol/L Increased
TSH 0.2 0.3-5.0Uiu/ML Decreased

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

33
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.

34
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.

35
CONCEPT MAP

Patient’s name: Mr. Bean 2.) Imbalanced


1.) Increase cardiac Age: 28 yrs old nutrition: less than
workload related to Gender: Male body requirements
hypermetabolic state related to hyper
Increased appetite metabolic state
Heat tolerance secondary to excessive
Fatigue
Anxiety
Insomnia
Bilateral exopthalmos
6.) Disturbed body Weight loss
image related to disease Restless 3.) Anxiety (mild) related to
process Tremors (fine) increased stimulation secondary
(hyperthyroidism) Increase sweating to excessive thyroid hormone
Irritability secretion
Silky resilient hair

4.) Fatigue related to


5.) Disturbed sleep Vital signs: increased energy requirements
pattern related to PR: 120 bpm secondary to hypermetabolic
daytime activity BP: 140/90 mmHg state
pattern Temp: 36.5 °C
RR: 27 cpm

36
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.

37
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.

38
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis

Subjective: Increased At 4 hours Independent: After 4 hours of


“ madali nga ako cardiac of nursing • Monitor vital signs • May indicate rendering nursing
mapagod” as workload intervention especially blood compensatory intervention the
verbalized by the related to the patient pressure changes in stroke patient was able
patient hypermetabolic will be able volume to maintain
as evidenced by to maintain • Place the client in • Elevating the head adequate cardiac
Objective: increase blood adequate semi-Fowler’s may decrease output as
pressure, pulse cardiac position or position cardiac work load evidence by
- Restless rate and output as of comfort • Rest periods stable vital signs
- Irritability respiratory rate evidence by • Provide restful decrease oxygen as follows blood
- fatigue stable vital environment consumption pressure (120/80)
signs as Dependent: , pulse rate (110
follows bpm) and
• Maintain adequate • To provide proper
blood respiratory rate
nutrition and fluid nourishment to
Vital Signs: pressure (24bpm)
balance as ordered the patient
(from
by the physician
- BP: 140/90 140/90 to
( low iodine and low
mmHg 120/80) ,
root crops foods)
- PR: 120 bpm pulse rate
Collaborative:
- RR: 27 cpm (120- 60-
100 bpm) • Administer Beta • Decreases heart
and Blockers rate/ cardiac work
respiratory (Propanolol) Inderal by blocking
rate (27- as ordered). conversion of T3
20bpm). to T4.

39
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Independent:
Subjective: Imbalanced At 4 hours of After 4 hours
nutrition: less nursing • Provided • To enhance of rendering
“Pumayat talaga ako, maski than body intervention good oral client’s appetite nursing
malakas ako kumain, ganito requirements the patient hygiene and ability to eat intervention the
siguro talaga pag may related to hyper will be able to before and patient was
goiter” as verbalized by the metabolic state consume after meals able to
patient secondary to adequate • Monitor food • Continued weight consume
excessive nourishment. intake loss in face of adequate
Objective: thyroid adequate caloric nourishment.
hormone intake may
- Increased appetite secretion as indicate failure of
- Weight loss evidenced by anti- thyroid
weight loss, therapy.
(Weight before: 60 kg) restlessness and • Encourage • Keeping enough
(Weight now: 52 kg) irritability. patient to eat caloric intake
and increase aids in
- Restless meals and hypermetabolic
- Irritability snaks with state
high calorie
that are easily
digested
• Instruct the • It is increased GI
patient to motility may
avoid foods result in diarrhea
that increased and impair
peristalsis (eg. absorption of

40
Tea. Coffee, needed nutrients
fibrous and
highly
seasoned
foods) and
fluids that
causes
diarrhea (eg.
Apple/ prune
juice).
• Provide • To enhance the
relaxing and intake ability
pleasant
environment

Dependent:

• Determine • To provide patient


healthy body the appropriate
weight for age diet.
and height

Collaborative:

• Administer • To meet energy


medication requirements
indicated
( vitamin B
complex)

41
Nursing Planning Intervention Rationale Evaluation
Assessment Diagnosis

42
Independent:
Subjective: Anxiety (mild) At 8hours of After 8 hours of
“ naiinip na ako dito”
related to nursing • Observe behavior • Mild anxiety rendering nursing
as verbalized by theincreased intervention indicative of is manifested intervention the patient
patient stimulation the patient will level of anxiety by irritability was able to verbalized
secondary to be able to and insomnia feelings of anxiety
Objective: excessive thyroid verbalize
hormone feelings of • Establish • To have an open
- Irritability secretion as anxiety therapeutic communication
- Restless evidenced by relationship
- Fatigue irritability, • To establish
- Tremors (fine) insomnia, • Stay with patient, rapport.
- Increased restlessness, maintaining calm
sweating tremors( fine), manner.
- Increased increased
• Attention span
respiration sweating, and
may be
(RR 27 cpm) increased • Speak in brief shortened,
respiration statements, using concentration
simple words. reduced, limiting
ability to
assimilate
information.

• To promote
• Provide comfort clients safety.
measures (putting
up the bed
siderails and
don’t leave the
client alone at • To know the

43
bedside) coping strategy
of the client
• Encourage client
to express • Helps the patient
feelings to know the
reality

• Provide accurate
information about
the situation
• To determine
those that might
Dependent: be helpful to the
current situation
• Review coping of the patient
strategies or
mechanism

44
Nursing Planning Intervention Rationale Evaluation
Assessment Diagnosis

Subjective: Fatigue related to At 8 hours of Independent: After 8 hours of


hypermetabolic nursing rendering
• To note if there nursing
“eto madali ako state with increases intervention the • Monitor vital is tachycardia
mapagod” as energy requirements patient will be signs or incresed in intervention the
verbalized by the as evidenced by able to verbalize (especially pulse rate patient was able
patient fine tremors, increased energy pulse rate) to verbalized
anxiety, incresed and improve well- • Reduces stimuli increased energy
that may
Objective: sweating with vital being • Provide quiet aggravate and improved
signs of pulse rate environment hyperactivity or well-being
- Tremors 120 bpm, blood to relief fatigue
(fine) pressure of 140,90
- Heat mmHg and • Encourage • Helps to
intolerance respiratory rate of patient to counteract
- Restless 27 cpm effects of
restrict increased
- Increased activity and metabolism
sweating rest as much
as possible
Vital signs:
• Provide • May reduce
PR: 120 bpm anxiety
diversional
BP: 140/90 mmHg
activities (e.g
RR: 27 cpm
reading, radio,
television)

• Evaluate need • To know what


for assistance or are the needs of
assistive devices the patient

45
• Assist with self
care needs; keep • For easy access
bed in low and to avoid
position and accidents
travel ways
clear of
furniture

46
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Long Term: Independent: Long Term:
Subjective: Disturbed sleep After 24 hours After 24 hours of
pattern related to of nursing • Provided quiet • To enhance rendering nursing
“Hindi ako daytime activity intervention environment and client ability intervention the patient
masyado nakatulog pattern as the patient comfort measures to fall asleep. was be able to obtained
kagabi, kumakabog evidenced by will be able to (e.g backrub, the different measures of
yung dibdib ko” as irritability identify the washing hands and an 8 hours normal
verbalized by the tremors (fine) different face, cleaning and sleeping pattern as
patient Presence of eye measures how straitening sheets) evidenced by (-)
bags. to obtain a in preparation to irritability, relax, and
Objective: Frequent normal sleep. minimal yawning.
yawning. sleeping
- Irritability pattern • Recommended • Caffeine
- fatigue evidenced by limiting intake of increases
- tremors non- irritable, chocolate and awaking time
(fine) relax, and caffeine/alcoholic during the
- Presence of absence of beverages esp. prior night. A full
eyebags on. eye bags, and to bedtime stomach
- Frequent no frequent interferes
yawning. yawning. with sleep

• Encourage the • Effective in


client to develop a inducing and
bedtime ritual that maintaining
includes quiet sleep
activities such as
reading
pocketbooks or

47
watching television

Dependent:
• To monitor
• Obtain history clients
including bed time sleeping
routines pattern.

48
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Subjective: Long Term: Independent: Long Term:
Disturbed body After 2 days of After 2 days of
“Para nga ko si image related to nursing • Encourage • For support to rendering nursing
Garfield yung dalawa disease process intervention the client to make patient about his intervention the
kong mata, ang laki.” (hyperthyroidis patient will be own decisions illness patient was able
As verbalized by the m) as evidence able to and accept both to accept self
patient by, bilateral demonstrate inadequacies image as
exopthalmos. acceptance of and strengths evidenced by
Objective: self image as interaction with
evidence by • Assess for and • Good nutrition the student
- Bilateral interact with the promote good and sleep patters nurses
exopthalmos nurse on duty, nutrition and promote faster
- Silky resilient and student sleep patterns healing and better
hair nurses coping
- Shy at first
- Weight loss • Acknowledge • Assist the client
coping to coping to
(Weight before: 60 kg) mechanisms as renewed sense of
(Weight now: 52 kg) a normal well-being &
feelings when increases trust
adjusting to between the nurse
changes in body and patient.
and lifestyle

• Encourage • To enhance
client to coping or
verbalize handling his
feelings situation

49
Dependent:
• Social support
• Encourage enhances both
significant other emotional and
to offer support physical health

• To have
• Alert staff or acceptance and
significant not embarrassed
others to the patient when
monitor facial his appearance is
expressions and affected
nonverbal
behaviors

50
DRUG STUDY

Name Mode of Action Indications Contraindication Adverse Nursing


s Effects Interventions

Generic Name: Increases For treating Thyrotoxicosis, Side effects:  Instruct patient to
methimazole metabolic rate, Hyperthyroidism myocardial Nausea and take the drug with
cardiac output and infarction and vomiting, meals to decrease
Brand Name: protein synthesis. severe renal disease diarrhea, cramps, gastrointestinal
Tapazole 10 mg Useful for treating tremors, symptoms
thyrotoxic crisis nervousness,
Dose: 10 mg and in preparation insomnia,  Advise patient about
for subtotal headache and the effects of iodine
Route: PO thyroidectomy. weight loss and its presence in
iodized salt, shellfish
Frequency: q6 Adverse Effects: and OTC cough
Tachycardia, medicines
hypertension and
palpitations
 Emphasize the
importance of drug
compliance; abruptly
stopping the
antithyroid drug
could bring on a
thyroid crisis

 Teach patient the

51
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

52
Name Mode of Indications Contraindications Adverse Effects Nursing
Action Interventions

Generic Name: Selectively To control Second and Third Side Effects:  Monitor vital signs
propanolol Hcl blocks beta  - hypertension and degree heart block, Bradycardia, especially blood
adrenergic management for cardiogenic shock, thrombocytopenia, pressure and pulse
Brand Name: receptor sites, thyrotoxicosis CHF, sinus drowsiness, dry
Inderal 20 mg decreases bradycardia mouth and  Instruct patient to
sympathetic dizziness comply with drug
Dose: 20 mg outflow to the Caution: regimen: abrupt
periphery, Hepatic, renal or Adverse Effects: discontinuation of
Route: PO suppresses thyroid dysfunction; Complete heart antihypertensive
rennin- asthma; peripheral block, drug may cause
Frequency: OD angiotensin- vascular disease; bronchospasm, rebound
aldosterone type 1 diabetes agranulocytosis hypertension
system mellitus
 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

53
increase fluid intake
Instruct client to avoid
excessive intake of alcoholic
beverages. Alcohol can
cause vitamin B complex
deficiencies

54
Name Mode of Indications Contraindications Adverse Nursing
Action Effects Interventions

Generic Name: Water- soluble To treat Patient with liver GI irritation and  Instruct client to take
Vitamin B vitamins are not peripheral dysfunction vasodilation, the prescribed amount
Complex stored in the neuritis, essential resulting in of drug.
body and are for building flushing sensation
Brand Name: readily excreted block of nucleic  Advise client to check
Nevramin in the urine. acids, red blood the expiration dates
Protein binding cell formation on vitamin containers
Route: PO of water – and synthesis of before purchasing and
soluble vitamins hemoglobin taking them. Potency
Frequency: OD is minimal. 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

55
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

56
57
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