HYPETHYROIDISM

NURSING CARE PLAN

Nursing Diagnosis
Imbalanced nutrition, less than body requirements related to exaggerated metabolic
rate, excessive appetite, and increased gastrointestinal activity as manifested by weight loss
of 11 lbs (5 kg), elevated potassium and low value of sodium, hyperactive bowel sounds, 8 -
10 liquid stools per day, and verbalization of “Malakas po akong kumain ngunit ang pagbaba
ng aking timbang ay progresibo”.

Nursing Inference
In hyperthyroidism, the action of thyroid hormone on the body is stimulatory that

results to hypermetabolism and increased nutrient metabolism. When this happens, there is

an increase in sympathetic nervous system activity that can accelerate the body's

metabolism, causing unintentional weight loss and a rapid or irregular heartbeat leading to a

negative nitrogenous balance, lipid depletion, and the resultant state of nutritional

deficiency. It also goes on to mention that this sympathetic hyperstimulation in the gut leads

to increased motility leading to diarrhea and malabsorption. Hence, Imbalanced nutrition,

less than body requirements.

Nursing Goal
At the end of 5-7 days of rendering nursing interventions, the patient would be able
to gain at least 1 lb (0.45 kg), have a normal potassium and sodium values, regain normal
bowel elimination patterns, demonstrate understanding of medical treatment and self-care
needs, and verbalization of “Hindi na ako gaanong malakas kumain at hindi na rin progresibo
ang pagbaba ng aking timbang”.
 Nursing Interventions Rationale
1. Assess real, exact weight; do not To be used as basis for caloric and
estimate. nutrient requirements.

2. Assess nutritional history with the Family members may provide more
participation of significant others. accurate details on the patient’s eating
habits
3. Monitor vital signs. To have baseline data.

4. Monitor input and output. Loose watery stools can lead to profound
dehydration.
5. Weigh daily and report losses. Continued weight loss in face of adequate
caloric intake may indicate failure of
antithyroid therapy.
6. Request laboratory procedure on Potassium is typically elevated, and
serum electrolyte values (K, Na). sodium is typically lowered in
malnutrition.
7. Administer loperamide as prescribed. To help assist in slowing intestinal motility

8. Provide a quiet atmosphere during May aid digestion and to help the patient
mealtime. relax

9. Discuss adopting a high-calorie diet Aids in keeping caloric intake high enough
like unsalted nuts and nut butters, to keep up with rapid expenditure of
breads made without salt, dairy, and calories caused by hypermetabolic state.
eggs, oats, and other. Identify food
likes and dislikes, as well as foods that
increase diarrhea, before instituting a
plan.

10. Instruct to have adequate and timely Increased fluid intake replaces fluid lost in
fluid intake. the liquid stool.

11. Instruct to avoid stimulants (e.g., Increased motility of GI tract may result in
caffeine, carbonated beverages) diarrhea and impair absorption of needed
nutrients.
12. Instruct to keep a stool chart, noting Evaluation of defecation pattern will help
the time, type, and precipitating direct treatment.
factors for diarrhea stools.

13. Teach comfort measures for irritated Mild cleansing of the perianal skin after
anal area (clean washcloth and soap, each bowel movement will prevent
nonirritating ointment). excoriation. Barrier creams can be used to
protect the skin.
14. Impart to patient the importance of Hygiene reduces the risk of perianal
good perianal hygiene. excoriation and promotes comfort.

15. Educate about hyperthyroidism, the To promote compliance on the treatment

medication’s effects and side effects, regimen.
 and the need for continued medical
care.

16. Evaluate the patient’s response to To help the primary health care provider
the given medications. to determine if there is a need to increase
or decrease dose.

17. Refer with the dietitian to provide May need assistance to ensure adequate
diet high in calories, protein, intake of nutrients, identify appropriate
carbohydrates, and vitamins. supplements.

Nursing Evaluation
At the end of 5-7 days of rendering nursing interventions, the patient gained at least
1 lb (0.45 kg), had normal potassium and sodium values, regained normal bowel elimination
patterns, demonstrated understanding of medical treatment and self-care needs, and
verbalized “Hindi na ako gaanong malakas kumain at hindi na rin progresibo ang pagbaba ng
aking timbang”. The goal was met.
 DRUG STUDY
Drug: Propylthiouracil
Therapeutic class: Antithyroid agents
Pharmacologic class: Thioamides
Dosage, frequency, route of administration: 50mg/tab, 1tab TID PO
Mechanism of action: It inhibits the production of new thyroid hormone in the thyroid gland. It
acts by inhibiting the enzyme thyroid peroxidase, which usually functions to convert iodide to
iodine molecule and incorporate the iodine molecule into amino acid tyrosine. Hence, DIT
(diiodotyrosine) or MIT (monoiodotyrosine) does not get produced, which are the main
constituents in the production of thyroxine (T4) and triiodothyronine (T3). Peripherally, it acts
by inhibiting the conversion of T4 to T3. It has effects on the existing thyroid hormones stored
in the thyroid gland or circulating in the blood.

Desired effects: To decrease signs and symptoms of hyperthyroidism.

Nursing Responsibilities Rationale

BEFORE
1. Perform hand hygiene To prevent spread of microorganisms.
2. Obtain vital signs Provides baseline data for comparison
3. Observe 12 Rs To ensure safe drug administration
DURING
4. Position the patient appropriately for To ensure patient safety and comfort
medication administration
5. Administer Propylthiouracil, 50 mg/tab 1 To decrease signs and symptoms of
tab thrice a day. hyperthyroidism and to ensure that the
patient is receiving the correct medication
for the correct reason
6. Administer at the same time each day with Food may alter drug response by changing
relation to meals. absorption rate.

7. Administer with a full glass of water to To prevent difficulty of swallowing and

prevent difficulty of swallowing and esophageal atresia.
esophageal atresia.
AFTER
8. Store drug at controlled room To maintain efficacy of the drug
temperature and in light resistant
containers.
9. Monitor cardiac response To detect cardiac adverse effects.
10. Provide comfort measures (temperature To help patient cope with drug effects.
control, rest as needed, safety precautions)
11. Provide patient and significant others To enhance patient knowledge and to
education about drug effects and warning promote compliance
signs to report such as
sore throat, fever, chills, headache, malaise,
weakness, yellowing of eyes or skin, unusual
bleeding or bruising, symptoms of
hyperthyroidism or hypothyroidism, or rash
to seek health care professional promptly.
9. Perform hand hygiene Reduce transmission of microorganism
10. Document the procedure For accurate and completely record
11. Caution patient to avoid driving or other The drug may cause drowsiness, dizziness
activities requiring alertness until response and sleepiness
to medication is known.
12. Instruct patient to take medication To achieve desired effect of the drug
exactly as directed, around the clock. If a
dose is missed, take as soon as remembered;
take both doses together if almost time for
next dose; check with health care
professional if more than 1 dose is missed.
Consult health care professional prior to
discontinuing medication.

13. Emphasize the importance of routine to monitor progress and to check for side
exams effects.

14. Advise patient to consult health care

professional regarding dietary sources of
iodine (iodized salt, shellfish).
References:

 Geffner DL, Hershman JM. Beta-adrenergic blockade for the treatment of

hyperthyroidism. Am J Med. 1992 Jul;93(1):61-8. doi: 10.1016/0002-9343(92)90681-z.
PMID: 1352658. Retrieved on May 28, 2021 from
https://pubmed.ncbi.nlm.nih.gov/1352658/

 U.S. National Library of Medicine. (n.d.). Nursing pharmacology. Retrieved on May 28,
2021 from https://wtcs.pressbooks.pub/pharmacology/chapter/4-14-beta-2-
antagonist/

 Pillai, S. et. Al. (2013, March 3). Hyperthyroidism. Retrieved on May 28, 2021 from
https://www.slideshare.net/shraddhamire/hyperthyrodism