Thyroid gland - disordesa , symptomes and treatment
Adult nursing[1] edit
1. Betty, aged 32, is a housewife with two children aged 2 and 3 years old. For the past 3 months she has been constantly hungry despite eating more than usual. She has lost 6.8kg of her body weight. Her hands tremble and she has palpitations. She feels hot, would often become anxious and cries for no apparent reason. There is some pain on swallowing food. She consulted a doctor. A thyroid scan was done and the result showed an enlarged thyroid with increased iodine uptake.
9. Etiology of thyroid gland one of the largest endocrine glands in the body It is found in the neck, inferior to (below) the thyroid cartilage (Adam's Apple) and at approximately the same level as the cricoid cartilage.
16. Thyroid hormone regulation thyroid itself is regulated by another gland located in the brain, called the pituitary. In turn, the pituitary is regulated in part by thyroid hormone that is circulating in the blood and in part by another gland called the hypothalamus (controls body temperature, hunger, and thirst). The hypothalamus releases a hormone called thyrotropin releasing hormone (TRH), which sends a signal to the pituitary to release thyroid stimulating hormone (TSH). In turn, TSH sends a signal to the thyroid to release thyroid hormones. If over activity of any of these three glands occurs, an excessive amount of thyroid hormones can be produced. hyperthyroidism
17. Pathopsychology Excessive production of thyroid hormones T3 & T4 T3- 350 ng/dL T4- 16.1 ug/dL Increase in Metabolic rate Increase sympathetic nervous system activity ↑ appetite ↑ Bowel movement ↑ BP, RR,PR palpitations ↑ sensitivity to neurotransmitters heat intolerance ↑ Temperature Nutritonal deficiencies Anxiety & cry for no reason Skin moist & warm Weight loss & tremble of hands
18. Causes of hyperthyroidism Graves' Disease Excessive intake of thyroid hormones Abnormal secretion of TSH Thyroiditis (inflammation of the thyroid gland) Excessive iodine intake
25. Radioactive Iodine Therapy Lugol’s Iodine Non radioactive therapy Indication: shut off thyroid hormone release after PTU or to prevent thyroid hormones from circulating. Must be taken with PTU Lugol usually given before patient went for operation, is to decreases intraoperative blood loss during thyroidectomy.
31. Discharge plan Pain management Patient education Diet Wound care Seek medical attention immediately
32. Patient education Remind betty to come for follow up appointment. Tell betty that she may have some pain and soreness in your neck at first, especially when she swallow and her voice may be a little hoarse for the first week. Advice betty to get plenty of rest when you get home. Instruct betty to keep her head raised while she are sleeping for the first week. Tell betty that she will probably be able to start her everyday activities in just a few weeks. Teach betty calming relaxation techniques such as deep breathing, music and meditation to helps decrease stimuli, stressors, anxiety that can increase cardiac workload. Teach betty about eye care to implement eye care at home.
33. Pain Management Doctor may have prescribed a Pain-killer medicine. Take all of the pain medicines the way the doctor or nurse told you to. Try taking the pain medicine 30 minutes before a meal to ease the pain of swallowing. Instruct betty that she may put a cold compress on your surgical wound area for 20 minutes at a time to ease pain. Do not put the ice directly on your skin. Make sure it is wrapped in a towel. Keep the area dry.
34. Wound Care Instruct betty to take good care of her drain (if any) and dressings. If she have a drainage bulb, tell her to keep track of the amount of fluid drain out each day and If there’s any excessively fluid output consult doctor. If betty have dressings over the wound area, advice betty to change them the way her doctor or nurse education her. Keep the area dry. Watch for any sign & symptoms of infections and bleeding. Betty may be taking antibiotics to prevent infection. Instruct her take the full course of antibiotics.
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36. Betty may slowly start adding her regular foods to your diet. Your doctor may suggest you see a dietician to help you with your meals.
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