home Analyzes Treatment of hypothyroid coma. Nursing process The role of the nurse in thyroid diseases

Treatment of hypothyroid coma. Nursing process The role of the nurse in thyroid diseases

Hypothyroidism– a disease caused by decreased function of the thyroid gland or its complete loss.

Causes:

autoimmune thyroiditis

congenital aplasia of the thyroid gland

surgical treatment (subtotal resection of the thyroid gland)

drug effects (overdose of Mercazolil)

Patient complaints:

Objective examination:

Appearance – adynamia, poor facial expressions, slow speech

Puffy face

The palpebral fissures are narrowed, the eyelids are swollen

The skin is dry, cold to the touch, dense swelling of the feet and legs (no pit remains when pressed)

Body temperature is reduced

Weight gain

Decreased blood pressure

Decreased heart rate - less than 60 beats. per minute (bradycardia)

Laboratory methods:

Clinical blood test (anemia)

Blood chemistry:

Determination of thyroid hormone levels (T3, T4 – reduced level)

Thyroid-stimulating hormone (TSH) levels are elevated

Level of antibodies to thyroid tissue

Cholesterol levels – hypercholesterolemia

Instrumental methods:

Uptake of radioactive iodine J 131 by the thyroid gland (thyroid function test)

Thyroid scan

Ultrasound of the thyroid gland

Treatment:

Diet No. 10 (exclude foods rich in cholesterol, reduce the energy value of food, recommend foods containing fiber)

Drug therapy - hormone replacement therapy: thyroxine, L-thyroxine

Complications:

Decrease in intelligence,

Disturbances in satisfying needs: eating, excreting, maintaining body temperature, being clean, dressing, undressing, working.

Patient problems:

Muscle weakness

Chilliness

Memory loss

Increase in body weight.

Nursing care:

Give recommendations for diet therapy (exclude foods containing animal fats, include foods rich in fiber - bran bread, raw vegetables and fruits, limit the consumption of carbohydrates).

Control of frequency, pulse, blood pressure, weight control, stool frequency,

Teach the patient how to maintain personal hygiene.

Train relatives on how to communicate with patients

Train relatives to care for patients.

Follow doctor's orders.

Clinical examination:

Regular control visits to the endocrinologist.

Controlling thyroid hormone levels and cholesterol levels.

ECG monitoring once every six months.

Body weight control.

Endemic goiter- a disease that occurs in areas with limited iodine content in water and soil. It is characterized by a compensatory enlargement of the thyroid gland. The disease is widespread in all countries of the world. Sometimes there is sporadic goiter and enlargement of the thyroid gland without previous iodine deficiency.

In addition to iodine deficiency in the environment, the consumption of goitrogenic nutrients contained in certain varieties of cabbage, turnips, rutabaga, and turnips is also of some importance. In response to external iodine deficiency, hyperplasia of the thyroid gland develops, the synthesis of thyroid hormones and iodine metabolism change.

There are diffuse, nodular and mixed forms of goiter. Thyroid function may be normal, increased or decreased. More often, however, hypothyroidism is noted. A typical manifestation of thyroid deficiency in children in endemic areas is cretinism. Significant goiter sizes can cause compression of the neck organs, breathing problems, dysphagia, and voice changes. When the goiter is located retrosternally, the esophagus, large vessels, and trachea can be compressed.

The uptake of I131 by the thyroid gland is usually increased, the level of T3 and T4 in the blood is reduced (with hypothyroidism), and the level of TSH is increased. Ultrasound helps in diagnosis, and for retrosternal and intramediastinal goiter, radiography.

Treatment of nodular and mixed forms of goiter is only surgical. The same applies to large goiters and ectopic localization. In other cases, antistrumin, microdoses of iodine (with unimpaired gland function), thyroidin, thyrocomb, thyroxine are used. For hypothyroidism, thyroid hormone replacement therapy is used in compensating dosages. In endemic foci, prophylactic intake of iodized products and iodine preparations, antistrumin is indicated.

Currently, a number of painful conditions caused by the influence of iodine deficiency are known. The consensus (agreed opinion) of leading endocrinologists in our country on the problem of endemic goiter believes that insufficient intake of iodine into the human body at various periods of his life causes the following diseases.

Diseases caused by iodine deficiency

Topic: “Nursing care for thyroid diseases:

diffuse toxic goiter, hypothyroidism"

Diffuse toxic goiter (DTZ)– a disease caused by excessive secretion of thyroid hormones (thyroxine and triiodothyronine) by the tissue of the thyroid gland, leading to dysfunction of various organs and systems. DTG is a genetically determined autoimmune disease caused by the formation of specific thyroid antibodies that have a stimulating effect on the function of thyroid cells.

Causes:

mental trauma
dysfunction of the pituitary gland
hereditary predisposition

Complaints:

From the side of the central nervous system : tremor of the fingers, feeling of internal trembling, sleep disturbance, irritability, tearfulness, conflict in the family and at work
From the outside CVS: palpitations, heart pain, shortness of breath during exercise
From the side digestive system: increased appetite, increased stool frequency (up to 3-4 times a day), decreased body weight,
From the g side hole: sensation of feeling sand", lacrimation, decreased visual acuity.
From the endocrine system:a feeling of tightness in the neck, difficulty swallowing, menstrual irregularities.

General complaints : increased sweating, increased body temperature to subfebrile levels, constant feeling of heat, muscle weakness.

Objective research methods:

The patient has a youthful appearance,

Neck deformity (enlarged thyroid gland).

The skin is moist, warm, velvety to the touch

Reduction of subcutaneous fat layer (loss of body weight)

Increased body temperature.

Eye symptoms:

sparkle in eyes
Stellwig's symptom - wide opening of the palpebral fissure (staring, “angry” look)
Mobius sign - violation of the convergence of the eyeballs
Graefe's symptom - the appearance of a white stripe when the eyeball moves downward between the edge of the upper eyelid and the edge of the cornea

CVS – tachycardia, atrial fibrillation; increased blood pressure (systolic)

CNS - finger tremor

Laboratory methods:

Clinical blood test (hypochromic anemia, leukopenia)
Blood test for thyroid hormones (increased levels of T3 and T4 hormones, decreased TSH levels)
Biochemical blood test (low cholesterol levels)
Blood test for sugar (hyperglycemia)

Instrumental methods:

131
Ultrasound of the thyroid gland

Treatment:

1. Hospitalization for moderate and severe thyrotoxicosis

2. Diet No. 15 with a high content of protein and vitamins

3. Drug therapy:

Basic therapy - drugs from the group of thyreostatics - Mercazolil at a dose of 20-30 mg

per day (under the control of a clinical blood test)

Symptomatic therapy:

sedatives – valerian tincture, motherwort tincture,
minor tranquilizers phenazepam, seduxen, etc.
cardiac glycosides - corglucon, strophanthin (for heart failure and atrial fibrillation).
- adrenergic blockers (anaprilin, obzidan) to normalize blood pressure and heart rate

4. Surgical methods of treatment – subtotal resection of the thyroid gland.

Complications:

thyrotoxic crisis,
exophthalmos, prolapse of the eyeball, clouding and ulceration of the cornea,
compression of the neck organs by the enlarged thyroid gland.

Satisfaction of needs is impaired:eat, drink, breathe, sleep, be clean, maintain body temperature, communicate, work.

Patient problems:

Nursing care:

recommendations on work and rest schedules
nutritional recommendations - inclusion of foods rich in protein and vitamins in the diet
psychological support for patients.
regular walks before bed, ventilation of the room.
monitor heart rate, blood pressure, body weight
teach the patient the rules of skin care.
change of underwear and bed linen
for exophthalmos, it is recommended to wear dark glasses on sunny days
talk with the patient about the need to take thyreostatic drugs
train relatives to create a psychological climate in the family
teach relatives the rules of counting heart rate, respiratory rate, measuring blood pressure, weighing, thermometry

Clinical examination:

Observation by an endocrinologist (control appearance as prescribed by an endocrinologist)
Examination by an ophthalmologist once every six months
ECG monitoring once every six months
Clinical blood test
Blood for sugar.
Monitoring blood pressure and pulse rate.

Hypothyroidism.

Hypothyroidism – a disease caused by decreased function of the thyroid gland or its complete loss.

Causes:

autoimmune thyroiditis
congenital aplasia of the thyroid gland
surgical treatment (subtotal resection of the thyroid gland)
drug effects (overdose of Mercazolil)

Patient complaints:

lethargy, weakness, drowsiness
increased fatigue
memory loss
chilliness
aching pain in the heart area, shortness of breath
muscle pain
hoarseness of voice
hair loss
constipation
weight gain
in women, menstrual irregularities (may be infertility)
in men, decreased libido

Objective examination:

Appearance – adynamia, poor facial expressions, slow speech
Puffy face
The palpebral fissures are narrowed, the eyelids are swollen
Hoarseness of voice
The skin is dry, cold to the touch, dense swelling of the feet and legs (no pit remains when pressed)
Body temperature is reduced
Weight gain
Decreased blood pressure
Decreased heart rate - less than 60 beats. per minute (bradycardia)

Laboratory and instrumental research methods

Laboratory methods:

Clinical blood test (anemia)

Blood chemistry:

Determination of thyroid hormone levels (T3, T4 – reduced level)
Thyroid-stimulating hormone (TSH) levels are elevated
Level of antibodies to thyroid tissue
Cholesterol levels – hypercholesterolemia

Instrumental methods:

Absorption of radioactive iodine J 131 thyroid gland (thyroid function test)
Thyroid scan
Ultrasound of the thyroid gland

Treatment:

Diet No. 10 (exclude foods rich in cholesterol, reduce the energy value of food, recommend foods containing fiber)
Drug therapy - hormone replacement therapy: thyroxine, L-thyroxine

Complications :

1.Decreased intelligence,

Disorders of need satisfaction: eat, excrete, maintain body temperature, be clean, dress, undress, work.

Patient problems:

Muscle weakness
Chilliness
Memory loss
Constipation
Increase in body weight.

Nursing care:

Give recommendations for diet therapy (exclude foods containing animal fats, include foods rich in fiber - bran bread, raw vegetables and fruits, limit the consumption of carbohydrates).
Control of frequency, pulse, blood pressure, weight control, stool frequency,
Teach the patient how to maintain personal hygiene.
Train relatives on how to communicate with patients
Train relatives to care for patients.
It is recommended to wear warm clothes during the cold season.
Follow doctor's orders.

Clinical examination:

Regular control visits to the endocrinologist.
Controlling thyroid hormone levels and cholesterol levels.
ECG monitoring once every six months.
Body weight control.

Control questions:

Define diffuse toxic goiter.
The main causes of the development of diffuse toxic goiter.
Main complaints in thyrotoxicosis.
Main eye symptoms of thyrotoxicosis.
Definition of hypothyroidism
Main clinical manifestations of hypothyroidism

Introduction…………………………………………………………………………………3
Chapter 1. Thyroid diseases
1.1 Hypothyroidism………………………………………………………………..4
1.2 Hyperthyroidism………………………………………………………………………………….6
1.3 Endemic goiter……………………………………………………….12
Chapter 2. Nursing process for thyroid diseases…….16
General conclusions………………………………………………………………………………….22
References…………………………………………………………….24
Applications

Introduction
Relevance. Currently, thyroid diseases are among the most common in the world. Thus, thyroid hormone drugs are among the 13 most commonly prescribed drugs in the United States. In the UK, more than 1% of the country's population receives these same hormones. The high prevalence of thyroid diseases puts them on a par with diseases such as diabetes and diseases of the cardiovascular system. According to some reports, the prevalence of thyroid diseases is even higher than currently known. This is due to the frequent asymptomatic or subclinical course of many of its diseases.
Manifestations of thyroid lesions are varied. The most common and well-known symptom of thyroid disease among the population is an enlarged thyroid gland - the development of a goiter.
The incidence is growing further, which is due to many factors, among which iodine deficiency, increased background radiation and environmental pollution are especially important.
Therefore, pathologies of the thyroid gland require close attention, not only from medicine, but also from ecology, as a science that aims to reduce the consequences of human activity.
Objective: to review the nursing process for kidney disease
Tasks:
1. Study literature data on the topic.
2. Consider the characteristics of thyroid diseases
3. To specify the features of the nursing process for diseases of the thyroid gland

Chapter 1. Thyroid diseases
Thyroid diseases are divided into:
- decreased activity of the thyroid gland (hypothyroidism);
- increased activity of the thyroid gland (hyperthyroidism, thyrotoxicosis);
- endemic goiter.
1.1 Hypothyroidism

Hypothyroidism is a disease characterized by decreased function of the thyroid gland.
Etiology
The disease can be caused by the absence of the thyroid gland, delayed development of the thyroid gland (hypoplasia), a defect in the enzyme systems of the thyroid gland, inflammatory and autoimmune processes in the thyroid gland, surgical removal of the gland due to tumor pathologies, inflammatory or tumor processes in the pituitary gland and hypothalamus.
Clinical manifestations
Congenital hypothyroidism (myxedema) is detected during the neonatal period. Characterized by a large weight of the child at birth (more than 4 kg), lethargy, drowsiness, jaundice of the newborn, rough facial features, wide bridge of the nose, widely spaced eyes, large swollen tongue, difficulty breathing through the nose, low voice, large belly with an umbilical hernia, dry skin , acrocyanosis, long body, short limbs. Subsequently, there are delays in physical and mental development, dystrophic disorders, and slow maturation of bone tissue. (Appendix 1. Fig. 1)
Acquired hypothyroidism is characterized by the appearance of puffiness of the face, retardation of speech and movements, poor performance at school, memory impairment, hair loss, brittle nails, dry skin, constipation, and chilliness.
A blood test in a hypothyroid state reveals an increased concentration of thyroid-stimulating hormone and a decrease in the levels of thyroxine and triiodothyronine. The concentrations of these hormones are always interdependent, since the neurohumoral regulation of the thyroid gland is based on the feedback principle. If the thyroid gland produces few hormones, then the synthesis of thyroid-stimulating hormone by the pituitary gland increases.
Complications
Hypothyroid coma.
Diagnostics
1. UAC.
2. OAM.
3. Biochemical blood test.
4. Determination of thyroid hormone levels.
5. Ultrasound of the thyroid gland.
6. ECG.
7. Consultations with an endocrinologist, neurologist.
8. X-ray of the skull and tubular bones.
Treatment
1. Treatment regimen.
2. Medical nutrition.
3. Drug therapy: replacement therapy with thyroid hormones, vitamins, iron supplements, and for autoimmune processes - immunosuppressive therapy.
4. Physiotherapy.
5. Exercise therapy.
6. Massage.
7. If the disease is of a tumor nature, surgical treatment is required.
Prevention
Including iodine-rich foods in your diet. Increasing the dose of thyroid hormones in pregnant women with thyroid diseases accompanied by hypothyroidism to prevent congenital hypothyroidism in the fetus.
Nursing care
1. Children with hypothyroidism experience chilliness and have cold extremities, so it is recommended to dress them warmly.
2. To prevent constipation, you need to give your child fresh juices, fruits, vegetables, as well as dishes made from them. Of course, nutrition should be appropriate for the child’s age. It is necessary to enrich the diet with foods high in vitamins.
3. Skin changes due to hypothyroidism require special care. It is necessary to moisturize and soften the skin with children's cosmetics (baby creams, skin care oils).

1.2 Hyperthyroidism
Diffuse toxic goiter is a disease based on hyperfunction and hyperplasia of the thyroid gland. The resulting hyperthyroidism (increased production of hormones) leads to disruption of the functioning of all organs and systems of the body.
In case of diffuse toxic goiter, a study of the level of blood hormones is carried out: an increased concentration in the blood of triiodothyronine, thyroxine and a decreased concentration of thyroid-stimulating hormone are determined.
Etiology
Toxic goiter is an autoimmune disease that is inherited.
Clinical manifestations
Damage to the nervous system: increased excitability, irritability, hasty speech and fussy movements, anxiety, tearfulness, increased fatigue, sleep disturbance, general weakness.
Autonomic disorders: low-grade body temperature, sweating, feeling of heat, trembling of hands, eyelids, tongue, sometimes tremor of the whole body, loss of coordination.
Complaints from the cardiovascular system: feeling........

Bibliography

1. Bomash N.Yu. Morphological diagnosis of thyroid diseases. M. Medicine, 2011
2. Valdina E.A. Diseases of the thyroid gland (surgical aspects). Moscow, 2012
3. Smoleva E.V. Nursing in therapy with a primary care course, Rostov-on-Don, Phoenix. 2014
4. Paleeva A.V. Medical care. A complete nurse's handbook. Moscow. 2011
5. Internet resources

Medicina/zabolevanija_shitovidnoi_zhelezy_lechenie_i_profilaktika/p4.php

Responsibilities of a nurse

The nurse plays one of the main roles in the provision of medical care to the population and the effectiveness of the services provided. The functions of a nurse are varied. They affect not only diagnostic and therapeutic measures, but also directly relate to the care of patients with the goal of their speedy recovery.

For a good nurse, resistance to stress, accuracy, diligence, cleanliness, attentive attitude towards patients, and, of course, special knowledge are very important. Therefore, there are certain requirements for the training of nurses.

A nurse, working with patients with hypothyroidism, must competently carry out the following procedures;

· independently collect the patient’s medical history and carry out some diagnostic measures;

· work with documents, fill out and store medical histories, submit forms for discharge;

Monitor the physical and emotional state of the patient;

· every nurse must be able to provide first aid in the absence of a doctor;

· carry out the nursing process - carry out the necessary procedures (droppers, dressings, injections), distribute dosed doses of medications;

· take an interest in the well-being of patients, prepare patients for tests and pick them up, measure temperature and pressure;

· quickly and accurately follow the doctor’s orders.

In addition, the nurse must have a good understanding of the causes and symptoms of the disease, know the methods of therapy and apply them competently.

Goals of nursing care for thyroid disease in children

The nursing process for hypothyroidism is the care of a patient in which his psychological and physical needs are fully satisfied. Having the necessary knowledge and skills, the nurse must inform, educate and guide the patient.

There are specific nursing process goals when caring for patients with hypothyroidism.

They are as follows:

· Detect existing and potential problems in a timely manner.

· Satisfy the patient's needs and ensure an acceptable quality of life.

· Provide moral support to the patient, his family and friends, inform them about the state of health and the course of the disease.

· Support and restore the patient’s independence in meeting everyday needs.

Based on these points, the nursing tactics for patients with hypothyroidism are built. A single goal may include many activities that contribute to its successful implementation.

Nursing process for thyroid disease in children

For patients admitted to the clinic with a diagnosis of hypothyroidism, a special tactics of the nursing process has been determined, consisting of several stages. They are all interconnected. Each stage of nursing care is another step towards achieving the main goal of treatment - complete recovery of the patient.

Stage I - history taking

This period includes interviewing the patient. The nurse identifies:

lethargy, apathy, fatigue, lack of interest in life;

hair loss, thinning and brittle nails;

Chest pain, shortness of breath and other symptoms of hypothyroidism.

All collected information is analyzed by the nurse, and on its basis the obvious and hidden needs of the patient are determined.

Stage II - identifying the patient’s problems

After collecting anamnesis, a nursing diagnosis is made and impaired needs are identified.

The problems of a patient with hypothyroidism are conventionally divided into existing ones, which are currently troubling, and possible ones (which may appear in the future).

A survey conducted by a nurse reveals existing difficulties. The most common among them are:

· psychological (stress, immersion in illness, low self-esteem, fear of losing a job);

· social (lack of funds due to illness and long-term disability);

· spiritual.

In the future, sudden weight gain and constipation are possible. Women often experience irregular menstruation and infertility.

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Nursing process for thyroid diseases

The nursing process in diseases of the thyroid gland plays an important role. It is the nurse who closely monitors the patient’s compliance with all the doctor’s prescriptions, and therefore brings recovery closer.

The thyroid gland is one of the most important organs of the human body and produces vital hormones: thyroxine (T3) and triiodothyronine (T4). They are responsible for metabolism, thermoregulation and have a direct effect on most organs and systems.

The thyroid gland, one of the endocrine glands, is susceptible to several diseases. They are caused by a number of reasons, for example: iodine deficiency, unfavorable environment, congenital anomalies, inflammatory and autoimmune diseases.

All diseases of this organ can be conditionally divided into 2 large groups. In some cases, the function of the gland decreases and it produces insufficient amounts of hormones. This condition is called hypothyroidism. Or, on the contrary, the gland produces an excess amount of hormones and poisons the body. Then they talk about hyperthyroidism.

Hypothyroidism is a rather unsafe condition that can lead to very serious consequences, especially if a child suffers from it. After all, a lack of thyroid hormones leads to mental retardation and even the occurrence of cretinism. Therefore, many countries around the world are very active in preventing this condition.

Hypothyroidism is a pathological condition in which the amount of hormones produced is significantly reduced. It can be caused by inflammatory diseases in the gland, lack of iodine in food and water, congenital aplasia of the gland, removal of most of it, or an overdose of certain medications (for example, Mercazolil).

This condition is diagnosed through blood tests, ultrasound, and other thyroid tests.

In case of hypothyroidism, the nurse plays an important role in treatment. Caring for such patients requires special patience, because the dysfunction of this organ is almost primarily reflected in the mental state of the patient. Here are the functions that a nurse performs:

Constant monitoring of heart rate, blood pressure, body temperature, stool frequency.
Monitoring the patient's weight. Weekly weighing is required.
Recommendations for diet therapy. Such patients are prohibited from consuming animal fats and are recommended to eat foods rich in fiber. This is due to a slowdown in metabolism.
Teaching relatives of patients how to communicate with them.
Organization of hygiene procedures and room ventilation.

Since patients with hypothyroidism often freeze, the nurse must ensure a comfortable air temperature in the room or use heating pads, warm clothes and blankets.

Diffuse toxic goiter

Diffuse toxic goiter is a pathology that is caused by the fact that the thyroid gland produces too much hormones T3 and T4. This leads to the fact that metabolic processes in the body are greatly accelerated, which ultimately leads to disruption of the functioning of many organs and systems.

This disease has a long course, so the nursing process for diffuse toxic goiter is especially important. Here are the functions that a nurse performs:

Creates conditions for patients to fully relax and ensures their psychological comfort.
Constantly monitors blood pressure, pulse rate, and bowel movements.
Monitors the patient's nutrition. Conducts weekly control weighing.
Monitors the patient's body temperature and room temperature. Use heating pads and warm blankets if necessary.
Creates a favorable microclimate around the patient, trains relatives to care for such a patient.

Patients with diffuse toxic goiter are very irritable, tearful, and conflict-ridden. Therefore, in this case, a lot of patience and tact are required from the sister.

It is the nurse who must monitor the implementation of all the doctor’s recommendations and teach relatives the basics of caring for patients.

As you can see, the nursing process for thyroid diseases plays almost a key role in the patient’s recovery. It is extremely important for the patient to follow all the recommendations of the medical staff and make every effort to overcome his illness.

nuzhenjod.ru

What are the features of caring for patients with hypothyroidism?

The concept of healthcare development in the Russian Federation implies new methods of nursing for diseases of the thyroid gland, in particular hypothyroidism.

Modern technologies of care and rehabilitation assume high responsibility and delineation of duties of nurses and are aimed at improving the quality of life of the patient.

The term "nursing process" originated in the United States and was first used by Lydia Hall in 1995.

Specialists in this field of activity must be sufficiently qualified to independently identify problems and solve them according to the situation.

What do you have to deal with?

A condition in which a person does not have enough thyroid hormones is called hypothyroidism.

This disease was first identified and described at the end of the 19th century. Hypothyroidism is the opposite of another disease - hyperthyroidism, in which there is excessive hormonal activity of the thyroid gland.

The most severe forms of this disease are myxedema and cretinism.

Also, in advanced cases, the patient may fall into a myxedematous coma.

With a mild form of hypothyroidism, minimal assistance is required from the nurse, but with myxedema or coma, the amount of work increases many times over.

The body's reactions to hypothyroidism, which occur due to a lack of thyroid hormones, reduce the patient's performance and contribute to depressive syndrome.

A nurse should help a person perform minimal self-care procedures, eat normally, and feel well.

When the necessary substances are replenished, replaced by synthetic analogues, the symptoms of the disease usually go away.

The severity of symptoms is largely determined by the etiology of the disease.

Hypothyroidism can be caused by:

various pathological processes in the thyroid gland;
surgical interventions on the thyroid gland;
lack of iodine in the body;
heredity;
pathologies of the hypothalamus and pituitary gland.

In Russia, approximately 2% of the population suffers from this disease, which means that many medical personnel must be able to care for the victim.

Most thyroid pathologies are detected in women, and it is in patients that emotional lability is most acutely manifested.

The nurse should be trained to behave in conflict situations and be patient with the patient's condition.

The disease also depends on geographical factors, since in some areas there may be a significant iodine deficiency.

In mountainous areas, medical staff encounters victims of hypothyroidism 2-5 times more often than in coastal areas.

People with hypothyroidism have the following symptoms:

The disease is diagnosed based on laboratory tests; if the condition is assessed as critical, the person should be admitted to a hospital.

In both inpatient and outpatient departments, the nurse assists the endocrinologist with diagnostic and therapeutic procedures.

The level of thyroxine and triiodothyronine in the blood is significantly reduced, and the amount of thyroid-stimulating hormones is increased.

For drug treatment, synthetic thyroid hormones such as thyroxine are used.

In a hospital setting, a nurse should dispense medications that compensate for hormonal imbalances.

If the patient is undergoing outpatient treatment, he buys and takes medications on his own; the help of a nurse may only be needed during a consultation with an endocrinologist.

What exactly do you need help with?

Caring for a patient by meeting his physical and psychological needs is called the nursing process.

There are state standards for performing this type of activity, including the organization and execution of care for patients with various diseases.

The goals of nursing interventions when caring for a person with hypothyroidism are:

Coma with hypothyroidism of the thyroid gland is a serious condition.

Most often it occurs in older people and in cases where treatment has been neglected.

Coma is caused by a sharp disruption of metabolic processes.

Against this background, pathologies of the adrenal glands and a decrease in the protective mechanisms of the human body develop.

The probability of such an outcome is about 38%.

Therefore, a person in this condition needs constant care and medical support.

Emergency care for a patient who has fallen into a coma includes:

preparing the site and placing the patient in the correct position;
oxygen therapy, or providing air flow to the patient's lungs;
collecting tests, measuring blood pressure and pulse;
preparation of drugs for intravenous administration.

Hypothyroidism develops gradually. Often, patients do not immediately notice the initial signs of this disease.

A sudden deterioration in condition and exacerbation of all symptoms of the disease precedes the onset of coma.

Drowsiness develops into loss of consciousness. Body temperature decreases to 20°C and breathing slows down.

Blood pressure decreases and the patient's pulse rate drops to 32 beats per minute.

After providing emergency care, the nurse's responsibilities include ongoing care for a person suffering from hypothyroidism.

He needs to be given 25 mcg of levothyroxine intravenously every few hours.

In case of collapse, you need to give injections of 150 mg of prednisolone or 300 mg of hydrocortisone and about 200 mg of dopamine.

In order to maintain a sufficient level of oxygen in the patient's body, oxygen therapy must be carried out.

You should also regularly place drips of glucose solution.

All prescriptions are given by the attending physician, the nurse simply does what the endocrinologist recommended.

Nurse training requirements

Nurses work in both private and public health care institutions.

To provide more effective patient care, there are nurse training and licensing requirements for educational institutions.

For hypothyroidism, it is necessary for the nurse to know and be able to carry out procedures and tests:

carrying out various diagnostic methods;
collection of tests and various indicators of the functioning of the body;
ability to carry out various medical procedures;
ability to work with documentation;
knowledge of the causes, symptoms and treatments of major diseases;
knowledge of safety precautions when working with devices and tools.

Depending on the geographic location, the scope of this profession may differ due to the uniqueness of the state culture and the quality of the health care system.

For example, in endemic areas, much attention is paid to the prevention of goiter.

The International Council of Nurses, whose symbol is a white heart, operates in more than 130 countries.

The Council gave its definition to the tasks and goals of the nursing process: this is the activity of joint and individual care for people suffering from various diseases, including thyroid pathologies.

The definition clarifies that patients of different ages and social groups have the same right to qualified care.

The nursing process also involves promoting a healthy lifestyle among those who are at risk for thyroid diseases.

Where can you find a great nurse?

You can hire a paid nurse in specialized clinics.

Regular clinics sometimes also provide home care, paid or free.

You can clarify this issue with an endocrinologist or at the reception.

Prices for medical support vary from 300 to 3000 rubles per visit; the price list for specific manipulations also has significant differences.

Care for elderly patients is sometimes provided at discounted prices, 20-50% lower than usual.

White heart

The responsibilities of a nurse or brother include providing emergency first aid, assisting during operations, caring for patients, and performing various therapeutic measures.

Florence Nightingale is considered the founder of nursing.

In her notes, this activity is characterized as using the environment to improve the health of the patient.

This woman's birthday is Nurse's Day.

Professionalism, participation and compassion are qualities inherent in workers in this field.

Thyroid diseases such as hypothyroidism or hyperthyroidism can cause severe conditions in which the nurse or brother will become the patient's friend and helper for a long time.

proshhitovidku.ru

Topic: "Nursing care for diseases of the endocrine system (hypothyroidism)."

Hypothyroidism is a disease caused by decreased function of the thyroid gland or its complete loss.

autoimmune thyroiditis

congenital aplasia of the thyroid gland

surgical treatment (subtotal resection of the thyroid gland)

drug effects (overdose of Mercazolil)

Patient complaints:

Objective examination:

Appearance – adynamia, poor facial expressions, slow speech

Puffy face

The palpebral fissures are narrowed, the eyelids are swollen

The skin is dry, cold to the touch, dense swelling of the feet and legs (no pit remains when pressed)

Body temperature is reduced

Weight gain

Decreased blood pressure

Decreased heart rate - less than 60 beats. per minute (bradycardia)

Laboratory methods:

Clinical blood test (anemia)

Blood chemistry:

Determination of thyroid hormone levels (T3, T4 – reduced level)

Thyroid-stimulating hormone (TSH) levels are elevated

Level of antibodies to thyroid tissue

Cholesterol levels – hypercholesterolemia

Instrumental methods:

Uptake of radioactive iodine J 131 by the thyroid gland (thyroid function test)

Thyroid scan

Ultrasound of the thyroid gland

Diet No. 10 (exclude foods rich in cholesterol, reduce the energy value of food, recommend foods containing fiber)

Drug therapy - hormone replacement therapy: thyroxine, L-thyroxine

Complications:

Decrease in intelligence,

Disturbances in satisfying needs: eating, excreting, maintaining body temperature, being clean, dressing, undressing, working.

Patient problems:

Muscle weakness

Chilliness

Memory loss

Increase in body weight.

Control of frequency, pulse, blood pressure, weight control, stool frequency,

Teach the patient how to maintain personal hygiene.

Train relatives on how to communicate with patients

Train relatives to care for patients.

Follow doctor's orders.

Clinical examination:

Regular control visits to the endocrinologist.

Controlling thyroid hormone levels and cholesterol levels.

ECG monitoring once every six months.

Body weight control.

Endemic goiter is a disease found in areas with limited iodine content in water and soil. It is characterized by a compensatory enlargement of the thyroid gland. The disease is widespread in all countries of the world. Sometimes there is sporadic goiter and enlargement of the thyroid gland without previous iodine deficiency.

Diseases caused by iodine deficiency

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Nursing process for diffuse toxic goiter

Nursing process in diffuse toxic goiter. Diffuse toxic goiter (Graves' disease, thyrotoxicosis) is a disease characterized by increased secretion of thyroid hormones. The main importance in the etiology of the disease is given to hereditary predisposition. Psychotrauma and infections (sore throat, flu, rheumatism) are also important in the occurrence of the disease. solar radiation, pregnancy and childbirth, organic lesions of the central nervous system (CNS), diseases of other endocrine glands. The main clinical manifestations of the disease are: enlarged thyroid gland, increased excitability, irritability. tearfulness. The patient's behavior and character change: fussiness, haste, touchiness, and hand tremors appear.

Complaints and medical history when questioned are poorly presented by the patient; he often focuses on trifles and misses important symptoms. Patients often complain of increased sweating, poor heat tolerance, low-grade fever, trembling of the limbs and sometimes the whole body, and sleep disturbances. significant and rapid weight loss with a good appetite. There are often changes in the cardiovascular system: palpitations, shortness of breath that worsens with physical activity, irregularities in the heart area. Women often experience menstrual irregularities. During examination, the patient’s appearance is noteworthy: the facial expression often takes on an “angry” or “frightened” look due to ocular symptoms and primarily due to exophthalmos (bulging eyes) and rare blinking. Graeffe's symptom (a lag of the upper eyelid when lowering the eyes, with a white stripe of the sclera visible) and Moebius' sign (loss of the ability to fix objects at close range), eye gloss and lacrimation appear. Patients may complain of pain in the eyes, sensations of sand, a foreign body, and double vision. From the cardiovascular system, pronounced tachycardia up to 120 beats is noted. min, possible atrial fibrillation, increased blood pressure.

Nursing process for diffuse toxic goiter: Patient problems: A. Existing (present): - irritability; - tearfulness: - touchiness: - palpitations, irregularities in the heart area: - shortness of breath; pain in the eyes; - weight loss: - increased sweating; - trembling of limbs; - weakness, fatigue; - sleep disturbance; - poor heat tolerance. B. Potential: - risk of developing “thyrotoxic crisis”; - “thyrotoxic heart” with symptoms of circulatory failure; - fear of the possibility of surgical treatment or treatment with radioactive iodine.

Collection of information during the initial examination:

Collecting information from a patient with diffuse toxic goiter sometimes causes difficulties due to the peculiarities of her behavior and requires tact and patience from the nurse when talking with him. A. Questioning the patient about: - the presence of thyroid diseases in close relatives; - previous diseases, injuries of the central nervous system; features of professional activity; connection of the disease with psychotrauma; - the patient’s attitude towards sun exposure, tanning: - duration of the disease; - observation by an endocrinologist and the duration of the examination, its results (when and where was the last time examined); - medications used by the patient (dosage, regularity and duration of use, tolerability); - for women, find out whether the manifestation of the disease is associated with pregnancy or childbirth, and whether there are any irregularities in the menstrual cycle; - patient complaints at the time of examination. B. Examination of the patient: - pay attention to the patient’s appearance, the presence of eye symptoms, tremor of the hands and body; - examine the neck area; - assess the condition of the skin; - measure body temperature; - determine the pulse and characterize it; - measure blood pressure; - determine body weight.

Nursing interventions, including work with the patient's family:

1. Provide physical and mental rest to the patient (it is advisable to place him in a separate room). 2. Eliminate irritating factors - bright light, noise, etc. 3. Observe deontological principles when communicating with the patient. 4. Conduct a conversation about the essence of the disease and its causes. 5. Recommend a nutritious diet with a high content of protein and vitamins, with a limit on coffee and strong tea. chocolate, alcohol. 6. Recommend wearing lighter and looser clothing. 7. Ensure regular ventilation of the room. 8. Inform about medications prescribed by a doctor (dose, features of administration, side effects, tolerability). 9. Monitor: - compliance with the regime and diet; - body weight; - pulse frequency and rhythm; - arterial pressure; - body temperature; - condition of the skin; - taking medications prescribed by a doctor. 10. Ensure the patient is prepared for additional research methods: biochemical blood test, test for accumulation of radioactive iodine in the thyroid gland, scintigraphy. Ultrasound.

11. Conduct a conversation with the patient’s relatives, explaining to them the reasons for changes in the patient’s behavior, reassure them, recommend that they be more attentive and tolerant with the patient.

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