Hyperthyroidism, also known as Grave’s disease, Basedow’s disease, or thyrotoxicosis is a metabolic imbalance that results from overproduction of thyroid hormones triiodothyronine (T3) and thyroxine (T4). The most common form is Graves’ disease, but other forms of hyperthyroidism include toxic adenoma, TSH-secreting pituitary tumor, subacute or silent thyroiditis, and some forms of thyroid cancer.
Thyroid storm is a rarely encountered manifestation of hyperthyroidism that can be precipitated by such events as thyroid ablation (surgical or radioiodine), medication overdosage, and trauma. This condition constitutes a medical emergency.
Nursing care management for patients with hyperthyroidism requires vigilant care to prevent acute exacerbations and complications.
Here are seven (7) nursing care plans (NCP) and nursing diagnosis for patients with hyperthyroidism:
- Risk for Decreased Cardiac Output
- Risk for Disturbed Thought Processes
- Risk for Imbalanced Nutrition: Less Than Body Requirements
- Risk for Impaired Tissue Integrity
- Deficient Knowledge
- Other Possible Nursing Care Plans
Deficient Knowledge: Absence or deficiency of cognitive information related to a specific topic.
May be related to
- Lack of exposure/recall
- Information misinterpretation
- Unfamiliarity with information resources
Possibly evidenced by
- Questions, request for information, statement of misconception
- Inaccurate follow-through of instructions/development of preventable complications
- Client will verbalize understanding of disease process and potential complications.
- Client will identify the relationship of signs/symptoms to the disease process and correlate symptoms with causative factors.
- Client will verbalize understanding of therapeutic needs.
- Client will initiate necessary lifestyle changes and participate in the treatment regimen.
|Review the disease process and future expectations.||Provides knowledge base from which patient can make informed choices.|
|Provide information appropriate to individual situation.||This information includes the severity of the condition, cause, age, and concurrent complications to determine the course of treatment.|
|Identify stressors and discuss precipitators to thyroid crises: personal or social and job concerns, infection, pregnancy.||Psychogenic factors are often of prime importance in the occurrence and/or exacerbation of this disease.|
|Provide information about signs and symptoms of hypothyroidism and the need for continuous follow-up care.||A patient who has been treated for hyperthyroidism needs to be aware of the possible development of hypothyroidism, which can occur immediately after treatment or as long as 5 yr later.|
|After 131I therapy, tell the patient not to expectorate or cough freely. Stress need for repeated measurement of serum T4 levels.||Saliva will be radioactive for 24 hours.|
|Monitor CBC periodically.||To detect leukopenia, thrombocytopenia, and agranulocytosis if the patient is taking propylthiouracil and methimazole. Instruct to take medications with meals to minimize GI distress and to avoid OTC cough preparations because many contain iodine.|
|Discuss drug therapy, including the need for adhering to the regimen, and expected therapeutic and side effects.||Antithyroid medication (either as primary therapy or in preparation for thyroidectomy) requires adherence to a medical regimen over an extended period to inhibit hormone production. Agranulocytosis is the most serious side effect that can occur, and alternative drugs may be given if problems arise.|
|Identify signs and symptoms requiring medical evaluation: fever, sore throat, and skin eruptions.||Early identification of toxic reactions (thiourea therapy) and prompt intervention are important in preventing the development of agranulocytosis.|
|Explain the need to check with a physician and/or pharmacist before taking other prescribed or OTC drugs.||Antithyroid medications can affect or be affected by numerous other medications, requiring monitoring of medication levels, side effects, and interactions.|
|Emphasize the importance of planned rest periods.||Prevents undue fatigue; reduces metabolic demands. As euthyroid state is achieved, stamina and activity level will increase.|
|Review need for a nutritious diet and periodic review of nutrient needs. Tell patient to avoid caffeine, red/yellow food dyes, artificial preservatives.||Provides adequate nutrients to support the hypermetabolic state. A hormonal imbalance is corrected, the diet will need to be readjusted to prevent excessive weight gain. Irritants and stimulants should be limited to avoid cumulative systemic effects.|
|Stress necessity of continued medical follow-up.||Necessary for monitoring the effectiveness of therapy and prevention of potentially fatal complications.|
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Endocrine and Metabolic Care Plans
Nursing care plans related to the endocrine system and metabolism:
- Acid-Base Balance
- - Respiratory Acidosis Nursing Care Plan
- - Respiratory Alkalosis Nursing Care Plan
- - Metabolic Acidosis Nursing Care Plan
- - Metabolic Alkalosis Nursing Care Plan
- Addison's Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 13+ Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances | 10 Care Plans
- - Fluid Balance: Hypervolemia & Hypovolemia
- - Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
- - Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
- - Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
- - Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 4 Care Plans
- Thyroidectomy | 5 Care Plans