Question

 

You have a 49-year-old female that reports she is fatigued, has gained 7 pounds, and has noticed her hair is very brittle. You suspect she has hypothyroidism

a. What testing will you order?

b. What will you teach your patient about hypothyroidism?

c. Discuss the pathophysiology of hypothyroidism and the causes

d. How do you manage a patient with hypothyroidism, discussing the different medications used to treat hypothyroidism

e. How do you follow up with someone diagnosed with hypothyroidism

f. What EBP guidelines did you use?

Answer 1

A The diagnostic tests ordered will be T3 and T4 level,Serum cholesterol level

b Provideclient teaching about Thyroid hormone replacement which includes

• Thyroid hormone replacement-take daily dose in the morning to prevent insomnia
• self-monitor for signs of thyrotoxicosis
• The importance of regular follow up care
• Need for additional protection protection in cold weather.
• Measures to prevent constipation.

c Slowing of metabolic processes caused by hypofunction of the thyroid gland with decreased thyroid hormone secretion,causes myxedema in adults and cretinism in children.it commonly occurs more often in women between ages 30-60.Primary hypothyroidism occurs as a result of atrophy of the gland possibly caused by an autoimmune process.Secondary hypothyroidism caused by decreased stimulation from pituitary TSH.In severe or untreated case myxedema coma may occur characterized by intensification of signs and symptoms of hypothyroidism and neurologic impairement leading to coma.precipitating factors include failure to take prescribed medications,infections,trauma,exposure to cold,use of sedatives,narcotics or anesthetics

d Medical management include driug therapy such as Levothyroxine,thyroglobulin,dessicated thyroid,liothyrnine.Myedema coma is a medical emergency treat with IV thyroid hormones,Correction of hypothermia,maintenance of vital functions and tretment of precipitating causes.Nursing interventions include monitoring vital signs,I&O,daily weights,observe for edema and signs of cardio vascular complications.Administer thyroid hormone replacement therapy.provide a low calorie diet.institute measures to prevent skin break down .Provide increased fluids and foods high in fiber to prevent constipation.Administer stool softeners as ordered

e The patient with hypothyroidism and myxedema needs considerable follow-up and health care.Before hospital discharge ,arrangements are made to ensure that the patient returns to an environment that will promote adherence to the prescribed treatment plan.the nuse reinforces the importance of continued thyroid hormone replacement and periodic follow-up testing and instructs the patient and the family members about the signs of overmedication and undermedication..if indicated a referral is made for home care .The home care nurse assess the patients progress toward recovery and ability to cope with the recent changes,along with the patients physical and cognitive status and the patients and familys understanding of the importance of prescribed long-term medication therapy and compliance with the medication schedule and recommended follow-up tests and appointments.The nurse documents and report to patients primary health care provider ,subtle signs and symptoms that indicate either inadequate or excessive thyroid hormone..