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Grave's Disease 30624tn (CLINICAL MANIFESTATIONS (Myocardial…
Grave's Disease
DEFINITION
Autoimmune disease caused by circulating autoantibodies.
CAUSES
Thyrotropin receptor antibody misfunction.
IgG autoantibodies production directed against thyrotropin receptor.
Malfunctioning of body's disease-fighting immune system.
PATHOPHYSIOLOGY
Hyperthyroidism results and is characterised by:
Hypertrophy
Hyperplasia of the thyroid gland.
Increased vascularity and blood flow.
Enlargement of the gland.
Toxic nodular goiter continues to be overactive.
This appears after emotional shock or infection.
Thyroid hormone production and secretion is stimulated.
This occurs on the thyroid plasma membrane.
TSI is thus capable of reacting with the receptor of TSH.
Diffuse hyperfunction of thyroid gland occurs.
DIAGNOSTIC TESTS
Radioactive iodine uptake test.
Thyroid imaging scan.
Blood tests detecting thyroid-stimulating immunoglobulin.
PHARMACOLOGICAL THERAPY
Thioamides inhibiting hormone formation
Methimazole
Propylthiouracil
Beta blockers to control peripheral manifestations
Propanolol
Glucocorticoids
CLINICAL MANIFESTATIONS
Myocardial hypertrophy
Hyperexcitability
Nervousness
Flushed, warm and moist skin
Tachycardia at rest
Restlessness
Enlarged thyroid gland
Puffy and retracted eyelids
Heat sensitivity with increased perspiration
NURSING DIAGNOSIS
Low self-esteem due to physical appearance
Imbalanced nutrition due to excessive appetite
Altered body temperature
Ineffective coping due to emotional instability
NURSING CARE PLAN
Enhancing coping measures
Reassure patient that symptoms will subside
Keep patient's environment quiet and uncluttured
Reassure patient of the effectiveness of medication
Assist patient to administer prescribed medication
Explain encountered emotional reactions
Improving nutritional habits and status
Offer meals in a quiet environment to facilitate digestion
Monitor and record daily weight
Prevent consumption of highly-seasoned food causing diarhea
Monitor and record dietary intake daily
Provide small, frequent, well-balanced meals.
Monitoring and managing potential complications
Administer IV fluids to maintain blood glucose levels
Administer IV fluids to replace lost fluids
Monitor respiratory and cardiac function 2 hourly
Monitor for hypothyroidism clinical manifestations
Monitor closely for thyroid storm symptoms
Promoting home based care
Encourage on avoiding stimulating thyroid storm situations.
Encourage patient to repost specified adverse effects.
Explain medication regimen prescribed.
Teach patient on thyroidectomy to be performed.
Advise on how to administer prescribed medication.
EVALUATION
Maintanance of normal body temperature
Patient displays improved nutritional status
Improved self-esteem
Patient displays effective coping methods
