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Hyperthyroidism (Grave's Disease) Jenna Machin - Coggle Diagram
Hyperthyroidism (Grave's Disease)
Jenna Machin
Pathophysiology and Etiology
(Lewis et al., 2011; VanMeter & Hubert, 2018)
Occurs more frequently in women over 30
autoimmune disorder of unknown etiology marked by thyroid growth and excessive thyroid hormone secretion
insufficient iodine supply, infections, or stressful life events can act as precipitating factors when combined with genetic factors
hypermetabolic state caused by excess circulating levels of T3, T4, or both
referred to as thyrotoxicosis
characterized by remissions and exacerbations
Assessment
Signs and Symptoms
(VanMeter & Hubert, 2018; Lewis et al., 2011)
flushed and warm skin
heat intolerance
Goiter present
Exophthalmos
protruding, staring eyes and decreased blinking and eye movements. Visual impairments can occur from optic nerve damage or corneal ulceration if untreated
increased tissue mass in the orbit pushes the eyeball forward and increased sympathetic stimulation affects the eyelids
increased BP
tachycardia and palpations
restlessness, irritability, tremors
weight loss
increased appetite and thirst
Hyperactive bowel; increased peristalsis, diarrhea, increased bowel sounds
menstrual irregularities
Diagnosis
(Mayo Clinic, 2020; Lewis et al., 2011)
Medical history and physical exam
ECG, ophthalmological exam
Blood tests
low TSH
elevated free thyroxine (T4) levels
Radioiodine uptake test (RAIU)
differentiates between Grave's disease and other forms of thyroiditis
Grave's disease positive clients will show a diffuse, homogenous uptake of 50-80%
Nursing Care
(Vera, 2022; Lewis et al., 2011)
Treatment
Drug therapy
antithyroid drugs
iodine
ß-adrenergic blockers
Radioactive Iodine Therapy (RAI)
treatment of choice for nonpregnant adults
damages or destroys thyroid tissue which limits thyroid hormone secretion
Surgical therapy
surgical removal of the thyroid gland
drug therapy and RAI must be attempted prior to this treatment
Activity intolerance related to fatigue, exhaustion, and heat intolerance caused by hypermetabolism as evidenced by complaints of weakness, irritability, and impaired ability to concentrate
Discuss condition with client's family to educate them on coping mechanisms and supportive strategies for the client
Assess vital signs at baseline and with activity to monitor tachycardia presence
Work with client to identify stressors or environments that increase symptoms (tachycardia, dyspnea, anxiety)
Demonstrate comfort measures such as touch therapy, massage, cool showers, to decrease nervous energy and restlessness
Monitor risk for decreased cardiac output due to hypermetabolic state, increased cardiac workload, and changes in rate, rhythm, and conduction
Assess pulse and heart rate while client is sleeping to gain more insight to tachycardia
Observe signs and symptoms of severe thirst, dry mucous membranes, or poor capillary refill to identify possible rapid dehydration
Monitor BP lying, sitting, and standing to determine if orthostatic hypotension occurs, which is likely with decreased circulating volume
Educate client to inform provider immediately if chest pain occurs and investigate promptly if reported as this may indicate increased myocardial oxygen demands or ischemia
Address nutritional deficit caused by hypermetabolism as evidenced by nausea, diarrhea, and increased appetite and thirst
Monitor daily food intake and complete daily weight checks to report further losses and evaluate effectiveness of intervention
Monitor lab values to evaluate protein and electrolyte levels
Educate client on the need to prevent muscle breakdown and weight loss caused by hypermetabolism. Create meal plan with client which includes several nutritious finger foods full of proteins and calories, and encourage ingesting 6 meals per day
Assess client's food preferences and work with dietician to determine current nutritional status and to gain information that will assist in creating a meal plan
Avoid foods that increase peristalsis and fluids that can cause diarrhea to address impaired absorption
Client Education
(Lewis et al., 2011; Vera, 2022)
Promote physical exercise to improve muscle tone, cardiovascular system, and increase energy levels. Encourage weight-bearing exercises to maintain bone density
Emphasize the importance of continuing regular appointments with primary care provider to monitor condition
Educate client regarding correct nutrition and the importance of consulting a dietician when considering any changes in diet
Educate client on the effect of stress on condition and demonstrate various relaxation techniques, such as meditation or mindful breathing exercises
Educate client on the nature of their diagnosis to address any knowledge deficits
Provide resources for client regarding high protein/calorie foods that they can incorporate into their diet