NURSING MANAGEMENT OF A

PATIENT WITH BY: GROUP 19&20

HYPERTHYROIDISM
OBJECTIVES
1. Utilize the nursing process in the care of client with problems in Hyperthyroidism.
2. Perform a comprehensive health history and assessment based on the case scenario
presented.
3. Utilize assessment information to formulate a patient-centered plan of care.
4. Discuss the therapeutics done for the simulated patient.
5. Explain appropriate nursing interventions per problems identified.
6. Document the care rendered to assigned patient in the simulated health care
record accurately.
INTRODUCTION
Hyperthyroidism occurs when your thyroid gland produces too much of the hormone thyroxin and
also can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular
heartbeat. This fourth case study, we, the student nurses from BSN 13-E group 19 and 20, are currently in
distance learning. However at the meantime as we cannot evaluate in a hospital yet because of this
pandemic, we are just searching for methods and strategies about this disease. Now we are just focusing to
know more about this disease to be more prepared if this happen when we can evaluate through the
hospital. Hopefully soon after this pandemic ends we can experience it personally and apply what we’ve
learned about this case study while in digital learning.
The group’s chosen patient, PS, 25 years old, was admitted due to complaints of feeling of fatigability,
palpitations, severe headache, nausea and vomiting, tremors and moist hands. He was diagnosed with
Hyperthyroidism, which is characterized medical attention right away. The patient claimed that the she has
been experiencing since yesterday of having a feeling of nervousness and dyspnea upon exertion and also
pain scale of severe headache as claimed was 8/10.
.
Hyperthyroidism are common conditions with potentially devastating health consequences that all population worldwide. Iodine
nutrition is a key determinant of thyroid disease and risk; however, other factors, such as ageing, smoking status, genetic
susceptibility, ethnicity, endocrine disruptors and the advent of novel therapeutics, including immune checkpoints inhibitors, also
influence thyroid disease epidemiology. A meta-analysis of European studies estimated a mean prevalence rate of 0.75% for males
and females combined and a incidence rate of 51 cases per 100,000 per year. The prevalence of thyroid cancer in patients with
hyperthyroidism varies widely in the literature—from 1.6% to 21.1%—according to a review in Hormone and Metabolic Research.
The prevalence of thyroid dysfunction in the Philippine survey is 8.53% with the predominant problem being subclinical
hyperthyroidism at 5.33%. Hyperthyroidism among Filipinos is known to be more aggressive, with higher recurrence rates. Many
Filipinos with thyroid cancer receive radioactive iodine (RAI) as part of adjuvant therapy. Filipinos in particular have been identified
to have higher risk and recurrence rates for thyroid cancer and hyperthyroidism compared to other races or ethnicities in the Unites
States. One study done in the Philippines showed that Filipino patients with thyroid cancer had lower mean age, larger mean tumor
size on presentation, and higher rate.
Because of this case, the group decided to work on it. We student nurses will be able to assess the patient with Hyperthyroidism
although this pandemic was going on we have still knowledge how to assess the client and apply the intervention we learned in
nursing management during our class discussion. Hoping that this case will help other researcher on how to deal with patients and
give some health teaching.
This case study could help some other student nurses or even registered nurses to widen their knowledge about Hyperthyroidism. It
will have many benefits and contribution in nursing management to teach some patient who is affected on that specific disease to
avoid factors that increase Hyperthyroidism. To the nursing practice, this study will guide you and added information about
Hyperthyroidism to improve their management and intervention to their clients and also to practice their professions.
PATIENT’S PROFILE
A. Biographic Data B. Clinical Data
NAME: SHELLY, PEARLY CHIEF COMPLAINT: FATIGUALIBITY,
PALPITATIONS, SEVERE HEADACHES, NAUSEA
AGE: 25 YEARS OLD AND VOMITING, TREMOR AND MOIST HAND.
GENDER: FEMALE DATE OF ADMISSION: MARCH 1 2021
BIRTHDAY: DECEMBER 4 1996 TIME OF ADMISSION: 2:30PM
ADDRESS: N/A HOSPITAL: DAVAO DOCTORS HOSPITAL
NATIONALITY: FILIPINO ROOM: 210
RELIGION: ROMAN CATHOLIC ATTENDING PHYSICIAN: Dr. NGO
FINAL DIAGNOSIS: HYPERTHYROIDISM
VITAL SIGN UPON ADMISISON:
BP 160/100mmgH

RR 28cpm

PR 120bpm

T 36.5

O2 92%

PAIN 8/10
C. Present Health History
Patient Pearly Shell a 25 years old, female has been rushed in the emergency department of
Davao Doctors Hospital on March 1, 2021 at 2:30 pm with a chief complaint of feeling of
fatigability, palpitations, severe headache, nausea and vomiting, tremors and moist hands. She
claimed that she has been experiencing since yesterday of having a feeling of nervousness
and dyspnea upon exertion. No History of surgeries. No known allergies. Vital signs checked,
BP: 160/100, Temp: 37.9, HR: 150bpm, RR: 22cpm, O2 Sat 94%, pain scale of severe
headache as claimed was 8/10. On the same day prior to her admission the patient stated
that before she go to the hospital in this morning she's not already feeling well that’s why she
ask her cousin to check her blood pressure and the result was 160/110(high) that’s why her
cousin ask her to go to hospital to have another checkup. The patient also claims that last 3
weeks ago before her admission she felt something strange that she couldn't understand,
sometimes she felt cold and sometimes she felt hot. She also noticed that her menstruation
period has no longer lasted for 5 days. Moreover, she added that she is also a sporty person,
she runs and go to the gym during her rest days. However, she said that she just really don’t
know what is happening to her body that’s why she stopped her exercises since then.
Moreover, she added that she is also a sporty person, she runs and go to the gym during her
rest days. However, she said that she just really don’t know what is happening to her body
that’s why she stopped her exercises since.
D. Past Health History
1 month ago patient Pearly Shell a 25 year old female verbalize that she felt a sudden weakness in his
body, headache and she suddenly loss weight with 40 kg, height 5 ft. tall and her BMI was 17.2. Patient
Pearly consult immediately to a physician and the doctor said it was just a vertigo. The physician
administer a medication (Serc) for her dizziness. She was also ordered by the physician to have a blood
test, CBC, urinalysis and X-ray then all the results were normal. Patient also stated that she was
diagnosed with Dengue Fever when she was a 4th yr. high school.
E. Family History
Upon doing the assessment the Patient stated that Diabetes and Asthma is a common disease on her
mother's side, her mother was actually asthmatic, her grandfather died of asthma then her grandmother
died of diabetes. She have an Auntie, her mother's sister had a US surgery on her thyroid because she
was previously diagnosed with Hyperthyroidism when she was very young. On my mother's side they
have cysts that grow everywhere but it's not that cancerous. In her father side she did not know what
are the diseases that existing in her father's side.
Social History
Patient Shell was a QHSE and Training Manager at Dubai, a sporty person and runs to the gym during
her rest days but she stopped her exercises because she just really don’t know what’s happening to her
body.
HEALTH ASSESSMENT
PHYSICAL ASSESSMENT:

General: Patient’s weight is 40 kg, height of 5 ft tall and BMI of 17.2 that results underweight, patient’s body built appears to be
thin, and patchy hair loss noted
Eyes: The patient’s eyes appears to be slightly bulging with periorbital edema noted known as Proptosis
Ears: Normally, the patient’s tympanic membrane were clear and no unusual ties noted
Skin: The patient’s skin was warm, slightly afebrile (37.9 dc), shiny and moist, cold tremors moist hands, checked on the nail beds was
with distal separation of the nail plate
Nares: The pharyngeal mucous are pink and moist as a normal assessment
Throat: The thyroid gland is smoothly palpable diffused and enlarged
Cardiac: The patient experiences dyspnea upon exertion, presence of palpitations, has increased heart rate (150 bpm) and
respiratory rate (22 cpm), BP of 160/100 mmHg and O2 sat of 94%
Lungs: Patient’s breath sounds are clear and heard in all areas of the lungs but the heart is enlarged according to the CXR result
Abdomen: The patient’s abdomen is soft, symmetric, and non-tender without distention
Musculoskeletal: Patient feels fatigue, sudden body weakness, and tremors
Neuro: Severe headache with pain scale of 8/10, nausea and vomiting, feeling of nervousness and drowsiness.
REVIEW OF ANAPHY
THE THYROID GLAND
A butterfly-shaped organ, the thyroid gland is
located anterior to the trachea, just inferior to the larynx.
(The medial region, called the isthmus, is flanked by
wing-shaped left and right lobes. Each of the thyroid
lobes are embedded with parathyroid glands, primarily
on their posterior surfaces. The tissue of the thyroid gland
is composed mostly of thyroid follicles. The follicles are
made up of a central cavity filled with a sticky fluid
called colloid surrounded by a wall of epithelial follicle
cells. These follicles are the center of thyroid hormone
production and that production is dependent on the
hormones’ essential and unique component: iodine.
PATHOPHYSIOLOGY
A. Definition of Diagnosis

Hyperthyroidism is the second most prevalent endocrine disorder, after diabetes

mellitus. Graves’ disease, the most common type of hyperthyroidism, results from an
excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland
by circulating immune-globulins. Hyperthyroidism disorder may appear after an emotional
shock, stress, or an infection, but the exact significance of these relationships is not
understood. Other common causes of hyperthyroidism include thyroiditis and excessive
ingestion of thyroid hormone.
Graves’ disease a form of hyperthyroidism; characterized by a diffuse goiter and
exophthalmos.
Etiology
C. SYMPTOMATOLOGY
Present (Place a check mark if the client has manifested signs/symptoms)
E. Narrative

Hyperthyroidism is the second most prevalent endocrine disorder, after diabetes mellitus. Graves’
disease, the most common type of hyperthyroidism, results from an excessive output of thyroid hormones
caused by abnormal stimulation of the thyroid gland by circulating immune-globulins. It affects women
eight times more frequently than men, with onset usually between the second and fourth decades (Tierney,
et al., 2005).
Patients with well-developed hyperthyroidism exhibit a characteristic group of signs and symptoms
(sometimes referred to as thyrotoxicosis). The presenting symptom is often nervousness. These patients are
often emotionally hyperexcitable, irritable, and apprehensive, they cannot sit quietly, they suffer from
palpitations, and their pulse is abnormally rapid at rest as well as on exertion. They tolerate heat poorly
and perspire unusually freely. The skin is flushed continuously, with a characteristic salmon color, and is
likely to be warm, soft, and moist. However, patients may report dry skin and diffuse pruritus. A fine tremor
of the hands may be observed. Patients may exhibit ophthalmopathy, such as exophthalmos (bulging eyes),
which produces a startled facial expression.
Appropriate treatment of hyperthyroidism depends on the underlying cause and often consists of a
combination of therapies, including antithyroid agents, radioactive iodine, and surgery. Treatment of
hyperthyroidism is directed toward reducing thyroid hyperactivity to relieve symptoms and preventing
complications. Use of radioactive iodine is the most common form of treatment for Graves’ disease in North
America. Beta-adrenergic blocking agents (eg, propranolol [Inderal]) are used as adjunctive therapy for
symptomatic relief, particularly in transient thyroiditis (Cooper, 2005). Surgical removal of most of the
thyroid gland is a nonpharmacologic alternative.
 COURSE IN THE WARD/TREATMENT/INTERVENTIONS

A. Medical Management
B. LABORATORY/ DIAGNOSTIC EXAMINATIONS
NURSING MANAGEMENT

Nursing Care Plan

Nurses Notes
Clinical Reasoning Questions
Discharge Plan
 A. NURSING CARE PLAN
1. Hyperthermia related to increase metabolic rate
2. Decreased cardiac output related to malignant hypertension as
manifested by decreased stroke volume
3. Fatigue related to hypermetabolic state with increased energy
requirements
4. Anxiety related to change health status
5. Alteration in comfort related to headache as evidenced by pain scale
of 8/10
E. Discharge Planning
Medication
1. Antithyroid medicines decrease thyroid hormone levels and your symptoms.
2. Take your medicine as directed. Contact your healthcare provider if you think your
medicine is not helping or if you have side effects. Tell him or her if you are allergic to any
medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts,
and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry
your medicine list with you in case of an emergency.
Exercise
Walking is said to the best way to reduce weight and has no demerits to its very
nature. More walking only benefits. Walking is considered the best exercise for people
with hyperthyroid. But this will work out for you provided you don't have swelling in your feet.
Treatment

Your doctor may prescribe a beta-blocker medicine to slow your pulse and calm you down. But this is not a
treatment for hyperthyroidism. It is given for your fast heart rate. Your doctor may also give you antithyroid medicine.
This medicine keeps excess thyroid hormone in check. In some cases, doctors recommend radioactive iodine or
surgery to remove the thyroid. After either of these treatments, you may need to take medicine to replace thyroid
hormone for the rest of your life.

Hygiene

Graves' disease can make your eyes sore. Use artificial tears, eye drops, and sunglasses to protect your eyes
from dryness, wind, and sun. Raise your head with pillows at night to prevent your eyes from swelling. In some
cases, taping your eyelids shut at night will keep your eyes from being dry in the morning. Use creams or ointments
for irritated skin. Ask your doctor which type to use.
Outpatient/Check-up

You may need to return for more blood tests to check your thyroid hormone level. This will show if you are
getting the right amount of medicine. Do not stop taking your medicines without talking to your healthcare
provider first. Write down your questions so you remember to ask them during your visits.
Diet

Make sure you get enough calcium. Foods that are rich in calcium include milk, yogurt, cheese, and dark
green vegetables. Do not eat kelp. Kelp is high in iodine, which can make hyperthyroidism worse. Kelp is
commonly used in sushi and other Japanese foods. You can use iodized salt and eat bread and seafood. Try to
eat a balanced diet.

Spirituality

Spiritual care is often found to be a source of emotional support and comfort among people with a serious
disease and has been shown to reduce distressing symptoms and improve quality of life.
THANK YOU!!!!!!!!!! BY: GRP 19&20