Davao Doctors College Inc.

General Malvar St., Davao City

Nursing Program

Nursing Management of a Patient with

HYPERTHYROIDISM

A Case Study Presented to the Nursing Clinical Instructors of Davao Doctors College,
Inc.

In Partial Fulfillment of the Requirements in NRG 304: Care of Clients with Problem in
Nutrition, and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination
( ACUTE & CHRONIC)

SARMIENTO, ANNIKA GABRIELLE B., SERENOSO,KENT JEFFERSON R.,

LANOJAN,VEN SAMSON., DIMATINGCAL, WARDA., DIGAO,IRENE JOY., HAPINAT,
KATHLEEN.,GALICHA RAIZA., SAYMAN,EMBER., SAAVEDRA, ME-AD., MADIZA,
ANGELICA., LAGERA, ANGELIQUE., SAAVEDRA, ME-AD., PAYOSING, JULE.,

MARCH, 2021
 TABLE OF CONTENTS

I. OBJECTIVES (GENERAL AND SPECIFIC)

II. INTRODUCTION

III. PATIENT’S PROFILE

a. Biographic Data
b. Clinical Data
c. Past Health History
d. Present Health History
e. Family History

IV. HEALTH ASSESSMENT

V. REVIEW OF ANATOMY & PHYSIOLOGY

VI. PATHOPHYSIOLOGY

a. Definition of Diagnosis
b. Etiology
c. Symptomatology
d. Schematic Diagram
e. Narrative

VII. COURSE IN THE WARD/TREATMENT/INTERVENTIONS

a. Medical Management

VIII. NURSING MANAGEMENT

a. Nursing Care Plan

b. Nurses Notes
c. Clinical Reasoning Questions
d. Discharge Plan
 I. OBJECTIVES (GENERAL AND SPECIFIC)

The Bachelor of Science in Nursing – 13E Group 19 and 20 aims that within this
week of module exposure about Care of clients with Hyperthyroidism, the groups will be
able to formulate a comprehensive case study on the given subject who is assigned to
us in order to participate and learn about the overall development of health plan
including the appropriate teachings and interventions. Thus, it would improve our
knowledge and skills in carrying out a proper and effective Nursing Process Approach.

Specific Objectives:

Within our 1 week span of studying and analyzing the current module, the
following specific objectives will guide us to accomplish our general objectives.

Specifically:

At the end of this module, we are expected to:

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.
 II. 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.
 III. PATIENT’S PROFILE

A. Biographic Data

NAME: SHELLY, PEARLY

AGE: 25 YEARS OLD

GENDER: FEMALE

BIRTHDAY: DECEMBER 4 1996

ADDRESS: N/A

NATIONALITY: FILIPINO

RELIGION: ROMAN CATHOLIC

B. Clinical Data

CHIEF COMPLAINT: FATIGUALIBITY, PALPITATIONS, SEVERE HEADACHES,

NAUSEA AND VOMITING, TREMOR AND MOIST HAND.

DATE OF ADMISSION: MARCH 1 2021

TIME OF ADMISSION: 2:30PM

HOSPITAL: DAVAO DOCTORS HOSPITAL

ROOM: 210

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.
 IV. 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.

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.
 V. REVIEW OF ANATOMY & PHYSIOLOGY

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.

Synthesis and Release of Thyroid

Hormones

Hormones are produced in the colloid when atoms of the mineral iodine attach to a
glycoprotein, called thyroglobulin, that is secreted into the colloid by the follicle cells.
The following steps outline the hormones’ assembly:

1. Binding of TSH to its receptors in the follicle cells of the thyroid gland causes the
cells to actively transport iodide ions (I –) across their cell membrane, from the
bloodstream into the cytosol. As a result, the concentration of iodide ions “trapped” in
the follicular cells is many times higher than the concentration in the bloodstream.
2. Iodide ions undergo oxidation (their negatively charged electrons are removed).
The oxidation of two iodide ions (2 I –) results in iodine (I2), which passes through the
follicle cell membrane into the colloid.
3. In the colloid, peroxidase enzymes link the iodine to the tyrosine amino acids in
thyroglobulin to produce two intermediaries: a tyrosine attached to one iodine and a
tyrosine attached to two iodines. When one of each of these intermediaries is linked by
covalent bonds, the resulting compound is triiodothyronine (T3), a thyroid hormone
with three iodines. Much more commonly, two copies of the second intermediary bond,
 forming tetraiodothyronine, also known as thyroxine (T4), a thyroid hormone with four
iodines.

VI. 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.

Johnson, J. Y. (2010). Handbook for Brunner & Suddarths Textbook of medical-surgical

nursing, twelfth edition. Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins.

B. Etiology

PREDISPOSING FACTORS

1. Gender - Women are more likely than men

to develop hyperthyroidism. Due to
the production of special proteins
(called antibodies) that attack the
thyroid gland. The antibodies fool
the thyroid gland into thinking that
more thyroid hormone production
is needed, which results in
hyperthyroidism.
- A family history of Graves disease
2. Genetic Factors or other forms of hyperthyroidism
increases your risk.

- Diabetes and thyroid disorders

3. Family history of diabetes tend to coexist in patients. Both
conditions involve a dysfunction of
the endocrine system. Thyroid
disorders can have a major impact
 on glucose control, and untreated
thyroid disorders affect the
management of diabetes in
patients

PRECIPITATING FACTORS

1. Grave’s disease - The antibody associated with

Graves' disease — thyrotropin
receptor antibody (TRAb) — acts
like the regulatory pituitary
hormone. That means that TRAb
overrides the normal regulation of
the thyroid, causing an
overproduction of thyroid
hormones (hyperthyroidism)

2. Rich in iodine (excess iodine) - Iodine-induced hyperthyroidism. In

some susceptible patients, an
excess iodine load provides a rich
substrate for increased production
of thyroid hormones.

3. Adrenal Insufficiency
- The thyroid is another gland
responsible for producing
hormones that keep your body
running optimally. When the
thyroid gland, which is in the lower
front of your neck, isn’t functioning
well, you can become tired, and
depressed.

4. Caffeinated drinks
- Consuming caffeine will increase
the metabolism, which of course is
regulated by the thyroid gland. So
if someone drinks a lot of coffee or
soda on a daily basis, then this will
 affect the metabolism of the body.

C. SYMPTOMATOLOGY

Present (Place a check mark if the client has manifested signs/symptoms)

SIGNS AND SYMPTOMS

1. Unintentional weight loss ✓ - In most cases, excess thyroid

hormone is associated with a high
basal metabolic weight. This
means that your body burns more
energy while it's at rest. This also
means that not producing enough
thyroid hormone is usually
associated with a low basal
metabolic rate.

2. Rapid heartbeat (tachycardia) —

commonly more than 100 beats a
minute ✓ - Hyperthyroidism (overactive
thyroid) occurs when your thyroid
gland produces too much of the
hormone thyroxine.
Hyperthyroidism can accelerate
your body's metabolism, causing
rapid or irregular heartbeat.
3. Palpitations ✓
- Excess thyroid hormone causes
palpitations and some degree of
exercise intolerance that is due to
an increased heart rate and
fatigue. The changes in heart rate
are a result of a change in the
nervous system's control on the
4. Changes in menstrual patterns ✓ heart.
- Too much or too little thyroid
hormone can make your periods
very light, heavy, or irregular.
 - A goiter can sometimes occur
5. An enlarged thyroid gland (goiter) when your thyroid gland produces
✓ too much thyroid hormone
(hyperthyroidism). In someone who
has Graves' disease, antibodies
produced by the immune system
mistakenly attack the thyroid gland,
causing it to produce excess
thyroxine. This overstimulation
causes the thyroid to swell.

- Severe and prolonged

6. Patchy hair loss ✓ hypothyroidism and
hyperthyroidism can cause loss of
hair. The loss is diffuse and
involves the entire scalp rather
than discrete areas. The hair
appears uniformly sparse.
7. Sweating ✓

- When your thyroid gland makes

more thyroid hormones than your
body needs, your temperature is
also likely to rise. As a result, you
might find yourself extra sensitive
to heat and perspiring 24/7.

8. Hand tremors ✓

- Hyperthyroidism is a condition in
which the metabolic balance of the
body is up regulated, resulting in
increased energy production by
every cell of the body. As a result,
the nervous stimuli become
9. Nervousness ✓ excessive, resulting in hand
tremor.

- When your thyroid gland is

overactive, your body's processes
10. Increased temperature ✓ speed up. This acceleration can
bring about: nervousness.
 - Thyroxine affects the regulation of
your body's metabolism. An excess
of this hormone can cause your
body's metabolism to increase,
which leads to a rising body
temperature.

- In hyperthyroidism, thyrotoxicosis
may present in many ways,
11. Nausea and vomiting ✓
including nausea, abdominal pain,
palpitation, and vomiting. However,
vomiting as a prominent presenting
symptom of thyrotoxicosis is
uncommon.

- H]aving a thyroid disorder may

cause itching without any rash.
12. Itchy skin without a rash ✓ This is because the body's cells,
including those that make up the
skin, stop working properly and dry
out.

- Graves' disease is an autoimmune

condition, which is where the
13. Slightly bulging eyes ✓ immune system mistakenly attacks
healthy tissue. In the case of
thyroid eye disease, the immune
system attacks the muscles and
fatty tissues around and behind the
eye, making them swollen.
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.

VI. COURSE IN THE WARD/TREATMENT/INTERVENTIONS

A. Medical Management

A. Doctors Order

Date Doctors Order Rationale

March 01, 2021  Please admit under
@2:30pm the service of Dr.
Ngo
Vital signs  High Calorie Diet - To give more
BP: 160/100mmHg energy and extra
Temp: 37.9 nutrition
HR: 150bpm  Vsq4 I and O q shift - To obtain baseline
RR:22cpm data. I & O is
O2 sat: 94% important to assess
Weight: 40kgs if there is a fluid
BMI: 17.2 retention inside the
body of the patient
(+) severe headache 8/10  IVF PNSS 1L - Plain normal saline
solution is given to
(+) palpitation @100cc/hr use for replenishing
(+) hand tremors fluid and
electrolytes.
(+) nausea and vomiting
(+) moist hand
(+) fatigue
(+) plummer nails
(+) proptosis
(+) smooth diffusely
enlarged nodules (thyroid
gland)

Cbg- 118mg/dL Laboratory

 Complete blood
Admitting Diagnosis count
- CBC is order to
Hyperthyroidism
monitor RBC level
secondary to Graves and to detect variety
of diseases and
Diseases
condition such as
 Urinalysis infection and
anemia

- To know if the
patient has urinary
tract infection,
 Chest Posterior kidney disease and
diabetes
Anterior View
- To examine the
lungs, bony thoracic
cavity, great vessels
and mediastinum

 Electrocardiogram
STAT - A physician will
order
electrocardiogram
to patient who is
active smoker,
diabetic or
hypertensive.

 Radioimmunoassay
Test (T3, T4) - A test to measure
 concentration of
substance, usually
measuring antigen
 Complete blood concentration
glucose STAT - A test to measure
the glucose (sugar)
level in the body
 Serum Electrolytes
STAT
- A test to measure
levels of body’s
Medication main electrolytes
 Propanolol (Inderal)
40mg 1 tab now
then 1tab OD as - A medication used
to treat high blood
needed for pressure, irregular
palpitation heartbeats, shaking
and other conditions
 Methimazole
(Tapdin) 50mg TID
- Used to treat
 Propylthiouracil overactive thyroid
50mg 1tab TID (hyperthyroidism)

 Motilium 1tab TID - Used to manage

PRN vomting hyperthyroidism

- Blocking the action

of a chemical
messenger in the
brain which causes
the feeling of
nausea and
 Norgesic Forte 1tab vomiting
OD PRN for
headache
- A medication to
 Cetirizine 10mg 1
treat muscle pain
tab@ bedtime for
itchiness
- A medication
  Ultrasound at the reduces the effects
of natural chemical
thyroid tomorrow histamine in the
8am body

- To produce pictures
 IVF PNSS TF at of the thyroid gland
same rate

 Obtain daily weight

 Provide adequate
- Weight gain is one
rest of the signs of
retaining fluids
 Relay result once in - Adequate rest help
to prevent excess
weight gain, heart
disease and
increased illness
duration
 Continue VS
March 01, 2021
monitoring
8:20pm
(especially BP, HR)
Vital signs
- Hyperthyroidism is a
 Increase fluid intake
Bp: 130/90mmHg common cause of
 Continue systolic
HR: 120bpm
hypertension
RR: 16cpm Medication -
Temp: 36.8  Observe for any

(+) headache unusualities

(+) minimal palpitation

- To conduct further
(-) hand tremors assessment and to
lessen the possible
(-) moist hand
complications
(+) fatigue
(+) plummer nails
(+) proptosis

Intake 700mL
Output 1200mL
March 02, 2021  Neo mercazole - A medication used
@10:30am (carbimozole) 5mg to treat
1tab TID hyperthyroidism
UTZ of the thyroid gland  Start multi vitamins - Multivitamins help
(diffused goiter) (Mosegor vita produce enzymes
VS: capsule) 1 tab OD and hormones to
BP: 120/80mmHg boost immunity and
HR: 105bpm keep organs and
RR: 16cpm nerves function
Temp: 36.8 properly

(-) headache
(-) minimal patterns  Maintain High
(-) hand tremors Calorie Diet - Caffeine can affect
(-) nausea and vomiting  Avoid stimulant like the thyroid health
(-) moist hand caffeinated drinks
(-) fatigue – well rested  Decreased IVF rate
@80cc/hr - For fast recovery

 Continue and to avoid

Medication complication

 Refer Accordingly
March 03, 2021  For possible
@10:25am discharge tomorrow

VS: Review of Medication

BP:110/80mmHg  Propanolol (Inderal) - It affects the thyroid
HR: 90bpm 40mg 1tab OD as health
RR: 16cpm needed for
Temp: 36.5 palpitation
 Methimazole
(tapdin) 5mg TID
 Propylthiouracil
50mg TID
 Neo-Mercazole
(carbimazole) 5mg
1tab TID - For fast recovery

 Multivitamins and avoid

(mosegar vita complications

capsule) 1tab OD
 Motilium 1tab TID
PRN for vomiting
 Norgesic Forte 1tab
OD PRN for
headache
 Cetirizine 10mg 1
tab PRN @ bedtime
for itchiness
 Avoid food rich in
iodine
 Monthly
assessment
response to therapy
and dose
adjustment of
response of anti
thyroid drugs
 Continue meds and
increase fluid intake
 Refer Accordingly
 B. LABORATORY/ DIAGNOSTIC EXAMINATIONS

Procedure Purpose Normal Range Result Nursing Management

MARCH 1 Capillary Normal
Blood blood CBG: 15O - Explain to patient
CBG Glucose – glucose mg/dl the procedure
measure level (while f - Explain that you’ll be
whole blo asting) range  extracting small
od within 70 to amount of blood by
glucose a 99 mg/dL the use of the lancet
s opposed (3.9 to 5.5 and glucometer
to venous mmol/L).
samples Higher range
which s could
measure indicate pre-
plasma gl diabetes or di
ucose. It abetes
is used for
the care of
 people
with
diabetes,
as a
monitoring HEMOGLOBI
tool, giving N:
a guide - CBC (men) 4.5 137.0 g/L Complete Blood count
to blood – 5.9 cells/mcL HEMATOCRI - Explain the
glucose le (women) T: 0.40 procedure to the pt.
MARCH vels 4.1- 5.1 ERYTHROCY - Encourage to avoid
1, 2021 cells/mcL TES: stress if possible
2:30 PM - Urinalysis  2-5 4.57 because altered
- WBCs/hpf or THROMBOCT physiologic status
- Complete - Complete less ES: influences and
blood blood count i - Chest X-ray   255.00 changes normal
count is a group of the chest ca hematologic values
- Fasting tests that vity is SERUM
Blood evaluate the outlined on ELEC:
Sugar cells that each side by Sodium:
- Urinalysis circulate in the white 139mEq/L
- Chest X- blood, bony Potassium:

ray including red structures 4.0 mEq/L

Posterior/A blood cells that Calcium:

nterior (RBCs), represent 9.5mg/dL

- Lipid white blood the ribs of Ionized

Profile test cells (WBCs), the chest w Calcium:
- Serum and platelets all. On the 1.21mmol/L

Creatinine (PLTs) top portion Phosphorus:

- Urinalysis a of 4.3mg/dL
test
set of the chest ar Chloride: Urinalysis
- Electrocar
diogram screening e the neck 97mEq/L - Instruct the patient
test tests that can and the Magnesium: to void directly into a
detect some collar bones 1.7mg/dL clean, dry container.
common - Lipid Profile Urinalysis: Sterile, disposable
diseases. It Test Less than NORMAL containers are
may be used 100 mg/dL (2.59 recommended.
to screen for mmol/L); with CHEST X- - Cover all specimens
and/or help CVD or RAY: tightly, label properly
diagnose diabetes: less Lungs are and send
conditions than 70 mg/dL clear immediately to the
such as a (1.81 mmol/L) Tracheal Air laborator
urinary tract - Serum Column
infections, ki Glutamic Chest Xray
dney disorde Pyruvic - Remove all
rs, liver probl Transaminase  metallic
ems, 7 to 56 units objects
diabetes or per liter of - Assess
other blood serum. patient ability
metabolic - Blood Uric to hold breath
conditions, to Acid  1.5 to 6.0 - Instruct
name a few. milligrams/decil patient to
iter (mg/dL) for NORMAL cooperate
women and 2.5 RESULTS during the
to 7.0 mg/dL for ECG: procedure
men IMPRESSION
SINUS
TACHYCARD
- Chest X-ray IA,
It can help P WAVES
your ARE HIDDEN
healthcare WITHIN Lipid Profile
provider see EACH Test
 how well your PRECEDING - Educate the patient
MARCH 2, lungs and T WAVES for the purpose of
2021 heart are RHYTHM: the procedure.
8 AM working REGULAR
P WAVE: Electrocardiogram
NORMAL - Assess clients heart
PR: rate, heart sounds
INTERVAL; and blood pressure
NORMAL - Assess for chest
QRS: areas irritation
NORMAL - Skin breakdown

- Electrocardiog
ram QRS TSH
complex: 80- RESULT:
100 0.006
milliseconds.
ST segment:
80-120
- Lipid Profile milliseconds. T
Test is a wave: 160
blood test th milliseconds.
at can QT interval:
measure the 420
amount of milliseconds or
cholesterol less if
and heart rate is 60
triglycerides beats per
in your blood minute (bpm)
VIII. NURSING MANAGEMENT

a. Nursing Care Plan

b. Nurses Notes
c. Clinical Reasoning Questions
d. 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

B. NURSES NOTES

C. Clinical Reasoning Questions

 I AM CONCERNED that the patient given a medication not in the
right time .
C
I AM UNCOMFORTBALE because there are serious consequences
can cause severe injury and possible death to patients and in order

U for drugs to be effective, they must be taken in the right time.

THIS IS SAFETY ISSUE because medication should be taken

regularly to make sure that you have an effective amount of drug in
your body at all times and if the medication not taken on time the
level of drug in the blood can become low to effectively stop the
S virus multiplying.

D. ETHICO-MORAL-LEGAL

as a student nurse the father of the patient is allowed to view

NURSING the chart of the patient as long as have consent from her
ACTION daughter. Since the father of the patient is a doctor, he wants
to know the health status of her daughter.
Beneficence is doing good and the right thing for the patient.
Autonomy-patient self-determination are upheld when the
nurse accepts the patient as a unique person who has innate
ETHICAL
right to have their own opinions, perspectives, values ,and
PRINCIPLE
beliefs.
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. 
REFERENCE

Healthwise Staff. (2019, July 29). Hyperthyroidism: Care Instructions.

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