Grave's disease oveview

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    Alert

    Oriented to place & person

    Very scared

    Visual and auditory hallucinations (1 month

    PTA) Face covered with a mask that appeared in front of him from

    time to time male voice (he will be harmed)

    house possessed by demons that are coming to get him

    suspicious of family members

    someone was doing witchcraft on him

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    Bilateral proptosis

    Diplopia on superior

    and lateral gaze

    Minimal lid lag

    Conjunctival

    injection bilaterally,

    no ulceration

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    Thyroid glandvisibly, palpably

    enlarged 3 fold, smooth, symmetrical,

    nontender Bruitright lobe of the thyroid gland

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    3 months PTAGraves disease with

    hyperthyroidism

    (+) weight loss of 20-25 lbs. in 2 mos.

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    With Graves' disease, the immune system

    makes antibodies that act like TSH, causing

    the thyroid to make more thyroid hormone

    than your body needs. This is called anoveractive thyroid or hyperthyroidism. An

    overactive thyroid causes every function of

    the body to speed up, such as heart rate and

    the rate your body turns food into energy.

    Graves' disease is one cause of overactive

    thyroid

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    Goiter

    Weight Changes

    Temperature Problems

    Heart and BloodPressure Changes

    Gastrointestinal

    Problems

    Skin Changes

    Graves' Dermopathy/

    Pretibial Myxedema

    Changes to Hair / Nails / Hands

    Eye Problems

    Thinking/Cognition

    Problems Mood Problems

    Panic and Anxiety

    Reflex/Movement Issues

    Sleep Problems

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    Gender

    History

    Age

    Pregnancy

    Smoking

    Intake of too much thyroid hormone

    Exposure to or Excess of Iodine/Iodine Drugs

    Certain Medical Treatments and Drugs

    Trauma to the Thyroid

    Major Stress

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    Blood Test

    A diagnosis can be confirmed with blood tests thatmeasure the levels of thyroxine and TSH in yourblood. High levels of thyroxine and low or

    nonexistent amounts of TSH indicate an overactivethyroid. The amount of TSH is important becauseit's the hormone that signals your thyroid gland toproduce more thyroxine. These tests areparticularly necessary for older adults, who may not

    have classic symptoms of hyperthyroidism.

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    (-) Thyroid dysfunction treatment

    (-) History of radiation to the head &

    neck (-) Use of goitrogens

    (-) History of psychiatric illness or

    thyroid diseases.

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    Thyroid Blood Tests Result Reference

    Thyroxine (T4) 11.3 ug/d 5.011.5 ug/dL

    Triiodothyronine (T3) 35% 24% - 35%

    Thyrotropin(TSH) 0.006 mIU/mL 0.4 -5.0 mIU/mL

    Free Thyroxine (FT4) 2.4 ng/dL 0.8 -1.8 ng/dL

    Interpretation:

    A high level of T4 confirms hyperthyroidism.

    Total triiodothyronine (Total T3) is generally elevated in hyperthyroidism and

    decreased in hypothyroidism.Thyroid-stimulating Hormone (TSH, thyrotropin) is generally elevated in

    hyperthyroidism.

    Free thyroxine (Free T4) is generally elevated in hyperthyroidism.

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    Start of Risperidone and thyroid

    medications.

    No auditory and visual hallucinations orparanoid ideas

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    Psychosis secondary to uncontrolled

    hyperthyroidism

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    Included psychotic disorder not

    otherwise specified (DSMIV) probably

    secondary to uncontrolledhyperthyroidism.

    DSMIV schizophreniform disorder

    was included in differential diagnosis.

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    ASSESSMENT NURSINGDIAGNOSIS

    BACKGROUNDKNOWLEDE

    PLANNING INTERVENTION RATIONALE EVALUATION

    OBJECTIVE:

    - Weight loss of 20-25 lb over a 2-monthperiod.

    Imbalanced nutrition:Less than bodyrequirements relatedto weight loss of 20-25 lbs as manifested

    by signs of GravesDisease.

    Graves' disease stopsyour body fromabsorbing maximumnutrients from yourfood. Eating a high-

    fat diet will slowdown your digestion

    process and will allowyour body to pullmore nutrients from

    your foods. This mayalso help with anyhunger you may

    experience as a resultof the disease. Foods

    that may help yourcondition include leanmeats, grains, fruits

    and vegetables.

    Graves' disease maycause weight loss.Increasing your daily

    caloric intake andeating foods withhigher fat content canhelp you gain weight.Once your disease is

    under control, youshould return to yourprevious calorieintake. Treatment of

    Graves' disease canalso lead to weight

    gain. If you shouldexperience this sideeffect, alter your diet

    so that you are eatingfewer calories but are

    also eating nutrient-rich foods. This willensure that your body

    After 2 weeks ofnursing interventionsthe patient will gain 1lb.

    INDEPENDENT:

    -Monitor daily foodintake. Weight daily

    -Do health teachingsabout foods that goodfor his case like:

    >Encourage the

    patient to eat andincrease number ofmeals and snacks,

    using high-caloricfoods that are easilydigested

    >Encourage the

    patient to eat glutenfree foods (e.g leanmeat, fish, andchicken or turkey.Beans, corn, rice,

    milk, unprocessedcheeses, and fresh orfrozen fruits orvegetables)

    >Encourage the

    patient to eatGoitrogenic foods (e.gBrussel sprouts,

    cauliflower, broccoli,cabbage, turnips, and

    the like)

    -Monitoring theweight of the patientwill be the baseline of

    the caloric intake iseffective or not

    - Increased Nutrients

    as part of a well-balanced diet arenecessary to meet

    metabolic demands.

    - eating gluten causes

    celiac disease, anintestinal conditioncharacterized by theinability to absorbnutrients from food.

    - Goitrogens are

    thyroid antagonists;create less toxicitywhen cooked

    After 2 weeks ofNursing Interventionsthe patient was able togain 1 lb.

    SSESSMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION

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    SSESSMENT NURSINGDIAGNOSIS

    BACKGROUNDKNOWLEDE

    PLANNING INTERVENTION RATIONALE EVALUATION

    gets all its necessarynutrients while

    lowering your risk forweight gain.

    The hypermetabolicstate causes

    gastrointestinalhypermotility, withnausea,

    vomiting,diarrhea,and abdominal pain.Although, the clientmay have anincreased appetite and

    eat more than usual,weight loss continues.

    -Avoid foods thatincreases peristalsis(e.g tea, coffee,apple,etc.,)

    COLLABORATIVE:

    -Consult with dietician

    to provide diet high incalories,Protein,Carbohydrates,

    Vitamins A,B,C,D,Eand Zinc andSelenium

    -Increased motility ofGIT may result indiarrhea and impairabsorption of needed

    nutrients)

    - Vitamins C and E

    should also be takenfor proper thyroidfunction.

    - Vit B important fordeveloping theimmune system andfor the proper

    functioning of thyroidgland

    -Vit D for properabsorption of calcium

    in the body,supplemented toavoid osteoporosisand promote good

    bone health

    - Mineralsupplements like zincand selenium are alsorequired for their

    antioxidant propertiesand development ofimmune system.

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    Naldo, Bridget

    Parayaoan, Ericka Judith

    Pascual, Anne Janelle

    Punzalan, Irene

    Quibod, CristinaSantos, Aiza

    Teodoro, Michelle Ann