Hyperthyroidism

CHAPTER I

INTRODUCTION

           Hyperthyroidism, a term for overactive tissue within the thyroid gland, resulting in overproduction and thus an

excess of circulating free thyroid hormones: thyroxine (T4), triiodothyronine (T3) or both. Thyroid hormone is

important at a cellular level, affecting nearly every type of tissue in the body. It functions as a stimulus to metabolism,

and is critical to normal function of the cell.

            Hyperthyroidism, considered as the second most common endocrine disorder. It results from an excessive

output of thyroid hormones due to abnormal stimulation of the thyroid gland by circulating immunoglobulin. This

disorder affects women eight times more frequently than men and peaks between the second and fourth decades of

life. It generally occurs between 20 and 40 years old and is more common in females.

             Weight loss, exopthalmos (protrusion of the eyeballs), hypertension, and heat intolerance: these are some of

the signs and symptoms of Hyperthyroidism. Neurological manifestations can include tremors, irritability and

restlessness.              

Hyperthyroidism is the most common endocrine disorder that’s why we choose this as our case study

because of its relevance to our concept about disturbance in metabolism and endocrine. Since metabolism is all the

chemical and physical processes which occur in living organisms and that maintain life and growth, endocrine is

specifically producing secretions that are distributed in the body by the blood stream. Like with our patient with

hyperthyroidism, there is an excess T4 (thyroxine) and T3 (triiodothyronine) and decreased of TSH (Thyroid

Stimulating Hormone) that affects his metabolism (Medical surgical Nursing; Joyce Young Johnson).

ANATOMY AND PHYSIOLOGY

Thyroid Gland

The thyroid is one of the largest endocrine glands in the body. This gland is found in the neck inferior to

(below) the thyroid cartilage (also known as the Adam's apple in men) and at approximately the same level as the

cricoid cartilage. The thyroid controls how quickly the body burns energy, makes proteins, and how sensitive the body

should be to other hormones.

The thyroid participates in these processes by producing thyroid hormones, principally thyroxine (T4) and

triiodothyronine (T3). These hormones regulate the rate of metabolism and affect the growth and rate of function of

many other systems in the body. Iodine is an essential component of both T3 and T4. The thyroid also produces the

hormone calcitonin, which plays a role in calcium homeostasis.

The thyroid is controlled by the hypothalamus and pituitary. The gland gets its name from the Greek word for

"shield", after the shape of the related thyroid cartilage. Hyperthyroidism (overactive thyroid) and hypothyroidism

(underactive thyroid) are the most common problems of the thyroid gland.

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Anatomy

The thyroid gland is butterfly-shaped organ and is composed of two cone-like lobes or wings: lobus dexter

(right lobe) and lobus sinister (left lobe), connected with the isthmus. The organ is situated on the anterior side of the

neck, lying against and around the larynx and trachea, reaching posteriorly the oesophagus and carotid sheath. It

starts cranially at the oblique line on the thyroid cartilage (just below the laryngeal prominence or Adam's apple) and

extends inferiorly to the fourth to sixth tracheal ring. It is difficult to demarcate the gland's upper and lower border

with vertebral levels as it moves position in relation to these during swallowing.

The thyroid gland is covered by a fibrous sheath, the capsula glandulae thyroidea, composed of an internal

and external layer. The external layer is anteriorly continuous with the lamina pretrachealis fasciae cervicalis and

posteriorolaterally continuous with the carotid sheath. The gland is covered anteriorly with infrahyoid muscles and

laterally with the sternocleidomastoid muscle. Posteriorly, the gland is fixed to the cricoid and tracheal cartilage and

cricopharyngeus muscle by a thickening of the fascia to form the posterior suspensory ligament of Berry. In variable

extent, Zuckerkandl's tubercle, a pyramidal extension of the thyroid lobe, is present at the most posterior side of the

lobe. In this region the recurrent laryngeal nerve and the inferior thyroid artery pass next to or in the ligament and

tubercle. Between the two layers of the capsule and on the posterior side of the lobes there are on each side two

parathyroid glands.

The thyroid isthmus is variable in presence and size, and can encompass a cranially extending pyramid lobe

(lobus pyramidalis or processus pyramidalis), remnant of the thyroglossal duct. The thyroid is one of the larger

endocrine glands, weighing 2-3 grams in neonates and 18-60 grams in adults, and is increased in pregnancy

The thyroid is supplied with arterial blood from the superior thyroid artery, a branch of the external carotid

artery, and the inferior thyroid artery, a branch of the thyrocervical trunk, and sometimes by the thyroid ima artery,

branching directly from the aortic arch. The venous blood is drained via superior thyroid veins, draining in the internal

jugular vein, and via inferior thyroid veins, draining via the plexus thyroideus impar in the left brachiocephalic vein.

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Lymphatic drainage passes frequently the lateral deep cervical lymph nodes and the pre- and parathracheal lymph

nodes. The gland is supplied by sympathetic nerve input from the superior cervical ganglion and the cervicothoracic

ganglion of the sympathetic trunk, and by parasympathetic nerve input from the superior laryngeal nerve and the

recurrent laryngeal nerve..

Physiology

The primary function of the thyroid is production of the hormones thyroxine (T4), triiodothyronine (T3), and

calcitonin. Up to 80% of the T4 is converted to T3 by peripheral organs such as the liver, kidney and spleen. T3 is

about ten times more active than T4. T3 and T4 production and action

Thyroxine (T4) is synthesised by the follicular cells from free tyrosine and on the tyrosine residues of the

protein called thyroglobulin (TG). Iodine is captured with the "iodine trap" by the hydrogen peroxide generated by the

enzyme thyroid peroxidase (TPO) and linked to the 3' and 5' sites of the benzene ring of the tyrosine residues on TG,

and on free tyrosine. Upon stimulation by the thyroid-stimulating hormone (TSH), the follicular cells reabsorb TG and

proteolytically cleave the iodinated tyrosines from TG, forming T4 and T3 (in T3, one iodine is absent compared to T4),

and releasing them into the blood. Deiodinase enzymes convert T4 to T3. Thyroid hormone that is secreted from the

gland is about 90% T4 and about 10% T3.

Cells of the brain are a major target for the thyroid hormones T3 and T4. Thyroid hormones play a particularly

crucial role in brain maturation during fetal development. A transport protein (OATP1C1) has been identified that

seems to be important for T4 transport across the blood brain barrier. A second transport protein (MCT8) is important

for T3 transport across brain cell membranes.

In the blood, T4 and T3 are partially bound to thyroxine-binding globulin, transthyretin and albumin. Only a

very small fraction of the circulating hormone is free (unbound) - T4 0.03% and T3 0.3%. Only the free fraction has

hormonal activity. As with the steroid hormones and retinoic acid, thyroid hormones cross the cell membrane and bind

to intracellular receptors (α1, α2, β1 and β2), which act alone, in pairs or together with the retinoid X-receptor as

transcription factors to modulate DNA transcription.

T3 and T4 regulation

The production of thyroxine and triiodothyronine is regulated by thyroid-stimulating hormone (TSH), released

by the anterior pituitary (that is in turn released as a result of TRH release by the hypothalamus). The thyroid and

thyrotropes form a negative feedback loop: TSH production is suppressed when the T4 levels are high, and vice versa.

The TSH production itself is modulated by thyrotropin-releasing hormone (TRH), which is produced by the

hypothalamus and secreted at an increased rate in situations such as cold (in which an accelerated metabolism would

generate more heat). TSH production is blunted by somatostatin (SRIH), rising levels of glucocorticoids and sex

hormones (estrogen and testosterone), and excessively high blood iodide concentration.

Calcitonin

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An additional hormone produced by the thyroid contributes to the regulation of blood calcium levels.

Parafollicular cells produce calcitonin in response to hypercalcemia. Calcitonin stimulates movement of calcium into

bone, in opposition to the effects of parathyroid hormone (PTH). However, calcitonin seems far less essential than PTH,

as calcium metabolism remains clinically normal after removal of the thyroid, but not the parathyroids.

PATHOPHYSIOLOGY

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Modifiable

HYPERTHYROIDISM

CHAPTER IV

PRESENTATION AND

ANALIZATION OF DATA

DEMOGRAPHIC PROFILE

Patient’s name: Mr. Bean

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Non-modifiable

Diet

Increase TSH stimulation to the Pituitary Gland

Stimulation of Thyroid Hormone

Increase in T3 and T4

Hormonal Imbalance

Age

Lifestyle Gender

Occupation Health History

Nutrition

Multi-system Changes

Musculo-skeletal System

Integu-mentary

CV Neuro-logical

Eyes

Psycho-logical

Respira-tory System

Physical

Enlarge Thyroid gland

Exopthalmos

HR

BP

RR

Weight Loss

Appetite

Anxiety

InsomniaRestless

Fine Tremors

Sweating

Heat Intolerance

Irritability

Heavy drinker Navy

Age: 28 yrs old

Gender: Male

Address: Habay Bacoor, Cavite

Educational Attainment: College Graduate ( Nautical Engineering)

Employment: Navy

History of Present illness:

Few months PTA the pt increased his appetite but he didn’t gain weight instead he lost some weight. He

usually had an insomnia and restless on the rest of the day. He also experienced occasionally palpitation and fine

tremors.

Few days PTA the pt vomits all the foods he ate and experiencing fine tremors in his extremities.

On the day of his admission he experience severe palpitation/ tachycardia and he felt lightheadedness and

loss his consciousness that’s prompted his admission in one of the Tertiary Hospital in Cavite City.

History of Past Medical History

The patient was a fully immunized child except measles and chickenpox and no allergy in any medicines.

Patient had a primary KOCH’s during his childhood years but treated at 7 years old. The patient had different

diseases during his childhood he had measles and chickenpox which prompted his several admissions to hospital.

Family History of

Mother Side: Hypertension and Diabetes Mellitus

Father Side: Hypertension

Personal/ Social History

He usually had sedentary lifestyle. He likes to eat cabbage very often and he did’t usually eat fish.

He is an heavy alcohol drinker since he was in high school. He can drink up to 2 long necks of hard drinks like

emperador.

Patient Clinical Record

Final Diagnosis: Hyperthyroidism

Chief Complain: Loss of consciousness

Reason for Admission: For evaluation and management

Date of Admission: November 20, 2008

Weight: BEFORE 60 kg Height: 5’ 6”

AFTER 52 kg

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General survey

Receive patient alert, conscious, restless and coherent.

Review of System and Physical Examination

Dec. 3, 2008

Pulse: 120 bpm

BP: 140/90 mmHg

Temp: 36.5 ˚C

RR: 27 cpm

Physical Assessment

SKIN

HAIR

Areas to assess Findings

Characteristics Resilient, silky hair

SCALP

Areas to assess Findings

Characteristics Shiny and smooth without lesions, masses or

mumps

Deformities No trauma deformities

Redness or scaliness No redness or scaliness

SKULL

Areas to assess Findings

Characteristics Rounded and smooth skull contour without any

sings of enlargement.

Symmetry of facial features and movement Symmetrical in facial features and movement

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BMI= wt. in kg/ (ht. in m) ²

EYES

Areas to assess Findings

Characteristics Pink conjunctiva, anicteric sclera

Symmetry of eye features and movement Bilateral Exopthalmus; [+] PERRLA

NECK

Areas to assess Findings

Symmetry

Thyroid gland

Enlarged and palpable mass on anterior portion of the

neck

Presence of mass during palpitation

Nails

Areas to assess Findings

Capillary refill [-] slow capillary refill, [-] crushing pain

LUNGS

Areas to assess Findings

Characteristics [-] wheezes, [-] masses, [-] cough.

Musculoskeletal

Areas to assess Findings

Characteristics Fine tremors

Neurologic

Areas to assess Findings

Characteristics Irritable and restless

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ABDOMEN

Areas to assess Findings

Characteristics [+] symmetrical, [-] bruit sound, [-] pain.

After physical assessment there was no abnormalities expect for resilient and silky hair, bilateral

exopthalmus of his eyes, excessive sweating of his skin, enlarged and palpable mass on the anterior

portion of the neck, fine tremors, irritable and restless.

Diagnostic Test Results

Date: November 29, 2008

Examination/s Requested Results Normal Values Interpretation

T3 7.98 2.2-6.8 pmol/L Increased

T4 33.81 10.3-25.74 pmol/L Increased

TSH 0.04 0.3-5.0Uiu/ML Decreased

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Date: December 9, 2008

Examination/s Requested Results Normal Values Interpretation

T3 7.7 2.2-6.8 pmol/L Increased

T4 29.8 10.3-25.74 pmol/L Increased

TSH 0.1 0.3-5.0Uiu/ML Decreased

Date: January 15, 2009

Examination/s Requested Results Normal Values Interpretation

T3 7 2.2-6.8 pmol/L Increased

T4 26 10.3-25.74 pmol/L Increased

TSH 0.2 0.3-5.0Uiu/ML Decreased

Interpretation

The diagnostic result was increased T3 AND T4 this result indicate that the patient has a

hyperthyroidism. TSH is low it also an indicative of hyperthyroidism.

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3.) Anxiety (mild) related to increased stimulation secondary to excessive thyroid hormone secretion

5.) Disturbed sleep pattern related to daytime activity pattern

4.) Fatigue related to increased energy requirements secondary to hypermetabolic state

6.) Disturbed body image related to disease process (hyperthyroidism)

Patient’s name: Mr. BeanAge: 28 yrs oldGender: Male

Increased appetiteHeat toleranceFatigueAnxietyInsomniaBilateral exopthalmosWeight lossRestlessTremors (fine)Increase sweatingIrritability Silky resilient hair

Vital signs:PR: 120 bpmBP: 140/90 mmHgTemp: 36.5 °CRR: 27 cpm

1.) Increase cardiac workload related to hypermetabolic state

2.) Imbalanced nutrition: less than body requirements related to hyper metabolic state secondary to excessive thyroid hormone secretion

CONCEPT MAP

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Interpretation of Concept Map

1.) The first priority nursing diagnosis is cardiac output; risk for decrease. Because of the heart

inadequately pump blood to meet metabolic demands of the body. It should be prioritized based on the

ABC principle (Airway, Breathing and Circulation). The heart inadequately pumped blood it results to

inadequate oxygenation of the body. Which manifest the patient to restlessness, irritability, fatigue and

with vital signs of BP 140/90 mmHg, PR 120 bpm and RR 27 cpm.

Appropriate nursing interventions should be done for the patient to have adequate cardiac output

(Blood pressure, pulse rate and respiratory rate) within normal parameters.

2.) The second priority nursing is imbalanced nutrition: less than body requirements. Because the patients

body is having intake of nutrients insufficient to meet the metabolic needs of the body; which is cause by

hyper metabolic state secondary to excessive thyroid hormone secretion. Nursing interventions needs to

be formulated for the patient, to be able to consume adequate nourishment needed by the body based to

patient’s weight age and height.

3.) The third priority nursing diagnosis is anxiety. Patient is irritable, has insomnia, intolerance to heat,

restless, fatigue, has fine tremors, increased sweating, and has a respiratory rate of 27 cpm. Anxiety is an

alerting signal that warns of impending danger and because of the formulated nursing interventions the

patient will be able to take the verbalized feeling of anxiety and measures to deal with it.

4.) The fourth priority nursing diagnosis is fatigue. Based on the assessment done the patient is

manifesting fine tremors, anxiety, increased sweating and verbalizing lack of energy with vital signs of

pulse rate 129 bpm, blood pressure 140/90 mmHg and respiratory rate 27 cpm. Appropriate nursing

interventions are necessary to increase energy and improved well-being of the patient. Because fatigue is

an overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work at

usual level.

5.) The fifth priority nursing diagnosis is disturbed sleep pattern. Patient is verbally complaining of

difficulty falling asleep and based on the assessment done he is irritable, have fine tremors and unilateral

exopthalmos. Time- limited disruption of sleep this is what the patient experiencing. Which can affect the

recovery of the patient that is, why necessary nursing interventions should be done.

6.) The last priority nursing diagnosis disturbed body image. Disturbed body image means confusion in

mental picture of one’s physical self. The patient is manifesting weight loss, unilateral exopthalmos, silky

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resilient hair and he is shy at first. That’s why necessary nursing interventions should be done for the

patient to accept the change or loss and change in his lifestyle.

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Assessment Nursing Diagnosis

Planning Intervention Rationale Evaluation

Subjective:“ madali nga ako mapagod” as verbalized by the patient

Objective:

- Restless- Irritability- fatigue

Vital Signs:

- BP: 140/90 mmHg

- PR: 120 bpm- RR: 27 cpm

Increased cardiac workload related to hypermetabolic as evidenced by increase blood pressure, pulse rate and respiratory rate

At 4 hours of nursing intervention the patient will be able to maintain adequate cardiac output as evidence by stable vital signs as follows blood pressure (from 140/90 to 120/80) , pulse rate (120- 60-100 bpm) and respiratory rate (27- 20bpm).

Independent: Monitor vital signs

especially blood pressure

Place the client in semi-Fowler’s position or position of comfort

Provide restful environment

Dependent: Maintain adequate

nutrition and fluid balance as ordered by the physician

( low iodine and low root crops foods)

Collaborative: Administer Beta

Blockers (Propanolol) Inderal as ordered).

May indicate compensatory changes in stroke volume

Elevating the head may decrease cardiac work load

Rest periods decrease oxygen consumption

To provide proper nourishment to the patient

Decreases heart rate/ cardiac work by blocking conversion of T3 to T4.

After 4 hours of rendering nursing intervention the patient was able to maintain adequate cardiac output as evidence by stable vital signs as follows blood pressure (120/80) , pulse rate (110 bpm) and respiratory rate (24bpm)

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Assessment Nursing Diagnosis

Planning Intervention Rationale Evaluation

Subjective:

“Pumayat talaga ako, maski malakas ako kumain, ganito siguro talaga pag may goiter” as verbalized by the patient

Objective:

- Increased appetite- Weight loss

(Weight before: 60 kg)(Weight now: 52 kg)

- Restless- Irritability

Imbalanced nutrition: less than body requirements related to hyper metabolic state secondary to excessive thyroid hormone secretion as evidenced by weight loss, restlessness and irritability.

At 4 hours of nursing intervention the patient will be able to consume adequate nourishment.

Independent: Provided good

oral hygiene before and after meals

Monitor food intake

Encourage patient to eat and increase meals and snaks with high calorie that are easily digested

Instruct the patient to avoid foods that increased peristalsis (eg. Tea. Coffee, fibrous and highly seasoned foods) and fluids that causes diarrhea (eg. Apple/ prune juice).

Provide relaxing and pleasant environment

Dependent: Determine

healthy body weight for age and height

Collaborative: Administer

medication indicated

(vitamin B complex)

To enhance client’s appetite and ability to eat

Continued weight loss in face of adequate caloric intake may indicate failure of anti- thyroid therapy.

Keeping enough caloric intake aids in hypermetabolic state

It is increased GI motility may result in diarrhea and impair absorption of needed nutrients

To enhance the intake ability

To provide patient the appropriate diet

To meet energy requirements

After 4 hours of rendering nursing intervention the patient was able to consume adequate nourishment.

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AssessmentNursing

DiagnosisPlanning Intervention Rationale Evaluation

Subjective:“ naiinip na ako dito” as verbalized by the patient

Objective:

- Irritability- Restless- Fatigue- Tremors (fine)- Increased

sweating- Increased

respiration(RR 27 cpm)

Anxiety (mild) related to increased stimulation secondary to excessive thyroid hormone secretion as evidenced by irritability, insomnia, restlessness, tremors( fine), increased sweating, and increased respiration

At 8hours of nursing intervention the patient will be able to verbalize feelings of anxiety

Independent:

Observe behavior indicative of level of anxiety

Establish therapeutic relationship

Stay with patient, maintaining calm manner.

Speak in brief statements, using simple words.

Provide comfort measures (putting up the bed siderails and don’t leave the client alone at bedside)

Encourage client to express feelings

Provide accurate information about the situation

Dependent:

Review coping strategies or mechanism

Mild anxiety is manifested by irritability and insomnia

To have an open communication

To establish rapport.

Attention span may be shortened, concentration reduced, limiting ability to assimilate information.

To promote clients safety.

To know the coping strategy of the client

Helps the patient to know the realit

To determine those that might be helpful to the current situation of the patient

After 8 hours of rendering nursing intervention the patient was able to verbalized feelings of anxiety

AssessmentNursing

DiagnosisPlanning Intervention Rationale Evaluation

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Subjective:

“eto madali ako mapagod” as verbalized by the patient Objective:

- Tremors (fine)- Heat

intolerance- Restless - Increased

sweating

Vital signs:

PR: 120 bpmBP: 140/90 mmHgRR: 27 cpm

Fatigue related to hypermetabolic state with increases energy requirementsas evidenced by fine tremors, anxiety, incresed sweating with vital signs of pulse rate 120 bpm, blood pressure of 140,90 mmHg and respiratory rate of 27 cpm

At 8 hours of nursing intervention the patient will be able to verbalize increased energy and improve well-being

Independent:

Monitor vital signs (especially pulse rate)

Provide quiet environment

Encourage patient to restrict activity and rest as much as possible

Provide diversional activities (e.g reading, radio, television)

Evaluate need for assistance or assistive devices

Assist with self care needs; keep bed in low position and travel ways clear of furniture

To note if there is tachycardia or incresed in pulse rate

Reduces stimuli that may aggravate hyperactivity or to relief fatigue

Helps to counteract effects of increased metabolism

May reduce anxiety

To know what are the needs of the patient

For easy access and to avoid accidents

After 8 hours of rendering nursing intervention the patient was able to verbalized increased energy and improved well-being

Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

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Subjective:

“Hindi ako masyado nakatulog kagabi, kumakabog yung dibdib ko” as verbalized by the patient

Objective:

- Irritability- fatigue- tremors (fine)- Presence of

eyebags on.- Frequent

yawning.

Disturbed sleep pattern related to daytime activity pattern as evidenced by irritabilitytremors (fine)Presence of eye bags.Frequent yawning.

Long Term: After 24 hours of nursing intervention the patient will be able to identify the different measures how to obtain a normal sleeping pattern evidenced by non- irritable, relax, and absence of eye bags, and no frequent yawning.

Independent:

Provided quiet environment and comfort measures (e.g backrub, washing hands and face, cleaning and straitening sheets) in preparation to sleep.

Recommended limiting intake of chocolate and caffeine/alcoholic beverages esp. prior to bedtime

Encourage the client to develop a bedtime ritual that includes quiet activities such as reading pocketbooks or watching television

Dependent:

Obtain history including bed time routines

To enhance client ability to fall asleep.

Caffeine increases awaking time during the night. A full stomach interferes with sleep

Effective in inducing and maintaining sleep

To monitor clients sleeping pattern.

Long Term: After 24 hours of rendering nursing intervention the patient was be able to obtained the different measures of an 8 hours normal sleeping pattern as evidenced by (-) irritability, relax, and minimal yawning.

Assessment Nursing Diagnosis

Planning Intervention Rationale Evaluation

Subjective:

“Para nga ko si Garfield yung dalawa kong mata,

Disturbed body image related to disease process

Long Term:After 2 days of nursing intervention the

Independent:

Encourage client to make own

For support to patient about his illness

Long Term:After 2 days of rendering nursing intervention the

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ang laki.” As verbalized by the patient

Objective:

- Bilateral exopthalmos

- Silky resilient hair- Shy at first- Weight loss

(Weight before: 60 kg)(Weight now: 52 kg)

(hyperthyroidism) as evidence by, bilateral exopthalmos.

patient will be able to demonstrate acceptance of self image as evidence by interact with the nurse on duty, and student nurses

decisions and accept both inadequacies and strengths

Assess for and promote good nutrition and sleep patterns

Acknowledge coping mechanisms as a normal feelings when adjusting to changes in body and lifestyle

Encourage client to verbalize feelings

Dependent:

Encourage significant other to offer support

Alert staff or significant others to monitor facial expressions and nonverbal behaviors

Good nutrition and sleep patters promote faster healing and better coping

Assist the client to

coping to renewed sense of well-being & increases trust between the nurse and patient.

To enhance coping or handling his situation

Social support enhances both emotional and physical health

To have acceptance and not embarrassed the patient when his appearance is affected

patient was able to accept self image as evidenced by interaction with the student nurses

DRUG STUDY

Name Mode of Action Indications Contraindications Adverse Effects Nursing Interventions

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Generic Name:methimazole

Brand Name:Tapazole 10 mg

Dose: 10 mg

Route: PO

Frequency: q6

Increases metabolic rate, cardiac output and protein synthesis. Useful for treating thyrotoxic crisis and in preparation for subtotal thyroidectomy.

For treating Hyperthyroidism

Thyrotoxicosis, myocardial infarction and severe renal disease

Side effects:Nausea and vomiting, diarrhea, cramps, tremors, nervousness, insomnia, headache and weight loss

Adverse Effects:Tachycardia, hypertension and palpitations

Instruct patient to take the drug with meals to decrease gastrointestinal symptoms

Advise patient about the effects of iodine and its presence in iodized salt, shellfish and OTC cough medicines

Emphasize the importance of drug compliance; abruptly stopping the antithyroid drug could bring on a thyroid crisis

Teach patient the signs and symptoms of hypothyroidism: lethargy, puffy eyelids and face, thick tongue, slow speech with hoarseness, lack of perspiration and slow pulse. Hypothyroidism may result to treatment of Hyperthyroidism

Name Mode of Action Indications Contraindications Adverse Effects Nursing Interventions

Generic Name: Selectively blocks To control Second and Third Side Effects: Monitor vital signs

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propanolol Hcl

Brand Name:Inderal 20 mg

Dose: 20 mg

Route: PO

Frequency: OD

beta - adrenergic receptor sites, decreases sympathetic outflow to the periphery, suppresses rennin- angiotensin-aldosterone system

hypertension and management for thyrotoxicosis

degree heart block, cardiogenic shock, CHF, sinus bradycardia

Caution: Hepatic, renal or thyroid dysfunction; asthma; peripheral vascular disease; type 1 diabetes mellitus

Bradycardia, thrombocytopenia,drowsiness, dry mouth and dizziness

Adverse Effects:Complete heart block, bronchospasm, agranulocytosis

especially blood pressure and pulse

Instruct patient to comply with drug regimen: abrupt discontinuation of antihypertensive drug may cause rebound hypertension

Advise patient that antihypertensives may cause dizziness resulting from orthostatic hypotension. Instruct patient to remain in a sitting position for several minutes before standing

Encourage patient to increase fluid intake

Instruct client to avoid excessive intake of alcoholic beverages. Alcohol can cause vitamin B complex deficiencies

Name Mode of Action Indications Contraindications Adverse Effects Nursing Interventions

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Generic Name:Vitamin B Complex

Brand Name:Nevramin

Route: PO

Frequency: OD

Water- soluble vitamins are not stored in the body and are readily excreted in the urine. Protein binding of water – soluble vitamins is minimal.

To treat peripheral neuritis, essential for building block of nucleic acids, red blood cell formation and synthesis of hemoglobin

Patient with liver dysfunction

GI irritation and vasodilation, resulting in flushing sensation

Instruct client to take the prescribed amount of drug.

Advise client to check the expiration dates on vitamin containers before purchasing and taking them. Potency of the vitamin is reduced after the expiration date.

Advise client to eat a well-balanced diet that includes the recommended amounts and types of food detailed in the food pyramid

Encourage patient to eat foods high in Vitamin B such as grains, cereal, bread and meats

Instruct client to avoid excessive intake of alcoholic beverages. Alcohol can cause vitamin B complex deficiencies

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