grave's disease oveview

8/13/2019 Grave's disease oveview

1/22


2/22

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


3/22


4/22

Bilateral proptosis

Diplopia on superior

and lateral gaze

Minimal lid lag

Conjunctival

injection bilaterally,

no ulceration


5/22

Thyroid glandvisibly, palpably

enlarged 3 fold, smooth, symmetrical,

nontender Bruitright lobe of the thyroid gland


6/22

3 months PTAGraves disease with

hyperthyroidism

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


7/22


8/22


9/22

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


10/22

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


11/22

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


12/22


13/22

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.


14/22

(-) Thyroid dysfunction treatment

(-) History of radiation to the head &

neck (-) Use of goitrogens

(-) History of psychiatric illness or

thyroid diseases.


15/22

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.


16/22

Start of Risperidone and thyroid

medications.

No auditory and visual hallucinations orparanoid ideas


17/22

Psychosis secondary to uncontrolled

hyperthyroidism


18/22

Included psychotic disorder not

otherwise specified (DSMIV) probably

secondary to uncontrolledhyperthyroidism.

DSMIV schizophreniform disorder

was included in differential diagnosis.


19/22

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


20/22

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.


21/22


22/22

Naldo, Bridget

Parayaoan, Ericka Judith

Pascual, Anne Janelle

Punzalan, Irene

Quibod, CristinaSantos, Aiza

Teodoro, Michelle Ann

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