System Identification
Based on the symptoms of EB, as well as her test results, it can be assumed that the patient is suffering from hyperthyroidism, which is a condition of hyperthyroidism. Hyperthyroidism is characterized by such symptoms as weight loss while maintaining appetite, heart palpitations, nervousness, irritability, hand tremors, excessive sweating, menstrual irregularities, fever, diarrhea, enlarged thyroid gland, fatigue, muscle weakness, insomnia, blurred vision, and exophthalmos. EB has most of them, including enlargement of the visible part of the eyeballs, increased heart rate and blood pressure, hand tremors, weight loss, anxiety, and trouble sleeping.
Wijesinghe (2020) affirms that the symptoms of hyperthyroidism can be disguised as various diseases of cardiovascular, nervous, digestive, and other organ systems. Thus, the identification of this syndrome is not always an easy task. Although EB has some cardiovascular disorders, including tachycardia and hypertension, this is not indicative of cardiac disease. This fact is also confirmed by the normal level of troponin and the absence of blockage of the coronary artery.
Moreover, abnormal levels of thyroid hormones, which support metabolic processes in the human body, speak in support of hyperthyroidism. A change in their concentration in the blood leads to a digestive disorder and disrupts the work of the cardiovascular and nervous systems. EB has an increase in T3 to 7.8 pmol/L when 2.0 to 7.0 pmol/L is normal. Triiodothyronine (T3) and thyroxine (T4) – reflect the total amount of hormones synthesized by the thyroid gland. According to Taylor et al. (2018), their level is usually increased with hyperthyroidism. T4 total may remain normal in asymptomatic forms of hyperthyroidism. Moreover, hyperthyroidism is characterized by a reduced level of TSH with normal values of thyroxine (T4). This is precisely what is observed in EB when TSH, although normal, is at its lowest limit, and T4 is normal.
Normal Functioning of Identified System
The thyroid gland is located on the neck under Adam’s apple and has the shape of a butterfly. It consists of two lobes connected by an isthmus, and its size is no larger than a walnut. The work of the thyroid gland depends on iodine, which enters the body with food. Thyroid hormones that regulate metabolism are synthesized from it.
The thyroid gland plays a vital role in the functioning of the body. It produces hormones, thyroxine (T4) and triiodothyronine (T3), which, released directly into the blood, affect all cells and tissues of the body, which influence the functions of all organs and systems. Specifically, thyroid hormones regulate metabolic rate, appetite, glucose breakdown and uptake by cells, nutrient absorption and intestinal motility, fat breakdown, cholesterol levels, heart rate and strength, respiratory rate, cellular oxygen consumption, blood flow, body temperature, and calcium in the body.
The body has a mechanism that allows it to maintain an almost constant level of thyroid hormones in the blood. This system is controlled by thyroid-stimulating hormone (TSH), which is produced by the part of the brain, the pituitary gland. This hormone performs the function of stimulating the thyroid gland and inducing the production of thyroid hormones (T4, T3).
Alterations in Normal Function
If the thyroid gland does not produce enough hormones, then the metabolic processes in the body slow down, and hypothyroidism develops. On the contrary, if there is more thyroid hormone than necessary, the metabolism increases, and the opposite state of hypothyroidism develops – hyperthyroidism. Doenges et al. (2019) note that hyperthyroidism is a common pathology that leads to severe complications that can significantly reduce a person’s quality of life. An increase in the level of thyroid hormones in the blood accelerates metabolic processes in the body and hurts almost all organ systems.
The cardiovascular system is one of the main targets of the action of thyroid hormones. According to Khan et al. (2020), thyroid dysfunction is associated with higher morbidity and mortality from cardiovascular disease. Moreover, even fluctuations in thyroid hormone levels within normal limits may be associated with the risk of adverse cardiovascular events. Hyperthyroidism affects the cardiovascular system, which can be manifested by bradycardia, increased diastolic blood pressure, tachycardia, and fluid in the pericardium. The patient does not tolerate physical activity, and there is a violation of the heart rhythm.
However, the effects are reversible. Lane et al. (2020) note that the signs of arrhythmia are completely cured after the elimination of hyperthyroidism. In this regard, the timely detection of thyroid diseases is the key to successful treatment, leading to an increase in the quality of life.
Labs, Tests, Medications, and/or Other Treatments
When hyperthyroidism is suspected, the patient has prescribed an ultrasound of the thyroid gland to determine the size and structure of the gland, the nature of pathological changes, and the number and size of nodes. When visualizing nodes and focal formations in the thyroid gland, an ultrasound of the thyroid gland with elastography is prescribed, as well as a biopsy of the formation if a malignant process is suspected. Furthermore, tests such as CBC, the total protein test, blood glucose test, cholesterol test, a calcium blood test, Serum Calcitonin, Iodine Uptake Scan, and Thyroid Scan are helpful. In a clinical blood test, an increase in the level of leukocytes, ESR can be observed, which may indirectly indicate an inflammatory process in the tissues of the thyroid gland (Wijesinghe, 2020). In hyperthyroidism, the levels of total protein, glucose, and cholesterol may be reduced, and the amount of calcium may increase. With hyperfunction of the thyroid gland, the amount of calcitonin in the serum may also increase.
An Iodine Uptake Scan is done to check thyroid function when thyroid function blood tests show that a person may have an overactive thyroid. This test measures thyroid function by determining how much iodine is absorbed by the thyroid gland. Lane et al. (2020) note that high absorption of radioactive iodine indicates that the thyroid gland produces too much thyroxine. The most likely cause is either Graves’ disease or hyperfunctioning thyroid nodules. If the patient has hyperthyroidism and low absorption of radioactive iodine, this indicates that thyroxine stored in the gland is entering the bloodstream, which may indicate thyroiditis.
A thyroid Scan will show how iodine accumulates in the thyroid gland. This test is done to evaluate thyroid nodules or goiters and look for the cause of an overactive thyroid. Normal test results will show that the thyroid is the standard size, shape, and location (Doenges et al., 2019). This is a solid gray color in a computer image with no darker or lighter areas. Abnormal results will show darker or lighter nodules that absorb more or less iodine. Darker nodules absorb more iodine; they may be overactive and may be the cause of an overactive thyroid.
Furthermore, such tests as antibodies to TSH receptors, thyroperoxidase, and thyroglobulin may be prescribed. Antibodies to TSH receptors are protective proteins of the immune system that, in pathology, are produced to receptors located on thyroid cells, stimulating the production of T3 and T4. In turn, thyroperoxidase is an enzyme responsible for the activation of the iodine molecule and its inclusion in the synthesis of thyroid hormones. According to Doenges et al. (2019), an increase in the production of such antibodies speaks in favor of an autoimmune process. Thyroglobulin is a protein from which thyroid hormones are formed. An increase in their titer may also indicate favor of an autoimmune lesion.
Treatment consists of antithyroid drugs, such as methimazole (tapazole) and propylthiouracil, and radioactive iodine drugs, which suppress the overactive thyroid gland. Also, as a symptomatic treatment, B-blockers can be used to relieve symptoms of hyperthyroidism, such as tremors, heart palpitations, and palpitations. For the treatment of eye manifestations in the initial stages, moisturizing eye drops are used.
Moreover, it is recommended to balance nutrition according to BJU and introduce foods rich in vitamins A, B, and C and minerals into the diet. Diet and hydrotherapy help not only in the prevention of hyperthyroidism but also in the rehabilitation of patients after treatment. Refusal of bad habits, walks in the fresh air, and emotional stability will help maintain health not only in the endocrine system, but throughout the body.
Appropriate Nursing Interventions
Nursing interventions in hyperthyroidism should be aimed at all links in the pathogenesis of the disease and be carried out taking into account the type of disease, the severity of the course, the main symptoms, the state of compensation, the side effects of pharmacotherapy, and possible complications in order to prevent them. Gulanick and Myers (2021) assert that the nurse ensures that the patient complies with the motor and nutritional regimen prescribed by the doctor, the timely and correct intake of drugs and the control of their side effects, control of blood pressure, respiratory rate, heart rate, and preparing the patient for laboratory and instrumental studies.
Since EB has the adverse cardiovascular consequences of hyperthyroidism, the nurse should pay special attention to these conditions. Blood pressure monitoring, assessment of pulse and heart rate, and control of chest pain are necessary. Because EB has experienced weight loss, daily weight monitoring and a balanced diet are essential. The nurse should encourage the patient to eat and offer high-calorie foods that are easy to digest. In the case of prescribing drugs, it is necessary to administer them in the indicated dosage and form. Because EB suffers from anxiety and has trouble sleeping, the nurse needs to watch for behaviors that indicate levels of anxiety. Moreover, the nurse should reduce external stimuli, including being placed in a quiet room, providing soft, soothing music, reducing bright lights, and reducing the number of people in contact with the patient.
The nurse should conduct a detailed conversation with the patient and her relatives about the causes and symptoms of the disease. Recommend popular literature on lifestyle with this disease. Conduct a conversation about the need for strict adherence to diet, behavior, and use of drugs, their therapeutic and side effects.
References
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis.
Gulanick, M. & Myers, J. L. (2021). Nursing care plans: Diagnoses, intervention, & outcomes (10th ed.). Mosby.
Khan, R., Sikanderkhel, S., Gui, J., Adeniyi, A. R., O’Dell, K., Erickson, M., Malpartida, J., Mufti, Z., Khan, T., Mufti, H., Al-Adwan, S. A., Alvarez, D., Davis, J., Pendley, J., & Patel, D. (2020). Thyroid and cardiovascular disease: A focused review on the impact of hyperthyroidism in heart failure. Cardiology Research, 11(2), 68–75. Web.
Lane, L. C., Cheetham, T. D., Perros, P., & Pearce, S. H. (2020). New therapeutic horizons for Graves’ hyperthyroidism. Endocrine Reviews, 41(6), 873-884.
Taylor, P. N., Albrecht, D., Scholz, A., Gutierrez-Buey, G., Lazarus, J. H., Dayan, C. M., & Okosieme, O. E. (2018). Global epidemiology of hyperthyroidism and hypothyroidism. Nature Reviews Endocrinology, 14(5), 301-316.
Wijesinghe, S. (2020). 101 primary care case studies: A workbook for clinical and bedside skills. Springer Publishing Company.