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.

1
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

2
jugular vein, and via inferior thyroid veins, draining via the plexus thyroideus impar in the left brachiocephalic vein.

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

3
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

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.

4
 PATHOPHYSIOLOGY

HYPERTHYROIDISM

Modifiable
Non-modifiable

Diet Age
• Heavy drinker
Lifestyle Gender
• Navy

Occupation Health History

Increase TSH stimulation to the

Pituitary Gland

Stimulation of Thyroid
Hormone

Increase in T3 and T4

Hormonal Imbalance

Multi-system Changes

Physical CV Nutrition Neuro-

Musculo- Psycho- Integu-
skeletal logical mentary logical
HR System
Enlarge Weight
Thyroid BP Loss Anxiety
gland Sweating Irritability
Appetite Restless
Insomnia
Respira- Heat
tory Fine
Eyes Tremors Intolerance
System

Exopthalmos
RR
5
 CHAPTER IV

PRESENTATION AND ANALIZATION OF DATA

DEMOGRAPHIC PROFILE

Patient’s name: Mr. Bean

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

6
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

BMI= wt. in kg/ (ht. in m)²

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

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 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

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 Enlarged and palpable mass on anterior portion of the

neck

Thyroid gland 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

8
Areas to assess Findings
Characteristics Irritable and restless

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

9
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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 CONCEPT MAP

2.) Imbalanced
Patient’s name: Mr. Bean nutrition: less than
1.) Increase cardiac Age: 28 yrs old body requirements
workload related to Gender: Male related to hyper
hypermetabolic state metabolic state
Increased appetite secondary to excessive
Heat tolerance thyroid hormone
Fatigue secretion
Anxiety
Insomnia
Bilateral exopthalmos
6.) Disturbed body Weight loss
image related to disease Restless 3.) Anxiety (mild) related to
process Tremors (fine) increased stimulation secondary
(hyperthyroidism) Increase sweating to excessive thyroid hormone
Irritability secretion
Silky resilient hair

5.) Disturbed sleep 4.) Fatigue related to

pattern related to Vital signs:
PR: 120 bpm increased energy requirements
daytime activity secondary to hypermetabolic
pattern BP: 140/90 mmHg
Temp: 36.5 °C state
RR: 27 cpm

11
 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.

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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

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.

13
 Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis

Subjective: Increased cardiac At 4 hours of Independent: After 4 hours of

“ madali nga ako workload related nursing • Monitor vital signs • May indicate rendering nursing
mapagod” as verbalized to hypermetabolic intervention especially blood compensatory intervention the
by the patient as evidenced by the patient will pressure changes in stroke patient was able to
increase blood be able to volume maintain adequate
Objective: pressure, pulse maintain • Place the client in semi- • Elevating the head cardiac output as
rate and adequate Fowler’s position or may decrease cardiac evidence by stable
- Restless respiratory rate cardiac output position of comfort work load vital signs as follows
- Irritability as evidence by • Provide restful • Rest periods decrease blood pressure
- fatigue stable vital environment oxygen consumption (120/80) , pulse rate
signs as Dependent: (110 bpm) and
follows blood • Maintain adequate • To provide proper respiratory rate
pressure (from nutrition and fluid nourishment to the (24bpm)
Vital Signs: 140/90 to balance as ordered by patient
120/80) , the physician
- BP: 140/90 pulse rate ( low iodine and low root
(120- 60-100 crops foods)
mmHg
bpm) and Collaborative:
- PR: 120 bpm respiratory • Administer Beta • Decreases heart rate/
- RR: 27 cpm rate (27- Blockers (Propanolol) cardiac work by
20bpm). Inderal as ordered). blocking conversion of
T3 to T4.

14
 Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Independent:
Subjective: Imbalanced At 4 hours of • Provided good After 4 hours of
nutrition: less than nursing oral hygiene • To enhance client’s rendering nursing
“Pumayat talaga ako, maski body requirements intervention the before and after appetite and ability intervention the
malakas ako kumain, ganito related to hyper patient will be meals to eat patient was able
siguro talaga pag may goiter” as metabolic state able to consume • Monitor food to consume
verbalized by the patient secondary to adequate intake adequate
excessive thyroid nourishment. • Encourage • Continued weight nourishment.
Objective: hormone secretion patient to eat loss in face of
as evidenced by and increase adequate caloric
- Increased appetite weight loss, meals and snaks intake may indicate
- Weight loss restlessness and with high calorie failure of anti-
irritability. that are easily thyroid therapy.
(Weight before: 60 kg) digested • Keeping enough
(Weight now: 52 kg) caloric intake aids in
• Instruct the
hypermetabolic state
patient to avoid
- Restless
foods that
- Irritability
increased
peristalsis (eg.
• It is increased GI
Tea. Coffee,
motility may result in
fibrous and
diarrhea and impair
highly seasoned
absorption of needed
foods) and fluids
nutrients
that causes
diarrhea (eg.
Apple/ prune
• To enhance the
juice).
intake ability
• Provide relaxing
and pleasant
• To provide patient
environment
the appropriate diet
Dependent:
• Determine
• To meet energy
healthy body
requirements
weight for age
and height

Collaborative:
• Administer
medication
indicated

15
 (vitamin B complex)

Nursing Planning Intervention Rationale Evaluation

Assessment Diagnosis

Independent:
Subjective: Anxiety (mild) related At 8hours of • Mild anxiety is After 8 hours of rendering
“ naiinip na ako dito” as to increased nursing • Observe behavior manifested by nursing intervention the
verbalized by the patient stimulation secondary intervention the indicative of level of irritability and patient was able to
to excessive thyroid patient will be anxiety insomnia verbalized feelings of anxiety
Objective: hormone secretion as able to verbalize
evidenced by feelings of anxiety • Establish therapeutic • To have an open
- Irritability irritability, insomnia, relationship communication
- Restless restlessness,
- Fatigue tremors( fine), • Stay with patient, • To establish
- Tremors (fine) increased sweating, maintaining calm rapport.
- Increased and increased manner.
sweating respiration • Speak in brief • Attention span
- Increased statements, using may be shortened,
respiration simple words. concentration
(RR 27 cpm) reduced, limiting
• Provide comfort ability to assimilate
measures (putting up information.
the bed siderails and • To promote
don’t leave the client clients safety.
alone at bedside)
• Encourage client to
express feelings • To know the
• Provide accurate coping strategy of
information about the the client
situation
Dependent: • Helps the patient
to know the realit
• Review coping
strategies or
mechanism • To determine
those that might be
helpful to the current
situation of the
patient

16
 Nursing Planning Intervention Rationale Evaluation
Assessment Diagnosis

Subjective: Fatigue related to At 8 hours of nursing Independent: After 8 hours of

hypermetabolic state intervention the rendering nursing
“eto madali ako with increases energy patient will be able to • Monitor vital • To note if there is intervention the
mapagod” as verbalized requirements verbalize increased signs (especially tachycardia or patient was able to
by the patient as evidenced by fine energy and improve pulse rate) verbalized increased
incresed in pulse
tremors, anxiety, well-being energy and
rate
Objective: incresed sweating with • Provide quiet improved well-being
vital signs of pulse rate environment
- Tremors (fine) 120 bpm, blood • Reduces stimuli
- Heat pressure of 140,90 that may
intolerance mmHg and respiratory • Encourage aggravate
- Restless rate of 27 cpm patient to hyperactivity or to
- Increased restrict activity relief fatigue
sweating and rest as much
as possible
Vital signs:
• Provide • Helps to
PR: 120 bpm diversional counteract effects
BP: 140/90 mmHg activities (e.g of increased
RR: 27 cpm reading, radio, metabolism
television)

• Evaluate need for

assistance or
assistive devices
• May reduce
• Assist with self care anxiety
needs; keep bed in
low position and
travel ways clear of • To know what are
furniture the needs of the
patient

• For easy access

and to avoid
accidents

17
 Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

Long Term: Independent: Long Term:

Subjective: Disturbed sleep After 24 hours of After 24 hours of rendering
pattern related to nursing • Provided quiet • To enhance nursing intervention the
“Hindi ako masyado daytime activity intervention the environment and client ability to patient was be able to
nakatulog kagabi, pattern as patient will be comfort measures (e.g fall asleep. obtained the different
kumakabog yung dibdib evidenced by able to identify backrub, washing hands measures of an 8 hours
ko” as verbalized by irritability the different and face, cleaning and normal sleeping pattern as
the patient tremors (fine) measures how to straitening sheets) in evidenced by (-) irritability,
Presence of eye obtain a normal preparation to sleep. relax, and minimal yawning.
Objective: bags. sleeping pattern
Frequent yawning. evidenced by • Recommended limiting • Caffeine
- Irritability non- irritable, intake of chocolate and increases
- fatigue relax, and caffeine/alcoholic awaking time
- tremors (fine) absence of eye beverages esp. prior to during the night.
- Presence of bags, and no bedtime A full stomach
eyebags on. frequent interferes with
- Frequent yawning. sleep
yawning.
• Encourage the client to • Effective in
develop a bedtime ritual inducing and
that includes quiet maintaining
activities such as sleep
reading pocketbooks or
watching television

Dependent:
• To monitor
• Obtain history including clients sleeping
bed time routines pattern.

18
 Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Subjective: Long Term: Independent: Long Term:
Disturbed body After 2 days of After 2 days of
“Para nga ko si Garfield image related to nursing • Encourage client to • For support to patient rendering nursing
yung dalawa kong mata, disease process intervention the make own about his illness intervention the
ang laki.” As verbalized by (hyperthyroidism) patient will be able decisions and patient was able to
the patient as evidence by, to demonstrate accept both accept self image as
bilateral acceptance of self inadequacies and evidenced by
Objective: exopthalmos. image as evidence strengths interaction with the
by interact with the • Good nutrition and student nurses
- Bilateral nurse on duty, and • Assess for and sleep patters
exopthalmos student nurses promote good promote faster
- Silky resilient hair nutrition and sleep healing and better
- Shy at first patterns coping
- Weight loss
• Assist the client to
(Weight before: 60 kg) • Acknowledge coping to renewed
(Weight now: 52 kg) coping mechanisms sense of well-being &
as a normal increases trust
feelings when between the nurse
adjusting to and patient.
changes in body
and lifestyle
• To enhance coping or
• Encourage client to handling his situation
verbalize feelings

Dependent: • Social support

enhances both
• Encourage emotional and
significant other to physical health
offer support
• To have acceptance
and not embarrassed
• Alert staff or the patient when his
significant others appearance is
to monitor facial affected
expressions and
nonverbal
behaviors

19
 DRUG STUDY

Name Mode of Action Indications Contraindications Adverse Effects Nursing

Interventions

Generic Name: Increases metabolic For treating Thyrotoxicosis, Side effects:  Instruct patient to take the
methimazole rate, cardiac output Hyperthyroidism myocardial infarction Nausea and drug with meals to
and protein and severe renal vomiting, diarrhea, decrease gastrointestinal
Brand Name: synthesis. Useful for disease cramps, tremors, symptoms
Tapazole 10 mg treating thyrotoxic nervousness,
crisis and in insomnia, headache  Advise patient about the
Dose: 10 mg preparation for and weight loss effects of iodine and its
subtotal presence in iodized salt,
Route: PO thyroidectomy. Adverse Effects: shellfish and OTC cough
Tachycardia, medicines
Frequency: q6 hypertension and
palpitations
 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

20
 Name Mode of Action Indications Contraindications Adverse Effects Nursing
Interventions

Generic Name: Selectively blocks To control Second and Third Side Effects:  Monitor vital signs
propanolol Hcl beta  - adrenergic hypertension and degree heart block, Bradycardia, especially blood pressure
receptor sites, management for cardiogenic shock, CHF, thrombocytopenia, and pulse
Brand Name: decreases thyrotoxicosis sinus bradycardia drowsiness, dry
Inderal 20 mg sympathetic outflow mouth and dizziness  Instruct patient to comply
to the periphery, Caution: with drug regimen: abrupt
Dose: 20 mg suppresses rennin- Hepatic, renal or Adverse Effects: discontinuation of
angiotensin- thyroid dysfunction; Complete heart block, antihypertensive drug may
Route: PO aldosterone system asthma; peripheral bronchospasm, cause rebound
vascular disease; type 1 agranulocytosis hypertension
Frequency: OD diabetes mellitus
 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

21
 Name Mode of Action Indications Contraindications Adverse Effects Nursing
Interventions

Generic Name: Water- soluble To treat peripheral Patient with liver GI irritation and  Instruct client to take the
Vitamin B Complex vitamins are not neuritis, essential for dysfunction vasodilation, prescribed amount of drug.
stored in the body building block of resulting in flushing
Brand Name: and are readily nucleic acids, red sensation  Advise client to check the
Nevramin excreted in the blood cell formation expiration dates on vitamin
urine. Protein and synthesis of containers before
Route: PO binding of water – hemoglobin purchasing and taking
soluble vitamins is them. Potency of the
Frequency: OD minimal. 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

22
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1