Patient’s Name: H.A.D.

Age: 41 years old

Sex: Female
Admitted: March 15, 2023
Civil Status: Married
Religion: Roman Catholic
Height: 5’3
Weight: 55 kg
Temperature: 38
RR: 30
BP: 140/70
O2: 98%
Pulse: 147
Dr. Galura, Lyza Camille - Endocrinologist
Chief complaint: Fever and cough
Medical History: Asthma, Thyroid
Admitting diagnosis: CAPMR, Hyperthyroidism, DM type II
Final Diagnosis: Hyperthyroidism in storm - scowled, CAPM Bronchial Asthma in Acute Exacerbation
with Asthma COAPD overlap, Heart failure with inject ejection fract CA - AF in RUR

COMPLETE BLOOD COUNT

Hgb: 130gL
Hct: 0.38
RBC: 5.03
WBC: H.16.97
Platelet: Adequate
Neutrophils: 57
Lymphocytes: 35
Monocytes: 7
Eosinophils: 1
Basophils: 0

MCV: L74.6 fl
MCH: L25.8pg
MCHC: 34.7 Hgb/L
RDW: H16.1%

Clinical Chemistry
Cholesterol p L1.29mmol/L
Tri glyceride - p 0.80mmol/L
HDL L0.29
LDL 0.64
Potassium L2.6
Hemoglobin A1C 5.7
Remarks:
10hrs fasting
Time extracted 6:00 am
AST/SGOT 35U/L

Coagulation:
Prothrombin Time
Control 13.7 seconds
Patient 12.7
% activity H107.6
INR 0.93

Activated Partial Thromblasture Time

Control 38.0 secs
Patient 45.1

Immunology Qualitative
TSH <0.1
T3 >9.22
T4 239.71

Procalcitonin 0.08ng/ml
Method used: Enzyme-linked fluorescent Assar (ELFA)

Medications (please help identify ang meds for hyperthyroidism pahighlight lang po)
● Trimetazidine (vestar) 35mg/tab 1 tab BID
● Vildagliptin 50 mg/tab 1 tab BID
● Digoxin (lanoxin) 0.25mg/tab OD
● Sacubitril-valsartan (entresto) 50mg/tab BID
● Furosemide 40mg/tab 1 tab OD
● Sodium (Muconase) 2 sprays
● Cefixime 200mg/tab BID
● Levocetirizine + Montelukast (zykast) 1 tab OD after dinner
● Paracetamol 300 mg IVTT Q4H PRN for fever
● Vit B complex + Folic Acid (Hemorate) 1 tab OD after dinner
● Ralium Drule 1 tab BID
● Salbutamol + Protium 1 neb Q12H
● NAC 600mg/tab OD
● Fluconazole 50mg/cap 2 caps OD
● Piperacillin + tazobactam (piptam) 4.5g/Vtt Q6H
● Calmag 1 tab BID
● Pantoprazole 40mg/tab OD
● Carvedilol 25mg/tab ½ tab BID
● Methylpratsolome (solumedrol) 40mg IV Q8H
 ● Xarcito 15mg OD
● Spironolactone 25 mg/tab 1tab BID
● PTU 50mg/tab 4 tab Q8H
● Prednisone 10mg/tab
● Tranexamic acid 500mg Q8H PRN
● Hydrocortisone (cleacort) 100mg IVTT Q12H
● Budesonide ½ respute Q12H

Pathophysiology of Hyperthyroidism

Etiology
Hyperthyroidism, or overactive thyroid, happens when your thyroid gland makes more thyroid
hormones than your body needs.

The thyroid gland is this little butterfly-shaped organ behind the larynx that produces thyroid
hormones; thyroxine (T4) and triiodothyronine (T3) that control the way the body uses
energy. These hormones affect nearly every organ in your body and control many of your body's
most important functions. They are also responsible for certain metabolic processes such as
energy metabolism, temperature regulation, and other sympathetic activities in the human body.

Hyperthyroidism has several causes. They include:

● Graves' disease, an autoimmune disorder in which your immune system attacks your
thyroid and causes it to make too much hormone. This is the most common cause.
● Thyroid nodules, which are growths on your thyroid. They are usually benign (not
cancer). But they may become overactive and make too much thyroid hormone. Thyroid
nodules are more common in older adults.
● Thyroiditis, inflammation of the thyroid. It causes stored thyroid hormone to leak out of
your thyroid gland.
● Too much iodine. Iodine is found in some medicines, cough syrups, seaweed and
seaweed-based supplements. Taking too much of them can cause your thyroid to make
too much thyroid hormone.
● Too much thyroid medicine. This can happen if people who take thyroid hormone
medicine for hypothyroidism (underactive thyroid) take too much of it.

Risk Factors:
You are at higher risk for hyperthyroidism if you:

● Are a woman
● Are older than age 60
 ● Have been pregnant or had a baby within the past 6 months
● Have had thyroid surgery or a thyroid problem, such as goiter
● Have a family history of thyroid disease
● Have pernicious anemia, in which the body cannot make enough healthy red blood cells
because it does not have enough vitamin B12
● Have type 1 diabetes or primary adrenal insufficiency, a hormonal disorder
● Get too much iodine, from eating large amounts of foods containing iodine or using
iodine-containing medicines or supplements

Symptomatology
The signs and symptoms of hyperthyroidism are related to the increased levels of thyroid
hormone and can vary from person to person:
● nervousness, restlessness, fatigue, insomnia
● tachycardia, palpitations (atrial fibrillation is common in the elderly)
● shortness of breath
● weight loss despite an increased appetite, frequency of passing stools, nausea, vomiting
● muscle weakness, tremors
● warm, moist flushed skin
● fine hair
● staring gaze, exophthalmia
● goiter
● heat intolerance
and etc.

Pathogenesis

> Etiologic factors that leads to the development of hyperthyroidism are:

 ● Graves’ Disease
● Increase production of thyroxine (T4) and triiodothyronine (T3) and;
● Damage to thyroid follicular cells (e.g. thyroid cancer, thyroid nodules, viral thyroiditis,
postpartum thyroiditis)
> Hyperthyroidism causes:
● de novo synthesis (production) of thyroid hormones which increases iodine uptake and
persistent decrease of TSH, and increase production of T3/T4
● release the stored thyroid hormones which decreases the Iodine uptake, and still and
persistently decrease of TSH, and increase production of T3/T4
> Other mechanism of Hyperthyroidism that causes its signs and symptoms includes:
● Increase local synthesis of glycosaminoglycans which cause the increase of osmotic
pressure behind the eyes (i.e. proptosis, diplopia, lid retraction, conjunctivitis) and
increase hyaluronic acid in dermis and subcutis (i.e. pretibial myxedema)
● Increase renin-angiotensin-aldosterone system (RAAS) and erythropoietin synthesis
involved in the cardiovascular processes
● Increase sympathetic stimulation that causes gut hypermotility and CNS overstimulation
● Increase thermogenesis as a result of the stimulation of numerous metabolic pathways
involved in development, remodeling, and delivery of energy to the tissues.
 NURSING CARE PLAN

Defining Nursing Outcome Nursing Intervention Rationale Evaluation

Characteristi Diagnosis Identificatio
cs n

Subjective: Hypertherm Short Term: Independent: Goal is still

“Galain akon ia related to After 4-8 Assess for underlying Thyroid conditions, ongoing. At the
pamatyag infection, hours of conditions. autonomic end of
ma’am kay inflammatio Nursing dysfunction from discharge after
kainit sang n and heat intervention: spinal cord injuries, nursing
akon nga sensitivity infections, and brain interventions,
lawas” as AEB body -patient will lesions are a few client will be
verbalized by temperature maintain disorders that can able
the patient. above core body cause hyperthermia. to show signs
normal temperature that
Objectives: range, within Monitor neurological Note the level of fever is relieved
Elevated body elevated normal status. consciousness, and will report
temperature heart rate limits. orientation, pupil no
above normal secondary -patient will reaction, and any associated
range. to verbalize posturing. Confusion complications
T: 38
hyperthyroi underlying and delirium may
RR: 30
BP: 140/70
dism. factors that occur as the
O2: 98% contribute to condition worsens.
Pulse: 147 Rationale: hyperthermia
Hypertherm Rehydrate or encourage Administer IV fluids
ia is a Long Term: patient to increase fluid as prescribed to treat
condition At the end of intake every 2 hours. dehydration. Cooled
where an hospitalizati IV fluids can further
individual’s on, patient help in decreasing
body will maintain the body
temperature normal body temperature.
is elevated temperature
beyond and remain Provide tepid It could help reduce
normal free of sponge baths and body temperature.
range due life-threateni avoid using alcohol
to failed ng or ice water
thermoregul complication
ation. The s such as Advise patient to eat To strengthen
body brain healthy foods especially immune system
produces or damage or vitamin C(fruits). against infection.
absorbs organ failure
more heat from Cool the environment. Remove blankets and
than it hyperthermia heavy clothing.
dissipates. by the time Provide fans for
Hyperthyroi of discharge. ventilation.
dism is the
more If ice packs or cool
complex Assess the skin from rags/sheets are used
underlying cooling measures. to cool the body,
causes. monitor frequently
for damage to the
skin from prolonged
exposure to ice and
moisture.

To provide baseline
Monitor vital signs. data and fever
patterns may aid in
diagnosis of
underlying diseases.

Independent : Antipyretic drugs

Administer antipyretics helps decrease and
such as paracetamol as regulate body
per doctor’s order. temperature.

Administer antibiotics as To control the spread

prescribed by physician. of infection.

Teach patient about Heat-related illnesses

preventing heat are preventable. Heat
exhaustion. exhaustion
symptoms include
heavy sweating,
nausea, muscle
cramps, dizziness,
and headache. It can
be treated simply by
moving to a cool
place, cooling the
body, and drinking
water.
 Drug Name Classification and Indications and Side Effects and Special Precautions Nursing
Mechanism of Contraindications Adverse Effects Responsibilities
Action

Generic Name: Classifications: Indications: Side Effects: Serious allergic Check the doctor’s
N-acetylcysteine Antidote, Mucolytic - Mucolytic adjuvant therapy Increased reactions may occur order.
for abnormal, viscid or coughing, mouth after receiving this
inspissated mucus secretions in sores or painful medicine Apply the 10 rights of
acute and chronic swelling, nausea, medication.
Mechanism of bronchopulmonary disease, in vomiting, fever, Tell your doctor right
Trade/ Brand Actions: pulmonary complications of runny nose, away if you have Monitor vital signs
Name: Mucolytic activity: cystic fibrosis, and in clamminess, difficulty with
Acetadote, Splits links in the tracheostomy care; pulmonary chest tightness, breathing or Monitor signs of
Mucomyst mucoprotein complications associated with wheezing swallowing, fever, bronchospasm and
contained in surgery. hives, itching skin, respiratory irritation,
respiratory mucus - To prevent or lessen hepatic Adverse Effects: rash, nausea, reddening including wheezing,
secretions, injury that may occur after Bronchospasm, of the skin, especially cough, dyspnea,
Dosage: decreasing the ingestion of a potentially urticaria around the ears, increased secretions,
600mg/tab viscosity of the hepatotoxic dose of swelling of the eyes, and tightness in the
mucus. acetaminophen. face, or inside of the chest and throat.
nose, or unusual
Route: Antidote to Contraindications: tiredness or weakness. Report excessive or
Per Orem acetaminophen Mucolytic Use prolonged respiratory
hepatotoxicity: - Contraindicated with This medicine may problems to the
Protects liver cells hypersensitivity to increase the risk of physician.
Frequency and by maintaining cell acetylcysteine; use caution and bleeding in your
Timing: function and discontinue immediately if esophagus and
OD 8:00 am detoxifying bronchospasm occurs. stomach.
acetaminophen
metabolites. Antidotal Use
- No contraindications; use
caution with esophageal
varices, peptic ulcer.
 Drug Name Classification Indications and Side Effects and Special Precautions Nursing
and Mechanism Contraindications Adverse Effects Responsibilities
of Action

Generic Name: Classifications: Indications: Side Effects: Do not use pantoprazole Check the doctor’s
Pantoprazole Antisecretory - Short term (8 weeks or Blurred vision, dry together with medicines order.
Drug, Proton less) and long term mouth, flushed, dry containing rilpivirine (eg,
Pump Inhibitor treatment of GERD skin, fruit-like breath Complera, Edurant, Apply the 10 rights of
- Maintenance healing of odor, increased hunger, Odefsey). Using these medication.
erosive esophagitis increased thirst, medicines together may
Trade/ Brand - Long term treatment of increased urination, cause unwanted side effects. Monitor vital signs
Name: Mechanism of pathological nausea, stomach pain,
Protonix Actions: hypersecretory conditions sweating, trouble Serious stomach conditions Administer once or
Gastric breathing, unexplained may occur while taking this twice a day. Caution
acid-pump weight loss, vomiting medicine. patients to swallow
inhibitor: Contraindications: tablets whole, not to
Suppresses - Contraindicated with This medicine may cause cut, chew, or crush.
Dosage: gastric acid hypersensitivity to any Adverse Effects: hypomagnesemia (low
40mg/tab secretion by proton pump inhibitor or Absence of or decrease magnesium in the blood). Evaluate the patient’s
specific any drug components in body movements, This is more likely to occur nutritional status.
inhibition of the - Use cautiously with blindness, continuous if you are taking this
hydrogen-potassi pregnancy, lactation. ringing or buzzing or medicine for more than one Monitor bowel
Route: um ATPase other unexplained year, or if you are taking function.
Per Orem enzyme system noise in the ears this medicine together with
at the secretory digoxin (Lanoxin) or certain
surface of the diuretics.
Frequency and gastric parietal
Timing: cells; blocks the
OD 8:00 am final step of acid
production.
 Drug Name Classification and Indications and Side Effects and Special Precautions Nursing
Mechanism of Action Contraindications Adverse Effects Responsibilities

Generic Classifications: Indications: Side Effects: Do not administer to Check the doctor’s
Name: Alpha - and beta - Hypertension, alone or Dizziness, any patient with severe order.
Carvedilol -adrenergic blocker, with other oral drugs, paresthesias, hepatic impairment
Antihypertensive especially diuretics. insomnia, Apply the 10 rights of
- Treatment of mild to depression, fatigue, Avoid driving or medication.
severe heart failure of vertigo, performing dangerous
ischemic or arrhythmias, activities, getting up Monitor vital signs
Mechanism of Actions: cardiomyopathy origin hypotension, and changing positions
Trade/ Brand Competitively blocks with digitalis, diuretics, vomiting, diarrhea, slowly may help ease Monitor diabetic
Name: alpha-, beta-, and beta2- ACE inhibitors. nausea dizziness patient closely, drug
Apo-Carvedilo adrenergic receptors and - Left ventricular may mask
l, Coreg has some dysfunction (LVD) after Adverse Effects: Do not discontinue hypoglycemia or
sympathomimetic MI. Heart failure , drug abruptly after worsen hyperglycemia
activity at - Unlabeled uses: Angina pulmonary edema, chronic therapy
beta2-receptors. Both (25-50 mg bid). cerebrovascular Monitor for orthostatic
Dosage: alpha and beta blocking accident, hepatic hypotension and
25mg/tab ½ actions contribute to the failure, provide safe
tab BP-lowering effect; beta Contraindications: bronchospasms, precautions
blockade prevents the - Contraindicated with rhinitis, bronchial
reflex tachycardia seen decompensated heart obstruction, Monitor patient for any
with most alpha failure, bronchial asthma, sign of hepatic
Route: blocking drugs and heart block, cardiogenic impairment
Per Orem decreases plasma renin shock, hypersensitivity to
activity. Significantly carvedilol, pregnancy, Assess vital signs,
reduces plasma renin lactation. especially pulse and
Frequency activity. - Use cautiously with blood pressure to
and Timing: hepatic impairment, monitor for possible
BID 8:00 am - peripheral vascular excess stimulation of
4:00 pm disease, thyrotoxicosis, the cardiac system.
diabetes, anesthesia,
major surgery.
 Drug Name Classification and Indications and Side Effects and Special Precautions Nursing
Mechanism of Contraindications Adverse Effects Responsibilities
Action

Generic Name: Classifications: Indications: Side Effects: Hyperkalemia (high Check the doctor’s
Spironolactone Aldosterone - Diagnosis and maintenance of Dizziness, potassium in the order.
Antagonist, primary hyperaldosteronism headache, blood) may occur
Potassium-sparing - Adjunctive therapy in edema drowsiness, while you are using Apply the 10 rights
Trade/ Brand diuretic associated with HF, nephrotic fatigue, ataxia, this medicine. of medication.
Name: syndrome, hepatic cirrhosis confusion, rash,
Aldactone, when other therapies are cramping, Do not drive or do Monitor vital signs
Novospiroton Mechanism of inadequate or inappropriate diarrhea, dry anything else that
Actions: - Treatment of hypokalemia or mouth, thirst, could be dangerous Assess for signs of
Competitively prevention of hypokalemia in vomiting, nausea until you know how fluid and electrolyte
Dosage: blocks the effects patients who would be at high this medicine affects imbalance
25mg/tab 1 tab of aldosterone in risk if hypokalemia occurred, Adverse Effects: you. If you feel dizzy,
the renal tubule, patients with cardiac Impotence, lie down so you do Observe for and
causing loss of arrhythmias irregular menses, not faint. report immediately
Route: sodium and water - Essential hypertension, usually amenorrhea, the onset of mental
Per Orem and retention of in combination with other drugs postmenopausal This medicine may changes, lethargy, or
potassium. - Unlabeled use: Treatment of bleeding, cause swelling of the stupor in patients
hirsutism because of its anti hyperkalemia, breasts with liver disease.
Frequency and androgenic properties, palliation hyponatremia, (gynecomastia) and
Timing: of symptoms of PMS, treatment agranulocytosis, breast pain in some Monitor and record
BID 8:00 am - of familial male precocious gynecomastia, patients. regular weight to
4:00 pm puberty, short term treatment of hirsutism monitor mobilization
acne vulgaris This medicine may of edema fluid
also cause electrolyte
Contraindications: imbalances and an
- Contraindicated with allergy to increase in your uric
spironolactone, hyperkalemia, acid and blood sugar
renal disease, anuria, amiloride levels.
or triamterene use
- Use cautiously with
pregnancy, lactation.
 Drug Name Classification Indications and Side Effects and Adverse Special Precautions Nursing
and Mechanism Contraindications Effects Responsibilities
of Action

Generic Classification: Indication: Side Effects: Do not stop taking this Check the doctor’s
Name: Antidysrhythmics ● nausea, vomiting, medicine without first order.
Digoxin , V; Inotropic ● For the treatment of diarrhea, stomach pain; checking with your
Agents. mild to moderate heart ● fast, slow, or uneven doctor. Stopping Apply the 10 rights
Trade/ Brand failure in adult patients. heart rate; suddenly may cause a of medication.
Name: ● To increase myocardial ● a light-headed feeling, serious change in heart
Lanoxin Mechanism of contraction in children like you might pass out; function. Monitor BP
Action: diagnosed with heart ● bloody or black, tarry periodically in
Digoxin binds to failure. stools; Watch for signs and patients receiving IV
and inhibits the ● To maintain control of ● confusion, weakness, symptoms of overdose digoxin.
Dosage: sodium/potassiu the ventricular rate in hallucinations, unusual while you are taking
0.25mg/tab m-ATPase adult patients diagnosed thoughts or behavior; this medicine. Follow
(sodium pump) with chronic atrial ● breast swelling or your doctor's directions Monitor ECG during
within the plasma fibrillation. tenderness; carefully. IV administration
membrane of ● blurred vision, yellowed and 6 hr after each
Route: Do not take other
cardiac myocytes. Contraindication: vision; or dose. Notify health
IV or PO medicines unless they
This inhibition ● Acute myocardial care professionals if
● (in babies or children) have been discussed
increases the infarction. bradycardia or new
stomach pain, weight with your doctor. This
intracellular ● Hypersensitivity to the arrhythmias occur.
Frequency loss, growth delay, includes prescription or
and Timing: sodium content drug. behavior changes. nonprescription
which in turn ● Ventricular fibrillation. (over-the-counter Observe IV site for
OD 8:00 am increases the ● Myocarditis. [OTC]) medicines and redness or
intracellular ● Hypomagnesemia. Adverse Effects: infiltration;
nausea, diarrhea; herbal or vitamin
calcium content ● Hypokalemia. supplements. extravasation can
which leads to ● Wolf-Parkinson-White feeling weak or dizzy; lead to tissue
increased cardiac syndrome. headache, weakness, irritation and
contractility. anxiety, depression sloughing.
 Drug Name Classification Indications and Contraindications Side Effects Special Precautions Nursing
and and Adverse Responsibilities
Mechanism of Effects
Action

Generic Classification: Indications: Side Effects: Do not use Entresto if Check the doctor’s
Name: Angiotensin Indicated to reduce risk of cardiovascular dizziness, you are pregnant. Stop order.
Sacubitril - Receptor-Nepri death and hospitalization in chronic heart fainting, using and tell your
valsartan lysin Inhibitors failure (CHF); benefits are most clearly light-headedness doctor right away if Apply the 10 rights
(ARNi); ARBs; evident in patients with left ventricular , cough, you become pregnant. of medication.
Neprilysin ejection fraction (LVEF) below normal headache,
Trade/ Brand Inhibitors diarrhoea, You should not take Watch for signs of
Name: Contraindications: feeling sick, Entresto within 36 impaired renal
Entresto Mechanism of stomach pain, hours before or after function, including
Action: ● Hypersensitivity to the active tiredness, you have taken any decreased urine
substances ACE inhibitor output, cloudy urine,
Inhibits ● Concomitant use with ACE inhibitors Adverse medication. or sudden weight
Dosage: neprilysin and Entresto must not be administered Effects: gain due to fluid
50mg/tab blocks until 36 hours after discontinuing If you have diabetes, retention.
angiotensin II ACE inhibitor therapy. Weakness. do not use Entresto
type-I receptor, ● Known history of angioedema related swelling of the together with any Report these signs to
increasing the to previous ACE inhibitor or ARB face, lips, medication that the physician.
Route: levels of therapy Hereditary or idiopathic tongue and/or contains aliskiren
PO peptides angioedema throat and such as Tekturna or Monitor signs of
degraded by ● Concomitant use with difficulty Tekamlo. high plasma
neprilysin aliskiren-containing medicinal breathing, potassium levels
Frequency products in patients with diabetes swallowing and You may also need to (hyperkalemia),
and Timing: mellitus or in patients with renal drop in blood avoid taking Entresto including
impairment Severe hepatic pressure. with aliskiren if you bradycardia, fatigue,
BID 8:00 am - impairment, biliary cirrhosis and have kidney disease. weakness, numbness,
4:00 pm cholestasis and tingling.
● Second and third trimesters of
pregnancy
 Drug Name Classification and Indications and Side Effects and Adverse Special Precautions Nursing
Mechanism of Contraindications Effects Responsibilities
Action

Generic Classification: Indication: Side effects Check with your Check the doctor’s
Name: Class of antifungals Used to treat serious doctor right away if order.
Fluconazole called triazoles fungal or yeast infections, you have darkening
including vaginal ● fast or pounding of the skin, diarrhea, Apply the 10 rights of
candidiasis, heartbeat dizziness, fainting, medication.
Trade/ Brand Mechanism of oropharyngeal candidiasis loss of appetite,
● flutter in your chest
Name: Action: (thrush, oral thrush), mental depression,
Azocan, esophageal candidiasis ● shortness of breath nausea, skin rash, Drugs may be given
Diflucan, Fluconazole (candida esophagitis), unusual tiredness or orally or IV as needed.
● sudden dizziness The drug will need to
Canesten interacts with other candida infections weakness, or
14-demethylase, a (including urinary tract ● fever vomiting. This be taken for the full
cytochrome P-450 infections, peritonitis medicine may cause course and may need
● chills to be taken long term.
enzyme responsible [inflammation of the some people to
Dosage: for catalyzing the lining of the stomach], ● body aches become dizzy,
50mg/cap 2 conversion of ● flu symptoms drowsy, or less alert Use hygiene measures
caps lanosterol to Contraindication: than they are to prevent reinfection
ergosterol. As ● easy bruising or normally. or spread of infection.
ergosterol forms a Caution to patients with bleeding
critical part of the liver dysfunction.
fungal cell Arrange for frequent
Route:
membrane, Hypersensitivity to Adverse Effects: follow-up while you
PO or IV
fluconazole inhibits fluconazole or to any of are taking this drug.
the synthesis of its excipients. Be sure to keep all
ergosterol to ● nausea appointments,
Frequency
increase cellular including those for
and Timing: ● stomach pain
permeability. blood tests.
● diarrhea
OD 8:00 am
● upset stomach You may experience
● headache these side effects:
Nausea, vomiting,
● dizziness diarrhea (frequent
small meals may
● changes in your sense help); headache
of taste (analgesics may be
ordered).

Report rash, changes

in stool or urine color,
difficulty breathing,
increased tears or
salivation.
 Drug Classification and Indications and Side Effects and Special Precautions Nursing
Name Mechanism of Contraindications Adverse Effects Responsibilities
Action

Generic Classification: Indication: Side Effects: Use sunscreen, a hat, and Check the doctor’s order.
Name: Diuretics Treatment of edema ● Peeing more than protective clothing when
Furosemide associated with congestive normal. Feeling you are outdoors. Avoid Apply the 10 rights of
heart failure, cirrhosis of thirsty. sunlamps and tanning medication.
Mechanism of the liver, and renal ● Dry mouth beds. Make sure any
Trade/ Action: disease, including the ● Headache doctor or dentist who Assess fluid status.
Brand nephrotic syndrome ● Feeling confused treats you knows that you Monitor daily weight,
Name: Inhibiting or dizzy are using this medicine. intake and output ratios,
Lasix electrolyte Contraindication: ● Feeling or being This medicine may affect amount and location of
reabsorption from Contraindicated in sick (nausea or the results of certain edema, lung sounds, skin
the kidneys and patients with anuria and in vomiting) medical tests. turgor, and mucous
enhancing the patients with a history of membranes.
Dosage: excretion of water hypersensitivity to
40mg/tab 1 from the body furosemide. Adverse Effects: Notify health care
tab Diuretics can also professionals if thirst,
affect blood dry mouth, lethargy,
potassium levels. If weakness, hypotension,
Route: you take a thiazide or oliguria occurs.
IV diuretic, your
potassium level can Monitor BP and pulse
drop too low before and during
Frequency (hypokalemia), which administration.
and can cause
Timing: life-threatening
problems with your
OD 8:00 heartbeat.
am
 Drug Classification and Indications and Side Effects and Special Precautions Nursing
Name Mechanism of Contraindications Adverse Effects Responsibilities
Action

Generic Classification: Indication: Side Effects: Hyperthyroidism, Check the doctor’s order.
Name: Anti-inflammatory, Acute or chronic adrenal Insomnia, heartburn, cirrhosis, respiratory
Prednisone immunosuppressant. insufficiency, congenital nervousness, tuberculosis, untreated Apply the 10 rights of
adrenal hyperplasia, abdominal distention, systemic infections, medication.
adrenal insufficiency diaphoresis(sweating) renal/hepatic impairment,
Trade/ Mechanism of secondary to pituitary , acne, mood swings, following acute MI, Monitor B/P, serum
Brand Action: insufficiency increased appetite, diabetes, cataracts, electrolytes, glucose,
Name: facial flushing, glaucoma, seizures, results of bone mineral
Rayos Inhibits Contraindication: delayed wound peptic ulcer disease, density test, height,
accumulation of Hypersensitivity to healing, increased osteoporosis, myasthenia weight in children.
inflammatory cells predniSONE. Acute susceptibility to gravis, hypertension, HF,
at inflammation superficial herpes simplex infection, diarrhea, ulcerative colitis, Be alert to infection
Dosage: sites, phagocytosis, keratitis, systemic fungal constipation thromboembolic (sore throat, fever, vague
10mg/tab 4 lysosomal enzyme infections, varicella, disorders, elderly. symptoms); assess oral
tab release, synthesis administration of live or cavity daily for signs of
and/or release of attenuated virus vaccines Adverse Effects: Candida infection.
mediators of Anorexia, nausea,
Route: inflammation fever, headache,
PO rebound
inflammation,
fatigue, weakness,
lethargy, dizziness,
orthostatic
hypotension. Sudden
discontinuance may
be fatal
 Drug Classification and Indications and Side Effects and Special Precautions Nursing
Name Mechanism of Contraindications Adverse Effects Responsibilities
Action

Generic Classification: Indication: Side Effects: Thyroid dysfunction, Check the doctor’s order.
Name: Glucocorticoid Management of Insomnia, heartburn, cirrhosis, hypertension,
hydrocortis adrenocortical anxiety, abdominal osteoporosis, Apply the 10 rights of
one insufficiency, distention, thromboembolic medication.
Mechanism of anti-inflammatory, diaphoresis, acne, tendencies or
Action: immunosuppressive mood swings, thrombophlebitis, HF, Assess for edema. Be
Trade/ Inhibits increased appetite, seizure disorders, alert to infection
Brand accumulation of Contraindication: facial flushing, diabetes, respiratory (reduced immune
Name: inflammatory cells Hypersensitivity to delayed wound tuberculosis, untreated response): sore throat,
Cleacort at inflammation hydrocortisone. Fungal, healing, increased systemic infections, fever, vague symptoms.
sites, phagocytosis, tuberculosis, viral skin susceptibility to renal/hepatic impairment
lysosomal enzyme lesions; serious infections, infection, diarrhea or Monitor daily pattern of
release, synthesis constipation bowel activity, stool
Dosage: and/or release of consistency. Monitor
100mg mediators of Adverse Effects: electrolytes, B/P, weight,
inflammation Nausea, fever, serum glucose.
headache, sudden
Route: severe joint pain, Monitor for
IVTT rebound inflammation, hypocalcemia (muscle
fatigue, weakness, twitching, cramps),
lethargy, dizziness, hypokalemia (weakness,
orthostatic hypotension. paresthesia [esp. lower
Frequency
and extremities],
Timing: nausea/vomiting,
irritability, EKG
Q12HRS changes). Assess
emotional status, ability
to sleep.
 Drug Classification and Indications and Side Effects and Special Precautions Nursing
Name Mechanism of Contraindications Adverse Effects Responsibilities
Action

Generic Classification: Indication: Side Effects: Respiratory tuberculosis, Check the doctor’s order.
Name: Anti-inflammatory Anti-inflammatory or : Insomnia, heartburn, untreated systemic
methylpred immunosuppressant in anxiety, abdominal infections, hypertension, Apply the 10 rights of
nisolone treatment of hematologic, distention, HF, diabetes, GI disease medication.
sodium Mechanism of allergic, inflammatory, diaphoresis, acne,
succinate Action: autoimmune, or neoplastic mood swings, Monitor I&O, daily
Suppresses disorders increased appetite, weight; assess for
Trade/ migration of facial flushing, GI edema.
Brand polymorphonuclear Contraindication: distress, delayed
Name: leukocytes, reverses Hypersensitivity to wound healing, Monitor daily pattern of
SoluMedrol increased capillary methylprednisolone. increased bowel activity, stool
permeability Administration of live or susceptibility to consistency.
(Decreases attenuated virus vaccines, infection, diarrhea,
inflammation.) systemic fungal infection. constipation. Check vital signs at
Dosage: least twice daily. Be alert
40mg Adverse Effects: for infection (sore throat,
Anorexia, nausea, fever, fever, vague symptoms).
headache, severe
Route: arthralgia, rebound Monitor serum
IV inflammation, fatigue, electrolytes, including
weakness, lethargy, B/P, glucose. Monitor for
dizziness, orthostatic hypocalcemia (muscle
hypotension. twitching, cramps,
Frequency
and positive Trousseau’s or
Timing: Chvostek’s signs),

Q8HRS hypokalemia (weakness,

muscle cramps,
numbness, tingling [esp.
lower extremities],
nausea/vomiting,
 irritability, EKG
changes). Assess
emotional status, ability
to sleep.

Check lab results for

blood coagulability,
clinical evidence of
thromboembolism.

Drug Name Classification and Indications and Side Effects and Special Precautions Nursing
Mechanism of Contraindications Adverse Effects Responsibilities
Action

Generic Name: Classification: Indication: Side Effects: Patient undergoing Check the doctor’s
Propylthiouracil Thiourea Antithyroid Used to manage Fever, loss of surgery. Hepatic and order.
Agent hyperthyroidism appetite, nausea, renal impairment.
Trade/ Brand Name: which is due to an vomiting, tiredness, Children. Pregnancy Apply the 10 rights of
PTU overactive thyroid itching, dark urine, and lactation. medication.
Mechanism of gland (Grave's pale or light colored
Action: disease). stools, yellowing of Monitor I&O, daily
Propylthiouracil the skin or eyes, or weight; assess for
Dosage: binds to thyroid Contraindication: pain in the upper edema.
50mg peroxidase and Include a previous right part of the
thereby inhibits the history of stomach Monitor daily pattern
conversion of iodide hypersensitivity to of bowel activity,
Route: to iodine. Thyroid PTU or any of its Adverse Effects: stool consistency.
PO peroxidase normally drug components. Bleeding,
converts iodide to Caution is advised in hypoprothrombinemi Check vital signs at
iodine (via hydrogen patients with hepatic a, bone marrow least twice daily. Be
Frequency and peroxide as a impairment or suppression (e.g. alert for infection
Timing: cofactor) and also aplastic anemia,
 catalyzes the myelosuppression thrombocytopenia, (sore throat, fever,
Q8HRS incorporation of the and pediatric patients. leucopenia), vague symptoms).
resulting iodide exfoliative dermatitis,
molecule onto both fever, Monitor response of
the 3 and/or 5 hypothyroidism, symptoms of
positions of the lupus-like syndrome hyperthyroidism or
phenol rings of (e.g. splenomegaly), thyrotoxicosis
tyrosines found in nephritis, (tachycardia,
thyroglobulin. glomerulonephritis, palpitations,
Thyroglobulin is interstitial nervousness,
degraded to produce pneumonitis. insomnia, fever,
thyroxine (T4) and diaphoresis, heat
triiodothyronine (T3), intolerance, tremors,
which are the main weight loss,
hormones produced diarrhea).
by the thyroid gland.
Therefore Assess patient for
propylthiouracil development of
effectively inhibits hypothyroidism
the production of new (intolerance to cold,
thyroid hormones. constipation, dry
skin, headache,
listlessness, tiredness,
or weakness). Dose
adjustment may be
required.

Assess patient for

skin rash or swelling
of cervical lymph
nodes. Treatment
may be discontinued
if this occurs.
 Drug Name Classification and Indications and Side Effects and Special Precautions Nursing
Mechanism of Contraindications Adverse Effects Responsibilities
Action

Generic Name: Classification: Indication: Side Effects: Patients with diabetes Check the doctor’s
Budesonide Anti-inflammatory/ Dry/irritated throat, mellitus, myasthenia order.
Corticosteroids Management of hoarseness, voice gravis, thyroid
Trade/ Brand symptoms of changes, bad taste in disease, with history Apply the 10 rights
Name: Mechanism of seasonal or the mouth, runny nose, of tuberculosis, of medication.
Inhalation: Entocort Action: perennial allergic or nosebleeds may infections, diabetes,
(CAN), Pulmicort Budesonide is a rhinitis in adults occur. If any of these increased eye Monitor I&O, daily
Respules, Pulmicort potent topical and children; effects last or get pressure, high blood weight; assess for
Turbuhaler, anti-inflammatory nonallergic worse, tell your doctor pressure, weak bones, edema.
Rhinocort Aqua, agent. It binds and perennial rhinitis in or pharmacist promptly. stomach ulcer, who
Rhinocort Turbuhaler activates adults are taking other Monitor daily pattern
(CAN) glucocorticoid Turbuhaler: Adverse Effects: medications, bleeding of bowel activity,
receptors (GR) in the Maintenance Skin rash, arthritis, problems, cataracts, stool consistency.
Dosage: effector cell (e.g., treatment of asthma back pain, polyuria, or liver disease,
½ or 0.5 bronchial) cytoplasm as prophylactic acne, ecchymosis, during pregnancy and Check vital signs at
that allows the therapy in adults epigastric pain, and breastfeeding. least twice daily. Be
translocation of this and children > 6 yr hypertension. alert for infection
Route: budesonide-GR and for patients (sore throat, fever,
PO complex in the requiring vague symptoms).
bronchi nucleus, corticosteroids for
which binds to both asthma Oral: Make sure the
Frequency and HDCA2 and CBP Inhalation patient does not cut,
Timing: (HAT). suspension: crush, or chew
Maintenance capsules; they must
Q12HRS treatment and be swallowed whole.
prophylaxis therapy
of asthma in Administer the drug
children 12 mo–8 once each day, in the
yr morning; do not
Oral: Treatment administer with
and maintenance of grapefruit juice.
 clinical remission Encourage patients to
for up to 3 mo of complete a full 8 wk
mild to moderate of drug therapy.
active Crohn’s
disease involving Nasal inhalation:
the ileum or Prime pump eight
ascending colon times before first use.
If not used for 2
Contraindication: consecutive days,
reprime with 1 spray
Hypersensitivity. or until fine mist
Acute infections appears. If not used
uncontrolled by for more than 14
antimicrobial days, rinse applicator
chemotherapy. and reprime with 2
sprays or until fine
mist appears.

Inhalation: Arrange
for use of
decongestant nose
drops to facilitate
penetration if edema,
excessive secretions
are present.

Prime unit before use

for Pulmicort
Turbuhaler; have
patient rinse mouth
after each use.

Use aerosol within 6

mo of opening. Shake
well before each use.
Store Respules
upright and protected
from light; gently
shake before use;
open envelopes
should be discarded
after 2 wk.
DISCHARGE PLAN

Medications:
● Spironolactone 25 mg/tab 1tab BID
● Budesonide ½ respute Q12H
●

Health Teaching:
Primary care providers and nurse practitioners, should educate patients on:
● Knowing the importance of medical compliance
● Taking medications as directed and taking them simultaneously every day. This will help you
know if you’ve taken your medicine each day.
● Certain products like contrast dyes, expectorants, food supplements, and seaweed tablets may
contain high levels of iodine that could interfere with therapy.
● Try taking your medicine with the same food or drink daily. This will help you control the amount
of thyroid hormone in your body.
● Don’t stop taking medicine. If you do, symptoms will come back. Only make changes to your
medicine as your healthcare provider instructs.
● Use artificial tears, eye drops, and sunglasses to protect your eyes from dryness, wind, and sun.
Raise your head with pillows at night to prevent your eyes from swelling. In some cases, taping
your eyelids shut at night will keep your eyes from being dry in the morning.
● Do not smoke
● Lower stress
● Use creams or ointments for irritated skin. Ask your doctor which types to use.

Diet:
Diet can affect the production of thyroid hormones and how the thyroid functions. Nutrients and
chemicals that can affect hyperthyroidism:

● Iodine, which the thyroid gland uses to produce thyroid hormone. Too much iodine in the diet can
increase the production of thyroid hormones.
● Calcium and vitamin D are vital because hyperthyroidism can cause problems with bone mineral
density.
● Foods and drinks containing caffeine can worsen the symptoms of hyperthyroidism.

Foods to Eat:

● Low iodine foods such as:

○ non-iodized salt
○ egg whites
○ fresh or frozen vegetables
○ herbs and spices
○ vegetable oils
○ sugar, honey, or maple syrup (up to 2 tbsp.)
 ○ jams or jellies
○ unsalted nuts and nut butter
○ lemonade
○ beer and wine
○ moderate portions of beef, chicken, turkey, veal, and lamb
○ fruit and fruit juice
● Cruciferous vegetables:
○ Brussels sprouts and cabbage
○ collard greens, mustard greens, and turnip roots and greens
○ kale and arugula
○ radishes and rutabagas
○ bok choy
○ cauliflower
○ broccoli and broccoli rabe
● Foods containing iron (make sure that iodine intake is < 50mcg per day)
○ fortified cereals
○ raisins
○ dark chocolate
○ beef, chicken, turkey, and pork
○ spinach
○ oysters and fish
○ white beans, kidney beans, and black beans
○ lentils
○ sardines
○ chickpeas
○ canned beef, chicken or turkey
○ cured pork products (bacon, sausages, or hot dogs)

Foods to Avoid:

○ Iodine rich foods

○ Soy
○ Gluten
○ Caffeine

Call or seek immediate medical care if:

● You have symptoms of sudden, very high thyriod level (thyriod storm ). These include:
○ Being nauseated, vomiting, and having diarrhea
○ Sweating a lot
○ Feeling extremely restless and confused
○ Having high fever
○ Having fast heartbeat
● Sudden changes in vision or eye pain
● Fever or severe sore throat and taking antithyroid medicines, such as PTU
● Changes in health such as:
○ Sore throat or have problems swallowing
○ Swollen, itchy or red eyes, other eye symptoms get worse, or vision problems
○ Signs of low thyroid level, feeling tired, confused or weak.