List of Nursing Diagnosis

Assessment

1. Activity / Rest
Symptoms : Insomnia, increased sensitivity ; muscle weakness, impaired coordination ; Severe fatigue.
Signs : muscle atrophy.

2. Circulation
Symptoms : Palpitations, chest pain (angina).
Signs : dysrhythmias (atrial fibrillation), gallop rhythm, murmurs ; Increased blood pressure with a heavy tone pressure, tachycardia ; Circulatory collapse, shock (crisis thyrotoxicosis)

3· Ego Integrity
Symptoms : Experiencing severe stress both emotionally and physically.
Signs : Emotions labile (euphoria moderate to delirium), depression.


Physical Examination (ROS : Review of Systems)

1. Respiratory B1 (breath)
circulatory collapse, shock (crisis thyrotoxicosis), increased respiratory rate, dyspnea, and pulmonary edema.

2. Cardiovascular B2 (blood)
Hypertension, arrhythmia, palpitations, heart failure, lymphocytosis, anemia, splenomegaly, enlarged neck.

3. Nerves B3 (Brain)
Rapid and guttural speech, impaired mental status and behavior, such as confusion, disorientation, anxiety, sensitive excitatory, delirium, psychosis, stupor, coma, tremors smooth on hands, without purpose, some parts jerky, hyperactive deep tendon reflexes.

4. Urinary B4 (bladder)
Oligomenorrhea, amenorrhea, down libido, infertility, gynekomastia.

5. Digestive B5 (bowel)
Sudden weight loss, increased appetite, eat a lot, eat often, thirst, nausea and vomiting.

6. Musculoskeletal / integument B6 (bone)
Weakness, fatigue.


Nursing Diagnosis for Hyperthyroidism

Nursing Diagnosis : Hyperthermia related to inflammatory processes.

Goal : Normal body temperature.

Outcomes :

• No signs of dehydration,
• Lips moist.

Intervention :
1. Give warm water compress as needed.
R / : Can help decrease heat experienced by the patient.

2. Encourage clients to use clothes that can absorb sweat.
R / : Due to the humid conditions of the body triggers the growth of fungi that cause risk of complications.

3. Maintain a cool environment.
R / : To help maintain the body temperature of the patient to be in a normal state.

4. Collaboration with the medical team in drug delivery.
R / : Helps reduce body temperature of the patient.


Nursing Diagnosis : Imbalanced nutrition : less than body requirements related to the inability to absorb nutrients.

Goal : Nutritional needs fulfilled.

Outcomes :

• Return to normal eating,
• Normal weight,
• Normal laboratory examination,
• Showed no signs of malnutrition,
• Not nausea,
• Not vomiting.

Intervention :
1. Supervise dietary supply, give eat little but often.
R / : To avoid nausea and vomiting and nutritional needs of patients.

2. Encourage the patient to eat little but often.
R / : Increased appetite.

3. Provide information about the importance of nutrition for the body.
R / : Improving patients' knowledge about nutrition.

4. Collaboration with the medical team in drug delivery.
R / : To provide appropriate therapy for patients.

Hyperthyroidism is a condition in which an overactive thyroid gland produces an excessive amount of thyroid hormones that circulate in the blood . Thyrotoxicosis is a toxic condition caused by an excess of thyroid hormones from any cause. Thyrotoxicosis can be caused by an excessive intake of thyroid hormones or by the production of thyroid hormones excess by the thyroid gland.

Thyroiditis is the inflammation of the thyroid gland which is usually followed by symptoms of hyperthyroidism. The disease is more common in women after childbirth, a few months later the symptoms of hypothyroidism. Most will recover back to normal thyroid.

The thyroid is regulated by another gland located in the brain, called the pituitary. In turn, the pituitary is regulated in part by thyroid hormone that is circulating in the blood (a feedback effect of thyroid hormones on the pituitary gland) and partly by another gland called the hypothalamus, is also a part of the brain.

The hypothalamus releases a hormone called thyrotropin releasing hormone (TRH), which sends a signal to the pituitary to release thyroid stimulating hormone (TSH). In turn, TSH sends a signal to the thyroid to release thyroid hormones. If the excessive activity of whichever of these three glands occurs, an amount of thyroid hormones excess can be generated, thus resulting in hyperthyroidism.

Number or rate of thyroid hormone production is controlled by the pituitary gland. If there is no sufficient amount of thyroid hormone circulating in the body to allow for normal functioning, the release of TSH, enhanced by the pituitary in an attempt to stimulate the thyroid to produce more thyroid hormone. Conversely, when there is an excessive amount of circulating thyroid hormone, the pituitary release of TSH reduced when trying to reduce the production of thyroid hormones.


Some diseases that cause hyperthyroidism are:

a) Graves' Disease
The disease is caused by an overactive thyroid gland and is the most frequent cause of hyperthyroidism encountered. The disease is usually derived. Women 5 times more often than men. Suspected cause is an autoimmune disease, in which antibodies are found in the blood circulation, namely thyroid stimulating.
Immunoglobulin (TSI antibodies), thyroid peroxidase antibodies (TPO) and thyrotropin receptor antibody (TRAb). The originators of this disorder is stress, smoking, radiation, eye and skin disorders, blurred vision, sensitive to light, feels like there is sand in the eyes, the eyes may protrude up to double vision. This eye disease often runs itself and does not depend on the high / low thyroid hormone. Skin disorders cause the skin to be red, loss of pain, and sweating a lot.

b) Toxic Nodular Goiter
Lump in the neck due to enlargement of the thyroid in the form of solid grains, can be one or many. The word "toxic" means hyperthyroidism, whereas nodules or seeds that are not controlled by TSH, thus producing excessive thyroid hormone.

c) Drinking excessive thyroid hormone medication.
Drinking thyroid hormone with the aim of lowering the body until the side effects.

d) Production of abnormal TSH.
Pituitary TSH production can produce excessive TSH, which stimulates the thyroid issue that a lot of T3 and T4.

e) Thyroiditis (inflammation of thyroid gland).
Thyroiditis often occurs in women after childbirth, postpartum thyroiditis is called, where a complaint arises in the initial phase of hyperthyroidism, 2-3 months then quit hpotiroid symptoms.

f) Excessive iodine consumption.
When excessive consumption can cause hyperthyroidism, this disorder usually occurs when the patient previously had been no abnormalities of the thyroid gland.


In the mild stage often without complaint. Similarly, in older people, more than 70 years, the typical symptoms are often not apparent. Depending on the severity of hyperthyroidism, then a complaint can be mild to severe.

Complaints that often arise include:

• Anxiety, insomnia, and a fine tremor.
• Weight loss despite a good appetite.
• Heat intolerance and a lot of sweat.
• Palpitations, tachycardia, cardiac arrhythmias, and heart failure, which may occur as a result of the effects of thyroxine on myocardial cells.
• Amenorrhoea and infertility.
• Muscle weakness, especially in limb circumference (proximal myopathy).
• Osteoporosis with bone pain.

Nursing Diagnosis for Hyperthyroidism

1. Hyperthermia related to inflammatory processes.
2. Imbalanced nutrition : less than body requirements related to the inability to absorb nutrients.
3. Activity intolerance related to imbalance between oxygen supply and demand.
4. Ineffective Breathing Pattern related to respiratory muscle fatigue.