Hyperthyroidism Grave’s Disease Nursing Diagnosis NCLEX Review Care Plans
Nursing Study Guide: Grave’s Disease
Grave’s disease is an autoimmune disorder that results to the excessive production of thyroid hormones or hyperthyroidism.
Many cases of Grave’s disease occur in people age 40 and below, and more women have it than men. Grave’s disease is a common cause of hyperthyroidism, although other illnesses may result to the said thyroid problem.
About 30% of the cases of Grave’s disease manifest as eye problems, also known as Grave’s ophthalmopathy.
Reduction of the thyroid hormone levels is the most important treatment goal for Grave’s disease, followed by symptomatic relief and control.
Signs and Symptoms of Grave’s Disease
- Eye problems (Grave’s ophthalmopathy) such as bulging eyes, blurry vision or loss of vision, light sensitivity, eye pain or pressure, gritty sensation, or eye inflammation
- Grave’s dermopathy – thick red, skin found on top of the feet or shins
- Anxiety and irritability
- Fine tremor of the hands or fingers
- Weight loss, even if he/she has normal eating habits
- Goiter or enlargement of the thyroid gland
- Heat sensitivity
- Increased sweating and/or warm and moist skin
- Change in menstrual cycles
- Erectile dysfunction
- Reduced libido
- Frequent bowel movements
- Sleep problems
Causes and Risk Factors for Grave’s Disease
In Grave’s disease, there is a malfunctioning of the immune system, wherein an antibody called thyrotropin receptor antibody (TRAb) mimics the action of the regulatory pituitary hormone and causes the thyroid hormones to be overproduced.
It is still unknown what causes these malfunctions in the immune system. Opthalmopathy in Grave’s disease occurs due to the buildup of carbohydrates in the tissues and muscles located behind the eyes, causing them to swell and the eyes to bulge.
Having a family history puts a person at risk for Grave’s disease.
Women are more prone to it than men, and younger people aged 40 and below seemed to be more likely to develop the disease.
High levels of stress, pregnancy, and tobacco smoking can also lead to the development of Grave’s disease.
Complications of Grave’ Disease
- Thyroid storm. Although rare, Grave’s disease can cause a fatal condition called thyroid storm, wherein the hyperthyroidism is uncontrolled and goes into crisis.
- Osteoporosis. If left untreated, hyperthyroidism related to Grave’s disease can result to brittle and weak bones, as the thyroid hormones play a role in incorporating calcium into the bones.
- Pregnancy problems. During pregnancy, Grave’s disease can result to fetal thyroid dysfunction, preterm birth, miscarriage, preeclampsia, poor fetal growth, or maternal heart problems.
- Cardiac issues. One of the symptoms of Grave’s disease is palpitations. Chronic palpitations may eventually result to cardiac dysrhythmia and structural problems of the heart muscles.
Diagnosis of Grave’s Disease
- Physical exam and history taking – to check for signs and symptoms of Grave’s disease, particularly eye and skin manifestations; to check for risk factors related to the disease
- Blood tests – thyroid function tests (TFTs) require a blood sample and is used to determine the levels of TSH and thyroid hormones; antibody test may also be indicated to determine the presence of TRAb.
- Ultrasound of the thyroid – to see any enlargement; usually indicated for pregnant women who are not eligible for radioactive iodine uptake
- Radioactive iodine uptake – to measure the thyroid gland’s ability to uptake iodine, the patient is given a tiny amount of radioactive iodine uptake and is subjected to a scanning camera
- CT scan or MRI as needed
Treatment for Grave’s Disease
- Anti-thyroid medications. These medications cause interference with the uptake of iodine by the thyroid gland, thereby reducing the production of thyroid hormones. Examples include methimazole and propylthiouracil.
- Radioactive iodine therapy. The patient is prescribed radioactive iodine to take by mouth, and the radiation causes the destruction of overactive thyroid cells and reduction of the thyroid gland’s size. The treatment may last for a few weeks or months, depending on the severity of the hyperthyroidism.
- Beta blockers. These medications such as atenolol and metoprolol are used to control the symptoms of excessive thyroid hormones, such as palpitations, heat tolerance, tremors, and irritability or anxiety.
- Thyroidectomy. The surgical removal of the thyroid or a part of it can be used to treat Grave’s disease. However, it carries risks such as nerve damage that may affect the vocal cords, as well as damage to the parathyroid glands.
- Grave’s ophthalmopathy treatments. Corticosteroids like prednisone may be used to reduce the swelling of the eye muscles. Eye glass prisms and/or orbital decompression surgery may also be needed.
Nursing Care Plans for Grave’s Disease
- Nursing Diagnosis: Deficient Knowledge related to new diagnosis of Grave’s disease as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of Grave’s disease and its management.
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)||To address the patient’s cognition and mental status towards the new diagnosis of Grave’s disease and to help the patient overcome blocks to learning.|
|Explain what Grave’s disease is, and how it affects the vital organs such as the heart and bones, as well as how it can affect pregnancy if the client is pregnant. Avoid using medical jargons and explain in layman’s terms.||To provide information on Grave’s disease and its pathophysiology in the simplest way possible.|
|Educate the patient about hyperthyroidism, its side effects, and management.||To give the patient enough information on the risks of hyperthyroidism.|
|Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to control thyroid hormone levels and symptoms of Grave’s disease and explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.|
|Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can be linked to the development of Grave’s disease. Teach the patient on how to modify these risk factors (i.e. smoking and high stress levels).||To assist the patient in identifying and managing modifiable risk factors related to Grave’s disease.|
- Nursing Diagnosis: Fatigue related to hypermetabolic state due to increased energy demand, as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, irritability, and jittery behavior
Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
|Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.|
|Encourage activity through self-care and exercise as tolerated Alternate periods of physical activity with rest and sleep. Encourage enough rest and sleep and provide comfort measures.||To help the patient balance his/her physical activity and rest periods. To reserve energy levels and provide optimal comfort and relaxation.|
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To allow the patient to relax while at rest. To allow enough oxygenation in the room.|
|Refer the patient to physiotherapy / occupational therapy team as required.||To provide a more specialized care for the patient in terms of helping him/her build confidence in balancing daily physical activity and rest periods.|
Other Nursing Diagnoses:
- Risk for Imbalanced Nutrition: Less than Body Requirements
- Risk for Decreased Cardiac Output
- Risk for Disturbed Thought Processes
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Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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