Grave’s Disease Nursing Diagnosis & Care Plan

Graves’ disease is an autoimmune disorder that causes hyperthyroidism, where the thyroid gland produces excessive hormones. This nursing diagnosis guide provides comprehensive care planning for patients with Graves’ disease, focusing on the most common symptoms and complications that nurses need to address.

Causes (Related to)

Graves’ disease can be triggered by various factors that affect the immune system’s function. Common causes include:

• Genetic predisposition – Family history of autoimmune disorders
• Gender – More common in women
• Age – Usually develops before age 40
• Pregnancy – Can trigger or worsen symptoms
• Stress – May trigger an autoimmune response
• Other autoimmune conditions – Such as type 1 diabetes or rheumatoid arthritis
• Environmental factors – Including smoking and radiation exposure

Signs and Symptoms (As evidenced by)

Graves’ disease presents with various symptoms that nurses should monitor and assess:

Subjective: (Patient reports)

• Heat intolerance
• Anxiety and irritability
• Tremors in hands and fingers
• Weight loss despite increased appetite
• Sleep disturbances
• Fatigue
• Heart palpitations
• Muscle weakness

Objective: (Nurse assesses)

• Enlarged thyroid gland (goiter)
• Rapid heart rate (tachycardia)
• Elevated blood pressure
• Fine tremors
• Warm, moist skin
• Exophthalmos (bulging eyes)
• Hyperactive reflexes
• Irregular menstrual cycles in women
• Elevated thyroid hormone levels (T3, T4)
• Suppressed TSH levels

Expected Outcomes

The following outcomes indicate successful management of Graves’ disease:

• The patient will maintain stable vital signs
• The patient will report reduced symptoms of hyperthyroidism
• The patient will demonstrate proper medication compliance
• The patient will maintain the appropriate weight
• The patient will show improved eye symptoms
• The patient will exhibit reduced anxiety levels
• Patient will demonstrate an understanding of disease management

Nursing Assessment

Comprehensive nursing assessment is crucial for patients with Graves’ disease:

1. Monitor vital signs regularly
Track heart rate, blood pressure, temperature, and respiratory rate to assess thyroid hormone effects on body systems.

2. Assess thyroid gland
Check for the presence and size of goiter, tenderness, or nodules.

3. Evaluate cardiovascular status
Monitor for tachycardia, arrhythmias, and hypertension.

4. Check eyes and vision
Assess for exophthalmos, eye irritation, vision changes, or eye pain.

5. Monitor weight and nutrition
Track weight changes and dietary intake.

6. Assess psychological status
Evaluate for anxiety, irritability, and mood changes.

7. Review laboratory results
Monitor thyroid function tests (T3, T4, TSH) and other relevant blood work.

Nursing Care Plans

Care Plan 1: Hyperthermia

Nursing Diagnosis Statement:
Hyperthermia related to increased metabolic rate secondary to elevated thyroid hormone levels.

Related Factors:

• Increased metabolic rate
• Excess thyroid hormone production
• Heat intolerance

Nursing Interventions and Rationales:

1. Monitor temperature regularly
   Rationale: Helps track the effectiveness of interventions
2. Maintain cool environment
   Rationale: Reduces metabolic demands and improves comfort
3. Encourage adequate fluid intake
   Rationale: Prevents dehydration from increased metabolism
4. Provide lightweight clothing and bedding
   Rationale: Promotes heat loss and comfort

Desired Outcomes:

• The patient will maintain a normal body temperature
• The patient will report an improved comfort level
• The patient will demonstrate adequate hydration status

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Care Plan 2: Decreased Cardiac Output

Nursing Diagnosis Statement:
Risk for decreased cardiac output related to tachycardia and hypertension secondary to thyroid hormone excess.

Related Factors:

• Increased heart rate
• Elevated blood pressure
• Increased cardiac workload

Nursing Interventions and Rationales:

1. Monitor vital signs every 4 hours
   Rationale: Early detection of cardiovascular complications
2. Administer beta-blockers as prescribed
   Rationale: Reduces heart rate and blood pressure
3. Limit physical activity during the acute phase
   Rationale: Reduces cardiac workload

Desired Outcomes:

• The patient will maintain a heart rate < 100 bpm
• The patient will maintain blood pressure within normal limits
• Patient will report no chest pain or palpitations

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Care Plan 3: Anxiety

Nursing Diagnosis Statement:
Anxiety related to the disease process and treatment regimen as evidenced by restlessness and expressed concerns.

Related Factors:

• Disease progression
• Treatment uncertainties
• Hormonal changes
• Lifestyle modifications

Nursing Interventions and Rationales:

1. Provide emotional support and active listening
   Rationale: Reduces anxiety and builds trust
2. Teach relaxation techniques
   Rationale: Helps manage stress and anxiety
3. Explain procedures and treatments
   Rationale: Increases understanding and reduces fear

Desired Outcomes:

• The patient will report decreased anxiety levels
• The patient will demonstrate effective coping mechanisms
• The patient will verbalize understanding of the disease process

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Care Plan 4: Imbalanced nutrition: less than body requirements

Nursing Diagnosis Statement:
Imbalanced nutrition: less than body requirements related to increased metabolic rate.

Related Factors:

• Hypermetabolism
• Increased appetite with weight loss
• Altered nutrient absorption

Nursing Interventions and Rationales:

1. Monitor weight daily
   Rationale: Tracks nutritional status
2. Provide a high-calorie, high-protein diet
   Rationale: Meets increased metabolic demands
3. Document food intake
   Rationale: Ensures adequate nutrition

Desired Outcomes:

• The patient will maintain a stable weight
• The patient will demonstrate adequate nutritional intake
• The patient will show normal protein levels

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Care Plan 5: Disturbed sleep pattern

Nursing Diagnosis Statement:
Disturbed sleep pattern related to hypermetabolism and anxiety.

Related Factors:

• Increased metabolic rate
• Anxiety and restlessness
• Physical discomfort

Nursing Interventions and Rationales:

1. Establish bedtime routine
   Rationale: Promotes sleep hygiene
2. Provide quiet environment
   Rationale: Reduces stimuli that interfere with sleep
3. Administer medications as prescribed
   Rationale: Helps manage symptoms affecting sleep

Desired Outcomes:

• The patient will report improved sleep quality
• The patient will demonstrate a normal sleep-wake cycle
• The patient will report feeling rested after sleep

References

1. Cooper, D. S., & Laurberg, P. (2023). Hyperthyroidism in pregnancy. The Lancet Diabetes & Endocrinology, 11(1), 68-80.
2. Smith, T. J., & Hegedüs, L. (2022). Graves’ Disease. New England Journal of Medicine, 387(20), 1862-1874.
3. Ross, D. S., et al. (2023). American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid, 33(10), 1126-1176.
4. Kahaly, G. J., et al. (2022). Graves’ Disease: Current Understanding and Management. Journal of Clinical Endocrinology & Metabolism, 107(8), 2179-2194.
5. Brent, G. A. (2023). Clinical practice. Graves’ disease. New England Journal of Medicine, 388(24), 2244-2258.
6. Davies, T. F., et al. (2023). Thyroid autoimmune disease: Graves’ disease. Journal of Autoimmunity, 128, 102928.