Thyroid Storm Nursing Diagnosis and Nursing Care Plan

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Thyroid Storm Nursing Care Plans Diagnosis and Interventions

Thyroid Storm NCLEX Review and Nursing Care Plans

Thyroid storm is a life-threatening medical emergency associated with exacerbated clinical manifestations of thyrotoxicosis. Thyroid storm is also called other names such as hyperthyroid crisis, thyroid crisis, and thyrotoxic crisis.

It is a rare condition that has become even less common due to improved treatments for hyperthyroidism. Thyroid storm may be difficult to diagnose due to its multi-system involvement.

However, early diagnosis and treatment are keys in reducing the mortality and morbidity associated with this serious condition.

The thyroid is a small gland found in the lower neck. It is mainly responsible for the production of two hormones that help regulate important body processes including the respiratory and heart rate.

Overactivity of this gland leads to a cascade of signs and symptoms which can further cause medical issues, including thyroid storm.

Signs and Symptoms of Thyroid Storm

Thyroid storm involves many organs in the body. It has similarities to the clinical manifestations of hyperactive thyroid, only more severe.

This is the reason why people experiencing thyroid storm may be too unwell to call for help on their own. The following are the signs and symptoms of thyroid storm:

  • Severe tachycardia – heart rate may exceed 140 beats per minute
  • Cardiac arrhythmias, particularly atrial fibrillation
  • High fever
  • Profuse sweating
  • Shaking or jittery behavior
  • Agitation
  • Restlessness
  • Confusion
  • Diarrhea
  • Unconsciousness
  • High blood pressure

Causes of Thyroid Storm

Thyroid storm stems out of thyrotoxicosis which is a condition that occurs due to high levels of circulating thyroid hormones. Of all forms of thyrotoxicosis, Grave’s disease is the lead cause of thyroid storm.

In general, thyroid storm is precipitated by three main reasons:

Complications of Thyroid Storm

The mortality rate associated with thyroid storm is between 8 to 25 % of cases. Therefore, it is important that early diagnosis and treatment are made. Other complications are also known to be linked with thyroid storm and they are as follows:

  • Arrhythmias
  • High output cardiac failure
  • Seizures
  • Delirium
  • Coma
  • Elevated liver enzymes
  • Jaundice
  • Abdominal cramps, vomiting, and diarrhea
  • Atrial fibrillation
  • Thromboembolism

Diagnosis of Thyroid Storm

The diagnosis of thyroid storm is highly based on clinical assessment. It may also be more difficult to diagnose compared to other conditions due to its multisystem involvement. When thyroid storm is suspected, early treatment is necessary to reduce mortality and other serious complications.

  • Physical assessment and medical history taking – these two processes are important in the diagnosis of thyroid storm. The basic parameters such as the vital signs and the presence of signs and symptoms will be evaluated and reviewed by the physician.
  • Laboratory tests – blood tests including the measurement of thyroid stimulating hormone (TSH) will be taken. It may be expected to get a normal to below normal TSH level in people with thyroid storm. The levels of T3 and T4 will also be measured and will be expected to be higher than normal.
  • Differential diagnosis – an approach to diagnose thyroid storm is to rule out other possible medical conditions. The following are associated conditions with similar clinical manifestations to thyroid storm:
    • Hyperthyroidism
    • Atrial Fibrillation
    • Sympathomimetic toxicity

Treatment for Thyroid Storm

In the management of thyroid storm, treatment may begin prior to the arrival of test results. This is because of its associated mortality rate and serious complications. The main goals of the treatment for thyroid storm are the following:

  • To block the production of thyroid hormones
  • To block the sympathetic flow
  • To block the conversion of T4 to T3

Several methods are found helpful in the management of thyroid storm:

  1. Medications
    • Thionamides – these are antithyroid medications commonly used in people with Grave’s disease. They facilitate the body to achieve a “euthyroid” state usually before undergoing a radioiodine therapy.
    • Iodine compounds – iodine solutions may also be prescribed for people with thyroid storm. Iodine helps reduce the synthesis of thyroid hormones.
    • Beta-blockers – these drugs are also used in the treatment of thyroid storm. Aside from their effect on the moderation of blood pressure, they also block the peripheral conversion of T4 to its active form.
    • Steroids – similar to beta-blockers, steroids are also known to prevent the peripheral conversion of T4 to active form.
  2. Supportive Management. Care measures to address associated symptoms are helpful in promoting comfort and faster recovery. These may include:
    • Administration of muscle relaxants for muscular spasms
    • Use of cooling blankets and medications for hyperthermia
    • Administration of intravenous fluids and electrolytes for dehydration

Thyroid Storm Nursing Diagnosis

Thyroid Storm Nursing Care Plan 1

Nursing Diagnosis: Hyperthermia related to thyroid storm secondary to post thyroidectomy as evidenced by body temperature of 40 degrees Celsius, rapid and shallow breathing, racing heart rate, flushed skin, and profuse sweating

        Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

Nursing Interventions Thyroid StormRationales
Assess the patient’s vital signs at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of treatment given.
Remove excessive clothing, blankets, and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Encourage the patient to drink cool fluids, preferably those that come with electrolyte replacement such as sports drinks.To replace the water and electrolytes that have been eliminated from the body through the sweat glands.
Provide a body cooling technique as recommended by the physician.To facilitate the body in cooling down and to provide comfort.
Administer fluids and medications as prescribed.The following medications may be required to treat thyroid storm:

Anti-thyroid drugs such as thionamides and iodine compounds

Steroids

Anti-pyretics

Beta blockers

Thyroid Storm Nursing Care Plan 2

Nursing Diagnosis: Hypertension related to increased cardiac output secondary to thyroid storm as evidenced by elevated blood pressure levels, persistent heart rate of >140 bpm, and cardiac arrythmias

Desired Outcome: The patient’s vital signs will be within normal range and the cardiac output will stabilize. 

Nursing Interventions Thyroid StormRationales
Assess and monitor the patient’s vital signs.The patient’s vital signs are important markers to monitor the status of tissue perfusion which is directly affected by the cardiac output. 
Administer anti-thyroid medications and beta blockers as prescribed.Aside from their effect on the moderation of blood pressure, beta blockers also block the peripheral conversion of T4 to its active form.
Discuss the signs and symptoms of thyroid storm and increased cardiac output with the patient using easy-to-understand words.The patient will need to understand his/her condition fully to promote compliance to the prescribed treatments.
Discuss ways to reduce oxygen requirements with the patient:Bed restPromote normal, regular breathingReduce unnecessary activitiesRequest for assistance with intensive activitiesSemi to high-fowler’s positionUse of bedside commodeElevation of legs  There are ways to reduce the body’s metabolic requirements. These will help the body to meet oxygen demand and minimize the serious effects of decreased cardiac output.
Allow time for questions from the patient.The patient may have questions regarding his/her condition. Being available to answer questions can relieve his/her anxieties which will help promote relaxation.

Thyroid Storm Nursing Care Plan 3

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of thyroid storm 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 thyroid storm and its management.

Nursing Interventions Thyroid StormRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learningTo address the patient’s cognition and mental status towards the new diagnosis of Thyroid storm and to help the patient overcome blocks to learning.
Explain what thyroid storm is, and how it affects the vital organs such as the heart and brain. Avoid using medical jargons and explain in layman’s terms.To provide information on Thyroid storm and its pathophysiology in the simplest way possible.
Educate the patient about hyperthyroidism, its symptoms, 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 Thyroid storm 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 dietary and lifestyle choices that can help in obtaining a faster recovery from thyroid storm. Teach the patient on how to achieve these behavioral changes successfully.To assist the patient in a fast recovery following thyroid storm. The patient may need a referral from a dietitian to help with meal planning and nutritional support.

Thyroid Storm Nursing Care Plan 4

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.

Nursing Interventions Thyroid StormRationales
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 by providing 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.

More Thyroid Storm Nursing Diagnosis

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). 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

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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