1268 SECTION 10 Problems Related to Regulatory and Reproductive Mechanisms

patients head to promote fluid drainage from the periorbital area; the patient should sit upright as much as possible. Dark glasses reduce glare and prevent irritation from smoke, air cur-rents, dust, and dirt. If the eyelids cannot be closed, they should be lightly taped shut for sleep. To maintain flexibility, teach the patient to exercise the intraocular muscles several times a day by turning the eyes in the complete range of motion. Good grooming can be helpful in reducing the loss of self-esteem that can result from an altered body image. If the exophthalmos is severe, treatment options including corticosteroids, irradiation

of retroorbital tissues, orbital decompression, or corrective lid or muscle surgery may be used.

Thyroid Surgery. When subtotal thyroidectomy is the treatment of choice, the patient must be adequately prepared to avoid postoperative complications. To alleviate thyrotoxicosis, iodine treatment or PTU may be used before surgery. Iodine is mixed with water or juice, sipped through a straw, and administered after meals. Assess the patient for signs of iodine toxicity such as swelling of the buccal mucosa and other mucous membranes, excessive salivation, nausea and vomiting, and skin reactions.

NURSING DIAGNOSIS Activity intolerance related to fatigue, exhaustion, and heat intolerance secondary to hypermetabolism as evidenced by complaints of weakness, inability to perform usual activities, short attention span, memory lapses, dyspnea, tachycardia, irritability

PATIENT GOALS 1. Achieves a program of activity that balances physical activity with energy-conserving activities 2. Reports increased tolerance to activity with less weakness and fatigue

OUTCOMES (NOC) INTERVENTIONS (NIC) AND RATIONALESPsychomotor Energy Energy Management Exhibits concentration _____ Maintains personal grooming and hygiene _____ Exhibits stable energy level _____ Exhibits ability to accomplish daily tasks _____

Energy Conservation Balances activity and rest _____ Recognizes energy limitations _____ Uses energy conservation techniques _____

Measurement Scale1 = Never demonstrated2 = Rarely demonstrated3 = Sometimes demonstrated4 = Often demonstrated5 = Consistently demonstrated

Monitor patient for evidence of excess physical and emotional fatigue because hyperthyroidism results in protein catabolism, overactivity, and increased metabolism leading to exhaustion.

Monitor cardiorespiratory response to activity (e.g., tachycardia, other dysrhythmias, dyspnea, diaphoresis, pallor, blood pressure [BP], and respiratory rate) because tachycardia and BP elevations can indicate excessive activity.

Assist with regular physical activities (e.g., ambulation, transfers, turning, and personal care) to make certain patients daily needs are met.

Assist the patient to understand energy conservation principles (e.g., the requirement for restricted activity or bed rest) to avoid fatiguing patient.

Assist the patient to schedule rest periods. Avoid care activities during scheduled rest periods to promote adequate rest periods.

NURSING DIAGNOSIS Imbalanced nutrition: less than body requirements related to hypermetabolism and inadequate food intake as evidenced by complaints of weight loss; less than optimal body weight

PATIENT GOALS 1. Maintains weight appropriate for height (target weight ____ lb/kg) 2. Consumes food and fluid adequate to meet nutritional needs 3. Corrects nutritional deficiencies

OUTCOMES (NOC) INTERVENTIONS (NIC) AND RATIONALESNutritional Status: Nutrient Intake Nutrition Management Caloric intake _____ Protein intake _____ Carbohydrate intake _____ Vitamin intake _____ Mineral intake _____

Measurement Scale1 = Not adequate2 = Slightly adequate3 = Moderately adequate4 = Substantially adequate5 = Totally adequate

Nutritional Status Weight/height ratio _____ Fluid intake _____ Energy _____

Measurement Scale1 = Severe deviation from normal range2 = Substantial deviation from normal range3 = Moderate deviation from normal range4 = Mild deviation from normal range5 = No deviation from normal range

Determine, in collaboration with the dietitian, the number of calories and type of nutrients needed to meet nutrition requirements.

Ascertain patients food preferences to determine extent of the problem and plan appropriate interventions.

Provide patient with high-protein, high-calorie, nutritious finger foods and drinks that can be read-ily consumed because hyperthyroidism increases metabolic rate with resulting need to prevent muscle breakdown and weight loss.

Offer snacks (e.g., frequent drinks, fresh fruits/juice) to maintain adequate caloric intake. Monitor recorded intake for nutritional content and calories to evaluate nutritional status. Weigh patient at appropriate intervals to evaluate effectiveness of nutritional plan. Provide appropriate information about nutritional needs and how to meet them to promote

self-care. Assist the patient in receiving help from appropriate community nutritional programs.

NURSING CARE PLAN 50-1Patient with Hyperthyroidism