Nursing role in educating patients with hyperthyroidism (second part) بالانجليزية

 

When it comes to treating patients with hyperthyroidism, nursing role is essential. The focus of nursing interventions should be on offering ongoing care, reducing stress, preventing harm to the patient, and initiating education. Throughout education making sure significant others attend all of the instructional sessions is a helpful strategy. The primary role of the nurse in patient education is to provide a thorough explanation of thyroid gland function and nature of the disease. 

In terms of medications, Make sure the patient is aware of all the medicine's side effects, dose, action, and necessity for any laboratory monitoring when taking thyroid medications. While waiting for the drug to take action, reassure patients and encourage them to adhere to the prescribed Medications. Encourage also the patient to take medications with meals to reduce gastric irritation. If the patient is receiving an iodine, dilute it with milk or juice to reduce gastrointestinal distress and have them use a plastic straw to minimise the possibility of tooth discolouration.

Concerning nutritional support, Keeping an eye on the patient's food consumption, weigh daily, and educate them on the value of preserving their nutritional status is vital. So, cooperate with a dietitian to create a high-calorie, well-balanced meal that addresses both extreme hunger, weight loss and the nutritional deficits linked to hyperthyroidism. This achieved by promoting eating six times a day. The meals should be high in vitamins, minerals, carbs and protein (1-2g/kg of ideal body weight). Avoid eating excessive amounts of iodine-rich foods, such as: iodized salt, seaweed, fish, shellfish, dairy, and eggs. Avoid foods that induce accelerating of peristalsis and loose stools like fatty foods. 

Hyperthyroidism frequently results in iron insufficiency, hence eating a diet high in iron is also advised such as spinach, beef, chicken, turkey, raisins, dark chocolate, and fortified cereals. Zinc, which is typically low in these patients, is amazingly abundant in legumes and nuts such as walnuts, almonds, pumpkin seeds, and flax seeds. One necessary mineral, selenium, is required for the conversion of dormant T4 into active T3. A diet rich in mushrooms will include a good level of selenium. It has also been proposed that vitamin A is necessary for the synthesis of T3 and a functioning immune system like carrots and oily fish. When dormant T4 is transformed into active T3, oxidation takes place. Foods strong in antioxidants, such papaya leaf, green tea, haldi, amla, kalmegh, and cherries, can aid with it. Studies have demonstrated that ascorbic acid (vitamin C) and polyphenols have also antioxidant properties, improve insulin, and thyroid function. A diet rich in polyphenols and vitamin C includes      a variety of fruits, vegetables, and legumes. Examples of fruits and vegetables that are high in antioxidants, which are vital for maintaining thyroid hormone balance and fortifying the immune system, include strawberries, blueberries, raspberries, kiwifruit, tomatoes, and citrus fruits. Pumpkin, bell peppers, spinach, and kale are among the vegetables high in antioxidants. Sweet potatoes are also advised because they include phytonutrients that reduce inflammation and iron that promotes the creation of white and red blood cells and resilience to stress. 

Bone loss is a known consequence of hyperthyroidism, especially Graves' disease, and is exacerbated by a vitamin D shortage. Vitamin D helps prevent osteoporosis by facilitating quicker calcium absorption. If sufficient nutrients for bone formation are consumed in addition to vitamin D supplementation, this bone mass can be recovered. Foods high in vitamin D include eggs, fatty fish, dairy products, and mushrooms. Another possible source is sunlight. Patients who have low serum levels of vitamin D need to take extra vitamin D. 

Furthermore, dietary items high in omega-3 fatty acids should be consumed. Omega 3 improves the health of people with hyperthyroidism, calms the thyroid gland, increase immunity and lessen inflammatory responses in the body, and supplements the body with fatty acids. Omega 3 and vitamin-rich foods include walnuts, salmon, olive oil, and flaxseed oil.

Calcium supplements impede the appropriate absorption of thyroid drugs, hence while taking both, patients need to think about the timing. Research suggests allowing at least 4 hours to pass between taking thyroid medicine and calcium supplements. As well, avoid using caffeine and other stimulants  as these might reduce the thyroid medication's absorption, and make symptoms worse, such as a fast heartbeat, nervousness. 

At last, eating cooked vegetables, avoiding hydrogenated fat, avoiding gluten, stay hydrated, and avoiding soy-based products that may interact with drug  are some dietary recommendations that should be followed. 

Regarding eye, for patients who have Graves' disease, verify that they understand how to take care of their eyes. They should notify their doctor about alterations in vision. Patients should be advised to maintain lubrication in their eyes by using lubricating gels or drops. Positions that put undue strain on the eyes, such as head down, should be avoided. The delicate eyes can also be shielded by donning sunglasses outside. In addition, dark sunglasses and isotonic eye drops for lubrication are advised for exophthalmos. In order to prevent abrasion, a patient with exophthalmos may need to wear eye patches with a dome. For sleep, they put on a clean gauze cover to prevent dry eyes, and encourage sleep. Adhesive tape is also placed on their eyelids to keep them closed during sleep. Raising the head of the bed at night to alleviate eye swelling is important.

In relation to the management of activity and mobility, it is important to thoroughly assess the patient's level of activity. Schedule daily activities and rests to suit the patient's comfort and tolerance is important. Regular exercise can help prevent and minimise muscle wasting and joint stiffness.     Frequent exercise also improves muscular tone, increases bone density, lowers anxiety, and strengthens the heart. Thus, it is recommended by recent studies that yoga and other flexibility exercises be encouraged and incorporated into the care of thyroid patients. 

Regarding controlling body temperature, nurses need to be aware that patients with hyperthyroidism could feel overheated in a room with a usual temperature. As a result, it is advised to keep them dressed appropriately and at a cool, comfortable temperature. If the patients are feverish, give them a cooling blanket and have their thyroid function tested frequently.

When it comes to skin care, the following are important: using a moisturiser that suits the skin type, avoiding alcohol and caffeine, staying hydrated, and taking cold showers. Keeping the toenails and fingernails neatly cut, eating a balanced diet, exercising frequently, and taking the medicine as prescribed is crucial.

Related to complications, ask the patient to report any thyrotoxicosis symptoms, such as palpitations, fast heartbeat, breathing difficulties, sweating, trembling, shakiness, nausea, and vomiting, right away. Instruct the patient also to report any weight loss, swallowing difficulties, or increasing neck swelling. The nursing care plan must also involve precautions to avoid complications such as atrial fibrillation, heart failure, and other heart diseases. Thus, nurses should continually concentrate on assessing cardiac and respiratory functioning. 

Education related to thyroid surgery, nurse must provide emotional support for patients undergoing thyroidectomy. Teach patients undergoing total thyroidectomy they’ll need thyroid replacement hormones for life.

In terms of psychological support, offering psychological support can help with the psychological components of living with hyperthyroidism. The nurse should reassure the patients and offer professional counselling in a calm and leisurely manner. Talk about the causes of emotional instability and/or psychotic behaviour with the patient and his family. Give the patient a chance to talk about how they feel about their changed appearance and measures to improve their self-image. Provides information and reassures the patient that the situation is temporary and will improve with treatment. Nursing care plans must incorporate the use of nonpharmacological therapies, such as exercise, cognitive training, meditation, brain games, enough sleep, social connections, and daily living activities, for the prevention of cognitive deficits. If necessary, encourage speaking with mental health providers or support organisations. When dealing with irritation, provide a calm atmosphere and steer clear of topics that agitate or disturb the patients. As well, to lessen stress, use relaxation techniques like biofeedback, guided imagery, meditation, or other techniques .

Regards to house and social environment management, social and home environment should be modified to maintain optimum environmental temperature. This entails creating a cool atmosphere and preventing falls. Due to weakened bones, people with hyperthyroidism may fracture. Numerous external issues related to the home can cause falls, including inadequate illumination, poorly arranged furniture, slippery flooring, ripped carpets, unguarded staircases, lack of grab bars in bathrooms and toilets, and a congested living space. As a result, it is critical for nurses to evaluate both internal and external factors associated with fall risk in these patients to prevent falls. Social support is another important topic that needs to be taken into account.

Other crucial points that should be taken into consideration:

- Advise the patient of the possibility of high iodine content in some drugs, such as seaweed pills, expectorants, dietary supplements, and contrast dyes, which could interfere with treatment.

- As part of a comprehensive care plan, requiring a pregnancy test would help prevent possibly harmful radiation exposure.

- Saliva is radioactive for 24 hours following radioactive iodine therapy, thus patients should cover their mouths when expectorating or coughing.

- Checking vital signs frequently, especially heart rate and blood pressure, which both increase in hyperthyroidism.

- Tell the patient not to palpate their thyroid too much because this can overstimulate and result in         a thyroid crisis.

 

- Get enough sleep.

- Inform the patient when to seek medical assistance if they have any of the following symptoms: fever, high blood pressure, irregular heartbeat, dyspnoea, loss of consciousness, or changed mental status.

- Steer clear of conditions like infection, abrupt antithryroid drugs withdrawal, and trauma as they can raise serum thyroid hormone levels and cause thyroid storm, which has a high death rate and necessitates immediate medical attention.

- Emphasise the importance of ongoing medical follow up.

Continue: see third part..................

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