The nurse plays an important role in hypothyroidism management, enhancing the patient's physical, social, and emotional well-being. They offer support, help with achieving euthyroid state, and incorporate hypothyroidism care into patients' lives. Nursing care plans should prioritise patient education, including the disease, nutrition, medication, and modifications to lifestyles. It is critical to consider neurologic changes in patients, such as poor memory, disorientation, hearing loss, and lower attention span, and to schedule sessions at appropriate times for learning. Using written information supports verbal presentations.
Related to nutritional status, Hypothyroidism has a slower metabolism, which can result in weight gain and increased caloric intake, resulting in nutritional imbalances and significant health complications such as high blood pressure, a high cholesterol levels, and obesity. Patients should be educated on the importance of consulting a dietician about calorie requirements, and balanced diet. Analyse the patient's food intake over the course of 24 hours to offer baseline data for a personalised dietary plan according to the patient's altering metabolic needs.
It is necessary to give a low-calorie, high-protein, low-cholesterol, low-saturated-fat diet. Encourage patients to eat small, frequent meals (6 meals), and meal supplements. This ensures that the patient receives an adequate supply of nutrients while having low energy levels. Educate patients on the need of getting enough iodine to keep their thyroid hormones balanced such as: seaweed, fish, shellfish, dairy, and eggs. Other dietary guidelines include limiting soy, coffee and alcohol intake. As caffeine products can exacerbate tiredness, especially if consumed in the afternoon because they interrupt sleep. Excessive alcohol consumption also impairs quality sleep.
Hypothyroidism can delay lymphatic outflow, resulting in fluid retention. To minimise oedema, instruct on how to reduce salt intake, elevate the extremities, and use a cool compress to relieve periorbital oedema. Further, thyroid replacement should be administered in accordance with nutritional guidelines. Foods containing iron, calcium, or fibre should be avoided when using levothyroxine since they can reduce medication absorption.
In terms of fluids and fibre, Hypothyroidism delays the digestive process, resulting in constipation. Encourage increased fluid consumption within the parameters of fluid restriction. Also, a high fibre intake is indicated to reduce constipation and encourage regular bowel movements like vegetables and fruits. Patients with moderate to severe hypothyroidism, particularly those with myxoedema, may have lower sodium levels (<135 mmol/L). So, consider adopting fluid restrictions in cases of severe hyponatremia.
When it comes to fatigue, Fatigue is a common symptom of hypothyroidism because the body's metabolic rate slows, resulting in less energy. Nurses should assess their patient's daily activities, and energy levels. These assessments are useful in scheduling activities at times when the patient has the most energy. Also, promote rest and enough sleep, save energy throughout daily activities, and adjust thyroid hormone replacement therapy as needed. Providing a comfortable environment, a diet rich in fruits and vegetables, meditation, and yoga can also help manage fatigue.
Regarding skin care, As metabolism slows, skin and hair dry out, becoming thin and fragile. Encourage the use of skin moisturisers after bathing and hair conditioners. Take note of any excoriations or wounds, as healing may be impeded. Encourage adequate oral fluid intake because it can benefit skin and hair while also lowering the risk of dehydration unless contraindicated. Avoid hot showers or water, since these can irritate the skin and produce more dryness. Refer to dermatology as dermatologist can diagnose and treat more severe skin disorders such as hair loss, rashes, eczema, and hyperpigmentation.
Relation to body temperature regulation, In hypothyroidism, the problem is related to cold intolerance, hence an extra layer of clothes or blanket is recommended. Wearing layers, soaking the hands and feet in warm water, and limiting exposure to cold are all ways to maintain one's body temperature stable. Assess the patient's body temperature is also important one.
Considerations related to medications, People with hypothyroidism should be educated on the necessity of lifelong drug adherence, and proper administration. To ensure proper administration and prevent sleeplessness, drugs should be administered first thing on an empty stomach, an hour before a meal. If a dose is missed, the patient may take it as soon as possible. Skipping doses or quitting medication suddenly can disturb hormone levels, resulting in poor treatment outcomes.
It is also recommended that patients avoid switching between brand names and substitutes because the body is sensitive to thyroid drugs. If a switch is required, additional lab testing will be required to ensure efficacy. Furthermore, levothyroxine is incompatible with many other medications, therefore it should be taken on its own. Bile acid sequestrants (such as sevelamer), calcium supplements (including calcium acetate, carbonate, and citrate), aluminium, magnesium, lanthanum, and simethicone are examples of medications that bind to levothyroxine and lower its bioavailability. Also, taking levothyroxine with anticoagulants can increase its effect. Some drugs, such as antacids, require patients to wait 4 to 6 hours between each dose. Avoid sedatives and narcotics due to increased sensitivity to them. Coffee has also been proven to interfere with the absorption of T4.
Another critical step is to discuss the predicted advantages and any adverse effects. The patient should report any side effects or overdoses of thyroid medications, as well as recognise signs of hyperthyroidism such as insomnia, tachycardia, heat intolerance, chest pain/palpitations, tremors, fever, excessive sweating, changes in body weight, anxiety, and nervousness. As these may indicate that their medication needs to be changed. For constipation, it can be treated with laxatives. Furthermore, obtaining medical identification for hormone therapy is crucial due to potential drug interactions with levothyroxine, and making informed care decisions.
Related to exercise, Because hypothyroidism can cause muscle and joint discomfort, a regular exercise regimen can assist to ease these symptoms. Moderate exercise is still recommended to enhance energy levels throughout the day. Starting slowly with 5 to 15 minutes of walking per day is an exercise recommendation. In addition to standard treatment, nurses must seek alternative therapies. It encompasses practices like yoga, meditation, and other breathing techniques. Space activities that encourage rest and exercise, as tolerated.
Concerning complications, It is critical to check vital signs on a regular basis and look for symptoms of severe hypothyroidism, such as acute fatigue, lethargy, confusion, low body temperature, decreased heart rate, and respiratory depression. Also, monitor the following: mental health changes such as depression, cognitive impairment, and poor concentration; cardiovascular problems, such as excessive cholesterol and hypertension. This strategy ensures early detection, prevents serious occurrences, optimises therapy, and empowers patients.
Regards to psychological support, Most essential, nurses should give supportive care to deal with symptoms of hypothyroidism. Sharing accessible resources (e.g., mental healthcare professionals, hypothyroidism support groups) is also vital.
In terms of follow-up care, Explain that continuous medical evaluations are essential to monitor thyroid function. Regular monitoring of weight, thyroid hormone levels, and mental health is recommended. Vital signs should be checked twice a week, and the physician should be notified if the pulse rate exceeds 100 beat per minute. Blood glucose levels should also be maintained. Calling a healthcare provider is advised when necessary.
References
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care.
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and
Psychiatric-Mental Health.
Belleza, M.(2024). Hypothyroidism. Retrieved from https://nurseslabs.com/hypothyroidism/
Curtis,, L.(2022). Hypothyroidism nursing diagnosis and care plans. Retrieved from
https://www.verywellhealth.com/hypothyroidism-nursing-diagnosis-5509321
Martin, P.(2024).6 Hypothyroidism nursing care plans. Retrieved from
https://nurseslabs.com/hypothyroidism-nursing-care-plans/
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Pati, N., Rehman, A., Jialal, I., & Saathoff, AD.(2023).Hypothyroidism (nursing). Retieved from
https://www.ncbi.nlm.nih.gov/books/NBK568746
Salvad, K.(2022).Hypothyroidism: nursing diagnoses & care Plans. Retrieved from
https://www.nursetogether.com/hypothyroidism-nursing-diagnosis-care-plan/
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