1268

SECTION 10 Problems Related to Regulatory and Reproductive Mechanisms

NURSING CARE PLAN 50-1

Patient with Hyperthyroidism
NURSING DIAGNOSIS
PATIENT GOALS

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
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)
Psychomotor Energy

INTERVENTIONS (NIC) AND RATIONALES

Energy Management

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.

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 Scale

1 = Never demonstrated
2 = Rarely demonstrated
3 = Sometimes demonstrated
4 = Often demonstrated
5 = Consistently demonstrated

NURSING DIAGNOSIS
PATIENT GOALS

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
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)
Nutritional Status: Nutrient Intake

INTERVENTIONS (NIC) AND RATIONALES

Nutrition Management

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 readily 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.

Caloric intake _____

Protein intake _____
Carbohydrate intake _____
Vitamin intake _____
Mineral intake _____

Measurement Scale

1 = Not adequate
2 = Slightly adequate
3 = Moderately adequate
4 = Substantially adequate
5 = Totally adequate

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

1 = Severe deviation from normal range

2 = Substantial deviation from normal range
3 = Moderate deviation from normal range
4 = Mild deviation from normal range
5 = No deviation from normal range

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 currents, 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.