Antipyretics for children are prescribed by a pediatrician. But there are emergency situations for fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to give to infants? How can you bring down the temperature in older children? What medicines are the safest?
Hypothyroidism- a disease caused by a decrease in function thyroid gland or complete loss.
Causes:
autoimmune thyroiditis
congenital aplasia of the thyroid gland
surgical treatment (subtotal resection of the thyroid gland)
drug exposure (mercasolil overdose)
Patient complaints:
Objective examination:
Appearance - adynamia, facial expressions are poor, speech is slowed down
Puffy face
The palpebral fissures are narrowed, the eyelids are swollen
The skin is dry, cold to the touch, dense swelling of the feet and legs (there is no fossa when pressed)
Body temperature is reduced
Weight gain
decrease in blood pressure,
The decrease in heart rate - less than 60 beats. per minute (bradycardia)
Laboratory methods:
Clinical blood test (anemia)
Blood chemistry:
Determination of the level of thyroid hormones (T3, T4 - the level is reduced)
The level of thyroid-stimulating hormone (TSH) is elevated
The level of antibodies to thyroid tissue
Cholesterol level - hypercholesterolemia
Instrumental Methods:
Absorption of radioactive iodine J 131 by the thyroid gland (thyroid function test)
Thyroid Scan
Thyroid ultrasound
Treatment:
Diet number 10 (eliminate foods rich in cholesterol, reduce the energy value of food, recommend foods containing fiber)
Drug therapy - hormone replacement therapy: thyroxine, L-thyroxine
Complications:
Decreased intelligence
Violations of the satisfaction of needs: eat, excrete, maintain body temperature, be clean, dress, undress, work. 
Patient problems:
Increase in body weight.
muscle weakness
chilliness
Decreased memory
Nursing care:
Give recommendations on diet therapy (exclude foods containing animal fats, include foods rich in fiber - bran bread, raw vegetables and fruits, limit carbohydrate intake).
Control of frequency, pulse, blood pressure, weight control, stool frequency,
Teach the patient about personal hygiene.
Teach relatives how to communicate with patients
Train relatives in patient care.
Follow doctor's orders.
Medical examination:
Regular follow-up visits to the endocrinologist.
Control of the level of thyroid hormones, cholesterol levels.
ECG monitoring once every six months.
Body weight control.
endemic goiter- a disease that occurs in areas with a limited content of iodine in water and soil. It is characterized by compensatory enlargement of the thyroid gland. The disease is widespread in all countries of the world. Sometimes there is a sporadic goiter enlargement of the thyroid gland without previous iodine deficiency.
In addition to iodine deficiency in environment, have a certain value and the use of goitrogenic nutrients contained in some varieties of cabbage, turnip, rutabaga, turnip. In response to an external lack of iodine, hyperplasia of the thyroid gland develops, the synthesis of thyroid hormones and iodine metabolism change.
There are diffuse, nodular and mixed forms of goiter. The function of the thyroid gland may be normal, increased or decreased. More often, however, hypothyroidism is noted. A typical manifestation of thyroid insufficiency in children in endemic areas is cretinism. Significant sizes of the goiter can cause compression of the neck organs, respiratory disorders, dysphagia, voice changes. With the retrosternal location of the goiter, the esophagus, large vessels, and trachea can be compressed.
Absorption of I131 by the thyroid gland is usually increased, the level of T3 and T4 in the blood is reduced (with hypothyroidism), increased TSH level. Ultrasound helps in the diagnosis, with a retrosternal and intramediastinal location of the goiter - radiography.
Treatment of nodular and mixed forms of goiter is only surgical. The same applies to large goiter and ectopic localization. In other cases, antistrumine, microdoses of iodine (with unimpaired gland function), thyroidin, thyreocomb, thyroxine are used. In hypothyroidism, thyroid hormone replacement therapy is used in compensatory dosages. In endemic foci, preventive intake of iodized products and preparations of iodine, antistrumine is indicated.
Currently, a number of disease states are known due to the influence of iodine deficiency. The consensus (agreed opinion) of the leading endocrinologists of our country on the problem of endemic goiter believes that insufficient intake of iodine in the human body at different periods of his life causes the following diseases.
Diseases caused by iodine deficiency
The nursing process in hypothyroidism plays a very important role. The nurse is the doctor's right hand. She carries out all the appointments of the endocrinologist and makes sure that the patient of the hospital also clearly follows the instructions.
Being a paramedical staff, a nurse controls the work of nurses, nurses and nannies. The speed of recovery of a patient with hypothyroidism, his mental and physical condition upon discharge home depends on her professionalism and knowledge.
Hypothyroidism, or insufficiency of the thyroid gland, often causes children or adults.
A hormonal disorder can be caused by congenital or acquired as a result of surgical intervention absence of the thyroid gland, a defect in the enzyme systems of the body, pathogenic phenomena in the hypothalamus or pituitary gland.
Manifestations of hypothyroidism
Congenital pancreatic insufficiency is diagnosed immediately after the birth of a child. The pathology is characterized by a large weight of the baby, lethargy, drowsiness, a rough voice, a long torso and short limbs, dry, pale skin, a flat bridge of the nose and widely spaced eyes, and a voluminous stomach. At older ages, there is a delay mental development, dystrophy, disproportionate skeleton.
Acquired Violation hormonal background manifests itself:
- pastosity of facial tissues;
- memory impairment and lethargy;
- thinning, brittleness and dryness of nails and hair;
- cardiac arrhythmia, low blood pressure;
- constant chilliness and constipation.
In severe cases, myxedema coma occurs.
Insufficiency of the thyroid gland is always difficult and requires not only specific treatment, but also all kinds of procedures to care for the patient. Often, patients are affected by the central nervous system, the neuropsychic state worsens, it becomes aggressive, capricious and irritable. Therefore, the nurse requires a lot of endurance, calmness and patience in relation to such patients.
Responsibilities of a nurse
The nurse plays one of the main roles in the production medical care population and the effectiveness of the services provided. The functions of a nurse are varied. They affect not only diagnostic and therapeutic measures, but also directly relate to the care of patients with the aim of their speedy recovery.
For a good nurse, stress resistance, accuracy, diligence, cleanliness, attentive attitude to patients, and, of course, special knowledge are very important. Therefore, there are certain requirements for the training of nurses.
A nurse, working with patients with hypothyroidism, must be qualified to carry out the following procedures;
- independently collect the patient's history and conduct some diagnostic measures;
- work with documents, fill out and store medical records, submit discharge forms;
- monitor the physical and emotional state of the patient;
- each nurse should be able to provide first aid in the absence of a doctor;
- carry out the nursing process - carry out the necessary procedures (droppers, dressings, injections), distribute dosed norms of medicines;
- be interested in the well-being of patients, prepare patients for tests and take them, measure temperature and pressure;
- quickly and accurately follow the orders of the doctor.
In addition, the nurse must be well versed in the causes and symptoms of the disease, know the methods of therapy and correctly apply them.
Goals of nursing care for hypothyroidism
Nursing process in hypothyroidism is the care of the patient, in which his psychological and physical needs are fully satisfied. Possessing the necessary knowledge and skills, the nurse must inform and educate the patient, guide him.
There are specific goals for the nursing process in caring for patients with hypothyroidism.
They are as follows:
- Detect existing and potential problems in a timely manner.
- Satisfy the needs of the patient, provide an acceptable quality of life.
- Provide moral support to the patient, his family and friends, inform them about the state of health and the course of the disease.
- Maintain and restore the patient's independence in meeting daily needs.
Based on these points, the tactics of the nursing process for patients with hypothyroidism are built. A single goal may include many activities that contribute to its successful implementation.
Nursing process in hypothyroidism
For patients admitted to the hospital with a diagnosis of hypothyroidism, a special tactic of the nursing process has been determined, consisting of several stages. All of them are interconnected. Each stage of nursing care is another step towards achieving the main goal of treatment - the complete recovery of the patient.
Stage I - collection of anamnesis
This period includes a survey of the patient. The nurse reveals:
- lethargy, apathy, fatigue, lack of interest in life;
- hair loss, thinning and brittle nails;
- chest pain, shortness of breath and other symptoms of hypothyroidism.
All collected information is analyzed nurse, and on its basis, the explicit and hidden needs of the patient are determined.
Stage II - identifying the patient's problems
After taking an anamnesis, a nursing diagnosis is made and impaired needs are identified.
The problems of a patient with hypothyroidism are conditionally divided into existing ones that are currently worrying and possible ones (may appear in the future).
A survey conducted by a nurse reveals existing difficulties. Among them, the most common are:
- psychological (stress, immersion in illness, low self-esteem, fear of losing a job);
- social (lack of funds due to illness and long-term disability);
- spiritual.
In the future, a sharp increase in body weight, constipation is possible. In women, there is often a violation of the monthly cycle and infertility.
Stage III - strategy of nursing interventions
During this period, the nurse, together with the patient and his family, plans nursing activities. The main goal of the nursing process is to accelerate the recovery of the patient and reduce the risk possible complications.
The nursing intervention plan should include both short-term and long-term issues.
Stage IV - implementation of nursing interventions
At this stage, the nursing process is carried out according to a plan agreed with the leading doctor and the patient or his relatives.
Nursing interventions are:
- Dependents. Produced only by order of the doctor (appointment medicines and procedures).
- Independent. Performed by a nurse independently (measurement of blood pressure, setting droppers, injections).
- Interdependent.
At this stage, the nurse performs direct care for patients with hypothyroidism. It consists in thoroughly cleansing, moisturizing and softening the skin, as the skin becomes rough, dry and flaky.
In nursing care for patients who are often chilly, it is necessary to control the ambient temperature. If necessary, the patient should be offered a heating pad or an extra blanket.
Since the body temperature in this pathology reflects the degree of development of the disease, it is advisable to carry out thermometry several times a day.
Patients with hypothyroidism often suffer from low blood pressure and bradycardia, so the nurse needs to monitor blood pressure, recording all changes. At attacks of stenocardia the measures generally accepted in such cases are carried out.
Replacement therapy involves taking hormonal drugs, which are dosed and issued by a nurse strictly on time. Apart from drug treatment, patients are prescribed compliance, which helps to reduce the symptoms of hypothyroidism. Diet control is also part of the nursing process.
If a patient develops a myxedema coma, the nurse should immediately notify the doctor and do a test for the content of thyroid hormones in the blood. Then take ECG readings, measure blood pressure, conduct catheterization Bladder and warm the patient with blankets and increasing the room temperature.
After providing the first support, the duties of a nurse are supplemented by regular infusion of levothyroxine and oxygen therapy. In the event of a developed collapse, injections of prednisolone, dopamine or are necessary. The treatment regimen is prescribed by a doctor.
Stage V - assessment of the nursing process
If, after all nursing interventions, a patient with hypothyroidism has a persistent improvement in well-being, we can talk about the effectiveness of nursing care.
In case of failure of the measures taken, the nurse corrects the plan of nursing interventions, coordinating it with the endocrinologist.
Hypothyroidism is a rather serious disease that can lead to severe complications. The patient needs constant therapy to alleviate the condition and maintain the quality of life, so the nurse can become his friend and assistant for many years.
Responsibilities of a nurse
The nurse plays one of the main roles in the provision of medical care to the population and the effectiveness of the services provided. The functions of a nurse are varied. They affect not only diagnostic and therapeutic measures, but also directly relate to the care of patients with the aim of their speedy recovery.
For a good nurse, stress resistance, accuracy, diligence, cleanliness, attentive attitude to patients, and, of course, special knowledge are very important. Therefore, there are certain requirements for the training of nurses.
A nurse, working with patients with hypothyroidism, must be qualified to carry out the following procedures;
collect the patient's history independently and carry out some diagnostic measures;
work with documents, fill in and store medical records, submit discharge forms;
monitor the physical and emotional state of the patient;
Each nurse should be able to provide first resuscitation aid in the absence of a doctor;
carry out the nursing process - carry out the necessary procedures (droppers, dressings, injections), distribute dosed doses of medicines;
be interested in the well-being of patients, prepare patients for tests and take them, measure temperature and pressure;
Quickly and accurately follow the instructions of the doctor.
In addition, the nurse must be well versed in the causes and symptoms of the disease, know the methods of therapy and correctly apply them.
Goals of nursing care for thyroid disease in children
Nursing process in hypothyroidism is the care of the patient, in which his psychological and physical needs are fully satisfied. Possessing the necessary knowledge and skills, the nurse must inform and educate the patient, guide him.
There are specific goals for the nursing process in caring for patients with hypothyroidism.
They are as follows:
· Detect existing and possible problems in a timely manner.
Satisfy the needs of the patient, provide an acceptable quality of life.
Provide moral support to the patient, his family and friends, inform them about the state of health and the course of the disease.
Maintain and restore the patient's independence in meeting daily needs.
Based on these points, the tactics of the nursing process for patients with hypothyroidism are built. A single goal may include many activities that contribute to its successful implementation.
Nursing process for thyroid disease in children
For patients admitted to the polyclinic with a diagnosis of hypothyroidism, a special tactic of the nursing process has been determined, consisting of several stages. All of them are interconnected. Each stage of nursing care is another step towards achieving the main goal of treatment - the complete recovery of the patient.
Stage I - collection of anamnesis
This period includes a survey of the patient. The nurse reveals:
lethargy, apathy, fatigue, lack of interest in life;
hair loss, thinning and brittle nails;
Chest pain, shortness of breath and other symptoms of hypothyroidism.
All collected information is analyzed by a nurse, and based on it, the explicit and hidden needs of the patient are determined.
Stage II - identifying the patient's problems
After taking an anamnesis, a nursing diagnosis is made and impaired needs are identified.
The problems of a patient with hypothyroidism are conditionally divided into existing ones that are currently worrying and possible ones (may appear in the future).
A survey conducted by a nurse reveals existing difficulties. Among them, the most common are:
psychological (stress, immersion in illness, low self-esteem, fear of losing a job);
social (lack of funds due to illness and long-term disability);
Spiritual.
In the future, a sharp increase in body weight, constipation is possible. In women, there is often a violation of the monthly cycle and infertility.
| Problem | Nurse actions | |
| Sleep disturbance (insomnia) | Create conditions for a good rest (bed comfort, cleanliness, silence, fresh air). Offer milk with honey at night (exception - patients with diabetes), soothing herbal teas. Conduct a conversation in order to relax the patient. Talk to relatives about the need for psychological support for a loved one. Get a doctor's advice | |
| Weakness due to malnutrition | Provide the patient with adequate nutrition. Monitor body weight (weigh the patient every other day). Provide assistance to the patient when moving (if necessary) | |
| Poor cold tolerance | Advise the patient to dress warmly. Make sure the patient does not get cold. If necessary, warm the patient (heaters to the legs, cover with a blanket, give warm tea) | |
| Weight gain due to fluid retention | Monitor the patient's diet and drinking regimen. Weigh the patient twice a week. Daily diuresis is measured and counted water balance. Monitor patient intake medicines | |
| Risk of falls and injury due to muscle weakness | Assist the patient while moving. Provide emergency communication with medical staff. Lower the bed to a low level. Provide lighting in the ward at night. Provide walkers, a stick as an additional support when moving. Provide the patient with a vessel and urinal. Clear passages and corridors. Make sure that handrails are made in the necessary places | |
| Failure to maintain a safe environment due to memory, vision and hearing impairment | Provide complete patient care | |
| Non-compliance with the rules of personal hygiene, untidiness | Assist the patient in personal hygiene activities. Encourage the patient to maintain personal hygiene | |
| Loss of ability to work due to a decrease in intelligence | Help the patient in his life | |
| Eating more food than the body needs due to increased appetite; weight gain due to increased appetite and lack of physical activity | Explain to the patient the importance of following a low-calorie diet No. 8 (for obesity). Recommend an increase in physical activity, exercise therapy. Teach the patient to calculate the calorie content of the diet. Get a doctor's advice. Monitor the patient's compliance with the diet, rest regimen, and the implementation of the LF complex. Control transfers of relatives. Weigh the patient weekly | |
| Potential health hazard associated with a lack of information about the disease | Conduct a conversation with the patient about his disease, the prevention of possible complications. Provide the patient with the necessary scientific and popular literature. Patients with diabetes should be encouraged to attend classes at the Diabetes School in order to learn how to manage diabetes and cope with emerging problems on their own. | |
| Difficulty in making dietary changes due to established rank habits | Explain to the patient the importance of following a diet. Teach the principles of selection and preparation of products. Learn how to calculate your calorie intake. Encourage the patient to follow the diet. Control transfers of relatives. Monitor patient compliance with prescribed diet | |
| The need for continuous medication | Talk to the patient about the need for constant medication to maintain health. Explain the mechanism of action of prescribed drugs. Explain the possibility of side effects used medicines and the need for timely information about them to medical staff. Monitor the timely intake of medications. Explain the need to eat within 20-30 minutes after taking antidiabetic drugs | |
| Decreased ability to work due to weakness | Explain to the patient the importance of timely and systematic intake of medications, diet, work and rest regimen | |
| Inability to take care of the feet; the risk of infection of damaged skin of the feet | Educate the patient about drain care: daily inspection of their feet for skin lesions; purchase only comfortable shoes 1 size larger; lubricating the skin of the legs with creams (you can’t lubricate the skin between the fingers with cream); 1 neat cutting of nails (with scissors with rounded ends or special tongs) you can’t cut the nails at the level of the skin, if the nails are thick, then first hold them in warm water with the addition of vinegar); walking only in shoes; daily shoe inspection | |
| Headache, pain in the heart, palpitations due to high blood pressure | Teach the patient and his family members to measure blood pressure, pulse. Put a mustard plaster on the heart area, the collar zone. Convince the patient of the need for systematic medication and diet | |
| Increased excitability and irritability | Monitor compliance with the medical and protective regimen (separate room, elimination of irritants, silence, compliance with deontological principles, etc.) | |
| Poor heat tolerance | Supervise the cleaning and ventilation of the premises. Recommend wearing light clothing | |
| excessive sweating | Take good care of your skin. Frequently change underwear and bedding |
Topic: "Nursing care for diseases of the endocrine system (hypothyroidism)".
Hypothyroidism- a disease caused by a decrease in thyroid function or its complete loss.
Causes:
congenital aplasia of the thyroid gland
· surgery(subtotal resection of the thyroid gland)
drug exposure (mercasolil overdose)
Patient complaints:
lethargy, weakness, drowsiness
Increased fatigue
· 
memory loss
chilliness
· aching pain in the region of the heart, shortness of breath
· hair loss
increase in body weight
in women, menstrual irregularities (may be infertile)
in men, decreased libido
Objective examination:
1. Appearance- adynamia, facial expressions are poor, speech is slowed down
2. Puffy face
3. The palpebral fissures are narrowed, the eyelids are swollen
5. The skin is dry, cold to the touch, dense swelling of the feet and legs (there is no fossa when pressed)
6. Body temperature is reduced
7. Weight gain
8. Decreased blood pressure,
9. Reduced heart rate - less than 60 beats. per minute (bradycardia)
Clinical Analysis blood (anemia)
Biochemical analysis blood:
Determination of the level of thyroid hormones (T3, T4 - the level is reduced)
Increased thyroid-stimulating hormone (TSH) levels
The level of antibodies to thyroid tissue
Cholesterol levels - hypercholesterolemia
Instrumental Methods:
Absorption of radioactive iodine J 131 by the thyroid gland (study of thyroid function)
Thyroid scan
Ultrasound of the thyroid gland
Treatment:
1. Diet number 10 (exclude foods rich in cholesterol, reduce energy value food, recommend foods containing fiber)
2. Drug therapy - substitution hormone therapy: thyroxine, L-thyroxine
Complications:
Decreased intelligence
Violations of the satisfaction of needs: eat, excrete, maintain body temperature, be clean, dress, undress, work.
Patient problems:
chilliness
Decreased memory
The increase in body weight.
Nursing care:
2. Frequency control, pulse, blood pressure, weight control, stool frequency,
3. Teach the patient about personal hygiene.
4. Teach relatives how to communicate with patients
5. Train relatives in patient care.
7. Follow doctor's orders.
Medical examination:
· Regular follow-up visits to the endocrinologist.
Control over the level of thyroid hormones, cholesterol levels.
ECG monitoring once every six months.
Control of body weight.
endemic goiter- a disease that occurs in areas with a limited content of iodine in water and soil. It is characterized by compensatory enlargement of the thyroid gland. The disease is widespread in all countries of the world. Sometimes there is a sporadic goiter enlargement of the thyroid gland without previous iodine deficiency.
In addition to iodine deficiency in the environment, the use of goitrogenic nutrients contained in some varieties of cabbage, turnip, rutabaga, and turnip are also of some importance. In response to an external lack of iodine, hyperplasia of the thyroid gland develops, the synthesis of thyroid hormones and iodine metabolism change.
There are diffuse, nodular and mixed forms of goiter. The function of the thyroid gland may be normal, increased or decreased. More often, however, hypothyroidism is noted. A typical manifestation of thyroid insufficiency in children in endemic areas is cretinism. Significant sizes of the goiter can cause compression of the neck organs, respiratory disorders, dysphagia, voice changes. With the retrosternal location of the goiter, the esophagus, large vessels, and trachea can be compressed.
Absorption of I131 by the thyroid gland is usually increased, the level of T3 and T4 in the blood is reduced (with hypothyroidism), and the level of TSH is increased. Ultrasound helps in the diagnosis, with a retrosternal and intramediastinal location of the goiter - radiography.
Treatment of nodular and mixed forms of goiter is only surgical. The same applies to large goiter and ectopic localization. In other cases, antistrumine, microdoses of iodine (with unimpaired gland function), thyroidin, thyreocomb, thyroxine are used. Use for hypothyroidism replacement therapy thyroid hormones in compensatory dosages. In endemic foci, preventive intake of iodized products and preparations of iodine, antistrumine is indicated.
Currently, a number of disease states are known due to the influence of iodine deficiency. The consensus (agreed opinion) of the leading endocrinologists of our country on the problem of endemic goiter believes that insufficient intake of iodine in the human body at different periods of his life causes the following diseases.
Diseases caused by iodine deficiency
Patients in hypothyroid coma should be admitted to the intensive care unit or intensive care unit.
It is necessary to immediately take blood for the content of thyroid hormones, blood pH, glucose, sodium, chlorides, acid-base balance, record an ECG, and perform bladder catheterization. A progressive decrease in body temperature worsens the prognosis. To warm the patient, it is necessary to wrap the patient in blankets, gradually increase the room temperature. Heating pads, hot water bottles are not recommended for warming, as peripheral vasodilation appears, impairing blood flow internal organs(danger of collapse).
In a specialized hospital, the patient will be given intravenous L-thyroxine, intravenous glucocorticoids, to eliminate hypoglycemia - 40% glucose solution intravenously and 5% intravenous drip solution, to combat collapse - reopoliglyukin, 10% albumin solution, to increase blood pressure - angiotensinamide, for heart failure - cardiac glycosides (in a small dosage, since the myocardium in hypothyroidism is highly sensitive to glycosides), to improve metabolism in the myocardium - pyridoxal phosphate, lipoic acid, riboxin, cocarboxylase.
Urgent Care in hypothyroid coma
General activities include: slow gradual warming of the patient is not higher than one degree per hour during hypothermia, hydrocortisone is administered intravenously (50-100 mg, daily dose up to 200 mg), thyroxine is prescribed (daily dose of 400-500 mcg) as a slow infusion.
Along with this, oxygen therapy is carried out in combination with artificial ventilation of the lungs. To combat anemia, a blood or red blood cell transfusion is indicated (the latter is preferable). Infusion therapy carried out with great care, simultaneously administered glucocorticoids.
Vigorous antibiotic therapy is mandatory to suppress co-infection or prevent an outbreak of a dormant infection. In patients in a coma, atony of the bladder is constantly noted, therefore, a permanent urinary catheter is placed.
NURSING ACTIVITY IN HYPOTHYROISIS
Nursing uses a variety of theories and knowledge. This knowledge is used by the sister in informing the patient, teaching him and guiding him or guiding him.
Currently, the theory of Virginia Henderson is being applied. Within the framework of this theory, Henderson tried to highlight the basic human needs, the satisfaction of which should be aimed at patient care. These needs include:
1. Breath
2. Nutrition and fluid intake
3. Physiological functions
4. Motor activity
5. Sleep and rest
6. Ability to dress and undress independently
7. Maintenance of body temperature and the possibility of its regulation
8. Personal hygiene
9. Ensuring your own safety
10. Communication with other people, the ability to express their emotions and opinions
11. Ability to observe customs and rituals according to religions
12. Being able to do what you love
13. Recreation and entertainment
14. Need for information
Henderson is also known for her definition of nursing: "The unique function of the nurse is to assist the individual, sick or well, in carrying out such activities that contribute to the preservation or restoration of health, which he could provide for himself if he had the necessary strength, will and knowledge
Nursing Process- a scientific method of organizing and providing nursing care, implementing a plan for caring for therapeutic patients, based on the specific situation in which the patient and nurse are located.
The Purpose of the Nursing Process:
Ø identify real and potential problems in a timely manner;
Ø meet the violated vital needs of the patient;
Ø provide psychological support to the patient;
Ø Maintain and restore the patient's independence in meeting the daily needs of his daily activities.
Nursing process in hypothyroidism
Stage I: nursing examination(collection of information)
When questioning the patient: the nurse finds out
ü Increased fatigue
o hair loss
Stage II: identification of disturbed needs and problems of the patient
Possible violated needs:
physiological:
muscle pain
· hair loss
increase in body weight
Possible problems patient:
ü Aching pain in the heart, shortness of breath
ü in women, menstrual irregularities (may be infertile)
in men, decreased libido
lethargy, weakness, drowsiness
ü chilliness
ü memory loss
psychological:
Depression due to an acquired disease;
Fear of instability of life;
Underestimation of the severity of the condition;
Lack of knowledge about the disease;
Lack of self-service;
Care in sickness;
Lifestyle change
social:
loss of ability to work
Financial difficulties in connection with a decrease in working capacity;
social isolation.
spiritual:
Lack of spiritual participation.
priority:
aching pain in the heart, shortness of breath
potential:
risk of developing complications.
Stage III: nursing intervention planning
The nurse, together with the patient and his relatives, formulates goals and plans nursing interventions for a priority problem.
The goal of nursing interventions is to promote recovery, prevent the development of complications and the transition to a more severe course.
IV stage: implementation of nursing interventions
Nursing interventions:
Dependent (performed as prescribed by a doctor): ensuring the intake of medications, performing injections, etc.;
Independent (performed by a nurse without the doctor's permission): recommendations on diet, measurement of blood pressure, pulse, respiratory rate, organization of the patient's leisure and others;
Interdependent (performed by a medical team): providing advice from narrow specialists, ensuring research.
Stage V: evaluation of the effectiveness of nursing interventions
The nurse evaluates the result of interventions, the patient's response to measures of assistance and care. If the set goals are not achieved, the nurse adjusts the nursing intervention plan
Manipulations performed by a nurse
BP measurement
Target: diagnostic.
Indications: doctor's appointment, preventive examinations.
Equipment: tonometer, phonendoscope, alcohol, tampon (napkin), pen, temperature sheet.
| Stages | Rationale |
| I. Preparation for the procedure 1. Gather information about the patient. Kindly and respectfully introduce yourself to him. Clarify how to contact him if the nurse sees the patient for the first time | Establishing contact with the patient |
| 2. Explain to the patient the purpose and sequence of the procedure | Psychological preparation to manipulation |
| 3. Obtain consent to the procedure | Respect for patient rights |
| 4. Warn the patient about the procedure 15 minutes before it starts, if the study is carried out as planned | |
| 5. Prepare the necessary equipment | Ensuring the effective implementation of the procedure |
| 6. Wash and dry your hands | |
| 7. Connect the pressure gauge to the cuff and check the position of the pressure gauge needle relative to the zero mark of the scale | Checking the health and readiness of the device for operation |
| 8. Treat the phonendoscope membrane with alcohol | Ensuring infectious safety |
| II. Performing the Procedure 1. Have the patient sit or lie down with the arm positioned so that the middle of the cuff is at heart level. Apply the cuff to the patient's bare shoulder 2-3 cm above the elbow (clothes should not squeeze the shoulder above the cuff); fasten the cuff so that 2 fingers fit between it and the upper arm (or 1 finger in children and adults with a small arm). Attention! Blood pressure should not be measured on the arm on the side of the mastectomy, on the weak arm of the patient after a stroke, on the paralyzed arm | Elimination of possible unreliability of the results (every 5 cm displacement of the middle of the cuff relative to the level of the heart leads to overestimation or underestimation of blood pressure by 4 mm Hg). Exclusion of lymphostasis that occurs when air is injected into the cuff and the vessels are clamped. Ensuring the reliability of the result |
| 2. Invite the patient to put his hand correctly: in an unbent position, palm up (if the patient is sitting, ask him to place a clenched fist of his free hand under his elbow) | Ensuring maximum extension of the limb |
| 3. Find the place of pulsation of the brachial artery in the region of the cubital cavity and lightly press the membrane of the phonendoscope against the skin in this place (without effort). | Ensuring the reliability of the result |
| 4. Close the valve on the "pear", turning it to the right, and inject air into the cuff under the control of a phonendoscope until the pressure in the cuff (according to the pressure gauge) does not exceed 30 mm Hg. the level at which the pulsation disappeared | Exclusion of discomfort associated with excessive clamping of the artery. Ensuring the reliability of the result |
| 5. Turn the valve to the left and begin to release air from the cuff at a speed of 2-3 mm Hg / s, while maintaining the position of the phonendoscope. At the same time, listen to the tones on the brachial artery and monitor the readings on the manometer scale | Ensuring the reliability of the result |
| 6. When the first sounds (Korotkov sounds) appear, “mark” the numbers on the pressure gauge scale and remember them - they correspond to the systolic pressure | Ensuring the reliability of the result. The systolic pressure values should match the readings on the manometer, at which the pulsation disappeared during the process of air injection into the cuff |
| 7. Continuing to release air, note the diastolic pressure indicators corresponding to the weakening or complete disappearance of loud Korotkoff tones. Continue auscultation until the pressure in the cuff decreases by 15-20 mm Hg. relative to the last tone | Ensuring the reliability of the result |
| 8. Round the measurement data to 0 or 5, record the result as a fraction (in the numerator - systolic pressure; in the denominator - diastolic), for example, 120/75 mm Hg. Deflate the cuff completely. Repeat measurement procedure blood pressure two or three times with an interval of 2-3 minutes. Record averages | Ensuring a Reliable BP Measurement Result |
| 9. Inform the patient of the measurement result. Attention! In the interests of the patient, reliable data obtained during the study are not always reported. | Ensuring the patient's right to information |
| III. Finishing the procedure 1. Treat the membrane of the phonendoscope with alcohol | Ensuring infectious safety |
| 2. Wash and dry your hands | Ensuring infectious safety |
| 3. Make a record, reflecting the results obtained and the patient's reaction in it | Ensuring continuity of observation |
Note. At the first visit of the patient, the pressure on both hands should be measured, later on only on one, noting which one. If a stable significant asymmetry is detected, all subsequent measurements should be carried out on the arm with higher rates. Otherwise, measurements are carried out, as a rule, on the “non-working hand”.
