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Alert
Oriented to place & person
Very scared
Visual and auditory hallucinations (1 month
PTA) Face covered with a mask that appeared in front of him from
time to time male voice (he will be harmed)
house possessed by demons that are coming to get him
suspicious of family members
someone was doing witchcraft on him
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Bilateral proptosis
Diplopia on superior
and lateral gaze
Minimal lid lag
Conjunctival
injection bilaterally,
no ulceration
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Thyroid glandvisibly, palpably
enlarged 3 fold, smooth, symmetrical,
nontender Bruitright lobe of the thyroid gland
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3 months PTAGraves disease with
hyperthyroidism
(+) weight loss of 20-25 lbs. in 2 mos.
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With Graves' disease, the immune system
makes antibodies that act like TSH, causing
the thyroid to make more thyroid hormone
than your body needs. This is called anoveractive thyroid or hyperthyroidism. An
overactive thyroid causes every function of
the body to speed up, such as heart rate and
the rate your body turns food into energy.
Graves' disease is one cause of overactive
thyroid
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Goiter
Weight Changes
Temperature Problems
Heart and BloodPressure Changes
Gastrointestinal
Problems
Skin Changes
Graves' Dermopathy/
Pretibial Myxedema
Changes to Hair / Nails / Hands
Eye Problems
Thinking/Cognition
Problems Mood Problems
Panic and Anxiety
Reflex/Movement Issues
Sleep Problems
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Gender
History
Age
Pregnancy
Smoking
Intake of too much thyroid hormone
Exposure to or Excess of Iodine/Iodine Drugs
Certain Medical Treatments and Drugs
Trauma to the Thyroid
Major Stress
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Blood Test
A diagnosis can be confirmed with blood tests thatmeasure the levels of thyroxine and TSH in yourblood. High levels of thyroxine and low or
nonexistent amounts of TSH indicate an overactivethyroid. The amount of TSH is important becauseit's the hormone that signals your thyroid gland toproduce more thyroxine. These tests areparticularly necessary for older adults, who may not
have classic symptoms of hyperthyroidism.
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(-) Thyroid dysfunction treatment
(-) History of radiation to the head &
neck (-) Use of goitrogens
(-) History of psychiatric illness or
thyroid diseases.
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Thyroid Blood Tests Result Reference
Thyroxine (T4) 11.3 ug/d 5.011.5 ug/dL
Triiodothyronine (T3) 35% 24% - 35%
Thyrotropin(TSH) 0.006 mIU/mL 0.4 -5.0 mIU/mL
Free Thyroxine (FT4) 2.4 ng/dL 0.8 -1.8 ng/dL
Interpretation:
A high level of T4 confirms hyperthyroidism.
Total triiodothyronine (Total T3) is generally elevated in hyperthyroidism and
decreased in hypothyroidism.Thyroid-stimulating Hormone (TSH, thyrotropin) is generally elevated in
hyperthyroidism.
Free thyroxine (Free T4) is generally elevated in hyperthyroidism.
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Start of Risperidone and thyroid
medications.
No auditory and visual hallucinations orparanoid ideas
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Psychosis secondary to uncontrolled
hyperthyroidism
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Included psychotic disorder not
otherwise specified (DSMIV) probably
secondary to uncontrolledhyperthyroidism.
DSMIV schizophreniform disorder
was included in differential diagnosis.
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ASSESSMENT NURSINGDIAGNOSIS
BACKGROUNDKNOWLEDE
PLANNING INTERVENTION RATIONALE EVALUATION
OBJECTIVE:
- Weight loss of 20-25 lb over a 2-monthperiod.
Imbalanced nutrition:Less than bodyrequirements relatedto weight loss of 20-25 lbs as manifested
by signs of GravesDisease.
Graves' disease stopsyour body fromabsorbing maximumnutrients from yourfood. Eating a high-
fat diet will slowdown your digestion
process and will allowyour body to pullmore nutrients from
your foods. This mayalso help with anyhunger you may
experience as a resultof the disease. Foods
that may help yourcondition include leanmeats, grains, fruits
and vegetables.
Graves' disease maycause weight loss.Increasing your daily
caloric intake andeating foods withhigher fat content canhelp you gain weight.Once your disease is
under control, youshould return to yourprevious calorieintake. Treatment of
Graves' disease canalso lead to weight
gain. If you shouldexperience this sideeffect, alter your diet
so that you are eatingfewer calories but are
also eating nutrient-rich foods. This willensure that your body
After 2 weeks ofnursing interventionsthe patient will gain 1lb.
INDEPENDENT:
-Monitor daily foodintake. Weight daily
-Do health teachingsabout foods that goodfor his case like:
>Encourage the
patient to eat andincrease number ofmeals and snacks,
using high-caloricfoods that are easilydigested
>Encourage the
patient to eat glutenfree foods (e.g leanmeat, fish, andchicken or turkey.Beans, corn, rice,
milk, unprocessedcheeses, and fresh orfrozen fruits orvegetables)
>Encourage the
patient to eatGoitrogenic foods (e.gBrussel sprouts,
cauliflower, broccoli,cabbage, turnips, and
the like)
-Monitoring theweight of the patientwill be the baseline of
the caloric intake iseffective or not
- Increased Nutrients
as part of a well-balanced diet arenecessary to meet
metabolic demands.
- eating gluten causes
celiac disease, anintestinal conditioncharacterized by theinability to absorbnutrients from food.
- Goitrogens are
thyroid antagonists;create less toxicitywhen cooked
After 2 weeks ofNursing Interventionsthe patient was able togain 1 lb.
SSESSMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION
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SSESSMENT NURSINGDIAGNOSIS
BACKGROUNDKNOWLEDE
PLANNING INTERVENTION RATIONALE EVALUATION
gets all its necessarynutrients while
lowering your risk forweight gain.
The hypermetabolicstate causes
gastrointestinalhypermotility, withnausea,
vomiting,diarrhea,and abdominal pain.Although, the clientmay have anincreased appetite and
eat more than usual,weight loss continues.
-Avoid foods thatincreases peristalsis(e.g tea, coffee,apple,etc.,)
COLLABORATIVE:
-Consult with dietician
to provide diet high incalories,Protein,Carbohydrates,
Vitamins A,B,C,D,Eand Zinc andSelenium
-Increased motility ofGIT may result indiarrhea and impairabsorption of needed
nutrients)
- Vitamins C and E
should also be takenfor proper thyroidfunction.
- Vit B important fordeveloping theimmune system andfor the proper
functioning of thyroidgland
-Vit D for properabsorption of calcium
in the body,supplemented toavoid osteoporosisand promote good
bone health
- Mineralsupplements like zincand selenium are alsorequired for their
antioxidant propertiesand development ofimmune system.
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Naldo, Bridget
Parayaoan, Ericka Judith
Pascual, Anne Janelle
Punzalan, Irene
Quibod, CristinaSantos, Aiza
Teodoro, Michelle Ann