Nursing Care Plan for Hypothyroidism

Pathophysiology

Hypothyroidism is a common condition where the thyroid gland does not produce enough thyroid hormone. Thyroid hormones control how the body uses energy and can, therefore, affect every organ system.  When the body does not have enough of these hormones, all of the body’s functions begin to slow down. While it can happen to anyone of any age, it is more prominent among women between 30 – 60 years old.  Risk factors include genetic disorder (Turner syndrome), previous thyroid surgery or goiter, family history of thyroid disease, and autoimmune disorders such as lupus, rheumatoid arthritis, Sjogren’s syndrome and type 1 diabetes.

Etiology

Previous thyroid surgery or inflammation is one of the main causes of hypothyroidism as it damages many of the thyroid cells. However, the most common cause is autoimmune thyroid inflammation (called Hashimoto’s thyroiditis) in which the patient’s own immune system targets and attacks the thyroid.

Desired Outcome

Decreased fatigue, optimal energy level and metabolism

Hypothyroidism Nursing Care Plan

Subjective Data:

  • Fatigue, weakness
  • Sensitivity to cold
  • Irritability
  • Depression
  • Decreased libido
  • Memory loss
  • Muscle cramps / aches
  • Joint pain / stiffness
  • Constipation

Objective Data:

  • Dry hair and skin
  • Hair loss
  • Weight gain
  • Bradycardia

Nursing Interventions and Rationales

  1. Assess and monitor vital signs; watch for bradycardia, and decreased respirations

  2. The decreased thyroid hormone levels slow all the body processes, including respirations and cardiac output. Monitor for slower heart rate and respirations; encourage incentive spirometer to maintain or improve pulmonary sufficiency.

  3. Encourage self-care; schedule activities for times when patient has the most energy

  4. Fatigue is one of the biggest complaints among patients with hypothyroidism. Encourage patient to engage in self-care and activities during period of higher energy and allow for rest periods as needed.

  5. Administer medication:

    • Levothyroxine
  6. Education patients and caregivers regarding the need for thyroid replacement and how to properly take the medication:  give medication in the morning on an empty stomach approx 1 hour prior to meal for most effective treatment.

  7. Monitor food intake and appetite; encourage healthy food choices, avoid comfort foods

  8. Patients often have a decreased appetite, but continue to gain weight. Take note of patient’s eating habits and provide nutrition recommendations

  9. Assess skin integrity; dry skin and brittle hair; apply moisturizers and encourage adequate hydration

  10. As the metabolism slows, skin and hair begin to dry out and become thin and brittle. Encourage moisturizers applied to skin after bathing and conditioner for hair. Note any excoriations or wounds as healing may also be impaired.

  11. Provide comfortable environment and limit exposure to cold

  12. Patients are more sensitive to colder temperatures and often complain of being cold, even in hot weather. Provide blankets as needed.

  13. Monitor weight regularly

  14. Patients have a tendency to gain weight, but should begin to lose weight as medication takes effect.


References

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Video Transcript

Okay guys, I am excited to work through an example, nursing care plan for you, for a patient with Hypothyroidism. So again, we’re just going to do a, an exemplar here with a hypothetical patient who just has hyperthyroid as their primary problem. They don’t really have anything else going on. So what kind of data are we going to see with this patient? Well, remember with hypothyroid, we always think about low metabolism. Everything’s just kind of low and slow. And so you might see this patient has some fatigue. They’re really tired all the time. You might see a sensitivity to cold. That’s a really big one. They just are cold all the time. They feel cold, the can’t seem to get warm, can’t seem to regulate. They might be kind of irritable. And again, all of those are subjective.

You might see actual low temperatures. If you’re looking at objective data, you might have a patient report muscle cramps, or even joint pain because they’re just, everything’s just kind of achy and they’re just really just generally not feeling well. They might have some hair loss. Again, when your metabolism isn’t working like it’s supposed to, you’re definitely gonna have issues, you know, maintaining those proteins you might see some weight gain. Again, slow metabolism means that you’re more likely to gain weight. You might see a low heart rate, bradycardia. Again, things are slowing down. You could potentially see some constipation. And then of course, of course, of course we’re going to see low thyroid levels, right? Those levels are going to be low because their thyroid is not producing what they need. So again, these are just some symptoms that you might see, some assessment findings you may have, um, just from a patient with hypothyroid where that’s kind of all their big issue is.

So yes, you might have some other data, but let’s just focus on the relevant information. When you’re looking at an actual patient in a bigger, holistic scenario, you’re going to gather all of your information and then in this next step in analyze, you’re actually going to choose the relevant information and then figure out what your primary problems are. So let’s see, for this patient with hypothetical information, one of the biggest problems they have is they have this low metabolism. Things just are low and slow. This could potentially cause issues with blood glucose levels. It could have, you know, low blood sugars, they could have weight gain, remember they could have Bradycardia. All of those things can actually cause a lot of problems because of this metabolism issue. And then what about temperature? Like they tend to have a temperature regulation issues.

They tend to be really cold all the time, so we could help them improve their ability to regulate their temperatures. Then again, we talked about like joint pain, irritability, muscle cramps, so they probably have some comfort issues, um, or some pain control issues just kind of generally being uncomfortable. Right? So we’ve kind of identified based on the data that we have that these are some major problems. And I would say if you’re looking at a thyroid patient, a hyperthyroid patient, that main priority is always going to beat the metabolism. It’s always going to be making sure things are functioning like they should. So in this case, that’s their metabolism. We need to get them sped up a little bit. So now we can start to ask our how questions. So how do we know it’s a problem? Again, this is where we’re going to start data linking.

We’re going to take the little pieces of information we had linked them to the problems that we found. So what are the kinds of things that we would do for this patient? We’ve already looked at the data. We’ve said our major problems are metabolism, the temperature, regulation and pain or comfort. So let’s see. We could monitor, of course, we’re gonna monitor vital signs, so their heart rate, that tends to be low, but we can also monitor their blood sugars or blood glucose levels to make sure they’re really fatigued. Anytime you have a patient is fatigued, clustering care is really important because it helps them to get more rest time. Let’s see. Their thyroid levels are low. That’s their whole problem. So we could administer thyroid medications that would help interest, just improve the overall thyroid function. A lot of times that can improve their metabolism, we want to monitor things like their nutrition or their food intake because we know they have this slow metabolism.

So not only do we want to make sure that they’re eating foods that are going to help them with energy, help them to feel better, but also we want to prevent them from gaining too much weight, right? So healthy food choices are really important. What else do we want to monitor? You know, we might want to monitor skin and here’s the follow me here. If their temperatures really low all the time and their skin is really cold, then they’re going to lose some circulation to their skin, right? Because all that blood is going back to the core so they could potentially have some skin issues. A lot of times we’ll see like dry skin, that’s a really common. We want to keep them comfortable when it comes to temperature. So we’re going to limit exposure to cold, right? Limit exposure to cold.

Because if it’s really, really cold outside, we don’t want them going out without a jacket on. We want them to be able to self regulate as much as possible. And then of course, any other pain or comfort measures we could give pain meds, we could even be good, do heat or ice for the achy joints, anything like that. And then how do I know if it gets better? Well, I’m always looking back at the data. So the data that told me it was a problem is the same data that’s gonna tell me if it’s better. So maybe I actually see their T3/T4 levels go up. Um, maybe I see their BGL and their heart rate are regulated. Maybe their temperature’s better regulated, maybe they’re not gaining weight, right? So all these things that told me there was a problem are going to be the same things that I look for to tell me whether or not I’m making a difference for the patient.

Okay. So step four is translate. This is our way that we use whatever terms that we need to use so that we can concisely communicate what the major problems are for this patient. So whether this is high level nursing concepts, whether it’s NANDA nursing diagnoses, whatever it is, we personally prefer to use concepts because I think they give you the bigger picture priorities. So number one priority here that we talked about is going to be things related to metabolism. And I think we can possibly even throw in nutrition here like this idea that they’re not processing things right? We want to make sure they don’t gain too much weight. That’s kind of our big priority here. So second I would say probably the temperature regulation, which the fancy word we use for that in concept world is thermoregulation, but really just their ability to self regulate that temperature.

We really wanted to keep an eye on that and make sure we’re taking care of any problems because of that. And then we talked about pain, right? We talked about pain and comfort, we talked about achy joints, that fatigue. So I think definitely addressing their comfort and their pain control is probably a great idea. So now we’ve taken all this data, we figured out what was the problem and why it was a problem. And we’ve concisely translated it into three major nursing concepts. So once you’ve done that, it’s time to transcribe. So really all we’re doing here is we’re getting it on paper. We’re linking all of our information together, we’re making connections, we’re saying this is a problem and this is how I know here’s what I’m going to do about it and why and what am I expecting to find. So we set our major concerns here where metabolism or nutrition, they’re more regulation and comfort.

So let’s look across each one of these and see what data we had that told us that this was a problem. So fatigue, we’ve got low T3/T4 levels and we know that part of the thyroid’s job is to help with metabolism, right? So if those levels are low, we’re going to have problems. We might see weight gain, we might see hair loss and we might see constipation. Remember, everything is low and slow. And we may also even see like bradycardia, right? Might see a low heart rate. So these are things that tell us there’s a metabolism problem. Things are not working as quickly or as efficiently as they should. So what am I going to do? I’m going to monitor vital signs, I’m going to cluster care. Again, remember for that fatigue, I’ll give them the meds and I’ll probably educate on diet.

Cause again it’s really, really important that they’re eating foods that are going to help them with energy and keep them from gaining too much weight. So again, they might have bradycardia so we want to watch their vital signs. Clustering care can help ease fatigue issues. We want to improve their thyroid function and the Diet. Education’s going to help minimize weight gain and improve energy. So again, expected outcome based on our data. We want to see no weight gain and we would love for the patient to actually report increased energy levels. It’s really awesome to have a patient who’s been so fatigued for so long finally come back to you and be like, oh my gosh. I was like, I was able to play with my kids this week. Right? It’s really, really cool. So reporting those increased energy levels would be awesome. And of course not gaining any more weight.

You might even if you want to say weight loss. So let’s look at thermoregulation. Remember, they’re very sensitive to cold. So if they go outside and, and you and I will be fine and shorts and a tee shirt, they’re probably still gonna want a Hoodie on, right? They, they’re very, very sensitive to that cold and they may actually even have a lower temperature. So what are we going to do? We’re going to monitor that temperature. We’re going to limit their exposure to cold. Um, and we’re going to monitor that skin integrity because we know that really cold skin can actually have poor circulation, um, and can possibly even be dry. They see dry skin a lot. So definitely monitoring that. So again, we want to monitor their temp and limit exposure so that we can promote comfort. And again, the circulation issues. So the goal here is going to be that the patient can self regulate their temperature to normal limits and can be able to regulate their temperature on their own.

Let’s look at comfort. Well, we already said they’re probably a little bit irritable, probably has some muscle cramps, might even have some joint pain, right? So I’m going to give them some pain meds. I’m probably going to do some other comfort measures nonpharmacological things, right? And overall, why do we do both of those things? Well, because they decreased discomfort or they decreased pain. So what’s our expected outcome? Decrease pain or decreased discomfort, right? We’re always bringing this back to what was the problem originally? So let’s say you have a patient who says, I my both of my knees hurt like crazy. They’re both 9 out of 10 then maybe your expected outcome can be patient reports, a pain level of less than 5 out of 10 that can be your short term goal, right? Is to just get them to a more tolerable pain level.

So let’s just recap. This is our five step process for writing an amazing care plan. You’re going to collect all of your information, including the stuff that is normal or may or may not seem relevant. And then you’re going to analyze it. You’re going to choose the relevant information, identify your problems and your priorities that are going to ask those how questions, how did I know it was a problem? How would I address it? And how would I know if that worked? So plan, implement, and evaluate. Translate that into whatever terms you need, whether that’s concepts, whether that’s Nanda, whatever you need to use. Translate it, get those concise terms and then get it on paper so you use whatever form or template you prefer. And just get that in writing so that you can have a clear, clear plan of how to take care of your patient. So that’s it for our example care plan on a patient with hypothyroidism. I hope that was helpful. Make sure you check out the rest of the examples within this course, as well as our entire nursing care plan library. And I go out and be your best self today, guys. And as always, happy nursing.

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