3 Hypothyroidism Nursing Care Plans

3 Hypothyroidism Nursing Care Plans

---

Hypothyroidism is a condition classified by an under-active thyroid gland- when the thyroid does not produce enough hormones. It occurs primarily in women in 30 to 60 years old. If severe hypothyroidism occurs in an infant, it is called cretinism. If it developed in an adult, it is called myxedema. The most common cause of hypothyroidism is an autoimmune inflammation of the thyroid gland (Hashimoto’s thyroiditis) with resulting atrophy of glandular tissue. Hypothyroidism also commonly occurs in clients with previous hyperthyroidism that has been treated with radioiodine or antithyroid medications or thyroidectomy.

Nursing Care Plans

The nursing care plan for clients with hypothyroidism includes providing information about disease process/prognosis and therapy needs, guiding the client to meet their nutritional requirement, planning activities with a rest period, and preventing complications.

Here are three (3) nursing care plans (NCP) for hypothyroidism:

1. Imbalanced Nutrition: More Than Body Requirements

---

Imbalanced Nutrition: More Than Body Requirements:Intake of nutrients that exceeds metabolic needs.

May be related to

• - Greater intake than metabolic needs.

Possibly evidenced by

• - Decreased appetite.
• - Sedentary activity level.
• - Weight gain.

Desired Outcomes

• - Client will maintain a stable weight and takes in necessary nutrients.

Nursing Interventions	Rationale
Assess the client’s weight.	Due to excess fluid volume and low basal metabolic rate, clients with hypothyroidism experience weight gain and difficulty losing extra weight
Assess the client’s appetite.	Clients with hypothyroidism have decreased appetite. This opposite relationship between weight gain and decreased appetite is a manifestation finding in hypothyroidism.
Provide a food diary to the client.	Looking into the client’s food intake over the 24 hours will provide a baseline data for an individualized nutritional plan for the client’s changing metabolic needs.
Educate the client and family regarding body weight changes in hypothyroidism.	Teaching the client and family will make them understand the opposite relationship between appetite and weight gain in hypothyroidism. During the start of the thyroid hormone replacement therapy, the client can experience loss of weight. However, there will be an increased in appetite. This change may require a calorie controlled diet to prevent additional weight gain.
Collaborate with a dietician to determine client’s caloric needs.	The dietician can calculate the appropriate caloric requirements to maintain nutrient intake and achieve a stable weight.
Encourage the client to eat six small meals throughout the day.	This will make sure that the client has an adequate intake of nutrients in the client with decreased energy levels.
Provide assistance and encouragement as needed during mealtime.	Due to a decrease energy levels, the client will need the support to ensure the adequate intake of essential nutrients.
Encourage the intake of foods rich in fiber.	Hypothyroidism slows the action of the digestive tract causing constipation.
Encourage te client to follow a low-cholesterol, low-calorie, low-saturated-fat diet.	When thyroid hormone levels are low, the body doesn’t break down and remove bad cholesterol as efficiently as usual; Also, since the client has slow metabolism, he/she requires fewer calories to support metabolic need

2. Deficient Knowledge

---

Deficient Knowledge: Absence or deficiency of cognitive information related to a specific topic.

May be related to

• - Lack of exposure to hypothyroidism.
• - New disease process.
• - Unfamiliarity with information resources.

Possibly evidenced by

• - Limited questioning about hypothyroidism and taking thyroid hormone replacement.
• - Verbalization of lack of information about the disease and its management.

Desired Outcomes

• - Client and family members will verbalize correct information about hypothyroidism and taking thyroid hormone replacement.

Nursing Interventions	Rationale
Assess the client’s knowledge of hypothyroidism and thyroid hormone replacement therapy.	Client teaching should begin with the current knowledge about the disease and its management.
Provide information about hypothyroidism.	Clients experiencing hypothyroidism may have impaired memory, confusion, hearing loss, and a decrease attention span. These neurologic changes can hinder with learning new information. Teaching sessions should be planned at times when the client is best able to concentrate. Recalling of information is needed to facilitate learning. Using written information reinforces verbal presentation.
Educate the client and family regarding thyroid hormones. - Instruct the client to take the dose in the morning to avoid insomnia. - Instruct the client to take the medication on an empty stomach. - Teach the expected benefits and possible side effects.	Levothyroxine sodium (Synthroid) is a manmade thyroid hormone that is used to treat hypothyroidism.Thyroid hormone should be taken on a regular basis to achieve a hormone balance. The client is initially given a small dose that gradually increases until a euthyroid state is achieved. When the thyroid hormone level increases, the client experiences insomnia and weight loss. The client should report symptoms such as chest pain/palpitations; these happen due to the increased metabolic and oxygen consumption.
Emphasized the importance of rest periods.	Avoid undue fatigue; As euthyroid state is achieved, activity level will eventually increase.
Encourage the client to follow appointments for blood workups (T3, T4, and TSH levels).	These levels help determine the effectiveness of pharmacotherapy
Describe signs and symptoms of over- and underdosage of the medications.	This will serve as check for client to determine if the therapeutic levels are met.
Encourage the client to have medical identification about hormone therapy and to inform all health care provider.	Medical identification provides other health care providers with information to guide decisions about care. Levothyroxine is highly protein bound in circulation. This drug characteristic contributes to many drug interactions. The client needs to notify all health care providers about taking this drug.

3. Fatigue

---

Fatigue: An overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work at usual level.

May be related to

• - Impaired metabolic state.

Possibly evidenced by

• - Lethargic or listless.
• - Compromise concentration.
• - Increased rest requirements.
• - Unable to complete desired activities.
• - Verbalizes overwhelming lack of energy.

Desired Outcomes

• - Client will identify basis of fatigue and individual areas of control.
• - Client will verbalize reduction of fatigue and increased ability to complete desired activities.

Nursing Interventions	Rationale
Assess the client’s ability to perform activities of daily living (ADLs).	The client may experience fatigue with minimal exertion due to a slow metabolic rate. This symptom hinder the client’s ability to perform daily activities (e.g., self-care, eating)
Note daily energy patterns.	This will help in determining pattern/timing of activity.
Assess the client’s energy level and muscle strength and muscle tone.	Slow metabolism can result in decreased energy levels. The muscle may be weaker and joints stiffer due to mucin deposits in joints and interstitial spaces. This type of cellular edema may contribute to delayed muscle contraction and relaxation. The client may report generalized weakness and muscle pain.
Plan care to allow individually adequate rest periods. Schedule activities for periods when the client has the most energy.	This will ensure maximize participation.
Provide stimulation through conversation and non stressful activities.	Promotes interest without putting too much stress to the client.
Promote an environment conducive to relieve fatigue.	The client with hypothyroidism often complains of being cold even in a warm environment.

References and Sources : nurseslabs.com