Page 36 nursing.elitecme.com Complete Your CE Test Online - Click Here Environmental considerations The following interventions are appropriate for both home and hospital environments[5,6] : ● ● Provide a calm quiet environment to combat anxiety and promote rest. ● ● Teach patients and families relaxation techniques such as meditation and deep breathing exercises. ● ● Refer patients and families to community resources for counseling to help deal with emotional stressors. ● ● Promote sleep and relaxation as much as possible. Nutritional needs Nutritional needs focus on fluid and electrolyte replacement and promotion of a healthy diet[5,6] . Nurses should: ● ● Monitor intake and output and weight. ● ● Provide examples of a healthy, yet high calorie diet since weight loss is usually an issue. ● ● Monitor intravenous infusions and the patency of the intravenous site. ● ● Monitor lab results pertaining not only to hormone levels but electrolyte levels as well. Skin care Maintaining skin integrity is a priority. Nurses should take, and teach patients and families to take, the following steps to maintain skin integrity[5,6] : ● ● Monitor skin turgor. ● ● Monitor for diaphoresis and body odor due to excessive sweating. ● ● Encourage the patient to bathe frequently with cool water and to change clothing and bed linens when they become damp. ● ● Avoid soaps that are drying to the skin such as perfumed soaps and shower gels. ● ● Apply lotion and lubricants to skin, especially boney prominences. ● ● Monitor skin for reddened or open areas. Teach patients to use a long-handled mirror to check areas of the skin on the back, the buttocks, and behind the legs. Adherence to medication regimen ● ● Caution patients to wear a medical identification bracelet. ● ● Explain how to take medications. Have patients and families verbalize knowledge of their medication regimens by asking them to state what medication(s) they must take, dose, route, time, action, side effects and what to do if adverse effects occur. Be especially careful to explain signs of hypothyroidism, which may indicate that the doses of their anti-thyroid medications are too high. ● ● As always warn patients not to discontinue medications unless told to do so by their HCPs and to tell their HCPs providers about any medications they are taking including prescription, OTC, herbs, vitamins, minerals, and weight loss products. Most patients affected by hyperthyroidism can lead normal lives. However, they need ongoing, life-long monitoring and adherence to any treatment regimens prescribed. They also need support and contact information for persons and resources that can help them deal with the disease and its effects. Thyroiditis Margaret gave birth to her first child 3 months ago. She has become anxious and irritable and complains of fatigue and, a “racing” heart. Margaret has begun to lose weight even though her appetite is good and she is eating more than she usually does. Her mother and friends laugh at Margaret’s concerns and regale her with stories about how tired and nervous they were after the birth of their first children. “Wait until you have three like me, then you can complain!” one friend tells her. Margaret becomes more and more distraught until one day, she breaks down in tears while attempting to place the baby in his car seat for a visit to his pediatrician. Margaret’s next door neighbor, a retired RN, notices her distress and comes to help. Margaret tells her neighbor about her symptoms and says, “Everyone tells me I’m just over-reacting to being a new mother but I think something is really wrong!” The neighbor volunteers to babysit the next day so that Margaret can visit her family physician. When she returns, Margaret thanks her neighbor profusely. “The doctor says I have an inflamed thyroid gland. She says it doesn’t happen often after giving birth, but that it’s happened to me. Wait until I tell my mother and friends! This will shut them up!” Thyroiditis is inflammation of the thyroid gland. It is most prevalent in people between the ages of 30 and 50, and is more common in women than in men. The highest incidence is in the Appalachian region of the United States[5] . Types of thyroiditis There are several forms of thyroiditis, which usually have three phases: overactive thyroid (hyperthyroidism), underactive thyroid (hypothyroidism), and return to normal[17] . However, not all forms allow for the return of normal thyroid functioning. Some patients need life-long follow-up and thyroid hormone replacement[5,19] . Postpartum thyroiditis Postpartum thyroiditis is an uncommon disorder characterized by inflammation of the thyroid gland within the first year following childbirth[18] . Its exact etiology is unknown, but it is associated with an immune system reaction/underlying autoimmune thyroid condition [18,19] . Women at increased risk for postpartum thyroiditis are those who have [18] : ● ● An autoimmune disorder such as type 1 diabetes. ● ● A history of previous thyroid problems. ● ● A history of postpartum thyroiditis. ● ● A family history of thyroid problems. ● ● High concentrations of anti-thyroid antibodies. Most women who develop postpartum thyroiditis experience a return to normal thyroid function within 12 to 18 months of symptom onset. However, some women experience lingering signs and symptoms and can develop permanent complications[18,19] . There are generally two phases of postpartum thyroiditis. The first phase usually occurs within 1 to 4 months after giving birth and lasts for 1 to 3 months[18] . Signs and symptoms of the first phase are caused by inflammation and release of thyroid hormone and include [18] : ● ● Anxiety. ● ● Fatigue. ● ● Increased sensitivity to heat and heat intolerance. ● ● Irritability. ● ● Insomnia. ● ● Palpitations. ● ● Rapid heartbeat. ● ● Tremors. Later in the disease process, thyroid cells become impaired and signs and symptoms of hypothyroidism might become evident such as[18] : ● ● Aches and pains. ● ● Constipation. ● ● Dry skin. ● ● Fatigue and lack of energy. ● ● Increased sensitivity to cold and cold intolerance. ● ● Trouble concentrating.