MOTIVATION
Thymus gland (thymus) located in the upper section anterior mediastinum and is central authority immune system.
The thymus produces T-lymphocytes, hormones that regulate their maturation and differentiation (thymosin, thymopoietin, thymic factor, etc.), as well as insulin-like and calcitonin-like factors and growth factor.
The thymus gland reaches its maximum development in the early childhood, and from the age of 2, its involution begins.
adrenal glands located in the retroperitoneal tissue above the upper poles of the kidneys at the level of the XI-XII thoracic vertebrae. The adrenal glands are composed of the cortex and the medulla. The cortical substance produces more than 60 biologically active substances and hormones that affect metabolic processes. The main hormones are: glucocorticoids (regulate carbohydrate metabolism, have anti-inflammatory and desensitizing effects), mineralocorticoids (involved in the regulation of water-salt metabolism and carbohydrate metabolism), androgens and estrogens. The hormones of the medulla - adrenaline and norepinephrine - affect the level of blood pressure.
Pancreas located behind the stomach at the level of I-II lumbar vertebrae and has exocrine and intrasecretory functions.
Pancreatic hormones are synthesized in the islets of Langerhans: β-cells produce insulin, α-cells produce glucagon. Pancreatic hormones regulate carbohydrate metabolism, affect fat and protein metabolism.
By the time of the birth of a child, the hormonal apparatus of the pancreas is anatomically developed and has sufficient secretory activity. Insufficient production of insulin leads to the development of diabetes mellitus.
sex glands: ovaries
girls, testicles
in boys. The sex glands are already formed at birth, but begin to function intensively only by puberty. The hormones produced by them affect the growth and development of the body as a whole, determine the male or female type of body formation, character, and behavior. In girls, puberty begins at around 10 years of age, and in boys at around 11 years of age.
nursing care in diseases thyroid gland
Hypothyroidism
Hypothyroidism- a disease characterized by reduced secretion of thyroid hormones as a result of direct damage to the thyroid gland (primary hypothyroidism) or dysregulation of its function by the hypothalamic-pituitary system (secondary hypothyroidism).
One of the most common causes hypothyroidism in children is a congenital malformation of the thyroid gland. The frequency of congenital hypothyroidism is 1:4000-1:5000 among all newborns. Among children with congenital hypothyroidism, there are 2 times more girls than boys.
Causes of congenital (primary) hypothyroidism:
absence of the thyroid gland (agenesis);
its insufficient development in the process of embryogenesis (hypoplasia);
genetically determined defect in the synthesis of thyroid hormones;
autoimmune thyroiditis in the mother (damage to the gland by antithyroid antibodies);
x-ray or radioactive exposure;
insufficient intake of iodine in the body.
Causes of acquired (secondary) hypothyroidism:
violation of the hypothalamic-pituitary system, due to reduced production of thyroid-stimulating hormone (a hormone that stimulates the activity of the thyroid gland);
immunopathological lesion of the thyroid gland (autoimmune thyroiditis).
Thyroid hormones are stimulants of metabolism, growth and development. They directly affect normal growth, the development of skin and skeleton structures, the maturation of the central nervous system, and carbohydrate and protein metabolism. Deficiency of thyroid hormones (T3-thyroxine and T4-triiodothyronine) leads to significant disturbances in the body's vital functions. In addition, intermediate products of the breakdown of substances accumulate in the body (in the integumentary tissues - mucinous substance, skeletal and cardiac muscles - creatinine), leading to degenerative changes in the body.
There are three clinical forms hypothyroidism according to the severity of the course of the disease:
Light form.
Medium form.
Severe form (myxedema).
The main clinical manifestations of congenital hypothyroidism:
The disease usually manifests itself during the first weeks of the neonatal period. At the same time, all children suffering from a severe form are similar to each other:
large body weight at birth;
the face is unattractive, inexpressive, puffy, pale with an icteric tint, the nose is large, the eyes are widely spaced, the palpebral fissures are narrow, the large, swollen tongue does not fit in the mouth, the mouth is half open;
the neck is short, thick, the hands are wide, the fingers are thick, short;
the skin is dry, edematous, with a yellowish tint, marbling and acrocyanosis are pronounced;
the hair is coarse, brittle, dry and sparse, the hairline on the forehead is down, the forehead is wrinkled, especially when the child cries, the voice is rough and low;
Swelling of the face and body big tongue, umbilical hernia with congenital hypothyroidism
supraclavicular fossae filled with myxedematous tissue, in addition, it is expressed on the back surfaces of the hands, eyelids, genitals;
the child is lethargic, drowsy, indifferent, sucks poorly, but there is an increase in body weight;
shortness of breath is expressed, breathing is noisy, stridor, there may be episodic respiratory arrests;
muffled heart sounds, bradycardia, arterial hypotension;
the abdomen is enlarged, there is often a delay in the fall of the umbilical cord residue for more than 3-4 days, later - umbilical hernia, flatulence, constipation (disorder of absorption and excretory function);
child with athyreosis
growth retardation gradually forms, maturation slows down bone tissue(seams, fontanel close late, teeth erupt);
in the absence of timely treatment, brain function is impaired, mental and physical development is delayed.
The main clinical manifestations of acquired hypothyroidism.
The disease develops, as a rule, after a period of normal development of the child. Gradually developing hypofunction of the thyroid gland noticeably changes the appearance of the child:
speech and movements slow down, the voice becomes rough, memory is disturbed, school performance worsens, indifference and lack of interest in the environment appear;
puffiness of the face is expressed, the skin becomes pale and dry, the hair is brittle and dry, chilliness, hypothermia;
muscle tone is reduced despite hypertrophy of the muscular system (due to interstitial edema and mucin deposition);
anemia associated with impaired absorption of vitamin B12 (due to insufficient secretion of gastromucoprotein) is detected;
growth is low, there is a lag in bone age (ossification nuclei appear late), body proportions are violated (if treatment is not carried out in a timely manner, dwarfism may develop);
sexual development slows down;
often there is a lack of independent stool.
Examination of the spectrum of thyroid hormones (decrease in the level of hormones - T3 and T4 and an increase in the blood content of the pituitary thyroid-stimulating hormone - TSH in primary hypothyroidism; a decrease in TSH - in secondary);
X-ray of the hand (delayed rate of ossification in the wrist joints in children older than 3-4 months);
Ultrasound of the thyroid gland (tissue hypoplasia).
Prevention.
Registration and monitoring of pregnant women with an unfavorable history of thyroid diseases or living in areas endemic for goiter.
Timely identification of children at risk for the development of hypothyroidism (children born to mothers with thyroid pathology, from regions of the country endemic for goiter, exposed to ionizing radiation, with thyroid hypoplasia, suffering from vegetovascular dystonia).
Carrying out substitution therapy for hypothyroidism throughout life.
Replacement therapy should begin as early as possible, as a rule, combined synthetic thyroid drugs are prescribed - thyreotome, thyreocomb.
Additionally, vitamins A, group B are prescribed.
Neurotrophic drugs - piracetam, encephabol, cerebrolysin, pantogam.
Rehabilitation activities: massage, physiotherapy, classes with a speech therapist.
With adequate replacement therapy for mild forms of congenital and acquired hypothyroidism, the prognosis is favorable. When treatment for congenital hypothyroidism is started after 2 months of age, the prognosis for normal mental development is uncertain.
hyperthyroidism
hyperthyroidism- a disease characterized by an increased content of active thyroid hormones in the blood, due to its dysfunction.
It is less common in children than in adults.
It is customary to single out:
Diffuse toxic goiter (Graves' disease, Graves' disease).
Diffuse non-toxic goiter (endemic goiter).
family-hereditary factor (presence among family members of patients with hyperthyroidism);
chronic foci of infection, reinfection;
adverse factors external environment(environmental, radiation pollution);
imbalance of trace elements in the diet;
impact of different groups medicines(especially with uncontrolled intake of thyroidin);
mental trauma, etc.
A disease of an autoimmune nature, based on a genetically determined defect in immunity with a predominant lesion of T-lymphocytes (suppressors). Dysfunction of T-lymphocytes leads to the production of thyroid-stimulating antibodies (TS-lg), which have the ability to stimulate the functional activity and reproduction of thyrocytes. As a result, there is an increased release of thyroid hormones into the bloodstream.
The mechanism of development of diffuse non-toxic goiter.
The disease occurs due to insufficient intake of iodine, which, as a rule, causes a compensatory increase in the production of biologically active triiodothyronine. By mechanism feedback the production of thyroid-stimulating hormone (TSH) by the pituitary gland increases, and subsequently an increased sensitivity of thyrocytes to TSH is formed. The consequence of hyperproduction of thyroid hormones are violations of energy metabolism (decrease in ATP synthesis), tissue respiration, and metabolic processes.
There are several degrees of enlargement of the thyroid gland:
I degree - there is no visible increase in the gland.
II degree - the gland is visible when swallowing.
III degree - the gland fills the neck area between the sternocleidomastoid muscles.
IV-V degree - iron is very large sizes.
The main clinical manifestations of diffuse toxic goiter:
The disease is manifested, as a rule, by thyrotoxicosis:
the behavior and character of the child changes, excitability and emotional instability increase, unreasonable anger, sleep disturbance are noted;
expressed typical symptoms thyrotoxicosis: eye glitter, rare blinking, exophthalmos, lacrimation, tremor of the upper extremities;
warm skin, excessive sweating (hyperhidrosis), palms are wet, areas of hyperpigmentation appear;
changes from of cardio-vascular system: pain in the heart, palpitations, tachycardia, which is stable;
the thyroid gland is enlarged (goiter);
there is weight loss with increased appetite and increased growth, especially in the initial period of the disease, accelerated maturation of bones and teeth;
exophthalmos, thyroid enlargement
glands in a 12-year-old patient with thyrotoxicosis
dyspeptic phenomena (loose stools) are often noted;
there may be a delay in pubertal development (with severe hyperthyroidism).
Diffuse non-toxic goiter can remain without clinical changes for many years while maintaining the euthyroid state.
Laboratory and instrumental diagnostics:
Study of the spectrum of thyroid hormones (with diffuse toxic goiter, the levels of T3 and T4 are increased, TSH level normal or reduced, and with diffuse non-toxic goiter, the levels of T3 and T4 are normal or moderately reduced, and the content of TSH is increased).
X-ray of the hand (determination of bone age).
Ultrasound of the thyroid gland (various degrees of enlargement, the presence of cysts).
At diffuse toxic goiter children are hospitalized.
Drugs with a thyrotoxic effect are prescribed - mercazolil or propylthiouracil for 2-6 weeks at the rate of 0.5-1 mg / kg for 3 doses per day, then the dose is reduced every 1-2 weeks by 5-10 mg to a maintenance dose, which is 2, 5-5 mg, it is given for 6-12 months, under the control of clinical indicators and the level of hormones in the blood.
When allergic reactions or large goiter, surgical treatment is indicated.
At diffuse non-toxic goiter, proceeding with an increase in the thyroid gland more than II degree and an increase in the level of TSH - long-term therapy with the maximum tolerated doses of thyroid hormones is indicated: L-thyroxine, thyroidin until the size of the gland normalizes, followed by gradual withdrawal of drugs.
Properly performed treatment for diffuse toxic goiter in many patients leads to recovery. If conservative therapy fails, resort to surgical intervention. Subtotal removal of the thyroid gland can be the cause of the development of hypothyroidism, which requires lifelong replacement therapy.
endemic goiter
endemic goiter- an increase in the thyroid gland, which develops when iodine enters the body below the daily requirement. The disease occurs, as a rule, in people living in endemic goiter areas. An area is considered endemic if the prevalence of an enlarged thyroid gland in children and adolescents reaches more than 5%, among adults more than 30%.
Etiology. The main role in the development of endemic goiter is given to iodine deficiency: iodine deficiency in the atmosphere, intake of iodine in an inaccessible form for absorption, hereditary disorders of iodine metabolism. The manifestation of iodine deficiency can contribute to accompanying illnesses And physiological states(puberty, lactation). The living conditions, the cultural and social level of the population, the amount of microelements taken with food matter.
clinical picture. Clinical manifestations of the disease are determined by the functional state of the thyroid gland, its shape and size. The functional state of the thyroid gland in most cases is euthyroid. Preservation of the function of the gland is ensured by its compensatory increase. long-term illness can lead to a decrease in thyroid function and the development of hypothyroidism.
Complications of endemic goiter are thyroiditis, malignancy is possible.
Treatment. In the case of diffuse endemic goiter with a slight degree of enlargement of the thyroid gland, iodine preparations are effective. In the absence of effect, as well as in the hypothyroid course, therapy with thyroid hormones and thyroid preparations is indicated. With increased function, thyreostatic drugs are used. Indications for surgical treatment are nodular, mixed and diffuse forms of goiter IV-V degrees, accompanied by compression of the neck organs, atypical location of the thyroid gland, goiter with severe destructive changes.
Prevention.
For prophylaxis in goitre-endemic areas, iodized table salt is used (group prophylaxis) or taking one antistrumine tablet once a week (individual prophylaxis).
Nursing care for congenital and acquired thyroid diseases.
To give truthful information to parents about the causes of thyroid diseases, their course and the prospects for the development of the child.
To identify real and potential problems in a timely manner and meet the vital needs of the child and his parents.
Possible problems for the child:
malnutrition;
violation of the function of vital organs;
high risk of concomitant infections (due to reduced immunity);
lag in physical, mental and mental development;
violation of self-care due to mental and mental retardation;
suffering about appearance;
lack of communication;
lack of family support.
stress, psychological discomfort;
feeling of guilt towards the child;
lack of knowledge about the disease and its causes;
difficulties in caring for a child, feeding, raising, teaching;
situational crisis in the family (material difficulties, job loss, the need for constant care for a problem child, etc.);
search for specialists who own modern methods of treatment and rehabilitation, etc.
Support parents at all stages of realizing reality. Convince parents of the need for long-term replacement and maintenance therapy, monitor the effectiveness of ongoing therapy, and report side effects to the doctor.
Advise parents on the organization of nutrition of the child, adequate to his condition and age.
To help parents correctly assess the abilities and capabilities of the child, to teach them to control the level of their intellectual development. Encourage active gaming activity child. Advise to conduct classes with specialists (psychologist, speech therapist, etc.).
Teach parents to prevent intercurrent diseases (avoid contact with sick children and adults, conduct general strengthening activities, massage, physiotherapy exercises).
To convince parents after discharge from the hospital of the need for dynamic monitoring of the child by doctors - a pediatrician, endocrinologist, neurologist, psychoneurologist, speech therapist and other specialists according to indications: up to 3 years of age quarterly, up to seven years - 1 time in 6 months, then annually up to 14 years. Every 6 months it is necessary to carry out radiography of the hands (to track the bone age) until it matches the real age of the child.
To help families with children with hypothyroidism unite in a parent support group to jointly address issues of upbringing, education and social adaptation.
The nurse should be more responsive to the needs of the population than to the needs of the health system. It must transform itself into a well-educated professional, an equal partner, independently work with the population, contributing to the strengthening of the health of society. It is the nurse who is now assigned a key role in the medical and social care of the elderly, patients with incurable diseases, health education, organization of educational programs, promotion of healthy lifestyle life.
Nursing Process consists of major steps.
- 1. Nursing examination - the collection of information about the patient's health, which may be subjective and objective.
- 2. Establishing the patient's problems and formulating nursing diagnosis. The patient's problems are divided into existing and potential. Existing problems are those problems that the patient is currently concerned about. Potential - those that do not yet exist, but may arise over time. The nurse identifies the factors that contribute to or cause the development of these problems, also reveals the strengths of the patient, which he can oppose to the problems.
- 3. Determining the goals of nursing care and planning nursing activities. The nursing care plan should include operational and tactical goals aimed at achieving certain long-term or short-term results.
- 4. Implementation of the planned actions. This stage includes the measures taken by the nurse for the prevention of diseases, examination, treatment, rehabilitation of patients.
- 5. Evaluation of the effectiveness of the nursing process.
In addition to traditional patient care, the 21st century nurse has new areas of activity, she must take on a variety of functions. With the spread of higher nursing education, it became possible to independently conduct scientific research, the results of which nursing professionals are able to implement independently, as well as the possibility of training nursing personnel by the nurses themselves.
Among the first steps in this direction, it should be noted the organization of an educational and methodological room, where specialized training programs are developed and implemented on-the-job for nurses of various degrees of training, different professional groups, and continuous training of nurses contributes to improving the quality of medical care for patients. The next stage is the annual training of young nurses in the "school of a young nurse" with the delivery of a differentiated test at the end of training in sections:
- readiness to provide emergency first aid;
- · improvement of manipulation technique within the framework of TPMU standards;
- preparation of patients for laboratory-diagnostic and instrumental research methods.
For diseases thyroid gland The nursing process includes the following steps:
- - Creation of physical and mental rest, recommendations for diet. Monitoring of pulse, blood pressure, respiratory rate, physiological functions, weight, diet, regimen, condition is also organized. skin, weighing.
- - Organization of a consultation with a nutritionist, psychotherapy, exercise therapy.
- - Fence biological material for laboratory research, preparation for research and consultations, timely distribution of drugs and administration medicines, prompt implementation of all doctor's prescriptions, prevention of possible complications.
| 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 reduced nutrition | 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 nutrition and drinking regimen patient. Weigh the patient twice a week. Daily measure daily diuresis and calculate water balance. Monitor patient medication intake | |
| 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 insufficient 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 of the medications used and the need for timely information about them to the 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 endocrine system(hypothyroidism).
Hypothyroidism- a disease caused by a decrease in thyroid function or its 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:
lethargy, weakness, drowsiness
Increased fatigue
· 
memory loss
chilliness
aching pain in 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)
Laboratory methods:
Clinical Analysis blood (anemia)
Blood chemistry:
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
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 the energy value of 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 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), 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 in different periods his life causes the following diseases.
Diseases caused by iodine deficiency
1.1 Clinical picture of hypothyroidism
Hypothyroidism in adults was first described in late XIX century (1873) by Gall. The disease has long been referred to as "myxedema", less often - Gall's disease. The term hypothyroidism began to be used after the relationship between the symptom complex "myxedema" and thyroid insufficiency was established.
Hypothyroidism is currently defined as clinical syndrome due to insufficient production of thyroid hormones due to disruption of the functioning of one or more links of the hypothalamic-pituitary-thyroid system. Depending on the level of damage, primary, secondary and tertiary hypothyroidism is distinguished. Primary hypothyroidism is caused by damage to the thyroid gland itself, with secondary hypothyroidism, the pathological process is localized in the pituitary gland, with tertiary hypothyroidism, in the hypothalamus. The last two forms are commonly referred to as hypothyroidism of central origin (hypothalamic-pituitary or secondary).
1.2 Diagnosis of hypothyroidism
Laboratory diagnosis of hypothyroidism syndrome is quite simple and involves, if a decrease in thyroid function is suspected, a hormonal study, primarily the determination of the level of TSH in the blood serum, and in some cases the level of free T4. However, hypothyroidism is not always manifested by bright clinical symptoms, in a significant number of cases there are "monosymptomatic" forms of the disease, which distracts the doctor from the correct assessment. general condition patient and may cause an erroneous diagnosis of alimentary obesity, anemia, biliary dyskinesia, renal disease, accompanied by edematous syndrome, depression, coronary heart disease with symptoms of heart failure, amenorrhea, infertility, etc. Therefore, the diagnosis of hypothyroidism in some cases encounters significant difficulties, and patients can be observed for a long time by a cardiologist, nephrologist, gynecologist, psychiatrist and doctors of other specialties for various somatic diseases. The reason for conducting a hormonal study in these cases may be the lack of the expected therapeutic effect from traditional therapeutic measures. To suspect hypothyroidism in these patients, the detection of individual clinical symptoms such as bradycardia, cold intolerance, dry skin, constipation. If hypothyroidism is suspected, it is sufficient to determine only the level of TSH in the blood serum, which is the most sensitive indicator of the functional state of the thyroid gland.
1.3 General principles for the treatment and prevention of hypothyroidism
Treatment of both primary and secondary hypothyroidism involves lifelong replacement therapy with thyroid hormone preparations, which ensures the normalization of thyroid hormonal status And good quality patients' lives. long time With therapeutic purpose preparations containing dried thyroid powder of slaughter cattle were used, in particular, thyroidin, although their use did not guarantee an accurate dosage of thyroid hormones in the patient's blood and created certain difficulties in carrying out therapeutic measures. All of the above, as well as a threat to the health and life of a patient taking drugs from the organs of slaughtered cattle, dangerous transmission of virus-like particles-prions (similar to causative agents of spongiform encephalitis) were the basis for the prohibition of their use in medical practice.
2.1 Analysis of the activities of the therapeutic department
Murmansk City Clinical Emergency Hospital medical care- one of the largest medical institutions in the Murmansk region. The hospital operates 24 hours a day, 7 days a week, 365 days a year. More than 300 thousand people live in its service area. Of these, more than 14,000 people become hospital patients annually, 85% of them are delivered for emergency reasons. More than 1,300 employees are ready to immediately provide high qualified assistance on 20 profiles. At the same time, more than 580 people receive treatment in the hospital. The hospital has more than 50 structural divisions, whose employees, working in close cooperation, ensure the continuity of the diagnostic and treatment process, which in many ways is the key to successful treatment of patients.
2.2 The role of the nurse in healing process with hypothyroidism
The nurse should be more responsive to the needs of the population than to the needs of the health system. It must transform itself into a well-educated professional, an equal partner, independently work with the population, contributing to the strengthening of the health of society. It is the nurse who is now assigned a key role in medical and social assistance to the elderly, patients with incurable diseases, health education, organization of educational programs, and promotion of a healthy lifestyle.
2.3 Assessing the effectiveness and quality of nursing care for patients with hypothyroidism
In order to study patient satisfaction with the quality nursing care carried out at the department sociological research in the form of a survey. To conduct the survey, an author's questionnaire was developed (Appendix K), consisting of 15 questions with suggested answers, which were divided into two blocks. The first block of the questionnaire (6 questions) is devoted to characterizing the characteristics of patients.
CONCLUSION
Thyroid diseases are one of the most common forms of human pathology. In recent years, a significant increase in the frequency of thyroid diseases has been noted in many regions of Russia, which is associated with environmental degradation, insufficient iodine intake, negative changes in the population's diet, and an increase in the frequency of autoimmune diseases. Hypothyroidism occupies one of the leading places in the structure of thyroid pathology in terms of frequency and social significance.
Hypothyroidism is a clinical syndrome caused by a lack of thyroid hormones in the body or a decrease in their biological effect at the tissue level.
Having examined in our work the activities of the therapeutic department, which includes endocrinological beds, we came to the conclusion that the amount of congenital hypothyroidism has not changed over the analyzed period of time.
APPENDIX A
Table A.1 - Branch states
APPENDIX B
Table B.1 - Department performance indicators
APPENDIX B
Table B.1 - Structure of hospitalized patients by nosological forms in 2013.
APPENDIX D
Table D.1 - Structure of hospitalized patients by nosological forms in 2014
APPENDIX D
Table E.1 - Nursing care plan for a patient with hypothyroidism
APPENDIX E
Table E.1 - Structure of patients by age and sex
APPENDIX G
Table G.1 - Factors that determine the well-being and state of health of respondents
APPENDIX AND
Table I.1 - The opinion of patients on the importance of the qualities of nurses that they should possess
APPENDIX K
Questionnaire for patients
As part of the ongoing research, we ask you to fill out a questionnaire dedicated to assessing patient satisfaction with the quality of medical care in the department.
The human body is a reasonable and fairly balanced mechanism.
Among all known to science infectious diseases, infectious mononucleosis is given a special place ...
The disease, which official medicine calls "angina pectoris", has been known to the world for quite a long time.
Mumps (scientific name - parotitis) is called an infectious disease ...
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There are no people in the world who have never had ARVI (acute respiratory viral diseases) ...
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Nursing process in thyroid diseases
Nursing process in diseases of the thyroid gland plays an important role. It is the nurse who carefully monitors the patient's compliance with all the doctor's prescriptions, and therefore brings recovery closer.
The thyroid gland is one of the most important organs of the human body and produces vital hormones: thyroxine (T3) and triiodothyronine (T4). They are responsible for metabolism, thermoregulation and have a direct impact on most organs and systems.
The thyroid gland, one of the endocrine glands, is subject to certain diseases. They are due to a number of reasons, for example: lack of iodine, unfavorable environment, congenital anomalies, inflammatory and autoimmune diseases.
All diseases this body conditionally can be divided by 2 large groups. In some cases, the function of the gland decreases, and it produces an insufficient amount of hormones. This condition is called hypothyroidism. Or, on the contrary, iron produces an excessive amount of hormones and poisons the body. Then we talk about hyperthyroidism.
Hypothyroidism is a rather unsafe condition that can lead to very serious consequences, especially if a child suffers from it. After all, the lack of thyroid hormones leads to mental retardation and even the occurrence of cretinism. Therefore, many countries of the world are very actively carrying out the prevention of this condition.
Hypothyroidism is a pathological condition in which the amount of hormones produced is significantly reduced. It can be caused by inflammatory diseases in the gland, lack of iodine in food and water, congenital aplasia of the gland, removal of most of it, or an overdose of certain drugs (for example, Mercazolil).
This condition is diagnosed through blood tests. ultrasound and other thyroid tests.
With hypothyroidism, an important role in the treatment is given to the nurse. Caring for such patients requires special patience, because the dysfunction of this organ is almost primarily displayed on mental state sick. Here are the functions that a nurse performs:
- Continuous monitoring of pulse rate, blood pressure, body temperature, stool frequency.
- Controlling the patient's weight. Be sure to weigh yourself weekly.
- Recommendations for diet therapy. Such patients are forbidden to consume animal fats and are recommended to eat foods rich in fiber. This is due to a slowdown in metabolism.
- Teaching relatives of patients how to communicate with them.
- Organization hygiene procedures, room ventilation.
Since patients with hypothyroidism often feel cold, the nurse must ensure a comfortable room temperature or use heating pads, warm clothes and blankets.
Diffuse toxic goiter
Diffuse toxic goiter is a pathology that is caused by the fact that the thyroid gland produces too much hormones T3 and T4. This leads to the fact that metabolic processes in the body are greatly accelerated, which ultimately leads to disruption in the work of many organs and systems.
This disease has a long course, so the nursing process in diffuse toxic goiter is especially important. Here are the functions that a nurse performs:
- It creates conditions for a good rest of patients, provides their psychological comfort.
- Constantly monitors blood pressure, pulse rate, stool.
- Monitors the nutrition of the patient. Performs weekly weigh-ins.
- Monitors patient body temperature and room temperature. If necessary, uses heating pads and warm blankets.
- Creates a favorable microclimate around the patient, trains relatives to care for such a patient.
Patients with diffuse toxic goiter are very irritable, tearful, conflicted. Therefore, a sister in this case requires a lot of patience and tact.
It is the nurse who should monitor the implementation of all the recommendations of the doctor and teach relatives the basics of patient care.
As can be seen, the nursing process in diseases of the thyroid gland plays almost a key role in the recovery of the patient. It is extremely important for the patient to follow all the recommendations of the medical staff and make every effort to overcome their illness.
nuzhenjod.ru
What are the features of caring for patients with hypothyroidism?
The concept of health care development in the Russian Federation implies new methods of nursing in diseases of the thyroid gland, in particular in hypothyroidism.
Modern technologies of care and rehabilitation involve high responsibility and delimitation of duties of nurses and are aimed at improving the quality of life of the patient.
The term "nursing process" originated in the United States and was first used by Lydia Hall in 1995.
Specialists in this field of activity should be qualified enough to independently identify problems and solve them according to the situation.
What do you have to deal with?
A condition in which a person does not have enough thyroid hormones is called hypothyroidism.
This disease was first identified and described at the end of the 19th century. Hypothyroidism is the opposite of another disease - hyperthyroidism, in which there is excessive hormonal activity of the thyroid gland.
The most severe forms of this disease are myxedema and cretinism.
Also, in an advanced case, the patient may fall into a myxedematous coma.
At mild form Hypothyroidism requires minimal assistance from a nurse, but with myxedema or coma, the amount of work increases many times over.
The reactions of the body in hypothyroidism, occurring due to a lack of thyroid hormones, reduce the patient's performance and contribute to depressive syndrome.
A nurse should help a person perform minimal self-care procedures, eat normally, and feel good.
When replenishing the necessary substances replaced by synthetic analogues, the symptoms of the disease usually disappear.
The severity of symptoms is largely determined by the etiology of the disease.
Hypothyroidism can be caused by:
- various pathological processes in the thyroid gland;
- surgical interventions in the activity of the thyroid gland;
- lack of iodine in the body;
- heredity;
- pathologies of the hypothalamus and pituitary gland.
In Russia, this disease affects approximately 2% of the population, that is, many medical personnel should be able to care for the injured.
Most thyroid pathologies are detected in women, and it is in patients that emotional lability is most acute.
The nurse must be trained in behavior in conflict situations and be patient with the patient.
Also, the disease depends on the geographical factor, since in some areas there may be a significant deficiency of iodine.
In mountainous areas, medical staff encounter victims of hypothyroidism 2-5 times more often than in coastal areas.
People with hypothyroidism have the following symptoms:
The disease is diagnosed based on laboratory tests if the condition is assessed as critical, the person should go to the hospital.
Both in the inpatient and outpatient departments, the nurse helps the endocrinologist to carry out diagnostic and therapeutic manipulations.
The level of thyroxine and triiodothyronine in the blood is significantly reduced, and the amount of thyroid-stimulating hormones is increased.
For drug treatment, synthetic thyroid hormones such as thyroxine are used.
In a hospital, a nurse should give out drugs that compensate for hormonal imbalance.
If the patient is on outpatient treatment, then he buys and takes medicines on his own, the help of a nurse may be needed only during the consultation of an endocrinologist.
What exactly do you need help with?
Caring for a patient, in which his physical and psychological needs are met, is called the nursing process.
Exist state standards performing this activities, including the organization and execution of care for patients with various diseases.
Goals nursing interventions when caring for a person with hypothyroidism:
Coma with hypothyroidism of the thyroid gland is a serious condition.
Most often it occurs in the elderly and in cases where treatment is running.
Coma is due to a sharp violation metabolic processes.
Against this background, pathologies of the adrenal glands and a decrease in defense mechanisms human body.
The probability of such an outcome is about 38%.
Therefore, a person in this condition needs constant care and medical support.
Emergency care for a patient who has fallen into a coma includes:
- preparation of the place and laying the patient in the correct position;
- oxygen therapy or providing air flow to the patient's lungs;
- collection of analyzes, measurement of pressure and pulse;
- preparation of drugs for intravenous administration.
Hypothyroidism develops gradually. Often, patients do not immediately notice the initial signs of this disease.
Sudden deterioration and exacerbation of all symptoms of the disease precedes the onset of coma.
Drowsiness develops into loss of consciousness. The body temperature drops to 20°C and breathing slows down.
Blood pressure decreases and the patient's pulse rate drops to 32 beats per minute.
After providing emergency care, the tasks of a nurse include the constant care of a person suffering from hypothyroidism.
Every few hours you need to inject him with 25 micrograms of levothyroxine intravenously.
In case of collapse, injections of 150 mg of prednisolone or 300 mg of hydrocortisone and about 200 mg of dopamine should be given.
In order to maintain a sufficient level of oxygen in the patient's body, it is necessary to carry out oxygen therapy.
You should also regularly put droppers of glucose solution.
All appointments are given by the attending physician, the nurse simply does what the endocrinologist recommended.
Nurse training requirements
Nurses work in both private and public medical institutions.
To make patient care more effective, there are requirements for nurse training and licenses to educational institutions.
In case of hypothyroidism, it is necessary that the nurse knows and is able to conduct procedures and studies:
- carrying out various diagnostic methods;
- collection of analyzes and various indicators of the functioning of the body;
- ability to carry out various healing procedures;
- ability to work with documentation;
- knowledge of the causes, symptoms and treatments of underlying diseases;
- knowledge of safety precautions when working with devices and tools.
Depending on the geographic location, the scope of this profession may differ due to the uniqueness of the national culture and the quality of the healthcare system.
For example, in endemic areas great attention given to the prevention of goiter.
The International Council of Nurses, symbolized by the white heart, operates in more than 130 countries.
The Council gave its definition of the tasks and goals of the nursing process: this is an activity for the joint and individual care of people suffering from various diseases, including thyroid pathologies.
The definition specifies that patients different ages And social groups have the same right to qualified assistance.
Also, the nursing process involves the promotion of a healthy lifestyle among those at risk for thyroid disease.
Where to find a great nurse?
You can hire a paid nurse in specialized clinics.
Ordinary clinics sometimes also provide home care, paid or free.
You can clarify this issue with an endocrinologist or in the registry.
Prices for medical support vary from 300 to 3000 rubles per visit, the price for specific manipulations also has significant differences.
Care for older patients is sometimes provided at subsidized prices, 20-50% lower than usual.
white heart
The duties of a nurse or brother include providing emergency first aid, assisting in operations, caring for patients, and performing various therapeutic measures.
Florence Nightingale is considered the father of nursing.
In her notes, this activity is characterized as the use of the environment for the improvement of the patient.
The day of the nurse is celebrated on the birthday of this woman.
Professionalism, participation and compassion are qualities inherent in workers in this field.
Thyroid diseases, such as hypothyroidism or hyperthyroidism, can cause severe conditions in which the nurse or brother becomes a friend and helper of the patient for a long time.
proshhitovidku.ru
Topic: "Nursing care for diseases of the endocrine system (hypothyroidism)".
Hypothyroidism is a disease caused by a decrease in thyroid function or its complete loss. 
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 (examination of thyroid function)
Thyroid Scan
Thyroid ultrasound
Diet number 10 (exclude 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
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 is a disease that occurs in areas with limited iodine content 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. 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 
studfiles.net
Nursing process in diffuse toxic goiter
Nursing process in diffuse toxic goiter. Diffuse toxic goiter (Graves' disease, thyrotoxicosis) is a disease characterized by increased secretion of thyroid hormones. The main importance in the etiology of the disease is given to hereditary predisposition. In the occurrence of the disease are also important: trauma, infection (tonsillitis, influenza, rheumatism). solar radiation, pregnancy and childbirth, organic lesions of the central nervous system (CNS), diseases of other endocrine glands. Main clinical manifestations diseases are: enlargement of the thyroid gland, irritability, irritability. tearfulness. The behavior of the patient, his character changes: fussiness, haste, resentment, hand tremor appear.
Complaints and anamnesis during questioning are presented by the patient poorly, often he fixes attention on trifles and misses important symptoms. Patients often complain of excessive sweating, poor heat tolerance, subfebrile temperature, trembling of the extremities, and sometimes of the whole body, sleep disturbance. significant and rapid weight loss with good appetite. Often there are changes in the cardiovascular system: palpitations, shortness of breath, aggravated by physical activity, interruptions in the region of the heart. Women often experience menstrual irregularities. Draws attention on examination appearance Patient: Facial expression often takes on an "angry" or "frightened" look due to eye symptoms and primarily due to exophthalmos (bulging eyes) and rare blinking. Greffe's symptom appears (lagging behind upper eyelid when lowering the eyes, while a white stripe of the sclera is visible) and a Mobius symptom (loss of the ability to fix objects at close range), eye shine and lacrimation. Patients may complain of pain in the eyes, sensations of sand, foreign body, double vision. On the part of the cardiovascular system, there is a pronounced tachycardia up to 120 beats. min, possible atrial fibrillation, increased blood pressure.
Nursing process in diffuse toxic goiter: Patient's problems: A. Existing (real): - irritability; - tearfulness: - resentment: - palpitations, interruptions in the region of the heart: - shortness of breath; pain in the eyes; - weight loss: - increased sweating; - trembling of the limbs; - weakness, fast fatiguability; - sleep disturbance; - poor heat tolerance. B. Potential: - the risk of developing a "thyrotoxic crisis"; - "thyrotoxic heart" with symptoms of circulatory failure; - fear of the possibility of surgical treatment or treatment with radioactive iodine.
Collection of information during the initial examination:
Collecting information from a patient with diffuse toxic goiter sometimes causes difficulties due to the peculiarities of her behavior and requires the nurse to be tactful and patient when talking with him. A. Questioning the patient about: - the presence of thyroid diseases in the next of kin; - previous diseases, traumas of the central nervous system; features of professional activity; connection of the disease with psychotrauma; - the patient's attitude to sun exposure, tanning; - the duration of the disease; - observation by an endocrinologist and the duration of the examination, its results (when and where was examined in last time); - medicines used by the patient (vine, regularity and duration of administration, tolerability); - for women, find out if the manifestation of the disease is associated with pregnancy or childbirth, and if there are any menstrual irregularities; - complaints of the patient at the time of the examination. B. Examination of the patient: - pay attention to the appearance of the patient, the presence of eye symptoms, tremor of the hands, body; - inspect the neck area; - assess the condition of the skin; - measure body temperature; - determine the pulse and give it a characteristic; - measure blood pressure; - determine body weight.
Nursing interventions, including work with the patient's family:
1. Provide physical and mental rest to the patient (it is desirable to place him in a separate room). 2. Eliminate annoying factors - bright light, noise, etc. 3. Observe deontological principles when communicating with the patient. 4. Have a conversation about the essence of the disease and its causes. 5. Recommend a full-fledged diet with a high content of protein and vitamins, with a restriction of coffee, strong tea. chocolate, alcohol. 6. Recommend wearing lighter and looser clothing. 7. Ensure regular ventilation of the room. 8. Inform about the medicines prescribed by the doctor (dose, usage patterns, side effects, tolerability). 9. Control: - compliance with the regimen and diet; - body weight; - frequency and rhythm of the pulse; - arterial pressure; - body temperature; - the condition of the skin; - taking medications prescribed by a doctor. 10. Ensure patient preparation for additional methods biochemical blood tests, a test for the accumulation of radioactive iodine by the thyroid gland, scintigraphy. ultrasound.
11. Conduct a conversation with the patient's relatives, explaining to them the reasons for changes in the patient's behavior, reassure them, recommend being more attentive and tolerant with the patient.
sestrinskoe-delo.ru
