1) post-ablative hypothyroidism – uncontrolled
drug therapy problem – safety: dose too high – NM is experiencing hyperthyroidism symptoms such as improved energy and motivation, loss weight, increased heart rate, excessive and frequent stools, low TSH, high free T4 because her 112mcg dose of levothyroxine is too high.
The treatment goal is to maintain TSH, T4 free within normal range without experiencing any symptomatic side effects such as fatigue, weight gain, decreased heart rate, depression for hypothyroidism and increased heart rate, sudden weight loss, increased appetite, anxiety for hyperthyroidism.
Based on the 2012 Clinical Practice Guidelines for Hypothyroidism, levothyroxine is the preferred medication. Regarding the dosing, 1.6 mcg to 1.7 mcg/kg/day is mean
…show more content…
replacement dose, the patient’s weight is 157 pounds (71 kg), the recommended dose ranges from 113.6 mcg per day 120.7 mcg per day, the start dose (112 mcg) is suitable. However, the patient presents today with hyperthyroidism symptoms such as improvement in energy and motivation, loss weight, increased heart rate, excessive sweating and frequent stools. Her lab values including low TSH, high free T4 also indicates hyperthyroidism. The dose adjustment should be in 12.5 mcg to 25 mcg increments. Additionally, the commercially available strengths for levothyroxine are 25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg and 300 mcg. 100 mcg would be a suitable dose to choose at this time. When a hypothyroid patient is pregnant, the levothyroxine dose should be independently increased by 30%. Monitoring for pregnancy is important for treating hypothyroid. 2) contraception – controlled The goal of contraception is to prevent unintended pregnancy. Based on the CDC Select Practice Recommendations for Contraceptives, the combined oral contraceptive is effective, regarding typical use, 9% of women experiencing the unintended pregnancy within the first year of use, regarding perfect use, 0.3% of women experiencing the unintended pregnancy within the first year of use. The oral dosage form is easy to take, additionally, these are generally covered by health insurance. Combined oral contraceptive is commonly used in hormonal contraception product in women. NM is taking Ethinyl Estradiol/Norethindrone 35mcg - 1 mg tablet for contraception, which is a combined oral contraceptive, she is satisfied with her current conception treatment and does not experience any side effects from this. It is reasonable to continue this regiment. Additionally, for MN who is a post-ablative hypothyroidism patient, once she newly pregnancy, the dose of levothyroxine should be independently increased by 30%, which is usually adding two doses per week.
Regarding her post-ablative hypothyroidism, it is important to avoid the unpredictable pregnancy in case not aware of changing the dose independently.
3) general health – controlled
The goal of BMI is 18.5 to 24.9 indefinitely. Her BMI is 24.6, which meets the goal.
Plan:
1) Post-ablative hypothyroidism
-Initiate levothyroxine 100 mcg tablet: take 1 tablet by mouth once daily.
-Discontinue levothyroxine 112 mcg tablet: take 1 tablet by mouth once daily
-Instruct the patient to take the tablet with a full glass consistently 30 to 60 minutes before breakfast or at bedtime 4 hours after the last meal.
-Advise patient to expect improvement of symptoms in 2 to 3 weeks.
-Educate patient that this medication may reduce the absorption of antacids, calcium, and iron. Take 4 hours apart from antacids, calcium and iron supplements.
-Educate on the side effects including fatigue, heat intolerance, fever, sweating, hyperactivity, tremors, palpitations, myocardial infarction.
2)
contraception -Continue Ethinyl Estradiol/Norethindrone 35mcg - 1 mg tablet: take 1 active tablet by mouth once daily for 21 days followed by 1 inactive tablet by mouth once daily for 7 days -Educate patient about possible side effects, including nausea, cyclic weight gain, increased appetite, weight gain in general, breakthrough bleeding -Educate patient the important to take regularly, same time each day -Teach the correct use of backup contraception methods since the medication needs 7 days of active treatment to take effect 3) general health -Encourage patient to walk 15 to 20 minutes for at least 3 times per week for exercise, to eat the healthy diet which includes fruits, vegetables, low in saturated fat and total fat. -Educate on the importance to maintain BMI within range. Follow-up: Call patient in 1 week. Call pharmacy sooner if the patient has any side effects of medications or questions regarding the therapeutic intervention. -Evaluate for side effects of 100 mcg levothyroxine such as fatigue, heat intolerance, fever, sweating, hyperactivity, tremors, palpitations, myocardial infarction. Follow up with the patient in clinic 4 to 6 weeks. Call pharmacy sooner if the patient has any side effects of medications or questions regarding the therapeutic intervention. -Check TSH level to check the effectiveness of 100 mcg levothyroxine, evaluate for side effect such as fatigue, heat intolerance, fever, sweating, hyperactivity, tremors, palpitations, myocardial infarction to check the safety of 100 mcg levothyroxine. -Evaluate the consistent use and perform the pregnancy test if needed to check the effectiveness of Ethinyl Estradiol/Norethindrone 35mcg - 1 mg tablet, evaluate for side effect such as nausea, cyclic weight gain, increased appetite, weight gain in general, breakthrough bleeding to check the safety of Ethinyl Estradiol/Norethindrone 35mcg - 1 mg tablet. -Measure her weight and height, evaluate the BMI -Evaluate on her progress of exercise and healthy diet Once the adequate replacement dose is determined, follow up with the patient in the clinic in 6 months to test TSH level to check the effectiveness of levothyroxine, then follow up with the patient in clinic every 12 months.
Medications used to treat hypothyroidism consist of armour, proloid, synthroid, cytomel and euthroid (Dellipizzi-Citardi, 2011, p.59). Armour is a thyroid tablet consisting of extracts of the thyroid gland. Proloid is also known as thyroglobulin, which consists of purified extracts of a pig’s thyroid. Another name for synthroid is levothyroxine sodium. Cytomel is also referred to as liothyronine sodium. Lastly, euthroid is called liotrex. (Dellipizzi-Citardi, 2011, p.59). Some side effects of these medications are angina and arrhythmias. One nursing implication for these medications is administering a single dose before breakfast with a full glass of water, initial doses are low and gradually increase based on a thyroid function test. (“Thyroid, levothyroxine & liothyronine”, n.d.) Another nursing implication is if a patient has difficulty swallowing the tablet, crush it and put it in five to ten milliliters of water and administer it immediately by either spoon or dropper. (“Thyroid, levothyroxine & liothyronine ”, n.d.)
Thyroid and metabolism hormones play a large role in the daily lives of all living species. Thyroid hormones regulate the metabolism and the metabolism is responsible for maintaining a specific range for the biochemical reactions that occur in the body (Martini 2014). The most important hormone for metabolic maintenance is thyroxine (T4). This hormone also plays a large role in body heat regulation. It is produced by the pituitary gland and secreted by the thyroid gland. The thyroid releasing hormone (TRH) must trigger the thyroid stimulating hormones (TSH) to release thyroid hormones to the thyroid gland. These hormones are under control of the hypothalamus, or main neural control center. Propylthiouracil (PTU) is a medication used to treat
Some of the known side effects of GHB involve intoxication, talking, increased energy, happiness, desire to socialize, sensuality, possible nausea, enhanced sexual experience, feeling playful or affectionate, loss of gag reflex, loss of coordination due to loss of muscle tone, mild disinhibition, or the feeling of freedom; exposure, delusions, depression, dizziness, hallucinations, seizures, low blood pressure, slowed heart rate, or difficulty concentrating. Some of the more serious effects include amnesia, vomiting, respiratory problems, loss of conscienceness, being conscience but unable to move, rambling incoherent speech, sedation, disinhibition, giddiness, silliness, desire to sleep, passing out, and death, especially when GHB is mixed with alcohol or other drugs!
Furosemide is available in tablets, sublingual tablets, oral suspension, and intravenously. (2) The recommended schedule dose for adults for an initial dose is 20 to 80mg. (3) The same dose as well as higher doses may be administered 6 to 8 hours following the previous dose if needed. (2) When titrating doses it may be raised by 20 to 40mg but not within 6 to 8 hours after the initial dose, and this may continue until the desi...
...r height in metres, a healthy BMI for an adult is 18.5 to 25 and if you are classed as obese, your BMI is 30 or more. (Astrup 2009)
Today in America thyroid disease is becoming a much larger issue and the worse part of this problem is that many people are not yet diagnosed. This is due to the lack of education and awareness about thyroid disease. There are many different types of diseases but the one that I am passionate about is hypothyroidism. Hypothyroidism, or underactive thyroid is when the thyroid is no longer able to produce triiodothyronine, also known as T3 and thyroxine, also referred to as T4. Some of the symptoms include unexpected weight gain, tiredness, depression, or slow movements and thoughts. Most of the time many people notice the way that their bodies act on what they are feeling to their physicians. Many Americans struggle with this disease that
The following presentation will help this class in the teaching of a patient with hypothyroidism. The expected outcome of this presentation for the patient will be as follows:
Geffner DL, Hershman JM (July 1992). "β-Adrenergic blockade for the treatment of hyperthyroidism". The American Journal of Medicine 93 (1): 61–8.
Nearly two-thirds of the United States population is overweight. There are several ways to determine if a person is obese or overweight. Experts say that a person’s body mass index is the best way to determine an adults weight in relation to their height. A BMI from 18.5 to 24.9 kg/m2 is considered normal, adults with a BMI of 25 to 29.9 kg/m2 are considered overweight. There are exceptions with peoples BMI, an athlete can have a high BMI and not be overweight or obese. Adults with a BMI of 30 kg/m2 or higher are considered obese. A person with a high BMI can have a normal amount of body fat if they have more muscle tissue. However, the risk of death and disease is increased for adults who are overweight and obese (Kolata 1)
These effect will appear a few hours after usage and disappear in hours or days: Physical effects like, numbness, muscle weakness and trembling, rapid reflexes, increased blood pressure, heart rate, and temperatures, impaired motor skills and coordination, dilated pupils, nausea and sometimes seizers.
Among these disorders are hypothyroidism and hyperthyroidism. Hypothyroidism is a disorder in which one is diagnosed for having and underactive thyroid. The probability for women over the age of sixty to develop an underactive thyroid is higher than those of other individuals. If left untreated it can potentially lead to obesity, joint pain, heart disease, and other health complications. On the contrary, hyperthyroidism is a disorder in which a person is diagnosed for having an overactive thyroid. This can cause nervousness and anxiety, hyperactivity, unexplained weight loss, and swelling of the thyroid gland which causes a noticeable lump to form on throat (known as a
Most side effects go away after a while, but not always. Some common side effects are nausea, loss of appetite, headaches, dry mouth, dizziness, moodiness, trouble sleeping, and tics. If you change the times of when you take your medicine or what you eat with it then that can cause more side effects. The medication should be taken with food and you should eat throughout the day and drink plenty of fluids. Depending upon your side effects and the results from your medication, the doctor might change
The dosage of the pill determines the amount of sedation provided, anywhere from minimal to moderate, and it usually taken approximately one hour before the dental work takes place. Patients tend to remain awake with minimal sedation, but may dose off is a bigger dose is given. If a patient does fall asleep, he or she can easily be woken up once the work is done.
anorexic people. Some possible side effects could be having a dry mouth, red eyes, increased of