甲状腺功能亢进症病人的护理NursingofHyperthyroidismPatients71讲解

甲状腺功能亢进症病人的护理Nursingof

Hyperthyroidism

Patients广西卫生职业技术学院内科护理教研室DepartmentofMedicineNursing,GuangxiMedicalCollege护理程序Nursingprocedure护理评估NursingAssessment护理诊断Nursingdiagnosis护理目标Nursinggoals护理措施Nursingmeasures护理评价Nursingevaluation护理评估

NursingAssessment

1、病史疾病起始时间、主要症状、应激因素、家族史、月经史1、MedicalhistoryOnsettime,mainsymptoms,stressfactors,familyhistory,menstrualhistory护理评估

NursingAssessment

2、身体评估意识精神状态、营养状况、皮肤粘膜、眼征、甲状腺、心脏、消化系统、骨骼、肌肉2.PhysicalassessmentConsciousness,mentalstate,nutritionalstatus,skin

mucosa,eyesigns,thyroidgland,heart,

digestivesystem,skeletalmuscle护理诊断NursingDiagnosis护理诊断/问题NursingDiagnosis/Problem1、营养失调：低于机体需要量

与代谢率增高、消化吸收障碍有关Nutritionaldisorder:Lowerthaningestion

requirement

Relatedtoincreasedmetabolicrateanddigestionandabsorptiondisorders2、活动无耐力

与蛋白质分解增加、甲亢性心脏病、甲亢性肌病等因素有关Activityintolerance:

Relatedtoincreasedproteolysis,hyperthyroidheartdisease,hyperthyroidmyopathyandotherfactors护理诊断NursingDiagnosis护理诊断/问题NursingDiagnosis/Problem3、应对无效

与性格情绪改变有关Ineffectiveresponse:

Relatedtopersonalityandmoodchanges4、焦虑与神经系统功能改变、甲亢所致全身不适等因素有关Anxiety:Relatedtochangesinnervoussystemfunction,hyperthyroidism-causedgeneralmalaiseandotherfactors护理诊断NursingDiagnosis护理诊断/问题NursingDiagnosis/Problem5、有组织完整性受损的危险

与浸润性突眼有关Riskofimpairedtissueintegrity:

Relatedtoinfiltrativeexophthalmos6、潜在并发症：甲状腺危象Potentialcomplications:Thyroidstorm护理目标

Nursinggoals

病人能恢复并保持正常体重Patientbacktohealthandmaintainsnormalweight能逐步增加活动量，活动时无明显不适Graduallyincreasetheamountofactivitieswithoutobviousdiscomfort能恢复并保持足够的应对能力Recoverandmaintainadequateresponsecapability能保持情绪平和Maintainemotionalpeace护理目标

Nursinggoals

能积极采取措施保护组织完整性Takestepsactivelyfortissueintegritypreservation能主动避免诱发甲状腺危象的因素，或发生甲状腺危象能得到及时救治Activelyavoidthefactorsthatcausethyroidstorm,orabletoprovidetimelytreatmentwhenthyroidstormoccurs护理措施

Nursingmeasures休息与活动：轻者活动以不疲劳为度，重者卧床休息。Restandactivities:Activitiesforpatientswithmildcaseactivitiesshouldbelight,andpatientswithaseverecaseshouldstayinbed环境：安静，室温凉爽恒定。Environment:Quietwithcoolandconstantroomtemperature.一、一般护理Generalnursing护理措施

Nursingmeasures饮食：三高水多，禁含碘食物、浓茶、咖啡、高纤维食物。Diet:Patientswithhypertension,hyperproteinemiaandhyperglycemiahavemorewaterintake,noiodine-containingfoods,strongtea,coffee,orhigh-fiberfoods.监测：心率减慢、体重增加是治疗有效的指标。Monitoring:Heartratereductionandweightgainareindicatorsoftreatmenteffectiveness.一、一般护理Generalnursing护理措施

Nursingmeasures不可自行减量或停药，并密切观察不良反应Donotreduceorstopthedrugself-depedently,andcloselyobservetheadversereactions二、用药护理Medicationnursing护理措施

Nursingmeasures粒细胞减少：最初2-3个月，每周复查血象，以后2-4周/次WBC＜3.0*109/L或中性粒细胞＜1.5*109/L，应暂停药Neutropenia:Forthefirst2-3months,reviewthebloodcounteveryweek,thenevery2-4weeks.

ThedrugshouldbesuspendedifWBC<3.0*109/Lorneutrophils<1.5*109/L.二、用药护理Medicationnursing护理措施

Nursingmeasures药疹：较常见，轻者可用抗组胺药物如出现皮肤瘙痒、团块状严重皮疹等则应立即停药，以免发生剥脱性皮炎二、用药护理MedicationnursingDrugEruption:Acommonsymptom,whichantihistaminescanbeusedinmildcasesWhenskinitch,severelumpyrash,etc.appear,thedrugshouldbediscontinuedimmediatelytoavoidexfoliativedermatitis其他：中毒性肝病Otherillness:Toxichepatopathy护理措施

Nursingmeasures避免诱因AvoidCauses病情监测ConditionMonitoring紧急处理配合

绝对卧床休息，给氧，遵医嘱给药，密切观察生命体征。

Emergencytreatment

absolutebedrest,oxygensupply,dosingasdirectedandvitalsignscloseobservation.对症护理

降温、防摔、昏迷护理Symptomaticnursing

cooling,fall-protection,comanursing甲亢危象的护理Thenursingofhyperthyroidcrisis护理措施

Nursingmeasures鼓励病人表达自己的感受、减少不良刺激、平和、耐心地对待病人Encouragepatientstoexpresstheirfeelings,reduceadversestimulation,andtreatpatientscalmlyandpatiently治疗前Beforetreatment治疗后Aftertreatment四、心理护理Psychologicalnursing护理措施

Nursingmeasures治疗前Beforetreatment治疗后Aftertreatment四、心理护理Psychologicalnursing疾病知识指导DiseaseKnowledgeGuidance告知病人发病原因及注意事项，如碘过量或者药物引起甲减者应调整剂量或停药Informthepatientofthepathogenyandprecautions,suchaspatientswhohaveiodineoverdoseordrug-inducedhypothyroidism,theirdoseshouldbeadjustedordiscontinued注意个人卫生，预防感染和创伤Payattentiontopersonalhygienetopreventinfectionandtrauma衣领不宜过紧，避免挤压甲状腺Thecollarshouldnotbetootighttopreventthethyroidglandpressure护理措施

Nursingmeasures六、健康指导HealthGuidance用药和病情监测指导MedicationandConditionMonitoringGuidance解释长期服药重要性及定期复查血象Explaintheimportanceoflong-termmedicationandperiodicallyreviewthehemogram不可随意停药或减量Donotdiscontinueorreducethedose护理措施

Nursingmeasures六、健康指导HealthGuidance用药和病情监测指导MedicationandConditionMonitoringGuidance抗甲状腺药物治疗疗程一般1.5~2年Thecourseofantithyroiddrugtreatmentisgenerally1.5to2years脉搏减慢、体重增加是治疗有效的标志Slowpulseandweightgainaresignsofeffectivetreatment出现甲状腺危象，及时就诊Whenthesymptomsofthyroidstormappear,seekmedicaladvice护理措施

Nursingmeasures六、健康指导HealthGuidance生育指导Fertilityguidance妊娠可加重甲亢，适宜治愈后再妊娠Thehyperthyroidismcanbeaggravatedbypregnancy,bettertobecuredbeforebeingpregnant妊娠期甲亢：PTU，不能用甲巯咪唑，禁用131I，慎用普萘洛尔Hyperthyroidismduringpregnancy:PTU,methimazole,