Nursing care for thyroid disease. Nursing care for thyroid diseases: diffuse toxic goiter, hypothyroidism educational and methodological manual on the topic

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 the main stages.

• 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 a 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 steps taken nurse for the prevention of diseases, examination, treatment, rehabilitation of patients.
• 5. Performance evaluation 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 of nurses varying degrees training, different professional groups, and continuous training of nurses contributes to improving the quality of patient care. 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 methods research.

In thyroid disease, 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.
• - Collection of 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.

Nursing process in diffuse toxic goiter. Diffuse toxic goiter ( Graves' disease thyrotoxicosis) - a disease characterized by increased secretion of hormones thyroid gland.
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.
The main clinical manifestations of the disease are: an increase in the thyroid gland, increased excitability, 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 limbs, and sometimes the whole body, sleep disturbance. significant and rapid weight loss with good appetite. There are often changes from of cardio-vascular system: palpitations, shortness of breath, aggravated by physical activity, interruptions in the region of the heart. Women often have a disorder menstrual cycle. Draws attention on examination appearance patient: facial expression often takes on an "angry" or "terrified" 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 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, fatigue;
- sleep disturbance;
- poor heat tolerance.
B. Potential:
- the risk of developing a "thyrotoxic crisis";
- "thyrotoxic heart" with symptoms of circulatory failure;
- fear of opportunity surgical treatment or radioactive iodine treatment.
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 diseases of the thyroid gland in the next of kin;
- previous diseases, traumas of the central nervous system; features 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 the last examination);
- 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 a 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, features of administration, side effects, portability).
9. Control:
- adherence to the regimen and diet;
- body weight;
- frequency and rhythm of the pulse;
- arterial pressure;
- body temperature;
- the condition of the skin;
- reception medicines prescribed by the doctor.
10. Ensure patient preparation for additional methods research biochemical analysis blood, 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.

Patients in a state of hypothyroid coma should be hospitalized in the department intensive care or resuscitation.

It is necessary to immediately take blood for the content of thyroid hormones, blood pH, glucose, sodium, chlorides, acid-base balance, record an ECG, perform catheterization Bladder. A progressive decrease in body temperature worsens the prognosis. To warm the patient, it is necessary to wrap the patient in blankets, gradually increase the room temperature. Heating pads, hot water bottles are not recommended for warming, as peripheral vasodilation appears, impairing blood flow internal organs(danger of collapse).

In a specialized hospital, the patient will be given intravenous L-thyroxine, intravenous glucocorticoids, to eliminate hypoglycemia - 40% glucose solution intravenously and 5% intravenous drip solution, to combat collapse - reopoliglyukin, 10% albumin solution, to increase blood pressure - angiotensinamide, with heart failure - cardiac glycosides (in a small dosage, since the myocardium in hypothyroidism is highly sensitive to glycosides), to improve metabolism in the myocardium - pyridoxal phosphate, lipoic acid, riboxin, cocarboxylase.

Urgent care in hypothyroid coma

General activities include: slow gradual warming of the patient not higher than one degree per hour during hypothermia, hydrocortisone is administered intravenously (50-100 mg, daily dose up to 200 mg), thyroxine is prescribed (daily dose 400-500 mcg) in the form of a slow infusion.

Along with this, oxygen therapy is carried out in combination with artificial ventilation of the lungs. To combat anemia, a blood or red blood cell transfusion is indicated (the latter is preferable). Infusion therapy is carried out with great care, at the same time glucocorticoids are administered.

Vigorous antibiotic therapy is mandatory to suppress co-infection or prevent an outbreak of a dormant infection. In patients in a coma, atony of the bladder is constantly noted, therefore, a permanent urinary catheter is placed.

NURSING ACTIVITY IN HYPOTHYROISIS

Nursing uses a variety of theories and knowledge. This knowledge is used by the sister in informing the patient, teaching him and guiding him or guiding him.

Currently, the theory of Virginia Henderson is being applied. Within the framework of this theory, Henderson tried to highlight the basic human needs, the satisfaction of which should be aimed at patient care. These needs include:

1. Breath

2. Nutrition and fluid intake

3. Physiological functions

4. Motor activity

5. Sleep and rest

6. Ability to dress and undress independently

7. Maintenance of body temperature and the possibility of its regulation

8. Personal hygiene

9. Ensuring your own safety

10. Communication with other people, the ability to express their emotions and opinions

11. Ability to observe customs and rituals according to religions

12. Being able to do what you love

13. Recreation and entertainment

14. Need for information

Henderson is also known for her definition of nursing: "The unique function of the nurse is to assist the individual, sick or well, in carrying out such activities that contribute to the preservation or restoration of health, which he could provide for himself if he had the necessary strength, will and knowledge

Nursing Process– the scientific method of organizing and providing nursing care, the implementation of a care plan for therapeutic patients, based on the specific situation in which the patient and nurse are.

The Purpose of the Nursing Process:

Ø identify real and potential problems in a timely manner;

Ø meet the violated vital needs of the patient;

Ø provide psychological support to the patient;

Ø Maintain and restore the patient's independence in meeting the daily needs of his daily activities.

Nursing process in hypothyroidism

Stage I: nursing examination (collection of information)

When questioning the patient: the nurse finds out

ü Increased fatigue

o hair loss

Stage II: identification of disturbed needs and problems of the patient

Possible violated needs:

physiological:

muscle pain

· hair loss

increase in body weight

Possible problems patient:

ü Aching pain in the heart, shortness of breath

ü in women, menstrual irregularities (may be infertile)

in men, decreased libido

lethargy, weakness, drowsiness

ü chilliness

ü memory loss

psychological:

Depression due to an acquired disease;

Fear of instability of life;

Underestimation of the severity of the condition;

Lack of knowledge about the disease;

Lack of self-service;

Care in sickness;

Lifestyle change

social:

loss of ability to work

Financial difficulties in connection with a decrease in working capacity;

social isolation.

spiritual:

Lack of spiritual participation.

priority:

aching pain in the heart, shortness of breath

potential:

risk of developing complications.

Stage III: nursing intervention planning

The nurse, together with the patient and his relatives, formulates goals and plans nursing interventions for a priority problem.

The goal of nursing interventions is to promote recovery, prevent the development of complications and the transition to a more severe course.

IV stage: implementation of nursing interventions

Nursing interventions:

Dependent (performed as prescribed by a doctor): ensuring the intake of medications, performing injections, etc.;

Independent (performed by a nurse without the doctor's permission): recommendations on diet, measurement of blood pressure, pulse, respiratory rate, organization of the patient's leisure and others;

Interdependent (performed by a medical team): providing advice from narrow specialists, ensuring research.

Stage V: evaluation of the effectiveness of nursing interventions

The nurse evaluates the result of interventions, the patient's response to measures of assistance and care. If the set goals are not achieved, the nurse adjusts the nursing intervention plan

Manipulations performed by a nurse

BP measurement

Target: diagnostic.

Indications: doctor's appointment, preventive examinations.

Equipment: tonometer, phonendoscope, alcohol, tampon (napkin), pen, temperature sheet.

Note. At the first visit of the patient, the pressure on both hands should be measured, later on only on one, noting which one. If a stable significant asymmetry is detected, all subsequent measurements should be carried out on the arm with higher rates. Otherwise, measurements are carried out, as a rule, on the “non-working hand”.

Hypothyroidism- a disease caused by a decrease in thyroid function or its complete loss.

The reasons:

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

Treatment:

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:

muscle weakness

chilliness

Decreased memory

• Increase in body weight.

Nursing care:

Give recommendations on diet therapy (exclude foods containing animal fats, include foods rich in fiber - bran bread, raw vegetables and fruits, limit carbohydrate intake).

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- 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. 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

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Ministry of Education and Science Russian Federation

Federal Agency for Education

Penza Regional Medical College

Abstract on the topic

"Nursing process in diseases of the thyroid gland"

Introduction

1. Endemic goiter

2.Hypothyroidism and hyperthyroidism

3. Nursing process

Conclusion

Literature

Introduction

Thyroid problems can start various reasons. For their etiology, factors such as: congenital anomalies of the thyroid gland, its inflammation during infectious and autoimmune processes, as a complication surgical treatment and radioactive iodine therapy for diffuse toxic goiter, as well as as a result of a lack of iodine in the environment. Secondary hypothyroidism is a consequence of infectious, tumor or traumatic damage to the hypothalamic-pituitary system. An overdose of Mercazolil can cause functional primary hypothyroidism. With uncompensated hypothyroidism, psychoses can develop that resemble schizophrenia in their course.

Iodine deficiency leads to endemic goiter. This disease is widespread in all countries of the world. A deficiency of thyroid hormones inhibits the development and differentiation of brain tissues, inhibits higher nervous activity, so children with congenital and late diagnosed hypothyroidism develop incurable cretinism. Adults develop encephalopathy.

1.endemic goiter

Most diseases of the thyroid gland associated with a violation of its function are accompanied by an increase in the size of the gland, as a result of which it protrudes above the surface of the neck, deforming its contours. A goiter (or struma) is formed.

An endemic goiter is an enlargement of the thyroid gland, characteristic of residents of certain areas where there is a lack of iodine in soil, water, and food products. This disease affects more or less significant masses of the population and is characterized by special patterns of its development.

Endemic goiter has long been common among the population of various parts of the world. This disease occurs mainly in mountainous areas, far from the seas and oceans, to a lesser extent - in the foothill areas. There are significantly fewer endemic foci of goiter in river valleys, some swampy and wooded areas, and especially near the sea.

There is no country in the world that would be free from endemic goiter. The best known endemic foci of goiter are in Switzerland, the mountainous regions of Germany, Austria, France, Italy and Spain. They are also available in other places (USA, Central Asia, Africa, Australia). The zones of endemic goiter also include some areas of Western Ukraine, Belarus, Karelia, the upper reaches of the Volga, some areas of the Mari Republic, the Urals, the Central and North Caucasus, Central Asia (in particular, Kyrgyzstan, Uzbekistan, Tajikistan), a number of regions of Transbaikalia. In some areas (Upper Svaneti, Transcarpathian Ukraine, the Mari Republic, Pamir), the prevalence of endemic goiter is especially pronounced; 30-50% of the adult population and 60-70% of school-age children had goiter, and 1-5% of the population had cretinism.

The theory of iodine deficiency was created in the middle of the 19th century by Prevost and Chaten. Its essence boils down to the fact that endemic goiter occurs when the iodine content in soil and water decreases. If an area endemic for goiter is isolated, poorly supplied with imported products, then its inhabitants experience iodine starvation and are more often affected by goiter. The theory of iodine deficiency is also confirmed by the effectiveness of iodine prophylaxis, which has become widespread throughout the world.

At the same time, in the development of goiter, a certain role is currently assigned to microelements that are included in small quantities in the structure of such biologically active substances. active substances like vitamins, enzymes, hormones. Trace elements are unevenly distributed in the earth's crust, in some areas there may be a lack or excess of them. In areas endemic for goiter, the levels of bromine, zinc, cobalt and copper are reduced in the environment. Although the lack of these trace elements often manifests itself against the background of iodine deficiency and is not the main etiological (causal) factor, it can determine the specifics of endemic goiter in a particular area.

In the late 20s of the XX century, a group of substances that promote an increase in the thyroid gland - strumogens was identified. It has been established that with excessive consumption of vegetables such as cabbage, turnip, radish, rutabaga, beans, carrots, radishes, spinach, etc., an increase in the thyroid gland may occur.

Certain importance in the development of endemic goiter is heredity, especially among isolated groups of the population, related to each other by consanguinity. So, in endemic areas, not all family members who are in the same conditions are affected by goiter. In the presence of nodular goiter in both parents, its prevalence among children is 3 times higher than in the offspring of unaffected parents. Identical twins have a higher incidence of goiter than fraternal twins.

Iodine enters the body from the gastrointestinal tract in the form of potassium iodide or sodium iodide, is taken up by thyroid cells or excreted by the kidneys. Normally, the concentration of iodine in the thyroid gland is 20 times higher than in the blood plasma.

Thyroid iodides are oxidized enzymatically to molecular iodine. Further, iodine is used to form thyroid hormones (monioiodotyrosine, diiodotyrosine, triiodothyronine, tetraiodothyronine). The main thyroid hormone is tetraiodothyronine, containing 4 iodine atoms, or thyroxine. Thyroxine is bound to the protein thyroglobulin and accumulates in the follicles of the thyroid gland. In the blood, thyroxine is bound to plasma proteins. As needed, it is cleaved from protein, penetrates into cells and has a specific effect on metabolism. In the process of metabolism, thyroxin decomposes with the release of iodides, which enter the bloodstream and enter a new cycle of iodine circulation in the body.

Thus, in the complex process of hormone formation in the thyroid gland, iodine is the main component of all reactions. Violation of iodine metabolism at any of the stages leads to a decrease in the secretion of thyroid hormones.

Clinical picture endemic goiter depends on the degree of enlargement of the thyroid gland, its localization (location), structure and functional state. Endemic goiter develops slowly and the patient does not know about its existence for a long time. The disease is usually detected during a mass medical preventive examination or when seeking medical care for another reason.

Endemic goiter can affect all age groups, but the incidence of children under 14 years of age is especially characteristic. The physiological prerequisites for the appearance of goiter are periods of life when the need for iodine increases: the period of growth, pregnancy and lactation (milk secretion).

In the initial stages of the disease, the patient's complaints are nonspecific. They may be due to vegetative neurosis. Patients complain of general weakness, headache, sleep disturbance, memory and appetite. There are irritability, tearfulness, sweating of the palms and armpits. However, the body weight of patients, as a rule, does not change. When the goiter reaches a large size, there is a feeling of squeezing in the neck, swallowing is difficult. In advanced cases, when the goiter compresses the trachea and the neurovascular bundle of the neck, normal breathing is disturbed, shortness of breath and palpitations appear during exercise. These complaints are especially frequent with the retrosternal location of the goiter or with its development in an abnormally located thyroid gland (for example, with goiter of the root of the tongue).

Endemic goiter usually occurs with a deficiency of thyroid hormones. Toxic goiter is rare in endemic areas.

On the other hand, people in endemic areas in the absence of iodine prophylaxis often have a decrease in thyroid function (hypothyroidism). The percentage of malignant degeneration of the thyroid gland is quite high. However, in most patients with endemic goiter, symptoms of thyroid dysfunction are not clinically manifested.

A pronounced lack of iodine in the thyroid gland from birth is accompanied by profound changes in various organs and systems, which affects the mental and physical usefulness of the individual - cretinism develops. The appearance of patients with cretinism is characteristic. They are clumsy, weak, often react inadequately to external stimuli, often smile for no reason. There are growth retardation, disproportionate development of the limbs, a sharp delay mental development, saddle nose, dryness, pallor and wrinkling of the skin, puffiness of the face, poor hair growth, tongue-tied tongue, deafness.

2.Ghyperthyroidismand hypothyroidism

hyperthyroidism - a group of diseases in which thyroid begins to secrete its hormones in much larger quantities than normal healthy person. Hyperthyroidism is the opposite of hypothyroidism: with a decrease in the level of thyroid hormones, all processes in the body slow down, and with hyperthyroidism, the body works with increased intensity.

Patients with hyperthyroidism should be under the active supervision of an endocrinologist. During the started adequate treatment contributes to a faster recovery of good health and prevents the development of complications. Treatment must begin without fail after the diagnosis is made and in no case should you self-medicate.

Symptoms of hyperthyroidism

In hyperthyroidism, as in hypothyroidism, there are violations of many organs, only in this case too many hormones are produced.

What changes occur in the body?

1. The skin of patients is warm, moist, thin and noticeably slowed down. age-related changes, increased sweating, thin hair. Notable changes occur with the nails, manifested in the form of painful detachment of the nail plate from the nail bed.

2. There is an increase palpebral fissure and eyeball, as well as protrusion of the latter (exophthalmos), due to which the eyes take on a bulging appearance. Characteristic features is also edema and hyperpigmentation of the eyelids, i.e. they acquire a swollen appearance and a brownish tint.

3. In comparison with hypothyroidism, thyrotoxicosis has opposite effects, such as: increased blood pressure (hypertension), increased heart rate (tachycardia), increased heart rate. In connection with these deviations, patients develop heart failure (the heart does not cope with its work and cannot fully supply blood to all organs and tissues).

4. Not spared hyperthyroidism and respiratory system. Which is affected in the form of difficulty breathing (shortness of breath) and a decrease in the vital capacity of the lungs (VC - the maximum amount of air that can be exhaled after a deep breath).

5. With mild and moderate severity of the disease, appetite is often increased, and in severe cases it is mainly reduced, nausea, vomiting and diarrhea (loose watery stools) are also observed. All this leads to weight loss.

6. Patients have pronounced rapid muscle fatigue, against which they feel constant weakness, which is also accompanied by tremor (involuntary rhythmic movements, similar to pronounced trembling, of the whole body or its individual parts, such as limbs, head, etc.). In most cases, osteoporosis develops (a skeletal disease in which there is a decrease in bone mass and a violation of the structure of bones). Due to the accumulation of a large amount of potassium in the bones and the strengthening of reflexes (which ensure the movement of a person), it leads to a severe impairment of motor activity.

7. Increased excitability, nervousness, insomnia, anxiety and fear, increased intelligence, accelerated speech are the accompanying symptoms of hyperthyroidism.

8. Changes in the blood can only be established when laboratory research blood.

9. There is frequent and copious urination (polyuria).

10. Women may have menstrual irregularities, which may be irregular and accompanied by severe pain in the lower abdomen (more often in nulliparous girls), scanty discharge, nausea, vomiting, general weakness, headache, bloating, feeling of "cotton legs", fainting, fever. In men, there may be an increase in the mammary glands and a decrease in potency.

All this happens as a result of a violation of the production of male and female sex hormones. It can also lead to infertility.

11. Patients may develop thyroid diabetes, which occurs due to metabolic disorders (the intake of nutrients into the body and their "digestion" for energy), resulting in an increase in blood glucose. Temperature rise is possible.

Hypothyroidism

Hypothyroidism is clinical syndrome caused by a lack of thyroid hormones in the body or a decrease in their biological effect at the tissue level.

According to most researchers, the prevalence of the disease among the population is 0.5-1%, and taking into account subclinical forms, it can reach 10%.

Pathogenetically hypothyroidism is classified into:

* primary (thyroid);

* secondary (pituitary);

* tertiary (hypothalamic);

* tissue (transport, peripheral).

In practice, in the vast majority of cases, primary hypothyroidism. It has been found that the most common cause its development is autoimmune thyroiditis. At the same time, it is possible to develop hypothyroidism after surgery on the thyroid gland (postoperative hypothyroidism), during treatment with thyreostatics (medicated hypothyroidism), after exposure to radioactive isotopes of iodine (post-radiation hypothyroidism) and with endemic goiter. In some cases, the disease can develop as a result of long-term use of large doses of conventional, non-radioactive iodine, for example, during treatment with the iodine-containing antiarrhythmic amiodarone. The appearance of hypothyroidism is also possible with tumors of the thyroid gland. A great rarity is hypothyroidism, which developed as a result of subacute, fibrosing and specific thyroiditis. In some cases, the genesis of the disease remains unclear (idiopathic hypothyroidism).

Secondary and tertiary forms hypothyroidism (the so-called central hypothyroidism) is associated with damage to the hypothalamic-pituitary system in diseases such as pituitary adenomas and other tumors of the sellar region, the syndrome of the "empty" Turkish saddle, heart attacks and necrosis of the pituitary gland (their development is possible with DIC and massive bleeding) . Etiological factors can also be inflammatory diseases brain (meningitis, encephalitis, etc.), surgical and radiation effects on the pituitary gland. Decreased functional activity of the thyroid gland central forms hypothyroidism is associated with a deficiency of thyroid-stimulating hormone (TSH). In this case, TSH deficiency can be isolated, but more often it is combined with a violation of the secretion of other tropic hormones of the pituitary gland (in such cases, they speak of hypopituitarism).

In addition to acquired forms of hypothyroidism, there are congenital forms diseases. The frequency of congenital hypothyroidism in Russia is on average 1 case per 4000 newborns. The causes of congenital hypothyroidism can be: aplasia and dysplasia of the thyroid gland, genetically determined defects in the biosynthesis of thyroid hormones, severe iodine deficiency, autoimmune thyroid diseases in the mother (due to the penetration of thyroblocking antibodies through the placenta), treatment of thyrotoxicosis in the mother with thyrostatic drugs or radioactive iodine. Rare causes include congenital TSH deficiency, as well as peripheral thyroid hormone resistance syndrome.

3.Nursing Process

Philosophy of nursing

Decree of the Government of the Russian Federation dated 05.11.97, No. 1387 "On measures to stabilize and develop healthcare and medical science in the Russian Federation" provides for the implementation of a reform aimed at improving the quality, accessibility and economic efficiency medical care to the population in the conditions of formation of market relations.

Nurses are assigned one of the leading roles in solving the problems of medical and social assistance to the population and improving the quality and efficiency medical services nursing staff in healthcare facilities. The functions of a nurse are diverse and her activities concern not only the diagnostic and therapeutic process, but also patient care in order to fully rehabilitate the patient.

Nursing was first defined by world-famous nurse Florence Nightingale. In her famous Notes on Nursing in 1859, she wrote that nursing is "the act of using the patient's environment to promote his recovery."

Currently, nursing is an integral part of the health care system. It is a multifaceted medical and sanitary discipline and has medical and social significance, since it is designed to maintain and protect the health of the population.

In 1983, the First All-Russian Scientific and Practical Conference dedicated to the theory of nursing was held in Golitsino. During the conference, nursing was considered as part of the health care system, science and art, which are aimed at solving existing and potential problems concerning the health of the population in a constantly changing environment.

According to international agreement, the conceptual model of nursing is a structure based on the philosophy of nursing, which includes four paradigms: nursing, personality, environment, health.

The concept of personality occupies a special place in the philosophy of nursing. The object of the nurse's activity is the patient, a person as a set of physiological, psychosocial and spiritual needs, the satisfaction of which determines the growth, development and merging of it with the environment.

The sister has to work with different categories of patients. And for each patient, the sister creates an atmosphere of respect for his present and past, for his life values, customs and beliefs. It takes the necessary safety measures for the patient if his health is in danger from employees or other people.

The environment is considered as the most important factor influencing human life and health. It includes a set of social, psychological and spiritual conditions in which human life takes place.

Health is considered not the absence of disease, but as a dynamic harmony of the individual with the environment, achieved through adaptation.

Nursing is a science and art aimed at solving existing problems related to human health in a changing environment.

The philosophy of nursing establishes the basic ethical responsibilities of professionals in the service of the individual and society; goals that a professional strives for; the moral character, virtues, and skills expected of practitioners.

The basic principle of the philosophy of nursing is respect for human rights and dignity. It is realized not only in the nurse's work with the patient, but also in her cooperation with other specialists.

The International Council of Nurses has developed a code of conduct for nurses. According to this code, the fundamental responsibility of nurses has four main aspects: 1) the promotion of health, 2) the prevention of disease, 3) the restoration of health, 4) the alleviation of suffering. This code also defines the responsibility of nurses to society and colleagues.

In 1997, the Russian Association of Nurses adopted the Code of Ethics for Nurses in Russia. The principles and norms that make up its content specify the moral guidelines in professional nursing activities.

II.Main part

1. The concept of the nursing process (theoretical part)

The nursing process is one of the basic concepts of modern models of nursing. In accordance with the requirements of the State Educational Standard for Nursing, the nursing process is a method of organizing and performing nursing care for a patient, aimed at meeting the physical, psychological, social needs of a person, family, and society.

The purpose of the nursing process is to maintain and restore the independence of the patient, the satisfaction of the basic needs of the body.

The nursing process requires from a sister not only a good technical training but also a creative attitude to patient care, the ability to work with the patient as a person, and not as an object of manipulation. The constant presence of the sister and her contact with the patient make the sister the main link between the patient and the outside world.

The nursing process consists of five main steps.

1. Nursing examination. Collection of information about the patient's health status, which can be subjective and objective.

The subjective method is physiological, psychological, social data about the patient; relevant environmental data. The source of information is the questioning of the patient, his physical examination, the study of data medical records, conversation with the doctor, relatives of the patient.

An objective method is a physical examination of the patient, including the assessment and description of various parameters (appearance, state of consciousness, position in bed, degree of dependence on external factors, color and moisture of the skin and mucous membranes, the presence of edema). The examination also includes measuring the patient's height, determining his body weight, measuring temperature, counting and evaluating the number of respiratory movements, pulse, measuring and evaluating blood pressure.

The end result of this stage of the nursing process is the documentation of the information received, the creation of a nursing history, which is a legal protocol - a document of the nurse's independent professional activity.

2. Establishing the patient's problems and formulating a 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. Having established both types of problems, the nurse determines the factors that contribute to or cause the development of these problems, also reveals the strengths of the patient, which he can counter the problems.

Since the patient always has several problems, the nurse must establish a system of priorities. Priorities are classified as primary and secondary. Problems that are likely to have a detrimental effect on the patient in the first place have priority.

The second stage ends with the establishment of a nursing diagnosis. There is a difference between medical and nursing diagnosis. Medical diagnosis focuses on recognizing pathological conditions, and nursing - is based on a description of the reactions of patients to problems related to health. The American Nurses Association, for example, identifies the following as the main health problems: limited self-care, disruption of the normal functioning of the body, psychological and communication disorders, problems associated with life cycles. As nursing diagnoses, they use, for example, phrases such as “lack of hygiene skills and sanitary conditions”, “decrease in individual ability to overcome stressful situations”, “anxiety”, etc.

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.

When forming goals, it is necessary to take into account the action (execution), criterion (date, time, distance, expected result) and conditions (with the help of what and by whom). For example, "the goal is for the patient to get out of bed by January 5 with the help of a nurse." Action - get out of bed, the criterion is January 5, the condition is the help of a nurse.

Once the goals and objectives of care have been established, the nurse prepares a written care guide that details the nurse's special care activities to be recorded in the nursing record. nursing process thyroid gland

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.

doctor's orders and under his supervision. Independent nursing intervention refers to actions taken by the nurse on her own initiative, guided by her own considerations, without a direct request from the doctor. For example, teaching the patient hygiene skills, organizing patient leisure, etc.

Interdependent nursing intervention involves the joint activities of a sister with a doctor, as well as with other specialists.

In all types of interaction, the sister's responsibility is exceptionally great.

5. Evaluation of the effectiveness of nursing care. This stage is based on the study of the patients' dynamic responses to the nurse's interventions. The sources and criteria for evaluating nursing care are the following factors for assessing the patient's response to nursing interventions; assessment of the degree of achievement of the goals of nursing care are the following factors: assessment of the patient's response to nursing interventions; assessment of the degree of achievement of the goals of nursing care; assessment of the effectiveness of the impact of nursing care on the patient's condition; active search and evaluation of new patient problems.

An important role in the reliability of the assessment of the results of nursing care is played by the comparison and analysis of the results obtained.

Therapeutic nutrition for endemic goiter

The main etiological factor of endemic goiter is insufficient intake of iodine in the body due to its low content in soil, water and, consequently, food in some areas (Western Ukraine, Belarus, Uzbekistan, Russia (Karelia, the upper reaches of the Volga River, Mari El, Ural , Central and North Caucasus, Kyrgyzstan, Transbaikalia).

The development of this disease contributes to insufficient, monotonous, unbalanced nutrition (depleted in protein, vitamins, predominantly carbohydrate, with a sufficient or excess fat content).

Diet therapy is built depending on the functional state of the thyroid gland. With its normal function, diet No. 15 is indicated. With increased thyroid function, the recommendations indicated for diffuse toxic goiter should be followed. For patients whose goiter proceeds with reduced thyroid function, a diet recommended for patients with hypothyroidism is indicated. It is especially important to introduce a sufficient amount of iodine into the body. For this purpose, it is necessary to use iodized salt (contains 25 g of potassium iodide per 1 ton of sodium chloride) and foods rich in iodine (dishes from sea and ocean fish, crabs, shrimp, squid, sea kale).

There are indications of the goitrogenic effect of certain products (cabbage, radish, swede, turnip, dill, walnuts), and therefore it is advisable to limit their use.

Treatment of endemic goiter

The main method of treatment of endemic goiter is the use of thyroid drugs. They inhibit the release of thyrotropin on the feedback principle, reducing the size of the thyroid gland. These drugs also reduce autoimmune reactions in the thyroid gland, are a means of preventing hypothyroidism and malignancy in patients with euthyroid goiter and a means of replacement therapy in the development of hypothyroidism.

Indications for the appointment of thyroid drugs in endemic goiter:

diffuse euthyroid goiter 1c-2-3 st. increase (according to some endocrinologists - 1a-2-3 st.);

hypothyroidism in a patient with any form and with any degree of enlargement of the thyroid gland (for the treatment method, see the chapter “Treatment of hypothyroidism”)

For the treatment of endemic goiter, L-thyroxine, triiodothyronine, thyrotom, thyrotom-forte are used.

L-thyroxine is prescribed initially at 50 mcg per day in the morning before meals (if dyspeptic symptoms appear after meals). In the absence of symptoms of drug-induced hypothyroidism (sweating, tachycardia, a feeling of irritability of heat), after 4-5 days, you can gradually increase the dose and bring it to the optimum - 100-200 mcg per day. The drug should be administered mainly in the morning.

The initial dose of triiodothyronine is 20 mcg 1-2 times a day (in the first half of the day), then every 5-7 days, with good tolerance and the absence of drug-induced hyperthyroidism, the dose can be gradually increased and brought to 100 mcg per day.

Thyrotomy treatment (1 tablet contains 10 μg T3 and 40 μg T4) begins with ½ tablet per day (in the morning), then gradually increase the dose every week and bring it up to 2 tablets per day.

Tireotom-forte (1 tablet contains 30 µg T3 and 120 µg T4) is initially prescribed for 1/2 tablet per day, then, if well tolerated, the dose of the drug is increased to 1-11/2 tablets per day.

Thyreocomb is used less frequently in the treatment of endemic goiter. 1 tablet of thyreocomb contains 10 micrograms of T3, 70 micrograms of T4 and 150 micrograms of potassium iodide. The initial dose of the drug is 1/2 tablet per day, then the dose gradually increases every 5-7 days and is brought to the optimum (1-2 tablets per day). Taking into account the presence of potassium iodide in the thyrocomb and in order to avoid an overdose of iodine leading to iodine-Basedowism, it is advisable to treat with thyreocomb in courses of 2-3 months with interruptions for the same period.

Treatment of patients with endemic goiter with thyroid drugs lasts a long time - for 6-12 months, depending on the dynamics of the size of the thyroid gland.

During treatment with thyroid drugs every 3 months, follow-up examinations of the patient with a change in the circumference of the neck, ultrasound of the thyroid gland, palpation of the goiter should be carried out. With a decrease in goiter, the dose of thyroid drugs can be reduced.

AT last years there have been reports of the possibility of treating diffuse euthyroid goiter with potassium iodide. The drug is produced by Berlin-Chemie in tablets containing 262 μg of potassium iodide in 1 tablet, which corresponds to 200 μg of iodine.

According to the company's instructions, the dosages of potassium iodide are as follows:

newborns, children and adolescents - 1 / 2-1 tablet per day (i.e. 100-200 mcg of iodine);

young adults - 1 1/2-2 1/2 tablets per day (i.e. 300-500 micrograms of iodine).

Treatment of goiter in newborns is usually 2-4 weeks. Treatment of goiter in children, adolescents and adults lasts for 6-12 months or longer.

It is believed that the above doses of potassium iodide do not cause the Wolf-Caikoff effect (i.e., it does not cause inhibition of the organization of iodine in the thyroid gland, its absorption and does not disrupt the synthesis of thyroid hormones). This effect develops only when prescribing doses of iodine over 1 mcg per day.

In endemic goiter with hyperthyroidism, optimal doses of thyroid drugs are prescribed to compensate, but these doses are reached gradually, especially in the elderly.

Treatment of hypothyroidism is carried out with thyroid drugs for life.

Treatment of hypothyroidism

Hypothyroidism is a syndrome of insufficient provision of the body with thyroid hormones.

Depending on the cause, the following forms of the disease are distinguished: primary, secondary, tertiary, peripheral, mixed, congenital, acquired.

Primary hypothyroidism is an insufficient production of thyroid hormones due to various pathological processes in the gland itself. This form of hypothyroidism is the most common and accounts for 90-95% of all cases of underactive thyroid.

Secondary hypothyroidism is an insufficient function of the thyroid gland due to a violation of the formation or secretion of thyroid-stimulating hormone by the adenohypophysis.

Tertiary hypothyroidism is an insufficient function of the thyroid gland due to damage to the hypothalamus and a decrease in thyreoliberin secretion.

The peripheral form of hypothyroidism is hypothyroidism associated with inactivation of thyroid hormones during circulation or due to a decrease in the sensitivity of cell receptors of thyroid-dependent organs and tissues to thyroxine and triiodothyronine during normal biosynthesis and secretion of thyroid hormones.

Etiological treatment

Etiological treatment of hypothyroidism is not always possible and is almost ineffective. In rare cases etiological treatment can have a positive effect. So timely anti-inflammatory therapy in infectious and inflammatory lesions of the hypothalamic-pituitary region can lead to the restoration of the thyrotropic function of the pituitary gland. Drug-induced hypothyroidism may be reversible.

Replacement therapy with thyroid drugs

The main methods of treatment of primary, secondary and tertiary hypothyroidism are replacement therapy with thyroid hormones and preparations containing them.

The following thyroid drugs are used.

Thyreoidin (dried thyroid gland of animals) - available in tablets of 0.05 and 0.1 g. The iodine content in thyroidin ranges from 0.1 to 0.23%. The content of T3 and T4 in thyroidin depends on which animal it is derived from the thyroid gland. In thyroidin obtained from the pig thyroid gland, the ratio of T4 and T3 is (2-3): 1, in cattle - 3: 1, in sheep - 4.5: 1. Approximately 0.1 g of thyroidin contains 8-10 mcg T3 and 30-40 mcg T4.

L-thyroxine (euthyrox) - sodium salt levorotatory thyroxine, is available in tablets of 50 and 100 mcg. The action of L-thyroxine after oral administration is manifested after 24-48 hours, the half-life is 6-7 days.

Triiodothyronine - is available in tablets of 20 and 50 mcg. The action of triiodothyronine begins 4-8 hours after ingestion, the maximum effect occurs on the 2nd-3rd day, the drug is completely eliminated from the body after 10 days.

When taking triiodothyronine, 80-100% of the drug is absorbed orally, triiodothyronine has 5-10 times greater biological activity than thyroxine.

Tireotome - 1 tablet of the drug contains 40 mcg T4 and 10 mcg T3.

Thyreotom-forte - 1 tablet of the drug contains 120 mcg T4 and 30 mcg T3.

Thyreocomb - 1 tablet of the drug contains 70 micrograms of T4, 10 micrograms of T3 and 150 micrograms of potassium iodide.

The main principles of treatment of hypothyroidism with thyroid drugs are:

replacement therapy with thyroid drugs is carried out throughout life, with the exception of transient forms of hypothyroidism (with an overdose of thyreostatic drugs during the treatment of toxic goiter or in the early postoperative period after subtotal resection of the thyroid gland);

selection of doses of thyroid drugs should be done gradually and carefully, taking into account the age of patients, concomitant diseases, the severity of hypothyroidism and the duration of its treatment. The more severe the hypothyroidism and the longer the patients were without replacement therapy, the higher the sensitivity of the body (especially the myocardium) to thyroid drugs;

in the treatment of elderly patients with concomitant coronary artery disease, the initial doses of thyroid drugs should be minimal and their increase should be done slowly, under ECG control. Large doses of drugs and a rapid increase in doses can cause an exacerbation of coronary artery disease, the development of painless myocardial ischemia is possible;

the appointment of the next dose is made after the manifestation of the full effect of the previous dose (for the manifestation of the full effect of T3, 2-2.5 weeks are required, T4 - 4-6 weeks).

The drug of choice in the treatment of hypothyroidism is L-thyroxine due to the following circumstances:

the negative cardiotropic effect of L-thyroxine is much less pronounced than that of triiodothyronine and preparations containing it;

the constant conversion of thyroxine to triiodothyronine ensures minimal fluctuations in the blood level of triiodothyronine, a biologically more active hormone.

The initial dose of L-thyroxine in most cases is 1.6 mcg / kg 1 time per day (average 100-125 mcg per day. Given the possibility of painless myocardial ischemia, elderly patients are prescribed L-thyroxine 25-50 mcg 1 time per day.

The daily dose of the drug should be increased gradually, by 25-50 mcg every 4 weeks, until the thyroid insufficiency is fully compensated. Treatment is carried out under the control of the level of T4 and TSH in the blood and dynamics clinical manifestations. TSH level in primary hyperthyroidism, it is elevated and slowly normalizes during treatment of hypothyroidism.

Typically, the dose of thyroxine required to achieve euthyroidism is 150-200 mcg per day. However, this dose may not be the same for all patients. The dose of thyroxin, providing a euthyroid state, is individual and may differ significantly from that indicated.

Monotherapy with triiodothyronine has not become widespread due to a more pronounced negative cardiotropic effect (especially in the elderly) compared to thyroxine, and also because more frequent doses are needed to ensure a stable level of triiodothyronine in the blood.

Many endocrinologists use the technique combined treatment triiodothyronine and thyroidin.

The initial doses of triiodothyronine are 2-5 mcg, thyroidin - 0.025-0.05 g. Then the dose of triiodothyronine is increased every 3-5 days by 2-5 mcg and thyroidin - by 0025-0.05 g every 7-10 days until the optimal dose is reached, causing euthyroid condition. This dose, of course, is individual and can reach 0.2-0.25 g for thyroidin, and 50 mcg for triiodothyronine. Sometimes these doses can be even higher.

It is believed that 25 micrograms of triiodothyronine is equivalent to 100 micrograms of thyroxine in terms of its effect on the myocardium.

In the absence of thyroxin, for the replacement therapy of hypothyroidism, you can use combined preparations - thyreocomb, thyreot, thyreot-forte. The initial dose of these drugs is ? -1/2 tablets 1 time per day. Further increase in doses is done slowly - by? -1/2 tablets 1 time in 1-2 weeks until the optimal dose is reached (it can reach 1-2 tablets per day, sometimes more).

Thyroidin monotherapy is currently rarely used. This is due to the unstable composition of the drug, as well as its poor absorption by the gastrointestinal mucosa (in the intestine, thyroidin is first hydrolyzed and only then the T3 and T4 contained in it are absorbed into the blood). In addition, thyroidin contains thyroglobulin and other antigenic structures that may promote thyroid autoimmunity.

However, in the absence of other thyroid hormone preparations, thyroidin replacement therapy has to be carried out. The initial dose of thyroidin for young and middle-aged people is 0.05 g, and for the elderly - 0.025 g. Every 3-5 days, the dose is gradually increased, bringing it to the optimum (0.15-0.2 g per day, rarely more).

In the presence of IHD, thyroidin is prescribed at 0.02 g, increasing the dose every week by 0.01 g. At the same time, drugs that improve coronary circulation and metabolic processes in the myocardium should be prescribed.

Features of the treatment of hypothyroidism in patients with concomitant coronary artery disease

Against the background of treatment with thyroid drugs in patients with coronary artery disease, angina attacks may become more frequent, blood pressure may increase, tachycardia may develop, various arrhythmias. There are described cases of myocardial infarction in patients with coronary artery disease in the treatment of thyroid drugs.

Rules for the treatment of hypothyroidism in patients with concomitant coronary artery disease:

treatment of hypothyroidism should begin with minimal doses of thyroid drugs and slowly increase them to optimal doses that cause a euthyroid state;

preference among all thyroid drugs should be given to L-thyroxine as the least cardiotoxic;

treatment with thyroid drugs and especially an increase in their dose should be carried out under the control of blood pressure, heart rate, ECG;

the ability of thyroid drugs to enhance the effect of anticoagulants should be taken into account;

with the development of myocardial infarction, it is necessary to cancel thyroid drugs for several days, followed by their appointment at a lower dose.

Treatment of congenital hypothyroidism

In the treatment of congenital hypothyroidism, the following doses of L-thyroxine are recommended: at the age of 1-6 months - 25-50 mcg per day, at the age of 7-12 months 50-75 mcg per day, at the age of 2-5 years - 75-100 mcg per day day, at the age of 6-12 years - 100-150 mcg per day, at the age of over 12 years - 150 mcg per day.

Treatment of secondary hypothyroidism

In the treatment of patients with secondary hypothyroidism, thyrotropin preparations are almost never used, since they have allergenic properties. These drugs produce antibodies that reduce their effectiveness.

The main treatment for secondary hypothyroidism is also thyroid replacement therapy. The principles of treatment are the same as for primary hypothyroidism, however, it should be noted that secondary hypothyroidism is often combined with hypocorticism due to insufficient production of corticotropin and a rapid increase in the dose of thyroid hormones can cause acute adrenal insufficiency. In this regard, replacement therapy with thyroid drugs in the first 2-4 weeks should be accompanied by taking small doses of prednisolone (5-10 mg per day), especially in severe hypothyroidism.

In rare cases of secondary not advanced hypothyroidism (tumor of the hypothalamic-pituitary zone, infectious and inflammatory process in this zone), etiological treatment ( radiation therapy, anti-inflammatory treatment) can lead to recovery.

In the treatment of tertiary hypothyroidism, thyreoliberin treatment has not been widely used, and the basis of therapy is the use of thyroid drugs.

In addition to replacement therapy with thyroid drugs, patients with hypothyroidism should receive multivitamin complexes, it is also necessary to correct lipid metabolism disorders and take drugs that improve the functional state of the brain (piracetam, nootropil).

Hypothyroidism is treated for life. After selecting the optimal dose hormonal drug the patient should be examined annually, while the content of thyroid hormones and thyrotropin in the blood is mandatory. The optimal dose of thyroxine is considered to be one that provides a euthyroid state and normal level thyrotopin in the blood. Usually it is 100-200 mcg of thyroxine or 2-4 tablets of thyrotom or 1.5-2.5 tablets of thyreocomb per day.

With long-term therapy with thyroid drugs, their tolerance may improve in patients, moreover, with age, the need for thyroid drugs decreases somewhat. However, the physician must constantly pay attention to the possibility of manifestation side effects thyroid drugs, which is most likely in case of overdose:

tachycardia, disorder heart rate, exacerbation of coronary artery disease;

arterial hypertension;

dyspepsia and epigastric pain.

In the treatment of peripheral forms of hypothyroidism, the use of plasmapheresis and hemosorption is currently recommended, which in some cases makes it possible to remove antithyroid antibodies from the blood and restore tissue sensitivity to thyroid hormones.

Clinical examination

Dispensary observation of patients with hypothyroidism is carried out by an endocrinologist for life.

tasks dispensary observation is, first of all, the selection of an adequate, well-tolerated dose of thyroid drugs and the provision of a euthyroid state.

Treatment on an outpatient basis is carried out for mild to moderate hypothyroidism. Patients with severe hypothyroidism and patients with hypothyroidism complicated by severe concomitant diseases (hypertension, coronary artery disease, etc.) are subject to hospitalization.

The patient is examined by an endocrinologist and a therapist 3-4 times a year. During doctor visits general analysis blood and urine, a blood test for cholesterol, triglycerides, b-lipoproteins, glucose, an ECG is recorded. It is necessary to constantly monitor the patient's body weight, 2 times a year the blood content of T3, T4, antibodies to thyroglobulin, cortisol, thyroid-stimulating hormone is determined. The results of these studies are taken into account when choosing the dose of thyroid drugs.

During dispensary observation, the issue of the patient's ability to work is resolved. Patients with mild and middle degrees the severity of hypothyroidism with timely started and adequately carried out substitution therapy restores working capacity, however, heavy physical labor and work associated with being outdoors in the cold season should be avoided.

In severe hypothyroidism, a significant decrease in working capacity is possible, especially among intellectual workers.

Conclusion

Implementation of the nursing process:

Helps to prioritize care priorities and expected outcomes from a range of existing needs. priority issues are security problems (operational, infectious, psychological); problems associated with pain, temporary or permanent dysfunction of organs and systems; problems associated with the preservation of dignity, since in no other field of medicine is the patient so defenseless as in the surgical department during the operation.

Determines the nurse's action plan, a strategy aimed at meeting the needs of the patient, taking into account the characteristics of the pathology.

Ensures quality of care that can be monitored. It is in surgery that the application of intervention standards is most significant.

Literature

1.A.N. Okorokov. Treatment of diseases of internal organs. Vitebsk 1998

2. Smoleva E.V. Nursing in Therapy with Primary Care Course

3.Standards of practical activity of a nurse in Russia, volume I - II

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