Question

Jean Fields is a 72-year-old client who has been diagnosed with hyperthyroidism due to Graves’ disease. Her husband of 52 years died of lung cancer 2 weeks ago, and she has been dealing with extreme emotional upset and grief. She has been admitted to the hospital with fatigue, weakness, fever, tachycardia, and dehydration.

2. Ms. Fields is prescribed propylthiouracil (PTU) every 8 hours. What should the nurse include in teaching Ms. Fields about this drug?

Answer 1

Thyroid storm is a life-threatening health condition that is associated with untreated or under treated hyper thyroidism.

During thyroid storm, an individual's heart rate, blood pressure, body temperature, can soar to dangerously high levels. Without prompt treatment, thyroid storm becomes fatal.

Thyroid storm is rare and develops in people who have hyper thyroidism but aren't receiving appropriate treatment. Causes includes severe untreated hyperthyroidism

People with hyperthyroidism may develop thyroid storm after experiencing any of the following

• Trauma
• Surgery
• Severe emotional distress
• Stroke
• Diabetic keto acidosis
• Congestive heart failure
• Pulmonary embolism

In this case, Mrs. Field is having severe emotional distress following her husband's death.

Symptoms of thyroid storm are similar to hyper thyroidism but are more sudden, severe and extreme. Common symptoms includes

• Tachycardia ( above 140 beats/mt)
• High fever
• Persistent sweating
• Shaking
• Agitation
• Restlessness
• Confusion
• Diarrhea
• Unconsciousness
• Dehydration (due to excessive sweating or diarrhea)
• Fatigue

Mrs. Field is having symptoms such as fatigue, weakness, fever, tachycardia and dehydration.

The primary treatment of thyroid storm is with inorganic iodine and anti-thyroid drugs Propyl thiouracil or Methimezole to reduce the synthesis and release of thyroid hormone. Propyl thiouracil has a theoretical advantage in thyroid storm because of its early onset of action and capacity to inhibit peripheral conversion of T4 to T3 and controls cardiac rhytmn.

Mrs. Field is prescribed with Propyl thiouracil (PTU) every 8 hours.

2. Nursing Considerations and Client teaching includes

• Teach the patient regarding the adverse reaction or side effects of the drug includes drowsiness, headache, parasthesia,vertigo,rashes, skin discolouration, urticaria, hypo thyroidism.
• Advise her to report any of these side effects of PTU
• Instruct patient to take medication exactly as directed around the clock. If a dose is missed, take both doses together if almost time for next dose; check with health care professional if more than 1 dose is missed. Consult health care professional prior to discontinuing medications.
• Instruct patient to monitor weight 2-3 times weekly.
• May cause drowsiness. Caution the patient to avoid driving or other activities requiring alertness until response to medication is known.
• Advise patient to report sore throat, fever, chills, headache, malaise, weakness, yellowing of eyes or skin, unusual bleeding or bruising, symptoms of hyper thyroidism or hypo thyroidism, or rash to health care professional promptly.
• Advise patient to notify health care professional of all treatment or over the counter medications, herbal products being taken and to consult with health care professional before taking other medications.
• Emphasize the importannce of routine exam to monitor progress and to check for side effects.
• Avoid use of over the counter drugs for asthma, or cough treatment without checking with the physician. Iodides sometimes included in such preparations are contraindicated.
• Check with physician about use of iodized salt and inclusion of sea food in diet.
• Instruct patient to report changes in skin color or sclera to the health care provider.
• Instruct patient to immediately report signs of infection to health care provider.
• Instrut patient to report any edema.