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SECTION 10 Problems Related to Regulatory and Reproductive Mechanisms

NURSING CARE PLAN 50-2

Patient with Hypothyroidism
NURSING DIAGNOSIS

Imbalanced nutrition: more than body requirements related to calorie intake in excess of metabolic rate as evidenced by
weight gain secondary to hypometabolism
1. Attains weight appropriate for height (target weight _____ lb/kg)
2. Maintains caloric intake that meets nutritional needs

PATIENT GOALS

OUTCOMES (NOC)
Weight Maintenance Behavior

INTERVENTIONS (NIC) AND RATIONALES

Weight Management

Discuss with individual the medical conditions that may affect weight to reassure patient that
optimal weight can be maintained with treatment of hypothyroidism.
Discuss with individual the relationship between food intake, exercise, weight gain, and weight
loss to promote understanding of weight management.
Determine the individuals ideal body weight to plan weekly weight loss goals.
Assist in developing well-balanced meal plans consistent with level of energy expenditure.
Develop with the individual a method to keep a daily record of intake, exercise sessions, and/or
changes in body weight to promote progress toward final goal.

Monitors body weight _____

Maintains recommended eating pattern _____
Balances exercise with caloric intake _____
Maintains optimal daily caloric intake _____
Maintains optimum weight _____

Measurement Scale

1 = Never demonstrated
2 = Rarely demonstrated
3 = Sometimes demonstrated
4 = Often demonstrated
5 = Consistently demonstrated

Nutrition Management
Determine, in collaboration with dietitian, number of calories and type of nutrients needed to meet
nutrition requirements.
Provide appropriate information about nutritional needs and how to meet them so patient will be
more agreeable to dietary restrictions.
Monitor recorded intake for nutritional content and calories to evaluate patients management of
nutrition.
Weigh patient at appropriate intervals to monitor progress toward target weight.

NURSING DIAGNOSIS Constipation related to gastrointestinal hypomotility as evidenced by irregular, hard stools
PATIENT GOAL Experiences regular, soft formed stools that are easy to pass
OUTCOMES (NOC)
INTERVENTIONS (NIC) AND RATIONALES
Bowel Elimination
Constipation/Impaction Management

Elimination pattern _____

Stool soft and formed _____
Ease of stool passage _____
Passage of stool without aids _____

Measurement Scale

1 = Severely compromised
2 = Substantially compromised
3 = Moderately compromised
4 = Mildly compromised
5 = Not compromised

Encourage increased fluid intake (e.g., 2-3 L of fluids per day) to maintain soft stool.
Instruct patient/family on high-fiber diet to increase knowledge of how to increase fecal mass.
Monitor bowel movements, including frequency, consistency, shape, volume, and color, to plan
appropriate interventions.
Suggest use of laxatives/stool softeners to stimulate bowel evacuation.
Teach patient/caregivers about timeframe for resolution of constipation because elimination
patterns will improve with treatment of hypothyroidism.

NURSING DIAGNOSIS

Impaired memory related to hypometabolism as evidenced by forgetfulness, memory loss, somnolence, and personality
changes
Demonstrates cognitive orientation with correction of hormone deficiency

PATIENT GOAL
OUTCOMES (NOC)
Cognition

Comprehension of the meaning

of situations _____
Attentiveness _____
Concentration _____
Recent memory _____
Cognitive orientation _____
Measurement Scale

1 = Severely compromised
2 = Substantially compromised
3 = Moderately compromised
4 = Mildly compromised
5 = Not compromised

INTERVENTIONS (NIC) AND RATIONALES

Reality Orientation
Monitor for changes in orientation, cognitive and behavioral functioning, and quality of life to
determine appropriate interventions.
Inform patient of person, place, and time to decrease confusion.
Provide a low-stimulation environment for patient in whom disorientation is increased by overstimulation.
Speak to patient in slow, distinct manner with appropriate volume to allow patient to understand.
Avoid requests that exceed the patients capacity (e.g., abstract thinking when patient can think
only in concrete terms, decision making beyond preference or capacity) to decrease frustration and
loss of self-esteem.
Use environmental cues (e.g., signs, pictures, clocks, calendars) to maintain orientation to time
and day.

glucose at least daily because the return to the euthyroid state

frequently increases insulin requirements. In addition, thyroid
preparations potentiate the effects of anticoagulants and decrease
the effect of digitalis compounds. Instruct the patient regarding
the toxic signs and symptoms of these medications and the need
to remain under close medical observation until stable.

It is sometimes difficult for the patient to recognize signs

of overdosage or underdosage of drug therapy. Therefore you
should ask the patient to bring along the caregiver. See Chapter
4 for strategies to teach patients and caregivers.
With treatment, striking transformations occur in both
appearance and mental function. Most adults return to a normal