Nursing Care of Client with Hyperthyroidism课件.pptVIP

endocrine system * * Nursing Care of Client with Hyperthyroidism What is hyperthyroidism? Sustained increased synthesis and release of thyroid hormone by thyroid gland. When body tissue stimulated by increased thyroid hormones ,s/s appear referred to as thyrotoxicosis Both occur together as in Grave’s disease. Hyperthyroidism affects all systems of the body What cause hyperthyroidism? Autoimmune reaction Excessive secretion of TSH by pituitary gland Excessive intake thyroid medication Neoplasma( toxic multinodular goiter what causes hyperthyroidism Hypermetabolism Increased cardiac output,adrenergic response Protein ---negative nitrogen balance Carbonhydrate– decreased glucose tolerance Lipid ---mobilization, synthesis and breakdown of triglycerides ［病例摘要］杨某某，女性，32岁，多食、多汗、易怒1年，劳累后心慌、气短2个月 　　1年前与家人生气后，感心慌，易饥，食量由原来的5两/日增至1斤/日，同时怕热多汗，说话多，易怒、失眠，逐渐发现双眼突出，梳头困难，蹲下站起时困难，病后大便每日两次，成形便。体重减轻8kg.曾口服他巴唑（Tapazole)30mg/日，分三次口服，1月后病情好转，半年前自行停药。既往体健，无药物过敏史，月经初潮14岁，4-6天/30天，近一年闭经，家中无类似患者。 查体：T37℃，P110次/分，R26次/分，Bp110/60mmHg，发育正常，消瘦，自动体位，皮肤潮湿，浅表淋巴结不大，眼球突出，闭合障碍，唇无紫绀，甲状腺Ⅱ°肿大，质软，无结节，可及震颤，可闻血管杂音，无颈静脉怒张，双肺正常，心界稍向左扩大，心率130次/分，律齐，心尖部可闻及收缩期杂音，腹软，无压痛，肝脾肋下未及，无移动性浊音，肠鸣音正常，双下肢不肿，深腱反射亢进，双Babinski征（-）。 查T3 600ng/dl（RIA法），T4 20.5μg/dl，TSH0.015IU/ml，　　　［诊断］ 　　　　1.Graves病　 2.甲状腺功能亢进　 　　　　　　　　　 PE: T37℃，P110/min，R26/min，Bp110/60mmHg. Well-developed, fleshless, active position, moist skin .No palpable superficial lymph nodes. bulging of both eyes and disability in closing eyelid. No cyanosis. Moderately enlarged thyroid, with softness,no nodules, palpable vibration and auditory blood sound. No jugular vein distension, Normal lung sounds. Mild enlarged left boundary of heart , regular heartbeat with a rate of 150/min,systolic murmurs heard on the apex . Abdomen soft ,no tenderness. Liver and spleen are not palpable below the costal margin, No shifting dullness heard on percussion. Bowel sounds audible without high pitch. No edema in lower extremities. Deep tendon hyperreflexia detected Babinski’s