Show Monitor BP lying, sitting, and standing, if able. Note widened pulse pressure. General or orthostatic hypotension may occur as a result of excessive peripheral vasodilation and decreased circulating volume. Widened pulse pressure reflects compensatory increase in stroke volume and decreased systemic vascular resistance (SVR). Monitor central venous pressure (CVP), if available. Provides more direct measure of circulating volume and cardiac function. Investigate reports of chest pain or angina. May reflect increased myocardial oxygen demands or ischemia. Assess pulse and heart rate while patient is sleeping. Provides a more accurate assessment of tachycardia. Auscultate heart sounds, note extra heart sounds, development of gallops and systolic murmurs. Prominent S1 and murmurs are associated with forceful cardiac output of hypermetabolic state; development of S3 may warn of impending cardiac failure. Monitor ECG, noting rate and rhythm. Document dysrhythmias. Tachycardia (greater than normally expected with fever and/or increased circulatory demand) may reflect direct myocardial stimulation by thyroid hormone. Dysrhythmias often occur and may compromise cardiac output. Auscultate breath sounds. Note adventitious sounds. Early sign of pulmonary congestion, reflecting developing cardiac failure. Monitor temperature; provide cool environment, limit bed linens or clothes, administer tepid sponge baths. Fever (may exceed 104°F) may occur as a result of excessive hormone levels and can aggravate diuresis and/or dehydration and cause increased peripheral vasodilation, venous pooling, and hypotension. Observe signs and symptoms of severe thirst, dry mucous membranes, weak or thready pulse, poor capillary refill, decreased urinary output, and hypotension. Rapid dehydration can occur, which reduces the circulating volume and compromises cardiac output. Record I&O. Note urine specific gravity. Significant fluid losses through vomiting, diarrhea, diuresis, and diaphoresis can lead to profound dehydration, concentrated urine, and weight loss. Weigh daily. Encourage chair rest or bedrest. Limit unnecessary activities. Activity increases metabolic and circulatory demands, which may potentiate cardiac failure. Note history of asthma and bronchoconstrictive disease, sinus bradycardia and heart blocks, advanced HF, or current pregnancy. The presence or potential recurrence of these conditions affect the choice of therapy. For example use of [beta]-adrenergic blocking agents is contraindicated. Observe for adverse side effects of adrenergic antagonists: severe decrease in pulse, BP; signs of vascular congestion/HF; cardiac arrest. Indicates need for reduction or discontinuation of therapy. Administer IV fluids as indicated. Rapid fluid replacement may be necessary to improve circulating volume but must be balanced against signs of cardiac failure and need for inotropic support. Administer medications as indicated:
Which finding would the nurse assess in a patient with hyperthyroidism?Nursing Diagnosis. Fatigue.. Tremor.. Sweating.. Hyperactive.. Anxious.. Palpitations.. Heat intolerance.. Nervous.. Which of the following are appropriate positions for the client post thyroidectomy?The American Thyroid Association also recommended to keep the patient in a head-up at 45°-Fowler's position in the post anesthesia care unit following thyroidectomy to prevent hematoma formation on the incision site by facilitating venous return from the head and neck.
Which of the following instructions is appropriate for a nurse to give to a patient who has gastroesophageal reflux disease?Avoid placing the patient in supine position, have the patient sit upright after meals; instruct patient to avoid highly seasoned food, acidic juices, alcoholic drinks, bedtime snacks, and foods high in fat; elevate HOB while in bed.
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