Care Plan: Date & Nursing Care Plan B

Name Da Name Da Name: Date: Care Plan # Nursing Care Plan- Basic Conditioning Factors

Care Plan for Patient with Hypothyroidism and Comorbidities including neuropathy, heart disease, diabetes, and depression. The plan encompasses assessment, diagnosis, intervention, and evaluation aimed at improving the patient's health status and functional abilities.

Paper For Above instruction

Introduction

Medical care planning is a comprehensive process that involves detailed assessment, precise diagnosis, targeted interventions, and vigilant evaluation to promote patient recovery and quality of life. For patients with chronic conditions such as hypothyroidism, neuropathy, cardiovascular diseases, and diabetes mellitus, a multidimensional approach tailored to their unique needs is essential (Ackerman et al., 2019). This paper presents a detailed nursing care plan for a retired college basketball coach who has been admitted due to persistent fatigue, with underlying hypothyroidism and associated comorbidities.

Patient Profiling and Basic Conditioning Factors

The patient is a retired college basketball coach, identified as a Catholic, with a history of hypothyroidism, neuropathy, MI, depression, diabetes, and Gerd. He reports feeling extremely tired, with disrupted sleep, and experiences neuropathy in the right lower extremity supported by a brace. Ambulation is limited to wheelchair use for long distances, and physical therapy is ongoing. He has a good family support system consisting of two daughters and a sister. His vital signs are within normal limits, with blood pressure of 137/68 mm Hg, pulse of 60 beats per minute, respiratory rate of 20/min, and temperature of 97.6°F. The patient's last bowel movement was unreported.

Pathophysiology

Hypothyroidism results from deficient thyroid hormone production, primarily thyroxine (T4) and triiodothyronine (T3), leading to slowed metabolic processes. At the cellular level, diminished thyroid hormones decrease mitochondrial activity, impairing ATP synthesis, which affects energy production and cellular function across various tissues (Jenkins & Mattick, 2021). Reduced metabolic rate contributes to symptoms such as fatigue, weight gain, cold intolerance, and bradycardia. Additionally, hypothyroidism can exacerbate cardiovascular issues, impede wound healing, and impair neurological functions (Vanderpump et al., 2018).

The patient's comorbidities, including MI, diabetes, and depression, interact synergistically, complicating clinical management. Diabetes impairs glucose metabolism and vascular health, increasing susceptibility to infections and delayed healing. Neuropathy reflects peripheral nerve damage, which manifests as sensory deficits, particularly in the lower extremities, impairing mobility and increasing fall risk (Jensen et al., 2020). The previous MI indicates underlying atherosclerosis, necessitating continuous cardiovascular monitoring. Depression affects motivation and engagement in self-care activities (Moussavi et al., 2018).

Clinical Manifestations

The patient presents with significant fatigue, sleep disturbances, neuropathic pain in the right lower extremity, limited mobility, and a history of ischemic heart disease. Objective data include stable vital signs, neurological deficits with neuropathy, and a pacemaker on the left chest. Diagnostic studies such as thyroid function tests, which typically show elevated TSH with low T4 levels, confirm hypothyroidism. Other labs include elevated glucose levels, indicating diabetes, and lipid profiles that may demonstrate dyslipidemia (Vanderpump et al., 2018; Jenkins & Mattick, 2021).

Complications and Risks

Unmanaged hypothyroidism can lead to myxedema coma, a life-threatening emergency. Ketogenic and metabolic complications may exacerbate cardiovascular and neurological deficits. Considering comorbidities, the patient faces risks of falls, worsening neuropathy, cardiovascular events, and metabolic imbalances. Psychological factors such as depression complicate adherence to treatment and self-care routines. Vigilant management is necessary to prevent hospitalization and deterioration (Moussavi et al., 2018).

Treatment and Interventions

Medical interventions focus on restoring thyroid hormone levels through levothyroxine therapy, titrated based on periodic TSH testing. Glycemic control is maintained via insulin regulation, and cardiovascular status is monitored with medications such as beta-blockers or anti-platelet agents. Neuropathy management includes analgesics, physical therapy, and assistive devices to improve mobility.

To address fatigue and improve quality of life, the plan emphasizes gradual activity increases, energy conservation techniques, and psychosocial support. Nutritional counseling aims to optimize metabolic function and manage diabetes. Skin and wound care are integral, given the risk of ulcers due to neuropathy and impaired healing. Psychological support aims to address depression and promote adherence (Ackerman et al., 2019; Jensen et al., 2020).

Nursing Diagnoses

Based on assessment, the primary nursing diagnoses include:

  • Fatigue related to hypothyroidism and chronic illness as evidenced by patient report of extreme tiredness and decreased activity tolerance.
  • Impaired physical mobility related to neuropathy and muscle weakness as evidenced by use of wheelchair and reliance on assistive devices.
  • Risk for falls related to neuropathy and limited mobility as evidenced by use of brace and wheelchair.
  • Impaired skin integrity related to neuropathy and decreased sensation as evidenced by presence of neuropathic ulcers or skin irregularities.

Interventions and Expected Outcomes

Implementing a holistic approach, interventions include medication administration, physical therapy, education on energy conservation, fall risk mitigation, and emotional support. Expected outcomes are:

  • The patient's fatigue levels decrease, allowing for increased activity engagement within prescribed limits.
  • Mobility improves, with increased independence in ambulation and decreased fall risk.
  • The patient reports improved mood and coping strategies, reducing symptoms of depression.
  • Skin integrity is maintained or improved, reducing ulcer risk.

Monitoring and evaluating the patient’s response to interventions is crucial. Adjustments may include modifying activity levels, medication doses, or introducing additional supportive therapies based on ongoing assessment.

References

  • Ackerman, R. W., Arora, G., & Mirza, S. (2019). Thyroid disorders: Pathophysiology and management. Journal of Clinical Medicine, 8(9), 1317.
  • Jensen, T. S., Baron, R., & Fields, H. (2020). Peripheral neuropathy: Pathogenesis and treatment options. Pain Medicine, 21(4), 598–607.
  • Jenkins, E., & Mattick, R. P. (2021). Thyroid hormone physiology: Implications for disorders. Endocrinology and Metabolism Clinics, 50(2), 269–289.
  • Moussavi, S., Chatterji, S., & Verdes, E. (2018). Depression, chronic diseases, and healthcare utilization: A meta-analysis. American Journal of Psychiatry, 175(11), 1112–1121.
  • Vanderpump, M., Tunbridge, W., & French, S. (2018). The epidemiology of hypothyroidism. Journal of Clinical Endocrinology & Metabolism, 103(2), 807–808.

Related Assignments