Nursing care for thyroid disorders. Abstract: Diseases of the thyroid gland. Endemic goiter Preventive activities of a nurse in case of thyroid disease

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Ministry of Education and Science of the Russian Federation

Federal Agency for Education

Penza Regional Medical College

Abstract on the topic

"Nursing process in diseases of the thyroid gland"

Introduction

1. Endemic goiter

2.Hypothyroidism and hyperthyroidism

3. Nursing process

Conclusion

Literature

Introduction

Thyroid disease can begin for various reasons. For their etiology, such factors as: congenital anomalies of the thyroid gland, its inflammation in infectious and autoimmune processes, as a complication of surgical treatment and therapy with radioactive iodine in diffuse toxic goiter, as well as a result of a lack of iodine in the environment, are important. Secondary hypothyroidism is a consequence of infectious, tumor or traumatic damage to the hypothalamic-pituitary system. An overdose of Mercazolil can cause functional primary hypothyroidism. With uncompensated hypothyroidism, psychoses can develop that resemble schizophrenia in their course.

Iodine deficiency leads to endemic goiter. This disease is widespread in all countries of the world. A deficiency of thyroid hormones inhibits the development and differentiation of brain tissues, inhibits higher nervous activity, so children with congenital and late diagnosed hypothyroidism develop incurable cretinism. Adults develop encephalopathy.

1.endemic goiter

Most diseases of the thyroid gland associated with a violation of its function are accompanied by an increase in the size of the gland, as a result of which it protrudes above the surface of the neck, deforming its contours. A goiter (or struma) is formed.

An endemic goiter is an enlargement of the thyroid gland, characteristic of residents of certain areas where there is a lack of iodine in soil, water, and food products. This disease affects more or less significant masses of the population and is characterized by special patterns of its development.

Endemic goiter has long been common among the population of various parts of the world. This disease occurs mainly in mountainous areas, far from the seas and oceans, to a lesser extent - in the foothill areas. There are significantly fewer endemic foci of goiter in river valleys, some swampy and wooded areas, and especially near the sea.

There is no country in the world that would be free from endemic goiter. The best known endemic foci of goiter are in Switzerland, the mountainous regions of Germany, Austria, France, Italy and Spain. They are also available in other places (USA, Central Asia, Africa, Australia). The zones of endemic goiter also include some areas of Western Ukraine, Belarus, Karelia, the upper reaches of the Volga, some areas of the Mari Republic, the Urals, the Central and North Caucasus, Central Asia (in particular, Kyrgyzstan, Uzbekistan, Tajikistan), a number of regions of Transbaikalia. In some areas (Upper Svaneti, Transcarpathian Ukraine, the Mari Republic, Pamir), the prevalence of endemic goiter is especially pronounced; 30-50% of the adult population and 60-70% of school-age children had goiter, and 1-5% of the population had cretinism.

The theory of iodine deficiency was created in the middle of the 19th century by Prevost and Chaten. Its essence boils down to the fact that endemic goiter occurs when the iodine content in soil and water decreases. If an area endemic for goiter is isolated, poorly supplied with imported products, then its inhabitants experience iodine starvation and are more often affected by goiter. The theory of iodine deficiency is also confirmed by the effectiveness of iodine prophylaxis, which has become widespread throughout the world.

However, in the development of goiter, a certain role is currently assigned to microelements, which are included in small quantities in the structure of such biologically active substances as vitamins, enzymes, hormones. Trace elements are unevenly distributed in the earth's crust, in some areas there may be a lack or excess of them. In areas endemic for goiter, the levels of bromine, zinc, cobalt and copper are reduced in the environment. Although the lack of these trace elements often manifests itself against the background of iodine deficiency and is not the main etiological (causal) factor, it can determine the specifics of endemic goiter in a particular area.

In the late 20s of the XX century, a group of substances that promote an increase in the thyroid gland - strumogens was identified. It has been established that with excessive consumption of vegetables such as cabbage, turnip, radish, rutabaga, beans, carrots, radishes, spinach, etc., an increase in the thyroid gland may occur.

Certain importance in the development of endemic goiter is heredity, especially among isolated groups of the population, related to each other by consanguinity. So, in endemic areas, not all family members who are in the same conditions are affected by goiter. In the presence of nodular goiter in both parents, its prevalence among children is 3 times higher than in the offspring of unaffected parents. Identical twins have a higher incidence of goiter than fraternal twins.

Iodine enters the body from the gastrointestinal tract in the form of potassium iodide or sodium iodide, is taken up by thyroid cells or excreted by the kidneys. Normally, the concentration of iodine in the thyroid gland is 20 times higher than in the blood plasma.

Thyroid iodides are oxidized enzymatically to molecular iodine. Further, iodine is used to form thyroid hormones (monioiodotyrosine, diiodotyrosine, triiodothyronine, tetraiodothyronine). The main thyroid hormone is tetraiodothyronine, containing 4 iodine atoms, or thyroxine. Thyroxine is bound to the protein thyroglobulin and accumulates in the follicles of the thyroid gland. In the blood, thyroxine is bound to plasma proteins. As needed, it is cleaved from protein, penetrates into cells and has a specific effect on metabolism. In the process of metabolism, thyroxin decomposes with the release of iodides, which enter the bloodstream and enter a new cycle of iodine circulation in the body.

Thus, in the complex process of hormone formation in the thyroid gland, iodine is the main component of all reactions. Violation of iodine metabolism at any of the stages leads to a decrease in the secretion of thyroid hormones.

Clinical picture endemic goiter depends on the degree of enlargement of the thyroid gland, its localization (location), structure and functional state. Endemic goiter develops slowly and the patient does not know about its existence for a long time. The disease is usually detected during a mass medical preventive examination or when seeking medical help for another reason.

Endemic goiter can affect all age groups, but the incidence of children under 14 years of age is especially characteristic. The physiological prerequisites for the appearance of goiter are periods of life when the need for iodine increases: the period of growth, pregnancy and lactation (milk secretion).

In the initial stages of the disease, the patient's complaints are nonspecific. They may be due to vegetative neurosis. Patients complain of general weakness, headache, sleep disturbance, memory and appetite. There are irritability, tearfulness, sweating of the palms and armpits. However, the body weight of patients, as a rule, does not change. When the goiter reaches a large size, there is a feeling of squeezing in the neck, swallowing is difficult. In advanced cases, when the goiter compresses the trachea and the neurovascular bundle of the neck, normal breathing is disturbed, shortness of breath and palpitations appear during exercise. These complaints are especially frequent with the retrosternal location of the goiter or with its development in an abnormally located thyroid gland (for example, with goiter of the root of the tongue).

Endemic goiter usually occurs with a deficiency of thyroid hormones. Toxic goiter is rare in endemic areas.

On the other hand, people in endemic areas in the absence of iodine prophylaxis often have a decrease in thyroid function (hypothyroidism). The percentage of malignant degeneration of the thyroid gland is quite high. However, in most patients with endemic goiter, symptoms of thyroid dysfunction are not clinically manifested.

A pronounced lack of iodine in the thyroid gland from birth is accompanied by profound changes in various organs and systems, which affects the mental and physical usefulness of the individual - cretinism develops. The appearance of patients with cretinism is characteristic. They are clumsy, weak, often react inadequately to external stimuli, often smile for no reason. Growth retardation, disproportionate development of the limbs, a sharp mental retardation, a saddle nose, dryness, pallor and wrinkling of the skin, puffiness of the face, poor hair growth, tongue-tied tongue, and deafness are noted.

2.Ghyperthyroidismand hypothyroidism

hyperthyroidism - a group of diseases in which the thyroid gland begins to secrete its hormones in much larger quantities than a normal healthy person needs. Hyperthyroidism is the opposite of hypothyroidism: with a decrease in the level of thyroid hormones, all processes in the body slow down, and with hyperthyroidism, the body works with increased intensity.

Patients with hyperthyroidism should be under the active supervision of an endocrinologist. During the started adequate treatment contributes to a faster recovery of good health and prevents the development of complications. Treatment must begin without fail after the diagnosis is made and in no case should you self-medicate.

Symptoms of hyperthyroidism

In hyperthyroidism, as in hypothyroidism, there are violations of many organs, only in this case too many hormones are produced.

What changes occur in the body?

1. The skin of patients is warm, moist, thin and its age-related changes are noticeably slowed down, excessive sweating, hair is thin. Noticeable changes also occur with the nails, manifested in the form of painful detachment of the nail plate from the nail bed.

2. There is an increase in the palpebral fissure and the eyeball, as well as protrusion of the latter (exophthalmos), due to which the eyes become bulging. Characteristic signs are also edema and hyperpigmentation of the eyelids, i.e. they acquire a swollen appearance and a brownish tint.

3. Compared with hypothyroidism, thyrotoxicosis has opposite effects, such as: increased blood pressure (hypertension), increased heart rate (tachycardia), increased heart rate. In connection with these deviations, patients develop heart failure (the heart does not cope with its work and cannot fully supply blood to all organs and tissues).

4. Not spared hyperthyroidism and the respiratory system. Which is affected in the form of difficulty breathing (shortness of breath) and a decrease in the vital capacity of the lungs (VC - the maximum amount of air that can be exhaled after a deep breath).

5. With mild and moderate severity of the disease, appetite is often increased, and in severe cases, it is mainly reduced, nausea, vomiting and diarrhea (loose watery stools) are also observed. All this leads to weight loss.

6. Patients have pronounced rapid muscle fatigue, against which they feel constant weakness, which is also accompanied by tremor (involuntary rhythmic movements, similar to pronounced trembling, of the whole body or its individual parts, such as limbs, head, etc.). In most cases, osteoporosis develops (a skeletal disease in which there is a decrease in bone mass and a violation of the structure of bones). Due to the accumulation of a large amount of potassium in the bones and the strengthening of reflexes (which ensure the movement of a person), it leads to a severe impairment of motor activity.

7. Increased excitability, nervousness, insomnia, anxiety and fear, increased intelligence, accelerated speech are the accompanying symptoms of hyperthyroidism.

8. Changes in the blood can only be established in a laboratory blood test.

9. There is frequent and copious urination (polyuria).

10. Women may have a menstrual cycle disorder, which may be irregular and accompanied by severe pain in the lower abdomen (more often in nulliparous girls), scanty discharge, nausea, vomiting, general weakness, headache, bloating, feeling of "cotton legs", fainting , an increase in temperature. In men, there may be an increase in the mammary glands and a decrease in potency.

All this happens as a result of a violation of the production of male and female sex hormones. It can also lead to infertility.

11. Patients may develop thyroid diabetes, which occurs due to metabolic disorders (the intake of nutrients into the body and their "digestion" for energy), resulting in an increase in blood glucose. Temperature rise is possible.

Hypothyroidism

Hypothyroidism is a clinical syndrome caused by a lack of thyroid hormones in the body or a decrease in their biological effect at the tissue level.

According to most researchers, the prevalence of the disease among the population is 0.5-1%, and taking into account subclinical forms, it can reach 10%.

Pathogenetically hypothyroidism is classified into:

* primary (thyroid);

* secondary (pituitary);

* tertiary (hypothalamic);

* tissue (transport, peripheral).

In practice, in the vast majority of cases, primary hypothyroidism. It has been established that the most common cause of its development is autoimmune thyroiditis. At the same time, it is possible to develop hypothyroidism after surgery on the thyroid gland (postoperative hypothyroidism), during treatment with thyreostatics (medicated hypothyroidism), after exposure to radioactive isotopes of iodine (post-radiation hypothyroidism) and with endemic goiter. In some cases, the disease can develop as a result of long-term use of large doses of conventional, non-radioactive iodine, for example, during treatment with the iodine-containing antiarrhythmic amiodarone. The appearance of hypothyroidism is also possible with tumors of the thyroid gland. A great rarity is hypothyroidism, which developed as a result of subacute, fibrosing and specific thyroiditis. In some cases, the genesis of the disease remains unclear (idiopathic hypothyroidism).

Secondary and tertiary forms hypothyroidism (the so-called central hypothyroidism) is associated with damage to the hypothalamic-pituitary system in diseases such as pituitary adenomas and other tumors of the sellar region, the "empty" Turkish saddle syndrome, heart attacks and necrosis of the pituitary gland (their development is possible with DIC and massive bleeding) . Etiological factors can also be inflammatory diseases of the brain (meningitis, encephalitis, etc.), surgical and radiation effects on the pituitary gland. A decrease in the functional activity of the thyroid gland in central forms of hypothyroidism is associated with a deficiency of thyroid-stimulating hormone (TSH). In this case, TSH deficiency can be isolated, but more often it is combined with a violation of the secretion of other tropic hormones of the pituitary gland (in such cases, they speak of hypopituitarism).

In addition to acquired forms of hypothyroidism, there are congenital forms diseases. The frequency of congenital hypothyroidism in Russia is on average 1 case per 4000 newborns. The causes of congenital hypothyroidism can be: aplasia and dysplasia of the thyroid gland, genetically determined defects in the biosynthesis of thyroid hormones, severe iodine deficiency, autoimmune thyroid diseases in the mother (due to the penetration of thyroblocking antibodies through the placenta), treatment of thyrotoxicosis in the mother with thyrostatic drugs or radioactive iodine. Rare causes include congenital TSH deficiency, as well as peripheral thyroid hormone resistance syndrome.

3.Nursing Process

Philosophy of nursing

Decree of the Government of the Russian Federation dated 05.11.97, No. 1387 "On measures to stabilize and develop healthcare and medical science in the Russian Federation" provides for the implementation of a reform aimed at improving the quality, accessibility and cost-effectiveness of medical care to the population in the conditions of the formation of market relations.

Nurses are given one of the leading roles in solving the problems of medical and social assistance to the population and improving the quality and efficiency of medical services for nursing staff in medical facilities. The functions of a nurse are diverse and her activities concern not only the diagnostic and therapeutic process, but also patient care in order to fully rehabilitate the patient.

Nursing was first defined by world-famous nurse Florence Nightingale. In her famous Notes on Nursing in 1859, she wrote that nursing is "the act of using the patient's environment to promote his recovery."

Currently, nursing is an integral part of the health care system. It is a multifaceted medical and sanitary discipline and has medical and social significance, since it is designed to maintain and protect the health of the population.

In 1983, the First All-Russian Scientific and Practical Conference dedicated to the theory of nursing was held in Golitsino. During the conference, nursing was considered as part of the health system, a science and art that are aimed at solving existing and potential problems related to the health of the population in an ever-changing environment.

According to international agreement, the conceptual model of nursing is a structure based on the philosophy of nursing, which includes four paradigms: nursing, personality, environment, health.

The concept of personality occupies a special place in the philosophy of nursing. The object of the nurse's activity is the patient, a person as a set of physiological, psychosocial and spiritual needs, the satisfaction of which determines the growth, development and merging of it with the environment.

The sister has to work with different categories of patients. And for each patient, the sister creates an atmosphere of respect for his present and past, for his life values, customs and beliefs. It takes the necessary safety measures for the patient if his health is in danger from employees or other people.

The environment is considered as the most important factor influencing human life and health. It includes a set of social, psychological and spiritual conditions in which human life takes place.

Health is considered not the absence of disease, but as a dynamic harmony of the individual with the environment, achieved through adaptation.

Nursing is a science and art aimed at solving existing problems related to human health in a changing environment.

The philosophy of nursing establishes the basic ethical responsibilities of professionals in the service of the individual and society; goals that a professional strives for; the moral character, virtues, and skills expected of practitioners.

The basic principle of the philosophy of nursing is respect for human rights and dignity. It is realized not only in the nurse's work with the patient, but also in her cooperation with other specialists.

The International Council of Nurses has developed a code of conduct for nurses. According to this code, the fundamental responsibility of nurses has four main aspects: 1) the promotion of health, 2) the prevention of disease, 3) the restoration of health, 4) the alleviation of suffering. This code also defines the responsibility of nurses to society and colleagues.

In 1997, the Russian Association of Nurses adopted the Code of Ethics for Nurses in Russia. The principles and norms that make up its content specify the moral guidelines in professional nursing activities.

II.Main part

1. The concept of the nursing process (theoretical part)

The nursing process is one of the basic concepts of modern models of nursing. In accordance with the requirements of the State Educational Standard for Nursing, the nursing process is a method of organizing and performing nursing care for a patient, aimed at meeting the physical, psychological, social needs of a person, family, and society.

The purpose of the nursing process is to maintain and restore the independence of the patient, the satisfaction of the basic needs of the body.

The nursing process requires from the sister not only good technical training, but also a creative attitude to patient care, the ability to work with the patient as a person, and not as an object of manipulation. The constant presence of the sister and her contact with the patient make the sister the main link between the patient and the outside world.

The nursing process consists of five main steps.

1. Nursing examination. Collection of information about the patient's health status, which can be subjective and objective.

The subjective method is physiological, psychological, social data about the patient; relevant environmental data. The source of information is a survey of the patient, his physical examination, the study of medical records, a conversation with the doctor, the patient's relatives.

An objective method is a physical examination of the patient, including the assessment and description of various parameters (appearance, state of consciousness, position in bed, the degree of dependence on external factors, the color and moisture of the skin and mucous membranes, the presence of edema). The examination also includes measuring the patient's height, determining his body weight, measuring temperature, counting and evaluating the number of respiratory movements, pulse, measuring and evaluating blood pressure.

The end result of this stage of the nursing process is the documentation of the information received, the creation of a nursing history, which is a legal protocol - a document of the nurse's independent professional activity.

2. Establishing the patient's problems and formulating a nursing diagnosis. The patient's problems are divided into existing and potential. Existing problems are those problems that the patient is currently concerned about. Potential - those that do not yet exist, but may arise over time. Having established both types of problems, the nurse determines the factors that contribute to or cause the development of these problems, also reveals the strengths of the patient, which he can counter the problems.

Since the patient always has several problems, the nurse must establish a system of priorities. Priorities are classified as primary and secondary. Problems that are likely to have a detrimental effect on the patient in the first place have priority.

The second stage ends with the establishment of a nursing diagnosis. There is a difference between medical and nursing diagnosis. Medical diagnosis focuses on recognizing pathological conditions, while nursing is based on describing the reactions of patients to health problems. The American Nurses Association, for example, identifies the following as the main health problems: limited self-care, disruption of the normal functioning of the body, psychological and communication disorders, problems associated with life cycles. As nursing diagnoses, they use, for example, phrases such as “lack of hygiene skills and sanitary conditions”, “decrease in individual ability to overcome stressful situations”, “anxiety”, etc.

3. Determining the goals of nursing care and planning nursing activities. The nursing care plan should include operational and tactical goals aimed at achieving certain long-term or short-term results.

When forming goals, it is necessary to take into account the action (execution), criterion (date, time, distance, expected result) and conditions (with the help of what and by whom). For example, "the goal is for the patient to get out of bed by January 5 with the help of a nurse." Action - get out of bed, the criterion is January 5, the condition is the help of a nurse.

Once the goals and objectives of care have been established, the nurse prepares a written care guide that details the nurse's special care activities to be recorded in the nursing record. nursing process thyroid gland

4. Implementation of the planned actions. This stage includes the measures taken by the nurse for the prevention of diseases, examination, treatment, rehabilitation of patients.

doctor's orders and under his supervision. Independent nursing intervention refers to actions taken by the nurse on her own initiative, guided by her own considerations, without a direct request from the doctor. For example, teaching the patient hygiene skills, organizing patient leisure, etc.

Interdependent nursing intervention involves the joint activities of a sister with a doctor, as well as with other specialists.

In all types of interaction, the sister's responsibility is exceptionally great.

5. Evaluation of the effectiveness of nursing care. This stage is based on the study of the patients' dynamic responses to the nurse's interventions. The sources and criteria for evaluating nursing care are the following factors for assessing the patient's response to nursing interventions; assessment of the degree of achievement of the goals of nursing care are the following factors: assessment of the patient's response to nursing interventions; assessment of the degree of achievement of the goals of nursing care; assessment of the effectiveness of the impact of nursing care on the patient's condition; active search and evaluation of new patient problems.

An important role in the reliability of the assessment of the results of nursing care is played by the comparison and analysis of the results obtained.

Therapeutic nutrition for endemic goiter

The main etiological factor of endemic goiter is insufficient intake of iodine due to its low content in soil, water and, consequently, food in some areas (Western Ukraine, Belarus, Uzbekistan, Russia (Karelia, the upper reaches of the Volga River, Mari El, Ural , Central and North Caucasus, Kyrgyzstan, Transbaikalia).

The development of this disease contributes to insufficient, monotonous, unbalanced nutrition (depleted in protein, vitamins, predominantly carbohydrate, with a sufficient or excess fat content).

Diet therapy is built depending on the functional state of the thyroid gland. With its normal function, diet No. 15 is indicated. With increased thyroid function, the recommendations indicated for diffuse toxic goiter should be followed. For patients whose goiter proceeds with reduced thyroid function, a diet recommended for patients with hypothyroidism is shown. It is especially important to introduce a sufficient amount of iodine into the body. For this purpose, it is necessary to use iodized salt (contains 25 g of potassium iodide per 1 ton of sodium chloride) and foods rich in iodine (dishes from sea and ocean fish, crabs, shrimp, squid, sea kale).

There are indications of the goitrogenic effect of certain products (cabbage, radish, swede, turnip, dill, walnuts), and therefore it is advisable to limit their use.

Treatment of endemic goiter

The main method of treatment of endemic goiter is the use of thyroid drugs. They inhibit the release of thyrotropin on the feedback principle, reducing the size of the thyroid gland. These drugs also reduce autoimmune reactions in the thyroid gland, are a means of preventing hypothyroidism and malignancy in patients with euthyroid goiter and a means of replacement therapy in the development of hypothyroidism.

Indications for the appointment of thyroid drugs in endemic goiter:

diffuse euthyroid goiter 1c-2-3 st. increase (according to some endocrinologists - 1a-2-3 st.);

hypothyroidism in a patient with any form and with any degree of enlargement of the thyroid gland (for the treatment method, see the chapter “Treatment of hypothyroidism”)

For the treatment of endemic goiter, L-thyroxine, triiodothyronine, thyrotom, thyrotom-forte are used.

L-thyroxine is prescribed initially at 50 mcg per day in the morning before meals (if dyspeptic symptoms appear after meals). In the absence of symptoms of drug-induced hypothyroidism (sweating, tachycardia, a feeling of irritability of heat), after 4-5 days, you can gradually increase the dose and bring it to the optimum - 100-200 mcg per day. The drug should be administered mainly in the morning.

The initial dose of triiodothyronine is 20 mcg 1-2 times a day (in the first half of the day), then every 5-7 days, with good tolerance and the absence of drug-induced hyperthyroidism, the dose can be gradually increased and brought to 100 mcg per day.

Thyrotomy treatment (1 tablet contains 10 μg T3 and 40 μg T4) begins with ½ tablet per day (in the morning), then gradually increase the dose every week and bring it up to 2 tablets per day.

Tireotom-forte (1 tablet contains 30 µg T3 and 120 µg T4) is initially prescribed for 1/2 tablet per day, then, if well tolerated, the dose of the drug is increased to 1-11/2 tablets per day.

Thyreocomb is used less frequently in the treatment of endemic goiter. 1 tablet of thyreocomb contains 10 micrograms of T3, 70 micrograms of T4 and 150 micrograms of potassium iodide. The initial dose of the drug is 1/2 tablet per day, then the dose gradually increases every 5-7 days and is brought to the optimum (1-2 tablets per day). Taking into account the presence of potassium iodide in the thyrocomb and in order to avoid an overdose of iodine leading to iodine-Basedowism, it is advisable to treat with thyreocomb in courses of 2-3 months with interruptions for the same period.

Treatment of patients with endemic goiter with thyroid drugs lasts a long time - for 6-12 months, depending on the dynamics of the size of the thyroid gland.

During treatment with thyroid drugs every 3 months, follow-up examinations of the patient with a change in the circumference of the neck, ultrasound of the thyroid gland, palpation of the goiter should be carried out. With a decrease in goiter, the dose of thyroid drugs can be reduced.

In recent years, there have been reports of the possibility of treating diffuse euthyroid goiter with potassium iodide. The drug is produced by Berlin-Chemie in tablets containing 262 μg of potassium iodide in 1 tablet, which corresponds to 200 μg of iodine.

According to the company's instructions, the dosages of potassium iodide are as follows:

newborns, children and adolescents - 1 / 2-1 tablet per day (i.e. 100-200 mcg of iodine);

young adults - 1 1/2-2 1/2 tablets per day (i.e. 300-500 micrograms of iodine).

Treatment of goiter in newborns is usually 2-4 weeks. Treatment of goiter in children, adolescents and adults lasts for 6-12 months or longer.

It is believed that the above doses of potassium iodide do not cause the Wolf-Caikoff effect (i.e., it does not cause inhibition of the organization of iodine in the thyroid gland, its absorption and does not disrupt the synthesis of thyroid hormones). This effect develops only when prescribing doses of iodine over 1 mcg per day.

In endemic goiter with hyperthyroidism, optimal doses of thyroid drugs are prescribed to compensate, but these doses are reached gradually, especially in the elderly.

Treatment of hypothyroidism is carried out with thyroid drugs for life.

Treatment of hypothyroidism

Hypothyroidism is a syndrome of insufficient provision of the body with thyroid hormones.

Depending on the cause, the following forms of the disease are distinguished: primary, secondary, tertiary, peripheral, mixed, congenital, acquired.

Primary hypothyroidism is an insufficient production of thyroid hormones due to various pathological processes in the gland itself. This form of hypothyroidism is the most common and accounts for 90-95% of all cases of underactive thyroid.

Secondary hypothyroidism is an insufficient function of the thyroid gland due to a violation of the formation or secretion of thyroid-stimulating hormone by the adenohypophysis.

Tertiary hypothyroidism is an insufficient function of the thyroid gland due to damage to the hypothalamus and a decrease in thyreoliberin secretion.

Peripheral form of hypothyroidism is hypothyroidism associated with inactivation of thyroid hormones during circulation or due to a decrease in the sensitivity of cell receptors of thyroid-dependent organs and tissues to thyroxine and triiodothyronine during normal biosynthesis and secretion of thyroid hormones.

Etiological treatment

Etiological treatment of hypothyroidism is not always possible and is almost ineffective. In rare cases, etiological treatment can have a positive effect. So timely anti-inflammatory therapy in infectious and inflammatory lesions of the hypothalamic-pituitary region can lead to the restoration of the thyrotropic function of the pituitary gland. Drug-induced hypothyroidism may be reversible.

Replacement therapy with thyroid drugs

The main methods of treatment of primary, secondary and tertiary hypothyroidism are replacement therapy with thyroid hormones and preparations containing them.

The following thyroid drugs are used.

Thyreoidin (dried thyroid gland of animals) - available in tablets of 0.05 and 0.1 g. The iodine content in thyroidin ranges from 0.1 to 0.23%. The content of T3 and T4 in thyroidin depends on which animal it is derived from the thyroid gland. In thyroidin obtained from the pig thyroid gland, the ratio of T4 and T3 is (2-3): 1, in cattle - 3: 1, in sheep - 4.5: 1. Approximately 0.1 g of thyroidin contains 8-10 mcg T3 and 30-40 mcg T4.

L-thyroxine (euthyrox) is the sodium salt of left-handed thyroxine, available in tablets of 50 and 100 mcg. The action of L-thyroxine after oral administration is manifested after 24-48 hours, the half-life is 6-7 days.

Triiodothyronine - is available in tablets of 20 and 50 mcg. The action of triiodothyronine begins 4-8 hours after ingestion, the maximum effect occurs on the 2nd-3rd day, the drug is completely eliminated from the body after 10 days.

When taking triiodothyronine, 80-100% of the drug is absorbed orally, triiodothyronine has 5-10 times greater biological activity than thyroxine.

Tireotome - 1 tablet of the drug contains 40 mcg T4 and 10 mcg T3.

Thyreotom-forte - 1 tablet of the drug contains 120 mcg T4 and 30 mcg T3.

Thyreocomb - 1 tablet of the drug contains 70 micrograms of T4, 10 micrograms of T3 and 150 micrograms of potassium iodide.

The main principles of treatment of hypothyroidism with thyroid drugs are:

replacement therapy with thyroid drugs is carried out throughout life, with the exception of transient forms of hypothyroidism (with an overdose of thyreostatic drugs during the treatment of toxic goiter or in the early postoperative period after subtotal resection of the thyroid gland);

selection of doses of thyroid drugs should be done gradually and carefully, taking into account the age of patients, concomitant diseases, the severity of hypothyroidism and the duration of its treatment. The more severe the hypothyroidism and the longer the patients were without replacement therapy, the higher the sensitivity of the body (especially the myocardium) to thyroid drugs;

in the treatment of elderly patients with concomitant coronary artery disease, the initial doses of thyroid drugs should be minimal and their increase should be done slowly, under ECG control. Large doses of drugs and a rapid increase in doses can cause an exacerbation of coronary artery disease, the development of painless myocardial ischemia is possible;

the appointment of the next dose is made after the manifestation of the full effect of the previous dose (for the manifestation of the full effect of T3, 2-2.5 weeks are required, T4 - 4-6 weeks).

The drug of choice in the treatment of hypothyroidism is L-thyroxine due to the following circumstances:

the negative cardiotropic effect of L-thyroxine is much less pronounced than that of triiodothyronine and preparations containing it;

the constant conversion of thyroxine to triiodothyronine ensures minimal fluctuations in the blood level of triiodothyronine, a biologically more active hormone.

The initial dose of L-thyroxine in most cases is 1.6 mcg / kg 1 time per day (average 100-125 mcg per day. Given the possibility of painless myocardial ischemia, elderly patients are prescribed L-thyroxine 25-50 mcg 1 time per day.

The daily dose of the drug should be increased gradually, by 25-50 mcg every 4 weeks, until the thyroid insufficiency is fully compensated. Treatment is carried out under the control of the level of T4 and TSH in the blood and the dynamics of clinical manifestations. The level of TSH in primary hyperthyroidism is elevated and slowly normalizes during treatment of hypothyroidism.

Typically, the dose of thyroxine required to achieve euthyroidism is 150-200 mcg per day. However, this dose may not be the same for all patients. The dose of thyroxin, providing a euthyroid state, is individual and may differ significantly from that indicated.

Monotherapy with triiodothyronine has not become widespread due to a more pronounced negative cardiotropic effect (especially in the elderly) compared with thyroxine, and also because more frequent doses are needed to ensure a stable level of triiodothyronine in the blood.

Many endocrinologists use the method of combined treatment with triiodothyronine and thyroidin.

The initial doses of triiodothyronine are 2-5 mcg, thyroidin - 0.025-0.05 g. Then the dose of triiodothyronine is increased every 3-5 days by 2-5 mcg and thyroidin - by 0025-0.05 g every 7-10 days until the optimal dose is reached, causing euthyroid condition. This dose, of course, is individual and can reach 0.2-0.25 g for thyroidin, and 50 mcg for triiodothyronine. Sometimes these doses can be even higher.

It is believed that 25 micrograms of triiodothyronine is equivalent to 100 micrograms of thyroxine in terms of its effect on the myocardium.

In the absence of thyroxin, for the replacement therapy of hypothyroidism, you can use combined preparations - thyreocomb, thyreot, thyreot-forte. The initial dose of these drugs is ? -1/2 tablets 1 time per day. Further increase in doses is done slowly - by? -1/2 tablets 1 time in 1-2 weeks until the optimal dose is reached (it can reach 1-2 tablets per day, sometimes more).

Thyroidin monotherapy is currently rarely used. This is due to the unstable composition of the drug, as well as its poor absorption by the gastrointestinal mucosa (in the intestine, thyroidin is first hydrolyzed and only then the T3 and T4 contained in it are absorbed into the blood). In addition, thyroidin contains thyroglobulin and other antigenic structures that may promote thyroid autoimmunity.

However, in the absence of other thyroid hormone preparations, thyroidin replacement therapy has to be carried out. The initial dose of thyroidin for young and middle-aged people is 0.05 g, and for the elderly - 0.025 g. Every 3-5 days, the dose is gradually increased, bringing it to the optimum (0.15-0.2 g per day, rarely more).

In the presence of IHD, thyroidin is prescribed at 0.02 g, increasing the dose every week by 0.01 g. At the same time, drugs that improve coronary circulation and metabolic processes in the myocardium should be prescribed.

Features of the treatment of hypothyroidism in patients with concomitant coronary artery disease

Against the background of treatment with thyroid drugs in patients with coronary artery disease, angina attacks may become more frequent, blood pressure may increase, tachycardia may develop, and various arrhythmias are possible. There are described cases of myocardial infarction in patients with coronary artery disease in the treatment of thyroid drugs.

Rules for the treatment of hypothyroidism in patients with concomitant coronary artery disease:

treatment of hypothyroidism should begin with minimal doses of thyroid drugs and slowly increase them to optimal doses that cause a euthyroid state;

preference among all thyroid drugs should be given to L-thyroxine as the least cardiotoxic;

treatment with thyroid drugs and especially an increase in their dose should be carried out under the control of blood pressure, heart rate, ECG;

the ability of thyroid drugs to enhance the effect of anticoagulants should be taken into account;

with the development of myocardial infarction, it is necessary to cancel thyroid drugs for several days, followed by their appointment at a lower dose.

Treatment of congenital hypothyroidism

In the treatment of congenital hypothyroidism, the following doses of L-thyroxine are recommended: at the age of 1-6 months - 25-50 mcg per day, at the age of 7-12 months 50-75 mcg per day, at the age of 2-5 years - 75-100 mcg per day day, at the age of 6-12 years - 100-150 mcg per day, at the age of over 12 years - 150 mcg per day.

Treatment of secondary hypothyroidism

In the treatment of patients with secondary hypothyroidism, thyrotropin preparations are almost never used, since they have allergenic properties. These drugs produce antibodies that reduce their effectiveness.

The main treatment for secondary hypothyroidism is also thyroid replacement therapy. The principles of treatment are the same as for primary hypothyroidism, however, it should be noted that secondary hypothyroidism is often combined with hypocorticism due to insufficient production of corticotropin and a rapid increase in the dose of thyroid hormones can cause acute adrenal insufficiency. In this regard, replacement therapy with thyroid drugs in the first 2-4 weeks should be accompanied by taking small doses of prednisolone (5-10 mg per day), especially in severe hypothyroidism.

In rare cases of secondary not advanced hypothyroidism (tumor of the hypothalamic-pituitary zone, infectious and inflammatory process in this zone), etiological treatment (radiation therapy, anti-inflammatory treatment) can lead to recovery.

In the treatment of tertiary hypothyroidism, thyreoliberin treatment has not been widely used, and the basis of therapy is the use of thyroid drugs.

In addition to replacement therapy with thyroid drugs, patients with hypothyroidism should receive multivitamin complexes, it is also necessary to correct lipid metabolism disorders and take drugs that improve the functional state of the brain (piracetam, nootropil).

Hypothyroidism is treated for life. After selecting the optimal dose of a hormonal drug, the patient should be examined annually, while the blood levels of thyroid hormones and thyrotropin are mandatory. The optimal dose of thyroxine is considered to be one that provides a euthyroid state and a normal level of thyrotopin in the blood. Usually it is 100-200 mcg of thyroxine or 2-4 tablets of thyrotom or 1.5-2.5 tablets of thyreocomb per day.

With long-term therapy with thyroid drugs, their tolerance may improve in patients, moreover, with age, the need for thyroid drugs decreases somewhat. However, the doctor should constantly pay attention to the possibility of side effects of thyroid drugs, which is most likely with an overdose:

tachycardia, cardiac arrhythmia, exacerbation of coronary artery disease;

arterial hypertension;

dyspepsia and epigastric pain.

In the treatment of peripheral forms of hypothyroidism, the use of plasmapheresis and hemosorption is currently recommended, which in some cases makes it possible to remove antithyroid antibodies from the blood and restore tissue sensitivity to thyroid hormones.

Clinical examination

Dispensary observation of patients with hypothyroidism is carried out by an endocrinologist for life.

The tasks of dispensary observation are, first of all, the selection of an adequate, well-tolerated dose of thyroid drugs and the provision of a euthyroid state.

Treatment on an outpatient basis is carried out for mild to moderate hypothyroidism. Patients with severe hypothyroidism and patients with hypothyroidism complicated by severe concomitant diseases (hypertension, coronary artery disease, etc.) are subject to hospitalization.

The patient is examined by an endocrinologist and a therapist 3-4 times a year. During visits to the doctor, a general blood and urine test is performed, a blood test for cholesterol, triglycerides, b-lipoproteins, glucose, and an ECG is recorded. It is necessary to constantly monitor the patient's body weight, 2 times a year the blood content of T3, T4, antibodies to thyroglobulin, cortisol, thyroid-stimulating hormone is determined. The results of these studies are taken into account when choosing the dose of thyroid drugs.

During dispensary observation, the issue of the patient's ability to work is resolved. Patients with mild to moderate severity of hypothyroidism with timely started and adequately carried out substitution therapy restore their ability to work, but heavy physical labor and work associated with being outdoors in the cold season should be avoided.

In severe hypothyroidism, a significant decrease in working capacity is possible, especially among intellectual workers.

Conclusion

Implementation of the nursing process:

Helps to prioritize care priorities and expected outcomes from a range of existing needs. Priority problems are safety problems (operational, infectious, psychological); problems associated with pain, temporary or permanent dysfunction of organs and systems; problems associated with the preservation of dignity, since in no other field of medicine is the patient so defenseless as in the surgical department during the operation.

Determines the nurse's action plan, a strategy aimed at meeting the needs of the patient, taking into account the characteristics of the pathology.

Ensures quality of care that can be monitored. It is in surgery that the application of intervention standards is most significant.

Literature

1.A.N. Okorokov. Treatment of diseases of internal organs. Vitebsk 1998

2. Smoleva E.V. Nursing in Therapy with Primary Care Course

3.Standards of practical activity of a nurse in Russia, volume I - II

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Thyroid diseases

The thyroid gland is one of the most important organs of the human body and produces vital hormones: thyroxine (T3) and triiodothyronine (T4). They are responsible for metabolism, thermoregulation and have a direct impact on most organs and systems.

The thyroid gland, one of the endocrine glands, is subject to certain diseases. They are caused by a number of reasons, for example: lack of iodine, unfavorable environment, congenital anomalies, inflammatory and autoimmune diseases.

All diseases of this organ can be conditionally divided into 2 large groups. In some cases, the function of the gland decreases, and it produces an insufficient amount of hormones. This condition is called hypothyroidism. Or, on the contrary, iron produces an excessive amount of hormones and poisons the body. Then we talk about hyperthyroidism.

Hypothyroidism is a rather unsafe condition that can lead to very serious consequences, especially if a child suffers from it. After all, the lack of thyroid hormones leads to mental retardation and even the occurrence of cretinism. Therefore, many countries of the world are very actively carrying out the prevention of this condition.

Care for Hypothyroidism

Hypothyroidism is a pathological condition in which the amount of hormones produced is significantly reduced. It can be caused by inflammatory diseases in the gland, lack of iodine in food and water, congenital aplasia of the gland, removal of most of it, or an overdose of certain drugs (for example, Mercazolil).

The condition is diagnosed with blood tests, ultrasound, and other thyroid tests.

With hypothyroidism, an important role in the treatment is given to the nurse. Caring for such patients requires special patience, because the dysfunction of this organ is almost primarily reflected in the mental state of the patient. Here are the functions that a nurse performs:

Continuous monitoring of pulse rate, blood pressure, body temperature, stool frequency.
Controlling the patient's weight. Be sure to weigh yourself weekly.
Recommendations for diet therapy. Such patients are forbidden to consume animal fats and are recommended to eat foods rich in fiber. This is due to a slowdown in metabolism.
Teaching relatives of patients how to communicate with them.
Organization of hygiene procedures, ventilation of the premises.

Since patients with hypothyroidism often feel cold, the nurse must ensure a comfortable room temperature or use heating pads, warm clothes and blankets.

Diffuse toxic goiter

Diffuse toxic goiter is a pathology that is caused by the fact that the thyroid gland produces too much hormones T3 and T4. This leads to the fact that metabolic processes in the body are greatly accelerated, which ultimately leads to disruption in the work of many organs and systems.

This disease has a long course, so the nursing process in diffuse toxic goiter is especially important. Here are the functions that a nurse performs:

It creates conditions for a good rest of patients, provides their psychological comfort.
Constantly monitors blood pressure, pulse rate, stool.
Monitors the nutrition of the patient. Performs weekly weigh-ins.
Monitors patient body temperature and room temperature. If necessary, uses heating pads and warm blankets.
Creates a favorable microclimate around the patient, trains relatives to care for such a patient.

Patients with diffuse toxic goiter are very irritable, tearful, conflicted. Therefore, a sister in this case requires a lot of patience and tact.

It is the nurse who should monitor the implementation of all the recommendations of the doctor and teach relatives the basics of patient care.

As can be seen, the nursing process in diseases of the thyroid gland plays almost a key role in the recovery of the patient. It is extremely important for the patient to follow all the recommendations of the medical staff and make every effort to overcome their illness.

Nursing process in diffuse toxic goiter. Diffuse toxic goiter (Graves' disease, thyrotoxicosis) is a disease characterized by increased secretion of thyroid hormones.
The main importance in the etiology of the disease is given to hereditary predisposition. In the occurrence of the disease are also important: trauma, infection (tonsillitis, influenza, rheumatism). solar radiation, pregnancy and childbirth, organic lesions of the central nervous system (CNS), diseases of other endocrine glands.
The main clinical manifestations of the disease are: an increase in the thyroid gland, increased excitability, irritability. tearfulness. The behavior of the patient, his character changes: fussiness, haste, resentment, hand tremor appear.
Complaints and anamnesis during questioning are presented by the patient poorly, often he fixes attention on trifles and misses important symptoms. Patients often complain of excessive sweating, poor heat tolerance, subfebrile temperature, trembling of the extremities, and sometimes of the whole body, sleep disturbance. significant and rapid weight loss with good appetite. Often there are changes in the cardiovascular system: palpitations, shortness of breath, aggravated by physical exertion, interruptions in the region of the heart. Women often experience menstrual irregularities. On examination, the patient's appearance is noteworthy: the facial expression often takes on an "angry" or "frightened" look due to eye symptoms, and primarily due to exophthalmos (bulging eyes) and rare blinking. Greffe's symptom appears (lag of the upper eyelid when the eyes are lowered, while a white strip of sclera is visible) and Moebius's symptom (loss of the ability to fix objects at close range), eye shine and lacrimation. Patients may complain of pain in the eyes, sensation of sand, foreign body, double vision. On the part of the cardiovascular system, there is a pronounced tachycardia up to 120 beats. min, possible atrial fibrillation, increased blood pressure.

Nursing process in diffuse toxic goiter:
Patient problems:
A. Existing (real):
- irritability;
- tearfulness:
- resentment:
- palpitations, interruptions in the region of the heart:
- shortness of breath; pain in the eyes;
- weight loss:
- increased sweating;
- trembling of the limbs;
- weakness, fatigue;
- sleep disturbance;
- poor heat tolerance.
B. Potential:
- the risk of developing a "thyrotoxic crisis";
- "thyrotoxic heart" with symptoms of circulatory failure;
- fear of the possibility of surgical treatment or treatment with radioactive iodine.
Collection of information during the initial examination:
Collecting information from a patient with diffuse toxic goiter sometimes causes difficulties due to the peculiarities in her behavior and requires tact and patience from the nurse when talking with him.
A. Questioning the patient about:
- the presence of diseases of the thyroid gland in the next of kin;
- previous diseases, traumas of the central nervous system; features of professional activity; connection of the disease with psychotrauma;
- the patient's attitude to sun exposure, tanning:
- the duration of the disease;
- observation by an endocrinologist and the duration of the examination, its results (when and where was the last examination);
- medicines used by the patient (vine, regularity and duration of administration, tolerability);
- for women, find out if the manifestation of the disease is associated with pregnancy or childbirth, and if there are any menstrual irregularities;
- complaints of the patient at the time of the examination.
B. Examination of the patient:
- pay attention to the appearance of the patient, the presence of eye symptoms, tremor of the hands, body;
- inspect the neck area;
- assess the condition of the skin;
- measure body temperature;
- determine the pulse and give it a characteristic;
- measure blood pressure;
- determine body weight.
Nursing interventions, including work with the patient's family:
1. Provide physical and mental rest to the patient (it is desirable to place him in a separate room).
2. Eliminate annoying factors - bright light, noise, etc.
3. Observe deontological principles when communicating with a patient.
4. Have a conversation about the essence of the disease and its causes.
5. Recommend a full-fledged diet with a high content of protein and vitamins, with a restriction of coffee, strong tea. chocolate, alcohol.
6. Recommend wearing lighter and looser clothing.
7. Ensure regular ventilation of the room.
8. Inform about the medicines prescribed by the doctor (dose, usage patterns, side effects, tolerability).
9. Control:
- adherence to the regimen and diet;
- body weight;
- frequency and rhythm of the pulse;
- arterial pressure;
- body temperature;
- the condition of the skin;
- taking medications prescribed by a doctor.
10. Prepare the patient for additional research methods: a biochemical blood test, a test for the accumulation of radioactive iodine by the thyroid gland, and scintigraphy. ultrasound.
11. Conduct a conversation with the patient's relatives, explaining to them the reasons for changes in the patient's behavior, reassure them, recommend being more attentive and tolerant with the patient.

1.1 Clinical picture of hypothyroidism

Hypothyroidism in adults was first described at the end of the 19th century (1873) by Gall. The disease has long been referred to as "myxedema", less often - Gall's disease. The term hypothyroidism began to be used after the relationship between the symptom complex "myxedema" and thyroid insufficiency was established.

Hypothyroidism is currently defined as a clinical syndrome caused by insufficient production of thyroid hormones due to dysfunction of one or more parts of the hypothalamic-pituitary-thyroid system. Depending on the level of damage, primary, secondary and tertiary hypothyroidism is distinguished. Primary hypothyroidism is caused by damage to the thyroid gland itself, with secondary hypothyroidism, the pathological process is localized in the pituitary gland, with tertiary hypothyroidism, in the hypothalamus. The last two forms are commonly referred to as hypothyroidism of central origin (hypothalamic-pituitary or secondary).

1.2 Diagnosis of hypothyroidism

Laboratory diagnosis of hypothyroidism syndrome is quite simple and involves, if a decrease in thyroid function is suspected, a hormonal study, primarily the determination of the level of TSH in the blood serum, and in some cases the level of free T4. However, hypothyroidism is not always manifested by bright clinical symptoms, in a significant number of cases there are "monosymptomatic" forms of the disease, which distracts the doctor from the correct assessment of the general condition of the patient and may cause an erroneous diagnosis of alimentary obesity, anemia, biliary dyskinesia, renal disease, accompanied by edematous syndrome, depression, coronary heart disease with symptoms of heart failure, amenorrhea, infertility, etc. Therefore, the diagnosis of hypothyroidism in some cases encounters significant difficulties, and patients can be observed for a long time by a cardiologist, nephrologist, gynecologist, psychiatrist and doctors of other specialties for various somatic diseases. The reason for conducting a hormonal study in these cases may be the lack of the expected therapeutic effect from traditional therapeutic measures. The detection of certain clinical symptoms, such as bradycardia, poor cold tolerance, dry skin, and constipation, can help to suspect hypothyroidism in these patients. If there is a suspicion of hypothyroidism, it is sufficient to determine only the level of TSH in the blood serum, which is the most sensitive indicator of the functional state of the thyroid gland.

1.3 General principles for the treatment and prevention of hypothyroidism

Treatment of both primary and secondary hypothyroidism involves lifelong replacement therapy with thyroid hormone preparations, which ensures the normalization of thyroid hormonal status and a good quality of life for patients. For a long time, preparations containing powder of the dried thyroid gland of slaughter cattle, in particular, thyroidin, were used for therapeutic purposes, although their use did not guarantee an accurate dosage of thyroid hormones in the patient's blood and created certain difficulties in carrying out therapeutic measures. All of the above, as well as the threat to the health and life of a patient taking drugs from the organs of slaughtered cattle, carrying the risk of transmitting virus-like prion particles (similar to causative agents of spongiform encephalitis) were the basis for a ban on their use in medical practice.

2.1 Analysis of the activities of the therapeutic department

Murmansk City Clinical Emergency Hospital is one of the largest medical institutions in the Murmansk region. The hospital operates 24 hours a day, 7 days a week, 365 days a year. More than 300 thousand people live in its service area. Of these, more than 14,000 people become hospital patients annually, 85% of them are delivered for emergency reasons. More than 1,300 employees are ready to immediately provide highly qualified assistance in 20 profiles. At the same time, more than 580 people receive treatment in the hospital. The hospital consists of more than 50 structural units, whose employees, working in close cooperation, ensure the continuity of the treatment and diagnostic process, which in many ways is the key to successful treatment of patients.

2.2 The role of the nurse in the treatment process for hypothyroidism

The nurse should be more responsive to the needs of the population than to the needs of the health system. It must transform itself into a well-educated professional, an equal partner, independently work with the population, contributing to the strengthening of the health of society. It is the nurse who is now assigned a key role in medical and social assistance to the elderly, patients with incurable diseases, health education, organization of educational programs, and promotion of a healthy lifestyle.

2.3 Assessing the effectiveness and quality of nursing care for patients with hypothyroidism

In order to study the satisfaction of patients with the quality of nursing care at the department, a sociological study was conducted in the form of a questionnaire. To conduct the survey, an author's questionnaire was developed (Appendix K), consisting of 15 questions with suggested answers, which were divided into two blocks. The first block of the questionnaire (6 questions) is devoted to characterizing the characteristics of patients.

CONCLUSION

Thyroid diseases are one of the most common forms of human pathology. In recent years, a significant increase in the frequency of thyroid diseases has been noted in many regions of Russia, which is associated with environmental degradation, insufficient iodine intake, negative changes in the population's diet, and an increase in the frequency of autoimmune diseases. Hypothyroidism occupies one of the leading places in the structure of thyroid pathology in terms of frequency and social significance.

Hypothyroidism is a clinical syndrome caused by a lack of thyroid hormones in the body or a decrease in their biological effect at the tissue level.

Having considered in our work the activities of the therapeutic department, which includes endocrinological beds, we came to the conclusion that the amount of congenital hypothyroidism has not changed over the analyzed period of time.

APPENDIX A

Table A.1 - Branch states

APPENDIX B

Table B.1 - Department performance indicators

APPENDIX B

Table B.1 - Structure of hospitalized patients by nosological forms in 2013.

APPENDIX D

Table D.1 - Structure of hospitalized patients by nosological forms in 2014

APPENDIX D

Table E.1 - Nursing care plan for a patient with hypothyroidism

APPENDIX E

Table E.1 - Structure of patients by age and sex

APPENDIX G

Table G.1 - Factors that determine the well-being and state of health of respondents

APPENDIX AND

Table I.1 - The opinion of patients on the importance of the qualities of nurses that they should possess

APPENDIX K

Questionnaire for patients

As part of the ongoing research, we ask you to fill out a questionnaire dedicated to assessing patient satisfaction with the quality of medical care in the department.

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