Which action does the nurse take to provide improved care for a patient with hypothyroidism?

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

• Inform the patient this test can assist in evaluating thyroid function.
• Explain that a blood sample is needed for the test.

Filter Paper Test (Neonate)

• A kit is obtained to complete the testing.
• The heel is cleansed with antiseptic.
• A heel stick is performed by gently squeezing the infant’s heel and touching the filter paper to the puncture site. Gauze is used to completely dry the stick area.
• When collecting samples for newborn screening, it is important to apply each blood drop to the correct side of the filter paper card and fill each circle with a single application of blood. Overfilling or underfilling the circles will cause the specimen card to be rejected by the testing facility.
• Testing facility regulations usually require the specimen cards to be submitted within 24 hr of collection.
• Additional information is required on newborn screening cards and may vary by testing facility.
• Newborn screening cards should be allowed to air dry for several hours on a level, nonabsorbent, unenclosed area. If multiple patients are tested, do not stack cards.

After the Study: Potential Nursing Actions

Treatment Considerations

• Thought Process (altered): Minimize apprehension and dread. Collaborate with the health-care provider (HCP) to manage medical problem associated with decreased cerebral perfusion. Promote comprehension and understanding of current events. Provide a modified environment that promotes safety. Monitor the ability to provide self-care (activities of daily living), monitor injury risk (violence, fall risk, self-harm risk), and administer ordered thyroid hormone replacement medication.
• Cardiac Output (decreased): Assess and trend vital signs. Monitor and trend thyroid laboratory studies: TSH, T3, T4, and radioactive iodine uptake. Assess cardiac status indicators: peripheral pulses; skin color; skin temperature; dry, scaly skin; and periorbital edema. Administer ordered thyroid hormone replacement medication. Facilitate measures to improve patient warmth: blankets, warm clothing and liquids, and warmer environment. Pace activity and schedule rest periods to manage fatigue. Use pulse oximetry to monitor oxygen saturation. Assess respiratory status checking for crackles and increased respiratory rate, and monitor for fluid overload.

Nutritional Considerations

• Discuss how to avoid foods with high sodium, saturated fat, and cholesterol content.
• Discuss how eating a diet high in protein and low in calories to promote weight loss.
• Encourage eating small, frequent meals to prevent overeating and enhance weight management;
• Encourage the consumption of high-fiber foods such as fruits and vegetables with the skins and whole-grain breads to improve gastric motility.
• Monitor and trend daily weight.
• Accurately assess appetite and measure caloric intake over a 24-hr period.
• Arrange consult with a registered dietitian including cultural considerations in food choices.

Followup Evaluation and Desired Outcomes

• Understands that depending on the results of this study, additional testing may be performed to monitor disease progression and determine the need for a change in therapy.