甲狀腺功能亢進癥病人的護理NursingofHyperthyroidismPatients講解

甲狀腺功能亢進癥病人的護理Nursingof

Hyperthyroidism

Patients廣西衛(wèi)生職業(yè)技術(shù)學院內(nèi)科護理教研室DepartmentofMedicineNursing,GuangxiMedicalCollege臨床表現(xiàn)

Symptomsandsigns

甲狀腺毒癥表現(xiàn)Thyrotoxicosismanifestations甲狀腺腫Goiter眼部表現(xiàn)Ocularmanifestations特殊類型GDSpecialtypeGD

甲狀腺毒癥表現(xiàn)ThyrotoxicosisManifestationsT3、T4分泌過多導致交感神經(jīng)興奮性增高和新陳代謝加速：疲乏無力、怕熱多汗、低熱、多食善饑、消瘦…ExcessivesecretionofT3andT4leadstoincreasedsympatheticnerveexcitabilityandacceleratedmetabolism:fatigue,

fearofheat,perspiration,lowfever,feelhungryfrequentlywithenormousappetite,weightreduction...1、高代謝綜合征HypermetabolicSyndrome甲狀腺毒癥表現(xiàn)ThyrotoxicosisManifestations表現(xiàn)為興奮/抑郁，以興奮為主。神經(jīng)過敏、多言好動、焦躁易怒、失眠、緊張不安、注意力不集中、手、眼瞼和舌震顫Manifestedasexcitement/depression,mainlyexcitement,neuroticism,hyperactivity,irritability,insomnia,nervousness,lackofconcentration,tremorsofhands,eyelids,andtongue2、精神神經(jīng)系統(tǒng)MentalNervousSystem甲狀腺毒癥表現(xiàn)ThyrotoxicosisManifestations甲狀腺毒癥表現(xiàn)ThyrotoxicosisManifestations心悸氣短、心動過速（靜息仍增快），脈壓增大，心律失常（房顫最常見），心臟增大，心力衰竭….Palpitations,shortnessofbreath,tachycardia(stillfastatrest),increasedpulsepressure,arrhythmia(atrialfibrillationisthemostcommonsymptom),cardiomegaly,heartfailure….食欲亢進、腸蠕動加快、腹瀉Excessiveappetite,increasedbowelmovements,diarrhea心血管系統(tǒng)3.CardiovascularSystem4、消化系統(tǒng)DigestiveSystem甲狀腺毒癥性周期性癱瘓TPPThyrotoxicPeriodicParalysisTPP5、骨骼肌肉系統(tǒng)MusculoskeletalSystem6、生殖系統(tǒng)ReproductiveSystem7、造血系統(tǒng)HematopoieticSystem月經(jīng)減少、閉經(jīng)、陽痿…Spanomenorrhea,Amenorrhea,Impotence…白細胞總數(shù)偏低、淋巴細胞及單核細胞增多、血小板壽命縮短，可出現(xiàn)紫癜。Thetotalnumberofwhitebloodcellsislow,withtheincreasingamountoflymphocytesandmonocytes.

Thelifespanofplateletsisshortened,andpurpuramayappear.甲狀腺毒癥表現(xiàn)ThyrotoxicosisManifestations8、皮膚肢端表現(xiàn)CutaneousAcralManifestations9、甲狀腺危象ThyroidStorm脛前粘液性水腫Pretibialmyxedema短時間內(nèi)大量T3、T4釋放入血AlargeamountofT3andT4arereleasedintothebloodinashortperiodoftime甲狀腺毒癥表現(xiàn)ThyrotoxicosisManifestations脛前黏液性水腫Pretibialmyxedema甲狀腺危象ThyroidStorm應(yīng)激狀態(tài)（感染、手術(shù)、放射性碘治療、精神刺激、過度勞累、急性創(chuàng)傷等）Stressstates(infection,surgery,radioiodinetherapy,mentalstimulation,overwork,acutetrauma,etc.)嚴重軀體疾?。盒乃?、敗血癥等Seriousphysicaldiseases:cardiacfailure,hematosepsis,etc.常見誘因Commoninducements甲狀腺危象ThyroidStorm口服過量TH制劑OraloverdoseofTHpreparations甲狀腺手術(shù)準備不充分或術(shù)中過度擠壓甲狀腺等Inadequatepreparationforthyroidsurgeryorexcessivecompressionofthethyroidglandduringsurgery,etc.常見誘因Commoninducements甲狀腺腫大Goiter彌漫性對稱性，隨吞咽動作上下移動；Diffusesymmetry,movingupanddownwithswallowing;腫大程度與甲亢輕重無明顯關(guān)系Thereisnosignificantrelationshipbetweenthedegreeofgoiterandtheseverityofhyperthyroidism甲狀腺血流增多，可觸及震顫、聞及血管雜音，為GD的特異性體征。ThespecificsignsofGDarebasicallyincreasedbloodflowofthyroidgland,palpabletremor,andaudiblevascularmurmur.眼部表現(xiàn)Eyesymptoms眼球向前突出，一般不超過18mm；瞬目減少；上眼瞼攣縮，瞼裂增寬；雙眼向下看時，上眼瞼不能隨眼球下落；向上看時，前額皮膚不能皺起；兩眼看近物時，眼球輻輳不良。Exophthalmos,generallynomorethan18mm;blinksarereduced;uppereyelidscontractures,widenpalpebralfissures;uppereyelidscannotfallwiththeeyeballswhenbotheyeslookdown;foreheadskincannotbewrinkledwhenlookingupwards;theeyeballsareinpoorconvergencewhenlookingatnearbyobjects.1、單純性突眼Simpleexophthalmos眼部表現(xiàn)Eyesymptoms男性多見，單眼受累病人占10%-20%，除上述外，常有眼瞼腫脹肥厚，結(jié)膜充血水腫；眼球突出大于18mm；自述視力下降、視野縮小、眼內(nèi)異物感、畏光、復(fù)視、眼部脹痛、刺痛、流淚。Frequentlyoccursinmale,and10%-20%ofpatientsonlysufferoneeyeball.Inadditiontotheabove,thereareoftenswellingandhypertrophyoftheeyelidwithconjunctivalhyperemiaandedema;exophthalmosgreaterthan18mm;self-reportedvisionloss,reducedvisualfield,intraocularforeignbodysensation,photophobia,diplopia,eyepain,tingling,tearing.2.浸潤性突眼Infiltrativeexophthalmos眼部表現(xiàn)Eyesymptoms眼部表現(xiàn)Eyesymptoms眼部表現(xiàn)Eyesymptoms特殊類型SpecialtypeT3型甲狀腺毒癥：T3顯著多于T4T3thyrotoxicosis:significantlymorethanT4淡漠型甲亢：多見于老年人，癥狀重Apathetichyperthyroidism:frequentlyoccursintheelderly,withseveresymptoms亞臨床型甲亢：T3\T4正常，TSH降低，無癥狀或癥狀輕微Subclinicalhyperthyroidism:normalT3/T4,lowTSH,nosymptomsormildsymptoms妊娠期甲狀腺功能亢進癥Hyperthyroidismduringpregnancy臨床表現(xiàn)

Symptomsandsigns

甲狀腺毒癥表現(xiàn)ThyrotoxicosisManifestations高代謝、精神神經(jīng)、心血管、消化、肌肉與骨骼、生殖、造血、皮膚、甲亢危象Hypermetabolism,neuropsychiatric,cardiovascular,digestion,musculoskeletal,reproduction,hematopoietic,skin,hyperthyroidcrisis甲狀腺腫

Goiter

彌漫性對稱性Diffusesymmetry程度與甲亢輕重無關(guān)Thedegreehasnorelationshipbetweentheseverityofhyperthyroidism特殊類型GD

SpecialtypeGD

T3型甲狀腺毒癥、淡漠型甲亢T3thyrotoxicosis,Apathetichyperthyroidism亞臨床型甲亢Subclinicalhyperthyroid