Graves' disease is an autoimmune disease where the thyroid is overactive, producing an excessive amount of thyroid hormones (a serious metabolic imbalance known as hyperthyroidism and thyrotoxicosis). This is caused by thyroid autoantibodies (TSHR-Ab) that activate the TSH-receptor (TSHR), thereby stimulating thyroid hormone synthesis and secretion, and thyroid growth (causing a diffusely enlarged goiter). The resulting state of hyperthyroidism can cause a dramatic constellation of neuropsychological and physical signs and symptoms.
Nursing Assessment for Morbus Basedow (Graves' Disease)
Basic data on the assessment of patients with Morbus Basedow (Graves' Disease) is:
1. Activity / rest
Symptoms: insomnia, increased sensitivity, muscle weakness, impaired coordination, severe fatigue.
Signs: muscle atrophy.
2. Circulation
Symptoms: palpitations, chest pain (angina).
Signs: dysrhythmia (atrial fibrillation), the rhythm gallops, murmurs, increased blood pressure with a heavy tone pressure, tachycardia at rest, circulatory collapse, shock (crisis thyrotoxicosis).
3. Elimination
Symptoms: urine in large amounts, changes in stool (diarrhea).
4. Ego integrity
Symptoms: Experiencing severe stress both emotionally and physically.
Signs: Emotions labile (euphoria moderate to delirium), depression.
5. Food / fluid
Symptoms: sudden weight loss, increased appetite, eat lots, eat often, thirst, nausea and vomiting.
Signs: Enlarged thyroid, goiter, non-pitting edema especially the pretibial area.
6. Neuro-sensory
Signs: rapid and raspy speech, impaired mental status and behavior, such as: confusion, disorientation, restlessness, sensitive excitatory, delirium, psychosis, stupor, coma, tremors of the hands smooth, without purpose, some parts of the jolt snapped, hyperactive deep tendon reflexes ( RTD).
7. Pain / comfort
Symptoms: orbital pain, photophobia.
8. Respiration
Signs: increased respiratory frequency, tachypnea, dyspnea, pulmonary edema (the crisis thyrotoxicosis).
9. Security
Symptoms: no tolerance to heat, excessive sweating, allergic to iodine (may be used in the examination).
Signs: the temperature rises above 37.40 C, diaphoresis, skin smooth, warm and reddish, thin hair, shiny, straight, eksoftalmus: retraction, irritation of the conjunctiva and aqueous, pruritus, erythema lesion (often occur in pretibial), which became very severe .
10. Sexuality
Signs: decreased libido, hipomenore, amenorrhea, and impotence.
11. Guidance / learning
Symptoms: a family history of thyroid problems, history of hypothyroidism, hormone therapy toroid or antithyroid medication, discontinued antithyroid treatment, partial thyroidectomy surgery, history of administration of insulin causes hypoglycemia, heart problems or heart surgery, a new disease occurred (pneumonia) , trauma, X-ray examination with contrast images.
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