Children With Subclinical Hypothyroidism: Symptoms, Diagnosis, And Treatment

What is Subclinical Hypothyroidism?

Discuss About The Children With Subclinical Hypothyroidism?

The current chapter focuses on the concept clinical reasoning cycle and its application for the care and supervision of the ones seeking health care services. The clinical reasoning cycle could be divided into a number of components such as considering the present clinical condition of the patient, collecting cues and information regarding the patient health , processing the  health information of the patient for relating with specific health concerns, identification of the dominant health issues or problems, setting up of a smart objective for achievement of the goals, development of nursing intervention  or strategies, evaluating the outcomes and then reflecting upon the whole process.

For the present assignment, the case study of an 87 year old Mr. Ratin Bhai had been highlighted. Mr. Ratin Bhai had been living alone in a two storeyed house after the death of his wife and had been suffering from Parkinson’s and hypothyroidism since the last four years. Though his hypothyroidism has been under control, the symptoms of Parkinson’s seemed to be getting worse with the patient experiencing tremors in both his hands. The unstable movements had made performing Activities of Daily Life (ADL) difficult for him.  For the current assignment fall risk management has been taken as one of the major nursing priorities and the clinical reasoning cycle applied for assessment and controlling of the same.

In the present context, the patient had been suffering from advanced stage of Parkinson’s and hypothyroidism which had been detected four4 years ago. The chronic condition of the patient has a profound effect on the daily life activities of the patient. The patient  had been experiencing tremors in his hands which has made  managing some of the daily activities difficult for the patient such as cooking, making himself a cup of coffee, tying of his shoelaces. The increased tremors experienced also affect the ability to move independently of the patient (Baars et al. 2014). The patient had already experienced fall a number of times when getting up from a chair, during taking of a shower and feels an increased tendency to fall. As commented by Ham et al.  (2014), inability to perform the daily life activities owing to disabilities can result in the development of depressive behaviour in an individual.

The current literature present the case history of Mr. Ratin Bhai who had been suffering from adverse health issues such as Parkinson’s and hypothyroidism. Mr. Ratin had been living on a two storeyed house alone after the death of his wife. Moreover, due to the increased tremors he had been experiencing in both his hands owing to Parkinson’s, managing the daily life activities had become increasingly difficult for him.  Additionally, Mr. Ratin being an introvert in nature likes to keep up to himself and does not approve of escalating his problems to his brother and his family living close by. Therefore, his social isolation can subject him to increased risk of depression (Hiorth et al. 2014).

Symptoms of Subclinical Hypothyroidism

The patient had also been suffering from decreased level of BMI, which could be attributed to the presence of hypothyroidism. The patient also has a very small source of income funded by his self managed superannuation. Therefore, managing the medications for Parkinson’s becomes a difficult thing for him.  As commented by Johnson & Chang (2014), the annual charge of Parkinson’s management is almost 10 billion Australian dollars and a sharp increase of 42 % in the burden of the disease in noted every year (de Bock et al.2016). Mr. Ratin Bhai had been taking medications such as Thyroxine, Carbidopa and Entacapone , which is costly medicines to manage over the long term use.

The presence of hypothyroidism has made the muscles of the patients weak, which have further contributed in increased incidences of fall in the patients (de Bock et al. 2016). The patient had been suffering from tremors in both his hand along with a lack of muscular strength.  This could be attributed to the age related weakness of muscles as proposed by Miller. As commented by  Srivanitchapoom & Hallett (2015), muscle weakness in hypothyroidism could be linked to the deficit of the thyroxin hormone. This results in lack of muscle stamina often developing into feelings such as Paresthesia, Carpel tunnel syndrome and peripheral neuropathy(Haick et al. 2016).As  asserted by de Bock  et al.(2016), development of locomotors disabilities in the  patient due to the presence of Parkinson’s , the self managerial and daily life events of the patient are challenged. This can make him exposed to an increased risk of depression.In this context, Mr. Ratin Bhai is a retired employee and lacks any stable source of income. Thus, much of his financial requirements are met through the bare minimum offered by his superannuation fund. Also, Mr. Ratin Bhai has no additional monetary support from his family, which makes management of his financial liabilities difficult.

The case study analysis of Mr. Ratin Bhai had pointed towards three major nursing priorities such as fall risk management, assessment of isolation and financial needs of the patient.

Fall risk- the patient had been experiencing increased tremors attributed to muscle weakness which made management of daily activities difficult for him. Additionally, increased dependency on some of the medicines used by the patient for hypothyroidism can have profound side effects. This is because increased dose of thyroxin can lead to dizziness along with carbidopa which can lead to muscle stiffness (Alzoubi et al. 2016).Thus, such medicines can increase the fall risk in the patients by development of side effects.

Diagnosing Subclinical Hypothyroidism in Children

Additionally, the person was living in a two storeyed house alone and had to manage with most of his activities alone. He was also unwilling to take help from his relatives staying nearby. The aggravated symptoms of Parkinson’s made him unfit to perform some of the basic jobs such as cooking, making himself a hot cup of tea or even tie the lace of his shoes. As commented by Weiss et al. (2014), unsupervised medication can often increase the risks exposing an individual to plethora of diseases such as cardiovascular sickness, hypertension etc. Unsupervised medications for Parkinson’s often lead to dyskinetic movements, which can increase the risk of falls (Ejupi et al. 2016). Additionally, the orthostatic hypotension results in dizziness and light-headedness during changing positions.

Social isolation- MR. Ratin Bhai being an introvert in nature manages most of his tasks by himself and doesnot attribute much of his problems to his extended family living there. Additionally, his ill health can also result in the development of feelings of depression in him. Depression can develop into a number of mental and physical problems, which could develop into associated co-morbid conditions. As commented by Cancela et al. (2014), the presence of mental illnesses is often ignored due to the lack of knowledge or sufficient awareness in an individual. Therefore, adequate measures need to be employed for the purpose of depression care and management in an individual. The living environment can also be  a contributing factor for increasing the risk of depression in an individual(Pahwa & Lyons, 2013).

Financial stability- Mr. Ratin Bhai had limited or no source of income, therefore managing the cost of his medicines was a major problem with him. Mr. Ratin Bhai had been living upon the bare minimum offered to him by his superannuation funds. Parkinson’s need to be managed with proper medication and care depending upon the severity (Alzoubi et al. 2016). However, the financial condition of Mr. Bhai made it a challenge for him.

For the current scenario, priority has been given to assessment of the fall risks of the patient. The fall risks could result into major incidents such as injury to the head and fracture (Fox et al. 2017). In the current context, the Miller’s theory could be applied as a nursing assessment framework for the care and management of the elderly patients (Miller, 2014). The millers’ theory also addresses the physiological inherent changes that are brought about by ageing and make an individual weak and more prone to risks such as injury due to falling (Callisaya et al. 2014). The implementation of the model in the context of Mr. Bhai would enable him to perform the daily set of activities and reduce the risk of fall in the patient.

Treatment for Subclinical Hypothyroidism in Children

The Millers’ theory places the interventions given by the care givers at the centre that facilitates the highest level of independent functioning by the support users (Miller, 2014). This further improves the quality of life by reducing the dependency on the care givers.The risk factor of falling cannot be totally cured in the context of Mr. Ratin bhai due to his old age. However, with the provision of proper care and management the risk falling could be controlled in the care of Mr.bhai. The tremors could also be associated with the presence of hypothyroidism in the patient along with old age (Duncan et al. 2013).

The incidents of tremors increases manifolds in the patients with the increasing age. The risk factors are mainly reported in people with the age group of 80 and above (Murray et al. 2012). The rates of tremors have also been related to other causes. Reports suggested that 80% of people aged 65 and above suffer from fall risks annually. Evidences suggest Parkinson’s is a neurodegenerative disorder affecting 1% of the population older than 65 years (Pahwa, & Lyons, 2013). Therefore, the figures and the statistics suggest that apart from Parkinson’s old age vulnerability could be another contributing factor towards fall and injury due to Parkinson’s (Sangün et al. 2015). Therefore, comprehensive care measures along with planning of a Smart objective could help in the care and management of the progressive neurodegenerative disease.

The nurse could develop a SMART objective for the catering to the care needs of the patient. The SMART objectives refer to the Specific, Measurable, Achievable, Realistic and Time-bound.

Specific	·         Implementation of a fall risk assessment program ·         To inculcate support services from the nursing professional ·         To  be implemented within the living environment of the patient
Measurable	·         To take  regular feedback from the patient ·         Constant monitoring through a fall risk assessment tool
Achievable	·         To collect suitable resources for designing proper care plan ·         To implement light balancing exercises to help the patient to cope up with movement difficulties
Realistic	·         To sponsor generic medicines for Parkinson’s management
Time bound	·         The  entire goal to be achieved in six months time

Table 1: SMART Table

(Source: researcher)

For the conditions management of Mr. Ratin Bhai suffering from Parkinson’s there is a need to design a set of goals. The goals and the objectives have been designed as per the SMART framework. The SMART framework refers to specific, measurable. Achievable, realistic and time bound. The following helps in evaluating the performance of the measures or the process implemented for the conditions monitoring of Mr. Ratin Bhai. Some of the effective measures could be implemented within the living environment of the support user. In this respect, the patient needs to be provided with sufficient access to allied health care services such as nursing staff and support personals. Additionally, implementation of fall risk assessment programs could reduce the risk of injuries in the Patients. As commented by Pan  et al. (2015), implementation of effective exercises within the fall risk assessment program can help can be beneficial. Some of the light weight exercises which could be implemented over here are balancing exercises. This can help in restoring the mobility in the patient by providing them with individual self belief and confidence.

Possible Complications of Subclinical Hypothyroidism in Children

For the measurement of the patient condition regular feedback needs to be taken from the patient regarding the changes or improvement in the health condition. A risk assessment checklist could be designed which helps in controlling the risks of fall and managing the patient condition effectively. Light balancing exercise could be implemented for the patient as a measure for restoring the mobility of the patient (Wulf et al. 2016) additionally, as Mr. Bhai had relatively low income, thus provision of generic or cost effective medicine could help in providing the patient with sufficient financial stability. The process had to be bound within a time frame of 6 months which helps in achieving the objectives.

In order to cope up with the difficulties faced by Mr. Ratin Bhai a number of care options need to be provided such as implementing light exercises, palliative care. The implementation of such measures would help in meeting the care requirements of patients like Mr .Ratin Bhai.  The training exercises would also help in strengthening the muscle.

Palliative care- Parkinson’s had been defined as a progressive neurodegenerative disease with no proper cure (Haick et al. 2016). The Parkinson’s  disease is progressive in nature and needs palliative or specialised care techniques (Ham et al. 2014). The palliative care helps in the long term treatment and care management of the patient. Additionally, Mr. Bhai had been complaining of pain in both his hands which made the daily tasks difficult for him. Therefore, palliative care processes can help in controlling the pain in both his hands.

Rationale- the enabling of support from nursing professional would help in looking after the locomotor disabilities in the patient and also help in help him in performing the daily set of activities. Moreover, Mr. Bhai being an introvert would otherwise not access support and help from his relatives. Thus, provision of extended care services would help in managing the loneliness and risk of depression in the patient.

The outcomes need to be evaluated based upon the action plan implemented for looking after the immediate concerns of Mr. Bhai. For example, implementing the balance exercises would help in providing some stability to the patient. This would reduce the dependency of the patient over the nurses. Additionally, the implementation of the palliative health care policies would help in addressing the long concerns along with providing additional financial support to the patient (Sangün et al. 2015). Additionally, the implementation of the risk assessment tools would help in providing appropriate and optimum care services to the support users.

Mr. Ratin Bhai had been living in a two storeyed house alone without any help to accommodate for his care requirements. Therefore, provision of guidance and care through implementation of the palliative care programs would help in the restoring the previous condition of the patient. Additionally, the balancing exercises could help him gaining more confidence in doing the daily life activities (Alzoubi et al. 2014). The provision of community based free check up and free health care services could also help in the management of the financial liabilities of the patient (Sangün et al. 2015). Additionally, help from a large and collaborative team of medical professionals could help in delivery of appropriate health care services.

The assignment helped me in the understanding the nitty grities of the Parkinson’s disease. This, Parkinson can limit the movement as well as the self managerial skills of a person. The assessment would help me in the development of appropriate tools which would help me in providing fall support to the patients receiving treatment for Parkinson’s. This would also help me develop my skills as a nursing professional. The assignment helped me in understanding the details of nursing management for Parkinson’s management.

The assignment helped me in understanding the contradictions associated with Parkinson’s and the associated co-morbid conditions. However, I think implementation of a collaborative health care system could help in provision of a wide spectrum health management system to the support users. Moreover, the assignment also helped me in understanding the details of medication management in the patient. A vivid idea about Parkinson’s medicines can help in controlling the aggravates symptoms of the disease and help in reducing the fall risks in the patient.

Conclusion

The eight steps of the clinical reasoning cycle had been used for the identification of the priorities of nursing care. For provision of support services to care users like Mr. Ratin Bhai the major nursing priorities had been designed as follows such as provision of financial stability to the patient, assessment of the isolation and the fall risks of the patients. Therefore, the undertakings of the clinical reasoning cycle helps in the long term care plan and understand the in-depth problem associated with the patient. Thus, for helping Mr. Bhai handle his advanced stage of Parkinson’s a number of objectives or smart goals could be designed such as implementation of light balancing exercises within the care regimen of the patient. This helps in restoring the mobility in the patient. Additionally, inculcation of effective medicines can help in controlling the condition of the patient. Moreover, occupational therapies could be applied for providing stability to the patient. The implementation of the methods ensured that Mr.Bhai had better control over his Parkinson’s control and management.

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