Rajiv Gandhi University of Health Sciences Karnataka



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA

A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING PREVENTION OF SELECTED COMPLICATIONS OF HYPOTHYORIDISM AMONG HYPOTHYROIDISM PATIENTS IN SELECTED HOSPITALS IN KOLAR DISTRICT AT KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERATATION

Mrs. V. KARPUGAM, M.Sc., (N) (1st year)

AE & CS PAVAN COLLEGE OF NURSING, KOLAR-563101

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

|1. |NAME OF THE STUDENT |Mrs. V. KARPUGAM |

| | | |

| | |M.Sc NURSING STUDENT AE&CS PAVAN COLLEGE OF NURSING, KOLAR-563101 |

|2 |NAME OF INSTITUTION |AE&CS PAVAN COLEGE OF NURSING, KOLAR-563101 |

|3 |COURSE OF STUDY |M.Sc NURSING |

| | |MEDICAL SURGICAL NURSILNG. |

| | | |

|4. |DATE OF ADMISSION TO COURSE |13.06.2010 |

| | | |

|5 |TITLE OF TOPIC |A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON |

| | |KNOWLEDGE REGARDING PREVENTION OF SELECTED COMPLICATIONS OF HYPOTHYORIDISM |

| | |AMONG HYPOTHYROIDISM PATIENTS IN SELECTED HOSPITALS IN KOLAR DISTRICT AT |

| | |KARNATAKA. |

INTRODUCTION

“We often measured things that mean very little,

But fail to measure things that

Mean the most”

By – Albert Einstein

Hypothyroidism is due to under activity of the thyroid gland, and results from its failure to secrete sufficient thyroid hormones into the blood stream the thyroid gland is located in the front part of the neck and the hormone it produces is vital to normal metabolism.

Hypothyroidism is one of the most common chronic diseases the united states although this condition is believed to affect up to 11 million adults & children, as many as two out of every three people with hypothyroidism may not know they have the disease.

The most common cause of hypothyroidism in mid to late childhood and adolescence is hashimoto’s thyroiditis which occurs in up to 1.2 percent of the school age population Congenital hypothyroidism is less common one out of every 4000-5000 infants is born without a properly functioning thyroid gland.

Hypothyroidism is the condition that reflects decreased concentrations of thyroid hormones due to any cause. The resulting hypothetabolic state causes decreased heart production and generally slows many of the bodies process. Its prevalence hypothyroidism 1 to 3 percent of young to middle aged adults, mainly women and its incidence rises with age. Severe hypothyroidism occurs in 2 to 4 percent of women older than seventy years of age and milder forms of disease in 8 to 15%. Outside of North America, Iodine deficiency is a major cause of hypothyroidism.

PREVENTION OF SELECTED COMPLICATIONS OF HYPOTHYROIDISM LIKE

Goiter: constant stimulation of thyroid to release more hormes may cause the gland to become large conditions known as goiter. Hashimotothyroiditis is one of the most common causes of goiter.

Heart problems: Hypothyroidism may also be associated with an increased risk of heart disease, primarily because high levels of low density lipoprotein (LDL) cholesterol the “Bad” cholesterol can occur in people with an underactive thyroid. Hypothyroidism can also lead to an enlarged heart & heart failure.

Other complications also is present

1. Weight gain

2. Losing focus

3. Losing sleep

4. Hair loss etc.,

Mental health issues:

Depression may occur early in hypothyroidism and may become more severe over time. It will also cause slowed mental functioning.

Myxedema: This rare life threatening condition

Infertility: Low levels of thyroid hormone can interfere with ovulation, which impairs fertility; in addition some of the causes of hypothyroidism such as autoimmune disorder also impair fertility. Treating hypothyroidism with thyroid horme replacement therapy may not fully restore fertility.

Birth defects: Babies born to women with untreated thyroid disease may have a higher risk of birth defects than may babies born to healthy mothers. Infants with untreated hypothyroidism present at birth are at risk of serious problem with both physical and mental development. Effects of hypothyroidism and subclinical hypothyroidism unhealthy on the heart cholesterol levels and mild high blood pressure and heart failure.

Thyroid hormone is very import for normal cardiovascular function, so when not enough thyroid horme is present neither the heart nor the blood vessels function normally. In hypothyroidism the heart muscle in weakened in both its contraction phase, and also its relaxation phase.

This means that the heart cannot pump as vigorously as it should and the amount of blood it reflects with each heart beat is reduced. In addition because the heart muscles does not relax normally in between heart beats potentially serious conditions called diastolic dysfunction may results. Studies have shown that iodine supplementation can cretinism is highly effective in the prevention of endemic goiter.

A nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory endemic goiter is defined as thyroid enlargement that occurs in more than 10% of a population and sporadic goiter is a result of environmental or genetic factors that do not affect the general conditions.

Sporadic goiter is the most common cause of non toxic goiter in the United States. The incidence of sporadic non toxic goiter has been estimated in North America at approximately 5%. The prevalence of palpable nodules is approximately 5-6% in people aged 50 years.

Myxedema is also used to describe the clinical syndrome secondary to hypothyroidism symptoms can include depression, mental slowness, weakness, bradycardia, fatigue, hypothermia, alopecia etc., Myxedema can be considered the adult counter part of cretinism. Myxedema coma is rare & establishing the diagnosis requires is a high index of suspicion. Mortality rate of 30% - 40%.

It can occur due to long standing untreated hypothyroidism but is often liked to a precipitant such as acute infection myocardial infection CCF, CVA trauma, drug toxicity, and several medications can cause hypothyroidism thyroid replacement therapy it is important to detect existing adrenal insufficiency and treat patients with stress dose steroids to avoid precipitating adrenal crisis.

The prevalence of thyroid dysfunctions was found in males and females is follows overt Hypothyroid stimulation hormone (TSH) > 3.65 ml U/L & free thyroxine (FT4) < a pmo I/L. L-Thyroxine substitution in 2.6% and 8.4% respectively, subclinical HT (TSH>3.65, FT4 9-23 & No substitution in 4.3% & 15.0% respectively.

Higher prevalence of hypothyroid’s, was found in females with hypercholesterolemia and males and females with can comitant positive thyroid peroxides’ antibodies. Endemic goiters arising from and iodine deficiency are associated with some times immense thyroid hypertrophy hypothyroidism and cretinism

Occasionally the goiter may produce symptoms caused by pressure on anterior neck structures, including the trachea, the esophagus and the recurrent laryngeal nerve rarely obstruction can be dangerous because of narrowing of the trachea.

Hypothyroidism and infertility have a direct connection with one another. Hypothyroidism is a disease that is caused by an insufficient production of the thyroid hormone by the thyroid gland. Hypothyroidism along with infertility can happen in a male which causes low sperm count of the reduction of the sperms lifespan.

NEED FOR STUDY

As hypothyroidism is one of the most prevailing problems the investigator needs to know the awareness of public regarding knowledge on prevention of selected complication of hypothyroidism. Hypothyroidism has emerged as the leading disorder worldwide affecting more than 200 million people as a 2006. India 79% had Hypothyroidism. Hypothyroidism was due to thyroid digenesis in 75% in our experience of screening nearly 40000 new born 2.640 in adults.

In recent study in India, North America thyroid disease account for considerable morbidity in the United States. The annual incidence of hypothyroidism in adults is 0.08% to 0.2% hypothyroidism is more common among women then men and incidence increase with age. An estimated 6% of the US population and more than new cases 300000 are diagnosed each year. This disease is more prevalent in women.

A study was conducted in Karnataka south India by Health family welfare department started that there is attributes them fall in goiter cases, 1200 in 2006, to 626 in 2008 to the impact of iodized salt some goiter – endemic district in the state are Chikmagalur, Dakshina Kannada karwar, shimoga, a part from pockets in Mysore. Goiter is one of the selected complications in hypothyroidism.

There is a significant decline in number of cases in most endemic states. Recently a study by the Kasturba Medical College’s Community Medicine Department in Chikmagalur district revealed that from 41% in 1988, goiter cases declined to 16% in the district “said B Gopal Scientific Officer (Health & Family Welfare). Endemic goiter due to iodine deficiencies occurs during childhood with the goiter’s size increasing with age.

New information on the frequency of Hypothyroidism has been provided by a survey of a randomly selected population of 2779 adult living in Wickham Tyne and wear, who had baseline thyroid function tests and were there re-examined after 20 years. Remarkably 16% of the 1877 survivors participated in a follow-up survey and 91% had further tests. The mean incidence of spontaneous overt hypothyroidism in women was 3.5 survivors / 1000 / year and in men 0.6 / 1000 year. There was no apparent excess of hypothyroidism in those who had died. The incidence of goiter in women is 1.2 – 4.3 times as great as that in Men.

A study was conducted by Dr. Jaya Kumar, Chairman Thyroid society started that 5% women have infertility problems due to thyroid – related diseases. 8-10 % cholesterol cases are due to thyroid problems, leading to heart diseases. Globally more than 10% women over 40 years are affected by thyroid related diseases.

Thyroid hormones, notably triodothyronine (T3) affect the heart directly & indirectly. They are closely linked with heart rate & heart output. T3 provides particulars benefits by relaxing the smooth muscles of blood vessels. This helps keep the blood vessels open so that blood flows smoothly through them.

Effects of hypothyroidism & sub-clinical hypothyroidism on the mind

Depression: Depression is common in hypothyroidism and can be severe. It may occur chronic depression.

Mental behavior impairment: Untreated hypothyroidism can, overtime, cause mental & behavior impairment & eventually even dementia whether treatment can completely reverse problem in memory & concentration is uncertain, although many doctors believe that only mental impairment in hypothyroidism that occurs at birth is permanent.

Myxedema describes a specific form of coetaneous & dermal edema – secondary to increased deposition of connective tissue components and other in subcutaneous tissue as seen in various forms of hypothyroidism & grave’s disease.

“With awareness and accessibility to tests in urban centers, thyroid related diseases are being treated, findings of various studies suggest that patient education is a fundamental aspect of prevention of complications in patients with hypothyroidism.

Preventive measures have to focused on the risk profile of the patient and chronological appearance of symptom.

Myxedema coma is a medical emergency that occurs when the body’s level of thyroid hormones becomes extremely low. It is treated with intravenous thyroid hormone replacement and steroid medications. Some patients may need supportive therapy & intensive care nursing. Myxedema the most severe form of hypothyroidism.

February 2000 older women with sub-clinical hypothyroidism were almost twice as likely as women without this condition to have blockages in the aorta. They were also twice as likely to have had heart attacks. A study was done by “Rotterdam”.

According to Rotterdam published in “Annals of internal medicine” a slightly underactive thyroid – the condition knows as subclinical hypothyroidism is a major heart disease risk for older women. The Rotterdam study’s finding is a strong indication that screening programs to evaluate even slight hypothyroidism in older women could help prevent cardiovascular illness.

International level more than 2.2 billon people world wide have some form of iodine deficiency disorder twenty – nine percent of the world’s population lives in a region that has iodine deficiency primarily in Asia, Latin America, Central Africa & regions of Europe of those at risk 655 million were known to have goiter. In the iodine – deficient regions of the world goiter is more common than in the United States. The prevalence of goiter can be estimated on the iodine intake of the population.

W.H.O. the United Nations children’s fund & international council for the control of iodine disorders. The absence of iodine deficiency median urine iodine >100 mg/dl is associated with a goiter prevalence of less than 5-20% moderate iodine deficiency with a goiter prevalence of 20-30% & severe iodine deficiency with a goiter prevalence of greater than 30%

In a view of high incidence of hypothyroidism complications in hypothyroidism patients and also in view of the various studies which suggest the necessity of planned teaching programme for prevention of hypothyroidism complications among hypothyroidism patients. It was decided to conduct an evaluate study to assess the knowledge of risk factors leading to hypothyroidism complications and measure for its prevention among hypothyroidism complications and measures for its prevention among hypothyroidism & planned for structured teaching programme.

REVIEW OF LITERATURE

The review of literature is define as a broad comprehensive in depth systematic and critical review of scholarly publication, unpublished scholarly publication. Unpublished scholarly print materials audio visual material and personal communication. The related literature has been organized and presented under the following headings.

a) Studies related to knowledge regarding prevention of hypothyroidism selected complications.

b) Studies related to prevention of selected hypothyroidism complications.

c) Studies related to structured teaching programme regarding prevention of hypothyroidism complications.

a) STUDIES RELATED TO KNOWLEDGE REGARDING PREVENTION OF HYPOTHYROIDISM SELECTED COMPLICATIONS.

Abalobich.M.amino.V discussed about hypothyroidism occurs when the thyroid glands in out producing as much thyroid hormones as it should. Hypothyroidism is an under production of hormones by the thyroid gland characterized by lowered cellular metabolism including low basal body temperatures unexplained weight gain after symptoms sensitivity to cold aching muscles, decreased, appetite, fatigue, constipation, dry skin and hair, insomnia and tingling in the hands and feet. Sea vegetables may help hypothyroid because of its high iodine content. Many people ingest enough iodine in their diet through the consumption of iodized salt. However if you avoid processed foods and don’t over salt your foods.

AP.weetman professor of medicine explained about iodine deficiency disorder is collective name of the endemic goiter and cretinism. It is a major worldwide problem. Especially during pregnancy and childhood it is a threat to the social economic development of countries. Iodine deficiency is the main preventable cause of brain damage in children and constitutes a universal public health concern. Although cretinism is the most extreme manifestation the more subtle degrees of mental impairment leading to poor schools performance reduced intellectual ability and impaired work capacity are of considerably greater significance estimates suggest that 2million people globally have insufficient iodine in take according to data quoted the WHO global database on iodine deficiency 2004. In 1996 described major role about iodine supplementation goiter is conveniently referred to as endemic when it occurs in more than 10% of the population in a defined area. It is the chief consequence of iodine deficiency resulting from either low iodine in take or ingestion of goitrogens a total problem as per decision made by the key international bodies concerned 1992(UNICEF,WHO,ICCIDD) in this sub normal levels among adults children and neonates, WHO recommends that iodine deficiency surveys examine school age children 6-12 years because of their high physiologic vulnerability and their accessibility through school for studies in baseline health parameters supplements vitamin B1, magnesium, chromium, selenium, zinc, iodine, calcium etc. these foods avoid include peanuts Pine nuts cabbage, mustard and turnips, almonds and wheat germs are also helpful against hypothyroidism as they contain dietary sources of vitamin B2 a deficiency of which is linked to hypothyroidism. Avoid dried fruit, processed potatoes shrimp and wine in these foods can destroy riboflavin which can lead to deficiency.

Alexandria Lazarus JH was conducted to clear improvements in both cognition and mood from combination therapy and another in 2001 concluded that combined treatment seemed to be more effective than treatment with T4 alone 8 main symptoms of hypothyroidism. However more recent studies have shown improve in mood or mental abilities for those on therapy and possibly impaired well being from subclinical hypothyroidism. Hypothyroidism commonly manifest as slowing in physical and mental activity but may be asymptomatic symptoms and sign of this disease are often subtle and neither sensitive or specific. Classic signs and symptoms such as cold intolerance, puffiness, decreased sweating and coarse skin previously reported on 90-97% of patients may actually occur in only 50-64% off younger patients.

Mishra A agarwal.A conducted study together recording hypothyroidism in adults with newly diagnosed hypothyroidism that is under 50 and without ischemic heart diseases it is safe and efficient to start on full replacement dose of Levothyroxine. Levothyroxine replacement does is related to body mass a daily dose of about 1.6µg/kg/body mass is adequate replacement for most adults (100µg or 125µg daily for an average size women or men) elderly people those with ischemic heart diseases should start on a small dose of Levothyroxine and the dose increment should be gradually, current evidence does not support a clinical benefit from the use of a combination of Levothyroxine and Levothyroxine.

b) STUDIES RELATED TO PREVENTION OF SELECTED HYPOTHYROIDISM COMPLICATION

Lee.k.brandly was conducted to see the characteristic features of thyrotoxicosis the timely diagnosis and aggressive management of thyroid storm should result in a successful outcome. However severe storm may lead to irreversible cardiovascular collapse, especially in the adult patient who may have a atypical features of thyrotoxicosis. The fundamental approach is prompt & optimal treatment in the emergency department once the presenting clinical features suggest its presence. The prevention of Myxedema entails paying special attention to certain high risk patient groups.

A study was conducted to find the early diagnosis & management of endocrine crises in adulthood. The homeostasis of the body is regulated by concerted action of the endocrine, nervous and immune system. An imbalance in this equilibrium as a consequence of disease or endocrine failure, may lead to crises by sudden onset and severe symptoms. The classical endocrine emergencies are rare but life – threatening conditions. Prompt and aggressive treatment significantly reduces mortality so conclusive are these patients generally requiring admittance to an intensive care unit.

A study was conducted to defect the Myxedema coma is a fatal condition when left unrecognized with the advent of intensive supportive therapy and the use of intravenous thyroxine, however mortality for this disorder is declining further insights into the pathophysiology of hypothyroidism should lead to more rational as approaches to therapy & result in improved as a conclusion in severe condition patients will admitted in ICU.

A study was conducted on Myxedema coma is a rare condition associated with high mortality. The pathophysiology is complex & often involves profound hypothyroidism as well as an insisting event the diagnosis should be suspected based on the clinical presentation and treatment should not be delayed while awaiting confirmatory laboratory data. In critically ill patients laboratory differentiation between severe hypothyroidism and the enthyroid sick syndromes is difficult & may require measurement of free hormone levels. Treatment of respiratory and hemodynamic support, administration of stress – dose glucocorticoids, and thyroid hormone replacement.

A study was conducted on elderly patients in an endocrine condition found in elderly patients that is often confused with normal changes associated with aging, consequently the disorders may be quite advanced before it is diagnosed and treated depressed T4 and elevated TSH for levels confirm primary hypothyroidism. Patients are required to take levothyrokine for the rest of their lives. Myxedema coma, a life threatening complications of hypothyroidism recovery and stabilization may take six to eight months.

Mahmood.S.islam was conducted in incidence of hypothyroidism during pregnancy is 2.5% failure to diagnose the problem causes serious complications both to the matter and to the fetus. This pathological condition is verified on the basis of clinical analysis and above all in the laboratory. Auto immunity is frequently the cause of hypothyroidism where as this condition is rarely provoked as a result of surgery and therapy careful monitoring of women at risk. Therapy with L-thyroxine is essential to avoid damage to both mother and fetus and to monitor the glandular growth in the enthyroid goiter. So concluded it.

A study was recently conducted by evidence that even individuals with LDL cholesterol well below established guidelines benefited from taking a statin if they had elevated C-reactive protein levels investigator showed that 20 mg daily of vasuvastatin significantly reduced non fatal MI non fatal stroke, hospitalization of USA re vascularization and confirmed death from cardiovascular causes by 44%. It compared with individuals treated with place to. The company that makes resuvastin but the results are impressive. Studies that suggest may help to control your heart & thyroid disease. Two tests are normal (cholesterol & thyroid levels).

A study was conducted in poor circulation of the heart because it decreases blood circulation to the heart muscle & other organs. But circulation problems also cause some of the less dramatic complaints of hypothyroid sufferers, including dry, flaky, cold hands & feet in cases of hypothyroidism the skin may receives as little as 30 to 40% of its normal blood supply. This short fall interferes with the body’s ability to warm the extremities, such as the hands & feet, as a conclusion these problems resolve them solves once the thyroid is back to normal.

A study was conducted to asses whether patient were receiving regular hypothyroidism findings every day. A study was conducted regarding prevention of complications among hypothyroidism patients after post test patients are gained a lot of knowledge in this particular disease condition.

A study was conducted has been found a predictor of cardiovascular disease, aimed to as certain the prevalence of hypothyroidism in patients with manifest coronary heart disease. 410 patients 6-24 months after hospitalization for acute coronary syndrome or revascularization were include into the cross sectional study. The prevalence of thyroid dysfunction was found in males and females as follows. Thyroid stimulating hormone. TSH > 3.65 ml U/L T4 < apmol / and thyroxine substitution in 2.6% and 8.4% respectively. Hypothyroidism in 4.3% & 15.0% respectively. Conclusion higher prevalence of Hypothyroidism was found in females with hyper cholesterolemia, and in males and females with concomitant positive thyroid peroxides anti bodies.

Lezama was to assess the effectiveness of hypothyroid goiter is a rare but long term administration of iodine containing expectorants & disinfectants in children only few reports exist on iodine induced hypothyroidism after a single injection of the iodized radipaque dyelipiodol. A 15 year old boy with previously normal thyroid functions described who developed hypothyroid goiter within six weeks following bipedal lymphography. Urinary iodine excretion was extremely elevated upto 18 mg / day while serum concentration of total thyroxine was below the enthyroid range and thyrotrophic levels were elevated. After oral – thyroxine treatment the goiter disappeared thyroid function remained normal when treatment was discontinued after five months although iodine excretion was still 50 times higher 2.5. Mg/day than in normal age matched children. The observed alterations of the thyroid gland were caused by along lasting wollffchaikoff effect with a delayed adaptation to high iodide concentrations.

c) STUDIES RELATED TO STRUCTURED TEACHING PROGRAMME REGARDING PREVENTION OF HYPOTHYROIDISM COMPLICATIONS

Kapilu Sharma was conducted by The hormonal replacements of primary treatment right dose and it will help the patient achieve a normal metabolic rate and energy level.Right Dose: Explain finding just the right dose for her his gradual process this will allow to body her adjust slowly the changes resulting from medication helping to prevent complication.Good Advice: take the drug as prescribed not to adjust the dosage or discontinue drug without doctor advise to take medication at the same time every day for uniform absorption

.Yikes / Headache / Palpilation: Hair Loss:

Instruct her to watch for adverse reactions including a change in appetite abnormal bleeding, chest pain, fever, diarrhea etc., Because patients with hypothyroid have so little energy they tend to be sedentary as a rent you ill lead to encourage the patients activity.Caution the patient to increase her activity level gradually because she risk pain & impaired muscle function of MyxedemaTeaching about fiber diet rich iron also check regularly for blood test and physical examination, tell her to report sign & symptoms on infection such as severe, malaise, delirium avoid fats increase fiber diet.

Learning to live well with hypothyroidism well learn how to

❖ Find support continuously educate our selves on this condition

❖ Intelligently commonage our condition without doctors, specialists, therapists, families, friends etc.,

❖ Maintain a positive can do attitude despite it all

❖ Believe in yourself.

Myxedema: May develop in clients with undiagnosed or under treated hypothyroidism who experience stress stressors include infection, drugs (Barbiturates, Narcotics, a anesthetics) respiratory failure, heart failure, cerebral vascular accident, trauma, prolonged exposure to cold, metabolic disturbances, surgery and seizures. Myxedema is characterized by a drug wax tape of swelling of skin and other tissues.

The edema is of the non-pitting type and is common in the pretibial and facial areas. Untreated Myxedema has been associated with severe atherosclerosis and has been attributed to the increase in serum cholesterol concentration, particularly low density lipo-proteins TH replacement improves these changes.

Myxedema coma: The major complication of hypothyroidism is Myxedema coma an extremely rare condition with a mortality rate approaching 100% Myxedema coma is characterized by a drastic decrease in metabolic rate, hypoventilation leading to respiratory acidosis, hypothermia and hypotension.

Complicating conditions include hyponatremia, hypocalcaemia, secondary adrenal insufficiency, hypoglycemia and water intoxication.

Myxedema coma may be brought a by stress as from surgery infection or by non compliance with thyroid treatment thyroid hormone replacement medication called Levothyroxine for the rest of their lives.

Medication therapy is monitored closely with blood tests for several months after beginning treatment to ensure that a person is getting just the right amount the drug. Ideal does very between different people. If the dose of thyroid replacement medication is too small for an individual, it will not adequately replace thyroid hormone in the body. If the dose is too high it may result in side effects and a potentially serious called hyperthyroidism.

Susanna Augustian was conducted by unexplained weight gain is the stimulus that gets them off the coach and in to the doctor’s office for those who religiously diet and exercise and cannot seem to lose weight. Is their deit for hypothyroidism focusing on a particular fat diet those who hypothyroidism should concentrate on avoiding foods and supliments that could affects of there hormone medication.

Foods high in salt such as chips should be avoided and calcium supliments and vitamin high in iron should also be avoided. Ulcers medication antacids and cholesterols-lowering drugs may also inhabits that obsorbtion of synthetic hormones.you need a hypothyroidism foods plan and you need right knowledge. Hypothyroidism is treated with synthetic thyroxine which is identical to the T4 made by the thyroid the exact dose will depend on the patients age and weight the severity of the hypothyroidism the presence of other health problems. And weather the person is taking other drugs that might interfere with how will the body uses the thyroid hormone. Hypothyroidism can be completely controlled with synthetic thyroxine as the long recommended dose is taken as advised. Some symptoms of hypothyroidism are fatigue weight gain, cold intolerance, infertility.

Gobin Rh conducted by most effective treatment is generally thyroid hormone supplementation although treatment provides the necessary hormone control, hypothyroidism often continuous throughout life and the patient may require lifelong follow up and medication to control the conditions. Many people benefit from thyroid hormone therapy not everyone with hypothyroidism needs therapy. Some elderly people are plagued by disease that are made worse by this therapy. People are confused with trying to do so let explain some more I am a student IVN programme I have to write a teaching plan for hypothyroidism because that is what patient has she has dementia so have to create when teaching someone with decreased cognitive skills. And also hoping could give some advice as a nurse how to teach people that speak a different language. Teaching have sometimes goes on in this. Yoga is also one of the treatment of hypothyroidism.

STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of structured teaching programme on knowledge regarding prevention of selected hypothyroidism complications among hypothyroidism patients in selected hospital at Kolar district.

Objectives of the problem:

❖ To assess the knowledge on prevention of selected complications among hypothyroidism patients.

❖ To determine the effectiveness of structured teaching programme regarding prevention of selected complications among hypothyroidism patients.

❖ To find the association between post test knowledge score with their selected demographic variables. Regarding prevention of selected complications among hypothyroidism patients.

OPERATIONAL DEFINITIONS

1. Evaluate: It refers to determining the knowledge on prevention of complications among hypothyroidism patients.

2. Effectiveness: It refers to gain in knowledge on prevention of complications among hypothyroidism patients after structured teaching programme.

3. Structured teaching programme: It refers to an organized series of information given regarding prevention of selected hypothyroidism complications among selected hypothyroidism patients.

4. Knowledge: It refers to the understanding of prevention of selected hypothyroidism complications among hypothyroidism patients.

5. Prevention: it refers to the measures adopted by the hypothyroidism patients to prevent complications occurs due hypothyroidism

6. Selected complications: Selected complications refers to adverse effects which occurs in the hypothyroidism patients like Myxedema, infertility, heart disease goiter and birth defects etc.,

7. Hypothyroidism: Hypothyroidism is due to under activity of the thyroid gland and results from its failure to secrete sufficient thyroid hormones into the blood stream.

HYPOTHESIS

➢ There will be significant difference between pretest & post text knowledge score of client after structure teaching programme (STP) on prevention of hypothyroidism complications.

VARIABLES:

1. Dependent variables: Knowledge of patient on prevention of selected hypothyroidism complications and its prevention

2. Independent variables: Structure teaching programme regarding prevention of selected hypothyroidism complications

ATTRIBUTED VARIABLES:

Socio-demographic variables like age, sex occupation, economic status, living area food habits, height, weight.

MATERIAL & METHOD

Source of data: Male & Female patient coming to OPD and admitted in hospital with complaints of hypothyroidism

METHOD OF DATA COLLECTION

Research design: Quasi experimental one group pretest- post test

Setting of the study: The study will be conducted selected hospitals of kolar

Population: Clients who are attending OPD and admitted in ward with complaints of hypothyroidism the age group is between 30-50 years.

Sample: The sample consists of 30-50 years of age group who are diagnosed as Hypothyroidism an Attending outpatient department.

Sample size: 40 samples will be selected for the study

Sampling technique: As the selection of sample depends on availability clients. The non probability purposive sampling technique was adopted.

Sampling criteria:

❖ Clients who are attending to OPD with hypothyroidism

❖ Clients age group between 30 to 50 years

❖ Clients having Hypothyroidism patients.

❖ Clients who can communicate in Kannada or English

❖ Clients who are willing to participate in the study

Exclusion criteria

❖ Those who will be critically ill

❖ Hypothyroidism patients who are not associated with diseases.

❖ Clients who cannot understand Kannada & English.

TOOLS OF DATA COLLECTION

A structured questionnaire will be used by interview method for data collection

Section-A: Demographic data of subjects

Section-B: Deals with selected complications of hypothyroidism

Section-C: Deals with preventable measures of hypothyroidism complications

METHOD OF DATA COLLECTION

Structured interview schedule will be adopted by the researches to collect the data from the subjects. The purpose of the study will be explained to involve in the study. Pre-test to subjects will be conducted and structured teaching programme will be implemented.

➢ Post test assessment will be done after 7 days of the implementation of the structured teaching programme. Tentative period the study will be 6 weeks. The tool for data collection will be prepared and after validation by the experts the further refinement of the tool will be done. After that pilot study will be conducted before the main study.

DATA ANALYSIS AND INTER PRETATION

Descriptive and inferential statistics like mean, median standard deviation, paired “t” test correlation, co efficient and chi-square will. Be used for data analysis and presented in the form of tables, graphs and diagrams.

Does the study require any investigations or intervention to be conducted from other client or animal if so describe briefly

Yes the study is conducted on clients admitted in medical ward and who comes to OPD in a selected hospital at Kolar. Since this is a evaluate study in needs only teaching.

Has ethical clearance been obtained form concerned Authority

Yes, prior to the study permission will be obtained from the concerned authority to conduct the study and also from research committee of Pavan college of nursing Kolar the purpose of study will be explained to the respondents.

LIST OF REFERENCES

1. Lewis, Heitkemper et al., (2004) text book of “Medical Surgical Nursing 6th edition) New York, Mosby publications, 1260-1276.

2. Barbara C, long et al., (1993) Text book of “Medical Surgical Nursing” A Nursing process approach 3rd edition USA, Alison Miller, 864-868.

3. Brunner and suddarth (2000) text book of “Medical and surgical nursing (16th edition) Philadelphia Lippincott publications 1215-1219.

4. Gail A Harkens, Juditer R. Dincher (1999) text book of “medical surgical nursing total patients care” 10th edition New York, Mosby sally schiefer publisher 906-909.

5. Phipps J Wilma et al., (1980) Text book of “Medical surgical nursing” 7th edition Bombay BT. Publications, 1562-1568.

6. Metz, Larson “Bluebook of endocrinology (2nd edition) W.B Saunderg company 30-35.

7. Malcolm M.HY. Wheeler, John H. Lojones “Disease of the thyroid pathophysiology and management”5th edition Chapman and hall publications 245-248.

8. Caventure A, Delarosa J, Racly AA, Disarray JN, Belles G, Roux F, et al., Endemic loiter a research protocol elaboration for eradication collegiums anthropologies 1998 Jun; 22(1):1-8.

9. Toteja GS, Singh P, Dillon BS, saxena BN, Iodine deficiency in 15 districts of India. Indian Journal of pediatrics 2004 Jan; 71(1); 25-8 (35kb)

10. Dunn JT, Seven deadly sins in confronting endemic iodine deficiency, and how to avoid them. Journal of clinical endocrinology and metabolism 1996 Apr; 81(4): 1332-5 (594kb)

11. Delange F, Iodine deficiency in Europe and its consequences; an update, European journal of Nuclear medicine and molecular imaging 2002 Aug; 29 Supple 2:S 404-s416 (73kb)

12. Zimmermann MB, Wegmuller R, zederc to resanni T, chaouki N. Rapid relapse of thyroid dysfunction and goiter in school age children after discontinuation of satt indization American journal of clinical Nutrition 2004 Apr; 79(4): 642-5(82kb)

13. Burrow appenheimer Vol text book of thyroid function and disease 4th edition by W.B sanndur company 274-278.

14. B.T Basavanthappa (1998) textbook of nursing research 1st edition Noida, Jayee publications

15. Carol west suitor et al., (1984) text book of “Nutrition principles and applications on health promotion 2nd edition New York J.B Lippincott company 42A9

16. Polit and Hungler (1992) Text book of “Nursing research principles and methods” 4th edition New York, Y.B Lippincott company.

17.

18. hypothyroidism in India current status

19. American journals of medical generics 11 July 1997

20. Hypothyroidism: home>library>health >public health

21. Mayo foundation for medical educational and research 1998-2010

22. Author: Stephanie LLee MP Ph. D Associate professor dept. of Medicine 22.03.2010.

23. Shestakova ME., et al., terarkh, 2009.

24. Annl.L.Brown 6.11.199 Congenital hypothyroidism & Associated birth defects at lanta 197-1992.

JOURNALS

1. Maria Ternanda Barca, reyer Knobel S (2000) An international Journal of clinical endocrinology 1-21

2. Marcella D. Walker and shonni J. Silver berg (2007) the journal of clinical endocrinology and metabolism 1647-1652.

3. David cooper and Mauriac Rabin (2007) Endocrinology and metabolism News 17-19.

4. Black well (2007) the clinical journal of the society for endocrinology 757-786.

|1. |SIGNATURE OF THE CANDIDATE | |

|2. |REMARKS OF THE GUIDE | |

|3. |NAME AND DESIGNATION | |

|4. | GUIDE | |

|5. |SIGNATURE | |

|6. |CO-GUIDE | |

|7. |SIGNATURE | |

|8. |HEAD OF THE DEPARTMENT | |

|9. |SIGNATURE | |

|10. |REMARKS OF THE PRINCIPAL | |

|11. |SIGNATURE | |

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

Curriculum Development Cell

CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|Registration No |: | |

|Name of the candidate |: | V.KARPUGAM |

|Address |: |AE&CS PAVAN COLLEGE OF NURSING, KOLAR-563101 |

|Course of Study and Subject |: |M.Sc Nursing in Medical Surgical Nursing |

|Date of Admission to Course |: |01/06/2010 |

|Title of the Topic |: |A study to evaluate the effectiveness of structured teaching programme a |

| | |knowledge regarding prevention of hypothyroidism selected complications |

| | |among hypothyroidism patients in selected hospitals at Kolar. |

|Brief resume of the intended word |: |Attached |

|Signature of the Student |: | |

|Guide Name |: |Mrs. SHYAMALA RANI |

|Remarks of the Guide |: |THE SELECTED TOPIC IS APPRORIATE AND RELEVANT |

|Signature of the Guide |: | |

|Co-Guide Name |: |Nil |

|Signature of the Co-Guide |: | |

|HOD Name |: |Mrs. SHYAMALA RANI |

|Signature of the HOD |: | |

|Principal Name |: | |

|Principal Mobile No. |: | |

|Principal E-mail ID |: | |

|Remarks of the Principal |: | |

|Principal Signature | | |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download