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Chapter I INTRODUCTION A. Background of the Study

Hyperthyroidism, considered as the second most common endocrine disorder. It results from an excessive output of thyroid hormones due to abnormal stimulation of the thyroid gland by circulating immunoglobulin. This disorder affects women eight times more frequently than men and peaks between the second and fourth decades of life. It generally occurs between 20 and 40 years old and is more common in females. But more common in women during menopause and after child birth.

(http://www.thyroid.org/patients/patient_brochures/hyperthyroidism.html)

Thyroid hormones are essential for the body to function normally. To achieve this purpose, the thyroid hormones must be present in the body in the correct amount, not too little and not too much. Hyperthyroidism is the medical term applied to an over-active thyroid gland with consequent excess secretion of thyroid hormones, causing the body to speed up. It accelerates bodys metabolism causing weight loss, exopthalmos (protrusion of the eyeballs), hypertension, and heat intolerance. Neurological manifestations can include tremors, irritability and restlessness.

(http://www.aafp.org/afp/20050815/623.html)

Treatments include medications to inhibit thyroid-hormone production, and removal or destruction of the thyroid gland with radioactive iodine. The most common cause of the excessive thyroid production is Graves disease, an autoimmune disorder of the thyroid gland. (Medical Surgical Nursing: 6th edition. 2005.)

B. Statement of the Problem How can a client with endocrine problem (hyperthyroidism) be assisted in attaining a higher level of met needs utilizing Orlandos interactive theory in the nursing process?

C. Significance of the Study The study is of great relevance in the care of the client with Hyperthyroidism. Nursing Interventions are focused on the patients needs or responses to the environment. It enables the nurse to determine the effectiveness of interventions utilizing Ida Jean Orlandos Theory as a guide in nursing practice and render quality nursing care.

Chapter II THEORETICAL FRAMEWORK

A. Review of Literature Hyperthyroidism causes a sped-up metabolism and can cause the patient to feel hyper, edgy, nervous and anxious. While people with any thyroid disorder have potential to experience anxiety, those with hyperthyroidism are especially vulnerable to chronic and severe anxiety symptoms The most common cause in more than 70% of people is overproduction of the thyroid hormone of the entire thyroid gland, a condition called Graves Disease. (American Thyroid Association, http://www.thyroid.org.) The symptoms may include enlarged thyroid gland, nervousness, irritability, insomnia, diarrhea, heart palpitation, unexpected weight loss despite increased appetite, heat intolerance, increased in bowel movements. There may be puffiness around the eyes and a characteristic stare due to elevation of upper eyelids. Advanced symptoms are easily detected, but early symptoms especially in elderly , may be quite suspicious. (http://www.medicinenet.com/hyperthyroidism) The most common method used to diagnose thyroid disorders, is through blood testing. Blood is drawn and lab-tested to see if the thyroids hormone levels are in the normal range. If they are outside of the normal reference range, on the high end, this would indicate an over-active thyroid gland, hyperthyroidism. Hormone Replacement Medications are used to The treatment for the thyroids hyperthyroidism is also by oral medication but in this case, medications called Thyroid supplement underproduction of thyroid hormones. (Disease and Disorders: A Nursing Therapeutic Manual. 3rd Edition. 2007)

B. Theoretical Source
Ida jean Orlando was the first nurse to develop her theory from actual nursepatient situations. She used a qualitative method to obtain data from which she developed her theory. She describes her model as revolving around five major interrelated concepts; the function of professional nursing; the presenting behavior of the patient; the immediate response of the nurse; the nursing process discipline and improvement. Orlando views the professional function of nursing as finding out and meeting the patients immediate need for help. Orlandos theory focuses on how to produce improvement in the patients behavior. According to Orlando, a person becomes a patient requiring nursing care when he or she has needs for help that cannot be met independently because he or she has physical limitations, has negative reaction to an environment, or has experience that prevents the patient from communicating his or her needs. When the nurse acts, an action process transpires. This action process by the nurse in a nurse-patient contact is called nursing process. Orlandos theory is specific in nurse-patient interaction. The goal of the nurse is to determine and meet patients immediate need. The role of the nurse is to find out and meet the patient's immediate need for help. The patient's presenting behavior may be a plea for help; however, the help needed may not be what it appears to be. Therefore, nurses need to use their perception, thoughts about the perception, or the feeling engendered from their thoughts to explore with patients the meaning of their behavior. This process helps nurse find out the nature of the distress and what help the patient needs. Orlando's theory remains one the of the most effective practice theories available. The use of her theory keeps the nurse's focus on the patient. The strength of the theory is that it is

clear, concise, and easy to use. While providing the overall framework for nursing, the use of her theory does not exclude nurses from using other theories while caring for the patient. Professional nursing is conceptualized as finding out and meeting the clients immediate need for help. This framework will be important for Nurses who are assigned in special clinical areas that require quick decision making & critical thinking skills. If the patients condition improved, then the intervention is effective and the patient moves on to new problems. Orlandos major assumption about Nursing is that it is a distinct profession "Providing direct assistance to individuals in whatever setting they are found for he purpose of avoiding, relieving, diminishing, or curing the individual's sense of helplessness" Orlando assumes that a Human/Person is an individual in need. Unique individual behaving verbally or nonverbally. Assumption is that individuals are at times able to meet their own needs and at other times unable to do so. Orlando assumes that Health that freedom from mental or physical discomfort and feelings of adequacy and well being contribute to health. She also noted that repeated experiences of having been helped undoubtedly culminate over periods of time in greater degrees of improvement Orlando assumes Environment is a nursing situation that occurs when there is a nurse-patient contact and that both nurse and patient perceive, think, feel and act in the immediate situation. any aspect of the environment, even though its designed for therapeutic and helpful purposes, can cause the patient to become distressed. She stressed out that when a nurse observes a patient behavior, it should be perceived as a signal of distress. (Parker, Marilyn. Nursing Theories and Nursing Practice. FA Davis Company. 2005)

C. Conceptual Framework

Assessme

Level of Met Needs utilizing Orlandos Theory

Planning / Implementation

Goal s of Nursi ng Actio n

Level s of Met Need s

Evaluation
Figure1. The Nursing Process Flowchart The above figure illustrates the nursing care approach in assisting the client with need for help. The assessment Phase focuses on the client with need. The planning/implementation Phase directs to setting up of goals and objectives, and identifying and carrying out of the nursing actions. The Evaluation phase focuses on validating the effectiveness of the met needs.

D. Definition of Terms
Met Needs. Needs presented as behaviors that the client is able to meet whether

independently, with minimum assistance or solely with assistance. Level of Met Needs. Needs that presented as behaviors that are classified according to how the client is able to perform them and is categorized as high, average, below average, and low level of adaptation. High Level of Met Needs. Client is able to meet needs independently without the help, aid or support which has the mean score range of 3.1 4. Average Level of Met Needs. Client is able to meet needs with a little help, aid or support in the form of nursing care. of 2.1 3. Below Average Level of Met Needs. Client is able to meet needs solely with the help, aid or support in the form of nursing care. Success in meeting the human needs is low without assistance which has the mean score range of 1.1 2. Low Level of Met Needs. Clients needs that are barely met or not met at all which has the score range of 0 1. Observed Behavioral Response. These are the frequency of indicators in each category. Code Always Most of the time Sometimes Rarely Description Behavior observed all the time rated as 4. Behavior observed frequently rated as 3. Behavior observed occasionally rated as 2. Behavior observed once in a while rated as 1. Success in meeting the particular need is high without assistance which has the mean score range

Chapter III APPLICATION OF THE NURSING THEORY A. CLIENTS PROFILE Name: Address: Age: Sex: Status: Height: Weight: Occupation: Educational Attainment: Ethnic Group: Dialect/Language Spoken: Chief Complaints: Medical Impression:
B. CLINICAL HISTORY

Patient X 198-f Don Alfaro Street, Tetuan Zamboanga City 24 Male Single 58 60 kgs Unemployed College Graduate Zamboangueo Tagalog, English, and Chavacano Sudden Lost of Weight, On and Off Fever, Sore Throat, and Mouth Sores for 2 weeks Hyperthyroidism

Patient X was diagnosed of Hyperthyroidism 5 years ago. For the past 5 years, he doesnt have any complaints regarding hyperthyroidism. And he hasnt done laboratory tests for his condition as he should like the T3, TSH, and T4. He hasnt monitored his blood since then. He experienced simple cough, fever, or flu-like symptoms for the past years. Patient X was admitted due to decrease of WBC related to anti-thyroid drug side effects.

Last June 26, 2010 Patient X consulted an Endocrinologist and instructed him to do some laboratory tests such as T3, T4, TSH, CBC and SGPT. When they went back to the Endocrinologist, the doctor was alarmed since his WBC was only 3.5K/uL and his SGPT were so high to 144U/L. He instructed the patient that she cant treat his Hyperthyroidism unless his blood levels were normal. His Endocrinologist, prescribed patient X to continue drinking the Carbimazole 5mg and Indural 10mg to minimize his hyperthyroidism symptoms like palpitations, sweating, and insomnia. The Doctor advised him to watch out signs like mouth sores, sore throat, and fever. After a month, he went back to the doctor and consulted, after the laboratory tests done. The Doctor maintained a low dose of Carbimazole and to continue the Indural 10mg, TID. and follow-up after 6 weeks.

C. ASSESSMENT TOOL
The assessment tool was constructed based on the concept presented in the theory of Ida Jean Orlando categorized into four assessment parameters which are Physiological, Social, Psychological and Spiritual and sub-categorized to areas to which Orlandos Theory wants to focus. These areas assessed in accordance with the clients ability to meet own needs. This assessment serves as a basis for nursing actions.

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Table 1. Assessment Tool Direction: Put a check mark () on the scale corresponding to the observed behavioral response coded and described as follows: 4 Always; 3 Most of the time; 2 Sometimes; 1 Rarely.
ASSESSMENT PARAMETERS A. PHYSIOLOGIC NEEDS A. Oxygenation 1. Manifests clear breath sounds and effortless breathing 2. Demonstrates normal breathing pattern (16 20 breaths per minute) 3. Manifests normal pulse rate (60 100 beats per minute) 4. Manifests promptly capillary refill of fingernail beds (around 3 seconds) 5. Manifests normal Blood Pressure (100 120 / 60 80 mmHg) B. Nutrition 1. Eats well balanced diet during regular meals. 2. Eats regularly at least three times a day 3. Drinks Sufficient amount of water at least 6 8 glasses (2000ml) per day 4. Takes nutritional supplement like multivitamins 5. Exhibits ideal Body weight for height and age C. Elimination 4 3 2 1

1. Moves bowel with normal consistency and without difficulty.

2. Voids painlessly approximately 5 8 times daily (800 1000cc) D. Sleep and Rest 1. Sleeps at least 6 8 hours at night without interruption 2. Takes adequate amount of rest at daytime

B.

E. Exercise and Activity 1. Performs activities of daily living independently a. Takes a bath independently at least once daily b. Practices good dental hygiene at least once daily c. Grooms fingernails and toenails regularly d. Wears neat, clean, appropriate clothing e. Dresses and undresses independently 2. Exercise at least 15-30 minutes a day such as brisk walking & deep breathing, especially in early morning. PSYCHOLOGICAL NEEDS A. Self- Concept 1. Expresses fears about the nature of disease 2. Identifies feelings & concerns about physical ailment 3. Verbalizes understanding and acceptance of present condition
B. Self Esteem 1. Provides financial needs of the family 2. Works with a sense of accomplishment 3. Shows ability to work with dedication 4. Complies with the therapeutic regimen SOCIAL NEEDS A. Interpersonal Relationship Demonstrates harmonious relationship with parents 2. Mingles with friends and relatives B. Community Resources 1. Utilizes health facilities (like health center, hospital) appropriately

C.

1.

D.

2. Participates in learning activities or opportunities for learning SPIRITUAL NEEDS 1. Devotes regular worship time 2. Expresses gratification with compatibility of spiritual belief and daily living, 3. Practices spiritual belief that strengthen hope and comfort in facing life.

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TOTAL

The Evaluation Scale A. To get the clients level of Met Needs, statistical procedure for getting the Mean Score from each category is computed to determine which category is greatly affected in order to prioritize nursing intervention. The formula is as follows: Clients Score Mean Score (X) = ---------------------Number of Items

B. To come up with Over All Mean Score and to describe the clients level of Met Needs in 2 categories, the formula to be used is: Clients Score in all categories Over All Mean Score (OSM) = ---------------------------------------Number of Items in all categories

Scale 0 4 1 2 3

LOW

BELOW AVERAGE

AVERAGE

HIGH

Figure 2. The Evaluative Scale of clients met needs

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D. Nursing Process 1. Assessment Phase Table 2. Initial Assessment of Patient X

CATEGORY No. of Items Perfect Score Client Score Mean Score Rank Description

A. PHYSIOLOGIC NEEDS A. Oxygenation B. Nutrition C. Elimination D. Sleep and Rest E. Exercise and Activity Sub Total B. PSYCHOLOGICAL NEEDS A. Self- Concept B. Self Esteem Sub Total C. SOCIAL NEEDS A. Interpersonal Relationship B. Community Resources Sub Total D. SPIRITUAL NEEDS TOTAL

2
5 5 2 2 6 20 3 4 7 2 2 4 3 34 20 20 8 8 24 80 12 16 28 8 8 16 12 136
X = 2.14

12 9 5 2 15 43 4 8 12 6 3 9 9 73

2.4 1.8 2.5 1 2.5 2.15 1.3 2 1.7 3 1.5 2.25 3 2.14

3 2 4.5 1 4.5

Average Below Average Low Average Below Average Average

1
1 2 Below Average Below Average

3
2 1 Average Below Average

Average Average

Scale 0 4

LOW

BELOW AVERAGE

AVERAGE

HIGH

Figure 3. The Evaluative Scale of the level of met needs based on the initial assessment of Patient X

Interpretation

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The initial assessment of Patient X has a total score of 73. The mean score were added and divided by the total number of categories is equal to 2.14 as an overall mean score described as an Average level of met needs as demonstrated on the scale.