2. Diagnosis: Thyroid Storm
4. Vital signs: q1-4h. Call physician if BP >160/90, <90/60; P >130, <50; R>25, <10; T >38.5 °C
5. Activity: Bed rest
6. Nursing: Cooling blanket prn temp >39°C, inputs and outputs. Oxygen 2 L/min by nasal canula.
7. Diet: Regular
9. Special Medications:
Thyroid Storm and Hyperthyroidism:
-Propylthiouracil (PTU) 1000 mg PO, then 50-250 mg PO q4-8h, up to 1200
mg/d; usual maintenance dose 50 mg PO tid OR -Methimazole (Tapazole) 30-60 mg PO, then maintenance of 15 mg PO qd-bid AND
-Iodide solution (Lugol's solution), 3-6 drops tid; one hour after propylthiouracil AND
-Dexamethasone (Solu-Medrol) 2 mg IV q6h AND -Propranolol 40-160 mg PO q6h or 5-10 mg/h, max 2-5 mg IV q4h or propranolol-LA (Inderal-LA), 80-120 mg PO qd [60, 80, 120, 160 mg].
10. Extras: CXR PA and LAT, ECG, endocrine consult. If visual symptoms, obtain ophthalmology consult.
11. Labs: CBC, SMA 7&12; sensitive TSH, free T4. UA.
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It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.