Discharge And Home Healthcare Guidelines

Inform patients and families about the disease process, prognosis, and treatment plan. Discuss with them the possibility that abnormal urinary findings may persist for years after AGN has been diagnosed. Demonstrate all home care techniques, such as medication administration. Discuss the dosage, action, route, and side effects of all medications. If the patient is placed on antibiotics, encourage her or him to complete the entire prescription. Teach the patient and family to seek professional assistance for all infectious processes (particularly respiratory infections with sore throat and fever); monitor body weight and blood pressure at home or through a clinic; avoid contact with individuals with infectious processes. Discuss the need for ongoing laboratory monitoring of electrolytes and renal function tests during the months of convalescence, as recommended by the physician. Explain that after acute poststreptococcal glomerulonephritis, any gross hematuria that occurs when the patient has a viral infection needs to be reported to the physician.

378 Goiter

Goiter DRG Category: 300

Mean LOS: 6.3 days Description: MEDICAL: Endocrine Disorders with CC

GGoiter is the enlargement of the thyroid gland. It is usually a response to a thyroid hormone deficiency (primary hypothyroidism) that results in the hypersecretion of thyroid-stimulating hormone (TSH) from the anterior pituitary gland. Oversecretion leads to subsequent thyroid hypertrophy and hypervascularity. The body's response may compensate for thyroid hormone deficiency, leaving the patient asymptomatic. Goiter may also occur in conjunction with hyperthyroidism, known as Graves' disease. Finally, goiter may occur with the growth of thyroid tumors. Secondary hypothy-roidism occurs with TSH deficiency in the pituitary gland and is not associated with goiter.

Most goiters are classified as simple (or nontoxic). They result from any enlargement of the thyroid gland that is not caused by an inflammation or a neoplasm. Simple goiters can be classified as sporadic or endemic and are not associated initially with either hyperthyroidism or hypothyroidism. Sporadic goiters occur after a person eats certain foods (peaches, strawberries, radishes, spinach, peas, cabbage, soybeans, or peanuts) or takes certain medications (iodides, lithium, propylthiouracil) that decrease thyroxine (T4). Endemic goiters, in contrast, occur because of the patient's geographic location in areas where the soil is depleted of iodine. Endemic goiter that results from soil deficiencies is most likely to occur during autumn and winter.

Goiter becomes a problem only when the enlargement exerts pressure on other neck structures, such as the trachea, or when the enlargement is unsightly, causing the patient to become concerned.

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