During my practice in a nursing home, I had the opportunity write up a care plan for one of the residents. The patient concerned has a long-standing condition called myxoedema, which is a condition I had never come across before. Therefore, in order to compile an accurate and comprehensive care plan I had to look into what myxoedema was.
Myxoedema is caused by hypothyroidism (under activity of the thyroid gland). Myxoedema refers to the buildup of mucoploysaccharide in the subcutaneous tissues of the skin (Kumar and Clark, 1998). Signs and symptoms of myxoedema include oedematous swelling of the face, limbs and hands, dry and rough skin, loss of hair, slow pulse, subnormal temperature, slowed metabolism and mental dullness (Weller, 1999).
Although very rare, severe hypothyroidism, especially in the elderly, can cause confusion or even coma. Hypothermia is often present and the patient may have severe cardiac failure, hypoventilation, hypoglycaemia, and hyponatraemia (a sodium deficiency in the blood, Weller, 1999). Depression is quite common and severe hypothyroidism in the elderly can cause the patient to become demented and psychotic, sometimes with delusions (Kumar and Clark, 1998).
With an understanding of myxoedema, I then compiled the patient’s care plan and consulted with the patient, when I had finished. I explained to the patient about the condition that was affecting her, that is to say what it was and how it may affect her. I then went through the care plan with her and asked if she was happy with it. We then both signed it.
Patient education and consultation, involving the patient in the writing of her care plan reflects current best practice. Patient education is now viewed as an integral part of high quality health care (Walsh, 1997). It is vital that patient’s understand their rights and choices, especially for the elderly, because as a professional nurse one cannot discriminate between people and assume that because the patient is old they do not need to know what is happening to them and treat them as children (Rhonda, 1998).
Kumar, P. and Clark, M. (1998) Clinical Medicine. Fourth Edition. London: Harcourt Brace and Company Limited.
Rhonda, N. (1998) Contradictions between Perceptions and Practices of Caring in Long Term Care of Elderly People. Journal of Clinical Nursing. Vol. 7, No. 5, pp. 401-408.
Walsh, M. editor (1197) Watson’s Clinical Nursing and Related Sciences. London: Bailliére Tindall.
Weller, B.F. (1999) Baillière’s Nurses’ Dictionary. Twenty Second Edition. London: Bailliére Tindall.
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