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Graves disease is an autoimmune disorder that leads to overactivity of the thyroid gland (hyperthyroidism). The thyroid is a small gland in the front of the neck. It makes hormones called T3 and T4 that regulate how the body uses energy. Thyroid hormone levels are controlled by the pituitary, which is a pea-sized gland in the brain. It makes thyroid stimulating hormone (TSH), which triggers the thyroid to make thyroid hormone.

Many factors are thought to play a role in getting Graves' disease. These might include:

• Genes. Some people are prone to Graves' disease because of their genes. Researchers are working to find the gene or genes involved.
• Gender. Hormones might play a role, and might explain why Graves' disease affects more women than men.
• Stress. Severe emotional stress or trauma might trigger the onset of Graves' disease in people who are prone to getting it.
• Pregnancy. Pregnancy affects the thyroid. As many as 30 percent of young women who get Graves' disease have been pregnant in the 12 months prior to the onset of symptoms. This suggests that pregnancy might trigger Graves' disease in some women.
• Infection. Infection might play a role in the onset of Graves' disease, but no studies have shown infection to directly cause Graves' disease.

Nursing Diagnosis for Graves' Disease : Risk for Impaired Skin Integrity related to changes in the mechanism of protection of the eyes; damage eyelid closure / exophthalmos.

Goal: Able to identify measures to provide protection to the eyes and prevention of complications.

Interventions and Rationale:

Independent:

1. Observation periorbital edema, impaired eyelid closure, narrow field of vision, excessive tears. Note the presence of photophobia, taste any thing outside the eye and pain in the eyes.
Rationale: common manifestation of excessive adrenergic stimulation associated with thyrotoxicosis who require support to a resolution of the crisis intervention can eliminate symptomatology.

2. Evaluation of visual acuity, report any blurred vision or double vision (diplopia).
Rational: Oftalmopati infiltrative (Graves disease) is the result of an increase in retro-orbital tissue, which creates exophthalmos and lymphocyte infiltration of extra-ocular muscles that cause fatigue. The emergence of visual impairment, can worsen or improve independence therapy and clinical course of disease.

3. Instruct the patient to use dark glasses, when awake and closed with a blindfold over sleep as needed.
Rationale: Protecting corneal damage if the patient can not turn a blind eye to perfect as edema or fibrosis due to fat pad.

4. The head of the bed elevated and limit the use of salt if indicated.
Rationale: Reducing tissue edema when there are complications such as chronic heart failure which can aggravate exophthalmos.

5. Instruct the patient to exercise extra-ocular eye muscles if possible.
Rationale: Improve circulation and maintain eye movements.

6. Give the patient the opportunity to discuss their feelings about the changes in the size or shape of body image to improve the self-image.
Rationale: The ball slightly bulging eyes, causing a person is not attractive, it can be reduced by wearing makeup, wearing glasses.