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Hyperthyroidism and Graves
Medical Surgical (NUR425)
Arizona College of Nursing
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NUR1460Preview text
1 Case Study: Hyperthyroidism and Disease K. is a man admitted to the hospital after a episode of with complaints of dyspnea on exertion, palpitations, chest pain, insomnia, and fatigue. K. was diagnosed with disease 6 months ago and placed on methimazole (Tapazole) 15 His other past medical history includes heart failure and hypertension requiring antihypertensive however, he states that he has not been taking these medications on a regular basis. Vital signs (VS) are: 124 irregular, 20, 100 F (37 C). Admission assessment findings are: height 5 ft, 8 weight 132 appears anxious and loud heart pitting edema noted in bilateral lower diminished breath sounds with fine crackles in the posterior bases. K. begins to cry when he tells you he recently lost his you notice someone has punched several more holes in his belt so he could tighten it. Laboratory Values Hemoglobin (Hgb) 11 Hematocrit (Hct) Erythrocyte sedimentation rate (ESR) 48 Sodium 141 Potassium 4 Chloride 101 Blood urea nitrogen (BUN) 33 Creatinine 1 Free thyroxine (T4) 14 Triiodothyronine (T3) 230 1. Which of assessment findings represent manifestations of hypermetabolism? Fatigue, sudden weight loss, tachycardia, irregular heart rate, nervousness, anxiety 2. Interpret laboratory results. Elevated ESR, BUN, Creatinine, T4and T3 3. You go to assess K. What additional data do you need to obtain because he has Assess for any tremors, any weight loss, which medications he is currently taking, Check eyes for exophthalmos, sweating, muscle weakness, depression, double vision 2 Orders Propranolol (Inderal) 20 mg PO q6h Dexamethasone (Decadron) 10 mg IV q6h Verapamil (Calan SR) 120 PO Furosemide (Lasix) 80 mg IV push now, then 40 IVP Diet as tolerated STAT ECG and echocardiogram Up ad lib IV of D5W at 125 Daily weights with 4. The physician writes these admission orders. Which will you question, and why? I would question the patient being up as tolerated. I would like the patient should be on bedrest until more stable 5. Describe four priority problems related to nursing care. Elevated temp, elevated heart rate, edema, and diminished lung sounds with fine crackles at posterior bases dose? How many for the second (if needed)? 3 , second dose would be 4 ml 11. Describe how to safely administer solution. A dropper should be used for proper and safe administration 12. What is your primary nursing goal at this time? Decreased cardiac workload 13. Describe six interventions you will perform over the next few hours for K. based on this priority. Monitor BP laying, sitting Monitor heart rate and Monitor Continue bed Monitor urinary Assess edema to all Auscultate lung sounds 14. Why was K. at risk for developing thyroid storm? K is experiencing infection and stress which are risk factors for developing thyroid crisis 15. Identify three outcomes that you expect for K. as a result of your interventions. Decreased temperature, Decreased respiratory rate, Decreased and regular heart rate Case Study Progress After several hours of treatment, condition stabilizes. The physician discusses two treatment options with K. and his family: radioactive iodine (RAI) therapy, also known as and subtotal thyroidectomy. 16. K. is fearful of radiation treatment and asks you for your opinion. How would you respond? K would have to be educated on the side effects of radiation like nausea, vomiting, dry mouth and neck pain. He will also have to be informed of being highly radioactive for a few days as the dosage of radiation is high. This can then help K make a decision regarding the type of treatment he would chose to go through. 17. K. decides to receive RAI. During pretreatment instructions, the family asks whether he will be radioactive and what precautions they should take. Outline important guidelines for instructing K. and his family regarding home precautions. Family should stay at least 3 feet from K the first week after Family should minimize time with K should drink plenty of fluids 18. In the midst of all this, you remain concerned over bereavement after the loss of his wife. How would you address this issue? I would see if K would be interested in speaking to a therapist and get him connected with a support group for widows and widowers 19. K. does have some exophthalmos and is experiencing periodic photophobia and dry eyes. What should you include in teaching him how to manage these problems? Use cool compresses, wear sunglasses as needed, eye lubricants, and elevating the head of bed when sleeping to reduce pressure 20. Which statement indicates K. understands the discharge instructions?
Hyperthyroidism and Graves
Course: Medical Surgical (NUR425)
University: Arizona College of Nursing
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