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Hormone Regulation Case Studies
Human Pathophysiology (NUR 252)
Creighton University
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Case Study 1: Case Presentation
Fred R. Bird is a 57-year-old man who is overweight. His children and wife are growing increasingly concerned about his eating habits as he tends to over-indulge in soda and his favorite foods including pizza, double cheeseburgers and donuts from the shop down the street. Fred will often boast that he exercises daily, however, this entails walking the 2 blocks to the donut shop for the special consisting of 2 donuts and coffee. At his last physical exam at age 50, he was found to be “borderline” hypertensive and was instructed to increase his physical activity and improve his eating habits. Fred has not followed this advice and would tell others he “felt great” and didn’t need to change anything.
- Which Hormone Regulation exemplar is Fred at greatest risk for developing?
Diabetes Mellitus Type 2
- In addition to diet, what are some additional risk factors that apply to Fred’s case for this exemplar?
Age, weight (obesity), sedentary lifestyle
Genetics/family history, race (AA, Hispanic, American Indian), elevated lipid levels, fat distribution
- Explain the pathophysiology of this exemplar.
Type 2 diabetes is insulin resistance, impairment of hepatic glucose production and eventually beta cell decline.
Susan, his oldest daughter just entered her 3rd year of college and is in nursing school. She really wants to do well in her clinicals and has been performing physical exams on her parents and siblings. She performed a physical exam on her father and documented her findings.
Temp: 37 degrees C, HR: 75, RR: 12, weight: 125 kg, height: 5’10”, pain: 0/10, BP: 145/92. Physical Exam: Fred is sitting in his recliner, no acute distress. HEENT: normocephalic, PERRL, nares patent, mucus membranes pink and moist. Neck: supple. CV: regular rate and rhythm, no murmurs/rubs/gallop/thrill. CRT upper extremities < 3 sec, ~ 4 seconds in feet bilaterally. Resp: LCTA bilaterally, good aeration, no inc WOB. FEN/GI: abd rounded, panus noted, BS normoactive x4, no HSM, no tenderness. Skin: grossly intact, dark and leathery skin in the folds of the neck and in the axilla noted, striae across abdomen, light reddish-brown spots across both shins. Extremities: no deformity. Neuro: A&O x3, no focal deficits, some impairment of touch noted in both feet bilaterally on filament exam.
What are the pertinent positives in the exam above?
If you obtained labs for Fred and found the following, how would you interpret each value? Fasting blood glucose: 250, Hgb A1C: 9, Na: 137, K: 3, BUN: 35, Creatinine: 1.
Fasting blood glucose is elevated, A1C is elevated, Na & K are normal, BUN/Create are elevated
Case Study 2: Case Presentation
Susie is a 37-year-old woman who has been feeling off the past few months and she just can’t place the root of her symptoms. She feels depressed, fatigued and has noticed that she has gained 20 lbs over the past 3 months. To make things worse, her hair has been falling out! She does not want to be seen in public and has been had a hard time making it to work on time. Her children are complaining about the temperature of the house as well. Even though it is summer, Susie has been chilled and has wanted to keep the temperature set at 85 degrees. On the encouragement of her husband, she is seeking care in the clinic with her PCP. You are the nurse checking her in.
- Which exemplar is Susie exhibiting, given the above information?
Hypothyroidism
- What are the common clinical manifestations of this disorder?
Goiter, weakness, fatigue, lethargy, somnolence, mental slowness, muscle soreness, cold intolerance, depression, dry/cold skin, hair loss, weight gain, constipation, delayed DTRs, cold intolerance, sinus bradycardia.
- What is the pathophysiology of this exemplar and what would you expect disease specific labs to reflect (IE – what are the pertinent labs and would they be increased or decreased)?
Reduced production of T3/T4 that can result from primary (congenital, treatment for hyperthyroid, decreased iodine intake, thyroiditis) or secondary (hypothalamic or pituitary deficiencies) etiologies. The net result is a reduction in the amount of thyroid tissue with subsequent reduction in T3/T production with corresponding increase in TSH production. Hashimoto thyroiditis is the most common form of hypothyroidism. This is also an autoimmune process that results in global destruction of thyroid tissue through the creation of autoantibodies that lead to lymphocytic infiltration and fibrotic changes to the tissue.
What is the term for the opposite of this exemplar and how do the manifestations differ? Hyperthyroidism. Goiter, exophthalmos (bulging of the eyeballs), pretibial myxedema (thickening of the skin over this area), tachycardia, atrial fibrillation, tremor, warm/moist skin, proximal muscle weakness, hyperreflexia, staring, hair loss, anxiety, heat intolerance, DOE, palpitations, palmar erythema, weight loss, diarrhea
What are the typical treatments for Susie’s problem?
Usually surgery to remove the aganglionic section of bowel with anastomosis of the rectum to the functional colon. This is often completed in a stepwise procedure with the initial surgery resulting in a temporary ostomy. Later, a pull through procedure is completed that will connect the sections again. The surgeries are generally well tolerated and result in normal functional abilities. However, sometimes children and adults can experience constipation, inflammatory changes or even incontinence issues that may impact their quality of life. Those effects tend to be more likely in the setting of severe disease.
Case Study 4: Case Presentation
Trudy is a 35-year-old woman who has no significant past medical history. She considers herself healthy and active, in fact she recently started jogging and is working her way up to running a half marathon. She lives in Phoenix, and despite the heat, she loves running in the afternoons. With the goals she has set for herself, she has also worked on improving her diet and has also started taking several vitamin supplements including fish oil, vitamin B and calcium. The one area where she knows she needs to improve is her water intake. Despite running and trying to lead a healthier lifestyle, Trudy dislikes water and only drinks 2-8oz glasses of water a day. She realizes this is bad, but she just cannot bring herself to drink more.
Generally, over the weekends, Trudy will push herself harder during the week and will jog longer distances. She has started to note right sided back pain that is located over her flank area. This past weekend, the pain became so significant she had to stop jogging and also developed nausea and vomiting. Further, she noticed blood in the toilet when she urinated after running (she is not menstruating).
- Which exemplar is Trudy most likely experiencing?
Renal Calculi/renal stone
- What are the clinical manifestations that accompany this disorder and what is the pathophysiology that causes these manifestations to occur?
Acute unilateral flank pain (can be mild to severe, can wax and wane – renal colic), N/V, hematuria
Renal stones are crystalized masses of minerals (calcium, uric acid, struvite or cystine with calcium being most prominent) or other substances. With stone formation, damage to the lining of the GU tract occurs and the flow of urine slows. This allows for substances in the urine the opportunity to aggregate and for the urine to further crystalize. This whole process is stimulated when there is a supersaturation of solutes. This is an elevated concentration of certain substances when, under the right conditions, facilitates stone formation.
- What places Trudy at greater risk for the development of this disorder?
Dehydration, excessive calcium intake leading to hypercalcuria
- Trudy presents to the emergency room in severe pain and vomiting. You are the nurse caring for her while she is there. She is able to recount the pathophysiology of the disorder and can accurately identify the causes that led to the development of the disorder but remains unclear on how she will be treated. Can you help her understand the common treatment strategies?
Trudy will have to pass the stones to eliminate them from her system. Symptoms are managed with hydration and pain control using medications. In order to identify when stones have passed, her urine will have to be strained. If the stones are large (greater than 4mm in diameter) she may require surgery or shock wave lithotripsy to break the larger stones into smaller, more passable stones.
Hormone Regulation Case Studies
Course: Human Pathophysiology (NUR 252)
University: Creighton University
