Question

Don Smart, 55 years of age presents to the family physician to follow up on some symptoms he recently developed. The patient states that he is extremely tired and is having trouble concentrating. He states that his skin is dry and flaky. His nails are brittle and his hair is dry, dull, and falls out as he showers. He is 8 weeks postop after a modified radical neck procedure for laryngeal cancer and has completed the external radiation therapy. He is using a Blom--Singer prosthesis for speech. He states that his appetite is poor, yet he is gaining weight. The patient’s current medications include metformin (Glucophage) for a history of type 2 diabetes, digoxin 0.25 mg every day for a history of atrial fibrillation, and warfarin therapy being managed by the family physician for thromboembolism prophylaxis related to atrial fibrillation. The physician orders the following lab work: CBC with differential, serum albumin, TSH, FT4, PT, and INR.

What is the rationale for all of the labs ordered, based on the symptoms that the patient is exhibiting? The TSH and free T4 will assess thyroid function, and an elevated TSH and a low free T4 will confirm the diagnosis. The PT and INR monitors the effectiveness of the Coumadin.

The physician follows up with the patient with the diagnosis of hypothyroidism. What are reasons why the patient developed hypothyroidism?

Based on the results of the TSH and FT4, the physician starts the patient on levothyroxine (Synthroid) 0.025 mg/day and to have follow-up TSH and FT4 labs and visit to the oncologist in 4 weeks. The physician informs the patient that he will continue to have lab tests and monthly follow-up until the TSH and FT4 are stable. What is the rationale for this treatment plan?

What nursing interventions should the nurse provide the patient (name at least 4)?

Answer 1

Don Smart is a 55 years old patient with symptoms of fatigue, dry and flaky skin, brittle nails and hair fall during shower. These symptoms indicate hypothyroidism. Moreover the lab tests ordered by the physician included TSH, T4, PT and INR. The TSH and T4 assessed the thyroid function and PT and INR assessed Coumadin effectiveness. Increased TSH and decreased T4 further confirmed hypothyroidism. This was probably because of the recent neck surgery and radiations taken by the patient. Patients on Metformin prescription tends to develop hypothyroidism over the course of time. Diabetes and metformin can be the major cause of hypothyroidism for the patient.

Levothyroxine for the patient can minimize the impact of Metformin. Levothyroxine can interfere with the blood glucose control and minimize the impact of metformin. TSH and FT4 labs in 4 months can indicate the improvement in the condition.

Nursing intervention that the nurse should provide must include:

· Monitoring patient’s symptoms

· Setting goals for the patient’s improvement

· Educating the patient about his treatment plan

· Monitoring improvements.