Question

Case Study: The Patient with Endocrine Problems

The nurse is caring for a 41-year-old woman who is the mother of two small children. She states that she has felt “nervous and tired” for approximately 1 month. Today, she has had a sudden onset of breathlessness with cardiac palpitations. She states, “I have not been feeling well for about a month, but when I felt breathless I thought I should be checked out.” Upon further questioning, the nurse finds that the woman also has had an unexplained loss of weight of approximately 30 lbs over 3 months, frequent loose stools, loss of hair on the scalp, and a feeling of “burning up.”

1. What other findings would the nurse expect to see on physical examination of this patient?

2. What laboratory tests would the nurse expect to be ordered for this patient? What abnormalities could be expected for these laboratory tests? What diagnosis does the nurse suspect based on assessment findings and lab tests?

Answer 1

1. ANSWER

Based on the signs and symptoms ,

The findings that nurse expect to see on physicalexamination are

- elevated blood pressure

-protruding eyes

- enlarged thyroid gland

- moist eyes ( increased perspiration)

- thickening of skin ,especially pretibial

- bulging eyes ( lid retractionor proptosis) unblinking stare

- eye irritation ,periorbital edema, diplopia, change in visual acuity

- hyperreflexia

-tachycardia

-patches of complte hair loss

- examinationofpalms shows hot, red and sweatyhands

-brisk reflees are seen

-muscle wasting

-examine the neck for texture of gland , tenderness and the presence or absence nodularity or of distinct lumps or lymph nodes

2.ANSWER

The laboratory test that the nurse expect and abnormality found are

*-blood tests,THYROID FUNCTION TEST

blood tests that measure thyroxine and thyroid stimulaying hormone(TSH) can confirm the diagnosis. High levelsof thyroxine and low or nonexistent amounts of TSH indicate an overactive thyroid.The amount of TSH is important because it its the hormone that signals your thyroid gland to produce more thyroxine

with hyperthyroidism TSH is low while T4and T3 levels are high

the normal range of TSH test is 0.5 to5.0 mIU/L.

* Thyroid releasing hormone stimulation test

* Radioactive iodine uptake (RAIU)

A radioactive iodine uptake test uses a radioactive tracer and a specil probe to measure how much tracer the thyroid gland absorbs from the blood.

* throid scan can be done to identify autonomous nodule

Based on assessment findings and laboratory test the nurse suspects that the patient has HYPERTHYROIDISM

Hyperthyroidism - it is a disease process associated with increased thyroid secretion result in predictable hyermetabolic state.

the types of hyperthyroidism are

1. primary thyrotoxicosis

- diffuse toxic goitres-graves disease

2.secondary thyrotoxicosis

-toxic nodular goitre

-toxic nodule

-hyperthyroidism due to rare cause

-