Question

CASE STUDY:

You are working in a community outpatient clinic where you perform the intake assessment on R.M., a 38-year-old woman who is attending graduate school and is very sedentary. Her chief complaint is overwhelming fatigue that is not relieved by rest. She is so exhausted that she has difficulty walking to classes and trouble concentrating when studying. She reports a recent weight gain of 15 pounds over 2 months without clear changes in her dietary habits. Her face looks puffy, she has experienced excessive hair loss, and her skin is dry and pale. She complains of generalized body aches and pains with frequent muscle cramps and constipation. You notice she is dressed inappropriately warm for the weather.

■ Chart View: Vital Signs Blood pressure 142/84 mm Hg Heart rate 52 beats/min Respiratory rate 12 breaths/min Temperature 96.8 ° F (36 ° C)

QUESTIONS:

1. What should you teach R.M. regarding prevention of myxedema coma?

2. Before R.M. leaves the clinic, she asks how she will know whether the medication is “doing its job.” Outline simple expected outcomes for R.M.

3. Several weeks later, R.M. calls the clinic stating she can't remember whether she took her thyroid medication. What additional data should you obtain, and how would you advise her?

Answer 1

Myxedema coma can be defined as extreme hypothyroidism that may be characterized by loss of hair, dry and pale skin, weight gain, fatigue, puffy face, bradycardia and poor appetite altered mental state.

Prevention-

Educate the patient about the importance of recognising the early signs of myxedema coma .

Taking hypothyroidism medications on time.

Visiting the doctor on time.

Early diagnosis and treatment is essential.

Educate about having healthy diet.

2) within a few days the patient may experience low hormone levels, reversal of weight gain good appetite, restoration of health, there may be reduction in hair loss, better mental state.

3) in case of frequent forgetting advice the patient to ask a relative staying along to assess the administration, in case if alone advise to mark when taking medications, obtain a thyroid serum level to check for thyroid levels. Or call some close mate when taking drug.