Hyperthyroidism and Graves PDF

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Endocrine case study
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Case Study: Hyperthyroidism and Graves’ Disease K.B. is a 65-year-old man admitted to the hospital after a 5-day episode of “the flu” with complaints of dyspnea on exertion, palpitations, chest pain, insomnia, and fatigue. K.B. was diagnosed with Graves’ disease 6 months ago and placed on methimazole (Tapazole) 15 mg/day. His other past medical history includes heart failure and hypertension requiring antihypertensive medications; however, he states that he has not been taking these medications on a regular basis. Vital signs (VS) are: 150/90, 124 irregular, 20, 100.2 ° F (37.9 ° C). Admission assessment findings are: height 5 ft, 8 in; weight 132 lb; appears anxious and restless; loud heart sounds; 1+ pitting edema noted in bilateral lower extremities; diminished breath sounds with fine crackles in the posterior bases. K.B. begins to cry when he tells you he recently lost his wife; you notice someone has punched several more holes in his belt so he could tighten it. Laboratory Values Hemoglobin (Hgb) 11.8 g/dL Hematocrit (Hct) 36% Erythrocyte sedimentation rate (ESR) 48 mm/hr Sodium 141 mmol/L Potassium 4.7 mmol/L Chloride 101 mmol/L Blood urea nitrogen (BUN) 33 mg/dL Creatinine 1.9 mg/dL Free thyroxine (T4) 14.0 ng/dL Triiodothyronine (T3) 230 ng/dL 1.

Which of K.B.'s assessment findings represent manifestations of hypermetabolism? Fatigue, sudden weight loss, tachycardia, irregular heart rate, nervousness, anxiety

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Interpret K.B.'s laboratory results. Elevated ESR, BUN, Creatinine, T4and T3

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You go to assess K.B. What additional data do you need to obtain because he has Graves’disease? Assess for any tremors, any weight loss, which medications he is currently taking, Check eyes for exophthalmos, sweating, muscle weakness, depression, double vision

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Physician’s Orders Propranolol (Inderal) 20 mg PO q6h Dexamethasone (Decadron) 10 mg IV q6h Verapamil (Calan SR) 120 mg/day PO Furosemide (Lasix) 80 mg IV push now, then 40 mg/day IVP Diet as tolerated STAT ECG and echocardiogram Up ad lib IV of D5W at 125 mL/hr Daily weights with I&O 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

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Describe four priority problems related to K.B.'s nursing care.

Elevated temp, elevated heart rate, edema, and diminished lung sounds with fine crackles at posterior bases

Case Study Progress Later on your shift, you note that K.B. is extremely restless and disoriented to person, place, and time. VS are 174/82, 180 and irregular, 32 and labored, 104 ° F (40 ° C). His electrocardiogram (ECG) shows atrial fibrillation. 6.

What is likely happening with K.B.? State your rationale. Thyroid storm. It is a sudden worsening of hyperthyroidism which can be caused by stress and infection. It is considered a medical emergency. It is characterized by fever, decreased mental alertness, and abdominal pain. Additional complications include heart failure, cardiomyopathy, and osteoporosis.

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What will you do first? Notify the MD

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You need to call the physician regarding K.B.'s status. Using SBAR, what will you report to the physician? I would report the current situation, what orders were done and now his current vital signs and ECG results.

Case Study Progress The physician evaluates K.B. and determines he is in thyroid crisis and enters the following orders in the chart: • Oxygen at 2 L per nasal cannula • STAT arterial blood gases, brain natriuretic peptide (BNP), and cardiac enzymes • Digoxin (Lanoxin) 0.25 mg IV push now, then 0.125 mg IVP q8h × 2 doses • Diltiazem (Cardizem) bolus dose of 0.25 mg/kg IV; after 15 minutes, give a second dose of • 0.35 mg/kg IV for heart rate greater than 140 • Increase methimazole (Tapazole) to 15 mg PO q6h • Lugol's solution 10 drops PO tid: start 1 hour after first methimazole dose • Hydrocortisone (HydroCort) 50 mg IVP q6h • Absolute bed rest • Acetaminophen (Tylenol) 650 mg PO q6h prn for temp over 100 ° F (37.8 ° C)9. 9.

Describe how you would care for K.B. in the next hour. He will get something to reduce his fever, medication to reduce T3 and T4 levels, Bed rest, Heart monitoring and blood work, Oxygen to help aid in comfort, steroids for inflammation

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The label on the vial of diltiazem (Cardizem) states that there are 5 mg/mL. How many total milliliters will you administer for the first

dose? How many for the second (if needed)? 3.3ml , second dose would be 4.62 ml 11.

Describe how to safely administer Lugol’s solution. A dropper should be used for proper and safe administration

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What is your primary nursing goal at this time? Decreased cardiac workload

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Describe six interventions you will perform over the next few hours for K.B. based on this priority. Monitor BP laying, sitting standing; Monitor heart rate and rhythm; Monitor temperature; Continue bed rest; Monitor urinary output; Assess edema to all extremities; Auscultate lung sounds

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Why was K.B. at risk for developing thyroid storm? K.B is experiencing infection and stress which are risk factors for developing thyroid crisis

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Identify three outcomes that you expect for K.B. as a result of your interventions. Decreased temperature, Decreased respiratory rate, Decreased and regular heart rate

Case Study Progress After several hours of treatment, K.B.'s condition stabilizes. The physician discusses two treatment options with K.B. and his family: radioactive iodine (RAI) therapy, also known as I-131, and subtotal thyroidectomy. 16.

K.B. is fearful of radiation treatment and asks you for your opinion. How would you respond? K.B 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.B make a decision regarding the type of treatment he would chose to go through.

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K.B. 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.B. and his family regarding home precautions. Family should stay at least 3 feet from K.B the first week after therapy; Family should minimize time with K.B; K.B should drink plenty of fluids

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In the midst of all this, you remain concerned over K.B.'s bereavement after the loss of his wife. How would you address this issue? I would see if K.B would be interested in speaking to a therapist and get him connected with a support group for widows and widowers

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K.B. 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

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Which statement indicates K.B. understands the discharge instructions?...