Directions: Please complete Part 1 and Part 2. Note: All case studies are provided as

Directions: Please complete Part 1 and Part 2. Note: All case studies are provided as a learning tool for students who wish to have them. Part 1 Review the following case and answer the questions. A 53-year-old female wishes to review her laboratory results from 3 weeks prior. She is in “good health” and denies complaints. Her laboratory values are normal except for the following: free thyroxine index = 3.0 TSH = 30 mU/L T4 = 3.0 mcg/dL T3 = 90 ng/dL Free T4 = 0.5 mcg/dL Which thyroid disorder is likely? Hypothyroidism. Subclinical hyperthyroidism. Subclinical hypothyroidism. Hyperthyroidism. Is this condition usually symptomatic? Explain. What is the likely cause of this thyroid disorder? Iodine deficiency. Chronic autoimmune thyroiditis (i.e., Hashimoto thyroiditis). Autoimmune Graves’ disease. A pituitary adenoma (i.e., thyrotroph). This item is optional. What treatment is recommended? No therapy indicated. Beta blocker. Thyroid hormone replacement with T3. Thyroid hormone replacement with T4. How often should the client be evaluated for this condition? Six months from today. Return to have a TSH level done 6 weeks after starting therapy. An yearly evaluation is indicated. Which are possible symptoms of this thyroid disorder? Select all that apply. Anxiety. Palpitations. Diarrhea. Weight gain. Cold intolerance. Fatigue. Part 2 A 50-year-old female with a 9-year history of diabetes mellitus (DM) type 2 complains of high blood sugars x 2 weeks. Her self-monitoring glucose readings have been in the 200s-300s x 10 days. Her DM type 2 was managed with diet, exercise, and metformin 1,000 mg bid. Her last glycosylated hemoglobin (HgbA1c) level was 6.9% (2 months ago). She has had asthma since age 11. She felt her asthma was getting worse x 6 months as she was having increased dyspnea. She has managed her asthma with a daily combined long-acting beta-2 adrenergic agonist, an inhaled corticosteroid, and montelukast. She also uses her short-acting beta-2 adrenergic agonist, albuterol, about once a day. She went to her pulmonologist about 2 months ago and was diagnosed with severe asthma. A decision was made to start her on oral prednisone (corticosteroid). The 1st month she took 5 mg/day with some relief, but the symptoms returned, so her prednisone dose was increased to 10 mg a day. She has been taking the 10 mg dose x 3 weeks. She says her breathing has improved, but she feels easily fatigued and has gained weight. Physical examination reveals an anxious female with blood pressure of 144/92 mmHg; pulse of 90 bpm; respirations 18 per minute; and weight of 192 pounds. She speaks clearly in full sentences. Lung sounds are bilaterally clear. No cyanosis is present. No accessory muscles are being used. Though this item involves pharmacology, it is still important. Which is the most likely cause of this client’s loss of glucose control? Prednisone therapy. Inhaled corticosteroid. Asthma exacerbation. Albuterol inhalers. Which is most important for this client to learn regarding glucocorticoid therapy? Monitor cuts for wound healing. Contact her healthcare provider if the client has any signs of infection. Take medications with food. Do not cease taking the medication abruptly. The client is at risk of developing which condition? Pheochromocytoma. Cushing syndrome. Hyperthyroidism. Addison disease. Which intervention should be ordered for this client? Insulin per routine sliding scale (based on glucose levels). Increase exercise. Decrease caloric intake. Decrease prednisone dose. Integumentary Function Directions: Please complete the chart below. When learning skin disorders, it is important to note how different diagnoses/conditions appear on different skin tones. Note: All case studies are provided as a learning tool for students who wish to have them. Part 1 Irritant, allergic, and atopic dermatitis have similar clinical manifestations. Recognizing similarities and differences may aid in determining diagnosis. In this activity, determine whether the manifestations listed are present in irritant, allergic, or atopic dermatitis and identify the key manifestations for each dermatitis. The manifestations may be present in more than one type of dermatitis. Use this key: + Indicates manifestation present ++ indicates a key manifestation Type of Dermatitis Atopic Allergic Irritant General manifestations Erythema Pruritus Pain Xerosis (dry skin) Delay of manifestation after exposure Edema Appearance immediately after exposure Fissuring Papules Crusting Lichenification Well-demarcated lesions Vesicles Lesions affecting multiple areas Lesions confined to one area

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