Endocrinology Case study I only needs #

Endocrinology Case study I only needs # 13, 14, and 15 . Mrs. S. is a 44- year old white female who is admitted with a high fever (102 degrees) with complaints of palpitations and shortness of breath increasing over the last two days. Subjective Data: · Patient reports a 2 -month history of shortness of breath and palpitations with an HR of 144. · Additional symptoms include fatigue, unintentional weight loss of 10 pounds, insomnia, and heat intolerance. Objective data: · Fever 102 degrees · BP 122/84 HR 144 (Sinus tachycardia) RR 12 breaths/min · Hot, moist skin · Chest x-ray: Lungs clear throughout · Fine hand tremors bilaterally · Muscle strength is 2/5 all extremities. Pulses 2+ throughout. Following her workup, she is diagnosed with Grave’s Disease. The surgeon is consulted and discusses the treatment plan for her condition. He states that she will need a subtotal thyroidectomy to permanently remove the symptoms she is experiencing, in addition to daily medication. Mrs. S agrees with the treatment plan. Questions 1. What is the pathophysiology associated with the diagnosis of Grave’s Disease and Mrs. S symptoms? Graves’ Disease is characterized by the overproduction of thyroid hormones and is auto-immune in nature. SOB is caused by respiratory muscle weakness, and tachycardia is caused by the overstimulation of thyroid hormones which influence the sinoatrial node; fatigue and heat intolerance are secondary to the increased metabolic basal rate secondary to an overactive thyroid. 2. What diagnostic testing should be performed to diagnose Grave’s disease? T3, T4, and TSH serum values, radioactive iodine uptake, ultrasound of the thyroid, CT, and or MRI may be ordered. 3. What results of the diagnostic testing would confirm the diagnosis? A TSH receptor antibody (TRAb) with a positive result is the gold standard of diagnosis along with the clinical course. 4. List potential interventions, both nursing and medicine, that might be considered for this client based on presenting symptoms. Based on the presenting symptoms, one may encourage elevation of the head of the be to promote ease of breathing and promote relaxation techniques to reduce heart rate and blood pressure, including clustering care, maintaining a cool and non-stimulating environment, and providing a high-calorie diet. Mrs. S is scheduled for a partial thyroidectomy tomorrow due to the severity of her symptoms. The expected hospital length of stay of 3 days. Mrs. S. is taken to the operating room at 0700. Mrs. S is transferred to the PACU 2 hours later. VS: 120/80 HR 133, RR 12 T 99. Lungs are clear but patient is experiencing tremors in her hands and leg cramps. She has an IV of D5W at 125/hr in a 20- gauge needle in her left forearm. She is receiving Ancef 1 gram IV every 8 hours. Steri-strips and a dressing are covering the neck incision. A Jackson Pratt drain is noted to the left side of the dressing with 25 mL of serosanguinous drainage. Patient complains of a sore throat and dry mouth. 5. What are the postoperative assessments that must be completed in the first 24 hours? In the first 24 hours following a procedure, the priorities include airway, breathing, and circulation, so there should be constant assessments assuring the maintenance of the ABCs. The patient should also be passing flatulence or stool. Pain control should also be assessed and treated as appropriate per the physician’s orders. Assessment of drains and their subsequent drainage is key to preventing any significant complications. 6. What are the potential complications associated with a thyroidectomy? Potential complications include airway obstruction, hypocalcemia, laryngeal nerve injury, vocal cord paralysis, bleeding, and infection. 7. Develop a plan of care for the patient for the top 2 nursing diagnosis that could be applied to this condition. Please include a minimum of 2 interventions and evaluation strategies. 24 hours after surgery Mrs. S is complaining of twitching in her right arm and bilateral legs that seem to have worsened since surgery. Mrs. S. VS are 120/75, 110, 12 T 99 F, sats 94% on room air. The surgeon is notified and orders a basic metabolic panel and Hemoglobin and hematocrit and follow up chest x-ray. Results are: Chest x-ray: Clear upper lobes, atelectasis to lower bases, nonproductive cough Basic metabolic panel Hemoglobin & Hematocrit Other K 3.8 HGB 12.5 Hgb A1c 8.9 Na 138 HCT 25.0 Lactic acid 0.5 BUN 12 Creat 0.6 Calcium 5.5 8. Based on the lab results what complication is Mrs. S experiencing? Mrs. S is experiencing hypocalcemia. 9. What are the classic tests we use to assess this? What body system is most impacted by this condition? Chvostek sign: twitching of the facial muscle when tapping the facial nerve in front of the ear. Trousseau sign: a carpopedal spasm that occurs within 2-5 minutes when inflating a blood pressure cuff on the upper arm, 20mm hg above systolic pressure. The body system most impacted by this condition is the neuromuscular system. 10. How is this condition treated? It is treated by giving IV administration of calcium gluconate or calcium chloride. Also, by increasing dietary intake of calcium and initiating vitamin D therapy to increase calcium absorption from the GI tract. 11. What should you include in Mrs. S. postoperative education regarding this complication? Explain the importance of consuming calcium-rich foods, like milk products and green leafy vegetables, or consider supplements if dietary intake is insufficient. Food rich in phosphates, such as seafood, sardines, and organ meats, interfere with calcium absorption, so it is essential to have a low intake. If taking calcium supplements, take them with meals and make sure to increase fluid and fiber intake to prevent constipation. In addition, avoid caffeine and alcohol in high doses because they also inhibit calcium absorption. Finally, contact your doctor if you experience numbness and tingling on fingers or toes, muscle cramps or spasms, confusion or irritability, palpitations, and difficulty breathing. Mrs. S received ordered Inderal 20 mg PO daily and Propylthiouracil (PTU) and 1 gram of calcium gluconate IV x 1 to manage her symptoms. 2 hours after administration Mrs. S is symptom free. Orders for a basic metabolic panel are ordered for the morning. The next two postoperative days are uneventful, the client is discharged as planned on day 3 to home with family. 12. What are some teaching points you should reinforce with the patient after starting these medications? If Mrs. S cannot read what strategies might we choose to assist in education on her medications? Mrs. S should be taught about medication compliance, and side effects to be on the lookout for. If the patient cannot read, then short words and sentences should be used instead of medical jargon. Illustrations, audio and video information should be supplemented to a patient who cannot read. 13. After discharge what are some key teaching points for the client to manage her disease at home? 14. When should she contact her physician? 15. Based on the patients presenting symptoms and resulting plan of care what should the long- term plan of care look like for this client? Include assessments, medications, long term complications etc. ( well explain only number 13 , 14, 15 with proper address and type the answer), SCIENCE HEALTH SCIENCE NURSING NURSING 1 545

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