graves disease case study

[becky0124]

can anyone help with some of this I found what I could. I would appreciate any help I can get.

KB is an 80 yo woman admitted to the hospital following a 5 day episode of Flu with c/o DOE, palpitations, chest pain, insomnia, and fatigue. PMH includes CHF, HTN requiring meds which she has not been taking on regular basis. KB was diagnosed with Grave's disease 6 mos ago and placed on PTU 100 mg PO q6h.

Assessment findings

* Ht 62" weight 100 lbs. Appears anxious and restless. Loud heart sounds, VS 150/90, 104 irreg, 20, 100.2; 1+ pitting edema in le's; diminished BS with crackles in the bases.

* KB states she recently lost her husband.

* Lab: hgb 11.8; Hct 36% ESR 48; Na 141; K 4.7; Cl 101; BUN 33; creat 1.9; T4 14; T3 230.

Questions??

* Which assessment and lab findings represent manifestation of hypermetabolism?

fatigue, rapid, irregular heart rate, insomnia,

elevated ESR, BUN, Creatinine, T4, T3,

edema

* What additional S/O data would you gather for someone with Graves' disease?

Any signs of tremors? Any weight loss? Medications on. Check eyes for opthalomorpathy.

Excessive sweating? Muscle weakness? Depression? Double vision?

Questions?

* The physician leaves the following orders.

- Propranolol 20 mg po q6h

- Decadron 10 mg IV q6h

- Verapamil 120 mg PO qd

- Diet as tol.- high protein

- STAT ECG

- Up ad lib

* Which of the orders would you question and why?

(I can't see any reason any of them would be questioned)

Questions??

* What are the priority nursing diagnoses for KB?

Hyperthermia r/t loss of temperature regulation AEB elevated temperature

Disturbed thought process r/t hypermetabolism AEB restlessness and disorientation

Ineffective breathing pattern r/t muscle weakness AEB dyspnea

The Case Continues...

* You note the KB is extremely restless and is disoriented x3. VS are 104/62, 180 irreg, 32 and labored; 103. ECG shows a-fib. What do these findings indicate?

That patient is having a thyroid crisis

* The physician orders the following:

- STAT ABG

- Digoxin 0.125 mg IVP q8h x3

- D5W at 100ml/hr

- Lugol's solution 10 drops po tid

- Increase PTU to 200 mg po qid

- Hydrocortison 100 mg IVP q8h

- Cardiac monitor

- Absolute bed rest

- Cooling blanket for temp > 102

- Tylenol 650 mg po prn temp > 100

Questions???

* Why did the physician order tylenol instead of aspirin?

* Identify priority nursing measures for KB

Treat her hyprthermia, give medication to inhibit conversion of T4 to T3, give O2

* Identify 2 possible contributing factors that may have precipitated KB's thyroid storm

CHF HTN

Treatment Options

* Before discharge, the physician discusses 2 treatment options with KB: Radioactive iodine therapy and subtotal thyroidectomy.

* Before deciding KB asks if she will be "radioactive" if she takes the 131 I. What would you tell her about guidelines and precautions?

She would still be radioactive depending on how much was given, but whether she is or not she

should avoid close contact with her family for a few weeks, not to share any glass or eating utensils and

make sure they avoid any of her body fluids.

Subtotal Thyroidectomy

* KB decides to have a thyroidectomy. What medication would you expect that she would take prior to the surgery?

* What would you include in her pre-op teaching?