Scenario K_B_ is an 80-year-old man admitted
Scenario K_B_ is an 80-year-old man admitted to the hospital following a 5-day episode of the “flu” with com plaints of (C/O) dyspnea on exertion (DOE), palpitations, chest pain, insomnia, and fatigue_ His past medical history (PMH) includes heart failure (HF) and hypertension (HTN) requiring antihypertensive medications (he states that he has not been taking these medications on a regular ba is)_ K.B_ was diagnosed with Graves’ disease 6 months ago and was placed on methimazole (Tapazol ) 15 mg/day PO_Assessment findings are as follows: height 5’8″, weight 130 pounds; appears anxiou and restless; loud heart sounds; vital signs (VS): 150/90, 104 irregular, 20, 100-2°F; 1+ pitting ed ma noted in bilateral lower extremities; diminished breath sounds with fine crackles in the posteri r bases_ K_B_ begins to cry when he tells you he recently lost his wife; you notice someone has pu ched several more holes in his belt so he could tighten it_Laboratory findings are Hgb 11.8 g/dl, Hct 6%, erythro cyte sedimentation rate (ESR) 48 mm/hr, Na 141 mmol/L, K 4_7 mmol/L, Cl 101 mmol/L, UN 33 mg/di, creatinine 1.9 mg/di, T4 14.0 mcg/dl, T3 230 ng/dl. Of the physical assessment and laboratory findings, which represent manifestations of hypermetabolism? What additional subjective and objective data would you gather from someone with Graves’ disease? After morning rounds, the physician leaves the following orders: propranolol (Inderal) 20 mg PO q6h, dexamethasone (Decadron) 10 mg IV q6h, verapamil)Calan SR) 120 mg/day PO, diet as tolerated, STAT ECG, up ad lib. Which of the orders would you and why? Develop four priority problems related to K.B.’s care. 5. Later on your shift, you note that K.B. is extremely restless and disoriented to person, place, and time. VS are 104/62, 180 and irregular, 32 and labored , 104 F. His ECG shows atrial fibrillation (A-fib). What do these findings indicate? What would you do first? Identify four measures that would be essential in caring for K.B. Discuss how your discharge teaching instructions wi11 differ from those you would give to someone following a subtotal thyroidectomy.
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