You have a rotation in the ED

You have a rotation in the ED for your Acute Care Nursing class. A 58 y/o woman presents to the ED with feeling cold, muscle cramps, hair loss, complaints of weight gain, lethargy and brittle nails. She states that she has been feeling sluggish for the past few weeks. She is also having constipation. She decided to come to the ED to be checked out. She reports that she has not been seen by her family doctor for at least a year and also has not had bloodwork taken in over a year. She was due to see her PCP last spring, however, she had to cancel based on a conflict in her schedule. Past medical history includes radiation treatment to her neck due a melanoma found on her right side of her neck (completed treatment in 6/2019). Her height is 5’4”, weight 210lbs, BMI= 36.0, waist circumference 40 in. Her vital signs are HR=90, B/P=122/70; Resp.=12, Temp.=98.8, O2 Sat=96%. Other clinical findings include pupils equal, round and reactive to light and accommodation, mucus membranes moist, skin cool and dry. Breath sounds are clear to auscultation, heart rate regular, bowel sounds hypoactive in lower right and left quads. Her upper and lower extremity strength was equal bilaterally. Neuro: Alert and oriented times 3 (person, place, time). Medications include: Vitamin D3 1,000 IU QD; MVI; Baby Aspirin 81mg PO QD; Lab values: TSH: 6.0 mlU/L T3: 68 ng/dL T4: 3.5 ug/dL Hemoglobin A1c = 4.8% Glucose: 93 mg/dl Creatine: 0.6 mg/dl BUN: 16 mg/dl Sodium: 140 mEq/l Potassium: 4.0 mg/dl Calcium: 8.2 mg/dl Lipid panel: Normal (Total Cholesterol: 190 mg/dl; HDL: 50 mg/dl; LDL:135 mg/dl; Triglycerides: 184 mg/dl) Liver panel: Normal Urinalysis: Normal. NURS 260 Pathophysiology I Endocrine Case Studies Questions: 1. What type of Thyroid issue does this patient present? 2. Name the signs/symptoms that led you to believe this was a thyroid disorder? 3. Is this patient in Hypo or Hyperthyroid status? 4. What are some of the signs/symptoms of Graves disease? 5. Write a few paragraphs describing what information is critical for this patient prior

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