Case Study 2 Today:

Question Answered step-by-step Case Study 2 Today:Abby a 48 yr old female, is at the endocrinology out patient clinic for a follow up appointment. Abby underwent a subtotal right thyroidectomy 12 weeks ago. The thyroidectomy was performed as treatment for a thyroid tumor. The pathology testing determined the tumor was benign. The patient was started on levothyroxine 75mcg daily 10 weeks ago.Abby complains today of decreased energy, 15 lbs weight gain in the last 10 weeks, constipation and hair loss. “I have a bald spot and my hair is falling out!”Abby is due today for her routine blood work and states to nurse “I’ve been eating good for the past few days, so I am sure my fasting sugar and cholesterol levels are going to be ok.”Abby also voices frustration over the amount of pills she has to take:  “I thought I would be cured from my tumor after the surgery to remove it!…..why do I have to take a pill every day now?” Past Medical Hx:Benign Thyroid Tumor Active Chronic conditions: Hyperlipidemia (Diagnosed 1 year ago)Type II Diabetes Mellitus (Diagnosed 2 years ago)Hypertension (diagnosed 6 years ago) SHx:ETOH: 1-2 6 oz glasses of wine 1x month.Tobacco: 10-15 cigs/day x20yearsExercise: walks short distances when weather is good. Pt reports she hates being outside when it’s too hot, too cold. She reports that she also avoids exercise because her “muscles get too sore” Abby reports general body aches and pains with frequent muscle cramps in her legs even if she does a minimal amount of activity. Most recently, she reports that she has not had the energy for any kind of exercise at all.Sleep: Usually Abby would get 6-8 hrs/night and feels rested afterwards but since having surgery she reports “I am tired all the time even if all I do is sleep”. Allergies: NKDA Current Meds:levothyroxin  75mcg PO dailymetformin 500mg PO bidatorvastatin 20 mgramipril 5mg PO daily  O/E:T 37.0 RR 12 HR 80 B/P 145/90 Hgt 5’4″Wgt 90kgWC 110cm Well groomed, good affect.Abby’s face appears puffy, and her skin is pale and dry.You note that Abby is dressed inappropriately warm for the weather outside.Small quarter size area of alopecia noted in the occipital region of scalp. New hair growth seen and overall hair distribution is noted as uniformly thin. Abby’s chart review:Progress notes from 12 weeks ago indicate that her endocrinologist is noting that:Abby meets the criteria for metabolic syndrome.Abby is now in a primary hypothyroidism state. Most Recent labs (6/52 ago): Lipids: TC 5.6 mmol/L; LDL 3.5 mmol/L; HDL 1.3 mmol/L; TG 4.34 mmol/L FBS: 5.9 mmol/L HgB A1C: 8.0%TSH: 20.9 mU/L (2-10mU/L)Free T4: 0.2 ng/dL (0.8-2.4 ng/dL) Questions: What  are Abby’s Potential diagnosis and its pathophysiology: Differentiate between DM Type II and Metabolic Syndrome. Differentiate between primary and secondary hypothyroidism.Interpret Abby’s most recent lab results on file.Review and research medications listed: What concerns might the nurse have (if any) regarding Abby’s current medications? Work through ADPIE and identify priority nursing interventions and non-pharmacological treatments for this patient. (Remember: assessment/monitoring/patient teaching). Health Science Science Nursing PHA 5100 Share QuestionEmailCopy link Comments (0)