Exam (elaborations)
NUR 283 Transition To Registered Nursing Practice Case study 79 Endocrine Disorders Hyperthyroidism and Graves DZ 1 Review
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- Galen College Of Nursing
NUR 283 Transition To Registered Nursing Practice
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PART 1 MEDICAL-SURGICAL CASES CASE STUDY 79
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Case Study 79
Name Class/Group Date
Group Members
P> Scenario
K.B. is a 65-year-old man admitted to the hospital after a 5-day episode of “the flu” with complaints of dys-
pnea on exertion, palpitations, chest pain, insomnia, and fatigue. K.B. was diagnosed with Graves*disease
6 months ago and placed on methimazole (Tapazole) 15 mg/day. His other past medical history includes
heart failure and hypertension requiring antihypertensive medications; however, he states that he has
not been taking these medications on a regular basis. Vital signs (VS) are: 150/90, 124 irregular, 20, 100.2°
F (37.9° C). Admission assessment findings are: height 5ft, 8 in; weight 132 b; appears anxious and rest-
less; loud heart sounds; 1+ pitting edema noted in bilateral lower extremities; diminished breath sounds
with fine crackles in thie posterior bases. K.B. begins to cry when he tells you he recently lost his wife; you
notice someone has punched several more holes in his belt so he could tighten it.
Chart View
Laboratory Test Results
Hemoglobin (Hgb) 11.8g/dL
Hematocrit (Hct) 36%
Erythrocyte sedimentation rate (ESR) 48mm/hr .
Sodium 141 mmol/L !
Potassium 4.7mmol/L
Chloride T 101 mmel/L
Blood urea nitrogen (BUN) 33mg/dL
Creatinine 1.9mg/dL".
Free thyroxine (T,) 14.0ng/dL
Triiodothyronine (T,) 230ng/dL
1. Which of K.B.'s assessment findings represent manifestations of hypermetabolism?
2. Interpret K.B.'s laboratory results.
-d
371
Copyright © 2016 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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, PART 1 MEDICAL-SURGICAL CASES
Graves’
data do you need to obtain because he has
3. You go to assess K.B. What additional
disease?
_Chart View
Physician's Orders
Propranolol (Inderal) 20mg PO q6h
RS<= Dexamethasone (Decadron) 10mg IV q6h
et
D Verapamil (Calan SR) 120 mg/day PO
2 mg/day IVP
.~ Furosemide (Lasix) 80 mg IV push now, then 40 3
LV Diet as tolerated ‘
£h.
STAT ECG and echocardiogram
S Up ad lib
o
= IVof DSWat 125mL/hr
IS Daily weights with intake and output (1&0)
i
question, and why?
@ 4. The physician writes these admission orders. Which will you
5. Describe four priority problems related to K.B.'s nursing care.
CASESTUDY PROGRESS
Later on your shift, you note that K.B. is extremely restless and disoriented to person, place, and time. VS
are 174/82, 180 and irregular, 32 and labored, 104° F (40° C). His electrocardiogram (ECG) shows atrial
fibrillation.
7
372 Copyright © 2016 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
Scanned with CamSc;
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