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Case Study
A 32-year-old female client with a history of hyperthyroidism is brought to the emergency department by their spouse.
Nurses’ Notes
0900: Accompanied by spouse, client reports being short of breath and having palpitations. Placed in ER treatment room directly from triage. Alert and oriented x 4 appears restless, anxious, and fatigued. Has flushed skin that is hot to touch. Bilateral eye protrusion noted, client states this is not their baseline and that their eyes feel “very dry.” Lung sounds clear to auscultation, no reported cough but has intermittent and worsening dyspnea. Normal S1 and S2 and 2-3+ bilateral pulse strength palpated. Hyperactive bowel sounds auscultated on all 4 quadrants. The client does not report any pain and also states that they have felt excessive hunger and thirst over the past week that is unrelieved by oral intake. Also reports unexpectedly lost approximately 4.0 kg (approximately 8 lbs.) of body weight over the past week.
VITAL SIGNS:
TIME :900AM
Temp: 103.2 F
PR: 137
RR: 28
B/P: 152/98
Pulse Oximeter: 97% on RA.
Pain: 0
Laboratory Report
Lab
Results
Reference Range
White Blood Cells (WBC)
13 x 103 cells/mm3
4.5 – 10.5 x 103 cells/mm3
Potassium (serum)
5.0 mEq/L
3.5 to 5 mEq/L
Sodium (serum)
142 mEq/L
135 to 145 mEq/L
Thyroid stimulating hormone (TSH)
0.27 mU/L
0.45 to 4.5 mU/L
Serum triiodothyronine (T3)
400 ng/dL
80 to 200 ng/dL
Serum thyroxine (T4)
270 nmol/L
57 to 148 nmol/L.
1). What 4 client findings are most urgent?
Dyspnea
2-3+ pulse grade
Tachycardia
Palpitations
Hunger
Thirst
Fever
Anxiety
Hyperactive bowel sounds
Bilateral eye protrusion
2) For each assessment the nurse has made, click to specify whether the finding is helpful or not helpful in determining if the client is experiencing a thyroid problem.
Finding
Helpful
Not helpful
Fever
Bilateral eye protrusion
Lung sounds
Anxiety level
Palpitations
Dyspnea
3) The nurse recognizes that the condition the client is most likely experiencing is _________________.
4) The client receives a working diagnosis of (answer #3). Which of the following orders should the nurse anticipate? Select all that apply.
Humidified oxygen via nasal cannula at 2 L/min
12-lead EKG
Administration of oral acetaminophen
Application of a cooling blanket
Administration of oral acetylsalicylic acid
Administration of oral methimazole
Administration of levothyroxine
5) Describe the mechanism of action of a medication that you may see this patient being discharged with. What educational aspects would you like to educate your patient on?
