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Please complete the nursing concept map based on the CASE STUDY scenario.
Example is given.

Case Study 79

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INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will need to rewrite it.

Scenario

You are working in a community outpatient clinic where you perform the intake assessment on R.M., a 38-year-old woman who is attending graduate school and is very sedentary. Her chief complaint (C/C) is overwhelming fatigue that is not relieved by rest. She is so exhausted that she has difficulty walking to classes and trouble concentrating when studying. Her face looks puffy, and her skin is dry and pale. She complains of (C/O) generalized body aches and pains with frequent muscle cramps and constipation. You notice she is dressed inappropriately warm for the weather. Initial vital signs (VS) were 142/84, 52, 12, 96.80 F.

  1. Compare her VS with those of a healthy person her same age.
  • List eight general questions you might ask R.IVI. to get a “ball park” idea of what is going on with her.

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  1. You know that potential causes for some of R.M.’s symptoms include depression, hypothyroidism, anemia, cardiac disease, fluid and electrolyte imbalance, and allergies. As part of your screening procedures, describe how you would begin to investigate which of these conditions probably do not account for R.N’I.’s symptoms.

CASE STUDY PROGRESS

R.M. is slightly bradycardic but you find no obvious irregularities in her cardiopulmonary assessment.

  1. Unnecessary diagnostic tests are expensive. What tests do you think would be the most important for R.N’I., and why?

CASE STUDY PROGRESS

R.M.’s thyroid-stimulating hormone (TSH) comes back 20.9 IU/L; the family nurse practitioner diagnoses

R.M. with hypothyroidism and places her on thyroid replacement therapy.

  1. The practitioner prescribes levothyroxine (Synthroid) 1.7 mcg/kg body weight/ day. At this time, R.M. weighs 130 pounds. What should be her daily dose of levothyroxine in milligrams? How Ävould her prescription read?

* Note: Until recently, micrograms were alternately written as ug or mcg on prescriptions. These are still acceptable for calculations. However, Joint Commission standards have changed, and these units of measure are no longer acceptable on prescriptions.

  1. M.’s TSH level is increased. Explain the relationship between these laboratory results and hypothyroidism.

402                                                        Copyright 0 2009, 2005, 2001, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

medication issues.

  1. Why would you want to obtain a complete drug history on R.M.?
  2. What general teaching issues would you address with R.M.?

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  1. N’I. wonders whether she should take iodine supplements if she decreases her salt intake. She recognizes that salt is a significant source of iodine in her part of the country. What would you explain to her?
  2. What should you teach R.M. regarding prevention of myxedema coma?

* Note: TSH should be checked annually once R.M. is stable on medication.

  1. Before R.N’I. leaves the clinic, she asks how she will know whether the medication is “doing its job.” Outline simple expected outcomes for R.M.
  2. Several weeks later, R.M. calls the clinic stating she can’t remember whether she took her thyroid medication. What additional data should you obtain, and how would you advise her?

404                                                        Copyright 0 2009, 2005, 2001, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

  1. Under what circumstances should R.M. hold the drug or call the clinic?

CASE STUDY PROGRESS

R.M. comes in 2 months later for a follow-up (F/U) visit. You can’t believe she is the same person. She looks and walks as if she were 10 years younger. Her skin appears more radiant, and her hair looks much healthier. “You can’t believe how different 1 1 m feeling,” she says. “l didn’t know how bad off I was; I’m starting to live again.”

For more information, contact:

American Thyroid Association: http://www.thyroid.org National Library of Medicine: http://www.nlm.nih.gov

Thyroid Foundation of America: http:/www.allthyroid.org

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Patient Age/Sex:

Patient Medical Diagnoses:

 

Infection

                                                               

 

 

ASSESSMENT DATA:

 

 

 

 

 

NURSING DIAGNOSES:

Related to:

As Evidence By:

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            3.

 

PLANNING/INTERVENTIONS:

1.

 

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3.

 

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EVALUATION:

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5.

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