HESI Case Study Thyroid Disorders with complete
solution
Patient Profile
Ms. Eugena Cole is a 58-year-old African American female. She works full time as a
high school math teacher. She is currently working on a specialist degree, taking night
classes at one of the local colleges. Eugena has noticed that she is more sluggish than
normal. She doesn't have the energy for girls' nights out anymore, and for the past 4
months, she has not attended her exercise classes. She has gained 10 pounds in the
past 4 to 6 months. Her friends say she acts depressed and encouraged her to see a
healthcare provider (HCP). Eugena makes an appointment to see her healthcare
provider (HCP).
Given the initial history and vital signs, what other questions should the nurse
ask?
- Have you had any changes in your bowel habits? (Hypothyroidism can cause
constipation)
- Do you still feel sleepy when you wake up in the mornings despite getting a god night's
sleep? (Hypothyroidism can cause sleep disturbances)
- Have you noticed any changes in your hair or nails? (hypothyroidism can cause hair
loss and brittle nails)
Diagnostic Tests
Eugena is scheduled for a radioactive iodine uptake test. This test is used to measure
the rate of iodine uptake by the thyroid gland. She is also scheduled for a thyroid scan.
After the consent form is signed, what assessment data are most important to
obtain prior to the radioactive iodine uptake test?
- Find out if the client has ever had a reaction to a bee sting. (allergic reaction to bee
stings and shell fish should be assessed)
- Ask if she takes any OTC medications such as cough syrups. (many OTC cough
medications contain some iodine.)
- Investigate the client's use of OTC multivitamin and herbal products.
Based on Eugena's history and presenting symptoms, which additional
diagnostic tests does the nurse anticipate the HCP to order?
- CBC with differential (need to use to rule out other possible causes of Eugena's
symptoms which could include anemia/ infection)
- Blood chemistries (to evaluate the Pt's electrolyte and fluid status)
- TSH and free T4 (functioning or non-functioning of the thyroid gland)
Thyroid scans are one means of evaluating the thyroid gland for presence of a
nodule. Scanning also demonstrates the size, shape, function, and position of the
thyroid gland. Radioactive iodine is administered PO or parenterally, and the
uptake of the iodine by the thyroid gland is measured. Clients with
hypothyroidism will demonstrate a decreased uptake of the radioactive iodine.
Further physical examination reveals a slightly overweight female with a BMI of
, 27. While assessing her thyroid, the nurse finds a goiter. Goiter is the term for an
enlarged thyroid gland. Depending on the cause of hypothyroidism, the client
may have a goiter. A goiter can also be present with hyperthyroidism.
Eugena's lab result indicate mild anemia and a TSH that is 20 (normal is 0.5-5.0
microunits/ml). She asks, "How did I get this disease?"
Based on the results, Eugena is diagnosed with hypothyroidism. What other lab
should be monitored after the diagnosis of hypothyroidism is confirmed?
Triglycerides and cholesterol
(hypothyroidism can cause increased triglyceride and cholesterol levels, leading to
coronary atherosclerosis)
Which explanation by the nurse is accurate?
An autoimmune dysfunction causes thyroid dysfunction.
(The most common cause of hypothyroidism in adults is autoimmune thyroiditis
(Hashimoto's disease) in which the immune system attacks the thyroid. More than 95%
of patients either have primary or thyroidal hypothyroidism which refers to dysfunction of
the thyroid itself)
What symptoms are clients with hypothyroidism most likely to exhibit?
- Coarse dry skin
- Somnolence and cold intolerance
- Somnolence and fatigue
Pharmacologic Management
Medical treatment for hypothyroidism is based on replacement therapy. The HCP will
monitor Eugene's goiter for now. The primary medication used to treat hypothyroidism is
levothyroxine sodium (Synthroid). The HCP prescribes 1.7 mcg/kg body weight/day.
Eugena's weight is 150 lbs.
What is Eugene's daily dose of medication?
116
Which approach by the nurse describes the action of levothyroxine (Synthroid)
Increase fat, protein , carbohydrate metabolism
Which information in Eugena's history would be of concern to the nurse related
to the use of Synthroid?
- Eugena has an allergy to aspirin (Synthroid contains tartrazine, which can cause an
allergic reaction in patients who have sensitivity to aspirin)
- Eugena enjoys strawberries, peaches and pears. (Consumption of these foods can
inhibit thyroid secretion. Other foods that can inhibit thyroid secretion include kale,
cabbage, turnips, spinach, brussel sprouts, cauliflower, radishes and peas)
- Taking a daily calcium supplement. (calcium should be taken at least four hours after
the Synthroid dose to prevent interference with absorption)
- Eugena prefers to take her medication with tea or lemonade. (Synthroid should be
given in morning on empty stomach with a glass of water.)
Eugena tells the nurse she has a hard time taking medications regularly. She
asks how long she will need to take the Synthroid. What is the nurse's best
response?
solution
Patient Profile
Ms. Eugena Cole is a 58-year-old African American female. She works full time as a
high school math teacher. She is currently working on a specialist degree, taking night
classes at one of the local colleges. Eugena has noticed that she is more sluggish than
normal. She doesn't have the energy for girls' nights out anymore, and for the past 4
months, she has not attended her exercise classes. She has gained 10 pounds in the
past 4 to 6 months. Her friends say she acts depressed and encouraged her to see a
healthcare provider (HCP). Eugena makes an appointment to see her healthcare
provider (HCP).
Given the initial history and vital signs, what other questions should the nurse
ask?
- Have you had any changes in your bowel habits? (Hypothyroidism can cause
constipation)
- Do you still feel sleepy when you wake up in the mornings despite getting a god night's
sleep? (Hypothyroidism can cause sleep disturbances)
- Have you noticed any changes in your hair or nails? (hypothyroidism can cause hair
loss and brittle nails)
Diagnostic Tests
Eugena is scheduled for a radioactive iodine uptake test. This test is used to measure
the rate of iodine uptake by the thyroid gland. She is also scheduled for a thyroid scan.
After the consent form is signed, what assessment data are most important to
obtain prior to the radioactive iodine uptake test?
- Find out if the client has ever had a reaction to a bee sting. (allergic reaction to bee
stings and shell fish should be assessed)
- Ask if she takes any OTC medications such as cough syrups. (many OTC cough
medications contain some iodine.)
- Investigate the client's use of OTC multivitamin and herbal products.
Based on Eugena's history and presenting symptoms, which additional
diagnostic tests does the nurse anticipate the HCP to order?
- CBC with differential (need to use to rule out other possible causes of Eugena's
symptoms which could include anemia/ infection)
- Blood chemistries (to evaluate the Pt's electrolyte and fluid status)
- TSH and free T4 (functioning or non-functioning of the thyroid gland)
Thyroid scans are one means of evaluating the thyroid gland for presence of a
nodule. Scanning also demonstrates the size, shape, function, and position of the
thyroid gland. Radioactive iodine is administered PO or parenterally, and the
uptake of the iodine by the thyroid gland is measured. Clients with
hypothyroidism will demonstrate a decreased uptake of the radioactive iodine.
Further physical examination reveals a slightly overweight female with a BMI of
, 27. While assessing her thyroid, the nurse finds a goiter. Goiter is the term for an
enlarged thyroid gland. Depending on the cause of hypothyroidism, the client
may have a goiter. A goiter can also be present with hyperthyroidism.
Eugena's lab result indicate mild anemia and a TSH that is 20 (normal is 0.5-5.0
microunits/ml). She asks, "How did I get this disease?"
Based on the results, Eugena is diagnosed with hypothyroidism. What other lab
should be monitored after the diagnosis of hypothyroidism is confirmed?
Triglycerides and cholesterol
(hypothyroidism can cause increased triglyceride and cholesterol levels, leading to
coronary atherosclerosis)
Which explanation by the nurse is accurate?
An autoimmune dysfunction causes thyroid dysfunction.
(The most common cause of hypothyroidism in adults is autoimmune thyroiditis
(Hashimoto's disease) in which the immune system attacks the thyroid. More than 95%
of patients either have primary or thyroidal hypothyroidism which refers to dysfunction of
the thyroid itself)
What symptoms are clients with hypothyroidism most likely to exhibit?
- Coarse dry skin
- Somnolence and cold intolerance
- Somnolence and fatigue
Pharmacologic Management
Medical treatment for hypothyroidism is based on replacement therapy. The HCP will
monitor Eugene's goiter for now. The primary medication used to treat hypothyroidism is
levothyroxine sodium (Synthroid). The HCP prescribes 1.7 mcg/kg body weight/day.
Eugena's weight is 150 lbs.
What is Eugene's daily dose of medication?
116
Which approach by the nurse describes the action of levothyroxine (Synthroid)
Increase fat, protein , carbohydrate metabolism
Which information in Eugena's history would be of concern to the nurse related
to the use of Synthroid?
- Eugena has an allergy to aspirin (Synthroid contains tartrazine, which can cause an
allergic reaction in patients who have sensitivity to aspirin)
- Eugena enjoys strawberries, peaches and pears. (Consumption of these foods can
inhibit thyroid secretion. Other foods that can inhibit thyroid secretion include kale,
cabbage, turnips, spinach, brussel sprouts, cauliflower, radishes and peas)
- Taking a daily calcium supplement. (calcium should be taken at least four hours after
the Synthroid dose to prevent interference with absorption)
- Eugena prefers to take her medication with tea or lemonade. (Synthroid should be
given in morning on empty stomach with a glass of water.)
Eugena tells the nurse she has a hard time taking medications regularly. She
asks how long she will need to take the Synthroid. What is the nurse's best
response?
