I-Human Case Study—Erin Bradley NSG6420 Week 2 Discussion
Erin Bradley is a 21-year-old college student that presented to the ED with a chief complaint of
“I have nausea and vomiting, I can’t keep anything down. I feel hot and sweaty and very shaky.”
From her chief complaint there should be a methodical collection of data from the Practitioner.
This would include a collection data on any associated health symptoms which is critical in
assessing for new symptoms in a patient (Goolsby & Grubbs, 2015).
The data collected from Erin consisted of first asking her the reason for her visit. Once she was
able to tell why she presented, a collection of associated health symptoms was asked. The
questions related to here nausea, vomiting, heart fluttering, being hot, and shaky. It is important
that we stick to the symptoms related to the chief complaint so that you can narrow down the
diagnosis for a patient and ensure that you do not miss diagnosis that are a do not miss (Bickley,
2017). Asking the right questions were difficult because her symptoms were so different and
could have been related to several systems categories.
Erin Brandley is a 21-year-old female presenting with nausea and vomiting for 24 hours, feeling
shaky with feeling of heart flutter and heat intolerance. She reports palpations, fatigue and
generalized sickness. Upon examination she has a fever (101 F), tachycardia (150) with early
systolic ejection murmur, tachypnea (22), systolic elevated BP and orthostatic hypotension. She
has a productive cough she has tremulous anxiety, insomnia, and emotional lability, she recently
broke up with her boyfriend. Other symptoms included hyperreflexia, weight loss of 10 pounds,
hyperactive bowel sounds with increased frequency in bowel movements, intolerance to heat,
fatigue and exercise intolerance, enlarged thyroid with thrill and bruit, onycholysis on a couple
of nails bilaterally, oligomenorrhea x 6 months; missed one period.
The differential diagnoses for her are hyperthyroidism, thyrotoxic crisis, pneumonia, sepsis, and
drug Intoxication. The following test should be ordered to rule out the above diagnoses:
1. hyperthyroidism, thyrotoxic crisis (thyroid storm): thyroid stimulating hormone
(TSH), comprehensive metabolic panel, free thyroxine (T4), 12 lead electrocardiogram
(ECG)
2. pneumonia: Chest X-ray PA and Lateral, comprehensive metabolic panel (CMP), blood
culture and sensitivity, sputum culture and sensitivity (SCS), sputum gram stain,
complete blood count (CBC)
3. sepsis (septicemia): 12 lead electrocardiogram, urinalysis (UA) complete blood count
(CBC), serum lactic acid, blood culture and sensitivity, complete metabolic panel (CMP)
4. drug intoxication: blood drug toxicology test
Based upon the results of Ein’s labs, x-rays, and EKG she would have a definitive diagnosis of a
thyroid storm and pneumonia. These two diagnoses are a do not miss. The treatment plan for
Erin would be the following:
Admit to hospital for thyroid storm
Erin Bradley is a 21-year-old college student that presented to the ED with a chief complaint of
“I have nausea and vomiting, I can’t keep anything down. I feel hot and sweaty and very shaky.”
From her chief complaint there should be a methodical collection of data from the Practitioner.
This would include a collection data on any associated health symptoms which is critical in
assessing for new symptoms in a patient (Goolsby & Grubbs, 2015).
The data collected from Erin consisted of first asking her the reason for her visit. Once she was
able to tell why she presented, a collection of associated health symptoms was asked. The
questions related to here nausea, vomiting, heart fluttering, being hot, and shaky. It is important
that we stick to the symptoms related to the chief complaint so that you can narrow down the
diagnosis for a patient and ensure that you do not miss diagnosis that are a do not miss (Bickley,
2017). Asking the right questions were difficult because her symptoms were so different and
could have been related to several systems categories.
Erin Brandley is a 21-year-old female presenting with nausea and vomiting for 24 hours, feeling
shaky with feeling of heart flutter and heat intolerance. She reports palpations, fatigue and
generalized sickness. Upon examination she has a fever (101 F), tachycardia (150) with early
systolic ejection murmur, tachypnea (22), systolic elevated BP and orthostatic hypotension. She
has a productive cough she has tremulous anxiety, insomnia, and emotional lability, she recently
broke up with her boyfriend. Other symptoms included hyperreflexia, weight loss of 10 pounds,
hyperactive bowel sounds with increased frequency in bowel movements, intolerance to heat,
fatigue and exercise intolerance, enlarged thyroid with thrill and bruit, onycholysis on a couple
of nails bilaterally, oligomenorrhea x 6 months; missed one period.
The differential diagnoses for her are hyperthyroidism, thyrotoxic crisis, pneumonia, sepsis, and
drug Intoxication. The following test should be ordered to rule out the above diagnoses:
1. hyperthyroidism, thyrotoxic crisis (thyroid storm): thyroid stimulating hormone
(TSH), comprehensive metabolic panel, free thyroxine (T4), 12 lead electrocardiogram
(ECG)
2. pneumonia: Chest X-ray PA and Lateral, comprehensive metabolic panel (CMP), blood
culture and sensitivity, sputum culture and sensitivity (SCS), sputum gram stain,
complete blood count (CBC)
3. sepsis (septicemia): 12 lead electrocardiogram, urinalysis (UA) complete blood count
(CBC), serum lactic acid, blood culture and sensitivity, complete metabolic panel (CMP)
4. drug intoxication: blood drug toxicology test
Based upon the results of Ein’s labs, x-rays, and EKG she would have a definitive diagnosis of a
thyroid storm and pneumonia. These two diagnoses are a do not miss. The treatment plan for
Erin would be the following:
Admit to hospital for thyroid storm
