HESI Case Study: Thyroid Disorders - Questions & Answers

HESI Case Study: Thyroid Disorders - Questions & Answers 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