Exam (elaborations) NR 511 WEEK 6 PART 1

Exam (elaborations) NR 511 WEEK 6 PART 1 General Questions When did the fatigue start? Where is the fatigue? How long does it last? How would you describe it? Does anything make it worse? Does anything make it better? Have you done anything to treat it? How would you rate it? 1. Hypothyroidism ***Have you been fatigue? Do you have cold intolerance ? Has your hair been dry and brittle? Has your skin seemed dry? Have you had muscle cramps? Has you menstruation been abnormal? Have you had changes in your voice? Have you gained weight? 2.Adrenal Insufficiency/ Addison Disease Have you had trouble with depression? Do you have a history of anorexia? Have you had nausea and vomiting? Have you had diarrhea? Have you had cravings for salt? Have you had abdominal pain? ***Have you had weight loss? Have you had hair loss? Have you been dizzy? Type 2 Diabetes Have you experienced polydipsia? Have you had polyphagia? ***Have you had weakness? Have you had vision changes such as blurred vision Have you had frequent infections? Has your mouth been dry? Has your skin felt dry? DIFFERNETIAL DIAGNONSIS: This study source was downloaded by from CourseH on :38:44 GMT -05:00 This study resource was shared via CourseH NR 511 WEEK 6 PART 1 1 Hypothyroidism E03.9 Hypothyroidism is defined as failure of the thyroid gland to produce sufficient thyroid hormone to meet the metabolic demands of the body (Gaitonde, Rowley, Sweeney, & Eisenhower, 2012). The incidence increases with age, and is higher in females than in males. Hypothyroidism may occur as a result of primary gland failure or insufficient thyroid gland stimulation by the hypothalamus or pituitary gland. Primary gland failure can result from congenital abnormalities, autoimmune destruction, iodine deficiency, and infiltrative diseases. Patients may present with symptoms such as weight gain, fatigue, poor concentration, depression, diffuse muscle pain, and menstrual irregularities, constipation, cold intolerance, dry skin, proximal muscle weakness, and hair thinning or loss (Gaitonde, Rowley, Sweeney, & Eisenhower, 2012). This condition is a possibility for Mary due to her experiencing fatigue, her cold intolerance, and her gender. 2. Adrenal Insufficiency/ Addison Disease E27.1 Primary adrenal insufficiency, or Addison disease, has many causes, the most common of which is autoimmune adrenalitis. Autoimmune adrenalitis results from destruction of the adrenal cortex, which leads to deficiencies in glucocorticoids, mineralocorticoids, and adrenal androgens (Michels, & Michels, 2014). Patients may experience fatigue, weakness, weight loss, and gastrointestinal upset, salt cravings, postural dizziness, hypotension, vitiligo, and muscle or joint pain (Michels, & Michels, 2014). Symptoms are gradual and worsen over a period of years, making early diagnosis difficult. This is a possible condition for Mary because she has experienced abnormal fatigue further questions will need to be asked to determine if she has any other signs or symptoms. 3. Diabetes Mellitus Type 2 E11.9 Type 2 diabetes is a chronic, progressive disease characterized by insulin resistance and impaired insulin secretion (Rathmann, Scheidt-Nave, Roden, & Herder, 2013). These malfunctions may be acquired or inherited. This condition can be related to obesity, genetics, drug or chemical induced, ethnicity. It is commonly associated with hypertension, hyperlipidemia, metabolic syndrome, fatty liver disease, and infertility. Clinical presentation may involve polyuria, polydipsia, polyphagia, weight loss, weakness, fatigue, blurry vision, and frequent infections (Rathmann, Scheidt-Nave, Roden, & Herder, 2013). This condition is also a possibility for Mary due to her increased fatigue, her increased headaches could be a result of polyuria which means she could be dehydrate. Also if either of her children were greater than 9 pounds at birth that increases her risk for development of type 2 diabetes ( (Domino, Baldor, Golding, & Stephens, 2017). Since it seems as though Mary maybe having an endocrine issue a thorough assessment needs to be done. An endocrine condition can affect patients in many areas such as eyes, neck (thyroid), heart rate, neurologically, skin changes, muscle weakness. My exam will be focused on HEENT, cardiovascular, respiratory, GI, musculoskeletal, endocrine, skin and neurological. This study source was downloaded by from CourseH on :38:44 GMT -05:00 This study resource was shared via CourseH VITAL SIGNS: Asses for vitals that would be appropriate for her medical history. CONSTITUTIONAL: Mary is a woman who appears to be her stated age HEENT: Asses Head size and shape, asses facial symmetrical, Asses eyes: pupils equal, round and reactive to light, asses sclera, asses conjunctiva, asses for facial growths or lesions. Asses facial tenderness. Ears: asses externally for redness, tenderness, swelling, drainage, shape. Asses ear canal tympanic membrane for redness, blisters or perforations. Asses Nasally for: nasal obstructions, spetum alignment, drainage, redness, and tenderness. Asses Oral for: redness, tonsil grade, moist mucosa, good hygiene and dentition. Asses Neck for: tenderness, palpable lymph nodes, trachea midline, thyroid enlargement, goiter, carotid artery bruit. CARDIOVASCULAR: Asses for: regular rate and rhythm, normal S1 & S2, no murmur, no gallops, no rub, appropriate capillary refill, no cyanosis, no edema in extremities, asses for full and equal pulses RESPIRATORY: Asses for: clear breath sounds in all lung fields no rales/crackles, rhonchi, wheezing, tachypnea, retractions, sputum, cough, normal chest shape, no labored breaths, normal respirations, shortness of breath, no dyspnea, no friction rub, bilateral expansion, dullness, flatness or hyper hyperresonance on percussion, tenderness or lumps. GASTROINTESTINAL: Asses for: bowel Sounds, Inspect and Palpate abdomen for: tenderness, guarding, masses, rebound tenderness, or CVA tenderness. Asses for no liver abnormalities: non-tender and no hepatomegaly. Asses Spleen: non-tender and no splenomegaly. Asses for Hernia: none palpable. MUSCULOSKELETAL: Asses for: normal motor strength and tone. Asses Joints, Bones, and Muscles for no contractures, malalignment, tenderness, or bony abnormalities and normal movement of all extremities. Asses Extremities for no cyanosis, edema,varicosities, or palpable cord. Asses Appearance of spine for normal curvature. NEUROLOGICAL: Asses appearance, asses for orientation and consciousness, asses fo tremors, asses cranial nerves, asses extremities for sensation, asses reflexes and tone, asses gait, asses coordination, asses spine for normal curvature. ENDOCRINE: This study source was downloaded by from CourseH on :38:44 GMT -05:00 This study resource was shared via CourseH Asses stature, weight, asses nails. asses hands for size, tremor, palmar erythema, asses pigmentation, asses for axillary hair loss,asses for expohthalomos, asses buccal pigmentation, asses for neuropathy. SKIN: Asses for any rashes, lesions, blisters, jaundice, abrasions, redness, or growths, asses for pigmentation changes. LABS AND TEST Hypothyroidism TSH, free T4, TRH stimulation test (Gaitonde, Rowley, Sweeney, & Eisenhower, 2012). Adrenal Insufficiency/ Addison Disease ACTH, Insulin-induced hypoglycemia test, metapyrone test, 21-hydroxylase test, CMP, Potassium, BUN, Creatinine, calcium, TSH, aldosterone (Michels, & Michels, 2014 & Domino, Baldor, Golding, Stephens, 2017). Diabetes Mellitus type 2 HbA1c, fasting glucose, 2 hour postprandial glucose (Rathmann, Scheidt-Nave, Roden, & Herder, 2013). MICHEAL (Questions with *** apply to multiple diagnosis) General Questions When did the fatigue start? Where is the fatigue? How long does it last? How would you describe it? Does anything make it worse? Does anything make it better? Have you done anything to treat it? How would you rate it? Diabetes 1 & 2 Have you experienced polydipsia? Have you had polyphagia? Have you had weakness? Have you had vision changes such as blurred vision? Have you had frequent infections? Has your mouth been dry? Has your skin felt dry? Have you lost any weight? Have you had a hard time paying attention at school? This study source was downloaded by from CourseH on :38:44 GMT -05:00 This study resource was shared via CourseH Have you experienced muscle cramps? Are you physically active? Hypothyroidism ***Have you been fatigue? Do you have cold intolerance ? Has your hair been dry and brittle? Has your skin seemed dry? Have you had muscle cramps? Has you menstruation been abnormal? Have you had changes in your voice? Have you gained weight? DIFFERNETIAL DIAGNONSIS: 1. Diabetes Mellitus Type 1 E10.9 Type 1 diabetes typically is diagnosed in childhood and currently affects more than 170,000 youth in the United States (Cato, & Hershey, 2016). Type 1 diabetes is a chronic disease caused by pancreatic insufficiency of insulin production. A person with Diabetes Mellitus Type 1 will live with the disease for longer periods of time, requiring strict metabolic control involving medication and changes in lifestyle, such as healthy eating and physical activity, in order to prevent and delay the onset of complications related to diabetes ( Moreira et al., 2016). Children with type 1 diabetes may present with polyphagia, polydipsia, polyuria, ketosis, rapid onset, thin physique, weight loss, recurrent infection, increased fatigue, abdominal discomfort, nausea, altered school performance, bedwetting, and nausea (Cato, & Hershey, 2016). This condition is the top possibility for Michael he has not felt like himself, he has no energy, he has a decreased appetite, he is always thirsty, he has been wetting his bed, he cannot seem to rid himself of his cold, he has lost weight and he has been sleeping more. When children have diabetes it is most often type one unless they are overnight with poor dietary habits. 2. Diabetes Mellitus Type 2 E11.9 Type 2 diabetes is a chronic, progressive disease characterized by insulin resistance and impaired insulin secretion (Rathmann, Scheidt-Nave, Roden, & Herder, 2013). These malfunctions may be acquired or inherited. This condition can be related to obesity, genetics, drug or chemical induced, ethnicity. It is commonly associated with hypertension, hyperlipidemia, metabolic syndrome, fatty liver disease, and infertility. Clinical presentation may involve polyuria, polydipsia, polyphagia, weight loss, weakness, fatigue, blurry vision, and frequent infections (Rathmann, Scheidt-Nave, Roden, & Herder, 2013). This condition is also a possibility for Michael he has not felt like himself, he has no energy, he has a decreased appetite, he is always thirsty, he has been wetting his bed, he has lost weight and he has been sleeping more. 3. Congenital Hypothyroidism E03.9 This study source was downloaded by from CourseH on :38:44 GMT -05:00 This study resource was shared via CourseH Hypothyroidism is defined as failure of the thyroid gland to produce sufficient thyroid hormone to meet the metabolic demands of the body (Gaitonde, Rowley, Sweeney, & Eisenhower, 2012). Congenital hypothyroidism (CH) occurs in approximately one in 700 to 3400 deliveries, patients are usually asymptomatic at birth, which leads to delayed diagnosis (Seth, Aggarwal, Maheshwari, 2012). The incidence increases with age, and is higher in females than in males. Hypothyroidism may occur as a result of primary gland failure or insufficient thyroid gland stimulation by the hypothalamus or pituitary gland. Primary gland failure can result from congenital abnormalities, autoimmune destruction, iodine deficiency, and infiltrative diseases. Patients may present with symptoms such as weight gain, fatigue, poor concentration, depression, diffuse muscle pain, and menstrual irregularities, constipation, cold intolerance, dry skin, proximal muscle weakness, and hair thinning or loss (Gaitonde, Rowley, Sweeney, & Eisenhower, 2012). This condition is possible for Michael because he has been fatigue, he has been sleeping a lot but his other symptoms are not congruent with this condition. Michael focused exam should include HEENT, cardiovascular, respiratory, GI, musculoskeletal, neurological, urinary, endocrine and skin. These areas should be covered due to his fatigue, his recent cold, his bed wetting, and due to the fact that his symptoms appear related to his endocrine system. VITAL SIGNS: Asses for vitals that would be appropriate for his medical history. CONSTITUTIONAL: Michael is a 10 year old male. HEENT: Asses Head size and shape, asses facial symmetrical, Asses eyes: pupils equal, round and reactive to light, asses sclera, asses conjunctiva, asses for facial growths or lesions. Asses facial tenderness. Ears: asses externally for redness, tenderness, swelling, drainage, shape. Asses ear canal tympanic membrane for redness, blisters or perforations. Asses Nasally for: nasal obstructions, spetum alignment, drainage, redness, and tenderness. Asses Oral for: redness, tonsil grade, moist mucosa, good hygiene and dentition. Asses Neck for: tenderness, palpable lymph nodes, trachea midline, thyroid enlargement, goiter, carotid artery bruit. CARDIOVASCULAR: Asses for: regular rate and rhythm, normal S1 & S2, no murmur, no gallops, no rub, appropriate capillary refill, no cyanosis, no edema in extremities, asses for full and equal pulses RESPIRATORY: Asses for: clear breath sounds in all lung fields no rales/crackles, rhonchi, wheezing, tachypnea, retractions, sputum, cough, normal chest shape, no labored breaths, normal respirations, shortness of breath, no dyspnea, no friction rub, bilateral expansion, dullness, flatness or hyper hyperresonance on percussion, tenderness or lumps. This study source was downloaded by from CourseH on :38:44 GMT -05:00 This study resource was s