HESI EXIT CASE STUDY 1: 66-YEAR-OLD FEMALE
WITH RESPIRATORY SYMPTOMS 2025
Key Terms/Concepts
Hyperthyroidism: An endocrine disorder characterized by
excessive production of thyroxine, leading to symptoms
such as weight loss, palpitations, and fatigue.
Diabetic Ketoacidosis (DKA): A serious complication of
diabetes characterized by high blood sugar, ketones in the
urine, and acidosis, often requiring immediate medical
intervention.
Acute Renal Failure: A sudden decrease in kidney
function, often due to dehydration or other acute
conditions, leading to the accumulation of waste products
in the blood.
Key People
Nurse: The healthcare professional responsible for
assessing, planning, and implementing care for patients,
including monitoring vital signs and administering
medications.
Symptoms
Palpitations: A sensation of rapid or irregular heartbeat,
often associated with hyperthyroidism or anxiety.
Weight Loss: Unintentional loss of body weight, which
can indicate various health issues, including
hyperthyroidism or uncontrolled diabetes.
Slurred Speech: A speech impairment that can indicate
neurological issues, such as after a TIA (transient ischemic
attack).
,Key Investigations
Investigation Purpose
Blood Glucose To assess for hyperglycemia or diabetic
Level ketoacidosis
To evaluate thyroid function and diagnose
TSH Level
hyperthyroidism or hypothyroidism
To identify potential pneumonia or other
Chest X-ray
respiratory issues
To check for hyperkalemia, which can affect
Potassium Level
heart function
Interventions
Administer IV Insulin: Essential for managing high blood
glucose levels in diabetic patients, especially in cases of
DKA.
Encourage Fluid Intake: Important for hydration,
especially in patients with renal issues or dehydration.
Educate on Diabetic Diet: To help manage blood sugar
levels and prevent complications.
Facts to Memorize
Normal TSH levels: 0.4 to 4.0 μU/mL
Normal heart rate: 60-100 bpm
Normal blood pressure: 120/80 mm Hg
Normal respiratory rate: 12-20 breaths per minute
Normal body temperature: 98.6°F (37°C)
Normal glucose levels: 70-130 mg/dL (fasting)
Normal potassium levels: 3.5-5.0 mEq/L
Reference Information
Hyperthyroidism symptoms: fatigue, palpitations,
tachycardia, heat intolerance, weight loss, anxiety.
, Diabetic Ketoacidosis (DKA) symptoms: fruity breath,
high blood glucose, dehydration, lethargy.
Gout symptoms: sudden severe pain, swelling, redness in
joints, especially the big toe.
Concept Comparisons
Concept Hyperthyroidism Hypothyroidism
Symptoms Weight loss, palpitations, Weight gain, fatigue, cold
intolerance
heat intolerance
TSH Levels Low (TSH < 0.4 μU/mL) High (TSH > 4.0 μU/mL)
Common Causes Graves' disease, thyroiditis Chronic
thyroiditis
autoimmune
Treatment Antithyroid medications, Levothyroxine
radioactive iodine
Patient Presentation and Initial Assessment
A 66-year-old female presents with fever and a productive
cough of green, thick sputum lasting 3 days.
Reports fatigue and weight loss, indicating possible
systemic illness.
Additional symptoms include palpitations and dizziness,
which may suggest cardiovascular involvement.
Vital Signs and Physical Findings
Vital signs show hypertension (BP 142/92), tachycardia
(HR 126), tachypnea (RR 28), and fever (temp 101.5°F).
WITH RESPIRATORY SYMPTOMS 2025
Key Terms/Concepts
Hyperthyroidism: An endocrine disorder characterized by
excessive production of thyroxine, leading to symptoms
such as weight loss, palpitations, and fatigue.
Diabetic Ketoacidosis (DKA): A serious complication of
diabetes characterized by high blood sugar, ketones in the
urine, and acidosis, often requiring immediate medical
intervention.
Acute Renal Failure: A sudden decrease in kidney
function, often due to dehydration or other acute
conditions, leading to the accumulation of waste products
in the blood.
Key People
Nurse: The healthcare professional responsible for
assessing, planning, and implementing care for patients,
including monitoring vital signs and administering
medications.
Symptoms
Palpitations: A sensation of rapid or irregular heartbeat,
often associated with hyperthyroidism or anxiety.
Weight Loss: Unintentional loss of body weight, which
can indicate various health issues, including
hyperthyroidism or uncontrolled diabetes.
Slurred Speech: A speech impairment that can indicate
neurological issues, such as after a TIA (transient ischemic
attack).
,Key Investigations
Investigation Purpose
Blood Glucose To assess for hyperglycemia or diabetic
Level ketoacidosis
To evaluate thyroid function and diagnose
TSH Level
hyperthyroidism or hypothyroidism
To identify potential pneumonia or other
Chest X-ray
respiratory issues
To check for hyperkalemia, which can affect
Potassium Level
heart function
Interventions
Administer IV Insulin: Essential for managing high blood
glucose levels in diabetic patients, especially in cases of
DKA.
Encourage Fluid Intake: Important for hydration,
especially in patients with renal issues or dehydration.
Educate on Diabetic Diet: To help manage blood sugar
levels and prevent complications.
Facts to Memorize
Normal TSH levels: 0.4 to 4.0 μU/mL
Normal heart rate: 60-100 bpm
Normal blood pressure: 120/80 mm Hg
Normal respiratory rate: 12-20 breaths per minute
Normal body temperature: 98.6°F (37°C)
Normal glucose levels: 70-130 mg/dL (fasting)
Normal potassium levels: 3.5-5.0 mEq/L
Reference Information
Hyperthyroidism symptoms: fatigue, palpitations,
tachycardia, heat intolerance, weight loss, anxiety.
, Diabetic Ketoacidosis (DKA) symptoms: fruity breath,
high blood glucose, dehydration, lethargy.
Gout symptoms: sudden severe pain, swelling, redness in
joints, especially the big toe.
Concept Comparisons
Concept Hyperthyroidism Hypothyroidism
Symptoms Weight loss, palpitations, Weight gain, fatigue, cold
intolerance
heat intolerance
TSH Levels Low (TSH < 0.4 μU/mL) High (TSH > 4.0 μU/mL)
Common Causes Graves' disease, thyroiditis Chronic
thyroiditis
autoimmune
Treatment Antithyroid medications, Levothyroxine
radioactive iodine
Patient Presentation and Initial Assessment
A 66-year-old female presents with fever and a productive
cough of green, thick sputum lasting 3 days.
Reports fatigue and weight loss, indicating possible
systemic illness.
Additional symptoms include palpitations and dizziness,
which may suggest cardiovascular involvement.
Vital Signs and Physical Findings
Vital signs show hypertension (BP 142/92), tachycardia
(HR 126), tachypnea (RR 28), and fever (temp 101.5°F).
