NR 526 Case Study: Hashimoto’s Thyroiditis
Objectives:
At the end of the simulation the student will be able to:
State the signs and symptoms
... [Show More] of Hashimoto’s thyroiditis
Evaluate and interpret lab values related to diagnosis of Hashimoto’s thyroiditis
Identify the purpose of Levothyroxine and its pharmacokinetics
Case Study:
Merelan is a 29-year-old certified nursing assistant. Initially presented to the office
complaining of feeling more fatigue and sluggish than usual for the last 6 months. She also
complains of having muscle aches, joint stiffness, memory lapse, excessive/prolonged
menstrual bleeding, and an unexplained weight gain of 15 pounds within the last month.
Medical history: Hypertension, hyperlipidemia, and psoriasis
Past medical history: Acne and gestational diabetes
Social history: Nonsmoker and does not consume alcohol
Surgical history: Meniscus repair to right knee, tonsillectomy, and cholecystectomy
Family medical history: Mother and sister has hypothyroidism. Father has coronary artery
disease and hyperlipidemia. Brother has type 2 diabetes and coronary artery disease with
history of myocardial infarction.
Allergies: No known drug allergies.
Medications/supplements: Amlopidine 10mg tablet daily, Levothyroxine 25mcg tablet daily,
Multivitamin 1 tablet daily, and Fish oil 1200mg capsule daily
Clinical Impression
Fatigue
Sluggishness
Muscle aches
Joint stiffness
Memory lapse
Excessive/prolonged menstrual bleeding
Weight gain of 15 pounds within the last month
Puffy face
Dry skin
Delayed deep tendon reflexes
Palpable tender nodules in anterior neck
Temperature: 96.3 F
Pulse: 56
Blood pressure: 118/58
Respirations: 14
Labs/Diagnostic Test
TSH – 6.5 Normal range 0.5 - 5.0 (mIU/L)
Free T4 – 0.2 Normal range 0.7-1.9 (ng/dl)
Thyroid peroxidase antibody (TPO) - Positive
Thyroglobulin antibody (TGAb) – Positive
Ultrasound: Multiple nodules each measuring between 3-5mm on the thyroid gland noted.
Questions Referenced Rationale
Explain in your own words the signs and symptoms of Hashimoto’s thyroiditis?
It is important for nursing students to know the signs and symptoms of medical conditions which helps them to understand the progression of disease. Recognizing signs and symptoms is a part of assessment. Assessment is a fundamental aspect of nursing, it is the first stage of the nursing process, followed by planning, implementation and evaluation (Meek, 2015). The ability to appropriately assess a disease and gather subjective and objective data addresses the advanced health assessment/ physiology aspect of the 3Ps and helps the student to identify appropriate treatment options and care plans for the patient.
Can you identify what labs/diagnostic tests supports the diagnosis of Hashimoto’s thyroiditis and what does each test result indicate?
Clinical lab testing plays an important role in the delivery of today’s health care and guides more than 70 percent of medical decisions (American Clinical Laboratory Association, 2014). Being able to interpret lab values is pertinent and addresses the advanced health assessment/ physiology aspect of the 3Ps. Nursing students must learn numerical lab values to help guide clinical judgement and determine when a patient's values are within normal range or not. As a nurse, you must know how to explain to the patient the nature of the test, call the doctor's attention to the abnormal results, and recognize why the abnormal results are pertinent.
How would you apply what you learned to develop a concept map that explains the pharmacokinetics of Levothyroxine?
Nursing student must gain medication competence to understand and appropriately manage medications. Medication competence requires a good knowledge base and the ability to apply that knowledge in clinical practice. Addresses the pharmacokinetics of medications allows students to gain a comprehensive understanding of the medication absorption, elimination, and how it is metabolized in the body. Having comprehensive knowledge of the pharmacokinetics and pharmacodynamics of medications is indicted for nursing management of patient care and a broader understanding of medication management (Suhonen, Sulosaari, Suhonen & Leino-Kilpi, n.d).
References
American Clinical Laboratory Association. (2014). Importance of clinical lab testing highlighted during medical lab professionals week. Retrieved from www.acla.com/importance-of-clinical-lab-testing-highlighted-during-medical-lab-professionals-week/
Mayo Clinic. (2018). Hashimoto’s disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855
Meek, G. (2015). Teaching physical assessment skills to international nursing students in new zealand. International Journal of Nursing Education, 7(1), 230-234. doi:10.5958/0974-9357.2015.00047.1
Suhonen, R., Sulosaari, V., Suhonen, R., & Leino-Kilpi, H. (n.d). An integrative review of the literature on registered nurses' medication competence. Journal of Clinical Nursing, 20(3-4), 464-478. [Show Less]