Case Study, Chapter 45, Assessment and Management of Patients with Endocrine Disorders follow-up TSH and FT4 labs and vi

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Case Study Chapter 45 Assessment And Management Of Patients With Endocrine Disorders Follow Up Tsh And Ft4 Labs And Vi 1 (49.77 KiB) Viewed 16 times

Case Study, Chapter 45, Assessment and Management of Patients with Endocrine Disorders follow-up TSH and FT4 labs and visit to the oncologist in 4 weeks. The primary provider informs the patient that he will continue to have lab tests and monthly follow-up until the TSH and FT4 are stable. What is the rationale for this treatment plan? d. What nursing interventions should the nurse provide the patient? 1. Don Smart, 55 years of age, presents to the primary provider to follow up on some symptoms he recently developed. The patient states that he is extremely tired and is having trouble concentrating. He states that his skin is dry and flaky. His nails are brittle and his hair is dry, dull, and falls out as he showers. He is 8 weeks postop after a modified radical neck procedure for laryngeal cancer and has completed the external radiation therapy. He is using a Blom--Singer prosthesis for speech. He states that his appetite is poor, yet he is gaining weight. The patient's current medications include metformin for a history of type 2 diabetes, digoxin 0.25 mg every day for a history of atrial fibrillation, and warfarin therapy being managed by the primary provider for thromboembolism prophylaxis related to atrial fibrillation. The primary provider orders the following lab work: CBC with differential, serum albumin, TSH, FT4, PT, and INR (Learning Outcomes 2, 3 and 4) 2. Mrs. Ramirez was admitted to the hospital for wrist surgery secondary to rheumatoid arthritis. Postoperatively, she is stabilized and transferred to the general surgery unit. Mrs. Ramirez's medications include digoxin, furosemide, captopril, levothyroxine, aspirin, pantoprazole, and prednisone. When administering morning medications, Mrs. Ramirez refuses her aspirin and prednisone, and the nurse holds the medications Over the next 3 days, Mrs. Ramirez continues to refuse the prednisone, and the medication is not administered. On the third postoperative day, Mrs. Ramirez becomes hypotensive, tachycardic, and has a decrease in level of consciousness. STAT labs are sent for a complete blood cell count and chemistry panel, and the primary provider is notified of the change in patient status. On review of the patient's record, the primary provider notes that Mrs. Ramirez has not received her prednisone for 4 days Mrs. Ramirez has been on Prednisone for the past 5 years for her rheumatoid arthritis, and the primary provider begins to treat the patient for acute adrenalinsufficiency. (Learning Outcomes 2 and 3) a. What is the rationale for the labs ordered, based on the symptoms that the patient is exhibiting? b. The primary provider follows up with the patient with the diagnost of hypothyroidism What are the reasons the patient developed hypothyroidism? C. Based on the results of the TSH and FT4, the primary provider starts the patient on levothyroxine 0.025 mg/day and to have a. What other clinical manifestations should the nurse monitor for with suspected adrenalinsufficiency? b. The primary provider prescribes a STAT dose of IV hydrocortisone What is the rationale for this medication in this situation