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Hypothyroidism Concept Map

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History of Present Illness (HPI), Pathophysiology of Admitting Dx
(Cite References) Medical, Surgical, Social History (1).
The patient stated that in the last year she gain around 22 pounds even
though she didn’t change her diet and didn’t eat more than before. She is
feeling tired all the time even though she told the physicians that she not
lacking sleep . She currently is a housewife so she has plenty time of
rest.D.A said that sometimes she is feeling so tired that she is not even
able to go to the market for groceries. She complained of dry skin even
though she increased her fluid intake to around 3 liters/day. She also
complains of constipation which are frequent and last for todays and that
she can’t stand cold ,that’s why she always wears socks and sweaters.
Pathophysiology of admitting dx: Hypothyroidism is defined as being a
deficiency of the thyroid hormones T3 and T4. Their secretion and also
their action is altered which leads to a variety of clinical signs. The
symptoms are represented by depression, loss of eyebrows hair, dry hair
and skin, brittle nails, infertility, heavy menstrual periods, weight gain,
slow heartbeat, enlarged thyroid, puffy face, and constipation. The most
common form of hypothyroidism which is also known as primary is
Hashimoto's thyroiditis. In this pathology, the gland becomes fibrotic and
shrunken.( Athanassiou, , Ntalles,2010)
Medical History
Endometrial cancer ( treated) - this is a form of cancer which tends to
begin at the level of the uterus. It starts to tat the level of the
endometrium and is sometimes known as uterine cancer. Because it
produces abnormal vaginal bleedings, it is often detected in its early
stages. Removing the uterus represents a form of therapy which cures the
pathology. (Leslie,Thiel,Goodheart,De Geest,Jia,Yang,2012)
Deep Vein Thrombosis at the level of the ileac vein -DVT represents the
formation of a thrombus/blood clot in one of the deep veins. A
complication of it can be represented by pulmonary embolism which is
another condition that consists of arteries in the lung being blocked by
this thrombus. In case of our patient, the cause of the manifestation is
represented by thrombophilia which is also present in her family history.
She states that her father had it too.
(Kesieme,Jebbin,Irekpita,Dongo,2011)
Surgical History
Total Hysterectomy - for endometrial cancer. It represents a procedure
during which the uterus is removed. In some cases, the other organs such
as the ovaries, fallopian tubes, and the cervix can be removed too. It is
frequently done together with oophorectomy which represents the
removal of ovaries since this reduces the chanced of ovarian cancer too.
Social History
The patient denies smoking and alcohol consumption. She also states that
she never took any type of drugs . She was not able to carry her own child
and because of that she adopted one when she was 33 years old , after 6
years of trying . She worked as an accountant and is currently and
housewife.
Chief Complaint
Bradycardia, cold limbs, ongoing constipation,
weight gain even though her appetite is
diminished, skin friability
Admitting Diagnosis
Hypothyroidism
Patient Information
(1)
Name: B.A
Age: 51 years old
Gender: F
Code Status: Full Status
DPOA: N/a
Living Will: N/a
Patient Education (In Pt.) & Discharge Planning (home needs)
1. The patient needs to be cautious when using analgesics due to increased
sensitivity towards those drugs.
2. The patient should take medication as prescribed by the physician and
should avoid changing to the dosage.
3. The patient should be instructed to continue her therapy even if she is
feeling better.
4. The patient needs to be informed about the symptoms of hypothyroidism
so she can address to a medical center in case of complications.
5. The patient needs to be aware of possible interference of calcium
carbonate, iron, sucralfate or aluminum hydroxide.
6. The patient needs to be instructed about the importance of follows up and
the need to check her TSH levels and thyroid hormones regularly.
7. She should immediately refer to her physician in case she loses or gain
weight out of nowhere.
Concept Map
Student Name:
Instructor:
Diagnostic Test/ Lab Results with dates
and Normal Ranges (3)
Test
Norms
Date
Current
Value
TSH
0.27-
4.20
4/25/20
18
6
Free T3
2.0-4.4
4/25/20
18
1.4
Free T4
0.93-
1.7
4/25/20
18
0.4
Anti TPO
Negati
ve
4/25/20
18
Positive
Anti TG
Negati
ve
4/25/20
18
Positive
T3
0.92-
2.4
4/25/20
18
0.6
T4
0.8-1.8
4/25/20
18
0.2
ECG- The patient presents bradycardia
with small QRS complexes.
Ultrasound - diffusely enlarged thyroid
gland with hypoechoic micronodules that
are surrounded by echogenic space.
Medical Management/ Orders/ Medications & Allergies (2)
Name
Dose
RT
Freq.
MOA
RN
Considerations
Onset/Peak/
Duration
(Insulin)
Rivaroxaba
n
20mg
P.O
O.D
It inhibits Factor Xa
and has a rapid
onset of action. The
inhibition of this
factor will interrupt
both the extrinsic
and intrinsic
pathway of blood
coagulation
cascade.
-Monitor for
possible bleeding
-monitor for
possible side
effects
Aspirin
81
mg
P.O
O.D
Inhibits platelet
aggregation
-Frequent PT and
IRN
-Monitor for
salicylate toxicity
Sulodexide
250
LSU
P.O
b.i.id
Blocks thrombin and
cathepsin G platelet
aggregation inhibit
the adhesivity of
platelets.
-Monitor for
possible
bleedings
Erickson’s Developmental Stage Related to pt. & Cite
References (1)
Based on Erickson’s Developmental Stages, the patient is
in the 7
th
category entitled “ Generativity vs Stagnation
where the basic virtue is represented by care. It represents
the period during which people establish their careers , get
married and begin a family. If they are able to achieve all of
these they will have a feeling of care , if not , they will feel
unproductive . (Malone,Vaillant,Rentz,Waldinger,2016)
Our patient is handling well her current stage . Even though
she doesn’t have her own children , she managed to
substitute this absence by adopting one.

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Priority nursing diagnosis #1
Imbalanced Nutrition intake of
the nutrients can exceed the
metabolic needs
Vital Signs (4)
Temperature 97.5 F
Blood Pressure 90/60
Pulse 55 bpm
Respiratory Rate 20
cycles/min
Neurological (5)
Impaired Memory
Irritability
Depression
Delayed Reflexes
Respiratory (7)
Clear Lungs
No shortness of breath
or wheezing
No cackles/rhonchi
Sat O2 =97%
Priority nursing diagnosis #2
Fatigue this is described as
being a state of exhaustion
during which the physical and
mental capacity of the patient
are decreased.
Outcome/Goal #2
Increase the ability to completed
the daily activities .
Outcome/Goal #1
Maintain a stab le weight for
her age and height.
Interventions #1
-Measure the client weight
-Assess the patients appetite as in most
of the cases hypothyroidism show
signs of decreased appetite.
-Provide food diary
-Give information about the weight
changes that can occur in case of
hypothyroidism
-Collaborate with a specialized
dietician in order to prepare a meal
that has the correct value of calories.
-Encourage eating 6 meals/day
-Encourage eating food that is rich in
fibers.
Interventions # 2
-Determine the ability of the patient to
perform certain activity in order to
find out how severe is this symptom.
-Note possible daily energy patterns
-Try to stimulate the patient through
activities which don’t cause stress and
interesting conversation.
-Promote an environment that can be
efficient in order to relieve fatigue .
For example in case of
hypothyroidism we need to ensure that
there is a optimal temperature in the
room as they can feel uncomfortable in
case it is too warm or too cold.
Assessment/ Evaluation #1
As a result of this , we expect the patient to return to a normal
bowel function and avoid weight changes. We expect the
patient to have a better knowledge in regard to the pathology
and understand how to keep it under control.
Assessment/ Evaluation #2
Increase independence
Increase participation in daily activities
Increase the quality of life .
PC Interventions
-Instruct the patient about the importance of taking their
medications.
--Teach the patient that the hormone replacement therapy -
Levothyroxine needs to be taken during all her life and it
shouldn't be interrupted
-Monitor for signs of hypothyroidism such as fatigue, low blood
pressure, decreased heart rate.
PC Evaluation Plan
Do periodical check ups in order to ensure that the level of the
thyroid hormones in the blood is the one we expected.
We expect to be able to increase the quality of life of the patient.
PC Outcomes/Goal
Avoid decompensation caused by
low levels of thyroid hormones
which can lead to coma.
Potential Complications/ at
risk for
Myxedema coma
Nutrition/Hydration
(8)
Dry Skin,
Sluggish skin turgor
Rest/ Exercise (11)
Chronic Fatigue
GI (9)
Constipation,
Diminished bowel
sounds in all the four
quadrants
Abdominal distension
GU (10)
Post Histerectomy
Bladder Distension
Misc. (Ht/Wt)
5’7”
170 pound
BMI:26.63 =>
Overweight
Endocrine (13)
No palpable Thyroid
Nodules
Thick Neck
Cardiovascular (6)
Low blood pressure
and bradycardia
Small QRS Complexes
Soft heart sounds.
Diminished apical
impulse
Psychosocial (14)
Slow speech
Confusion
Integumentary (12)
Cold extremities
Periorbital puffiness
Macroglossia
Birttle Nails
Thin Hair
Pale Skin

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Concept Map Student Name: Instructor: Erickson’s Developmental Stage Related to pt. & Cite References (1) Based on Erickson’s Developmental Stages, the patient is th in the 7 category entitled “ Generativity vs Stagnation “ where the basic virtue is represented by care. It represents the period during which people establish their careers , get married and begin a family. If they are able to achieve all of these they will have a feeling of care , if not , they will feel unproductive . (Malone,Vaillant,Rentz,Waldinger,2016) Patient Education (In Pt.) & Discharge Planning (home needs) 1. The patient needs to be cautious when using analgesics due to increased sensitivity towards those drugs. 2. The patient should take medication as prescribed by the physician and should avoid changing to the dosage. 3. The patient should be instructed to continue her therapy even if she is feeling ...
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