Hypothyroidism Concept Map

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Cultural considerations, ethnicity, occupation, religion,

family support, insurance. (1) (14)

Retried,53 ,american female , married for the last 30 years .

She practices Christianity . She has one adopted son as she

was not able to carry her own because of an hysterectomy

procedure.

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

Free T3

2.0-4.4

4/25/20

1.4

Free T4

0.93-

1.7

4/25/20

0.4

Anti TPO

Negati

4/25/20

Positive

Anti TG

Negati

4/25/20

Positive

0.92-

2.4

4/25/20

0.6

0.8-1.8

4/25/20

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

Freq.

MOA

Considerations

Onset/Peak/

Duration

(Insulin)

Rivaroxaba

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

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

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.

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

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Hypothyroidism Concept Map