Case Study Thyroid Storm
Case Study:
Thyroid Storm
Tammy is a 33 year old white female found by her fiancé to be confused, agitated, diaphoretic, and incontinent of diarrhea stool. The patient was brought into the ED by her fiancé for evaluation. Her fiancé states he is concerned because he thinks the patient has the flu because she has had a fever, nausea, diarrhea and diaphoresis that have progressively gotten worse over the past 24 hours.
Vitals:
Temp: 104.5
BP: 144/68 Pulse: 158
EKG: Sinus Tachycardia O2 : 96%
Assessment: patient appears to be restless
Neuro: pupils are equal round and reactive to light; tremors are noted
Integumentary: Skin is warm and moist, face is flushed, and mucus membranes are moist
No jugular vein distention notes, no lymphadenopathy noted
Musculoskeletal: No nuchal rigidity
Endocrine: Slightly enlarged palatable thyroid gland is noted
Airway: Lungs are clear to auscultation
Cardiac: tachycardia, regular rhythm without murmur, rub, or gallop
GI: Abdomen is soft and non-tender; bowel sounds are hyperactive
Extremities: pedal pulses are present, no pedal edema noted
Patient: Tammy Storm
Sex: Female
Age: 33
DOB: October 28, 1980
Past History: Tammy has no previous medical problems
Social History:
Tammy is engaged and lives with her fiancé. She is currently in nursing school and works as a waitress on weekends. Her fiancé reports no previous health conditions, however fiancé does state that the patient has had a significant weight loss over the past two months
Pathophysiology: Thyroid Storm
Nursing Intervention
Rationale
Monitor BP lying, sitting, and standing
(Note if widened pulse pressure)
Orthostatic hypotension can occur as a result of peripheral vasodilation and decreased circulating volume
Monitor Central venous pressure
Direct measure of circulating volume and cardiac function
1) NSG Priorities
a) Reduce metabolic
Thyroid Storm
Tammy is a 33 year old white female found by her fiancé to be confused, agitated, diaphoretic, and incontinent of diarrhea stool. The patient was brought into the ED by her fiancé for evaluation. Her fiancé states he is concerned because he thinks the patient has the flu because she has had a fever, nausea, diarrhea and diaphoresis that have progressively gotten worse over the past 24 hours.
Vitals:
Temp: 104.5
BP: 144/68 Pulse: 158
EKG: Sinus Tachycardia O2 : 96%
Assessment: patient appears to be restless
Neuro: pupils are equal round and reactive to light; tremors are noted
Integumentary: Skin is warm and moist, face is flushed, and mucus membranes are moist
No jugular vein distention notes, no lymphadenopathy noted
Musculoskeletal: No nuchal rigidity
Endocrine: Slightly enlarged palatable thyroid gland is noted
Airway: Lungs are clear to auscultation
Cardiac: tachycardia, regular rhythm without murmur, rub, or gallop
GI: Abdomen is soft and non-tender; bowel sounds are hyperactive
Extremities: pedal pulses are present, no pedal edema noted
Patient: Tammy Storm
Sex: Female
Age: 33
DOB: October 28, 1980
Past History: Tammy has no previous medical problems
Social History:
Tammy is engaged and lives with her fiancé. She is currently in nursing school and works as a waitress on weekends. Her fiancé reports no previous health conditions, however fiancé does state that the patient has had a significant weight loss over the past two months
Pathophysiology: Thyroid Storm
Nursing Intervention
Rationale
Monitor BP lying, sitting, and standing
(Note if widened pulse pressure)
Orthostatic hypotension can occur as a result of peripheral vasodilation and decreased circulating volume
Monitor Central venous pressure
Direct measure of circulating volume and cardiac function
1) NSG Priorities
a) Reduce metabolic