Question

Crystal Acton, a 27-year-old married woman, pregnant with her first child, presents at the OB/GYN clinic for her first prenatal visit. The nurse-midwife begins her assessment of this patient by documenting a medical and family history.

Mrs. Acton states that the only medication she is taking is a multivitamin with folic acid daily. She has no family history of breast, ovarian, or vaginal cancer.
While performing the physical assessment, the nurse-midwife notes a thrill over the thyroid gland, which feels markedly enlarged. Auscultation confirms a bruit in the thyroid area.

Documentation includes the following: Head WNL; submental and submandibular lymph nodes hard and enlarged; thyroid gland markedly enlarged, thrill palpated, bruit auscultated.
The nurse prepares a teaching plan for this patient.

1. What risks involving the head and neck are addressed by assessment documentation? In other words, what is it about her assessment that concerns you? What are the abnormalities? Which conditions would the patient be at risk for, based on these findings? Explain your train of thought here.

2. What diagnostics would the nurse-midwife expect from her assessment discoveries?

3. How would the nurse-midwife proceed in light of her assessment data?

Answer 1

1. In another word

Head WNL means - Head within Normal limit, means there is no abnormality see in the head

Assessment of Neck shows lymphadenopathy, vascular murmur, and goiter

2. Thrill and bruit are signs is concerning to nurse, because it shows abnormality with heart. The patient has lymphadenopathy(Enlarged lymph nodes) and Goitwr(Enlarged thyroid gland).

All the signs and symptoms shows the possibility of Graves's disease. Graves disease is an autoimmune disorder in which thyroid-stimulating immunoglobulins are produced which causes increases in thyroid hormone production.

3. The patient is pregnant, in this case, Graves's disease can cause many issues in pregnancy like miscarriage, preterm birth, preeclampsia, Intrauterine growth retardation, etc.

Graves's disease can also cause osteoporosis. Congestive heart failure and thyroid storm.

So, in this case, we need to control the production of thyroid hormone production by medication. The nurse should advise the patient to follow up visits and regular lab investigations.

4. Diagnostics to conform to this condition include

Blood investigation (T3, T4, and TSH test)

Thyroid scan

radioactive iodine uptake test

thyroid stimulating immunoglobulin test