Question

Jean Fields is a 72-year-old client who has been diagnosed with hyperthyroidism due to Graves’ disease. Her husband of 52 years died of lung cancer 2 weeks ago, and she has been dealing with extreme emotional upset and grief. She has been admitted to the hospital with fatigue, weakness, fever, tachycardia, and dehydration.

1. What is a possible cause of Ms. Fields’ symptoms? What questions would the nurse need to ask Ms. Fields to help determine factors that may have contributed to her condition?

Answer 1

answer.

This is a case of THYROID STORM . It is a life threatening condition asssosiated with untreated hyperthyroidism.

here the patient is a known case of graves disease, which is a autoimmune diseae and produces more thyroid hormone in blood. People with hyperthyroidism may develop thyroid storm when they are exposed to one of following situations

a. trauma

b. surgery.

c. severe emotional distress( in this case)

d. stroke.

e. congestive heart failure.

f. pulmonary embolism

g.diabetic keto acidosis

A. symptoms

increased heart rate above 100(tachycardia) , fever, persistient sweating , shaking, restlessness, confusion , diarrhoea ,dehydration. and unconsiousness.

B. diagnosis

mainly clinicaly and with history of hyperthyroidsm and precipitatio factors.

as a blood test we can measure TSH level in blood. it will be very low.(normal 0.4 - 4 MIU/L) , becoz of negetive feedback mechanism .other tests are electrolyte , bloood sugar, liver function test,

C. treatment ( idealy in icu )

nomalize the vitals of patients with iv fluids and electrolytes.

give antipyrectics for fever control

oxygen supply if needed

give betablocker medications to control excess thyroid hormone symptoms such as palpitaion.

give antithyroid drugs like propyl thiouracil , it blocks t4 to t3 conversion in tissues and block new thyroid hormone synthesis

iodine therapy ,it blocks new hormone synthesis and release from thyroid gland.

steroid injection as a prophylactic for adrenal insufficiency

treat the precipitating causes

treat the hyperthyroidsm once patient became normal