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Case Study 79 – Hyperthyroidism and Grave’s Disease
1. Which of K.B.'s assessment findings represent manifestations of hypermetabolism?
He has a high pulse rate of 124, which means he is tachycardic. He has a high temperature of
100.2F, which means he is running a fever. He is experiencing feelings of anxiety, insomnia and
restlessness.
2. Interpret K.B.'s laboratory results.
His Hgb (11.8g/dL) and Hct (36%) are both low which is a result from a hypermetabolic state.
His ESR is elevated at 48mm/hr. which could indicate an infection or necrosis of the tissues. His
BUN is elevated at 33 mg/dL which can indicate impaired function of the kidneys. He has an
elevated T3 of 230 ng/dL. He has an elevated T4 of 12.0 ng/dL.
3. You go to assess K.B. What additional data do you need to obtain because he
has Graves’ disease?
His nutritional status, any nausea or vomiting, any changes in his bowel habits, any bulging of
the eyes or vision changes, any changes in his hair/skin/nails, is he having any tremors, does he
have shortness of breath, does he have any chest pain, is he sweating more than usual, does he
have an increased DTR, does he have a goiter?
4. The physician writes these admission orders. Which will you question, and why?
If the patient is dehydrated, why are we giving Lasix. This is a diuretic which can cause further
dehydration. His fluids are at a rate of 125/hr. which can be too fast if the patient is having heart
failure. Propanolol (betablocker) and Verapamil (CA channel blocker) can also cause progression
of heart failure.
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5. Describe four priority problems related to K.B.’s nursing care.
K.B. is experiencing arrhythmias, decreased cardiac output, hyponatremia, inadequate
oxygenation saturation, weight gain, and/or activity intolerance.
6. What is likely to happening with K.B.? State your rationale.
I believe K.B. is experiencing what is called a thyroid crisis or also called, thyroid storm. This is
a life-threatening condition that occurs in patients with hyperthyroidism. A thyroid crisis is when
the thyroid releases too much thyroid hormone in a short period of time. I feel that this is the
situation because his metabolic demand has rapidly increased based off his symptoms.
7. What will you do first?
This is a medical emergency so I will place him on oxygen and call a rapid response.
8. You need to call the physician regarding K.B.'s status. Using SBAR, what will
you report to the physician?
K.B.s came in with hyperthyroidism/graves disease. He has currently been showing symptoms of
a thyroid crisis. His current vital signs are 174/82 for BP, respirations of 32 and labored, 180 bpm
and irregular for pulse, Afib is showing on his ECG, he has a temperature of 104. We need
something to lower his heart rate and blood pressure? Can someone come and reassess this
patient?
9. Describe how you would care for K.B. in the next hour.
I would administer any prescribed medications (Acetaminophen, digoxin, diltiazem), I would
continuously check his oxygenation saturation, after receiving Diltiazem he would need to be
placed on bedrest and his HR should also be continuously monitored.
Case Study 79 – Hyperthyroidism and Grave’s Disease
1. Which of K.B.'s assessment findings represent manifestations of hypermetabolism?
He has a high pulse rate of 124, which means he is tachycardic. He has a high temperature of
100.2F, which means he is running a fever. He is experiencing feelings of anxiety, insomnia and
restlessness.
2. Interpret K.B.'s laboratory results.
His Hgb (11.8g/dL) and Hct (36%) are both low which is a result from a hypermetabolic state.
His ESR is elevated at 48mm/hr. which could indicate an infection or necrosis of the tissues. His
BUN is elevated at 33 mg/dL which can indicate impaired function of the kidneys. He has an
elevated T3 of 230 ng/dL. He has an elevated T4 of 12.0 ng/dL.
3. You go to assess K.B. What additional data do you need to obtain because he
has Graves’ disease?
His nutritional status, any nausea or vomiting, any changes in his bowel habits, any bulging of
the eyes or vision changes, any changes in his hair/skin/nails, is he having any tremors, does he
have shortness of breath, does he have any chest pain, is he sweating more than usual, does he
have an increased DTR, does he have a goiter?
4. The physician writes these admission orders. Which will you question, and why?
If the patient is dehydrated, why are we giving Lasix. This is a diuretic which can cause further
dehydration. His fluids are at a rate of 125/hr. which can be too fast if the patient is having heart
failure. Propanolol (betablocker) and Verapamil (CA channel blocker) can also cause progression
of heart failure.
, 1
5. Describe four priority problems related to K.B.’s nursing care.
K.B. is experiencing arrhythmias, decreased cardiac output, hyponatremia, inadequate
oxygenation saturation, weight gain, and/or activity intolerance.
6. What is likely to happening with K.B.? State your rationale.
I believe K.B. is experiencing what is called a thyroid crisis or also called, thyroid storm. This is
a life-threatening condition that occurs in patients with hyperthyroidism. A thyroid crisis is when
the thyroid releases too much thyroid hormone in a short period of time. I feel that this is the
situation because his metabolic demand has rapidly increased based off his symptoms.
7. What will you do first?
This is a medical emergency so I will place him on oxygen and call a rapid response.
8. You need to call the physician regarding K.B.'s status. Using SBAR, what will
you report to the physician?
K.B.s came in with hyperthyroidism/graves disease. He has currently been showing symptoms of
a thyroid crisis. His current vital signs are 174/82 for BP, respirations of 32 and labored, 180 bpm
and irregular for pulse, Afib is showing on his ECG, he has a temperature of 104. We need
something to lower his heart rate and blood pressure? Can someone come and reassess this
patient?
9. Describe how you would care for K.B. in the next hour.
I would administer any prescribed medications (Acetaminophen, digoxin, diltiazem), I would
continuously check his oxygenation saturation, after receiving Diltiazem he would need to be
placed on bedrest and his HR should also be continuously monitored.
