I-Human Case Study—Erin Bradley NSG 6420 Week 2 Discussion
Human Case Study Analysis: Erin Bradley
Patient: Erin Bradley, 21-year-old female
Chief Complaint: "I have nausea and vomiting, I can't keep anything down. I feel hot and
sweaty and very shaky."
History of Present Illness (HPI)
Erin Bradley is a 21-year-old female college student who presents to the Emergency Department
with a 24-hour history of nausea and vomiting. Her symptoms are accompanied by a feeling of
shakiness, palpitations ("heart fluttering"), and subjective heat intolerance ("feeling hot"). She
reports generalized sickness, profound fatigue, and exercise intolerance.
Further questioning reveals a constellation of symptoms that have been present or worsening
over the past several months. These include a 10-pound unintentional weight
loss, hyperreflexia, increased frequency of bowel movements with hyperactive bowel
sounds, and significant emotional lability, anxiety, and insomnia. She attributes some of her
emotional distress to a recent breakup with her boyfriend. She also
notes oligomenorrhea (infrequent menstrual periods) for the past 6 months and has missed her
last period entirely.
Physical Examination Findings
• General: Anxious, tremulous female in mild distress.
• Vitals:
o Temperature: 101°F (Fever)
o Heart Rate: 150 bpm (Tachycardia)
o Respiratory Rate: 22 breaths/min (Tachypnea)
o Blood Pressure: Systolic elevated with evidence of orthostatic hypotension.
• Cardiovascular: Tachycardic rate. A systolic ejection murmur is audible.
• Neck: Enlarged thyroid gland with a palpable thrill and an audible bruit.
, [Type here]
• Neurological: Hyperreflexia and fine tremors of the hands.
• Abdomen: Hyperactive bowel sounds.
• Skin/Nails: Warm, sweaty skin. Onycholysis (separation of the nail from the nail bed) is
noted on a couple of nails.
Differential Diagnoses & Rationale
Based on Ms. Bradley's multi-system presentation, the following differential diagnoses are
considered "do not miss" conditions due to their potential for rapid deterioration.
1. Hyperthyroidism / Thyrotoxic Crisis (Thyroid Storm): (Leading Diagnosis)
o Rationale: The patient's symptoms are a classic and severe presentation of
hyperthyroidism. The combination of high fever, extreme tachycardia (150 bpm),
anxiety, tremors, heat intolerance, weight loss, hyperactive bowel sounds, and
emotional lability is highly indicative of thyrotoxicosis. The physical findings of
an enlarged thyroid with a thrill and bruit are pathognomonic for Graves' disease,
the most common cause of hyperthyroidism. Her presentation is so severe that it
points towards a thyrotoxic crisis, or "thyroid storm," which is a life-threatening
exacerbation of hyperthyroidism often precipitated by a stressor (like her recent
breakup).
2. Pneumonia:
o Rationale: This is considered because of the patient's fever, tachycardia, and
tachypnea. The productive cough also supports this diagnosis. It is a common
cause of infection that can present with systemic symptoms.
o Diagnostic Tests: Chest X-ray (PA and Lateral), Complete Blood Count (CBC),
Sputum Culture and Sensitivity (SCS), Sputum Gram Stain.
3. Sepsis (Septicemia):
o Rationale: Sepsis must be considered in any patient presenting with fever,
tachycardia, and tachypnea. The patient's generalized sickness and altered mental
Human Case Study Analysis: Erin Bradley
Patient: Erin Bradley, 21-year-old female
Chief Complaint: "I have nausea and vomiting, I can't keep anything down. I feel hot and
sweaty and very shaky."
History of Present Illness (HPI)
Erin Bradley is a 21-year-old female college student who presents to the Emergency Department
with a 24-hour history of nausea and vomiting. Her symptoms are accompanied by a feeling of
shakiness, palpitations ("heart fluttering"), and subjective heat intolerance ("feeling hot"). She
reports generalized sickness, profound fatigue, and exercise intolerance.
Further questioning reveals a constellation of symptoms that have been present or worsening
over the past several months. These include a 10-pound unintentional weight
loss, hyperreflexia, increased frequency of bowel movements with hyperactive bowel
sounds, and significant emotional lability, anxiety, and insomnia. She attributes some of her
emotional distress to a recent breakup with her boyfriend. She also
notes oligomenorrhea (infrequent menstrual periods) for the past 6 months and has missed her
last period entirely.
Physical Examination Findings
• General: Anxious, tremulous female in mild distress.
• Vitals:
o Temperature: 101°F (Fever)
o Heart Rate: 150 bpm (Tachycardia)
o Respiratory Rate: 22 breaths/min (Tachypnea)
o Blood Pressure: Systolic elevated with evidence of orthostatic hypotension.
• Cardiovascular: Tachycardic rate. A systolic ejection murmur is audible.
• Neck: Enlarged thyroid gland with a palpable thrill and an audible bruit.
, [Type here]
• Neurological: Hyperreflexia and fine tremors of the hands.
• Abdomen: Hyperactive bowel sounds.
• Skin/Nails: Warm, sweaty skin. Onycholysis (separation of the nail from the nail bed) is
noted on a couple of nails.
Differential Diagnoses & Rationale
Based on Ms. Bradley's multi-system presentation, the following differential diagnoses are
considered "do not miss" conditions due to their potential for rapid deterioration.
1. Hyperthyroidism / Thyrotoxic Crisis (Thyroid Storm): (Leading Diagnosis)
o Rationale: The patient's symptoms are a classic and severe presentation of
hyperthyroidism. The combination of high fever, extreme tachycardia (150 bpm),
anxiety, tremors, heat intolerance, weight loss, hyperactive bowel sounds, and
emotional lability is highly indicative of thyrotoxicosis. The physical findings of
an enlarged thyroid with a thrill and bruit are pathognomonic for Graves' disease,
the most common cause of hyperthyroidism. Her presentation is so severe that it
points towards a thyrotoxic crisis, or "thyroid storm," which is a life-threatening
exacerbation of hyperthyroidism often precipitated by a stressor (like her recent
breakup).
2. Pneumonia:
o Rationale: This is considered because of the patient's fever, tachycardia, and
tachypnea. The productive cough also supports this diagnosis. It is a common
cause of infection that can present with systemic symptoms.
o Diagnostic Tests: Chest X-ray (PA and Lateral), Complete Blood Count (CBC),
Sputum Culture and Sensitivity (SCS), Sputum Gram Stain.
3. Sepsis (Septicemia):
o Rationale: Sepsis must be considered in any patient presenting with fever,
tachycardia, and tachypnea. The patient's generalized sickness and altered mental
