Case Study
Graves' Disease
Patient Profile Ruth Delaware, a 47-year-old woman, was admied to the hospital with a high fever. After an endocrine workup, she received a diagnosis of Graves' disease.
Subjective Data
• Reports recent job loss because of inability to cope with job stress
• Reports symptoms including fatigue, unintentional weight loss, insomnia, palpitations, and heat intolerance
Objective Data
Physical Examination
• Fever of 40°C
• BP of 150/78, pulse of 118, and respiratory rate of 24
• Hot, moist skin
• Fine tremors of the hands
• Grade 4+ deep tendon reflexes and muscle strength of grades 1 to 2
Collaborative Care
• Subtotal thyroidectomy planned for 2 months later
• Started on propylthiouracil and propranolol (Inderal)
Discussion Questions
1. What is the cause of Ms. Delaware's symptoms?
2. What diagnostic studies were probably ordered? What results have established the diagnosis of Graves' disease?
3. Why was surgery delayed?
4. What was the purpose of drug therapy for Ms. Delaware?
5. Priority decision: What are Ms. Delaware's priority learning needs? What teaching strategies would the nurse use if Ms. Delaware could not read?
6. What are the nursing interventions for successful long-term management of Ms. Delaware after the subtotal thyroidectomy?
7. Priority decision: On the basis of the assessment data presented, what are the priority nursing diagnoses pertinent to Ms. Delaware while she is hospitalized? Are there any collaborative problems?
8. Evidence-informed practice: Why is Ms. Delaware counselled to give up her longstanding cigaree smoking habit?