7.9 Learning Activities

Diabetes Case Study (Case Study answers are located in the Answer Key at the end of the book.)^[1]

Daisy Hernandez is a 65-year-old woman presenting to the emergency department complaining of fatigue, excessive thirst, and frequent urination. She is from a low-income background and primarily speaks Spanish. Her medical history includes hypertension, and she has a family history of diabetes mellitus type 2. Daisy mentions she has not visited a doctor in the last year due to financial constraints and has not had blood work done in the past two years. Her vital signs are stable, with a blood pressure of 130/80 mmHg, a heart rate of 78 beats per minute, and a respiratory rate of 16 breaths per minute.

Assessment Findings:

• General Appearance: Daisy appears tired and has a dry oral mucosa
• Skin: No apparent signs of infection or diabetic ulcers
• Heart and Lungs: Regular heart rate and rhythm, no murmurs or crackles
• Abdomen: Soft, nontender, and nondistended
• Neurological: No signs of focal deficits, sensory disturbances, or motor impairments
• Extremities: No evidence of peripheral neuropathy or vascular compromise
• BMI: 30 kg/m² (Overweight)
• Waist circumference: 40 inches

Lab Results:

• Blood glucose: 238 mg/dL (normal range: 70-110 mg/dL)
• Urine glucose: Positive
• Urine ketones: Negative

Provider Orders: 

Daisy’s provider initiates fluid replacement to address her dehydration and starts insulin therapy to manage hyperglycemia. Daisy has also been prescribed metformin as an oral hypoglycemic agent and lisinopril for blood pressure control.

Questions:

1. What cultural considerations should be taken into account when developing Daisy’s care plan?
2. How would you assess Daisy’s understanding of her diagnosis and treatment plan given her primary language is Spanish?
3. What lifestyle modifications would you suggest to Daisy, considering her socioeconomic background?
4. What community resources could be utilized to support Daisy’s long-term management of diabetes?
5. How might Daisy’s social and financial status impact her ability to access care and medications regularly?
6. How would you involve Daisy’s family in her care plan to support her management of diabetes?

Hyperthyroidism vs. Hypothyroidism Case Studies (Case Study answers are located in the Answer Key at the end of the book.)^[2]

1. When the thyroid stimulating hormone (TSH) is released, what two thyroid hormones are released by the thyroid? What element is needed for the body to use these hormones?
2. The most common cause of hyperthyroidism is ____________ disease.
3. Name two autoimmune diseases that affect thyroid function.
4. Describe signs/symptoms of a thyroid storm (thyrotoxicosis). What causes a thyroid storm?
5. The nurse is getting a new client with an admitting diagnosis of possible (“rule-out”) myxedema coma.

• What equipment should the nurse place in the room and why?
• What are two risk factors for myxedema coma?

6. What are the signs/symptoms of hypothyroidism? What content should be included when teaching a client with hypothyroidism about diet and activity?
7. The nurse is preparing to administer levothyroxine orally.

• What is the onset of action?
• When should levothyroxine be administered and why?

8. (TRUE or FALSE) Levothyroxine should not be taken during pregnancy.

Thyroid Case Study 1

Ms. Hype had a thyroidectomy three months ago for thyroid cancer and has been taking levothyroxine for thyroid hormone replacement. She is having difficulty sleeping at night and is losing weight even though she says she is eating “…all the time.” She is wearing shorts and a t-shirt in January because she feels “so hot all the time.” She is restless and frequently asking how long this appointment will take.

Vital Signs: Temperature 101.2 F, Pulse 112, Respirations 18, BP 162/94

9. What could be contributing to her symptoms?
10. What is the action of PTU (propylthiouracil)? What two side effects should be reported?
11. How does SSKI (potassium iodide) affect the thyroid?

Thyroid Case Study 2

A client with thyroid cancer has a scheduled thyroidectomy. The provider recently administered the capsule containing RAIU (radioactive iodine uptake).

12. Describe health teaching topics following their ingestion of this medication?
13. Describe nursing care following a thyroidectomy and identify two specific rationales for these nursing interventions.