You are working in a community outpatient clinic where you perform the intake assessment on R. M., a 38-year-old woman who is attending graduate school and is very sedentary. Her chief complaint is overwhelming fatigue that is not relieved by rest. She is so exhausted that she has difficulty walking to classes and trouble concentrating when studying. She reports a recent weight gain of 15 pounds over 2 months without clear changes in her dietary habits. Her face looks puffy, she has experienced excessive hair loss, and her skin is dry and pale. She complains of generalized body aches and pains with frequent muscle cramps and constipation. You notice she is dressed inappropriately warm for the weather. Vital Signs
Blood pressure 142/84 mm Hg
Heart rate 52 beats/min
Respiratory rate 12 breaths/min
Temperature 96.8 ° F (36 ° C)
Laboratory Test Results
TSH 20.9 mU/L (2-10 mU/L)
TRH 18.8 ng/dL (2-10 ng/dL)
T 3 24 mU/L (70-205 ng/dL)
Free T 4 0.2 ng/dL (0.8-2.4 ng/dL)
1. What are the top priority assessments (specific to this patient)? Include at least 3 with rationale.
2. Interpret R. M.'s laboratory results.
3. The family practitioner prescribes levothyroxine (Synthroid) 1.7 mcg/kg body weight/day. Patient weighs 130 pounds. What is the daily dose in milligrams?
4. What teaching will you review regarding medication? List 5 key teaching points with details.
5. Why are we concerned with Myxedema coma? What teaching will you provide for prevention of myxedema coma?