Critical Pathway Hyperthyroidism. - 840 Words

Critical Pathway: Hyperthyroidism Introduction Mrs. J.P. is a 30-year-old African-American female who presents to the local health department for her annual women’s health exam and establishment of primary care. Mrs. J.P. requests that pregnancy testing be performed due to her recent absence of menses. Mrs. J.P. states she and her spouse have been attempting pregnancy for some time; however, with each missed cycle, pregnancy tests have been negative despite corresponding notable fatigue. Mrs. J.P. explains her current uninsured status and frustration with walk-in clinics stating recent use of multiple clinics for â€Å"simple things† without resolution. Mrs. J.P. lists her primary complaint as difficulty sleeping due to significant heart†¦show more content†¦Mrs. J.P. appears very irritable as initial assessments are completed requesting the clinic door be propped open and that the visit is expedited as her heat intolerance and inability to remain stationary for long periods are difficult to overcome. A ctive diaphoresis is noted as she fumbles through papers scattered throughout her belongings. As vitals and were needed, Mrs. J was advised to report to intake for objective assessments. After great difficulty, rising from the clinic chair, Mrs. J.P. reports to the lab with the following vital signs: Height: 5 feet 8 inches Weight: 165 pounds Body Mass Index (BMI): 25.08 Blood pressure (BP): Heart Rate (HR): 120 Respirations: 17 Temperature: 98.9 Physical assessment reveals intermittent heart palpitations with strong carotid and radial pulses, brisk deep tendon reflexes, 1+ non-pitting edema of bilateral ankles, hair thinning, onycholysis, orbital lid lag and an enlarged neck with positive audible bruit. Mrs. J.P. denies pain upon palpation of neck as slight thyroid enlargement is noted. Orders to perform complete blood count (CBC), complete metabolic panel (CMP), thyroid stimulating hormone (TSH), thyroxine index, free (T4), triiodothyroine (T3), and pregnancy test result in abnormal values including: Hemoglobin (Hgb): 11.0 g/dl TSH: 0.5 mU/L Free, T4: 5.0 ng/dl T3: