Clinical Examination

You are working in a community outpatient clinic where you perform the admission 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 she has difficulty walking to classes and trouble concentrating when studying. Her face looks puffy, 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. Initial vital signs were 142/84, 52, 12, 96.8˚F.
-What are the abnormals and their clinical significance?
-Prioritize the top 3 abnormals.
-List the 5 most important interventions for the top priority (from question #2) and provide the rationale for each intervention.
-What are 3 potential complications that could happen with this client?
-List eight general questions you might ask R.M. to get a “ball park” idea of what is going on with her.
-You know potential causes for some of R.M.’s symptoms include depression, hypothyroidism, anemia, cardiac disease, fluid and electrolyte imbalance, and allergies. What are some screening or diagnostic tests you anticipate may be completed on this patient?  
R.M.’s thyroid-stimulating hormone (TSH) comes back 20.9 IU/L and the nurse practitioner diagnoses her with hypothyroidism and places her on thyroid replacement therapy. She prescribes levothyroxine (Synthroid) 1.7 mcg/kg body weight daily. 

-At this time, R.M. weighs 130 lbs. What should her daily dose of Synthroid be?
-(Opinion Question) What teaching issues would you address with R.M.?

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