Case Study 3Case Study 3Group 6Group 6

Michelle French, Lauren Kasparian, Kimberly Michelle French, Lauren Kasparian, Kimberly McGinness, Emily ParsonsMcGinness, Emily Parsons

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BackgroundBackground

Olivia Johnson is a 40 year old, Olivia Johnson is a 40 year old, single mother of two children. She single mother of two children. She works as a high school counselor works as a high school counselor and is a member of the city council.and is a member of the city council.

She sees her family physician She sees her family physician annually and presented no signs or annually and presented no signs or symptoms of illness until eight symptoms of illness until eight months ago.months ago.

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SymptomsSymptoms

Ms. Johnson has noticed a general feeling of Ms. Johnson has noticed a general feeling of nervousness, irritability, and pounding heartbeat. nervousness, irritability, and pounding heartbeat. She has noticed that she is less tolerant of the She has noticed that she is less tolerant of the summer heat, and is eating more than usual but summer heat, and is eating more than usual but losing weight.losing weight.

Upon examination, she complains of slight shortness Upon examination, she complains of slight shortness of breath with exertion, blood pressure of 180/92, of breath with exertion, blood pressure of 180/92, warm flushed skin, thin, friable nails, elevated warm flushed skin, thin, friable nails, elevated thyroid levels, an elevated BMR, and a height of thyroid levels, an elevated BMR, and a height of 5’4’’ and weight of 105 lbs. Giving her a BMI of 18. 5’4’’ and weight of 105 lbs. Giving her a BMI of 18.

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Medical DiagnosisMedical DiagnosisThe client was diagnosed with

hyperthyroidism (Grave’s Disease). Hyperthyroidism is caused by

autoimmune antibodies binding to the thyroid stimulating the production of thyroid stimulating hormone( TSH).

This stimulation causes uncontrolled and excessive production of TSH, increasing the creation and secretion of the thyroid hormones T4 and T3. Thus causing hypermetabolism.

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Gordon’s Functional Health PatternsGordon’s Functional Health Patterns

– Health Perception/Health Management: Risk for Health Perception/Health Management: Risk for Injury of the Eye related to exopthalmosInjury of the Eye related to exopthalmos

– Activity-Exercise: Activity Intolerance related to Activity-Exercise: Activity Intolerance related to exertional dyspneaexertional dyspnea

– Cognitive-Perceptional: Readiness for Cognitive-Perceptional: Readiness for enhanced Knowledgeenhanced Knowledge

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Gordon’s Functional Health PatternsGordon’s Functional Health Patterns

-Self-Perception/Self Concept: Anxiety related to -Self-Perception/Self Concept: Anxiety related to change in health statuschange in health status

-Role-Relationship: Interrupted Family Processes -Role-Relationship: Interrupted Family Processes related to a shift in the health status of a family related to a shift in the health status of a family membermember

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Holistic CareHolistic Care

EliminationElimination

1. What is your normal bowel 1. What is your normal bowel movement and voiding movement and voiding pattern?pattern?

2. Do you take laxatives or 2. Do you take laxatives or diuretics?diuretics?

3. Is there any pain on 3. Is there any pain on urination or defecation?urination or defecation?

Filling in the gaps; finding the missing FHP’sFilling in the gaps; finding the missing FHP’s

Sleep-RestSleep-Rest

1.1.How much sleep do you How much sleep do you normally get a day?normally get a day?2.2. Do you feel like you have Do you feel like you have adequate energy for daily adequate energy for daily tasks?tasks?3.3.Do you use any sleep aids Do you use any sleep aids including herbals?including herbals?

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Value/BeliefValue/Belief1. How do you perceive your spirituality?1. How do you perceive your spirituality?2. What do you value in life?2. What do you value in life?3. Would you consider your beliefs to be a 3. Would you consider your beliefs to be a positive force in your life?positive force in your life?

Coping/Stress ToleranceCoping/Stress Tolerance1. What do you feel are stressors 1. What do you feel are stressors in your life?in your life?2. How do you normally deal with 2. How do you normally deal with stress?stress?3. How would you describe your 3. How would you describe your support system?support system?

Sexuality-ReproductiveSexuality-Reproductive

1. What is your perception of 1. What is your perception of your sexual health?your sexual health?

2. Do you practice safe sex?2. Do you practice safe sex?

3. Are you satisfied with your 3. Are you satisfied with your sex life?sex life?

Holistic CareHolistic Care

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Nursing DiagnosisNursing Diagnosis

Nutritional-Metabolic: Nutritional-Metabolic:

Imbalanced Nutrition; Less than the Body Imbalanced Nutrition; Less than the Body Needs related to hypermetabolismNeeds related to hypermetabolism

S/S- S/S- Nervousness , less tolerance for summer heat, Irritability, Nervousness , less tolerance for summer heat, Irritability,

loss of weight with adequate food intake, restlessness, skin loss of weight with adequate food intake, restlessness, skin is warm and flushed, nails are thin and friable, she is 5’4’’ is warm and flushed, nails are thin and friable, she is 5’4’’ and 105 lbs.and 105 lbs.

PlanningPlanning

Progressively gaining weight until it is within Progressively gaining weight until it is within the normal range for her height and age, the normal range for her height and age, (114-154 lbs).(114-154 lbs).

Identify nutritional requirements.Identify nutritional requirements. Consume a nutritionally balanced diet Consume a nutritionally balanced diet

containing sufficient calories to prevent containing sufficient calories to prevent further weight lose.further weight lose.

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InterventionsInterventions

See a dietician to establish a diet based See a dietician to establish a diet based upon needs related to clients upon needs related to clients hypermetabolism.hypermetabolism.

Client should monitor signs of malnutritionClient should monitor signs of malnutrition

Recent excessive weight loss > 10lbs. Recent excessive weight loss > 10lbs.

BMI less than 20BMI less than 20

Daily weighingDaily weighing

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Outcomes and EvaluationOutcomes and Evaluation

Evaluating if weight and lab values have Evaluating if weight and lab values have increased or decreased.increased or decreased.

Continuing to evaluate with a holistic Continuing to evaluate with a holistic approach will look at the client’s over all approach will look at the client’s over all being to ensure a positive progression. being to ensure a positive progression.

It is important to evaluate the plan of care as a whole because the client’s total health is priority, rather than success or failure of individual interventions.

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Diagnosis

Impaired Nutrition related to hypermetabolism

Critical Steps- diagnostic reasoning using assessment data; data clustering to find patterns; identify defining characteristics that support NANDA nursing diagnoses.

Diagnosis

Impaired Nutrition related to hypermetabolism

Critical Steps- diagnostic reasoning using assessment data; data clustering to find patterns; identify defining characteristics that support NANDA nursing diagnoses.

Assessment

Data- nervousness, irritability, restless, less tolerance for summer heat, eating more but losing weight, skin is warm and flushed, nails are thin and friable, 5’4” and 105lbs, BMI of 18

Organize Data-gather objective data through initial and ongoing assessments and subjective data from therapeutic interaction

Assessment

Data- nervousness, irritability, restless, less tolerance for summer heat, eating more but losing weight, skin is warm and flushed, nails are thin and friable, 5’4” and 105lbs, BMI of 18

Organize Data-gather objective data through initial and ongoing assessments and subjective data from therapeutic interaction

Implementation

-Refer to a dietician to establish a diet based upon needs related to clients hyper metabolism.

-Client should monitor signs of malnutrition

*Recent excessive weight loss >10lb

*BMI less than 20

-Daily weighing

Skills that framed the case: each implementation we used critical thinking to evaluate the possible consequences of each intervention & decide if consequences out way benefits

Implementation

-Refer to a dietician to establish a diet based upon needs related to clients hyper metabolism.

-Client should monitor signs of malnutrition

*Recent excessive weight loss >10lb

*BMI less than 20

-Daily weighing

Skills that framed the case: each implementation we used critical thinking to evaluate the possible consequences of each intervention & decide if consequences out way benefits

Planning

-Progressively Gain weight until within normal range (114-154 lbs) - Identify nutritional requirements - Consume a nutritionally balanced diet to prevent further weight loss -Be free of signs of malnutrition -Recognize factors contributing to underweight -Consume adequate nourishment -Meet with a dietician to establish a nutritional plan and establish a time frame.

Planning

-Progressively Gain weight until within normal range (114-154 lbs) - Identify nutritional requirements - Consume a nutritionally balanced diet to prevent further weight loss -Be free of signs of malnutrition -Recognize factors contributing to underweight -Consume adequate nourishment -Meet with a dietician to establish a nutritional plan and establish a time frame.

Evaluation

-Evaluate if weight and lab values have increased or decreased

-Ongoing evaluation with a holistic approach and look at the client’s over all well being to ensure a positive progression

-Critically evaluate and revise therapy until you and client resolve problems as defined by nursing diagnosis

Evaluation

-Evaluate if weight and lab values have increased or decreased

-Ongoing evaluation with a holistic approach and look at the client’s over all well being to ensure a positive progression

-Critically evaluate and revise therapy until you and client resolve problems as defined by nursing diagnosis

40y/o mother of tPatient: Olivia Johnson

40y/o mother of twoDiagnosed with hyperthyroidism

ReflectionReflection

As a group we initially tried to divide up the As a group we initially tried to divide up the work. Realizing the topics all overlapped we work. Realizing the topics all overlapped we rerouted the plan and worked collaboratively rerouted the plan and worked collaboratively to formulate a congruent plan of care and to formulate a congruent plan of care and nursing process. nursing process.

If the project was to be redone we would If the project was to be redone we would establish this in the beginning and set times establish this in the beginning and set times focused on selective areas to better time focused on selective areas to better time managementmanagement. .

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References References

Ackley, B. J., & Ladwig, G. B. (2007). Mosby's Guide to Nursing Ackley, B. J., & Ladwig, G. B. (2007). Mosby's Guide to Nursing Diagnosis. St Louis,Missouri: Mosby.Diagnosis. St Louis,Missouri: Mosby.

Bahn, R. (2003). Pathophysiology of Graves? Ophthalmopathy: The Cycle Bahn, R. (2003). Pathophysiology of Graves? Ophthalmopathy: The Cycle of Disease . The Journal of Clinical Endocrinology and Metabolism, 88(5). of Disease . The Journal of Clinical Endocrinology and Metabolism, 88(5). Retrieved April 20, 2009.Retrieved April 20, 2009.

Loeb, S. (1994). Handbook of Medical-Surgical Nursing. Springhouse: Loeb, S. (1994). Handbook of Medical-Surgical Nursing. Springhouse: Springhouse Corporation.Springhouse Corporation.

Perry, A. G., & Potter, P. A. (2008). Fundamentals of Nursing Perry, A. G., & Potter, P. A. (2008). Fundamentals of Nursing (Fundamentals of Nursing (Potter & Perry). St Louis, Missouri: Mosby.(Fundamentals of Nursing (Potter & Perry). St Louis, Missouri: Mosby.

Tracy, S. (Director) (2009, February 5). Functional Health Patterns. , Tracy, S. (Director) (2009, February 5). Functional Health Patterns. , University Of New Hampshire, Durham.University Of New Hampshire, Durham.

Williams, M. (2002). Nutrition For Health, Fitness and Sport, 6th Edition, Williams, M. (2002). Nutrition For Health, Fitness and Sport, 6th Edition, pb, 2002. New pb, 2002. New York: Mcgraw Hill.York: Mcgraw Hill.

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