Reply to Amanda  Do you take any medications? Some medicati

Reply to Amanda  Do you take any medications? Some medications (Lithium) are notorious for causing hypothyroid. Have you ever been diagnosed with a thyroid disorder? Surgeries to the thyroid may result in hypothyroid. Are you allergic to anything? Relevant to treatment regimen. Have you experienced any significant life changes? Additional stress etc? Depression may manifest similar symptoms. PE: Hypothyroidism is six times more common in women than men, and is most common in older women (Carson, 2009). A thorough physical assessment should be completed. Clinical signs and symptoms may include paleness, brittle appearing hair and skin, elevated blood pressure, and bradycardia (Carson, 2009). The patient may have a “puffy” appearance to her face, irregular periods, and report sustained fatigue (Roberts et al, 2009). Differential Diagnoses Anemia, Depression Diagnostics            TSH – Will be elevated in Hypothyroid            Free T4 – Result will be low in Hypothyroid            Cholesterol – Often elevated with Hypothyroid            CBC – To rule out anemia            CMP – To monitor other electrolytes            EKG – to assess for any blocks, prolonged QRS, or electrolyte abnormalities Treatment            Patients with symptomatic hypothyroidism should be treated to prevent long-term complications (Roberts et al, 2004) Depending on the results of her TSH & T4 I would initiate a daily regimen of Levothyroxine. 4-6 weeks after the initiation of Levothyroxine I would recheck the patients TSH. After the TSH has reached a therapeutic level – I would recheck it again in 6 months. References Carson, M. (2009). Assessment and management of patients with hypothyroidism. Nursing Standard (through 2013), 23(18), 48-56; quiz 58. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/219883523?accountid=167104 (Links to an external site.)Links to an external site. Roberts, C. G. P., & Ladenson, P. W. (2004). Hypothyroidism. The Lancet, 363(9411), 793-803. doi:http://dx.doi.org/10.1016/S0140-6736(04)15696-1 reply to Quiana What additional questions should you ask the patient and why? Some questions include: How much weight has been gained? What kinds of meals/foods do you typically take? Do you exercise? Quantifying the amount of weight provides perspective. A gain of 5 lbs does not carry the urgency that a 20 lb weight gain does. Asking about her lifestyle habits can offer some insight into factors that can aggravate what sounds like hypothyroidism. This creates teachable opportunities for improving lifestyle habits. Are you still menstruating and if so, how regularly? This can rule out pregnancy or hormone changes that precipitate menopause. Also, with hypothyroidism, this condition can disrupt a normal menstrual cycle. For a woman in menopause, hypothyroid symptoms can be masked or ignored when it is assumed that it is a lack of ooestrogen that is causing her concerns (Baisier, Hertoghe, & Eeckhaut, 2000). Bowel habits, specifically any problem with constipation? (Chaker, Bianco, Jonklaas, & Peeters, 2017) Any hx of depression? Her reported complaints are common findings for hypothyroid but they can also be related to depression. Though the rate of depression in hypothyroid patients is >60% (Bathla & Singh, 2016), the patient should be screened for depression. Her symptoms could be psychosomatic. What should be included in the physical examination at this visit? Included items to address are skin for dryness, hair for thinning or irregular growth pattern, eyes for exopthalmus, neck/throat and thyroid for possible goiter, cardiac sounds for bradyarrhythmias, and also for peripheral manifestations like delayed relaxation of deep tendon reflexes (Chaker, et al., 2017). What are the possible differential diagnoses at this time? Hypothyroidism Depression Anemia What tests should you order and why? TSH and free T3 and T4 EKG CMP CBC Lipid Panel A depression screen can be done in office Hypothyroidism can increase lipids and alter cardiac function (Chaker, et al., 2017). EKG may reveal cardiac abnormalities. CBC can reveal anemia. The metabolic panel can reveal diabetes or problems with hepatic or renal function. Hypothyroidism continues to be researched as far as the specific link to renal and hepatic dysfunction (Chaker, et al., 2017). The depression screen serves, like the other lab orders, to exclude causes of her symptoms. The most obvious test is a thyroid panel. To assess the circulating amount of hormone in the body is to judge her thyroid function. How should this patient be managed? Pending the diagnosis, the patient should be encouraged to complete all lab work in a timely fashion. Since these labs can be resulted within 24hrs, if not same day, that would be my biggest priority for completion. For hypothyroidism, pending the thyroid results, the patient should start on hormone replacement with a drug like levothyroxine. Often, levothyroxine 50-100mcg is a starting dose (Dunphy, Winland-Brown, Porter, & Thomas, 2015), it should be taken daily, on an empty stomach, in the morning. She should return in about 1 mo to reassess symptoms and lab value. If the patient is difficult to manage, due to comorbid conditions or lack of therapeutic response, endocrine may be consulted. References Baisier, W. V., Hertoghe, J., & Eeckhaut, W. (2000). Thyroid insufficiency. is TSH measurement the only diagnostic tool? Journal of Nutritional & Environmental Medicine, 10(2), 105-113. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/215623935?accountid=167104 Bathla, M., & Singh, M. (2016). Reply to “how prevalent are depression and anxiety symptoms in hypothyroidism?”. Indian Journal of Endocrinology and Metabolism, 20(6) doi:http://dx.doi.org/10.4103/2230-8210.192913 Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. The Lancet, 390(10101), 1550-1562. doi:http://dx.doi.org/10.1016/S0140-6736(17)30703-1 Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing, (4th ed.). [VitalSource Bookshelf version].  Retrieved from https://bookshelf.vitalsource.com/books/9780803655621

Don't use plagiarized sources. Get Your Custom Essay on
Reply to Amanda  Do you take any medications? Some medicati
From $8/Page
Order Essay
Full satisfaction or return your money back

Our experts will write you a top-quality paper and revise it an unlimited number of times until you're 100% satisfied - or offer a refund.

Check Prices
Get the best discount and better grades here
Pages (550 words)
$0.00
*Price with a welcome 15% discount applied.
Pro tip: If you want to save more money and pay the lowest price, you need to set a more extended deadline.
We know that being a student these days is hard. Because of this, our prices are some of the lowest on the market.

Instead, we offer perks, discounts, and free services to enhance your experience.
Sign up, place your order, and leave the rest to our professional paper writers in less than 2 minutes.
step 1
Upload assignment instructions
Fill out the order form and provide paper details. You can even attach screenshots or add additional instructions later. If something is not clear or missing, the writer will contact you for clarification.
How to get the most out of your experience with Toptutor4me
One writer throughout the entire course
If you like the writer, you can hire them again. Just copy & paste their ID on the order form ("Preferred Writer's ID" field). This way, your vocabulary will be uniform, and the writer will be aware of your needs.
The same paper from different writers
You can order essay or any other work from two different writers to choose the best one or give another version to a friend. This can be done through the add-on "Same paper from another writer."
Copy of sources used by the writer
Our college essay writers work with ScienceDirect and other databases. They can send you articles or materials used in PDF or through screenshots. Just tick the "Copy of sources" field on the order form.
Here is what our happy clients say about us.
Receiving customer feedback and reviews from legit students who have utilized our services is one of our favorite part of the job. We love seeing testimonials from happy students whom we have helped to succeed. Read through the below review page to see what our partners think.
Classic English Literature
Great paper, thank you!
Customer 452591, May 5th, 2022
Sociology
Thank you so much! Appreciate it!
Customer 452483, November 8th, 2021
Mathematics
PERFECT! Thanks a million, you're all awesome!!!!
Customer 452483, July 7th, 2021
Communications
Well done! I thank you very much!
Customer 452483, July 9th, 2021
Healthcare Writing & Communications
Excellent!! You’re awesome, thank you very much for all of your hard work & help!!
Customer 452483, October 24th, 2021
Mathematics
Thank you so much!
Customer 452483, July 26th, 2021
Nursing
Excellent! Thank you.
Customer 452487, October 16th, 2021
Healthcare Writing & Communications
Perfect! Thank you for also remembering to highlight the necessary words. Appreciate all of your help and hard work!
Customer 452483, November 7th, 2021
English 101
Perfect! Thank you so much for all of your hard work and help! Appreciate it!!
Customer 452483, August 30th, 2021
Mathematics
Thank you, great work!
Customer 452483, July 19th, 2021
English 101
I would like to thank you for the writing, it was a very busy week for me and had no time this week to do a writing. I would recommend you to others and would utilize you again.
Customer 452639, October 16th, 2022
Healthcare Writing & Communications
Thank you so much for all of your hard work! Appreciate it all!
Customer 452483, November 14th, 2021
11,595
Total Reviews
98%
Satsfaction rate
6 pages
Average paper length
40%
Customers referred by a friend
Enjoy the best prices and lifetime 15% discount
Use a coupon TOP15 and enjoy expert help with any task at the most affordable price.
Order Now Order in Chat