A 32-year-old female client with a history of hyperthyroidis…
A 32-year-old female client with a history of hyperthyroidism is brought to the emergency department by their spouse Nurses’ Notes 0900: Accompanied by spouse, client reports being short of breath and having palpitations. Placed in ER treatment room directly from triage. Alert and oriented x 4 appears restless, anxious, and fatigued. Has flushed skin that is hot to touch. Bilateral eye protrusion noted, and states eyes feel “very dry.” Lung sounds clear to auscultation, no reported cough but has intermittent and worsening dyspnea. Normal S1 and S2 and 2-3+ bilateral pulse strength palpated. Hyperactive bowel sounds auscultated on all 4 quadrants. The client does not report any pain and also states that they have felt excessive hunger and thirst over the past week that is unrelieved by oral intake. Also reports unexpectedly lost approximately 4.0 kg (approximately 8 lbs.) of body weight over the past week. Vital Signs Time 0900 Temp 103.2 F ( 39.6 C) P 137 RR 28 B/P 152/98 Pulse oximeter 97% on RA Pain 0 Laboratory Report Lab Results Reference Range White Blood Cells (WBC) 13 x 103 cells/mm3 4.5 – 10.5 x 103 cells/mm3 Potassium (serum) 5.0 mEq/L 3.5 to 5 mEq/L Sodium (serum) 142 mEq/L 135 to 145 mEq/L Thyroid stimulating hormone (TSH) 0.27 mU/L 0.45 to 4.5 mU/L Serum triiodothyronine (T3) 400 ng/dL 80 to 200 ng/dL Serum thyroxine (T4) The nurse recognizes the patient is experiencing : 270 nmol/L 57 to 148 nmol/L.