Scenario Patient Questions

Running head: SCENARIO PATIENT QUESTIONS

Name

Institution

Running head: SCENARIO PATIENT QUESTIONS

Scenario Patient Questions

 Interpret data – subjective versus objective in terms of contributory versus

noncontributory findings, 5 points• Interpret data – subjective versus objective in

terms of contributory versus noncontributory findings, 5 points

Subjective information is given by the patient when they visit the physician. The patient

complains of fatigue which is not related activity, muscle weakness and difficulties in

concentrating for two months without improvement. The patient also confirms of weight gain

which she attributes to eating due to stress. The patient also does complain of body aches but

does not complain about any specific part of the body. On examination, states she feels that her

legs ache most of the time and change in bowel movement from a daily habit to 3 to for days

dely. She attributes bloating to gluten sensitivity (Cappola, et al, 2015)

Objective information is measurable and observable. The patient’s skin, lymph nodes and

musculoskeletal systems are dry to touch. Her nerves are awake but drowsy and her heart rate is

slower than normal.

 Create a chart to identify normal and abnormal findings, 5 points

Normal findings

Abnormal findings

No rashes or lesions noted, No

enlargement of lymph nodes.

Intact reflexes.

Sinus bradycardia noted, BP142/88, Pulse 50,

‘Drowsy’ nerves. Skin, musculoskeletal system

and lymph nodes are dry to touch.

Running head: SCENARIO PATIENT QUESTIONS

Chest, lungs and heart lungs clear to

auscultation, no use of accessory muscles,

no cough noted, no JVD noted.

No edema or erythema.

Bilateral pulses identified on the legs.

Hypoactive bowel sounds.

Abnormal hair growth.

 Provide a series of additional questions to be asked in order to provide additional

information for a comprehensive assessment, 5 points

How often do you constipate?

Are you very sensitive to cold?

Have you noticed a puffy face within the two months?

Does your skin dry abnormally?

Have you noticed muscle tenderness and stiffness within the two months you noticed fatigue and

muscle weakness?

Have you noticed any thinning of hair and falling off from your head?

Do your joints swell or become stiff and painful?

Running head: SCENARIO PATIENT QUESTIONS

Have you noted any change in your voice lately?

Provide a bulleted list for what other lab/diagnostic tests can be clinically indicated in this patient

scenario. 5 points

 Sigmoidoscopy- To monitor bowel movement

 TSH Test- To check Thyroid hormone levels

 Anti-thyroid Antibodies Tests- to check Thyroid hormone levels

 Urinalysis- To check Blood sugar levels

 Cholesterol test- to check Cholestrol levels

 Electrocardiogram- to monitor Cardiovascular activities

Provide a list of all differential diagnoses for this patient scenario. 5 points Central

Hypothyroidism

 Depression

 Alzheimer dementia

 Anemia

• Provide a detailed explanation of how each identified differential diagnosis applies to the

patient scenario situation 10 points 15

Running head: SCENARIO PATIENT QUESTIONS

Central Hypothyroidism

The symptoms for secondary hypothyroidism are similar to those of primary hypothyroidism for

instance fatigue, weight gain and increased sensitivity to cold, with or without the rest of

symptoms of hypopituitarism like hypogonadism and secondary adrenal insufficiency. On

physically assessing the patient, Hypothyroidism is indicated. The signs include dry skin, loss

and thinning of hair and sinus bradycardia. Sellar and parasellar masses might be seen. These

masses can be papilledema and bitemporal hemianopsia. The differentiation test is diagnostically

evaluating central hypothyroidism using TSH and T4. The free T4 and TSH might be low, a bit

dropped or normal. The physician can use an MRI to know the sellar or parasellar pathology

(Marvin& Parham, 2015).

Depression

Hypothyroidism exhibits nonspecific symptoms which can be caused by depression. Both

disorders often occur in primary care practice. The symptoms for Hypothyroidism are easily

relieved by a therapy that involves replacing the thyroid hormone. On the other hand, depression

is relieved by use of antidepressants and counseling.

There is no differentiating test is the TSH where hypothyroidism is diagnosed by increased TSH.

Depression on the other hand indicates normal TSH (Marvin& Parham, 2015).

Alzheimer dementia

Hypothyroidism and dementia are not easily distinguished in older patients. Thyroid replacement

therapy can be used to treat hypothyroidism and cognitive dysfunction. For differential test,

Running head: SCENARIO PATIENT QUESTIONS

dementia indicates normal TSH. A CT scan for a patient with dementia shows signs of atrophy

(Stott, et al, 2017).

Anemia

Both hypothyroidism and anemia exhibit similar symptoms like fatigue and dyspenia when

exerted. Hypothyroidism, during its primary stages, is associated with anemia. The

differentiating test for both disorders is TSH. In primary hypothyroidism TSH levels are

increased while in anemia the levels are not elevated. Anemia is normocytic with variable red

blood cells indices (Stott, et al, 2017).

4. (i). Select one of the provided diagnoses from the list of differential diagnoses that applies to

the patient and provide a therapeutic management plan.

Mononucleosis is a disease caused by Epstein-Barr virus. Its symptoms mainly involve fever,

sore throat, weak and sore muscles, fatigue and swollen glands. This virus is mainly found in the

saliva and it is spread through kissing with an infected person. It can also be transmitted through

sharing of toothbrushes, blood transfusion, and organ transplant and also through sex. For

diagnosis, a blood test is required (Brynda, 2014).

(ii). The therapeutic management plan should include but is not limited to: medications,

nutrition/diet, physical activity and ongoing medical/diagnostic therapies.

Priority Health

Pharmacy Name

Address

City, st

Running head: SCENARIO PATIENT QUESTIONS

Action plan for prescribed medication(insert your name, DOB: mmddyyyy)

This action plan will aid in letting you get the best results from your medication if you follow the

following rules,

 Read ‘What we talked about’

 Take the steps listed in the ‘activity’ box

 Fill in ‘My diet’

 Fill in ‘My follow-up plan’ and ‘Questions I want to ask’

 Fill in ‘ongoing medical therapy’

What we talked about(insert things to avoid)

Activities(Insert recommendations)

What I need to do:

What I did and when I did it:

My diet(include the suggested nutrients)

What I eat:

What to avoid:

My follow up plan( my next steps)

Questions I want to ask( include topics about medications and therapies)

Ongoing Medical Therapy( Include requirements for the therapy)

Running head: SCENARIO PATIENT QUESTIONS

5. Address health promotion areas focusing on primary, secondary and tertiary levels of

prevention as it applies to your patient based scenario.

Primary prevention of a disease deals with minimizing the incidence of a disease. These are

basically the interventions used to prevent the onset of a disease. It first involves modification

and identification of the risk factors, such as environmental disorders and genetic

predispositions. The most affected gender is the female sex. Some of the environmental

exposures that lead to hypothyroidism are iodine deficiency, smoking cigarettes, thyroidal

irradiation and excess of iodine in the body. Deficiency of dietary iodine is the most common

factor among the mentioned factors. Food rich in iodine nutrients should be taken in large

amounts. At the same time, taking of chronic pharmacologic amounts of iodine should be

prevented. One should also attempt smoke cessation to help prevent hypothyroidism as indicated

by Wilkes, (2017).

Amouzegar, (2018) stated that in secondary prevention of hypothyroidism, early detection

should be fulfilled through routine testing or testing by clinical suspicion. This is because

hypothyroidism is highly patent and it comes with consequences that are significant clinically.

The consequences can, however, be avoided by therapy and performing an early diagnosis of the

disease. Patients are advised to do a screening test as it is more accurate than clinical diagnosis

and diagnostic test. If pituitary disorders have caused central hypothyroidism, a measurement

called serum free thyroxine is needed.

Tertiary prevention of hypothyroidism is a way of avoiding major complications that can occur

in a patient. Complications that are potential and its treatment can be prevented by use of

sustained thyroxine therapy and constant monitoring in the laboratories and clinics. If a patient

Running head: SCENARIO PATIENT QUESTIONS

has been treated for hypothyroidism, tertiary prevention can be done by avoiding complications

that come with thyroid hormone therapy (Amouzegar, 2018).

Conclusion

Based on the symptoms the patient exhibited, it is clear that she has hypothyroidism. Firstly the

patient complained of poor memory, weight gain which she attributed to eating due to stress. She

also experienced bloating and flatulence which she attributed to gluten intolerance even after she

indicated that she follows a gluten free diet. The patient also had proactive bowel sounds upon

examination. The symptoms had persisted for two months with no signs of improvement. The

patient’s skin, musculoskeletal system and lymph nodes were dry and she complained of general

body pain. Upon examination, she complained of painful legs and abnormal hair growth. Her

vital signs were abnormal too. With her age and gender, the patient is prone to having

hypothyroidism. She exhibited many symptoms of the disease and the tests confirmed.

The treatment for hypothyroidism is simply by taking levotyroxine. This is a pill with thyroid

which should be taken once a day, most preferably in the morning (Mammen, et al, 2015).

Running head: SCENARIO PATIENT QUESTIONS

References

Cappola, A. R., Arnold, A. M., Wulczyn, K., Carlson, M., Robbins, J., & Psaty, B. M. (2015).

Thyroid function in the euthyroid range and adverse outcomes in older adults. The Journal of

Clinical Endocrinology & Metabolism, 100(3), 1088-1096.

Mammen, J. S., McGready, J., Oxman, R., Chia, C. W., Ladenson, P. W., & Simonsick, E. M.

(2015). Thyroid hormone therapy and risk of thyrotoxicosis in community-resident older adults:

findings from the Baltimore Longitudinal Study of Aging. Thyroid, 25(9), 979-986.

Marvin, K., & Parham, K. (2015). Differentiated thyroid cancer in people aged 85 and older. J

Am Geriatr Soc, 63(5), 932-7.

Stott, D. J., Rodondi, N., Kearney, P. M., Ford, I., Westendorp, R. G., Mooijaart, S. P., ... &

Baumgartner, C. (2017). Thyroid hormone therapy for older adults with subclinical

hypothyroidism. New England Journal of Medicine, 376(26), 2534-2544.

Riedel, T., Rodriguez-Emmenegger, C., de los Santos Pereira, A., Bědajánková, A., Jinoch, P.,

Boltovets, P. M., &Brynda, E. (2014). Diagnosis of Epstein–Barr virus infection in clinical

serum samples by an SPR biosensor assay. Biosensors and Bioelectronics, 55, 278-284.

Azizi, F., Mehran, L., Hosseinpanah, F., Delshad, H., &Amouzegar, A. (2018). Secondary and

tertiary preventions of thyroid disease. Endocrine research, 1-17.

Running head: SCENARIO PATIENT QUESTIONS

Dew, R., Okosieme, O., Dayan, C., Eligar, V., Khan, I., Razvi, S., ... & Wilkes, S. (2017).

Clinical, behavioural and pharmacogenomic factors influencing the response to levothyroxine

therapy in patients with primary hypothyroidism—protocol for a systematic review. Systematic

reviews, 6(1), 60.

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