University of Nevada, Las Vegas
NURS 320
Pathophysiology and Pharmacology for Nursing II
Module I: Single-Episode Case Study
Directions:
1. Download this document and save in Word adding your first name initial and last name to
the end of the document title: for example, save as NURS 320 – Module 1 – Single Episode Case
Study – MJones.
2. Answer all of the questions.
3. Following completion, upload to the appropriate place in the Assignments section by the due
date and time.
4. This is NOT a group assignment and you must complete this assignment on your own.
Single-Episode Case Study
Karmelina Naczmach is a 46-year-old who reports to the health care clinic. She is 5 feet tall and
185 pounds. She is the mother of 4 grown children. Two of her children have graduated from
college and both are nurses. Her other two children are in college, one studying to be a nurse and
the other in a liberal arts program. Her husband works as a truck driver. Karmelina is also a nurse
and recently graduated from a nursing program.
Karmelina denies smoking or drinking and denies using any drugs. She reports that she has been
healthy and does not take any prescribed drugs. She is very active and enjoys visiting friends and
family, attending craft fairs, shopping, and concerts. She is of Christian faith and attends church
services on a regular basis. She describes herself as a strong person and the support person for
her family.
Karmelina reports that lately she has been feeling tired and unable to partake in all of her normal
activities that she likes. She reports weakness and muscle aches. She tells the nurse that she feels
cold all of the time and that her skin and hair seem to be so dry and thinning. She verbalizes that
she is upset because she is gaining weight and her face is looking puffy. Karmelina also reports
recent constipation in spite of drinking water and eating high-fiber foods. On assessment the
nurse notes a pulse rate of 52 beats per minute and a blood pressure of 98/46 mmHg.
Recognize cues – Cues are the significant data that you note in a patient and can come from
many sources, for example from the nurse’s assessment findings, the medical record, the patient
etc.
Analyze cues – Analyzing cues means that you are determining the client’s problem(s). When
you analyze cues, you are connecting data to the client’s presentation – Think: is this data
expected? Unexpected? What are the concerns? What is the client’s problem?
1. Identify 9 cues in the case that are significant. Highlight your answers in the following
box. Please read each cues carefully before highlighting them.
Denies smoking or drinking
Has cold intolerance
Denies using any drugs.
Puffy face
Reports constipation
Has dry skin and hair
Does not take any prescribed
drugs
Feels tired
Drinks water
Has a pulse rate of 52 beats
per minute and
Is very active
Is gaining weight
Has weakness and muscle
aches
Eats high-fiber foods
Has a blood pressure of 98/46
mmHg.
2. Based on the significant data in the case, what do you think is the client’s problem?
Highlight the correct answer.
A.
B.
C.
D.
Hypothyroidism
Addison’s disease
Cushing’s syndrome
Growth hormone deficiency
3. Describe pathophysiology of the problem identified above. You should describe
physiological changes associated with the disease and not just describe what the disease is.
Hypothyroidism is the inability to produce a sufficient amount of thyroid hormones.
Hormones produced by the thyroid gland is triiodothyronine (T3) and thyroxine (T4) which has a
huge impact on the health a patient and affects all aspects of metabolism. The most common
early symptoms are sensitivity to cold, weight gain and join achiness, and fatigue due to slowed
metabolism and a slowed tendon-reflex relaxation, with hypotension. (Sommers,2019)
Decreased activity tolerance r/t muscular stiffness, shortness of breath upon exertion.
Constipation r/t decreased gastric motility. Impaired Gas exchange r/t respiratory depression.
Impaired Skin integrity r/t edema, dry or scaly skin. (Zanotti,2022). The goal of treatment is to
return the patient to the normal state and to prevent complications.
4. Provide two patient teaching points for this client.
Avoid foods such as cabbage, spinach and radish that is a deficient in iodine also
medications such as antithyroid, lithium carbonate which can cause hypothyroidism in a person
predisposed to the disease. (Sommers,2019)
Importance of follow-up exams to monitor the effectiveness of therapy such has
thyroxine and triiodothyronine radioimmunoassay which reflects underproduction of thyroid
hormones monitor response to therapy. (Zanotti,2022)
5. Fill in the Blanks by Highlighting One of the Options in the Parentheses



Based on the client’s problem, the anticipated drug to be prescribed is
____________________ (levothyroxine, prednisone, or growth hormone).
This drug is being prescribed because its action is to____________________ (Increase
thyroid hormone level, reduce the inflammatory process, or promote growth).
An important teaching point is to instruct the client to take the medication
_____________________ (In the morning, mid-afternoon with a snack, at bedtime).
Reference(s): List your reference(s) you used to complete this assignment here. They must be in
APA format. If no references are provided, you will lose 5 points.
Sommers, M. S. (2019). Hypothyroidism. In Diseases and Disorders (6th edition). F.A. Davis
Company. https://nursing.unboundmedicine.com/nursingcentral/view/Diseases-andDisorders/73630/all/Hypothyroidism
Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2020). Levothyroxine. In Davis's Drug Guide (16th
edition). F.A. Davis Company. https://nursing.unboundmedicine.com/nursingcentral/view/DavisDrug-Guide/109303/all/levothyroxine
Zanotti, B.A.G.L.M.B.F.M.M.M. M. Nursing Diagnosis Handbook, 12th Edition Revised Reprint with
2021-2023 NANDA-I® Updates. [Pageburstls]. Retrieved from
https://pageburstls.elsevier.com/#/books/9780323875714/