Case Study 3
Group 6
Michelle French, Lauren Kasparian, Kimberly
McGinness, Emily Parsons
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Background
 Olivia Johnson is a 40 year old, single
mother of two children. She works as a
high school counselor and is a member of
the city council.
 She sees her family physician annually
and presented no signs or symptoms of
illness until eight months ago.
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Symptoms
Ms. Johnson has noticed a general feeling of
nervousness, irritability, and pounding heartbeat.
She has noticed that she is less tolerant of the
summer heat, and is eating more than usual but
losing weight.
Upon examination, she complains of slight shortness
of breath with exertion, blood pressure of 180/92,
warm flushed skin, thin, friable nails, elevated
thyroid levels, an elevated BMR, and a height of
5’4’’ and weight of 105 lbs. Giving her a BMI of 18.
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Medical Diagnosis
The 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 Patterns
– Health Perception/Health Management: Risk for
Injury of the Eye related to exopthalmos
– Activity-Exercise: Activity Intolerance related to
exertional dyspnea
– Cognitive-Perceptional: Readiness for
enhanced Knowledge
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Gordon’s Functional Health Patterns
-Self-Perception/Self Concept: Anxiety related to
change in health status
-Role-Relationship: Interrupted Family Processes
related to a shift in the health status of a family
member
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Holistic Care
Filling in the gaps; finding the missing FHP’s
Elimination
Sleep-Rest
1. What is your normal bowel
movement and voiding
pattern?
2. Do you take laxatives or
diuretics?
3. Is there any pain on
urination or defecation?
1. How much sleep do you
normally get a day?
2. Do you feel like you
have adequate energy
for daily tasks?
3. Do you use any sleep
aids including herbals?
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Holistic Care
Sexuality-Reproductive
1. What is your perception of
your sexual health?
2. Do you practice safe sex?
3. Are you satisfied with your
sex life?
Coping/Stress Tolerance
1. What do you feel are stressors
in your life?
2. How do you normally deal with
stress?
3. How would you describe your
support system?
Value/Belief
1. How do you perceive your spirituality?
2. What do you value in life?
3. Would you consider your beliefs to be a
positive force in your life?
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Nursing Diagnosis
Nutritional-Metabolic:
Imbalanced Nutrition; Less than the Body
Needs related to hypermetabolism
S/S Nervousness , less tolerance for summer heat, Irritability,
loss of weight with adequate food intake, restlessness, skin
is warm and flushed, nails are thin and friable, she is 5’4’’
and 105 lbs.
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Planning
 Progressively gaining weight until it is within
the normal range for her height and age,
(114-154 lbs).
 Identify nutritional requirements.
 Consume a nutritionally balanced diet
containing sufficient calories to prevent
further weight lose.
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Interventions
See a dietician to establish a diet based
upon needs related to clients
hypermetabolism.
Client should monitor signs of malnutrition
Recent excessive weight loss > 10lbs.
 BMI less than 20
Daily weighing
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Outcomes and Evaluation
 Evaluating if weight and lab values have
increased or decreased.
 Continuing to evaluate with a holistic
approach will look at the client’s over all
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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40y/o mother of t
Patient: Olivia Johnson
40y/o mother of two
Diagnosed with hyperthyroidism
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
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
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
-Daily weighing
-Critically evaluate and revise therapy until you and client
Skills that framed the case: each
resolve problems as defined by nursing diagnosis
implementation we used critical
thinking to evaluate the possible
Planning
consequences of each intervention
& decide if consequences out way
-Progressively Gain weight until within normal range
benefits
(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.
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.
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Reflection
 As a group we initially tried to divide up the
work. Realizing the topics all overlapped we
rerouted the plan and worked collaboratively
to formulate a congruent plan of care and
nursing process.
 If the project was to be redone we would
establish this in the beginning and set times
focused on selective areas to better time
management.
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
References
Ackley, B. J., & Ladwig, G. B. (2007). Mosby's Guide to Nursing
Diagnosis. St Louis,Missouri: Mosby.

Bahn, R. (2003). Pathophysiology of Graves? Ophthalmopathy: The Cycle
of Disease . The Journal of Clinical Endocrinology and Metabolism, 88(5).
Retrieved April 20, 2009.

Loeb, S. (1994). Handbook of Medical-Surgical Nursing. Springhouse:
Springhouse Corporation.

Perry, A. G., & Potter, P. A. (2008). Fundamentals of Nursing
(Fundamentals of Nursing (Potter & Perry). St Louis, Missouri: Mosby.

Tracy, S. (Director) (2009, February 5). Functional Health Patterns. ,
University Of New Hampshire, Durham.

Williams, M. (2002). Nutrition For Health, Fitness and Sport, 6th Edition,
pb, 2002. New
York: Mcgraw Hill.
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