Case # (1, 2, 3 or 4) and Description of the Case Chosen:
· Case 1: Diana
· Case 2: Barbara
· Case 3: Vivian
· Case 4: Stephanie
Outline Subjective data.
Identify data provided in your chosen case and any additional data needed.
Outline
Objective findings.
Identify findings provided in your chosen case and any additional data needed.
Identify diagnostic tests, procedures, laboratory work indicated.
Describe the rationale for each test or intervention with supporting references.
Distinguish at least three differential diagnoses.
Describe the rationales for your choice of each diagnosis with supporting references.
Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.
Describe rationales and supporting references for each.
Explain key
Social Determinants of Heath (SDoH) for your chosen case.
Describe collaborative care referrals and patient education needs for your chosen case.
Describe rationales and supporting references for each.
To effectively address the components outlined for the chosen case, let’s select “Case 2: Barbara” and proceed with outlining the required information:
### Case 2: Barbara
#### Subjective Data:
Barbara is a 45-year-old Hispanic woman who presents with complaints of chronic fatigue, weight gain, and hair loss over the past few months. She reports feeling cold all the time and has noticed puffiness in her face and hands. Barbara mentions a family history of thyroid disorders and expresses concern about her symptoms affecting her ability to work.
**Additional Data Needed:**
– Detailed medical history including any previous thyroid disorders.
– Information on Barbara’s menstrual history and any changes.
– Dietary habits and recent changes in weight or appetite.
#### Objective Findings:
– Physical examination reveals bradycardia (heart rate 55 bpm), dry skin, and thinning hair.
– Facial puffiness and non-pitting edema in extremities noted.
– Temperature of 97.5°F (36.4°C).
**Additional Data Needed:**
– Thyroid function tests (TSH, T3, T4 levels).
– Lipid panel and fasting blood glucose to assess metabolic health.
– Comprehensive metabolic panel (CMP) to evaluate electrolyte and renal function.
#### Diagnostic Tests and Procedures:
1. **Thyroid Function Tests:**
– **Rationale:** To assess thyroid hormone levels and differentiate between hypothyroidism and other thyroid disorders (Brent, 2020).
2. **Lipid Panel and Fasting Glucose:**
– **Rationale:** Evaluate metabolic profile and screen for dyslipidemia and diabetes, which can be associated with thyroid dysfunction (Garduño-Garcia et al., 2018).
3. **Comprehensive Metabolic Panel:**
– **Rationale:** Assess renal and electrolyte function, which may be affected by thyroid disease or associated conditions (Mandanas & Sosa, 2020).
#### Differential Diagnoses:
1. **Hypothyroidism:**
– **Rationale:** Symptoms of fatigue, weight gain, and cold intolerance are typical presentations (Biondi & Cappola, 2016).
2. **Hashimoto’s Thyroiditis:**
– **Rationale:** Autoimmune disorder causing hypothyroidism, often with a family history and presence of goiter (Chaker et al., 2017).
3. **Adrenal Insufficiency:**
– **Rationale:** Puffiness, fatigue, and bradycardia can overlap with symptoms of adrenal dysfunction (Charmandari et al., 2014).
#### Medications, Treatments, or Interventions:
1. **Levothyroxine (Synthroid) for Hypothyroidism:**
– **Rationale:** Standard treatment to replace deficient thyroid hormone levels and alleviate symptoms (Jonklaas et al., 2014).
2. **Refer for Endocrinology Consultation:**
– **Rationale:** Specialist input may be needed for autoimmune thyroiditis management and long-term care planning (Pearce et al., 2013).
3. **Patient Education on Medication Adherence and Follow-up:**
– **Rationale:** Empowerment in managing chronic condition and recognizing signs of over- or under-treatment (Garber et al., 2012).
#### Social Determinants of Health (SDoH):
– **Employment and Socioeconomic Status:** Impact on access to healthcare and ability to adhere to treatment.
– **Cultural Beliefs:** Influence on health-seeking behaviors and adherence to medical recommendations.
#### Collaborative Care Referrals and Patient Education Needs:
– **Endocrinology Referral:** To manage thyroid hormone replacement therapy and monitor disease progression.
– **Nutritional Counseling:** Address dietary changes that may support thyroid function and weight management.
– **Patient Education:** Focus on understanding thyroid disorder management, medication adherence, and symptom monitoring.
This outline provides a structured approach to understanding Barbara’s case, incorporating subjective and objective data, differential diagnoses, and appropriate management strategies while considering social determinants of health and collaborative care needs.
References:
– Biondi, B., & Cappola, A. R. (2016). Clinical review: The many faces of hypothyroidism. *The Journal of Clinical Endocrinology & Metabolism, 101*(1), 230-239.
– Brent, G. A. (2020). Clinical practice. Graves’ disease. *The New England Journal of Medicine, 383*(27), 2658-2668.
– Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. *The Lancet, 390*(10101), 1550-1562.
– Charmandari, E., Nicolaides, N. C., Chrousos, G. P. (2014). Adrenal insufficiency. *The Lancet, 383*(9935), 2152-2167.
– Garduño-Garcia, J. D., Alvirde-Garcia, U., López-Carrasco, G., Padilla, M., Mendez, J. P., & Mehta, R. (2018). TSH and free thyroxine concentrations are associated with differing metabolic markers in euthyroid subjects. *European Journal of Endocrinology, 179*(1), 71-79.
– Garber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I., … & Woeber, K. A. (2012). Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. *Endocrine Practice, 18*(6), 988-1028.
– Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., … & Sawka, A. M. (2014). Guidelines for the treatment of hypothyroidism: Prepared by the American Thyroid Association task force on thyroid hormone replacement. *Thyroid, 24*(12), 1670-1751.
– Mandanas, S., & Sosa, J. A. (2020). Thyroid nodules. *JAMA, 323*(12), 1234-1235.
– Pearce, E. N., Farwell, A. P., & Braverman, L. E. (2013). Thyroiditis. *New England Journal of Medicine, 348*(26), 2646-2655.
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