Lydia is a 50-year-old businesswoman who has

Lydia is a 50-year-old businesswoman who has noticed a slight enlargement in her neck. Her mother had a goiter at about the same age Lydia is now, so she is concerned that she may also have a goiter. She knows a goiter merely means enlargement of the thyroid gland. What symptoms might Lydia exhibit if the goiter is due to hyperthyroidism? Hyperthyroidism refers to “any condition in which there is too much thyroid hormone present in the thyroid, meaning that the thyroid gland is overactive.” A goiter is defined as “an enlargement of the thyroid”. The most common cause of a goiter is iodine deficiency. However, we know that Lydia’s is caused due to hyperthyroidism. Most likely, Lydia’s immune system is producing thyroid stimulating immunoglobin. This protein caused the thyroid to pro……………….

NR 601 Week 3 Case Study Discussions(Part-1)

Katie Smith, a 65 year-old female of Irish descent, is being seen in your office for an annual physical exam. You are concerned since she has rescheduled her appointment three times after forgetting about it. She and her husband John are currently living with their daughter Mary, son-in-law Patrick, and their four children. She confesses that while she loves her family and appreciates her daughter’s hospitality, she misses having her own home. As she is telling you this, you notice that she develops tears in her eyes and does not make eye contact with you.

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Background:

Although Mrs. Smith is scheduled for an annual physical exam and reports no particular chief complaint, you will need to complete a detailed geriatric assessment. Katie reports a lack of appetite. She tells you that she nibbles most of the time rather than eating full meals. She also reports having insomnia on a regular basis.

PMH:

Katie reports a recent bout of pneumonia approximately 3 months ago, but did not require hospitalization. She also has a history of HTN and high cholesterol.

Current medications:

HCTZ 25mg daily

Evista 60mg daily

Multivitamin daily

Surgeries:

Appendectomy as a child in Ireland (date unknown)

1968- Cesarean section

Allergies: Denies food, drug, or environmental allergies

Vaccination History:

Cannot remember when she had her last influenza vaccine

Does not recall having received a Pneumovax

Her last TD was greater than 10 years ago

Has not had the herpes zoster vaccine

Screening History:

Last Colonoscopy was 12 years ago

Last mammogram was 4 years ago

Has never had a DEXA/Bone Density Test

Social history:

Emigrated with her husband from Ireland in her 20s and has always lived in the same house until recently. She retired a year and a half ago from 30 years of teaching elementary school; has never smoked but drinks alcohol socially. She states that she does not have an advanced directive, but her daughter Mary keeps asking her about setting one up.

Family history:

Both parents are deceased but lived disease-free up into their late 90s. She has one daughter who is 44 years old with no chronic illness and two sons, ages 42 and 40, both in good health.

Discussion Day 1:

Differential Diagnoses with rationale

Further ROS questions needed to develop DD

Based on the patient data provided, choose geriatric assessment tools

that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.