CASE STUDY:
You are making home visits to an 82-year-old woman who is recovering from a fractured femur. During your last three visits she has consistently complained of being cold, even though it is summer and her house is very warm. In addition, she has had frequent complaints of constipation, has not felt like eating, and been tired. She has a bottle of hand lotion next to her chair for her dry skin. What is your assessment, and is any action warranted on your part?

SYMPTOMS: Why is patient presenting with these s/s
CONSTIPATION:
Immobility r/t fractured femur
Pain meds: Analgesics
BEING COLD:
Anemia
Low RBC production r/t femur fracture
DRY SKIN:
Dehydration
FATIGUE:
Pt could be pain
LABS: What labs should be ordered for patient
CBC; TSH; Serum Electrolyte Levels;

Kanahi Beathea
Johnnie Tolbert
Critical Thinking Chapter 21
From the findings the pt was presenting with s/s of hypothyroidism. Hypothyroidism develops when the thyroid gland fails to produce or secrete as much Thyroxine(T4) as the body needs. Because thyroxine regulates such essential functions as heart rate, digestion, physical growth, and mental development, an insufficient supply of this hormone can slow life sustaining process, damage organs and tissue in every part of the body, and lead to life-threatening complications.
Hypothyroidism is very common in patients over 60 years of age, and is steadily increasing with age. The symptoms of hypothyroidism are very non-specific in all patients, even more so in the older patient. Symptoms and signs of hypothyroidism may include weight gain, sleepiness, dry skin, and constipation. But lack of these symptoms does not rule out the diagnosis. To make this diagnosis in the elderly patient, you will need to palpate the patient thyroid for a lump to determine thyroid dysfunctions. Clues to possibility of hypothyroidism include a positive family history of thyroid disease, past treatment for hyperthyroidism, or a history of extensive surgery and /or radiotherapy to the neck.
TREATMENT of the older patient with hypothyroidism As with younger patient, pure synthetic thyroxine, take once daily by mouth, fully replaces the function of the thyroid gland and successfully treats the symptoms of hypothyroidism in most patients. In particular, treatment of the older patient must take into account that full thyroid hormone replacement need not take place rapidly, and in fact may put stress on the heart and CNS if accomplished too quickly. Rather, hormone treatment is usually begun slowly with a partial daily dose. The patient and family members must be aware of a possible increase in angina, shortness of breath, confusion and change in sleep habits, and notify the prescribing physician if these occur.
Thyroid disorders have no age limits, but hypothyroidism is clearly more common in older than in younger adults. Older patients with thyroid disorders require special attention for gradual and careful treatment, and, as always, require lifelong follow-up. At this point of care the patient should have and assessment of her thyroid done, a Thyroid function should be performed, and her doctor should be notified.