1043:
Subjective: Client presents for a follow-up appointment five weeks after she was prescribed sertraline for depressive symptoms. She reports no improvement and even reports worsening as she is having difficulty focusing at work. Specifically, she reports feeling like she is in a 'brain fog.' Two weeks ago, she started taking over-the-counter stool softeners because of constipation, which did not improve even after introducing more fiber in her diet. Finally, she reports that her shoes are no longer fitting because of edema in her ankles and feet.
Objective: Client is alert and oriented to person, place, and time. 2+ peripheral pulses. S1/S2 heart tones. Hypoactive bowel sounds in all quadrants. Clear lung sounds. Trace periorbital and 1+ pedal edema.
Assessment and plan: Will order laboratory testing as this client is showing strong clinical signs of primary hypothyroidism.
T 97°F (36.1°C) P 58 RR 16 BP 107/65 Pulse oximetry reading 98% on room air
- obtain thyroid panel
- discontinue sertraline
The nurse reviews the physician's progress notes, orders, and the client's vital signs.
➢ Complete the sentence below with the appropriate answers.
If the client has primary hypothyroidism, the client's thyroid panel will have a high [thyroid-stimulating hormone (TSH) / free thyroxine (T4) / serum triiodothyronine (T3)] and low [thyroid-stimulating hormone (TSH). / free thyroxine (T4). / thyrotropin receptor antibodies (TRAbs).]
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