Davao Doctors College, Inc.

College of Allied Health Sciences

Nursing Program

NRG304: CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND

GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND
COORDINATION (ACUTE & CHRONIC)
Learning Medical-Surgical Nursing One Case Analysis at a Time!

Message from your Course Instructor

Hello! I am MARC ANDREO C. MALALA,RN,MAN, and I

will be your clinical instructor for this week. Congratulations
on finishing our first module for this semester! I hope that
you learned a lot about DIABETES MELLITUS from our
previous week’s discussion. If you have queries regarding
the topic(s) that we have covered last week, just let me
know.

For this week, we will be learning about a client with a

HYPERTHYROIDISM. I am looking forward to guiding
you in learning this course well. If you want to reach me
for any academic-related concerns, you can reach me
through the following:

Facebook account: https://www.facebook.com/marcandrew.malala/

E-mail address: marcandreo058@davaodoctors.edu.ph
Consultation hours: Wednesdays/Saturdays; 3:00PM – 4:00PM

Requirements in Completing the RLE Activities

Since most of our sessions for this semester will be delivered through distance learning activities,
the submissions will also be primarily done online. To do this, you need to have access to the
following applications:

1. Microsoft Office/Google Docs

2. Microsoft PowerPoint/Google Slides
3. Google Classroom or Quipper (Will depend on the instructor in-charge)
4. Google Meet (or any other teleconferencing app, duly agreed by the whole group)
5. Internet connectivity

Please expect that you might need to print some parts of the worksheets in this module (i.e.,
documentation and transcribing parts). If any difficulties in participating in synchronous classes
are encountered, inform your instructor right away! For absences, secure an excuse slip from
your RLE Supervisor.
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Your output must be submitted through the Learning Management System (LMS) so that it
will be traced and secured easily.

Daily Activities
Every week, you are expected to follow through the following deliverables:

Day 1 (Monday) Day 2 (Tuesday) Day 3 (Wednesday)

Virtual Circle Virtual Circle Virtual Circle

Completion of Module, to be Receiving of Handover Case Presentation (cont.)

submitted within the day

Case Presentation Weekly Quiz and Discussion of

Preparation of PPT Module and Quiz Answers
Presentation

Orientation of Next Week’s Activity

Now that you are done acquainting yourself with the instructor and the course itself, please
proceed to Module 3: Care of Clients with HYPERTHYROIDISM.
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Module 3: Care of Clients with

HYPERTHYROIDISM
Term: Second Semester S.Y. 2022-2023
Dates: Week 8 February 27 – March 1, 2023
Class Schedule: MTW: 7:00AM – 3:00PM
No. of Hours: 8 HRS/DAY

Instructions
The case analysis manuscript may be handwritten or computer written. Observe pagination.
Once done, send the compilation of your group’s answers to your clinical instructor.

After the submission, prepare a PPT presentation for your case presentation slated for Days 2
and 3 of your RLE classes. Each member of the group is expected to present during the case
presentations.

Learning Outcomes
At the end of this module, you are expected to:
Utilize the nursing process in the care of client with problems in HYPERTHYROIDISM.
1. Perform a comprehensive health history and assessment based on the case scenario
presented.
2. Utilize assessment information to formulate a patient-centered plan of care.
3. Discuss the therapeutics done for the simulated patient.
4. Explain appropriate nursing interventions per problems identified.
5. Document the care rendered to assigned patient in the simulated health care record
accurately.

As you start with this module, you are free to consult and coordinate with your assigned clinical
instructor. Be sure to get his/her email address and contact number for collaboration and
assistance. Just keep going, you can do it!
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Case Scenario: Patient with HYPERTHYROIDISM

On March 1, 2023 at 2:30PM, patient, Ms. Pearly
Shell, 27 years old, has been rushed in the
emergency department with a chief complaint
of feeling of fatiguability, palpitations, severe
headache, nausea and vomiting, tremors and
moist hands. She claimed that the she has been
experiencing since yesterday of having a feeling
of nervousness and dyspnea upon exertion.
Vital signs checked, BP:160/100, Temp:37.9,
HR: 150bpm, RR:22cpm, O2 Sat 94%, pain
scale of severe headache as claimed was 8/10.
Patient stated, “While I was using laplop,
parang sumama pakiramdam ko, so I decided
to ask my cousin for a blood pressure check, and my cousin told me na 160/110mmHg daw. She
insisted na pumunta daw ako sa hospital for further evaluation, since mataas blood pressure ko.
And even last week, parang kakaiba na talaga feeling ko, minsan grabe yung ginaw, minsan
grabe din ang init. Kaya ako mismo na we-weirdohan ng feeling. I am afraid na feeling ko bumalik
na yung sakit ko before when I was working in Dubai 1 month ago. May times na nanghihina
lang katawan ko, parang mabigat ang feeling ko, sobrang sakit ang ulo ko din. Halos hindi ako
makabangon that time, at namatay ako. I thought I was having a cancer, naparanoid na ata ako.
Napansin ko din na nanlalagas buhok ko, and parang parati akong pinagpapawisan, especially
yung kamay ko. Nagpa check ako that time sa isang doctor sa Dubai, as per that doctor, may
vertigo daw ako. He gave me a medication for vertigo. Serc ata ang brand name nun, not sure
though.

At that time, my doctor in Dubai ordered me some blood tests, CBC ata yun, urinalysis too, and
X-ray, then as per sa findings, normal naman daw lahat. After my check-up that time, I went
home na sa flat (apartment) namin for me rest, but after 2 hours I felt an excrutiating pain sa
mata ko, and in between sa upper part of my eyes. Grabe yung takot ko kasi parang tinutusok
yung mata ko. Then, just 3 weeks ago, napansin ko na parang paunti lang ng paunti ang
menstration ko. Before yung menstration ko will last for 5 days, but that time it’s just 2-3 days
lang. Di ko na talaga alam what’s happening to me, it’s like parang may sudden shift sa katawan
ko. Then, pati yung pag ihi ko, parang ang dami parati at ang dalas. Maybe it’s from my high-
fiber intake kaya ganun siguro ihi ko? I am very afraid that time, I am a QHSE and Training
Manager in Dubai, but I decided to go home na sa Philippines kasi sabi din ng Mama ko na umuwi
nalang muna ako for me to rest for a while, and mahirap magkasakit sa ibang bansa. Totoo pala
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

yun. I applied for a resignation and my boss agreed naman since it’s for health reasons. But
maybe I will go back again sa Dubai if nakapagpahinga na ako and feeling better na. And just
last week, parang feeling ko parati akong kinakabahan, pero binabale-wala ko lang nag
pakiramdam, and parang nangangati ako parati, parang allergies, but before naman hindi ko to
nararamdaman. And just now, ang taas ng blood pressure ko, kaya when my cousin told me to
go here sa hospital, I obliged nalang kasi di ko na din maintindihan ang nangyayari sa katawan
ko.” Moreover, she added that she is also a sporty person, she runs and go to the gym during
her rest days. However, she said that she just really don’t know what is happening to her body
that’s why she stopped her exercises since then.

Further assessment was conducted to the patient, weight was obtained with 40 Kg, height 5 ft
tall and her BMI was 17.2. The physician was asking the patient’s family history, she said “In my
family, Diabetes, and Asthma are common na sakit sa side ng mother ko. Actually, she’s
asthmatic. My grandfather died because of asthma, and my grandmother naman passed away
because of diabetes. Though, may auntie ako, sa side ng mother ko din naoperahan sa US for
her hyperthyroidism. In my father’s side, wala akong idea sa health history nila, kasi bata pa ako
naghiwalay na sila ng mother ko. I’m not that close sa family nila. In my case, nagka dengue
fever ako before when I was in high school and I was admitted here actually sa Davao Doctors
Hospital.”

Upon conducting a physical examination, the patient’s eyes appear to be slightly bulging,
periorbital edema noted. Patchy hair loss noted. Skin observed to be warm, shiny and moist.
Checking on the nail beds, distal separation of the nail plate observed, cold tremors moist hands
are also noted. Thyroid gland is smoothly palpable diffused enlarged. Patient’s body built appears
to be thin.
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

March 1, 2023
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

March 1, 2023

March 2, 2023
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

March 3, 2023
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Laboratory Results:
March 1, 2023 2:30PM

Pearly Shell : 3/1/2022 2:30PM

: 3/1/2022 2:45PM
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

URINALYSIS RESULT:

NEGATIVE

ECG Result:
March 2, 2023 2:50PM
RATE: 150 bpm

RHYTHM: Regular
P WAVE: Normal
PR INTERVAL: Normal
QRS: Normal

IMPRESSION: Sinus Tachycardia; P waves are hidden within each preceding T wave.
TSH Result:
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

March 2, 2023 3:00PM

Pearly Shell
March 2, 2022

: 3/2/2022
: 3/2/2022 3:00PM

FT3 and FT4 Result:

March 2, 2023 5:00PM

Pearly Shell

3/2/2022
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

SERUM ELECTROLYTES: 3/1/2023

CAPILLARY BLOOD GLUCOSE: 3/1/2023

Test Patient Value Normal Range

RBS 150mg/dl 80–140mg/dl

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Radiology Report: Thyroid Ultrasound

March 3, 2023 8:00AM

Pearly Shell

3/21/2022

3/21/2022 5:00PM

CHEST XRAY: 3/3/22

FINDINGS:

THE LUNGS ARE CLEAR

TRACHEAL AIR COLUMN IS AT MIDLINE

THE HEART IS T ENLARGED

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

What to Do?
To immerse yourself in the care management of your patient, let us do some detailed description
of your patient care tasks. Using the Case Scenario assigned to you, you are expected to perform
the following:

1. Fill-up the needed data based on the given scenario/case.

2. Conduct a history taking and physical assessment of your patient. Discuss the health
history of the patient narratively, in chronological order as much as possible. Use the DDC
Health Assessment form for documenting PA findings.
3. Discuss the pathophysiology of the patient’s condition. Discuss the FF: definition of
diagnosis, etiology, symptomatology, schematic diagram of the pathophysiology of the
condition of the patient, narrative description of the condition of the patient.
4. Interpret the therapeutics done for the patient: doctor’s orders, laboratory and diagnostic
tests done, and surgical procedures to be performed. Use format presented.
5. Present your drug study and IVF data. One drug study per student. Transcribe the
IVF and medications in the appropriate sheets.
6. Formulate a patient-centered care plan for your patient. Integrate in your care
intervention significant bioethical and legal standards of patient care. One NCP per student.
7. Document the care given by making a nurse documentation following the FDAR format.
8. Clinical Reasoning Questions - Collaboration: As a student nurse, you were assigned
to handle patient Pearly Shell, you may be allowed also to give the medications prescribed
to the patient under the supervision of your clinical instructor in collaboration with the
bedside and medicating nurse assigned to the patient. The nurse forgot to give the due
medication about an hour ago despite of reminding her because she’s been very busy using
cellphone and chit-chatting with the charge nurse on duty. In a while, she called you and
instructed to give the medication secretly and no need to inform your clinical instructor for
the said activity because she said “ nothing to worry about, anyway, I am still the one will
do the signing in the chart.” Using C-U-S as an assertive technique, what would you tell the
staff nurse? Answer narratively
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

9. Clinical Reasoning Questions - Ethico-Moral-Legal: The father of a patient is a

doctor. He visited his daughter and asking about her present condition including the
laboratory results as well as the diagnosis to the nurse on duty. He wanted to view the
patient’s chart and insisting that it’s allowed since he’s also a doctor.

What would be your nursing action in this scenario? What ethical principle is applicable in
this scenario? Justify? Answer narratively.

Have you answered all of the questions above? Great! Congratulations! You have
completed this module. You may now proceed to the next activity for the week. Please wait for
further instructions from you instructor.

References:
Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts,
process, and practice (10th ed.). Pearson Education, Inc.

Hinkle, J. & Cheever, K. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing
(14th ed.). Wolters Kluwer