2.

Medication(s)

The client is undergoing a pharmacologic therapy specific to his disease condition. Mr. K.B. is
placed under Methimazole 15mg/day. Methimazole is an antithyroid medication commonly
used in the treatment of hyperthyroidism, including Grave’s disease. The rationale for
prescribing methimazole at a dose of 15mg/day can be based on several factors, including the
patient’s thyroid function, the severity of hyperthyroidism, and the individual response to the
medication.

The following reasons why a healthcare provider may prescribe methimazole at a dose of
15mg/day:

1. Control of thyroid hormone production

 Methimazole works by inhibiting the production of thyroid hormones T4 and T3 in
the thyroid gland. A dose of 15mg/day may be prescribed to effectively decrease
the levels of thyroid hormones in the body and help normalize thyroid function.

2. Severity of hyperthyroidism
 The dose of methimazole prescribed may be influenced by the severity of
hyperthyroidism. A higher initial dose such as 15mg/day may be recommended
for patients with more severe symptoms or significantly elevated thyroid hormone
levels.

3. Individual response
 The response to antithyroid medications like methimazole can vary among
patients. Some individuals may require higher doses to achieve adequate control
of hyperthyroidism, while others may respond well to lower doses.

4. Titration of dosage
 The initial dose of methimazole at 15mg/day may be part of a titration plan where
the dose is adjusted based on the patient’s response to the medication and
thyroid hormone levels. Monitoring the patient’s thyroid function tests and adjust
the dosage as needed to maintain thyroid hormone levels within the normal
range.

5. Maintenance therapy
 Once the patient’s thyroid function is stabilized and symptoms are controlled,
methimazole may be continued at a lower maintenance dose to prevent the
recurrence of hyperthyroidism while minimizing the risk of side effects.

 It is important for patients prescribed methimazole to follow their healthcare provider’s

instructions carefully, attend regular follow-up appointments for monitoring, and report
any side effects or concerns promptly. Adjustments to the dosage or treatment plan may
be made based on the individual patient’s response and thyroid function tests.
Based on the clinical presentations provided, the following diagnostic examinations may be
considered to further evaluate the patient’s condition.
1. Electrocardiogram (ECG)

 An ECG can help assess the patient’s heart rhythm and identify any
abnormalities that may be contributing to the symptoms of a fast heart rate and
loud heart sounds.
2. Chest X-ray

 A chest X-ray can help evaluate the presence of any lung abnormalities, such as
pneumonia or congestive heart failure, which may be causing the diminished
breath sounds and fine crackles in the posterior bases.

3. Echocardiogram

 An echocardiogram may be ordered to assess the structure and function of the

heart, especially in the presence of symptoms like loud heart sounds and +1
pitting edema in the lower extremities, which could be indicative of heart failure.

4. Complete blood count (CBC) and basic metabolic panel (BMP)

 These blood tests can provide information about the patient’s overall health
status, electrolyte levels, kidney function, and the presence of any infection or
inflammation.

5. Brain natriuretic peptide (BNP) test

 BNP levels can be measured to help diagnose or rule out heart failure, as
elevated levels are often seen in heart failure.

6. Arterial blood gas (ABG)

 An ABG test can provide information about the patient’s oxygenation, carbon
dioxide levels, and acid-base balance, especially in the presence of respiratory
symptoms and a high respiratory rate.

7. Thyroid function tests (TFTs)

 Given the patient’s symptoms of anxiety and restlessness, it may be prudent to

assess thyroid function to rule out hyperthyroidism as a contributing factor.

 Based on the results of these diagnostic tests, healthcare providers can further evaluate
the patient’s condition, determine the underlying cause of the symptoms, and develop
an appropriate treatment plan. It is important for the patient to be closely monitored and
managed in a timely manner given the severity of the symptoms and vital sign
abnormalities.