Physiological Integrity Q 15

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A 25-year-old client with Grave’s disease is admitted to the unit. What would the nurse expect the admitting assessment to reveal?

  

     A. Bradycardia

     B. Decreased appetite

     C. Exophthalmos

     D. Weight gain

    

    

Correct Answer: C. Exophthalmos

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Exophthalmos (protrusion of eyeballs) often occurs with hyperthyroidism. Graves’ orbitopathy (ophthalmopathy) is caused by inflammation, cellular proliferation and increased growth of extraocular muscles and retro-orbital connective and adipose tissues due to the actions of thyroid stimulating antibodies and cytokines released by cytotoxic T lymphocytes (killer cells). These cytokines and thyroid stimulating antibodies activate periorbital fibroblasts and preadipocytes, causing synthesis of excess hydrophilic glycosaminoglycans (GAG) and retro-orbital fat growth.

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Option A: Physical signs of hyperthyroidism include tachycardia, systolic hypertension with increased pulse pressure, signs of heart failure (like edema, rales, jugular venous distension, tachypnea), atrial fibrillation, fine tremors, hyperkinesia, hyperreflexia, warm and moist skin, palmar erythema and onycholysis, hair loss, diffuse palpable goiter with thyroid bruit and altered mental status.

Option B: Hyperthyroidism usually increases the appetite. If the client is taking in a lot more calories, they can gain weight even if their body is burning more energy. Make sure to eat healthy foods, get regular exercise, and work with a doctor on a nutrition plan. These steps can all help combat weight gain from an increased appetite.

Option D: In younger patients, common presentations include heat intolerance, sweating, fatigue, weight loss, palpitation, hyper defecation, and tremors. Other features include insomnia, anxiety, nervousness, hyperkinesia, dyspnea, muscle weakness, pruritus, polyuria, oligomenorrhea or amenorrhea in the female, loss of libido, and neck fullness.

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