What is your primary diagnosis for this patient as the cause for the CC of fatigue?

POSITIVE FEEDBACK  Case Study 2 Part 2 1.What is your primary diagnosis for this patient as the cause for the CC of fatigue? (support your decision for your diagnosis with pertinent positives and negatives from the case) The primary diagnoses for this patient is hypothyroidism based on the following: Subjective Findings: Weight gain, constipation. Cold intolerance, fatigue, depressive sx secondary to unproductiveness and feeling tired all the time; not feeling rested; generalized weakness; intermittent cramping to calves; intolerance to cold Objective Findings: Decreased DTR 1+; Dry skin; Coarse and thickened hair; Elevated TSH level at 6.770 uIU/ml; low free T4 level at 0.62 ng/dl. ). With primary hypothyroidism, the TSH level is elevated, Free T4 is low to normal (Curl, 2014). Additionally, a TSH level above 4-5 mU/L can confirm the diagnosis of hypothyroidism (Epocrates, 2019). With this information, the diagnoses of hypothyroidism can be made with confidence. Pertinent Negatives: -family history of autoimmune disorders; -thyrotoxic medication usage; -enlargement of the thyroid upon palpation; -menstrual irregularities, -decreased libido; – memory loss; -bradycardia; -anemia; -hyponatremia. Although these are negative findings, there is ample evidence to support the diagnoses of hypothyroidism. 2. Identify the corresponding ICD-10 code. ICD10 code for hypothyroidism is E03.9 (Epocrates, 2019). 3. Provide a treatment plan for this patient’s primary diagnosis which includes: Medication* Levothyroxine (Levoxyl) 50 mcg tablet Disp: #30 Sig: Take one tablet PO QAM Take one tablet by mouth in the morning daily with a full glass of water RF: 0 (Hollier, 2018) According to Jonklass et al (2014), the primary pharmacological treatment for hypothyroidism is daily administration of thyroid hormone to restore the patient to a euthyroid state. In order to achieve a euthyroid state, a synthetic preparation of T4 called levothyroxine is administered. The recommendation for patients older than 50 years of age should be treated with a start dose of 25 to 50 mcg per day (Jonklass et al., 2014). The adult maintenance doses range from 25mcg to 200 mcg per day (Hollier, 2018). The weight based dose for this patient is Start: 1.6 mcg/kg PO qday, then adjust dose by 12.5-25 mcg/day q4-6wk (Epocrates, 2019). Patient weighs 82kg = 1.6 (82kg) = 130 mcg/day. Therefore, I feel comfortable starting this patient with a conservative dose of 50 mcg. Any additional testing necessary for this particular diagnosis* -Measure TSH after patient has been on Levothyroxine for six weeks, and subsequently every 6-8 weeks until goal is reached (Hollier, 2018). Once goal levels are met, TSH should be measured annually, unless patient becomes symptomatic (Hollier, 2018). -Additionally. a fasting lipid panel should be drawn concurrently because those with hypothyroidism are at increased risk for atherosclerotic heart disease. Therefore, a baseline measurement should be obtained so that treatment can be promptly initiated, if indicated (Jonklaas et al., 2014). According to Hollier (2018), lipid levels are expected to be elevated in those with hypothyroidism. If lipids are still elevated after TSH is <10mIU/L, pharmacological treatment for hyperlipidemia is indicated and subsequently an annual lipid assessment is needed (Hollier, 2018). In order to assess baseline liver and kidney function, I would also order a BMP and LFT. Patient education* -Take in the morning on an empty stomach with a full glass of water to increase absorption. Do not eat a meal until 30 minutes has passed (Jonklaas, 2014). -Antacids or simethicone can decrease absorption of medication (Hollier, 2018). -Educate about the need for lifelong adherence to thyroid replacement and the need to report signs of toxicity, infection, or cardiac symptoms (Hollier, 2018). -Encourage a diet high in fiber to prevent constipation (Hollier, 2018). -If patient is obese, encourage diet an exercise for weight loss /body fat reduction (Hollier, 2018). -After initiation of therapy, educate the patient that symptom improvement can be expected two weeks after and the resolution of symptoms and could take anywhere from three to six months (Jonklaas et al., 2014).POSITIVE FEEDBACK