The health assessment for Mrs. Lee at the health center. He finds that she now weighs 150 lb (68 kg)an increase of 10 lb (4.5 kg) over her weight at her last visit 6months earlier. Mrs. Lee states that she always feels cold, tired, and weak. She also states that she is constipated, has difficulty remembering things, and looks different. Physical assessment findings include a palpable and bilaterally enlarged thyroid; dry, yellowish skin; nonpitting edema of the face and lower legs; and slow, slurred speech.Diagnostic tests revealed the following abnormal findings: T3, 56 ng/dL (normal range: 80 to 200 ng/dL); T4, 3.1 (normal range: 5 to 12 mg/dL); TSH increased.The medical diagnosis of hypothyroidism is made, and Mrs. Lee is started on levothyroxine 0.05 mg daily
Constipation, related to decreased peristalsis, as evidenced by hard, formed stools every 4 days Impaired verbal communication, related to changes in speech patterns and enlarged tongue Low self-esteem, related to changes in physical appearance and activity intolerance
Regain normal bowel elimination patterns, having a soft, formed stool at least every other day.
Experience improvement in verbal communication.
• Regain positive self-esteem as medication reduces physical changes and fatigue.
PLANNING AND IMPLEMENTATION
• Teach to increase fluids,bulk, and fiber in the diet to help regain a normal bowel elimination pattern of a soft,formed stool every other day.
• Take medication as prescribed and do not expect immediate reversal of symptoms affecting speech.
• Plan activities around rest periods. Encourage husband and daughter to help with housecleaning and cooking.
On return to the health center 2 months later, Mrs. Lee reports that she is no longer constipated but that she is continuing to drink six glasses of water and eating oatmeal every day. She no longer feels cold, is regaining her normal energy, and even feels
well enough to plant her garden. Her speech is clear and easy to understand.As she leaves the examining room,Mrs. Lee says,“It’s hard to believe that I have changed so much—now I look and feel like the ‘old’me!”