Nursing Case Study Jennie

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This case study will evaluate a 23-year-old female named Jennie. From the given scenario, Jennie complains of irregular menses, fatigue, generalized aches/pains, and darkened areas on her posterior neck. Jennie is a ½ pack-per-day smoker for 7 years otherwise no significant medical history except for a miscarriage at age 18. She denies any other pregnancies. Jennie works at Starbucks and lives with her boyfriend. Jennie has had laboratory work and the values are as follows: Hemoglobin 10.7 g/dL, Creatinine 0.8 mg/dL, BUN 20 mg/dL, Sodium 135 mmol/L, Potassium 4.1 mEq/L, Calcium 9.0 mg/dL, Vitamin D 11 ng/dL, Magnesium 1.6 mEq/L, Phosphorous 3.8 mg/dL, Fasting Glucose 124 mg/dL, HgBA1C 5.8, Fasting Insulin 102, Total Cholesterol mg/dL, …show more content…
Pertinent positives include: irregular menses, fatigue, generalized aches/pains, darkened areas on posterior neck, 7 year smoking history, Hemoglobin 10.7 is consistent with anemia, Vitamin D 11ng/mL is deficient, Fasting Glucose 124 mg/dL is high and HgBA1C 5.8 is high consistent with pre-diabetes, Fasting Insulin 102 is elevated consistent with insulin resistance, Total cholesterol 221 is high and HDL 34 mg/dL is low indicative of dyslipidemia, and TSH 13.6 is high indicative of hypothyroidism (Woo & Robinson, …show more content…
Natural killer cells activated by antibodies, cytokines, and autoreactive T lymphocytes may also be involved in the destruction of thyroid tissue. This degrades the ability of the thyroid to produce thyroid hormones. The hypothalamus-pituitary-thyroid axis responds to the decreased level of circulating thyroid hormone by the hypothalamus increasing the production of thyrotropin-releasing hormone (TRH) which causes the anterior pituitary to produce thyroid-stimulating-hormone (TSH) (McCance & Heuther, 2014). The thyroid gland is unable to respond to the TSH due to the lack of functional tissue (McCance & Heuther, 2014). Jennie’s TSH is significantly elevated at 13.6. Thyroid hormone is involved in the regulation of metabolism in most cells and organs in the body through intracellular protein synthesis (McCance & Heuther, 2014). Hypothyroidism can be responsible for Jennie’s irregular menses, body aches/pains, fatigue, and elevated cholesterol (Kapustin, 2010). Insulin resistance may be a result of hypothyroidism due to alteration of skeletal muscle metabolism (Peppa, Koliaki, Nikolopoulos, & Raptis, 2010). The darkened areas on Jennie’s neck are consistent with acanthosis nigricans and can be indicative of hyperinsulinemia (Chen et
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