49.2k views
0 votes
Which assessment finding for a 33-year-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse?

1) Bilateral exophthalmos
2) Heart rate 136 beats/minute
3) Temperature 103.8° F (40.4° C)
4) Blood pressure 166/100 mm Hg

1 Answer

0 votes

Final answer:

For a patient with Graves' disease, the most rapid intervention is required for a temperature of 103.8° F (40.4° C), which can indicate a potentially life-threatening thyroid storm.

Step-by-step explanation:

The assessment finding for a 33-year-old female patient with Graves' disease that requires the most rapid intervention by the nurse is a temperature of 103.8° F (40.4° C). This is an indicator of a potential thyroid storm, which is a life-threatening complication of hyperthyroidism that can present with extreme fever, tachycardia, and other systemic effects.

The bilateral exophthalmos is a common sign of Graves' disease and, while important, does not constitute an emergency. A heart rate of 136 beats/minute is concerning and should be closely monitored and addressed, but it is not as immediately life-threatening as the high fever. A blood pressure of 166/100 mm Hg is also critical but secondary to addressing the high temperature.

Treatments aim to stabilize vital signs and may include antithyroid medications, beta-blockers, and supportive care. Immediate intervention for a high fever may involve antipyretics, cooling measures, and rapid evaluation for potential complications. Advanced supportive care and hospitalization may be necessary.

User Moak
by
8.5k points