Question

A client is exhibiting signs of Graves' disease. What clinical manifestations of this disorder would the nurse document that would indicate this disease state? Select all that apply.

• A goiter
• Ophthalmolopathy (exophthalmos)
• Tachycardia and rapid respiratory rate

Answer 1

A nurse should document a goiter, ophthalmopathy (exophthalmos), and tachycardia as clinical manifestations indicating Graves' disease, which is associated with hyperthyroidism.

Step-by-step explanation:

Graves' disease is an autoimmune disorder that causes hyperthyroidism, which is an overactive thyroid condition. The clinical manifestations of Graves' disease that a nurse should document include:

• A goiter, which is a visible enlargement of the thyroid gland.
• Ophthalmopathy or exophthalmos (protruding eyes), also known as Graves' ophthalmopathy.
• Tachycardia (increased heart rate) and a rapid respiratory rate, reflecting an elevated metabolic state.

These symptoms occur due to the presence of thyroid-stimulating immunoglobulin (TSI), which stimulates the thyroid to produce excess thyroid hormone or can block thyroid hormone production. Graves' disease is characterized by symptoms such as heat intolerance, rapid and irregular heartbeat, weight loss, and sensitivity to heat. Medications that mitigate symptoms or decrease thyroid hormone production may be prescribed.