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June 2010, Volume 40 Number 6 , p 72 - 72


  • Susan Simmons PhD, RN, ARNP-BC


ARLENE GRANGER, 65, arrives by ambulance accompanied by her husband. She's unresponsive to verbal and noxious stimuli. Mr. Granger says that for the past few days his wife complained of weakness, fatigue, and feeling cold. She also complained of constipation and being unable to empty her bladder completely.Ms. Granger's vital signs are: BP, 152/120; heart rate, 50; respirations, 12; and temperature, 96° F (35.5° C). You note that her face is puffy with periorbital edema and that her tongue seems enlarged. She's not drooling and her gag reflex is intact. You also note diffuse alopecia and bilateral nonpitting pretibial edema, as well as diminished deep tendon reflexes.Mr. Granger said that when he arrived home from work and found his wife unresponsive, he called 911. She'd been diagnosed with pneumonia a week ago and was taking azithromycin. She has a history of hypothyroidism, but Mr. Granger says he suspects that his wife hasn't taken her levothyroxine for

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