Case Study Scenario: Mrs. Angela Campbell Summative Assessment

It is 1300 hours, and you are working on a general medical ward in a large metropolitan
hospital. You are caring for Mrs. Angela Campbell, a 53-year-old woman, who presented to
ED yesterday with dizziness, extreme fatigue, feeling generally unwell and severe
constipation. She is evaluated and diagnosed with primary hypothyroidism.
Medical history:
Angela has a skin cancer removed from her neck 10 years ago, treated with low dose
radiation therapy to the lesion, she no longer has skin cancer.
Bilateral carpal tunnel syndrome
Nil known allergies
Takes no prescribed medication and denies illicit drug use
Blood work demonstrates:
Thyroid Stimulating hormones (TSH) are increased with low levels of free T3 & T4.
Full blood examination (FBE) mild anaemia, otherwise normal
Fasting lipids are pending
Social History:
Angela lives with husband Paul, and 6-year-old cocker spaniel named Charles, they
have no children
Angela left her job as a Human Resources manager for Westpac Bank 6 months ago
due to severe fatigue
Angela lacks any motivation to engage in any interests and acknowledges that she
has felt flat over the last year or so.
Angela also advises that she has gained 10kg over the last 6 months.

On examination:
Angela has moderate preorbital puffiness
She is also noted to have coarse and dry skin (Xerosis).
She has slow speech with a hoarse voice
Angela demonstrates a fine motor tremor in her hands.
Objective data:
Temp: 35.5 Celsius
HR: 42 beats per minute
RR: 16 breaths per minute
BP: 125/70 mmHg,
SaO2: 99% on Room air
BSL: 5.7mmol/l
GCS: 13 with mild bilateral limb weakness
Bowels not opened for 4 days, distended abdomen, passing flatus
No nausea or vomiting
Has mild generalised muscle aches rated 2/10
Dizzy on standing.
You are caring for Angela on admission to the ward, for management and treatment of her
symptoms, please work through the Clinical Reasoning Cycle to detail the provision of
evidence-based, person-centred care.