Diffuse toxic goiter: Graves disease, the most common cause of hyperthyroidism (over

activity of the thyroid gland), with generalized diffuse overactivity ("toxicity") of the entire thyroid
gland which becomes enlarged into a goiter.
There are three clinical components to Graves disease:

Hyperthyroidism (the presence of too much thyroid hormone),

Ophthalmopathy specifically involving exophthalmos (protrusion of the eyeballs),

Dermopathy with skin lesions.

Factors that can trigger the onset of Graves disease include stress, smoking, radiation to the
neck, medications (such as interleukin-2 andinterferon-alpha), and infectious organisms such as
viruses.
The diagnosis of Graves disease is made by a characteristic thyroid scan(showing diffusely
increase uptake), the characteristic triad of ophthalmopathy, dermopathy, and hyperthyroidism,
or blood testing for TSI (thyroid stimulating immunoglobulin) the level of which is abnormally
high.
Atrial fibrillation is a form of abnormal heart rhythm. There are several types of atrial
fibrillation. One type is called paroxysmal atrial fibrillation.
Paroxysmal atrial fibrillation is a condition in which an irregular heart rhythm occurs periodically.
The heart returns to its normal sinus rhythm on its own -- in a few minutes, hours, or days.
People who have this type of atrial fibrillation may have episodes every day, or only a few times
a year. When these episodes begin and end is usually unpredictable, which can be very
unsettling.
About 1 in 4 people with paroxysmal atrial fibrillation eventually develop the permanent
form of the condition.

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin
or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be
absorbed into the cells of the body. Symptoms include frequent urination, lethargy, excessive
thirst, and hunger. The treatment includes changes in diet, oral medications, and in some cases,
daily injections of insulin.
The most common form of diabetes is Type II, It is sometimes called age-onset or adult-onset
diabetes, and this form of diabetes occurs most often in people who are overweight and who do

not exercise. Type II is considered a milder form of diabetes because of its slow onset
(sometimes developing over the course of several years) and because it usually can be
controlled with diet and oral medication. The consequences of uncontrolled and untreated Type
II diabetes, however, are the just as serious as those for Type I. This form is also called
noninsulin-dependent diabetes, a term that is somewhat misleading. Many people with Type II
diabetes can control the condition with diet and oral medications, however, insulin injections are
sometimes necessary if treatment with diet and oral medication is not working.
The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic
factors passed on in families) and environmental factors involved. Research has shown that
some people who develop diabetes have common genetic markers. In Type I diabetes, the
immune system, the bodys defense system against infection, is believed to be triggered by a
virus or another microorganism that destroys cells in the pancreas that produce insulin. In Type
II diabetes, age, obesity, and family history of diabetes play a role.
In Type II diabetes, the pancreas may produce enough insulin, however, cells have become
resistant to the insulin produced and it may not work as effectively. Symptoms of Type II
diabetes can begin so gradually that a person may not know that he or she has it. Early signs
are lethargy, extreme thirst, and frequent urination. Other symptoms may include sudden weight
loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not
unusual for Type II diabetes to be detected while a patient is seeing a doctor about another
health concern that is actually being caused by the yet undiagnosed diabetes.
Individuals who are at high risk of developing Type II diabetes mellitus include people who:

are obese (more than 20% above their ideal body weight)

have a relative with diabetes mellitus

belong to a high-risk ethnic population (African-American, Native American, Hispanic, or

Native Hawaiian)

have been diagnosed with gestational diabetes or have delivered a baby weighing more
than 9 lbs (4 kg)

have high blood pressure (140/90 mmHg or above)

have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a
triglyceride level greater than or equal to 250 mg/dL

have had impaired glucose tolerance or impaired fasting glucose on previous testing

Diabetes mellitus is a common chronic disease requiring lifelong behavioral and lifestyle
changes. It is best managed with a team approach to empower the client to successfully
manage the disease. As part of the team the, the nurse plans, organizes, and coordinates care
among the various health disciplines involved; provides care and education and promotes the
clients health and well-being. Diabetes is a major public health worldwide. Its complications
cause many devastating health problems.

OBJECTIVES
The study aims to analyze the factors that contributed to the development of actual and
potential health problems of a patient with Diffuse Toxic Goiter; Paroxysmal Atrial Fibrillation;
Diabetes mellitus type 2:
1. Identify the factors that led to the problem.
2.

ANATOMY AND PHYSIOLOGY:

Every cell in the human body needs energy in order to function. The bodys
primary energy source is glucose, a simple sugar resulting from the digestion
of foods containing carbohydrates (sugars and starches). Glucose from the
digested food circulates in the blood as a ready energy source for any cells
that need it. Insulin is a hormone or chemical produced by cells in the
pancreas, an organ located behind the stomach. Insulin bonds to a receptor
site on the outside of cell and acts like a key to open a doorway into the cell
through which glucose can enter. Some of the glucose can be converted to
concentrated energy sources like glycogen or fatty acids and saved for later
use. When there is not enough insulin produced or when the doorway no
longer recognizes the insulin key, glucose stays in the blood rather entering
the cells.

PATHOPHYSIOLOGY:

Patient
30 years old
Filipino
Male
Single
Roman catholic