Case Study Cushing\'s Diseasse PDF

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Case Study: Addison’s Disease NUR 3219C Keiser University

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1) Differentiate between Cushing’s syndrome and Cushing’s disease. Cortisol is a hormone normally made by the adrenal glands and is necessary for life. Cushing's syndrome refers to the condition caused by excess cortisol in the body, regardless of the cause. When Cushing's syndrome is caused by a pituitary tumor, it is called Cushing's disease. 2) Your assessment includes the following findings. Determine whether the findings are attributable to J.S.’s COPD or possible Cushing’s syndrome. Place an “L” besides the symptoms consistent with COPD and a “C” next to those consistent with Cushing’s syndrome. 1. L 2. C 3. L 4. L 5. C 6. C 7. C 8. L 9. C 3) You inform the physician of J.S.’s assessment. The physician believes J.S. has developed Cushing’s syndrome and decides to change his prescription from dexamethasone to prednisone given on alternate days. Explain the rationale for this change. These medications will be administered on alternate days because of their overall effects. The dexamethasone will have less adrenal suppression and the prednisone will have less side effects. 4) Identify possible consequences of suddenly stopping the dexamethasone therapy. After taking steroid medications for some time, the body stops producing its own naturally. If the patient were to stop taking the medication suddenly, they might experience severe fatigue, weakness, body aches, and joint pain. It could take months before the body began to make these naturally again. 5) Cushing’s syndrome can affect memory. Patients can easily forget what medications have been taken, especially when there are several different drugs. List at least three ways you can help J.S. remember to take his pills as prescribed. J.S. could set a reminder on his smartphone to remind him to take which pill and when, he could use a pill organizer to add greater organization to the process, and he could keep a journal of his medication administration noting when he took or missed a dose. 6) J.S. states that his appetite has increased but he is losing weight. H reports trying to eat, but he gets short of breath and cannot eat any more. How would you address this problem? I would advise J.S. to try to eat smaller meals more frequently throughout the day, I would suggest that he wait until he is well rested before attempting to eat, and maybe suggest that he wait until he is finished eating before drinking. 7) You advise J.S. to take his prednisone in the morning with food. You ask him a series of questions related to possible gastric discomfort, vision, and joint pain. Discuss the rationale for your line of questioning.

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A person taking prednisone should be aware that possible side effects include joint pain, vision, and upset stomach. If these effects are experienced, the patient’s dose may need to be adjusted. 8) Differentiate between glucocorticoid and mineralocorticoid effects of prednisone. The difference between glucocorticoids and mineralocorticoids is that glucocorticoids have a high affinity for cortisol and mineralocorticoids have a high affinity for aldosterone and cortisol. 9) How would your assessment change if J.S. were taking a glucocorticoid that also has significant mineralocorticoid activity? I would assess the patient for signs and symptoms of both hypotension and hypertension. I would also be sure to track the patient’s potassium levels because he has been prescribed both this steroid and Lasix. 10) Review J.S.’s list of medications. Based on what you know about the side effects of loop diuretics and steroids, discuss the potential problem of administering these in combination with digoxin. The greatest risks that come with administering these drugs together would be digoxin toxicity, electrolyte imbalances, and cardiac arrythmias. Hypokalemia is also a great concern as both digoxin and loop diuretics waste potassium. 11) Realizing that patients like J.S. are susceptible to all types of infections, you write guidelines to reduce the risk of infection. Identify four major points that these guidelines will include. The four points that I would emphasize in J.S.’s teaching would be effective hand washing, avoidance of large crowds and sick people, the maintenance of clean surroundings, and effective washing of all fruits and vegetables. 12) Besides measure to reduce the risk of infection, what other information would you want to stress to J.S. at your visit? A, B, C, D

References Ignatavicius, D. D., Workman, L. M., & Rebar, C. R. (2018). care, Medical Surgical Nursing: Concepts for interprofessional collaborative (Vol. 1). St. Louis, Missouri, USA: Elsevier.

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