NRSG353 Acute Care Nursing

Questions

1. Describe two (2) common classes of drugs used for patients with the identified condition including physiological effect of each class on the body.
a. This does not mean specific drugs but rather the class that these drugs belong to.

2. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient.

Case Study 2: Cushing’s syndrome

Ms Maureen Smith is a 24 year old female who presented to her GP for ongoing gastrointestinal bleeding, abdominal pain and fatigue which has been worsening, and was referred to the local hospital for further investigation. Maureen was diagnosed with rheumatoid arthritis (RA) when she was 15 years old, and has experienced multiple exacerbations of RA which have required the use of high dose corticosteroids. She is currently taking 50mg of prednisolone daily, and has been taking this dose since her last exacerbation 2 months ago. Maureen also has type 2 diabetes which is managed with metformin. She is currently studying nursing at university and works part-time at the local pizza restaurant.

On assessment, Maureenâ€™s vital signs are: PR 88 bpm; RR 18 bpm; BP 154/106 mmHg; Temp 36.9ÂºC: SpO2 99% on room air. She has a body mass index (BMI) of 28kg/m2 and the fat is mainly distributed around her abdominal area, as well as a hump between her shoulders. Maureenâ€™s husband notes that her face has become more round over the past few weeks. Her fasting BGL is 14.0mmol/L. Blood test results show low cortisol and ACTH levels, and high levels of low density lipoprotein cholesterol. She is awaiting a bone mineral density test this afternoon, and is currently collecting urine for a 24-hour cortisol level measurement.

Answers

Cushing’s syndrome

1. Signs and Symptoms of Cushing’s syndrome.

Obesity	Obesity is one of the symptoms of cushing’s disease whereby the BMI of the patient is 28 which is above the expected parameters. The patient also has unequal fat distributed at her abdomen and then hump. Due to the other underlying physiological mechanisms of the body associated with Cushing’s disease such as steroid hormones such as cortisol and Adreoncorticotrophic lead to unequal fat accumulation around the abdomen. This can also be due to insulin imbalances in the body due to excessive deposition of free fats in body organ and tissues.
High blood pressure	Increased blood pressure is another manifestation which is shown by a value of 154/106mmhg after a laboratory investigation was done. The rise in pressure is usually secondary to use of glucocorticoids medications as the patient reports to have used them for a period of time in the treatment of rheumatoid arthritis. (F, 2017)
High blood sugars	In Cushing’s disorder of the endocrine system, the levels of sugars in the blood tend to be usually high which is a consequence of the prolonged consumption of corticosteroids which lead to impairment of the physiological mechanism of insulin hormone secretion of which functions to facilitate convert the excess amount of body glucose to glycogen for storage in tissues and cells of the body. This conversion helps to prevent rising of blood glucose values which can cause diabetes. In this situation also, the metabolic mechanisms of glucose in the body is impaired. These instances lead to a rise in parameters of glucose in the blood which is usually dangerous to the cells, tissues and organs of the human body. This instance ends up being diagnosed as type II diabetes and can consequently cause hypertension (F, 2017)
Round face	Moon face is also another manifestation which is usually found in individuals with Cushing’s disease. It results from the unequal accumulation of the free fat of the body in neck and face regions of the body (“About Cushing’s”, 2017).
Fatigue and weakness of the body	Weakness of muscles and frequent episodes of feeling of fatigue are other manifestations of Cushing’s disorder. This is usually associated with the use of steroid drugs such as glucocorticoids as they have been used by the patient to treat Rheumatoid Arthritis. This Consumption of these glucocorticoids is associated a condition called myopathy. The drugs lead to hypertrophy of muscles of the body as they affect the type number II of the glycolytic fibers which function in fast twitching of the body mechanisms.
Abdominal bleeding and pain	Cushing’s syndrome leads to high susceptibility of the gastrointestinal system to other infections. The development of duodenal and stomach ulcers usually known as Cushing’s ulcer. This ulcer is associated with the bleeding in the gastrointestinal system hence leading to pain as it is evidenced by the presenting illness history and the chief complaints of the patient.

2. Strategies of nursing care applied to the patient within the first 24hours post- admission to the emergency department.

To be able to decide on the strategies of care to be used in the healthcare of the patient, it is critical for a nurse who is in charge consider the main patient complaints which made her come to the emergency department and take a thorough and detailed history. This should include history of the health condition the patient is presenting with which includes the onset, characteristics, duration which the illness has taken before the patient decided to seek medical assistance, the specific anatomical location of the illness of the patient, the factors which aggravate the illness, the factors which the patient feels that they relieve the condition and also any measures of treatment including medications, tests or any procedures which have been taken before in other centers which offer health care. He or she should also take history on any medical disorders or illnesses the patient has ever had before and also history concerning the family of the patient to ascertain any illness which might be across the family or the generation because there some health disorders which are usually inherited directed directly from the lineage family such as asthma, tuberculosis or sickle cell and also the history of any factors such as foods or medications to which the patient is allergic to. This detailed information will be used as a guideline by the nurse and other physicians to initiate care to this patient (Gulanick & Myers, 2013).

The patient in this case presented to the emergency section complaining of pain which is located in her abdomen, bleeding in the digestive tract and frequent episodes of fatigue and weakness of muscles. Based on this history, the nurse practitioner should initiate appropriate strategies of ensuring her comfort by relieving her of the pain by administering medications which relieves pain and give an educate to the patient more on the importance of the administered medications and the benefits of adhering to them, any impacts or effects which are related to the medications and any contraindications. This equips the patient with knowledge on the situation and ensures that patient is comfortable.

The nurse should monitor the vitals of the patient as she waits other procedures within the 24 hours. These vitals include pulse, oxygen saturation, temperature, respirations, blood pressure and a random test for glucose values in the blood. This will help in detecting any undesirable or unexpected changes in these vitals of which some of them might call for an immediate attention for example, very high levels of glucose should be stabilized back to normal values of the body. Explanation on the processes of urine collection should be clearly given to the patient. The nurse should also give clear instructions on how to collect urine sample because mid-stream urine is the best one. The nurse should explain to the patient the rationale behind collection of these urine samples quoting the normal and expected values and the abnormal values of cortisol and the impacts to her health. The nurse should fully equip her with adequate and quality knowledge on these procedural aspects. He or she should offer a reassurance to the concerning her health condition and also enlighten on the procedure of she is waiting undergo. This helps to alley the level of anxiety of the patient and ensures no cases of knowledge insufficiency concerning the case. It also makes have a proper understanding of the procedure hence improving on coordination and facilitating management of time during the procedure since the patient has adequate knowledge which was instilled prior to the procedure (Gulanick & Myers, 2013).

The nurse should offer an encouragement to the patient on resting due to complains of weakness of the body and feeling of fatigue. He or she can achieve this by establishing a plan which indicates periods which the patient should rest in order to relieve the fatigue feeling and restore comfort to the patient. The nurse should ensure implementation and adherence to this plan by the patient by ensuring silent and conducive environmental aspect which is suitable for sleeping or rest by the patient. On the other hand, nurse should encourage some moderate exercises or activities in order to prevent further complications which are related to immobility and also to boost the level of self esteem by the patient (Gulanick & Myers, 2013).

References

About Cushing’s. (2017). Living with Cushing’s Disease. Retrieved 11 May 2017, from https://cushieworld.wordpress.com/about/.

Arnaldi, G., Scandali, V. M., Trementino, L., Cardinaletti, M., Appolloni, G., & Boscaro, M. (2010). Pathophysiology of dyslipidemia in Cushing’s syndrome. Neuroendocrinology, 92(Suppl. 1), 86-90.

Chanson, P., & Salenave, S. (2010). Metabolic syndrome in Cushing’s syndrome. Neuroendocrinology, 92(Suppl. 1), 96-101.

Cicala, M. V., & Mantero, F. (2010). Hypertension in Cushing’s syndrome: from pathogenesis to treatment. Neuroendocrinology, 92(Suppl. 1), 44-49.

Edward, K. L., Rasmussen, B., & Munro, I. (2010). Nursing care of clients treated with atypical antipsychotics who have a risk of developing metabolic instability and/or type 2 diabetes. Archives of Psychiatric Nursing, 24(1), 46-53.

Feelders, R. A., Hofland, L. J., & De Herder, W. W. (2010). Medical treatment of Cushing’s syndrome: adrenal-blocking drugs and ketaconazole. Neuroendocrinology, 92(Suppl. 1), 111-115.

FF, C. (2017). Hypertension in Cushing’s syndrome: from pathogenesis to treatment. – PubMed – NCBI. Ncbi.nlm.nih.gov. Retrieved 11 May 2017, from https://www.ncbi.nlm.nih.gov/pubmed/20829617

Gulanick, M., & Myers, J. L. (2013). Nursing care plans: nursing diagnosis and intervention. Elsevier Health Sciences.

Gupta, Y., & Gupta, A. (2017). Glucocorticoid-induced myopathy: Pathophysiology, diagnosis, and treatment. Retrieved 11 May 2017, from

Pecori Giraldi, F. (2009). Recent challenges in the diagnosis of Cushing’s syndrome. Hormone Research in Paediatrics, 71(Suppl. 1), 123-127.

Pivonello, R., De Leo, M., Vitale, P., Cozzolino, A., Simeoli, C., De Martino, M. C., … & Colao, A. (2010). Pathophysiology of diabetes mellitus in Cushing’s syndrome. Neuroendocrinology, 92(Suppl. 1), 77-81.

Pivonello, R., De Martino, M. C., De Leo, M., Lombardi, G., & Colao, A. (2008). Cushing’s syndrome. Endocrinology and metabolism clinics of North America, 37(1), 135-149.

Syndrome?, W. (2017). Why is weight gain a symptom of Cushing’s Syndrome?. Biology.stackexchange.com. Retrieved 11 May 2017, from https://biology.stackexchange.com/questions/10779/why-is-weight-gain-a-symptom-of-cushings-syndrome

Trementino, L., Arnaldi, G., Appolloni, G., Daidone, V., Scaroni, C., Casonato, A., & Boscaro, M. (2010). Coagulopathy in Cushing’s syndrome. Neuroendocrinology, 92(Suppl. 1), 55-59.

Get a 10 % discount on an order above $ 100
Use the following coupon code :
SAVE10

Order Now