Bachelor Nursing Assignment

This document is a Bachelor Nursing Assignment that discusses the disease, causes, incidence, and risk factors of Exogenous Cushing’s Syndrome on the patient and their family. It also explains the impact of the disease and discusses three common signs and symptoms of Exogenous Cushing’s Syndrome along with their underlying pathophysiology. Furthermore, it discusses the pharmacodynamics and pharmacokinetics of one common class of drug relevant to Ms Maureen Smith. Lastly, it develops a nursing care plan for the chosen patient who has just arrived on the ward.

Running head: BACHELOR NURSING ASSIGNMENT 1
Bachelor Nursing Assignment
Student’s Name
Professor’s Name
Institution Affiliation
Date

BACHELOR NURSING ASSIGNMENT 2
Q1. Outline the Disease, Causes, Incidence and Risk Factors. Discuss the Impact of the
Exogenous Cushing’s Syndrome on the Patient and Their Family
Ms Maurine Smith is suffering from Exogenous Cushing's Syndrome. According to
Jarvis et al. (2016). The disease is caused by prolonged exposure to cortisol hormone that is
overproduced from the adrenal glands. Besides, the cortisol may be produced by use of cortisol-
like medications such as prednisolone or tumour that activate the adrenal glands to overproduce
cortisol hormone. On the other hand, Exogenous Cushing’s Syndrome may be as a result of after
medication of diseases such as pituitary adenoma. Other various tumours also cause Cushing’s
syndrome whereby some are associated with inherited disorders such as Carney complex.
Moreover, Cushing’s syndrome risk of infection may be increased by other factors such
as long term taking of corticosteroid medications and type 2 diabetes and poor regulation of
blood glucose levels that may lead to hypertension and blood sugar. Also, Nursing and
Midwifery Board of Australia (2016) illustrates that pituitary gland tumour, ectopic ACTH-
secreting tumour which is an organ that causes abnormality in the production of ACTH hormone
that is responsible for cortisol regulation and primary adrenal gland disease consist of other
significant factors responsible for Exogenous Cushing's Syndrome infections.
A research conducted by the Nursing and Midwifery Board of Australia (2018) illustrates
that Cushing's syndrome is sporadic with an incidence of less than one case per year over a
million people. However, pituitary gland infections are in 1 out of the six individuals. Although
researches show a low incidence of exogenous Cushing's syndrome, there are more patients with
uncontrolled diabetes mellitus, obesity, and hypertension.
According to Berman (2014), avoidance in the treatment of exogenous Cushing's
syndrome may lead to other effects such as bone loss. Loss of bones reduces the Body Mass

BACHELOR NURSING ASSIGNMENT 3
Index (BMI) of an individual to abnormal. Besides, exogenous Cushing’s syndrome may lead to
bone fractures as a result of the general body weakness and muscle loss. Consequently,
exogenous Cushing’s syndrome disease leads to high blood pressure and type 2 diabetes
infections that put the patient at high risk of other associated infections (Farrell and Dempsey,
2016). Lastly, the disease results in effects such as the enlargement of the pituitary tumour of the
patient and kidney stone a condition that causes instability in glucose balance within the patient's
body. By interfering with the pituitary glands due to exogenous Cushing's syndrome, other
hormone production within the body also interferes.
Extensive research conducted by Berman (2017) indicates that the patients suffering from
exogenous Cushing’s syndrome suffered from emotional, mental and physical effects. Besides,
the analysis illustrates that the results were extended to family members as well as their
performance at work and school. For instance, Maureen' s work at the restaurant can be
significantly affected by the disease she is suffering from since she cannot perform the tasks
assigned correctly while having fatigue or depression. On the other hand, while seeking for
medication, it means that Maureen will stop attending the nursing classes regularly. The family
members such as the husband should also incur the costs of treatment of his spouse and as well
pay attention to the patient while abandoning other tasks he might be having.
Q2. Discuss Three (3) Common Signs and Symptoms of Exogenous Cushing’s Syndrome
and Explain the Underlying Pathophysiology of Each
Symptom Underlying Pathophysiology
1. The patient experiences weight gain
around the trunk and waist. Besides,
there is also the loss of fats in the legs
1. Fats accumulated in the mid-section of
the patient's face leads to a rounded
face or a moon-shaped face.

BACHELOR NURSING ASSIGNMENT 4
and arms. The lost fats are deposited
in the mid-section of the patient’s
body (McCance and Huether, 2014).
Furthermore, fat deposits also
experienced in the shoulders and the
back causing a buffalo hump.
Similarly, fat accumulation may lead
to narrowing of veins and arteries, a
condition that limits efficient blood
flow leading to increased blood
pressure together with sodium
concentrations and low water
retention.
2. The patient’s pituitary gland secretes
too much ACTH hormone. ACTH
hormone in excess corresponds to
overproduction of excess cortisol
hormone from the adrenal gland that is
responsible for stress.
2. The patient may experience headache
and anxiety. Besides the patient may
experience increased depression and
similarly dysfunction in cognitive
(McCance and Huether, 2014). Stress
also puts the patient at high risk of
other disease infection such as
hypertension. Thus, low water
concentrations, sodium and potassium
accumulations that increase the blood
pressure of the patient. Increase in the
patient's blood pressure makes even
movements difficult therefore easy fat

BACHELOR NURSING ASSIGNMENT 5
accumulation within the patient's body
which leads to the development of
other related abnormalities.
3. There is a weakened immune system
of the patient infected with Exogenous
Cushing’s Syndrome. The weak
immune system is further extended to
mood disorders such as anxiety and
depressions.
3. Other diseases such as diabetes and
RA easily attack the patient infected
with the disease. Among the other
illnesses that the patient is at high risk
to suffer from including the thinning
of the skin that bruises easily, injuries
that occur on the skin that are not easy
to heal, bone loss and muscle
weakness (Martini, Nath, and
Bartholomew, 2017). As a result of
muscle weaknesses, it becomes
difficult for the patient to make
movements easily and therefore
demanding patient support when
conducting the nursing care plans. On
the other hand, the bruised skins may
lead to overbreeding that leads to loss
of body fluids and causing open
wounds that are at risk of other
associated infections.

BACHELOR NURSING ASSIGNMENT 6
Q3. Discuss the Pharmacodynamics & Pharmacokinetics of One (1) Common Class of
Drug Relevant to Ms Maureen Smith
Exogenous Cushing’s syndrome can be treated using various options that include surgery,
reducing corticosteroid use, medications, and radiation therapy. However, according to Tiziani
(2017), medicines as a means of treating exogenous Cushing's syndrome is associated with
different pharmacodynamics and pharmacokinetics. Medications control cortisol production
especially when surgery and radiation therapy fail to work.
Furthermore, medications improve signs and symptoms before surgery, thus minimising surgical
risks. Besides Tiziani (2017) illustrates that medications help control excessive production of
cortisol from the adrenal glands such as the Nizoral, mitotane, and metyrapone. Also, other drugs
such as Mifepristone help in the treatment of patients with two diabetes and blocking of cortisol
effects on the patient’s tissues.
However, the above-stated medications are associated with side effects such as fatigue,
muscle aches, vomiting, nausea, swelling, low potassium, and high blood pressure. Other current
medications include the use of pasireotide that helps in decreasing ACTH production from a
pituitary tumour more especially when surgery is impossible (Tiziani, 2017). Like other
medications, they are associated with side effects such as diarrhoea, abdominal pain, and nausea.

BACHELOR NURSING ASSIGNMENT 7
Q4. In Order of Priority, Develop A Nursing Care Plan for Your Chosen Patient Who Has
Just Arrived on The Ward from Ed. Nursing Care Plan Goals, Interventions, and
Rationales Must Relate to the First 8 Hours Post Ward Admission
Assessment Nursing
Diagnosis
Patient
Outcomes Interventions
Rationale Evaluation
of Outcomes
Objective Data:
-Abdominal pain
and fatigue which
has been
worsening.
-Gastrointestinal
bleeding
-PR 88 bpm
-RR 18 bpm
- BP 154/106
mmHg
-Temp 36.9˚ C.
-SpO2 99% on
#1: Excess fluid
volume
associated with
a hump between
her shoulders.
#2: Body image
disturbance,
associated with
physical
changes
secondary to
Cushing’s
syndrome
#3: Risk for
Patient will:
1. Regain the
normal body
fluid balance
and avoid
gastrointestinal
bleeding.
2. Remain free
from injury.
3. Remain free
from other
infections.
4. Verbalise
understanding of
1. Weigh the
patient’s Body
Mass Index
using the same
scale.
2. Monitor the
vital signs
especially BP
and RR
(Tiziani, 2017)
3. Ask the
patient to
elevate feet
while sited
1. Due to the
expanded
fluid.
Cushing's
syndrome may
result in
increased
pressure with
sodium and
water retention
2. Elevating
feet when
sitting down
reduces fluid
accumulation
1. Gastrointestinal
with no
bleedings.
2. Blood pressure
decreased (Perrin,
2014).
3. Uniform
distribution of
fats with no hump
between the
patient’s
shoulders.
4. The wound did
not have signs of

BACHELOR NURSING ASSIGNMENT 8
room air.
-Body Mass Index
(BMI) of 28kg/m₂
-Fat distributed
around her
abdominal area.
-Hump between her
shoulders.
injury,
associated with
generalised
weakness and
fatigue.
#4: Risk of
infection,
associated with
an impaired
immune
response due to
RA and type 2
diabetes
the physical
effects of the
disease process
and realistic
expectations of
desired changes
in appearance.
5. Normal face
shape and
uniform
distribution of
fats within the
patient’s body
4. Develop a
schedule for
the rest of the
activity periods
5. Lighting
should be
adequate in the
room and
ensure the
patients wear
shoes and
glasses when
getting out of
bed (Farrell
and Dempsey,
2014)
6. If in
agreement
provide a
private room
and restrict
parents and
in the lower
extremities
added infection.
5. Patient’s face
regaining the
original shape
with fewer
infections.
Subjective Data:
-Patient’s husband
noted the patient’s
face becoming
round over the past
few weeks.
-Patient’s fasting
BGL is
14.0mmol/L
-Blood tests results
show low cortisol
and ACTH levels
3. Excess
cortisol will
increase blood
pressure as a
result of
sodium and
water retention
(McKenna and
Lim, 2014).

BACHELOR NURSING ASSIGNMENT 9
-High levels of
low-density
lipoprotein
cholesterol.
teachers at the
moment.
7. When
providing care,
use strict and
surgical
asepsis.
8. Time should
be created for
the discussion
regarding the
disease and
treatment.
Identify the
successful
coping
mechanisms
used in the past
and encourage
verbalization.
9. For every 2-
4 hours,
Medical Diagnoses:
-She was diagnosed
with rheumatoid
arthritis (RA) at 15
years old.
- She has
experienced
multiple
exacerbations of
RA and is currently
taking 50mg of
prednisolone.
-Patient has two
types of diabetes
that are managed
with metformin.

BACHELOR NURSING ASSIGNMENT 10
coughing,
turning and
deep breathing
incentive
spirometry.
References

BACHELOR NURSING ASSIGNMENT 11
Berman, A., Snyder, S., Kozier, B., Erb, G., Levett-Jones, T., Dwyer, T., et al. (2014). Kozier
and Erb’s fundamentals of nursing. (3rd Australian ed.) French’s Forest, NSW: Pearson
Australia.
Berman, A., Snyder, S., Kozier, B., Erb, G., Levett-Jones, T., Dwyer, T., et al. (2017). Kozier
and Erb’s fundamentals of nursing. (4th Australian ed.) French’s Forest, NSW: Pearson
Australia.
Farrell, M., & Dempsey, J. (2014). Smeltzer and Bare’s textbook of medical-surgical nursing
(3rd Australian and New Zealand ed.). Sydney: Wolters Kluwer Health/ Lippincott
Williams & Wilkins.
Farrell, M., & Dempsey, J. (2016). Smeltzer and Bare’s textbook of medical-surgical nursing
(4th Australian and New Zealand ed.). Sydney: Wolters Kluwer Health/ Lippincott
Williams & Wilkins.
Jarvis, C. Australian Adapting Editors Forbes, H., Watt, E. (2016). Physical Examination &
Health Assessment (2nd Australian and New Zealand ed.). Chatswood, NSW: Elsevier/
Saunders
Martini F., Nath J & Bartholomew E. (2017). Fundamentals of anatomy and physiology. 11th
ed). San Francisco: Pearson.
McCance, K., & Huether, S. (2014). Pathophysiology: The biologic basis for disease in adults
and children (7th ed.). St. Louis: Elsevier/Mosby.
McKenna, L. & Lim, A. G. (2014). Pharmacology for nursing and midwifery. (2nd Australian
and New Zealand Edition). Broadway: Lippincott Williams & Wilkins

BACHELOR NURSING ASSIGNMENT 12
Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice.
Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements/Professional-standards.aspx
Nursing and Midwifery Board of Australia. (2018). Professional Standards. Retrieved from
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx
Perrin, R. (2014) Pocket guide to APA Style (5Massachusetts: Wadsworth/ Cengage Learning.
(Highly recommended). the ed.) Boston
Tiziani, A. (2017). Harvard’s nursing guide to drugs. (10th ed.). Sydney: Mosby/Elsevier