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(PDF) Cushing's syndrome Disease

   

Added on  2021-04-24

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Running head: CUSHING’S SYNDROME 1CRITICAL CARE NURSING-CUSHING’S SYNDROME-SUSAN SUMMERS CASESTUDYStudent’s NameUniversity AffiliationCourseDate

CUSHING’S SYNDROME 2This essay focuses on Susan Summers, a female client aged 40 years with three children all aged below ten years. She works in a supermarket as a casual at night. She takes wine in order to adapt to her. She had been diagnosed with type 2 diabetes and obesity with 90kg which corresponds to a Body Mass Index of 35kg/m. She was admitted for laparoscopic right adrenalectomy following noticeable changes in her general appearance because of Cushing’s syndrome which resulted from a benign tumor on the right adrenal gland. Cushing’s syndrome is a medical condition associated with excessive levels of cortisol hormone. Susan had to undergo right adrenalectomy under general anesthesia. Adrenalectomy refers to the surgical removal of the adrenal grand. Susan stayed in the Post-anesthetic recovery room (PARU) for two hours and then taken to the ward. She had an indwelling Urinary Catheter and a record of observations. The essay will focus on causes and pathophysiology of Cushing’s syndrome. It will also discuss the pathophysiology behind the deterioration of Susan’s condition post operation and the appropriate nursing interventions. Lastly, the essay will touch on some of the members of the interdisciplinary health care team.Cushing’s syndrome is associated with prolonged or excessive exposure of body tissues to excessive levels of cortisol hormone which is produced by the adrenal glands. Adrenal gland also produce other hormones such as epinephrine, dehydroepiandrosterone and norepinephrine. Cortisol hormone is responsible for regulation of blood pressure, counteraction of allergies and inflammation, maintaining stress resistance and normal functioning of the cardiovascular system.A tumor on the adrenal gland may lead to excessive production of cortisol hormone. It can also result from excessive use of corticosteroids such as prednisone (Nieman et al, 2015 High levels of cortisol hormone are associated with factors such as stress, alcoholism, malnutrition, depression and emotional stress. A tumor on the pituitary gland may lead to

CUSHING’S SYNDROME 3excessive release of adrenocorticotropic hormone (ACTH) which consequently leads to increased release of cortisol from the adrenal gland cortex. A primary disease of the adrenal gland can also lead to excessive production of cortisol leading to Cushing’s syndrome. Heredity is also a contributing factor to Cushing’s syndrome but rarely. High levels of cortisol leads to hypertension, hyperglycemia, insulin resistance, obesity, weight gain, type 2 diabetes and fat deposition on the neck, face and belly (Craft et al, 2015).After making a diagnosing Cushing’s syndrome, Susan had to go for laparoscopic adrenalectomy of the right adrenal gland based on her clinical presentation, location and size of the tumor (Maestre-Maderuelo et al, 2013). After operation, Susan was taken to post-anesthetic recovery unit (PARU) for recovery from the general anesthesia. At post anesthetic recovery unit (PARU) she was put under close monitoring for any signs of deterioration and complications. She was later taken to the ward for management as she awaited discharge after two days. Her observations in the ward include: Blood pressure-160/90mmHg, Temperature-35.0c, respirations-30breaths per minute, pain score-0/10, pulse-128beats per minute and an Indwelling Urinary Catheter indicating 5mls of urine for 1hour (Maestre-Maderuelo et al, 2013).Operation under general anesthesia could have led to hypothermia –temperature of 35.0c compared to normal of (36.5-37.0c). During general anesthesia, the normal mechanisms of thermoregulation in the body are inhibited leading to low body temperature (Aksu et al, 2014). Postoperative hypothermia is also associated with female gender, old age, emergency surgery and amount of blood loss during the surgical procedure. Prolonged anesthetic period or surgery, technique used in anesthesia and room temperature can also lead to hypothermia. Postoperative hypothermia can lead to infection of the surgical site, blood transfusions, discomfort, pressure sores and mortality (Aksu et al, 2014).

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