Nursing Case Study on Exogenous Cushing’s Syndrome
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This nursing case study discusses the causes, risk factors, symptoms, and impact of Exogenous Cushing’s Syndrome on the patient and their family. It also includes a nursing care plan for a patient with Exogenous Cushing’s Syndrome.
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Running head: NURSING CASE STUDY1 Nursing Case Study Student’s name Institutional affiliation
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NURSING CASE STUDY2 Nursing Case Study Disease, causes, incidence and risk factors Exogenous Cushing’s syndrome is a condition that occurs when the glands secrete other ACTH hormone, and the cortisol hormone gets secreted in excess. The leading causes of Exogenous Cushing’s syndrome are surplus levels of the cortisol hormone which get formed in the adrenal glands.The hormones play range of performances in the body like regulating the blood pressure and also keeping the system of ordinary cardiovascular. The cortisol hormone also assists a person to control the method of converting fats, proteins, and carbohydrates and also responding to stress (Nieman et al., 2015). Exogenous Cushing’s syndrome has risk factors that get associated with lack of early treatment. The risk factors include hypertension, frequent abnormal infections, type 2 diabetes, bone loss and loss of strength and mass. Maureen Smith, a 24 year of age is diagnosed to have Exogenous Cushing’s syndrome after a lengthy assessment.Before the testing of the diseases, she got presented in the hospital due to the enduring abdominal pains, gastrointestinal bleeding, and fatigue. She reported that the symptoms have been worsening and her GP sent her to another hospital for more tests. In the local hospital, the doctor conducted her past health history and found out she got diagnosed with RA (Rheumatoid Arthritis) at the age of 15. The report also showed that she had multiple exacerbations of RA which she used the corticosteroids dosage to treat. Currently, Maureen is using prednisolone every day and has used it for the last two months since her previous exacerbation. Maureen is also diagnosed with type 2 diabetes, and she uses metformin to manage the disease. Although the results show that the ACTH levels and cortisol are low, Maureen’s husband reports that in the past weeks her face has been getting rounder every time. Impact of Exogenous Cushing’s syndrome disease on the patient and their family
NURSING CASE STUDY3 The primary psychiatric complaints that get perceived in patients with Exogenous Cushing’s syndrome include depression which comprises of affective, cognitive, mood, and vegetative functions. Some patients may also have anxiety and mania although the recession is a significant impact on a patient with Exogenous Cushing’s syndrome. The effects of the Exogenous Cushing’s syndrome affect not only the patients but also the family members. Family members of patients suffering from the Cushing syndrome mainly suffer from emotional distress. Most family members of the patient experience frustration, worry, and stress (Valassi et al., 2017). The disease also affects the daily activities of the household since they have to spare extra time to attend to the sick (Li, Chung, Patel, & Papademetriou, 2018). This interrupts the day-to-day operations and even their work. Some family members have to quit their jobs to ensure that the ill individual is well-taken care. The expenditure costs also increases due to the medications expense, and this affects the members of the family (Nieman et al., 2015). A report shows that family relationships are also widely changed since they have to decide on who to pay or who to spend time with the sick individual. Additionally, exogenous Cushing’s syndrome has risk factors that get associated with lack of early treatment. The risk factors include hypertension, frequent abnormal infections, type 2 diabetes, bone loss and loss of strength and mass. Common signs and symptoms of the Exogenous Cushing’s syndrome and the underlying pathophysiology of each The cortisol hormone cause symptoms like weight gain around the waist and trunk, hypertension, and type 2 diabetes. The disease deteriorates the immune system and causes disorders like depression, anxiety and mood change to the patient. The most common symptoms of Exogenous Cushing’s syndrome weight gain, diabetes, and hypertension where each of them has pathophysiology.
NURSING CASE STUDY4 Signs and symptomsPathophysiology Weight gainWeight gain gets connected with increased mortality and morbidity because of cardiovascular, dyslipidemia, blood pressure and diabetes. The occurrence of weight gain and diseases that are related to obesity is generally increasing in the world which is risky. Obesity is a worldwide issue that gets associated with factors like metabolic, environmental, and genetic and their relation on how they control the body weight (Kotchen, 2010). Imbalances of these factors cause the effects that lead to weight gain. HypertensionThe primary reason why hypertension gets connected to mortality and morbidity is that it leads to kidney disease and cardiovascular (Binka & Brady, 2019). Latent mechanisms that link the blood pressure and weight gain are factors like neuroendocrine imbalances, vascular dysfunction, metabolic, sodium retention and inflammatory responses (Kotchen, 2010). The adipose tissues develop to be resistant to leptin and insulin which is the location for the secretion of hormones and molecules (Thang et al., 2018). Research also shows that microbiome gut is essential to modulate the above mechanisms for a patient suffering from the exogenous Cushing syndrome. Type 2 DiabetesThe type 2 diabetes is caused by a relative shortage of insulin which makes the body to lack the aptitude for secreting adequate
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NURSING CASE STUDY5 insulin and meeting the requirements of the body. Outlying insulin resistance means that there is no low blood sugar or hypoglycemia despite the blood levels of insulin being high (Kotchen, 2010). This condition gets caused by the changes in the receptors of insulin that bring the performances if the insulin. The leading cause of insulin resistance is obesity wherein most circumstance the patients required to take insulin when the medicines fail to stimulate the release of insulin. Pharmacodynamics & pharmacokinetics one common class of Exogenous Cushing’s syndromedrug relevant to the chosen patient with Exogenous Cushing’s syndrome The corticosteroid medications used to treat exogenous Cushing syndrome have pharmacodynamics & pharmacokinetics in an individual. Preferably, the sooner the patients begin treatment of exogenous Cushing syndrome, the outcomes have a high probability of being better. The outlook of an individual depends on the particular case and treatment given to an individual. Untreated exogenous Cushing syndrome may cause pavement organ damage, or it will get fatal due to the therapy attempted at a late stage. The role of corticosteroid medications can cause the development of Cushing syndrome to an individual if they use them for a long time or in a high dosage (Ren, Sowers, & Zhang, 2018). In case of a high dosage or overusing, the medications have the same impacts that are caused by excess secreted cortisol in the body (Gadde, Martin, Berthoud, & Heymsfield, 2018). Initially, the drugs are essential to treat disorders like the RA (rheumatoid arthritis), inflammatory diseases, asthma, and lupus. The medications also prevent the body from resisting an organ which is transplanted (Nieman et al.,
NURSING CASE STUDY6 2015. However, the corticosteroid dosages needed to treat the disorders are higher than the average amount that the body requires cortisol. This means that the medications can cause significant side effects that can occur in the process. The corticosteroid medications that are injected directly to the patient have the aptitude to cause a Cushing syndrome since at the time they repeat injection for a symptom like a pain in the joints or back pain. Although the injected corticosteroid is not likely to cause the syndrome, the excess usage of the dosage may cause some patient to develop the exogenous Cushing syndrome. A nursing care plan for a patient with Exogenous Cushing’s syndrome has just arrived on the ward from ED. Goals The desired outcome for a care plan for Smith is to control the symptoms, maintain the hypertension and the level of insulin with the required range. In the case of Maureen Smith, the syndrome might have different causes and the nurses need to have adequate planning care to assist her (Aghamohammadzadeh, & Heagerty, 2012). Interventions The ABCDE (airway, breathing, circulation, disability, exposure) method will be an effective way to help Smith in treating the Cushing syndrome in the first eight hours after arriving in the ward. The approach will immediately assess and find the best method to use for the treatment. The technique is pertinent in emergencies, and it is used at least within eight hours after the patient has arrived (Aghamohammadzadeh, & Heagerty, 2012). Rationales
NURSING CASE STUDY7 Experts acknowledge the methodology since it has a high percentage probability of improving the health of the patients (Thim et al., 2012). The nurses should ensure that they have their gloves and aprons and also first look at the patient’s condition. The following is an ABCDE nursing approach for Smith who is suffering from Cushing syndrome and has just arrived in the hospital. The best approach for smith is comprised of A B and E in the methodology which is appropriate for the Cushing syndrome in the first eight hours of being in the hospital. Approach (ABCDE)DescriptionAdditional information Airway (A)In this stage, the nurses ensure airway is patent and that the patient gets immediate help. The nurses should also check the immediate signs like swelling and vomiting. The goals of this stage are to avoid risks like brain damage, cardiac arrest, kidney failure or death(Thim et al., 2012). . 1.The nurses will check if Smith has any signs for the obstruction of the airway like swelling 2.If there is any obstruction it will be treated like an emergency 3.Nurses will then provide oxygen to the patient at a high concentration(Thim et al., 2012).
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NURSING CASE STUDY8 Breathing (B)After the first assessment, the nurses will ensure that the breathing system is adequate and treat the conditions that are life-threatening like severe asthma or massive haemothorax. In this stage the nurses also evaluate the analysis of blood gas to check if the levels of carbon dioxide and oxygen in the blood. 1.Nurses will check the typical signs of the distress in a respiratory system like sweating 2.Measure the rate of the respiratory system 3.Assess the pattern and depth of each breath (Thim et al., 2012). Exposure (E)In this stage the nurses will examine full disclosure of Smith’ body that may be required(Thim et al., 2012). The nurses will also find any appropriate clues to explain the condition and how to treat. 1.Check Smith’s clinical history 2.Assess her charts and notes 3.Review the laboratory results 4.Come up with the right methodology of treatment for Smith
NURSING CASE STUDY9 References Aghamohammadzadeh, R., & Heagerty, A. M. (2012). Obesity-related hypertension: epidemiology, pathophysiology, treatments, and the contribution of perivascular adipose tissue.Annals of medicine,44(sup1), S74-S84. Binka, E., & Brady, T. M. (2019). Real-World Strategies to Treat Hypertension Associated with Pediatric Obesity.Current hypertension reports,21(2), 18. Gadde, K. M., Martin, C. K., Berthoud, H. R., & Heymsfield, S. B. (2018). Obesity: pathophysiology and management.Journal of the American College of Cardiology,71(1), 69-84. Kotchen, T. A. (2010). Obesity-related hypertension: epidemiology, pathophysiology, and clinical management.American journal of hypertension,23(11), 1170-1178. Lavie, C. J., Arena, R., Alpert, M. A., Milani, R. V., & Ventura, H. O. (2018). Management of cardiovascular diseases in patients with obesity.Nature Reviews Cardiology,15(1), 45. Li, P., Chung, A. K., Patel, S. S., & Papademetriou, V. (2018). Hypertension Management in African Americans: The AASK.Management of Hypertension: Current Practice and the Application of Landmark Trials, 145. Nieman, L. K., Biller, B. M., Findling, J. W., Murad, M. H., Newell-Price, J., Savage, M. O., & Tabarin, A. (2015). Treatment of Cushing's syndrome: an endocrine society clinical practice guideline.The Journal of Clinical Endocrinology & Metabolism,100(8), 2807- 2831. Ren, J., Sowers, J. R., & Zhang, Y. (2018). Metabolic stress, autophagy, and cardiovascular aging: from pathophysiology to therapeutics.Trends in Endocrinology & Metabolism.
NURSING CASE STUDY10 Thang, C., Whitley, M., Izadpanah, N., DeUgarte, D., & Slusser, W. (2018). Retrospective Review of Comorbid Conditions in a Multidisciplinary Pediatric Weight Management Clinic.Clinical pediatrics,57(7), 815-820. Thim, T., Krarup, N. H. V., Grove, E. L., Rohde, C. V., & Løfgren, B. (2012). Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach.International journal of general medicine,5, 117. Valassi, E., Franz, H., Brue, T., Feelders, R. A., Netea-Maier, R., Tsagarakis, S., ... & Komerdus, I. (2017). Diagnostic tests for Cushing's syndrome differ from published guidelines: data from ERCUSYN.European journal of endocrinology,176(5), 613-624.