NRSG353 Assessment Task 1 – Case Study

Read about a case study on NRSG353 Assessment Task 1, its underlying pathophysiology, signs and symptoms, pharmacodynamics, pharmacokinetics, and interventions. The patient is diagnosed with rheumatoid arthritis and experienced an exacerbation of the same two months prior and also suffering from type 2 diabetes. The patient is suffering from Exogenous Cushing syndrome, which is caused by excess level of cortisol hormone when roused by Adrenocorticotropic hormone. Get expert solutions for your assignments at Desklib.

Running Head: NRSG353 ASSESSMENT TASK 1 –CASE STUDY
NRSG353 ASSESSMENT TASK 1 –CASE STUDY
Name of the student:
Name of the university:
Author note:

1NRSG353 ASSESSMENT TASK 1 –CASE STUDY
Question 1-
Ms Maureen was diagnosed with rheumatoid arthritis and experienced an
exacerbation of same two months prior and also suffering from type 2 diabetes. There are
some side effects observed such as, abdominal pain, weakness and fatigue (Nee & Fried,
2018). Considering the symptoms it is concluded that she is suffering from Exogenous
Cushing syndrome, which is caused by excess level of cortisol hormone when roused by
Adrenocorticotropic hormone. Adrenocorticotropic hormone is secreted from anterior
pituitary gland as a reaction to CRH hormone from the hypothalamus (Isidori, 2015).
Cortisol is produced by the adrenal glands and helps in regulating blood pressure and
cardiovascular system, but if the level of cortisol increases it can cause Exogenous Cushing
syndrome (Isidori, 2015). It is caused by the intake of corticosteroids hormone (Ferraù &
Korbonits, 2018). Hence in the case of Ms Maureen, it is caused by the use of prednisolone
and other symptoms such as abdominal pain and fatigue are caused by the medication of
metformin due to lactic acidosis (Nee & Fried, 2018).
Cushing syndrome is common in females than in males, especially in the age between
20 to 60 years. About 2.4 million cases of exogenous Cushing Syndrome is reported every
year in Australia. The ratio between the men and women affected with Cushing Syndrome is
1 to 3 (Barber, 2017).
Cushing syndrome usually rare, but is more prevalent in case of women. One of the
risk factor involved in causing Exogenous Cushing syndrome is obesity. Type 2 diabetes and
high BP are also considered as risk factor Excessive administration of glucocorticoid drugs
can also increases the risk of the diseases, as it increases the amount of cortisol in the body.
People with obesity have increased level of cortisol into their body which causes Cushing
syndrome (Drey, et al., 2017). Patient suffering from diabetes have high blood glucose level

2NRSG353 ASSESSMENT TASK 1 –CASE STUDY
which increases the level of cortisol (Nathan, 2015). In patient with hypertension, blood
pressure increases which increases the level of cortisol (Sanchez-de-la-Torre, et al., 2015).
Hence excessive consumption of corticosteroid hormone can be considered as a risk factor of
Cushing syndrome (Pivonello, et al., 2016).
In case of patient suffering from Cushing syndrome special care from family and
friends is required with respect to diet and other requirements. Cushing syndrome also gives
rise to emotional symptoms such as anger and irritation (Katznelson, 2017). Ms Maureen will
also have to go through all these which is hampering her relation with her husband and other
family members. She feels irritated and frustrated most of the times and is not able to
concentrate neither in her studies nor in her work. Despite of the sickness she have to work,
which is making her more angry and frustrated and she ends up yelling at her family
members.
Question 2-
Signs and symptoms Underlying pathophysiology
Central obesity Obesity is one of the common symptoms
observed in patient suffering from
exogenous Ms Maureen is also suffering
from obesity. Her body fat is mainly
distributed around her between her shoulder,
face and abdominal area. Her facial
appearance is changed. Her body mass
index is 28kg/m2 which is greater than the
normal level (18.5 kg/m2), which states that
she is overweight (Gona, et al., 2017).
Cortisol is a hormone that controls the

3NRSG353 ASSESSMENT TASK 1 –CASE STUDY
process of formation of fat in the body.
Cushing syndrome is caused by the presence
of excess level of cortisol hormone. The
high level of cortisol decreases the insulin
level which in turn increases crave for
eating sugary and fatty foods. Metabolism
of fatty acid is slower and hence instead of
metabolizing the fatty acid, it is distributed
in body causing obesity (Drey, et al., 2017).
Increased glucose level Type 2 diabetes is commonly observed in
patient suffering from exogenous Cushing
syndrome. Type 2 diabetes is caused the
increase in the level of blood sugar. In case
of patient suffering from Cushing
syndrome, high amount of cortisol level is
increased in the body (Sharma, Nieman &
Feelders 2015). Cortisol manages the level
of blood sugar and hence when the level of
cortisol increases it also increases the blood
glucose level in the body of an individual
(Pivonello, et al 2016). The normal fasting
blood glucose level is 7mmol/L and the
fasting blood glucose level of Ms Maureen
is 14.0mmol/L, which states that her blood
glucose level is high and have diabetes

4NRSG353 ASSESSMENT TASK 1 –CASE STUDY
(Nathan, 2015).
Hyper tension Hypertension is triggered by rise in the
plasma volume, cardiac output and
peripheral vascular resistance (Lonardo, et
al., 2018). Cortisol hormone manages the
systolic pressure level in the body, if the
pressure is increased it can cause
hypertension (Sanchez-de-la-Torre, et al.,
2015. Cushing syndrome caused by the
increases in the level of cortisol in the body.
Ms Maureen is continuously taking
prednisolone, which increases the
glucocorticoids in the body, which increases
the blood pressure of the patient. Her blood
pressure is 154/106 mmHg, whereas, the
normal BP level should be 120/80 mmHg,
which causes hypertension in the individual
(Sanchez-de-la-Torre, et al., 2015).
Question 3
Ms Maureen is taking prednisolone because of rheumatoid arthritis. Prednisone is
converted to prednisolone after administration and prednisone belongs to a group of drugs
called corticosteroids. Corticosteroids are the drugs used to treat RA, allergies, asthma and
other condition. These include, cortisone, prednisone and hydrocortisone (Whitcup, et al.,
2018).

5NRSG353 ASSESSMENT TASK 1 –CASE STUDY
Pharmacodynamics is the branch which deals with the mechanism involved of their
action into the body and the effect of specific drugs (Rosenbaum, 2016). Corticosteroids
increases the plasma clearance and volume of distribution, which is caused by non-linear
binding between the drug and plasma protein (Carnt, et al., 2016). It decreases the
inflammation effect and also diminishes the action of immune system. Inflammation is
caused when the white blood cells of the body is activated to provide protection against
foreign substance. These steroids reduces the inflammation by reducing the production of
specific chemicals responsible for inflammation (Carnt, et al., 2016). These steroids also
minimises the action of immune system by altering the activity of white blood cells in to the
body.
Pharmacokinetics is the branch which deal with the study of movement of drugs
within the body (Wagner, 2018). Corticosteroids are the steroids drugs, is an Intranuclear
binding agent which binds with DNA (Deoxyribonucleic acid). After administration, it passes
through the cell membrane and react with receptor protein of the cytoplasm and forms a
complex known steroid-receptor (Rao Bondugulapati & Rees, 2016). This complex then
moving through the nucleus binds to DNA. The binding with DNA changes the messenger
RNA’s (Ribonucleic acid) transcription. The mRNA (messenger Ribonucleic acid) template
either inhibit or stimulate the synthesis of definite proteins. Hence, it increases the level of
glycoproteins known as lipocortin. Lipocortin inhibits the level of phospholipase A2 from
which Archidonic acid is released and along with that it lowers the synthesis of Interleukin-2.
Lower level of interkeukin-2 produces immunosuppressive, anti-mitogenic and anti-
inflammatory effects (Rao Bondugulapati & Rees, 2016).

6NRSG353 ASSESSMENT TASK 1 –CASE STUDY
Question 4-
Character Goals Intervention Rationale evaluation
High blood pressure
Patient BP- 154/106
mmHg
Normal BP- 120/80
mmHg
To reduce the
blood pressure
of the
individual
within 8 hours
of
administration.
Anti- hypertensive
drugs are suggested
such as,
 Diuretics
 Angiotensin
-converting
enzyme
inhibitors
 Angiotensin
II receptor
blockers
 Calcium
channel
blockers
 renin
inhibitors
 Beta
blockers
(Wright,
Musini &
Gill, 2018).
 Diuretics is
a drug
which
removes the
water and
sodium
content
from the
body, which
in turn
reduces the
amount of
blood
flowing
through the
blood vessel
 ACE
inhibitors
prevents the
formation of
angiotensin
hormone
that is
accountable
for
narrowing
the blood
vessel thus,
decreasing
the plasma
pressure.
 ARBs,
instead of
preventing
the
formation of
angiotensin,
blocks the
action of
angiotensin
hormone.
 Calcium
channel
blocker
prevents the
Regular
monitoring of
blood pressure by
sphygmomanome
ter (Shahbabu, et
al , 2016)

7NRSG353 ASSESSMENT TASK 1 –CASE STUDY
entry of
calcium into
the heart
and blood
vessel, thus
help the cell
to relax.
 Beta
blockers
help in
blocking the
activity of
epinephrine,
which is
responsible
for lowering
the heart
beat rate.
 Renin is an
enzyme
produced in
the kidney.
Renin
inhibitor
with the
help of
several
chemical
steps lowers
the blood
pressure
level by
inhibiting
the
formation of
renin
enzyme
(Wiysonge,
et al., 2017).
Increased blood
glucose level
Fasting blood glucose
level of patient-
14.0mmol/L
Normal fasting BGL
is 7.0 mmol/L
To reduce the
level of
glucose in
blood, which
in turn help in
treating
diabetes.
Drugs which are
used to lower the
blood glucose level
are suggested
which are:
 Alpha-
glucosidase
inhibitors
 Biguanides
 Dopamine
agonist
 Alpha-
glucosidase
inhibitors
assists the
body in
breaking
down the
complex
foods filled
with starch,
which helps
Regular monitoring
of blood glucose
level by taking blood
sample (Chatterjee,
Khunti & Davies,
2017).

8NRSG353 ASSESSMENT TASK 1 –CASE STUDY
 DPP-4
inhibitors
 Glucagon
like peptides
 Meglitinides
 Sodium
glucose
transporter
inhibitors
(Chaudhury,
et al., 2017)
in lowering
the blood
pressure.
 Biguanides
helps in
decreasing
the
absorption
of glucose
into the
intestine and
also helps in
the
absorption
of glucose
into muscle
cells.
 Dopamine
agonist
helps in
preventing
insulin
resistance.
 DPP-4
inhibitors
helps in the
formation of
insulin,
which
reduces the
blood
glucose
level.
 Glucagon
like peptides
increases
the growth
of b-cell.
 Meglitinides
helps the
body in
releasing
insulin
which
lowers the
blood sugar
level.
 SGLT 2
inhibitors
prevent the

9NRSG353 ASSESSMENT TASK 1 –CASE STUDY
absorption
of glucose
into the
kidney and
get rid of
the glucose
through urea
(Taylor,
Blau &
Rother
2015).
Abdominal pain To reduce
abdominal
pain
 Ensure adequate
hydration
 Administration
of analgesics
and muscle
relaxant
(Korterink, et
al., 2016).
 People
suffering
from
abdominal
pain loses
appetite and
does not
drink much
water and
remain
dehydrated.
 Administrati
on of
analgesics
and muscle
relaxant
helps in
reducing the
abdominal
pain (Guay,
Nishimori,
& Kopp,
2016).
Assessing abdominal
pain by iliopsoas
muscle test (Akalan,
et al., 2016)
Gastrointestinal
bleeding
To reduce the
bleeding of
gastrointestina
l lining.
 Monitoring
heart rate
and blood
pressure
 Administrati
on of
pantoprazol
e (Strate,
Saltzman &
Travis,
2018)
 When the
heart rate
and blood
pressure
decreases,
the body
start to
thrust blood
to other
vital organs.
Hence by
keeping an
eye into the
blood
Regular assessing of
gastrointestinal
bleeding by Upper
endoscopy and
colonoscopy (Levy &
Gralnek, 2016).

10NRSG353 ASSESSMENT TASK 1 –CASE STUDY
pressure and
heart rate,
gastro
intestinal
bleeding can
be stopped.
 Pantoprazol
e is a proton
pump
inhibitor,
which
reduces the
amount of
acid in the
gastro
intestinal
lining
thereby
prevents
gastrointesti
nal bleeding
(Lué &
Lanas,
2016).

11NRSG353 ASSESSMENT TASK 1 –CASE STUDY
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12NRSG353 ASSESSMENT TASK 1 –CASE STUDY
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14NRSG353 ASSESSMENT TASK 1 –CASE STUDY
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