University Nursing Report: Acute Care of Cushing Syndrome Case Study

This report presents a comprehensive case study focused on a patient, Maureen Smith, diagnosed with Cushing syndrome within an acute care nursing context. The report begins with an overview of Cushing syndrome, detailing its causes, incidence, risk factors, and impact on the patient's life. It then delves into the specific signs and symptoms exhibited by the patient, including moon face, weight gain, hypertension, and muscle weakness, explaining the underlying physiological mechanisms. The report further explores the pharmacological interventions, such as steroid inhibitors and cortisol-lowering medications, used in managing the condition. A detailed care plan is outlined, addressing the patient's gastrointestinal bleeding, muscle weakness, fatigue, risk of infection, and altered body image, with specific nursing interventions and rationales provided for each concern. The report references multiple research articles to support the information presented.

Running head: ACUTE CARE IN NURSING
Acute care in nursing
Name of the student:
Nam of the university:
Author note:

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ACUTE CARE IN NURSING
Table of Contents
Question 1: 2
Question 2: 3
Question 3: 5
Question 4: 6
References: 9

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Question 1:
Cushing syndrome is caused by excessive production or exposure to the hormone cortisol.
Elaborating more on the hormone cortisol, it can be mentioned that this hormone is produced by
the adrenal cortex of the adrenal glands in the human body and is responsible for many key
physiological function of the body. This hormone plays fundamental roles in maintaining and
regulating the functionality of the cardiovascular system and helps in the task of maintaining the
blood pressure of the body. On a more elaborative note, it has to be mentioned that there is an
intricate hormonal signalling framework invested in the process of hypercortisolism. The
paraventricular nucleus present in the hypothalamus contains neuroendocrine neurons that
secrete the corticotrophin releasing hormone or CRH (Brown et al., 2017). This hormone in turn
controsl the secretin of adenocorticotropin hormone or ACTH from the anterior lobe of the
pituitary glands. Now the feedback loop of both of the hormone affects the adrenal cortex and in
turn affects the cortisol hormone. Now Cushing’s syndrome is characterized by the
overproduction of cortisol hormone and there can be a few conditions that can lead to his
phenomenon. A tumor is the most likely cause, either in the pituitary gland, adrenal gland, or
somewhere else in case of ectopic Cushing syndrome. However another very common concern
for overproduction of the hormone cortisol is the prolonged usage of the corticosteroids. In this
case the patient had been suffering from rheumatoid arthritis from the age of 15 year, and had to
undergo a prolonged period of corticosteroid therapy, hence for the patient, this the most
plausible cause (Crespo Martín et al., 2016). Considering the incidence rate of the disease in
Australia, the statistics reveal that 1-2 people per 100000 individuals are suffering from this
disease. The prevalence of this disease in Australia is close to 40 per 100000 people.

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Considering the risk factors for this disease, obesity, type 2 diabetes, rheumatoid arthritis,
corticosteroid therapy and tumors can be the most plausible ones. However, in this case the age
and gender can also be important risk factors for this disease, as it is more commonly found in
women rather than in men. The patient has been suffering from gastrointestinal bleeding, muscle
weakness and fatigue due to this disease, it can impact her social and personal life. It might
restrict her from participating in the day to day activities that she is usually accustomed with.
Another very important impact of this disease is the localized obesity which can contribute to
altered body image which can be a significant psychological burden on the patient and can
impose social withdrawal and loss of self worth (De Freitas Luzia, de Goes Victor & de Fátima
Lucena, 2014). And the patient family might suffer emotionally and economically while
attending to and watching their loved one suffer.
Question 2:
There are various signs and symptoms that are associated with the Cushing’s syndrome and
each of the signs contributes to the deterioration of the health and wellbeing of the patient.
Among all different kinds of signs and symptoms, 5 key ones are,
 One of most conspicuously significant signs of the Cushing’s syndrome can be the moon
face. It has to be understood that the hormonal imbalance caused by this particular
disease in the body results into abnormal and localized fat deposition. The rounding of
the face is due to the fat deposition around the face facilitated by increased fat
metabolism due to cortisol imbalance and prolonged consumption of prednisone (Ejaz et
al., 2011).

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 The second sign or symptom that can be mentioned in this context is the abnormal weigh
gain and abdominal obesity. It has to be mentioned that the imbalance in the feedback
loop between the CRH, ACTH, and the increased concentration of the cortisol hormone
often results into increased fat accumulation in the particular locations of the body,
especially in the abdominal section resulting into a conspicuous abdominal obesity and
can even lead to a fatty hump between the shoulders, which had been also reported in
Maureen (Feelders et al., 2010).
 Another very important and signature sign or symptom for this disease is the onset of
hypertension. The mechanism of hypertension or high blood pressure in the Cushing’s
syndrome is facilitated by the hypersecretion of glucocorticoids. And along with that it
has to be mentioned that increased cortisol levels in the body even leads to high
mineralocorticoid secretion. Both of this cumulatively impact on cardiovascular regulatin
and in turn cardiac output, hence resulting into hypertension. The impact of obesity and
diabetes which is often associated with this disease and as is in this case as well, might
also contribute to the increase in the blood pressure (Guaraldi & Salvatori, 2012).
 Lastly fatigue and muscle weakness is the also a key sign or symptom of the disease is
the muscle and bone weakness that is frequently observed in the patients. It has to be
understood that the HPA hub or the hypothalamus-adrenal conjuncture helps to control
the stress response and induction in the body. As he increased level of cortisol disrupts
the equilibrium of the HPA hub functions, impacts the mucular dystrophy and causes
muscle fatigue (Fleseriu & Petersenn, 2015).

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Question 3:
The first class of drugs that can be given to the patient includes the steroid inhibitors like
mifepristone. It has to be mentioned this is an abortifacient drug that is used for helping the
patients suffering from Cushing’s syndrome as a critical antagonist of steroidal medication.
According to the research it is the second most favoured line of drugs in case of the treating
or managing the symptoms of the Cushing syndrome. Exploring the mechanism of action of
this class of drug it can be mentioned that it acts as the perfect antagonist to the
glucocorticoids by the means of inhibiting the progestin receptors. This is the most favoured
medication for patients who have diabetes type 2 along with Cushing syndrome and helps in
regulating the ACTH levels in body as well. Along with that, this medication has been
proved to act on the hypertension symptoms of the body as well making it the best choice for
Maureen (Mazziotti, Gazzaruso & Giustina, 2011).
The second line of drugs that the patient will require will be for managing the imbalance
of cortisol in the body, hence the first class of drugs that can be given to the patient is the
cortisol lowering medication like the ketoconazole or Nizoral. It has to be mentioned in this
context that ketoconazole is nothing but a synthetic imidazole that is the most favourable and
frequently used medication for this disease. It has to be mentioned in this context that this is a
potent antifungal antibiotic which acts exceptionally well in balancing the cortisol levels in
the body. According to the research ketoconazole helps in the process of steroidogenesis and
controls the production or exposure of the patient to corticosteroids and its impact that the
overexposure will have on the pathophysiology of the patient. Elaborating on the
pathophysiology of the mechanism of action that this medication, it can be mentioned that
this acts like an inhibitor of the key enzymes and cytochromes in the pathway of production

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of the steroid hormones (Nieman, 2015). However, there are various side effects like the
nausea, gastrointestinal bleeding, confusion, depression and even liver damage hence the
dosage calculation needs to be very precise.
Question 4:
The case study represents the condition of a young patient named Maureen Smith, who had
been represented in the heath care facility with gastrointestinal bleeding, abdominal pain and
fatigue. The past medical history of the patient is presenting the diagnosis of rheumatoid arthritis
diagnosed at 15 years of age and type 2 diabetes. Based on the assessment data and the blood test
results, it had been discovered that the most plausible diagnosis is Cushing syndrome. It has to be
mentioned that Cushing syndrome is a common disorder caused by the overproduction of the
hormone cortisol in the body (Pivonello et al., 2016). The medical term for this disease is
hypercortisolism and it is a very common condition and can be facilitated by the fact
overexposure to the hormone cortisol in the body. In this case the care plan for the patient will
require to be completely based on the three key symptoms that the patient has been presented
with and will also focus on the related psychosocial concerns that the patient might face in the
future.
Care priority Nursing outcome Intervention Rationale
Gastrointestinal
bleeding and abdominal
pain
The patient will be
relieved of the pain
and the bleeding will
cease completely
The nursing profession
will monitor the vital
signs of the patient and
will perform
haemoglobin count
check.
Vital signs will analyse
the condition of the
patient and haemoglobin
count will be indicative
of the accurate blood
loss.

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Administration of
diuretics and
hypertensive medication
like pantaprazole
Move the patient into
recovery position to
ensure that the patient is
relaxed and comfortable
The mediction will help
reduce the blood
pressure and will help in
managing the blood loss
The recovery position
will calm the patient
(Raff, H, & Carroll,
2015).
Muscle weakness and
fatigue
The patient will be
relieved from the risk
of injury due to
weakness and fatigue
Assessment of skin
integrity to check for any
skin redness, bumps or
bleeding.
Administering a fibre and
antioxidant rich diet to
help the patient regain
energy and health
(Tiryakioglu et al.,
2010).
High cortisol levels
have detrimental impact
on the skin integrity.
A facultative energy
inducing diet will help
the patient overcome the
weakness and fatigue.
Risk for infection and
pain
The patient will be
relieved from the risk
of infection or any
pain.
Through assessment of
the patient to check for
any visible signs of
infection
Rapid and prompt
diagnosis of the
symptoms will be
helpful to provide
instant intervention.
Altered body image and The patient will be Engage the patient with The engagement wil

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localised obesity. accepting of the
changes in her body
image and will be
relieved from any
depression or loss of
self worth.
positive therapeutic
interaction about self
worth and body image.
Help her with personal
grooming and CBT
intervention to enhance
her coping strategy.
help her with her self
imposed social isolation
and will improve her
perceptions of body
image (Tritos, Biller &
Swearingen, 2011).
The grooming and
psychotherapy will help
in overcoming any
depression.

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References:
Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-Surgical
Nursing: Assessment and Management of Clinical Problems. Elsevier Health
Sciences.
Crespo Martín, I., Youdale, S. W., Valassi, E., & Resmini, E. (2016). Neuropsychological
evaluation of patients with acromegaly and Cushing's syndrome: Long-term effects.
De Freitas Luzia, M., de Goes Victor, M. A., & de Fátima Lucena, A. (2014). Nursing
Diagnosis Risk for falls: prevalence and clinical profile of hospitalized
patients. Revista Latino-Americana de Enfermagem, 22(2), 262.
Ejaz, S., Vassilopoulou‐Sellin, R., Busaidy, N. L., Hu, M. I., Waguespack, S. G., Jimenez,
C., ... & Habra, M. A. (2011). Cushing syndrome secondary to ectopic
adrenocorticotropic hormone secretion. Cancer, 117(19), 4381-4389.
Feelders, R. A., de Bruin, C., Pereira, A. M., Romijn, J. A., Netea-Maier, R. T., Hermus, A.
R., ... & de Herder, W. W. (2010). Pasireotide alone or with cabergoline and
ketoconazole in Cushing's disease. New England Journal of Medicine, 362(19), 1846-
1848.
Fleseriu, M. (2015). Medical treatment of Cushing disease: new targets, new
hope. Endocrinology and Metabolism Clinics, 44(1), 51-70.
Fleseriu, M., & Petersenn, S. (2015). Medical therapy for Cushing’s disease: adrenal
steroidogenesis inhibitors and glucocorticoid receptor blockers. Pituitary, 18(2), 245-
252.