University Case Study: NRSG258 Analysis of Susan Summers' Post-Op Care

This case study examines Susan Summers, a patient diagnosed with Cushing's syndrome, a condition stemming from prolonged cortisol exposure. The analysis delves into the etiology, pathophysiology, causes, and symptoms of the disease, highlighting the roles of the hypothalamus, pituitary gland, and adrenal glands. The case study discusses the impact of corticosteroid medications and other contributing factors like alcohol consumption. It details the patient's post-operative vital signs, including tachypnea, hypertension, and elevated pulse rate, and correlates these with the syndrome. Furthermore, the study covers post-operative care, including dietary recommendations, medication, and the roles of healthcare professionals such as a nutritionist, endocrinologist, and physical therapist in the patient's recovery. The conclusion emphasizes the importance of surgical intervention and comprehensive care in managing Cushing's syndrome.

Running head: NRSG258
Case Study 1- Susan Summers
Name of the Student
Student Number
Name of the University
Author Note

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Analysis of Case Study 1- Susan Summers
Cushing’s syndrome encompasses a collection of symptoms and signs that occur due to
prolonged cortisol exposure. In other words, Cushing’s syndrome or hypercortisolism occurs
due to abnormality in the levels of cholesterol. Corticosteroid medications are considered as a
primary reason for this physiological abnormality (Lacroix, Feelders, Stratakis & Nieman, 2015).
Most common symptoms of this condition include hypertension, abdominal obesity, round red
face, lump between shoulders, muscle weakness and weak bones. This essay will contain a
discussion on a case study of a patient Susan Summers and will describe the etiology,
pathophysiology, cause and symptoms of this health abnormality.
Pathophysiology refers to the disorder or disrupted physical processes that are associated
with development of an illness or disease. The pituitary gland and hypothalamus, located in the
brain are responsible for the disease. The hypothalamus comprises for paraventricular nucleus
(PVN), which releases CRH, the corticotropin-releasing hormone. This hormone is responsible
fro stimulating the pituitary gland, which in turn gets triggered to release the polypeptide tropic
hormone, adrenocorticotropin (ACTH) (Manenschijn et al., 2012). This hormone is found to get
released in the bloodstream and travel along it, followed by reaching the adrenal glands, located
on the top of kidneys. Upon reaching the adrenal gland, ACTH facilitates secretion of cortisol.
Evidences suggest that cortisol belongs to the class of glucocorticoids and are released by the
zona fasciculata layer of the adrenal cortex, in response to ACTH secretion (Lodish, Dunn,
Sinaii, Keil & Stratakis, 2012). An increase in the levels of cortisol is found to create a negative
feedback loop on corticotropin hormone, which results in a subsequent reduction in the ACTH
amount released from the anterior pituitary (Dekkers et al., 2013).

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Cortisol is responsible for regulating blood pressure and maintain normal functioning of the
cardiovascular system. Thus, cortisol-releasing adenoma present in the adrenal cortex of the
adrenal glands can be considered as the primary aetiology of Cushing’s syndrome. This results I
an elevation in the levels of cortisol. A dexamethasone suppression test, followed by MRI of the
pituitary gland and CT scan of the adrenal glands confirms the disease.
The potential causes or aetiology of Cushing’s syndrome include prescribed
administration of glucocorticoids for the treatment of other health abnormalities. Corticosteroid
treatment is used for a plethora of diseases such as, rheumatoid arthritis, asthma, or
immunosuppression after an organ transplantation to prevent the immune cells from rejecting the
transplant. Administration of medroxyprogesterone is also considered as a major factor that
contributes to development of Cushing’s syndrome (Stratakis, 2012). It results in glucocorticoids
are found to downregulate the release of ACTH hormone. Furthermore, a deviation from the
normal functioning of the body in cortisol secretion also result in a condition, commonly referred
to as endogenous Cushing’s syndrome. ACTH secretion is also found to occur from tumors
located outside the pituitary-adrenal system, which in turn creates an impact on the adrenal
glands (Guaraldi & Salvatori, 2012). This aetiology is commonly referred to as paraneoplastic
Cushing’s syndrome, due to its association with cancer cells in the body (de Bruin et al., 2012).
Excess cortisol secretion can also occur due to high levels of stress, malnutrition, alcoholism or
depression. Thus, the fact that Susan consumes wine on a regular basis significantly contributes
to her current medical state.
Most common signs and symptoms associated with Cushing’s syndrome include rapid
gain of weight, in the face and trunk, sparing certain parts of the limbs. Accumulation of fat
along the collarbones, back of neck and face are commonly observed. Other major symptoms

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encompass capillary dilation, excess perspiration, skin thinning that results in dryness and
bruises along the hands, red or purple striae, muscle weakness or hypoglycemia (Nieman, 2015).
Women suffering from the condition are also found to suffer from irregular menstrual period and
thicker facial or body hair. In addition, other symptoms such as, cognitive impairment, headache,
impaired growth among children, emotional disturbances, and hypertension may also be
observed.
Thorough assessment and monitoring of post-operative patients are considered
imperative for identifying all kinds of deterioration in the prevailing health condition. Such
physical assessments involve measurement of a patient’s vital signs that encompass evaluation of
the major life-sustaining functions of the physiological system. Measurements of vital signs help
in assessing the general physical condition of the individual and also provides cues to detect
probable health deteriorations or recuperation from a disease. Susan’s post-operative respiratory
rate (RR) was found to be 30 breaths per minute. It commonly refers to the number of breaths
taken by a person per minute. In other words, it indicates the number of movements that depict
inspiration and expiration per unit time. Normal levels of RR range from 16-20, at rest (Elliott &
Coventry, 2012). This suggests that the patient Susan is suffering from tachypnea, where her RR
has increased beyond 20 bpm.
Blood pressure is another vital sign, the normal range of which is around 120/80 mmHg
(Elliott & Coventry, 2012). The patient demonstrates a higher blood pressure (160/90 mm Hg),
that indicates presence of hypertensive symptoms. Her post-operative vital signs also show a
huge deviation from the normal pulse range of 50-80 bpm for adults, which indicate the rate at
which the heart beats for pumping blood in the arteries.

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Pulse rate of 128 bpm area clear indication of deterioration in the health status, following
laparoscopic right adrenalectomy (Elliott & Coventry, 2012). Susan also demonstrates a decrease
in body temperature, below the normal range 36.5 °C. Evidences suggest that elevated heart rate
are found to be associated with an increase in blood pressure or hypertension. Normal urine
output is around 800-2000 milliliters/day with an intake of 2 liters/day. Low urine output can be
attributed to the surgical procedure of adrenalectomy that was performed in the patient. High
abdominal pressure due to pneumoperitoneum contributes to a reduction in urine production.
Overweight is also considered as a major risk factor that contributes to an increase in blood
pressure (Nguyen & Lau, 2012). Furthermore, regular alcohol consumption results in a
temporary increase in blood pressure, and heart rate and results in weakening of the heart
muscles. This contributes to irregularities in the heart beat. Moreover, associations have also
been established for obesity and respiratory complications that result in an increased demand for
ventilation (Sarkhosh, Birch, Sharma & Karmali, 2013).
This elevates the breathing rate due to inefficiency of the respiratory muscles. Alcohol
consumption can have also been linked to diminished respiratory compliance. Moreover, the
post-operative deteriorating vital signs can be directly correlated with Cushing’s syndrome.
Hypertension occurs due to the fact that renal conversion of cortisol hormone to cortisone gets
reduced in the disorder. This directly elevates mineralocorticoids., which in turn result in
increased reabsorption of tubular sodium, and hypokalemia. Cortisols also inhibit the
vasodilators, thereby increasing blood pressure (Prodam et al., 2013). The glucocorticoids exert
their direct effect on the heart that results in tachycardia (over 100bpm). Furthermore,
hypertension leads to dysregulation of the autonomic nervous system that leads to heart rate
variability.

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Hypothermia refers to core bosy temperatures that are below 35°C. It results in a drastic
drop in the metabolic rate of the body. At such low temperatures, the bosy will fail to produce
the necessary heat and the core body temperature will quickly drop. This will make the patient
shiver, followed by contraction of the blood vessels and release of hormones to facilitate heat
generation. A direct impact of the condition will be observed on the other vital signs such as,
blood pressure, respiratory rate and heart rate, all of which will increase. Further drop in
temperature will lead to reduction in oxygen consumption, and irregular heart rhythm. Major
effects will be manifested in the form of reduced cardiac output, slow brain activity, dilated
pupils, and a state of coma (Pasquier et al., 2014). Post-operative safe care involves
administration of a regular diet after problems of nausea get resolved.
All wounds should be closed using skin glue and the patient might be allowed to shower
the following morning. Performing exercise should be prevented until 10 days following the
operation. Deep breathing exercise and administration of Tylenol are required to relieve pain and
aches (Dimopoulou et al., 2014). Persistent swelling or calf pain would indicate presence of
blood clot and the patient should be immediately assessed. The patient needs to be started on
steroid therapy such as, prednisone to restore normal functioning of the adrenal gland (Hartmann
et al., 2016). NSAIDs such as, naproxen and ibuprofen should also be prescribed for immediate
pain relief. Narcotics might result in constipation. Thus, there is a need to intake extra fluids,
fiber, along with usage of stool softeners.
Several healthcare professionals will play a major role in enhancing the health outcome
and subsequent patient satisfaction in this context. A nutritionist would play an essential role in
evaluating the diet consumed by the patient on a regular basis. This healthcare professional will
be responsible for formulating a diet plan that includes around 8 ounces or 2 liters of daily fluid

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intake. The nutritionist will also help in making the patient consume a diet that is rich in fibers,
such as, whole grain, cereals and fruits (Dietiticians association of Australia, 2014). The
endocrinologist will also assist in the patient’s long term recovery by monitoring and balancing
long-term hormonal imbalances in the body. He/she will be involved in administering selective
steroids following the surgery to restore the levels of coritsol in the body, Another healthcare
professional imperative to improvement of patient health is a physical therapist who will assist
the patient in pain reduction and mobility restoration (Australian physiotherapy association,
2016). This professional will help the patient during walking or climbing steps. Thus, complete
assistance from the aforementioned healthcare professionals are needed to improve Susan’s
health condition.
To conclude, it can be stated that Cushing syndrome is a major health abnormality that
occurs due to prolonged exposure of the human body to cortisol hormones, and results in fat
accumulation in the face, shoulders and marks on the skin. This occurs due to improper
functioning or tumor of the adrenal glands. Thus, surgical removal of the adrenal glands are
essential to restore normal body functioning.

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