Question

Chapter 49: Nursing Management: Endocrine Problems Case Study: Cushing Syndrome Patient Profile: H. is a 26-year old elementary school teacher. He seeks the advice of his health care provider because of changes in his appearance over the past year. Subjective Data: Reports weight gain (particularly through his midsection), casy bruising, and edema of his feet, lower legs, and hands .Has been having increasing weakness and insomnia Objective Data: Physical examination: BP 150/110: 2 edema of lower extremities; purplish striae n abdomen; thin extremities with thin, friable skin; severe acne of the face and neck Blood analysis: 600/ml, lymphocytes 12%; red blood cell (RBC) count 6.6 X 102/mL; K. 32 mEqL Glucose 167 mg/dL (9.3 mmol/L); white blood cell CwBC) court İ3, . (3.2 mmol/L) Discussion Questions Answer the following questions: I. Discuss the probable causes of the alterations in T.H.'s laboratory results. 2. Explain the pathophysiology of Cushing syndrome. 3. What diagnostic testing would identify the cause of T.H.'s Cushing syndrome? 4. What is the usual treatment of Cushing syndrome? 5. What is meant by a "medical adrenalectomy" 6. What are the priority nursing responsibilities in the care of this patient? 7. Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?

Answer 1

Answer: T.H. noticed changes in his appearance over the past year as he has gained weight, midsection means near the stomach areas. He also complaint about the edema near legs etc. The possible cause of these changes directs towards the Cushing's syndrome.

Cushing syndrome occurs when there is too much of cortisol present in the body. Cortisol is also known as stress hormones which when gets accumulated in the body causes swelling, edema and weight gain specially near the mid portion of the body.

• The adrenal gland secretes cortisol and other steroid hormones when stimulated by ACTH.
• The pituitary gland produxes ACTH and released into the petrosal venous sinuses in response to stimulation by corticotropin-releasing hormone (CRH) from the hypothalamus.
• Hence increases the cortisol levels in the body.

It can be diagnosed by the urine test i.e 24 hours urine test as in this test level of cortisol is checked. Late night salivary test to check the cortisol levels in the body.

The Cushing's syndrome can be treated by lowering the steroids if taken for a long duration. If the reason is not the medication then changing in life style may be helpful. Removal of steroids producing tumors.

Medicines given to minimise excessive production of cortisol at the adrenal gland such as ketoconazole (Nizoral), mitotane (Lysodren).