Question

A 68-year-old woman with an 8-year history of diabetes mellitus presents to the clinic for worsening dyspnea and cough. She has had chronic obstructive pulmonary disease since age 55. She now has dyspnea from walking one-third of a block, as well as a persistent cough. She has managed her type 2 DM with diet and exercise. Her last glycosylated hemoglobin (HgbA1c), which was measured 1 month ago, was 6.8% (normal range is 4– 6%). Physical examination reveals an anxious woman with blood pressure of 134/ 70 mm Hg, pulse of 116, respiratory rate of 24 breaths per minute, and weight of 190 pounds. Expiratory wheezing is present bilaterally. No accessory muscles are being used. No cyanosis is present. The lab evaluation results are as follows: arterial blood gas (ABG) 7.46; PaO2 60; PaCO2 40; O2 sat 88% The patient is started on albuterol (bronchodilator) and a course of prednisone (glucocorticoid) at 40 mg/ day for 3 days, then tapering over 2 weeks. On day 3, she calls back to the clinic to report that her blood glucose level is 358 mg/ dL at 4: 00 p.m.

3. Which of the following endocrine conditions is this patient at risk of developing?

A. Hyperthyroidism

B. Pheochromocytoma

C. Addison’s disease

D. Cushing’s syndrome

4. Given this patient’s acute loss of glucose control, which of the following interventions would the nurse expect to be ordered for this patient?

A. Insulin as needed per routine sliding scale (dosing based on blood glucose levels)

B. Increase exercise

C. Decrease caloric intake

D. Decrease prednisone dose

Answer 1

3. Pheochromocytoma is characterised by the tumour of medulla of adrenal gland.

It causes excessive secretion of catecholamines.

The symptoms pheochromocytoma are similar to that of sympathetic overactivity.

The answer is pheochromocytoma

4. Prednisone is a corticosteroid. Prednisone increases the level of blood glucose by mobilizing the glycogen storage in liver and reduced transport of glucose to adipose tissue and muscle cell. This leads to significate increase in blood glucose levels.

The answer is (D) decrease prednisone dose