Question

Mr. H is a 26-years-old elementary school teacher. He seeks the advise of his health care provider because of changes in his appearance over the past year.

Subjective Data:

• Complain of weight gain, particularly in his midsection, easy bruising, and edema of his feet, lower legs, and hands.
• Has been having increase insomnia

Objective Data:

• Physical Examination
  • BP 150/110 mmHg
  • 2+ edema in lower extremities
  • Purplish striae on abdomen
  • Thin extremities with thin friable skin
  • Severe acne of face and neck
• Blood analysis
  • Glucose 167 mg/dl-
  • WBC 13,600/micro liter
  • Lymphocyte 12%
  • RBC 6.6 X 10 ⁶ micro liter
  • K 3.2 mEq/

1. What is the probable cause of alteration in the blood values?

2. What is the Pathophysiology and the difference between Cushing’s disease and Cushing’s syndrome?

3. What is meant by medical adrenalectomy?

4. What are the major nursing responsibilities in the care of this client?

5. What would be 3 appropriate nursing diagnoses with 3  collaborative problems?

Answer 1

1. Cushing's syndrome , incresed cortisol production are responsible for changes in blood values

2.

Cushing's syndrome		Cushing's disease
Any disorder that promote adrenal glands to produce excessive cortisol is known as Cushing's syndrome		it is a form of Cushing's syndrome in which pitutory tumor producing excessive ACTH
ACTH levels are sometimes high		always high

Cancer is sometimes become a cause		Cancer is the major cause of the disease
Prevalence depends upon causes		More common in men than women
More common		Less common

3.

Medical adrenelectomy is that drugs that inhibit steroidogenesis

4.

• Drugs to control cortisol production eg.ketakonazole, aminoglutethimide, mitotane
• Discontinue or alter the dose of exogenous corticosteroids
• Surgical removal of tumour or radiation
• Transsphenoidal resection
• Radiation therapy
• Adrenelectomy

5.

1. Imbalanced nutrition more than body requirements related to increased appetite
2. Impaired skin integrity related to excess corticosteroid production
3. Disturbed body image related to change in appearance
4. Risk for infection related to lowered resistance to stress and suppression of immune system