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Word count: 1600 words (every question has a specific word count, which must be adhered to) Instructions: • Students are to choose one (1) of the case studies below and answer the associated...

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Word count: 1600 words (every question has a specific word count, which must be adhered to) Instructions: • Students are to choose one (1) of the case studies below and answer the associated questions. The assignment is to be presented in a question/answer format not as an essay (i.e. no introduction or conclusion). • Each answer has a word limit (1600 in total); each answer must be supported with citations. • A Reference List must be provided at the end of the assignment. • Please refer to the marking guide available in the unit outline for further information. ** The following questions must be answered for your chosen case study ** The following questions relates to the patient within the first 24 hours: 1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family (400 words) 2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology (350 words) a. This can be done in the form of a table – each point needs to be appropriately referenced3. Describe two (2) common classes of drugs used for patients with the identified condition including physiological effect of each class on the body (350 words) a. This does not mean specific drugs but rather the class that these drugs belong to. 4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient (500 words).
Ms Maureen Smith is a 24 year old female who presented to her GP for ongoing gastrointestinal bleeding, abdominal pain and fatigue which has been worsening, and was referred to the local hospital for further investigation. Maureen was diagnosed with rheumatoid arthritis (RA) when she was 15 years old, and has experienced multiple exacerbations of RA which have required the use of high dose corticosteroids. She is currently taking 50mg of prednisolone daily, and has been taking this dose since her last exacerbation 2 months ago. Maureen also has type 2 diabetes which is managed with metformin. She is currently studying nursing at university and works part-time at the local pizza restaurant. On assessment, Maureen’s vital signs are: PR 88 bpm; RR 18 bpm; BP 154/106 mmHg; Temp 36.9ºC: SpO2 99% on room air. She has a body mass index (BMI) of 28kg/m2 and the fat is mainly distributed around her abdominal area, as well as a hump between her shoulders. Maureen’s husband notes that her face has become more round over the past few weeks. Her fasting BGL is 14.0mmol/L. Blood test results show low cortisol and ACTH levels, and high levels of low density lipoprotein cholesterol. She is awaiting a bone mineral density test this afternoon, and is currently collecting urine for a 24-hour cortisol level measurement.Impression: Cushing’s syndrome
Answered Same Day Mar 30, 2020

Solution

Anju Lata answered on Apr 01 2020
128 Votes
Running Head: CASE STUDY-CUSHING’S SYNDROME
2
CASE STUDY-CUSHING’S SYNDROME
NURSING & HEALTHCARE
ASSIGNMENT
CASE STUDY- CUSHING’S SYNDROME
 1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family.
Maureen has been identified to be suffering from Cushing’s syndrome. The condition is caused due to long time exposure to high dose of corticosteroid drug. The incidence of the disease is rare and occurs at the rate of 13 people per million population every year. Maureen has been taking a high dose of corticosteroids due to her prolonged Rheumatoid Arthritis since the age of 15 years. Cu
ently, she is taking 50 mg daily dose of prednisolone. The people with high BP, type 2 diabetes, bone loss and high BMI >30 are at the highest risk of getting the disease. Maureen’s BP is quite high 154/106 mmHg though her BMI is less than 30. She is also suffering from diabetes and most probably her bone mineral density test may diagnose bone loss or osteoporosis (CSRF,2016).
The Cushing’s syndrome affects the complete physiology of the patient. The patient develops a high risk of infection, fatigue, muscular weakness, weakening of bones, depression and related psychological issues, along with i
egular menstrual cycles. The gastrointestinal pain and bleeding of Maureen may be associated with infection and i
egular menstruations. Moreover, she is having Rheumatoid Arthritis which involves swelling of joints of hands and feet. RA is an autoimmune disorder which adversely affects the immune system (NICHD,2016). RA disease causes huge weight loss, fatigue, and bone erosion. Maureen has been experiencing recu
ent exace
ations of RA since she was just 15 years old and has been taking a high dose of corticosteroids due to serious RA. She has developed high fat distribution around her abdominal midsection area and upper back which affects her physical appearance to look awkward. Her face has become more round due to fat deposit around it. Moreover, she has also experienced high fat loss from her arms and legs area.
Maureen’s blood reports reveal a low level of cortisol and ACTH which confirms the presence of acute adrenal insufficiency of the secondary and tertiary level and issues related to the malfunctioning pituitary gland. High level of low-density lipoprotein (LDL) cholesterol is associated with high risk of cardiovascular problems, mostly in the patients with diabetes and high BP (NICHD,2016). Maureen may develop plaques in blood vessels and constricted lumen of arteries. As she is also suffering from diabetes and high BP, such symptoms can be fatal for her health.
The family may get highly distu
ed from Maureen’s incidence of multiple diseases. Initially, they may support her but as the frequency and intensity of severity increases, her health issues may impose ove
urden of financial expenses on her family(CSRF,2016).
2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying Pathophysiology.
    
    Signs and symptoms
    Pathophysiology
    1
    Round Face and
Fatty hump
    It is caused due to i
egular fat deposition on the face and upper dorsal back area. Due to excessive weight gain, the fat deposits i
egularly around the face, and at the upper dorsal part of back causing moon face and hump appearance at the back. High level of cortisol is responsible for the redistribution of fat in the body, especially around the chest, face and stomach area. The skin develops
uises and becomes thin (NIDDK,2012).
    2
    Diabetes
    Due to high levels of body glucose in the blood. When there are stressed conditions inside the body, cortisol supplies necessary glucose to the body through the process of gluconeogenesis. But increased levels of cortisol...
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