Acute Care Nursing

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.

1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family.

2. List five common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology.

a. This can be done in the form of a table – each point needs to be appropriately referenced

3. Describe two common classes of drugs used for patients with the identified condition including physiological effect of each class on the body.
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.

Answers

1. Cushing’s syndrome is a syndrome or disease which is caused by either excess production of cortisol or excess use of high dose corticosteroids. Cortisol is a hormone which is produced in outer portion of adrenal glands of kidney. The regulation of the production of cortisol is done by a hormone named adrenocorticotrophic (ACTH). It helps the body in condition of changes and stress like swelling or high blood sugar. In this case study Ms Maureen smith took high dose of corticosteroids during her treatment of Rheumatoid Arthritis which leads to her Cushing’s syndrome. This form is called iatrogenic and is a common side effect of high dose of steroid hormones which is used for life threatening disease like Rheumatoid Arthritis (RA) (Lacroix et al., (2015)..

This disease was named after Harvey Cushing who identified the disease first in women in 1912. This type of disease is common in nature as the corticosteroids use is found worldwide for diseases like RA. In adults it is more common in women than men. The age limit is normally from 25- 45 years. The total incidence is about 5 to 25 case per million people per year. In Australia this disease is rare and probably affects 300 to 1200 Australians per year. Ectopic ACTH which causes this Cushing’s syndrome is more common than the normal form (almost 660 per million per year)

The risk factors included in this disease are type 2 diabetes, obesity, high blood pressure and low control of blood sugar. All these symptoms are found in the patient of case study 2.

The indications and deficiencies of person with Cushion’s Syndrome is based on the amount of cortisol in the patient, disease time period and normal health of the patient. If proper treatment is provided then the disease can be cured within 2 to 18 months. The patient and their family get frustrated because the treatment takes long time and slow improvement occurs. The patient feels weakness and fatigue due to which visit do doctor becomes in huge number which is problem for the patient and family. If this Cushing’s syndrome is not getting cured then the Patient will suffer more from weakness of muscle, weight gain in face and abdomen depression and mood swing. The family of patient feels serious burden because they have to take the patient to doctor several times for blood test and treatments of the symptoms and complications of the disease.

2.