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Question Answered step-by-step Unfolding Case Study #38  LindaLinda is a 58-year-old female with a medical history of hypertension, asthma, and chronic bronchitis. She has a past history of smoking one to one and a half packs of cigarettes per day for 35 years. Linda quit smoking when her asthma worsened; she has been smoke-free for 3 years now. As part of her treatment regimen, Linda has been taking prednisone 20 mg orally daily for the past 12 months. At her most recent primary care provider's (PCP) appointment, Linda expresses concern at the changes that are occurring in her body. She reports that she is putting on weight and her face has become very round. She has also noticed increasing hair growth on her face. Linda shows the nurse multiple bruises on her arms.1. Taking into consideration Linda's medical history, medications prescribed, and presenting signs and symptoms, the nurse believes that Linda has manifestations of___________________________________________________________________________.2. Identify the three types of steroid hormones and their prototypes that are produced by the adrenal cortex:_____________________________________________________________________3. Briefly explain how the hormones secreted by the adrenal cortex are regulated through the hypothalamic-pituitary-adrenal axis.            4. Match the adrenal hormone in Column A with its effects in Column B.                     Column A                                                                       Column BGlucocorticoids           ________ Major effects on electrolyte metabolism; long-term regulation of sodium balanceMineralocorticoids       ________ Effects similar to male sex hormones; secretes small amount of estrogenSex hormones              ________ Influence glucose metabolism; inhibit the inflammatory responseLinda is seen by her PCP and diagnosed with Cushing's syndrome. She is surprised to learn that the medicine that is helping keep her asthma under control is likely the source of her new signs and symptoms. The PCP has talked to Linda about making changes to her medication regimen, but Linda is concerned about how this will impact her asthma. She has many questions about how prednisone can cause Cushing's syndrome.5. Briefly explain how the use of prednisone can lead to Cushing's syndrome.         6. Identify other potential causes of Cushing's syndrome: (Select all that apply).  Hyperplasia of the adrenal cortexPituitary gland tumorsThyroid gland tumorsBronchogenic carcinomaUndersecretion of adrenocorticotropic hormone7. Identify clinical manifestations associated with Cushing's syndrome: (Select all that apply). Truncal obesityBuffalo humpHyponatremiaImpaired wound healingMood changesHypoglycemiaOsteoporosisThe HCP has ordered a basic metabolic panel (BMP) and an overnight dexamethasone suppression test. The nurse gives Linda instructions for the overnight dexamethasone suppression test and an appointment for follow-up in 1 week.8. Identify whether the following statements about diagnostic findings of Cushing's syndrome are true or false:_______ A. Serum sodium levels may be increased._______ B. Serum glucose levels may be increased._______ C. Serum potassium levels may be increased._______ D. A cortisol level of greater than 5 mg/dL obtained at 8 a.m. (overnight dexamethasone suppression test) indicates that the hypothalamic-pituitary-adrenal axis is functioning properly.Linda returns to see her PCP 1 week later. Her cortisol level is 3.6 mg/dL. The PCP explains that her Cushing's syndrome is related to her long-term prednisone use. Linda is changed to an alternate-day dosing of prednisone to decrease the signs and symptoms associated with Cushing's syndrome. The nurse then educates Linda on other interventions to help her deal with the Cushing's syndrome.9. Identify three nursing diagnoses for the patient with Cushing's syndrome:_____________________________________________________________________________________________ 10. Identify interventions that decrease the risk of injury and infection and promote skin integrity: (Select all that apply). Avoid use of adhesive tape on the skin Place furniture close together to assist with ambulation Avoid exposure to others with infection Encourage moderate activity with frequent position changes Establish a protective environment that helps prevent falls11. Identify whether the following dietary recommendations for patients with Cushing's syndrome are true or false:_______ A. Select foods low in calcium and vitamin D to minimize osteoporosis_______ B. Select foods high in protein to minimize muscle wasting_______ C. Follow a low-sodium, low-carbohydrate diet to control weight gain 12. What is the nurse's best response when Linda remarks that she is so upset about her physical appearance and body changes that have occurred as a result of Cushing's syndrome?"Unfortunately, you can't control these signs and symptoms.""I know how you must be feeling about all these changes.""As the Cushing's syndrome is treated, the physical changes will eventually disappear.""Perhaps you need to talk to someone about your concerns."14. When educating Linda on the correct administration of prednisone, the nurse determines that she understands the information when she states:"Since I am on prednisone only once every other day, it does not matter what time I take the medication.""It is best to take my prednisone at 8 a.m. on my scheduled days.""I am less likely to have signs and symptoms of Cushing's syndrome if I take my prednisone from 4 p.m. to 8 p.m. on my scheduled days.""I should divide the dose to take it twice a day on my scheduled days."15. Briefly explain why patients prescribed corticosteroid medications should never abruptly stop taking them.               Health Science Science Nursing NURSING NUR2392 Share QuestionEmailCopy link Comments (0)
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