You are working on a medical/surgical floor with a client with adrenal dysfunction. The client is a 41-year-old female who is admitted with complaints of weight gain, muscle weakness, and fatigue. She has noticed that her skin is fragile and bruises easily. She states she has difficulty rising from low chairs. Her last menstrual period was 8 months ago. She has truncal obesity with thin arm and legs. She has a moon-shaped face with coarse, thin hair. On assessment, you notice a dorsocervical fat pad and that her abdomen has purple striae. She has 1+ non-pitting edema in her feet. Her vital signs on admission are: P = 60, RR = 18, B/P = 152/96, & T = 98.2 (F). She is diagnosed with Cushing's syndrome.
Answer the following questions:
1. Explain the pathophysiology of your clients' disease processes.
2. Explain the fluid volume, electrolyte, hemodynamic, and metabolic imbalances your clients are experiencing.
3. What other lab value abnormalities would you anticipate?
4. What symptoms, other than the ones listed, might your clients manifest?
5. What tests would confirm the diagnoses?
6. What medical interventions do you anticipate?
7. What medications do you expect to be ordered, and what are the nursing implications of those meds?
8. What are your priorities in planning care for these clients?
9. What nursing interventions will you implement?
10. What discharge teaching will you provide?
1, Because of the stimulatioin by ACTH, leads to the secreation of cortisol and other steroid hormone leads to ACTH released in to the petrosal venous response to stimulation by corticotropin releasing hormone from the hypothalamus leads to cushing disease.
2,Untreated Cushing syndrome can lead to heart disfunction, and leads to hypokalemia, and hypernatreamia.
3,Saliva test, cortisol levels in the saliva,imaging tests like CT, petrosal sinus sampling.
4, hump between shoulders,round face, pink or purple stretch marks, excess sweating,excessive hunger,exessive hairness, hypertension, osteoporosis.loose muscles, pot belly, loss of libido,weighht gain.
5,Elevated level of salivary cortisol level.
6,ketoconazoll, mitotane, mifiprestone. therapy
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