Question

Sara Haines is a 38-year-old who runs Grand Central Restaurant at Toowoomba shopping center. She presented to St Vincent's Private Hospital, Toowoomba complaining of drastic weight gain over six months, significant facial hair growth, menstrual abnormalities, and both excessive thirst and appetite. Recently, Sara also feels dull and depressed, does not have much energy, and has stopped performing all her favorite activities including tennis at Action Indoor Sports Stadium.
Sara is a successful and busy business person in Toowoomba, never smoked and only consumes alcohol in moderation at social events. She has several allergies (House dust mites, cockroaches, and dog's dander) and is not taking any medications other than a daily multivitamin tablet and betamethasone (as needed) for her asthma (used for many years). On clinical examination, the clinician, Dr John Smith noticed protuberant with striae and minimal bruising in her abdomen, and no abdominal tenderness, and both upper and lower extremities show areas of hyperpigmentation. Laboratory results confirmed that her cortisol levels were high indicating Cushing syndrome.

Required:
a. Explain the causative factors and pathophysiology of Cushing syndrome and how she developed this condition.
b. Describe the primary signs and symptoms of Cushing syndrome.
c. What aspects of her clinical history place Sara at increased risk of hypertension and, briefly explain the difference between Graves' disease and Cushing syndrome.
d. What treatment and follow up options are there for her condition?
e. Identify 10 nursing diagnosis and work out one care plan

Answer 1

Answer and Explanation:

A. Cushing's syndrome occurs with the dysregulation of cortisol production in the body. Thus, when the body has very high levels of cortisol in the blood, the hormonal balance is impaired, which can cause this syndrome. In the case presented in the question above, the elevated levels of cortisol were caused by the use of betamethasone. We can reach this conclusion because betamethasone is a corticosteroid and the prolonged use of this type of medication can promote uncontrolled cortisol in the body.

B. The main signs and symptoms are: rapid weight gain in the abdomen and facial swelling, abnormal appearance of hair on the face, increased blood pressure, appearance of red streaks on the belly, muscle weakness, healing problems, irregular menstruation, oily skin and acne breakouts, increased blood sugar, decreased libido, fertility problems.

C. Excessive appetite and lack of exercise and physical activity can put Sara at risk for hypertension, as this can decrease the diameter of the veins and arteries, in addition to causing the accumulation of fat in the veins and arteries, which causes an increase in blood pressure. We can see that she does not have Graves' disease, due to the lack of symptoms associated with this disease, which are not seen in Crushing's Syndrome as nervousness, irritability in the eyes, diarrhea, weight loss even with increased appetite and swelling in the region. thyroid.

D. Sara's treatment must be established by an endocrinologist, as this is a hormonal problem. In this case, it is likely that the doctor will reduce the dose of the medication she uses against asthma or even change the medication, if it is possible to treat Sara's asthma without corticosteroids.

E. The diagnosis can be made with blood test, hormonal analysis, magnetic resonance (since this syndrome can be caused by brain tumors), analysis of saliva, analysis of feces, analysis of urine, analysis of cortisol levels and test of stimulation of dexamethasone. A care plan includes regulation of food and fluid intake, hormonal regulation and regular physical activity.