Cushing Syndrome Decision Tree Essay

Cushing Syndrome Decision Tree Essay

The case focuses on a 45-year-old female patient (V) suffering from Cushing’s syndrome.  Cushing’s syndrome has been diagnosed in the patient for the last three years with an etiology of glucocorticoids abuse and misuse of skin care products and bleaching medications, in addition to excessive corticosteroid production due to (N) adrenal cortex hyperplasia and a pituitary tumor that secretes ACTH and stimulates the adrenal cortex to raise hormone secretion (Cohen et al., 2019). (PN) She also presents with central adiposity, a buffalo hump in the shoulder and supraclavicular areas, fat deposits in the belly, and fairly thin extremities. On palpation, (PN) her skin is also thin, delicate, and easily damaged, with visible bruises and purple striae (Hinkle & Cheever, 2018). The patient reports fatigue and weakness. (PN) She also complains of sleep disruption due to changes in cortisol output during the day (Hinkle & Cheever, 2018). (PN) My goal in this study is to investigate a case scenario (V) involving a woman (V) living with Cushing’s syndrome, the management, and the three pharmaceutical decisions which can be administered.

Decision 1

Because pituitary tumors are among the reasons for the patient’s symptomatic Cushing’s disease, therapy is aimed at the pituitary gland. (PN) Our therapy of choice, as surgical team, is surgical excision of the tumor through (N) transsphenoidal hypophysectomy, which has an 80% success rate (Hinkle & Cheever, 2018). Radiation of the pituitary gland is also a good option and beneficial. However, symptom management may take many months and since the client has suffered from Cushing’s symptomatology for a long time, (PN) she awaits fast treatment results, and therefore this is not a good option. During the transsphenoidal hypophysectomy, the patient will be given a prophylactic antibiotic, (N) ceftriaxone 2 grams intravenous to prevent infections. Since the surgery will be performed under general anesthesia with an (N) anesthesiologist present, it is important for a catheter to be in situ as general anesthesia can lead to incontinence, as well as to monitor fluid input and output during surgery.

(N) Adrenalectomy is also a treatment option as the patient has adrenal hyperplasia. Post adrenalectomy surgery, adrenal insufficiency manifestations may emerge Twelve to 36 hours (V) following surgery due to a decrease in the elevated quantities of systemic adrenal hormones. (N) Hydrocortisone replacement medication may be required for months until the adrenals start to respond properly to the body’s natural demands (Hinkle & Cheever, 2018). If both adrenal glands are removed, adrenal cortex hormone replacement is required for the rest of the patient’s life.

Decision 2

Hydrocortisone medications function as a hormone replacement for the naturally (V) occurring hormone cortisol. The most frequent adverse effects of hydrocortisone include dizziness, headaches, (V) swelling ankles, and fatigue. (V) Taking hydrocortisone pills can suppress the patient’s immune system, making (PN) her more susceptible to illnesses (Kahramangil et al., 2022). The patient should be advised to maintain an antiseptic environment to avoid getting diseases that might lead to further complications.

As there is a possibility that the patient might use hydrocortisone pills for a lifetime, long-term hydrocortisone adverse effects include (N) osteoporosis and eye disorders (Kahramangil et al., 2022). The client must be urged to exercise regularly and get adequate calcium in their diet to strengthen their bones. Calcium deficiency exacerbates osteoporosis development in Cushing’s disease.  Calcium is abundant in dairy and should be included in (PN) her diet. It is also important to schedule a bone scan to monitor the client’s bones and give calcium supplements if necessary. The patient should also visit an ophthalmologist every 12 months to test for excessive (N) glaucoma and (N) cataracts to lower the risk of having visual impairment.

Decision 3

As the patient admits to abuse and misuse of corticosteroids, (N) Cushing’s syndrome can be exacerbated by corticosteroid therapy. (PN) I, as a nurse practitioner can make an attempt to decrease and taper over-the-counter steroids and beauty products (V) containing steroids to the least dosage required to address the underlying illness process to prevent the patient’s condition from (V) deteriorating further. Generally, alternate-day treatment reduces the manifestations of Cushing’s disease.

Conclusion

Cushing’s disease is a debilitating disorder and transsphenoidal surgery is the preferred first-line therapy.  Medication therapy might be an essential addition to the therapeutic choices for the patient post-surgery.  The nurse monitors (PN) her laboratory (V) readings and daily weights to determine hydration and electrolyte status post-surgery. (PN) Her blood sugar (V) monitoring is started due to the elevated risk of glucose intolerance and hyperglycemia post-operatively.

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References

Cohen, A. C., Goldney, D. C., Danilowicz, K., Manavela, M., Rossi, M. A., Gómez, R. M., Cross, G. E., & Bruno, O. D. (2019). Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome. Archives of Endocrinology and Metabolism, 63(5), 470–477. https://doi.org/10.20945/2359-3997000000144

Hinkle, J. L., & Cheever, K. H. (2018). Brunner and suddarth’s textbook of Medical-Surgical Nursing. Wolters Kluwer.

Kahramangil, B., Montorfano, L., Gutierrez, D., Erten, O., Zhou, K., Li, D., Rao, P., & Berber, E. (2022). Biochemical assessment of adrenal insufficiency after adrenalectomy for non-cortisol secreting tumors: clinical correlation and recommendations. Surgical Endoscopy, 36(10), 7638–7646. https://doi.org/10.1007/s00464-022-09232-8

This discussion question will have you demonstrate your knowledge of the medical terms, understanding of the use of nouns, pronouns, and verbs, by creating a scenario of a patient. Research a medical disease and write 2-3 paragraphs to your classmates describing your patient’s condition using 20 of the words in Section 1, 2, and 3 of the textbook under “Medical Spelling.” You must highlight these words in yellow. You will also need to highlight at least ten nouns, ten pronouns, and ten verbs. Provide at least one reference to support your discussion of the disease.
The response must have the medical term used highlighted or the non-medical word/phrase highlighted in yellow.