Question

CASE STUDY Patient Profile Mahmoud is a 26-year-old secondary school teacher. He seeks the advice of his health care provider because of changes in his appearance over the past year. Subjective Data • Reports weight gain (particularly through his midsection), easy bruising, and edema of his feet, lower legs, and hands • Has been having increasing weakness and insomnia Objective Data • Physical examination: BP 150/110; 2+ edema of lower extremities; purplish striae on abdomen; thin extremities with thin, friable skin; severe acne of the face and neck • Blood analysis: Glucose 167 mg/dL (9.3 mmol/L); white blood cell (WBC) count 13,600/μL; lymphocytes 12%; red blood cell (RBC) count 6.6 × 106/μL; K+ 3.2 mEq/L (3.2 mmol/L) Discussion Questions (answer the following questions): 1. Discuss the probable causes of the alterations in Mahmoud’s laboratory results. 2. Explain the pathophysiology of Cushing syndrome. 3. What diagnostic testing would identify the cause of Mahmoud’s Cushing syndrome? 4. What is the usual treatment of Cushing syndrome? 5. What is meant by a “medical adrenalectomy”? 6. What are the priority nursing responsibilities in the care of this patient? 7. Based on the assessment data presented, what are the priority nursing diagnoses?

Answer 1

1, Patients highly stressed job increase their stress that blocks the insulin level it increases the sugar level and stressful situations increase their blood pressure. patient high WBC count and lymphocytes counts indicate there is an infection, low RBC indicate anemia.
2, Cushing syndrome used to describe a condition by long term exposure to high glucocorticoids. it is caused by excess secretion of adrenocorticotrophin hormone by a pituitary tumor. when stimulated by ACDH, the adrenal gland secretes cortisol and steroid hormone. ACDH produced by the pituitary gland and released into the petrosal venous sinuses when CRH stimulates by the hypothalamus.
3, Diagnostic tests:
24 hours of urine and blood test measure the hormone level in urine.
Saliva test at night find the cortisol level
CT and MRI scans provide pictures of pituitary and adrenal gland tumors.
Petrosal sinus sampling find the ACDH level.
4, Treatment goal to reduce the cortisol level, reduce the corticosteroid use reduce the signs and symtpoms. medication block the cortisol level include ketoconazole reduce the cortisol level. surigical treatment to remove the tumor as a optional.