Question

In: Nursing

John is a 32 year old IT worker with a wife and a 3 year old...

John is a 32 year old IT worker with a wife and a 3 year old child. During a previous physical, it was noted that John has an ‘obese’ BMI of 33. John attributed his weight problem to a lack of exercise because of his work/family life, and because of his moderate to severe asthma. John mentioned that he regularly The only prescription John was taking at the time of that former visit was prednisolone, an asthma medication he has been taking for the last 3 years. In this hospital visit, John’s wife mentions that he hasn’t taken his medication for the last few weeks because of a stomach flu- she commented that he hasn’t had the time or energy to refill his prescription. Upon arrival at the hospital, the following were noted in the current work up of John: · He was irritable, dizzy, complained of progressive weakness, fatigue, poor appetite, and weight loss. · He has relapsed into nausea, diarrhea, vomiting, and muscle/ joint pains. · Other new complaints include a strong salt craving, body hair loss and sexual dysfunction, and a general pattern of depressed mood and lack of motivation. · He is displaying darkening of the skin (hyperpigmentation) prominent on the sun-exposed areas of the skin, and extensor surfaces (knuckles, elbows, knees). · His numbers: body temp: 37.3C; BP= 80/60mm Hg. · A blood sample was also taken and the following were evaluated: T4: 1.1 ng/dl and T3: 4.2 pg/ml; cortisol: 2 mcg/dL and aldosterone: 4 ng/dL; blood glucose: 60 mg/dl. Questions: Based on this scenario, what is your diagnosis and why? Discuss and create a diagram of what is ‘normal’ in your answer. (2 pts for correct diagnosis, 4 pts for correct and thorough description with a diagram of the underlying pathways.) Is this because of a primary or secondary defect? What test could you use to differentiate and confirm this assessment? (3pts) Explain what is causing hypotension in this patient. (2pts) Explain the underlying reasons for the hyperpigmentation. (2pts) What short-term and long-term treatments would you recommend for this patient? (2pts)

Solutions

Expert Solution

Diagnosis: Addison disease

The patient shows all typical signs and symptoms of this disease like weakness, fatigue, dizziness,loss of consciousness,mood swings,decreased motivational power, nausea, vomiting, diarrhoea, anorexia, weight loss, hyperpigmentation,salt craving, blood value of decreased cortisol and aldosterone levels,loss of body hair, decreased sexual pleasure,low BP,low sugar level.

Alteration in the adrenal glands>>fluctuations of blood loss>>low BP>>decreases cortisol and adrenal production>>gastrointestinal symptoms,central nervous symptoms,,low sexual drive, alteration in thyroid hormone>>increase body hair>>salt lost from body>>salt craving>>energy used from muscles>>muscle weakness, joint pain>>hypoglycemia>>adrenal crisis

Hypotension is caused because of insufficient adrenal function which helps control and maintain blood pressure leading to low blood pressure.

Hyperpigmentation occurs due to increased effect on the ACTH( adrenocorticotropic ) hormone on melanocytes and increasing melanin causing hyperpigmentation of skin ,and may be due to exposure to sunlight

Short term treatment:

Symptomatic treatment of the signs

Administration of hydrocortisone, Prednisone,fludrocortisone

Long term treatment;

Always have medical alert card

Medication life long

Increase dosage of medications during illness, surgery or dental treatment.

Weight loss and it's management

Lifestyle changes for managing asthma


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