Question

 Scenario
You graduated 3 months ago and are working with a home care agency. One patient in your caseload is
J.S., a 60-year-old man with chronic obstructive pulmonary disease (COPD) related to cigarette smoking.
He has been on home oxygen, 2L oxygen by nasal cannula, for several years. Approximately 10 months
ago, he started on chronic oral steroid therapy. His current medications include an ipratropium/albuterol
(Combivent) inhaler, beclomethasone (Beclovent) inhaler, dexamethasone (Decadron), digoxin (Lanoxin),
and furosemide (Lasix).

1. On the way to J.S.'s home, you make a mental note to check him for signs and symptoms of
Cushing syndrome. Why?
2. Differentiate between Cushing syndrome and Cushing disease.

3. Your assessment includes the following findings. Determine whether the findings are
attributable to J.S.'s COPD or possible Cushing syndrome. Place an L beside the symptoms
consistent with COPD and a C next to those consistent with Cushing syndrome.
_____ 1. Barrel chest
_____ 2. Full-looking face (moon face)
_____ 3. BP 180/94mm Hg
_____ 4. Pursed-lip breathing, especially when patient is stressed
_____ 5. Striae over trunk and thighs
_____ 6. Bruising on both arms
_____ 7. Acne
_____ 8. Diminished breath sounds throughout lungs
_____ 9. Truncal obesity with thin extremities
_____10. Supraclavicular and posterior upper back fat
4. You inform the physician of J.S.'s assessment. The physician believes J.S. has developed
Cushing syndrome and decides to change his prescription from dexamethasone (Decadron)
daily to prednisone (Deltasone) given on alternate days. Explain the rationale for this change.

5. Identify possible consequences of suddenly stopping dexamethasone (Decadron) therapy.
6. You advise J.S. to take the prednisone (Deltasone) at breakfast. Why?

7. Cushing syndrome can affect memory. Patients can easily forget what medications have been
taken, especially when there are several different medications and some are taken on
alternating days. List at least three ways you can help J.S. remember to take his medications
as prescribed.
8. J.S. states that his appetite has increased but he is losing weight. He reports trying to eat, but
he gets short of breath and cannot eat any more. How would you address this problem?
9. You ask him questions related to the presence gastric discomfort, vision, and joint pain. Why?

10. Differentiate between the glucocorticoid and mineralocorticoid effects of prednisone
(Deltasone).

11. How would your assessment change if J.S. were taking a glucocorticoid that had significant
mineralocorticoid activity?
12. Review J.S.'s list of medications. Based on what you know about the side effects of loop
diuretics and steroids, discuss the potential problem of administering these in combination
with digoxin.
13. You need to assess J.S. for signs and symptoms of an infection. Why?

14. What signs and symptoms of infection do you assess for in J.S.? Select all that apply.
a. Pain
b. Fever
c. Loss of function
d. Palpitations
e. Unusual drainage
f. Localized edema

15. Realizing J.S. is susceptible to infection, you review with him ways to reduce the risk of
infection. Identify four major points to include.
16. In addition to measures to reduce the risk of infection, what other information would you
want to stress to J.S. at your visit? Select all that apply.
a. Drink at least 4000mL of fluids daily.
b. Increase intake of foods high in sodium.
c. Weigh yourself first thing in the morning.
d. Take vitamin and electrolyte supplements as prescribed.
e. Notify the physician if your pulse is lower than 60 beats/min.
f. Call the doctor if your weight increases more than 2-3 pounds in 1 day.
g. Take the furosemide (Lasix) first thing in the morning and again at bedtime.

Glucocortocoids Medications

Fludrocortisone

Dexamethasone

Aminpglutethimide

Metyrapone

Mitotane

Etomidate

The Nursing Process

What nursing assessment will you perform regarding each medication? 

What planning and implementation do you need to do for each medication?

How would you evalute the effectiveness of each medication?

Answer 1

1)It is necessary to check signs and symptoms of cushing syndrome because people with COPD also have cushing syndrome.It is a harmonal condition where people who are more than 50 are prone to this condition.It is necessary to check the signs and symptoms of COPD patients to know if they have cushing syndrome.Signs and symotoms of cushing syndrome is weight gain, increase urine secretion,strech marks,high blood pressure,acne and fatigue etc.

2)Difference between cushing syndrome and cushing disease is .

Cushing syndrome is caused by the excessive secretion of cortisol in the blood where as cushing dieseas is caused by the tumour in pitutary which secreted ACTH.

Cushing syndrome is more common than cushing diseases.

3)

1)Barrel chest -L

2)Full looking face -C

3)B.P 180/94 mm Hg.- C

4)Pursed lip breathing particularly when patient is stressed -L

5)Striad over trunk and thigh's --C

6)Bruising on both arms -C

7)Acne -C

8) Diminished breath sounds throhouthr lungs -L

9)Truncal obesity with thin extremists -C

10) Suoerclavical and posterior upper back fat -C

4)To prevent the risk of heart failure and gigh blood pressure.

5)Adrenal insufficiency may result if the medicine is suddenly stopped.If symptoms such as fatigue, weakness, nausea,hypoglycemia they may be life threatening and physician should be consulted immediately.

6)It is taken every morning at breakfast because it may decrease the interference with the patient sleep cycle.

7)Notes should be used.Routine should made.

Pill box,alarm.on phone.

8)Take 6 small meals and take rest between eating and rest before eating and take high protein diet.

9)He has a risk of developing ulcers and osteoporosis because he is taking glucocorticoid.