Question

CRITICAL THINKING EXERCISES

Identify the priorities, approach, and techniques you would use to perform a comprehensive assessment on a 60-year-old patient newly diagnosed with Cushing syndrome. How will your priorities, approach, and techniques differ if the patient has a visual impairment or is hard of hearing? If the patient is from a culture with very different values from your own?

Answer 1

Identify the priorities, approach, and techniques you would use to perform a comprehensive assessment on a 60-year-old patient newly diagnosed with Cushing syndrome

Clinical decision making for sufferers with suspect hypercortisolism includes a complicated diagnostic assessment. Cushing's syndrome stays one of the most difficult endocrine pathologies. Most clinical elements overlap with these of frequent diseases determined in the typical population, and some patients have an extraordinary clinical presentation with solely remoted symptoms. Recently, quite a few research have cautioned that the occurrence of Cushing's syndrome is greater than until now thought. Therefore, efficient screening exams are wished to perceive the few uncovered patients additionally among unselected high-risk ambulatory sufferers with disorders potentially associated to cortisol excess. The encouraged diagnostic tests are 24-h urinary free cortisol, 1-mg overnight dexamethasone suppression test, and late-night salivary cortisol. Once the prognosis of Cushing's syndrome is established, the next step is the size of plasma ACTH. Then, dynamic take a look at and suitable imaging techniques are the most useful noninvasive investigations for the differential diagnosis. Patients with Cushing's syndrome are normally responsive to the CRH test and to high-dose glucocorticoid feedback. Bilateral inferior petrosal sinus sampling is regarded the gold fashionable for organising the beginning of ACTH secretion, and it is endorsed in sufferers with ACTH-dependent Cushing's syndrome whose clinical, biochemical, or radiological studies are discordant or equivocal. The existing scientific case shows that even if rare, the ectopic ACTH secretion be viewed additionally in those instances the place the pretest likelihood is low. The management of Cushing's syndrome depends on the genuine knowledge of its a number of causes, paying interest to the many achievable diagnostic pitfalls. The preference of test, the modality of specimen series (blood, urine, and saliva), the high-quality of measurement (assay methodology and standardization), and close speak among endocrinologists, chemical pathologists, and neuroradiologists are key factors for optimum care of patients.

Nursing Assessment

Assessment focus  on the effects on the body of high concentrations of adrenal cortex to respond to adjustments in cortisol and aldosterone levels.

Health history. The records includes information about the patient’s levelof activity and ability to carry out routine and self-care activities.

Physical exam. The skin assessed for trauma, infection, breakdown, bruising, and edema.

Mental function. The nurse assesses the patient’s mental function consisting of mood, responses to questions, focus of environment, and degree of depression.

How will your priorities, approach, and techniques differ if the patient has a visual impairment or is hard of hearing?

Effective communication with a person who is hearing impaired

• Move closer to the person. Shortening the distance between the speaker and listener will increase the loudness of sound. This strategy is a lot greater positive than elevating your voice. Never shout at a person who is hard of hearing.
• Reduce background noise. Many noises that we take for granted are amplified via a hearing aid or cochlear implant.
• Talk face to face. Speak at eye level. Do no longer cowl your mouth with a masks when you’re asking the affected person questions or giving instructions.
• Try rewording a message. At times a person with a hearing loss can also be in part dependent on speech analyzing (lip reading) due to the fact some sounds may additionally no longer be without difficulty heard even with a hearing aid. Because some words are simpler to speech study than others, rephrasing a message may make it less complicated for the person to understand.
• Use a notepad to write down important questions or directions so that the person can read them. This helps do away with misunderstandings. If the man or woman can't study or reads in a language that is unfamiliar to you, a picture board may also be quite helpful.
• Make certain that the man or woman thoroughly understands what you said. Some people, specially if the hearing loss is recent, are reluctant to ask others to repeat themselves. They sense embarrassed via their listening to loss. Simply ask the person to repeat what you said. For example, say, “If you should please repeat returned to me what I said, I can make sure I told you every- thing that I want to.”
• Show exclusive cognizance of the listening to problem. Call the individual with a listening to loss by name to provoke a communication. Give a body of reference for the discussion by means of mentioning the subject matter at the outset (“I would like to review your medications”). Be patient, particularly when the man or woman is worn-out or ill and may additionally be much less able to hear.

If the patient is from a culture with very different values from your own?

Tips for Improving Cross-Cultural Communication
Cross-cultural conversation is about dealing with humans from different cultures in a
way that minimizes misunderstandings and maximizes have confidence between sufferers and
health care providers. The following simple hints will enhance communication.
1. Speak slowly, no longer loudly. Slow down and be cautious to pronounce words clearly. Do not communicate loudly. A loud voice implies anger in many cultures. Speaking loudly might cause the patient to turn out to be nervous. Use a caring tone of voice and facial
expressions to bring your message.
2. Separate questions. Try now not to ask double questions. Let the patient answer one question at a time.
3. Repeat the message in unique ways. If the patient does now not understand a statement, strive repeating the message the usage of distinct words. Be alert to words the patient understands and use them frequently.
4. Avoid idiomatic expressions or slang. American English is full of idioms. An idiom is a distinctive, often colorful expression whose that means cannot be understood from the combined which means of its person words, for example, the phrase “to kill two birds with one stone.”
5. Avoid tough words and needless information. Use short, simple sentences. Do not overwhelm the patient with too many data and lengthy, complicated explanations.
6. Check meanings. When communicating throughout cultures, by no means anticipate that the other person has understood. Be an active listener. Summarize what has been stated in
order to verify it. This is a very tremendous way of making sure that correct cross-cul-tural communication has taken place.