Nursing Case Study for Cushing Syndrome -myassignmenthelp.com

Question: Discuss about theNursing Case Study for Cushing Syndrome. Answer: Introduction: Cushing syndrome can be defined as hypercorticosolism is a particular health adversity which is caused by excessive exposure to high levels of cortisol hormone for a prolonged period of time. On a simpler note, it can be mentioned that this particular disease is facilitated by the abnormality in the concentration of the hormone cortisol. There are a few hallmark signs of the Cushing syndrome, some of them can be considered as a fatty hump between the shoulders, a rounded face, and pink or purple stretch marks on the skin. Other physiological manifestations of this disease include extreme hypertension, localized obesity mostly abdominal, and weakness in both the muscles and the bones. Therefore, along with the risk of high blood pressure, weakness and other related co-morbidities, it has to be mentioned in this context that this particular health adversity is also associated with body image alterations and facultative mobility restriction (de Bruin et al., 2012). Therefore, it has to be mentioned that the physical as well as psychological burden of this diseases is extremely high for this particular disease and hence there is often the need for surgical intervention like adrenalectomy. However, for extremely obese patients, which is mostly the case for the Cushing syndrome sufferers, the post operative deterioration can be a significant health and wellbeing concern for the patients. This assignment will attempt to deal with the different post operative complications that are common for the adrenalectomy surgery for Cushing syndrome and the relevant post operative care requirements taking the aid of a case study. Aetiology and pathophysiology of the patient: This case study represents the case of Susan Summers, a 40 years old woman, a victim of two much related co-morbidities, obesity and diabetes. Along with that the patient had also been suffering from excessive obesity at 90kg with a BMI of 35kg/m2. Susan had also had the risk of mild alcoholism and had a history of drinking a bottle or more of wine every night to cope with her life. However, her history of having a benign tumor in her right adrenal gland had been the primary reason behind the overexposure to cortisol enzyme and the resultant abdominal obesity in the patient due to cushing syndrome. The patient had to undergo an adrenalectomy surgery attempting for positive changes in her appreacnce nad body image (Dekkers et al., 2013). Now pathophysiology and aetiology for the disease condition of the present is relative. Cushing syndrome is facilitated by the overexposure of cortisol hormone and there is an intricate hormone signalling pathway employed behind this phenomenon. It has to be mentioned that complementary action of both the corticotrophin releasing hormone and the adrenocorticotropin facilitates the secretion of the hormone cortisol in the adrenal glands of the human body. It has to be understood that the increase in the cortisol levels effects the kidney functions and in turn impacts the blood glucose level in the body (Elliott Coventry, 2012). This is the pathway following which the cortisol overexposure leads to type 2 diabetes in the patients. Along with that it has to be mentioned as well that the cortisol hormone is also associated with the process of maintaining the functionality of the cardiovascular system and the regulates the fluctuations in the blood pressure levels, which in turn facilita tes the abdominal obesity. Therefore, it can be concluded that the cortisol releasing adrenal cortex is the primary aetiology of this diseases and in the case of the patient under consideration as well, the abnormality in the cortisol levels and its impact on the CRH-ACTH feedback loop results into the obesity, hypertension and type 2 diabetes in the patient (Dimopoulou et al., 2014). Pathophysiology of the postoperative deteriorations: It has to be mentioned in this context that a key requirements for the analysis of the different post operative deteriorations, there is need for adequate monitoring and analysis of the vital signs of the patient in the hours following a surgery. It has to be understood that the different vital signs are indicative of the different life sustaining physiologic and metabolic function of the body, hence any fluctuations in the vital signs can indicate directly at the anomaly in the body system facilitated by any post operative deterioration (Tang et al., 2015). First and foremost, the respiratory rate in the patient had been 30 breaths per minute. Now it has to be mentioned that the respiratory rate of any normal healthy adult is 12-20 breaths per minute, hence the patients respiratory rate is undoubtedly enhanced. An underlying cause to this phenomenon can be the pulmonary dysfunction caused by the tachypnea facilitated by the pulmonary dysfunction due to post anaesthetic effect and th e extra pressure on the thoracic cage due to the extreme abdominal obesity (Guaraldi Salvatori, 2012). Along with that, it has t o be mentioned that the pulse rate of the patient had been 128 beats per minute, where as the normal heart rate for a healthy adult is 80-100 beats per minute. This coupled with the high blood pressure levels of the patient at 160/90 mmHg is the clear indication of the deteriorating health status of the patient. Elaborating more it has it be mentioned that for the obese and diabetic patients the post anaesthetic period is associated with many cardiovascular complications. It has to be understood in this context that the increased insulin resistance in the diabetic patients coupled with the high BMI due to the high obesity is the primary reason behind the hypertension which is manifested as the high pulse rate and the blood pressure (Nieman, 2015). Along with that, it also needs to be mentioned that regular alcohol consumption also can be a major contribut ing factor behind the pathophysiology of hypertension in the patients which is accentuated in the post anaesthetic period. The temperature of the patient had also been a little reduced from the normal levels attributing to the effects of anaesthesia. Along with that, it has to be mentioned that the last vita sign of the patent had been the low urine output at 5ml in the last hour. The normal urine output is generally is close to 1000-2000 ml on a daily basis and depending on that calculation; the patient had been suffering from low urine output. It has to be mentioned that the high abdominal pressure after the surgery can contribute to the low urine output (Gupta et al., 2011). As per post operative care that the patient will be requiring, it has to be mentioned that wound management and surgical site infection control is the most important fact. It has to be mentioned that wound care needs to be systematic and aseptic at all times. Along with that the patient would require a few breathing exercises and even airway clearance deepening on the severity of the need of the patient. Beta blockers will also be needed to be provided to the patient in an attempt to restore the normal cardiac functions. Following an adrenalectomy surgery the patient will require the assistance of the steroid therapy to ensure normal adrenal gland functioning. For increasing the urine output of the patient taking extra fluids, fiber, along with usage of stool softeners will be beneficial (Hartmann et al., 2016). Interdisciplinary care: It has to be mentioned that along with the care provided by the nursing professional and the health practitioner, the patient in this case study will require the assistance of the different interdisciplinary health care members in order to have the most optimal and best health outcomes. First and foremost, the patient will require the assistance dieticians or nutritionist who will play a vital role in both the obesity and diabetes management of the patient. It has to be mentioned that for Susan reducing her weight and better control of the diabetes is very important in order to attain optimal recovery. The dietician will be responsible for maintaining a strict and multipurpose diet plan based on whole grains and fluids for the patient so that she can regain control of her daily calorie intake and can manage her blood glucose levels effectively (Kiriakopoulos et al., 2011). The assistance of an endocrinologist will help the patient in maintaining a control on the hormonal imbalance in the body, and help overcome the impact of the recent adrenalectomy and steroid therapy. Lastly the patient will also require the assistance of a physiotherapist in order to provide assistance in different mild gross motor skill exercises that will help the patient control her post operative recovery. Hence, the interdisciplinary care from the above mentioned 3 care members will optimize the hospice care after the surgery and will help the patient attain rapid recovery (Manenschijn et al., 2012). Conclusion: On a concluding note, it has to be said that Cushing syndrome is a very common health adversity and the resultant impact of the different health adversities are also very severe. However, one of the most impactful and altering effects of this particular disease is the localised obesity and altered body image which can be a very distressing factor for many. Hence, the most plausible option for such patients is the adrenalectomy which is also associated with many post operative complications. Although, as mentioned above an interdisciplinary care plan can help the patient attain speedy recovery. Reference: de Bruin, C., Hofland, L. J., Nieman, L. K., Van Koetsveld, P. M., Waaijers, A. M., Sprij-Mooij, D. M., ... Feelders, R. A. (2012). Mifepristone effects on tumor somatostatin receptor expression in two patients with Cushing's syndrome due to ectopic adrenocorticotropin secretion. The Journal of Clinical Endocrinology Metabolism, 97(2), 455-462. Dekkers, O. 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