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Cushing’s Syndrome Case Study (60 min)

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Ms. Smith Is a 33 year old female who presents to her primary care provider for General muscle weakness and low back pain.  She reports that this pain has been going on for about 3 months and the weakness has been getting worse over the last 2 weeks and she has been more fatigued with basic physical exertion. She reports getting “steroid injections” in her back previously, but they “didn’t last long at all”.

Critical Thinking Check
Bloom's Taxonomy: Application

What further history questions should be asked of Ms. Smith?

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Ms. Smith has a history of Type II Diabetes and Asthma, and has been taking inhaled corticosteroids for the past 6 years.  She also reports reports having irregular menstrual cycles for the past 2 years accompanied by unexplained weight gain in her abdomen. Her previous provider told her she might have Polycystic Ovarian Syndrome.

Critical Thinking Check
Bloom's Taxonomy: Application

What initial nursing assessments should be performed?

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Ms. Smith’s Vital Signs were as follows:

HR 78

BP 156/92

RR 14

Temp 98.8°F


The nurse notes purple/pink stretch marks on arms, abdomen, and thighs. Ms. Smith has multiple cuts and bruises on her arms. When asked how she got them, she says “my skin is just so thin these days”. She is obese with noticeable fatty deposits in the midsection and upper back.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What diagnostic testing do you anticipate for Ms. Smith?

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Ms. Smith is sent home with a pain reliever for her back pain while the laboratory results are processed.  An ultrasound of her kidneys and ovaries is ordered, pending scheduling an appointment for next week. Two days later, lab values result and show the following:

Cortisol 28 mg/dL (H)

Glucose 265 mg/dL

K 3.3 mEq/L

Na 148 mg/dL

Ca 7.8 mg/dL

Testosterone levels elevated

 

Critical Thinking Check
Bloom's Taxonomy: Analysis

Which finding(s) is/are concerning and need to be reported to the provider? Why?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What do you believe is going on physiologically with Ms. Smith?

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The provider notifies Ms. Smith that she needs to be seen again ASAP for further diagnostic testing to rule out any cardiac abnormalities. He tells her to stop taking her inhaled corticosteroid and prescribes a different rescue inhaler for her asthma.  He also tells her she needs to begin taking some supplements, including calcium and potassium

Critical Thinking Check
Bloom's Taxonomy: Analysis

Why does Ms. Smith need to have her heart checked out? What test would they do?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

Why does Ms. Smith need calcium supplements? What caused her hypocalcemia? How might this contribute to her back pain?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

Why does Ms. Smith have to stop taking her inhaler?

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