Cushing’s Syndrome Case Study (60 min)
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Outline
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”.
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. Ms. Smith’s Vital Signs were as follows: HR 78 BP 156/92 RR 14 Temp 98.8°F 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 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 potassiumWhat further history questions should be asked of Ms. Smith?
What initial nursing assessments should be performed?
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.What diagnostic testing do you anticipate for Ms. Smith?
Which finding(s) is/are concerning and need to be reported to the provider? Why?
What do you believe is going on physiologically with Ms. Smith?
Why does Ms. Smith need to have her heart checked out? What test would they do?
Why does Ms. Smith need calcium supplements? What caused her hypocalcemia? How might this contribute to her back pain?
Why does Ms. Smith have to stop taking her inhaler?
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Nursing Case Studies
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.
We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.