Cushing’s Syndrome Case Study (60 min)

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Study Tools For Cushing’s Syndrome Case Study (60 min)

Addison’s vs. Cushing’s (Cheatsheet)
Cushings Pathochart (Cheatsheet)
Moon Face in Cushing’s Syndrome (Image)
Symptoms of Cushing’s Syndrome (Image)
Cushing’s Syndrome Signs (Image)
Cushings Assessment (Mnemonic)
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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”.

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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Dysrhythmias

Concepts Covered:

  • Circulatory System
  • Emergency Care of the Cardiac Patient
  • Disorders of the Posterior Pituitary Gland
  • Endocrine
  • Multisystem
  • Cardiac Disorders
  • Renal
  • Fundamentals of Emergency Nursing
  • Adult
  • Medication Administration
  • Disorders of the Adrenal Gland
  • Disorders of the Thyroid & Parathyroid Glands
  • Central Nervous System Disorders – Brain
  • Vascular Disorders
  • Depressive Disorders
  • Urinary System
  • Eating Disorders
  • Shock
  • Emergency Care of the Trauma Patient
  • Communication
  • Basics of NCLEX
  • Renal Disorders
  • Upper GI Disorders
  • Intraoperative Nursing
  • EENT Disorders
  • Labor Complications
  • Bipolar Disorders
  • Acute & Chronic Renal Disorders
  • Substance Abuse Disorders
  • Anxiety Disorders
  • Cardiovascular Disorders
  • Musculoskeletal Disorders
  • Trauma-Stress Disorders
  • Postpartum Complications
  • Emergency Care of the Respiratory Patient
  • Respiratory Emergencies
  • Noninfectious Respiratory Disorder
  • Somatoform Disorders
  • Emergency Care of the Neurological Patient
  • Neurological Emergencies
  • Respiratory Disorders

Study Plan Lessons

02.10 12 Lead EKG- Lead V1-V6 for CCRN Review
02.11 12 Lead EKG- Injuries for CCRN Review
03.02 Diabetes Insipidus for CCRN Review
06.03 Multi-System CCRN Important Points for CCRN Review
06.04 Differentiating Ectopy and Aberrancy for CCRN Review
09.05 Chronic Renal Failure for CCRN Review
1st Degree AV Heart Block
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
3rd Degree AV Heart Block (Complete Heart Block)
Abuse and Neglect for Certified Emergency Nursing (CEN)
ACLS (Advanced cardiac life support) Drugs
Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome for Certified Emergency Nursing (CEN)
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
Advanced Cardiovascular Life Support (ACLS)
Amiodarone (Pacerone) Nursing Considerations
Amitriptyline (Elavil) Nursing Considerations
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Antidepressants
Antidepressants
Arterial Pressure Monitoring
Atrial Fibrillation (A Fib)
Atrial Flutter
Calcium and Magnesium Imbalance for Certified Emergency Nursing (CEN)
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Calculating Heart Rate
Cardiac (Heart) Enzymes
Cardiac Anatomy
Cardiac Stress Test
Cardiogenic Shock and Obstructive Shock for Certified Emergency Nursing (CEN)
Cardiopulmonary Arrest
Cardiovascular Trauma for Certified Emergency Nursing (CEN)
Communicating with Providers
Congestive Heart Failure Concept Map
Critical Thinking
Cushing’s Syndrome Case Study (60 min)
Dialysis & Other Renal Points
Diltiazem (Cardizem) Nursing Considerations
Dopamine (Inotropin) Nursing Considerations
Dysrhythmia Emergencies
Dysrhythmias Labs
EKG (ECG) Course Introduction
EKG (ECG) Waveforms
EKG Basics – Live Tutoring Archive
Electrical A&P of the Heart
Electrical Activity in the Heart
Electrolytes Involved in Cardiac (Heart) Conduction
Enteral & Parenteral Nutrition (Diet, TPN)
General Anesthesia
Heart (Cardiac) Failure Therapeutic Management
Heart Failure Case Study (45 min)
Heart Failure for Certified Emergency Nursing (CEN)
Hypertension for Certified Emergency Nursing (CEN)
Hypertensive Emergency
Hyperthyroidism Case Study (75 min)
Increased Intraocular Pressure for Certified Emergency Nursing (CEN)
Lung Surfactant
Lung Surfactant for Newborns
Magnesium Sulfate (MgSO4) Nursing Considerations
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Mood Stabilizers
Mood Stabilizers
Myocardial Infarction (MI) Case Study (45 min)
Nitroprusside (Nitropress) Nursing Considerations
Norepinephrine (Levophed) Nursing Considerations
Normal Sinus Rhythm
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Case Study for (PTSD) Post Traumatic Stress Disorder
Nursing Case Study for Cardiogenic Shock
Nursing Case Study for Head Injury
Nursing Case Study for Rheumatic Heart Disease
Obstetric Trauma for Certified Emergency Nursing (CEN)
Pacemakers
Peptic Ulcer Disease Case Study (60 min)
Performing Cardiac (Heart) Monitoring
Pericardial Tamponade for Certified Emergency Nursing (CEN)
Potassium-K (Hyperkalemia, Hypokalemia)
Premature Atrial Contraction (PAC)
Premature Ventricular Contraction (PVC)
Procainamide (Pronestyl) Nursing Considerations
Pulmonary Embolus for Certified Emergency Nursing (CEN)
Pulmonary Hypertension for Certified Emergency Nursing (CEN)
Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)
Rheumatic Fever
Sinus Bradycardia
Sinus Tachycardia
Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)
Somatoform Disorder Case Study (30 min)
Stroke Case Study (45 min)
Stroke for Progressive Care Certified Nurse (PCCN)
Supraventricular Tachycardia (SVT)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
The EKG (ECG) Graph
Thoracic Surgery (Lobectomy, Pneumonectomy) for Progressive Care Certified Nurse (PCCN)
Troponin I (cTNL) Lab Values
Vasopressin (Pitressin) Nursing Considerations
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V-tach)