Case Study in Endocrine

Case Study in Endocrine in preparation for Discussion. A 51-year-old unemployed salesman is brought to the emergency department by EMS at 0800, accompanied by his wife.  His wife tells the emergency department nurse that her husband has not been feeling well for the last week, but that when he got up this morning, he was so weak he couldn’t dress and didn’t know where he was.

She also tells the nurse her husband has been taking a cortisone drug for the treatment of his rheumatoid arthritis for the past 2 years, but notes, “We didn’t have the money to buy it this month.”

Assessment data includes:

The patient is dehydrated with dry oral mucous membranes and tongue, poor skin turgor, and sunken eyeballs. His blood pressure is 94/44, and his pulse is rapid and thread.  He is weak, dizzy, and disoriented about time and place.  Diagnostic tests done at 0830 reveal the following abnormal findings:

  • EKG: widening QRS complex and increased PR interval (had peaked T-waves in the ambulance)
  • Sodium: 129 mEg/L (normal range: 135-145 mEq/L)
  • Glucose: 54 mg/ dL (normal range: 70-110 mg/dL)
  • Potassium: 6.2 mEq/L (normal range: 3.5-5 mEq/L)
  • Cortisol: 2 mg/dL (normal for morning draw: 5-23 mg/dL)

The physician determines that the patient is probably suffering from adrenal insufficiency.  The physician orders 5% Dextrose in 0.9 % sodium chloride in water (D5NS) to run at 250 mL/hr intravenously and Hydrocortisone 200 mg IV.  After initiation of the IV fluids and medication, the patient is admitted to an inpatient bed with continuous heart monitoring.

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  1. Briefly explain what adrenal insufficiency is.  Is there one kind or multiple—if so, what are the differences—this should be a discussion of the pathophysiology and presentation of adrenal insufficiency
  2. What are the data that support this diagnosis in this patient? Which of the above does the patient have?
  3. What contributed to the patient developing this condition?
  4. Give a brief explanation of each of the above lab/diagnostic test results, with the pathophysiology behind each.
  5. Identify at least 2 methods that could be used to lower the potassium level if the patient has symptomatic hyperkalemia.
  6. Name 1 priority nursing diagnosis and 1 educational nursing diagnosis.  This condition is potentially deadly for the patient, so the priority diagnosis must reflect a serious response to adrenal insufficiency that the nurse can address
  7. Name a goal statement for each nursing diagnosis.
  8. List 3 nursing interventions for each nursing diagnosis and please be specific about what is essential to teach this patient and his wife

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