Case Study 78 Cushing’s Syndrome
Scenario
You graduated 3 months ago and are working with a home care agency. Included in your caseload is J.S., a 60-year-old man suffering from chronic obstructive pulmonary disease (COPD) related to (R/T) cigarette smoking. He has been on home oxygen, 2 L oxygen by nasal cannula (O2/NC), for several years. Approximately 10 months ago, he was started on chronic oral steroid therapy. Medications include ipratropium-albuterol (Combivent) inhaler, formoterol (Foradil) inhaler, dexamethasone (Decadron), digoxin, and furosemide (Lasix). On the way to J.S.’s home, you make a mental note to check him for signs and symptoms (S/S) of Cushing’s syndrome.
Clinical Presentation
• Centripedal (truncal) obesity or
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Prednisone can cause upset stomach. It can have serious side effect with vision problems. If it’s not helping with joint pain then the dose may need altering.
8. Differentiate between the glucocorticoid and mineralocorticoid effects of prednisone.
Mineralocorticoids=
The name mineralocorticoid derives from early observations that these hormones were involved in the retention of sodium, a mineral. The primary endogenous mineralocorticoid is aldosterone, although a number of other endogenous hormones (including progesterone and deoxycorticosterone) have mineralocorticoid function.
Aldosterone acts on the kidneys to provide active reabsorption of sodium and an associated passive reabsorption of water, as well as the active secretion of potassium in the principal cells of the cortical collecting tubule and active secretion of protons via proton ATPases in the lumenal membrane of the intercalated cells of the collecting tubule. This in turn results in an increase of blood pressure and blood volume.
Glucocortiocoids=
Glucocorticoids (GC) are a class of steroid hormones that bind to the glucocorticoid receptor, which is present in almost every vertebrate animal cell.
GCs are part of the feedback mechanism in the immune system that turns immune activity (inflammation) down. They are therefore used in medicine to treat diseases that are caused by an overactive immune system, such as allergies, asthma, autoimmune diseases and sepsis. GCs have
1. Write a client outcome to help Mrs. Ross resolve the symptoms (i.e., defining characteristics). Refer to Section III (beginning on p. 119) of the Ackley and Ladwig text.
Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org.
Poor work life balance for gen. y – When gen. y can’t work due to their social life outside of work. The gen. y wanted more flexible working hours instead of wanting to only have to work full-time. Francoli gave them the solution to pick between two option which where 1) was to work longer hours four days a week and have the Friday off or 2) employees get to choose when they want to work put to only 8 hours a day.
Patient has been previously certified with 4 Butrans Patches 10 mcg/hr on 04/12/16 ( Review 256727).
3. Any travel/accommodation for interstate attendees would need to be arranged. Also the same for the guest speaker (if needed). Transfers to and from the airport would be advisable.
The side effect of corticosteroid (comprise, cortisone, hydrocortisone and prednisone) is a treatment done for asthma and other types of illnesses, the reaction of this treatment can be:
Corticosteroids are normally made by the adrenal glands located on the top of each kidney. It is often prescribed for a major variety of conditions to help reduce inflammation and to let the immune system relax. Specific hormones that the body cannot produce automatically can be replaced by corticosteroids. An example of the body not being able to manufacture hormones itself, would be the Addison’s disease. This disease occurs due to the inability of the adrenal glands to produce the sufficient amount of homones that
Patients taking oral glucocorticoids should be monitored for steroid myopathy which can contribute to muscle weakness, decreased functionality, and respiratory failure in subjects with very severe COPD (GOLD,2017).
1- There are not enough studies that investigated the use of other corticosteroids aside from prednisone and methylprednisolone that showed efficacy in the treatment of PCP. There have been case report using hydrocortisone doses of up to 1000 mg to treat patient with PCP, however, the data is outdated and has not been validated in head to head trials (Montaner JS1,
In general, low dosage Glucocorticoid therapy has minor side effects associated with it; however more serious side effects may also result from high dosage or prolonged administration.
Glucocorticoids are produced by the adrenal gland and involved in a variety of functions in the body including regulation of glucose and fat metabolism. However,
Base on what i read in the book, and how prednisone works " The precise mechanism of action of corticosteroids is not known. It is thought that they diminish the activation of inflammatory cells and increase the production of anti-flammatory mediators, which in turn reduces mucus production and edema and decrease airway
Prednisolone is chemically known as a corticosteroid which is a ‘steroid hormones’ (DIAAIC). The corticosteroids are produced in the adrenal cortex and come in two forms; glucocorticoids and mineralocorticoids. The two forms differ in that glucocorticoids act as anti-inflammatory steroids and as a metabolising agent. The mineralocorticoids however, work to maintain a balance between the water and salt levels in the body. Prednisolone is used to treat inflammatory diseases and is therefore known as a ‘synthetic glucocorticosteroid’. Steroids work by reducing swelling and inflammation (DIAAIC).
Corticosteroids are usually used with acute flares of disease only and have no role in the maintenance of remission. Commonly used Corticosteroids are prednisolone, methylprednisolone and budesonide, and they are usually administered orally, in the form of enemas, suppositories or systematically. The use of corticosteroids is limited by their adverse effects, particularly with prolonged use compared with Aminosalicylates. The potential complications of corticosteroids use include fluid and electrolyte abnormalities, osteoporosis, cataracts, endocrine dysfunctions and psychosis. Although Corticosteroids have beneficial effect in treating moderate and severe flare-ups of UC, they are not useful for maintenance treatment of UC. Corticosteroids are highly effective drugs for induction of remission in patients with active CD compared with
Inaash (a Lebanese non-profit organization that supports the Palestinian refugees) has created jobs for thousands women in camps through the production of Palestinian embroidery products. Although the organization had made significant achievements—from supporting refugees to offering medical help to elderly and sponsoring children’s education—major changes in its environment have resulted to diminishing sales and increased dependence on donations. As a result, Inaash’s