The initial post must include responses to all the questions in both case studies.
Mrs. A has been taking high doses of glucocorticoids for much of the past 2 years to control severe rheumatoid arthritis. She has now developed hypertension and type 2 diabetes and would like to stop taking the cortisone because of the unwanted changes in her appearance.
Discussion Questions
- How does Cushing’s syndrome affect the individual?
- Discuss how hypertension and diabetes have developed and the potential complications of these conditions.
- Discuss other potential problems that Mrs. A may experience resulting from long-term use of glucocorticoids.
Mrs. L is a 63-year-old woman who reports constant back pain. Further inquiry into her medical history revealed that over the past 3 years, she has suffered fractures of her femur and wrist after minor falls. She experienced menopause at age 49. Mrs. L has a secretarial job, drives to work, and she “does not have time for exercise.” She reports that she consumes 8 to 10 cups of coffee a day and has been a smoker most of her adult life. She has not seen her physician recently nor had a recommended bone density test because of the time and cost involved.
Discussion Questions
- Relate Mrs. L’s history to the diagnosis of osteoporosis. What risk factors are present, and how does each predispose to decreased bone density?
- Explain the cause of pathological fractures in this patient.
- How could osteoporosis have been prevented in Mrs. L?
- Discuss the treatments available to the patient
How to Solve The initial post must include responses to all the questions in both case studies. Mrs. A has been taking high doses of glucocorticoids for much of the past 2 years to control severe rheumatoid arthri Nursing Assignment Help
Introduction:
The following responses aim to provide an understanding of medical conditions and their potential complications. The case studies outline two scenarios and require comprehensive answers to the given questions. The first case study examines the effects of long-term glucocorticoid use on an individual and the potential complications that may arise from it. The second case study discusses osteoporosis and the predisposing factors that lead to decreased bone density along with its diagnosis, cause of pathological fractures, and treatment options.
Answers:
1. Cushing’s syndrome is a condition caused by long-term exposure to high levels of cortisol, a hormone produced by the adrenal glands. It can result from the use of glucocorticoids or can occur naturally. The syndrome affects the individual in several ways, including weight gain, particularly in the face, neck, and abdomen, muscle weakness, skin thinning and increased bruising, hirsutism, and thinning of bones, among others. Moreover, individuals with Cushing’s syndrome may experience psychological changes, such as irritability, anxiety, depression, and cognitive difficulties. In severe cases, the syndrome can cause life-threatening complications, such as infections, blood clots, and heart failure.
2. Hypertension and type 2 diabetes may develop due to the long-term use of glucocorticoids and are potential complications of Cushing’s syndrome. Hypertension occurs due to the vasoconstrictive effects of cortisol, which causes the constriction of blood vessels. Moreover, glucocorticoids increase insulin resistance, thereby causing hyperglycemia, which may lead to the development of type 2 diabetes mellitus. The complications associated with hypertension and diabetes include cardiovascular disease, kidney disease, retinopathy, neuropathy, and amputations, among others.
3. Long-term use of glucocorticoids may cause other potential problems, including osteoporosis, susceptibility to infections, impaired wound healing, and increased risk of gastrointestinal ulcers. Osteoporosis is a condition characterized by decreased bone density and an increased risk of fractures. Glucocorticoids cause bone resorption and inhibit bone formation, leading to decreased bone density and increased risk of fractures. Moreover, long-term use of glucocorticoids may also cause muscle weakness, which can further exacerbate the risk of falls and fractures.
4. Mrs. L’s history is indicative of osteoporosis, a condition characterized by decreased bone density, which predisposes individuals to fractures. Her risk factors include menopause, sedentary lifestyle, caffeine consumption, smoking, and lack of recommended bone density testing. Menopause leads to decreased estrogen levels that further decrease bone density. Sedentary lifestyle inhibits the stimulation of bone formation by mechanical stress, leading to decreased bone density. Caffeine consumption and smoking increase the secretion of cortisol, which promotes bone resorption, leading to decreased bone density.
5. Pathological fractures occur because of decreased bone density, which weakens the bones, making them susceptible to fractures. In Mrs. L’s case, her decreased bone density is a result of osteoporosis, making her bones more fragile, which increases the risk of fractures even from minor falls.
6. Osteoporosis could have been prevented in Mrs. L by adopting a healthy lifestyle, monitoring bone density, and treating complications such as vitamin D and calcium deficiency. Regular weight-bearing exercise can stimulate bone formation and reduce the risk of developing osteoporosis. Monitoring bone density through recommended tests helps to detect a decrease in bone density in its early stages, allowing for early intervention to prevent further bone loss. Vitamin D and calcium supplements are essential in maintaining healthy bones.
7. Treatment options available to the patient may include pharmacotherapy, non-pharmacological interventions or a combination of both. Pharmacotherapy includes bisphosphonates, estrogen therapy, and calcitonin, among others. Non-pharmacological interventions may include exercise, smoking cessation, and reducing caffeine intake. A combination of pharmacotherapy and non-pharmacological interventions may be used to achieve optimal outcomes.
