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 cigarette smoking. He has been on home oxygen, 2 L oxygen by nasal cannula (O 2 /NC), for several years. Approximately 10 months ago, he was on chronic oral steroid therapy. His current medications include an ipratropium/albuterol (Combivent) inhaler, beclomethasone (Beclovent) inhaler, dexamethasone (Decadron), digoxin (Lanoxin),
and furosemide (Lasix).
1. On the way to J. S.'s home, you make a mental note to check him for signs and symptoms of
Cushing syndrome. Why?
2. Differentiate between Cushing syndrome and Cushing disease.
3. Your assessment includes the following findings. Determine whether the findings are
attributable to J. S.'s COPD or possible Cushing syndrome. Place an L beside the symptoms
consistent with COPD and a C next to those consistent with Cushing syndrome.
1. Barrel chest
2. Full-looking face (moon face)
3. BP 180/94mm Hg
4. Pursed-lip breathing, especially when patient is stressed
5. Striae over trunk and thighs
6. Bruising on both arms
7. Acne
8. Diminished breath sounds throughout lungs
9. Truncal obesity with thin extremities
10. Supraclavicular and posterior upper back fat
4. You inform the physician of J. S.'s assessment. The physician believes J. S. has developed
Cushing syndrome and decides to change his prescription from dexamethasone (Decadron)
daily to prednisone (Deltasone) given on alternate days. Explain the rationale for this change.
5. Identify possible consequences of suddenly stopping dexamethasone (Decadron) therapy.
6. You advise J. S. to take the prednisone (Deltasone) at breakfast. Why?
7. Cushing syndrome can affect memory. Patients can easily forget what medications have been
taken, especially when there are several different medications and some are taken on
alternating days. List at least three ways you can help J. S. remember to take his medications
as prescribed.
8. J. S. states that his appetite has increased but he is losing weight. He reports trying to eat, but
he gets short of breath and cannot eat any more. How would you address this problem?
9. You ask him questions related to the presence gastric discomfort, vision, and joint pain. Why?
10. Differentiate between the glucocorticoid and mineralocorticoid effects of prednisone
(Deltasone).
11. How would your assessment change if J. S. were taking a glucocorticoid that had significant
mineralocorticoid activity?
12. Review J. S.'s list of medications. Based on what you know about the side effects of loop
diuretics and steroids, discuss the potential problem of administering these in combination
with digoxin.
13. You need to assess J. S. for signs and symptoms of an infection. Why?
14. What signs and symptoms of infection do you assess for in J. S.? Select all that apply.
a. Pain
b. Fever
c. Loss of function
d. Palpitations
e. Unusual drainage
f. Localized edema
15. Realizing J. S. is susceptible to infection, you review with him ways to reduce the risk of
infection. Identify four major points to include.
16. In addition to measures to reduce the risk of infection, what other information would you
want to stress to J. S. at your visit? Select all that apply.
a. Drink at least 4000mL of fluids daily.
b. Increase intake of foods high in sodium.
c. Weigh yourself first thing in the morning.
d. Take vitamin and electrolyte supplements as prescribed.
e. Notify the physician if your pulse is lower than 60 beats/min.
f. Call the doctor if your weight increases more than 2-3 pounds in 1 day.
g. Take the furosemide (Lasix) first thing in the morning and again at bedtime.
Glucocortocoids Medications
Fludrocortisone
Dexamethasone
Aminpglutethimide
Metyrapone
Mitotane
Etomidate
The Nursing Process
What nursing assessment will you perform regarding each medication?
What planning and implementation do you need to do for each medication?
How would you evalute the effectiveness of each medication?