A 63-year-old woman presented with increasing darkening of the skin, dizziness, and easy fatigability, nausea with occasional vomiting and progressive weight loss over eight months prior to presentation. There were no headaches, blurred vision, and neither loss of consciousness nor change in her bowel habit. The medical history and systemic review revealed no abnormality and were not significant as to the likely cause of her disease state. Physical examination revealed an elderly lady, pale, asthenic with generalized hyperpigmentation especially on the face, oral mucosa, palmar creases and knuckles. No features of malnutrition or hypovitaminosis. There was no significant peripheral lymphadenopathy. Main findings in the systemic examination were a pulse of 106 bpm, regular and small; blood pressure 100/60 mmHg supine and 70/40mmHg sitting. She could not stand on account of severe postural dizziness. The apex beat was normal. Fundoscopy revealed a normal fundus. All other systems were essentially normal. A clinical assessment of Addison’s disease to exclude paraneoplastic syndrome was made. Laboratory investigations and results are shown in Table 1. Of note are the anaemia (haemoglobin10gm/dl), with normal red cell morphology; ESR 58mm/hr (Westergreen method); fasting blood sugar was 76mg% and total serum protein of 7.8g/L (albumin-3.4g/L and globulin 4.4g/L). Plasma cortisol was undetectable at 0 and 30 minutes of cosyntropin administration (0.25 mg). Plasma rennin and aldosterone activity could not be estimated. HIV screening was negative (HIV 1 & II) Radiological diagnostic tests included an abdominal ultrasound, which was reported as showing normal liver, spleen, pancreas and pelvic organs. However, the left kidney was not outlined. A computerised tomography scan (CT) of the abdomen showed a non-enhancing oval shaped left suprarenal mass with calcification and an ipsilateral hypoplastic but functional left kidney. There was neither ascites nor significant abdominal lymph nodes. The conclusion was a suprarenal tumour-adenoma or adrenocortical carcinoma to exclude tuberculous adrenalitis. A CT brain scan was normal. In view of the CT abdominal findings suggestive of adrenal tuberculosis, and ESR 58mm/hr, she was commenced on anti-tuberculous drugs. Ten days after admission, she had nausea, vomiting, fever with chills and extreme lethargy. Cardiovascular examination showed a tachycardia, low volume pulse, BP 70/40 mmHg and blood film showed trophozoites of plasmodium falciparum. Blood cultures done thrice revealed no growth. She was managed with intravenous fluids (dextrose in saline), antimalarials, antibiotics and hydrocortisone. She made remarkable recovery and was maintained on oral prednisolone and fludrocortisone. Create a Nursing Care Plan focusing on the possible adverse effect of administering specific medication based on the case of the patient.

Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
Problem 1SRQ
icon
Related questions
Question
A 63-year-old woman presented with increasing darkening of the skin, dizziness, and easy fatigability, nausea with occasional vomiting and progressive weight loss over eight months prior to presentation. There were no headaches, blurred vision, and neither loss of consciousness nor change in her bowel habit. The medical history and systemic review revealed no abnormality and were not significant as to the likely cause of her disease state. Physical examination revealed an elderly lady, pale, asthenic with generalized hyperpigmentation especially on the face, oral mucosa, palmar creases and knuckles. No features of malnutrition or hypovitaminosis. There was no significant peripheral lymphadenopathy. Main findings in the systemic examination were a pulse of 106 bpm, regular and small; blood pressure 100/60 mmHg supine and 70/40mmHg sitting. She could not stand on account of severe postural dizziness. The apex beat was normal. Fundoscopy revealed a normal fundus. All other systems were essentially normal. A clinical assessment of Addison’s disease to exclude paraneoplastic syndrome was made. Laboratory investigations and results are shown in Table 1. Of note are the anaemia (haemoglobin10gm/dl), with normal red cell morphology; ESR 58mm/hr (Westergreen method); fasting blood sugar was 76mg% and total serum protein of 7.8g/L (albumin-3.4g/L and globulin 4.4g/L). Plasma cortisol was undetectable at 0 and 30 minutes of cosyntropin administration (0.25 mg). Plasma rennin and aldosterone activity could not be estimated. HIV screening was negative (HIV 1 & II) Radiological diagnostic tests included an abdominal ultrasound, which was reported as showing normal liver, spleen, pancreas and pelvic organs. However, the left kidney was not outlined. A computerised tomography scan (CT) of the abdomen showed a non-enhancing oval shaped left suprarenal mass with calcification and an ipsilateral hypoplastic but functional left kidney. There was neither ascites nor significant abdominal lymph nodes. The conclusion was a suprarenal tumour-adenoma or adrenocortical carcinoma to exclude tuberculous adrenalitis. A CT brain scan was normal. In view of the CT abdominal findings suggestive of adrenal tuberculosis, and ESR 58mm/hr, she was commenced on anti-tuberculous drugs. Ten days after admission, she had nausea, vomiting, fever with chills and extreme lethargy. Cardiovascular examination showed a tachycardia, low volume pulse, BP 70/40 mmHg and blood film showed trophozoites of plasmodium falciparum. Blood cultures done thrice revealed no growth. She was managed with intravenous fluids (dextrose in saline), antimalarials, antibiotics and hydrocortisone. She made remarkable recovery and was maintained on oral prednisolone and fludrocortisone. Create a Nursing Care Plan focusing on the possible adverse effect of administering specific medication based on the case of the patient. You have review and read first the medication intended for this patient before you can proceed to the Nursing Care Plan.
Expert Solution
trending now

Trending now

This is a popular solution!

steps

Step by step

Solved in 3 steps

Blurred answer
Similar questions
  • SEE MORE QUESTIONS
Recommended textbooks for you
Phlebotomy Essentials
Phlebotomy Essentials
Nursing
ISBN:
9781451194524
Author:
Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:
JONES+BARTLETT PUBLISHERS, INC.
Gould's Pathophysiology for the Health Profession…
Gould's Pathophysiology for the Health Profession…
Nursing
ISBN:
9780323414425
Author:
Robert J Hubert BS
Publisher:
Saunders
Fundamentals Of Nursing
Fundamentals Of Nursing
Nursing
ISBN:
9781496362179
Author:
Taylor, Carol (carol R.), LYNN, Pamela (pamela Barbara), Bartlett, Jennifer L.
Publisher:
Wolters Kluwer,
Fundamentals of Nursing, 9e
Fundamentals of Nursing, 9e
Nursing
ISBN:
9780323327404
Author:
Patricia A. Potter RN MSN PhD FAAN, Anne Griffin Perry RN EdD FAAN, Patricia Stockert RN BSN MS PhD, Amy Hall RN BSN MS PhD CNE
Publisher:
Elsevier Science
Study Guide for Gould's Pathophysiology for the H…
Study Guide for Gould's Pathophysiology for the H…
Nursing
ISBN:
9780323414142
Author:
Hubert BS, Robert J; VanMeter PhD, Karin C.
Publisher:
Saunders
Issues and Ethics in the Helping Professions (Min…
Issues and Ethics in the Helping Professions (Min…
Nursing
ISBN:
9781337406291
Author:
Gerald Corey, Marianne Schneider Corey, Cindy Corey
Publisher:
Cengage Learning