Case Study 1

Description

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references.


Critical Thinking Questions

1. Of all the tests this young woman had, which single test would be easiest, most diagnostic,
and would have explained her entire symptom complex?

2. What are some of the other adrenal function tests that could have been performed to assist in
the diagnosis of this woman’s adrenal failure?

3. What is the difference between primary and secondary Addison disease, and how can the two
be separated?

4. Why was this woman’s sodium low and her potassium elevated?

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Addison’s Disease
Case Studies
This 32-year-old white professional female was noted to have increasing melanosis affecting her
skin and gums. She noted that she had become weaker over the past several weeks. She
complained of nausea, occasional vomiting, and anorexia. She experienced a 10-pound weight
loss in the last 8 weeks. She complained of a relative recent onset of moderate high-back pain.
She has noted constipation but has no other gastrointestinal symptoms. She noted early satiety.
Over the last 2 years she has developed Reynaud’s phenomena.
Her physical exam reveals a thin woman with a dark tan (she recently returned from a vacation
in the Caribbean). She weighed 90 lbs and was 5’2” tall. She had very little axillary hair but had
all normal primary and secondary sexual characteristics. There was evidence of a melanotic gum
line around her teeth. The creases of her hands were hypermelanotic. The remaining physical
examination was normal.
Studies
Results
CBC,
Normal
Chemical profile
Normal except:
Na = 129 (normal: 136-145 mEq/L)
K = 5.1 (normal: 3.5-5 mEq/L)
Albumin 3.0 (normal: 3.5-5 g/dL)
EGD
Mild gastritis
Gastric Emptying
Delayed gastric emptying
CT Scan Abdomen
Adrenal glands not visible
CT Scan of the Brain
No pituitary tumor
Cortisol 8 AM
2 mcg/dL (normal: 5-23 mcg/dL)
ACTH 8 AM
3,200 pg/mL (normal:
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References:

Nursing Standards

Nursing and Midwifery Board of Australia. (2018). Code of conduct for midwives. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Clinical Guidelines

Guideline Adaption Committee. (2016). Clinical practice guidelines and principles of care for people with dementia. NHMRC Partnership Centre for Dealing with Cognitive and Related Function Decline in Older People. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf

Living Guideline

Stroke Foundation. (2022). Australian and New Zealand living clinical guidelines for stroke management – chapter 1 of 8: Pre-hospital care. https://app.magicapp.org/#/guideline/NnV76E

Evidence-based practice

BMJ Best Practice

Goldfarb, S., & Josephson, M. (2020). Cystic fibrosis. BMJ Best Practice. https://bestpractice.bmj.com/

Schub, T., & Cabrera, G. (2018). Bites: Head lice [Evidence-based care sheet]. Cinahl Information Systems. https://www.ebscohost.com

Beyea, S. C., & Slattery, M. J. (2006). Evidence-based practice in nursing: A guide to successful implementation. http://www.hcmarketplace.com/supplemental/3737_browse.pdf

JBI: Evidence summary

Swe, K. K. (2022). Blood glucose levels: Self-monitoring [Evidence summary]. JBI EBP Database. https://jbi.global

JBI: Best practice information sheet

Bellman, S. (2022). Experiences of living with juvenile idiopathic arthritis [Best practice information sheet]. JBI EBP Database, 24(1), 1-4.

Cochrane Database of Systematic Reviews

Srijithesh, P. R., Aghoram, R., Goel, A., & Dhanya, J. (2019). Positional therapy for obstructive sleep apnoea. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010990.pub2

Drug Information

Codeine. (2023, January). In Australian medicines handbook. Retrieved February 2, 2023, from https://amhonline.amh.net.au

Colorado State University. (2011). Why assign WID tasks? http://wac.colostate.edu/intro/com6a1.cfm

 

Dartmouth Writing Program. (2005). Writing in the social sciences. http://www.dartmouth.edu/~writing/materials/student/soc_sciences/write.shtml

Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing practice? [Abstract]. Online Journal of Issues in Nursing, 13(1). http://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/StandardizedNursingLanguage.html

Wagner, D. (n.d.). Why writing matters in nursing. https://www.svsu.edu/nursing/programs/bsn/programrequirements/whywritingmatters/

Writing in nursing: Examples. (n.d.). http://www.technorhetoric.net/7.2/sectionone/inman/examples.html

Perth Children’s Hospital. (2022, April). Appendicitis [Emergency Department Guidelines]. Child and Adolescent Health Service. https://www.pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Appendicitis

Department of Health. (n.d.). Who is being active in Western Australia? https://ww2.health.wa.gov.au/Articles/U_Z/Who-is-being-active-in-Western-Australia

Donaldson, L. (Ed.). (2017, May 1). Healthier, fairer, safer: The global health journey 2007-2017. World Health Organisation. https://www.who.int/publications/i/item/9789241512367

NCBI Bookshelf

Rodriguez Ziccardi, M., Goyal, G., & Maani, C. V. (2020, August 10). Atrial flutter. In Statpearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK540985/

Royal Perth Hospital. (2016). Procedural management: Pre and post (24-48 hours) NPS. Canvas. https://courses.ecu.edu.au

 

 

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