Susan Jones' Cushing's Syndrome - Adrenalectomy Case (Case Study Sample)

CASE STUDY ONE: Susan Jones ' Cushing's Syndrome - Adrenalectomy
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Question 1
Persons suffering from Cushing’s syndrome often get the disease from a tumour of cortisol-like medications. More often than not, a tumor of the adrenal glands makes excessive cortisol. The adrenal glands are increasingly significant in human body and these glands are situated above kidneys. In fact, adrenal glands are divided into outer regions that are referred to as the adrenal cortex as well as inner regions that are referred to as the adrenal medulla. It must be noted that the adrenal cortex is affected by ACTH coming from the anterior pituitary (Matfin et al, 2005). Nevertheless, functions often associated with the adrenal glands include secretion of hormones by the adrenal cortex. In particular, mineralocorticoids are released by the outer cortex regions and this hormone is critical to regulation of blood volume as well as blood mineral concentration. Aldosterone is the main mineralcorticoid hormone, and it is responsible for maintaining potassium as well as sodium levels in the body (The Pituitary Society, 2013). On the other hand, glucocorticoids are secreted through the inner and middle cortex layers, which promote normal function of cells including the conversion of fats into glucose. What is more, estrogens as well as androgens are some of the key sex hormones that are secreted by the inner ad middle layers of the cortex. The other function associated with the adrenal cortex of the adrenal glands involves adrenaline as well as norepinephrine that are products of the adrenal medulla. They are released in response to stress and have a number of effects including stimulating the heart, increase blood pressure and others.
Cushing syndrome is an endocrine disease that has multiple etiologies. This disease is characterized through a constellation of clinical manifestations resulting out of hypercortisolism or excessive circulation cortisol concentration (Smith and Hirsh, 2000, P 7). In fact, this syndrome is named after H. Cushing who was a surgeon from the United States and reported the ailment in 1912 (Jones and Huether, 2006, p 74). As far as current surgical treatment for an adrenal tumour is concerned, a technique referred to as minimally invasive surgery involving removal of the adrenal glands is characteristically undertaken via three or four half-inch incisions (Fitzgerald, 2007). It must be noted that the decision to utilize surgery in treatment of gland tumors is increasingly dependent upon a number of factors that are considered by a surgeon prior an operation. More often than not, a surgeon will employ a smaller or laparoscopic technique and then make a decision halfway the operation if larger incision is necessary. Indeed, this surgical treatment has been associated with a number of benefits including shorter hospital stay, less post-operative suffering, enhanced cosmetic outcome, swift return to normal activity, as well as reduced risk of wound separation. It has been claimed that patients may leave hospital within two days.
Question 2
Surgery for patients with Cushing’s syndrome requires considerable amount of anaesthetics to ensure that a patient remains in a stable and manageable condition. In fact, smooth as well as rapid emergence out of anaesthesia is essential to facilitate early neurological examination as well as maintenance of stable respiratory as well as cardio-vascular factors. It must be pointed out that this is facilitated through the utilization of some short-functioning agents for anaesthesia maintenance. Respiratory complications are known to occur in a considerable number of patients in post-anaesthetic recovery room including inadequate ventilation or oxygenation, airway obstruction, as well as aspiration. In fact, general anaesthesia used in Cushing’s patients who have undergone surgery lead to a number of physiological effects that cause ventilation issues (Menon et al, 2016, p 136). Nevertheless, post-operative care for Cushing’s syndrome patient in post-anaesthetic recovery room consists of meticulous airway management. Maintaining a clear airway among Cushing’s syndrome surgery patients can be a challenging task and requires undivided attention given that under anaesthesia, the soft tissues of patient’s airway relax as well as patency loss. What is more, protective airway reflexes may be suppressed, a number of techniques such as jaw thrust, and chin tilt may be applied as soon as the patient shows signs of losing airway tone to evert obstruction. Indeed, blood presence in the oropharynx as well as nasopharynx all tends to suppress airway patency. Ventilation management is increasingly significant for patients that have a history of sleep apnoea and in the post-anaesthetic recovery room (Domi et al, 2014). This may include a number of means including patient observation as well as monitoring through techniques that are appropriate to Cushing’s syndrome patients. As an example, in our case study ventilation problems can be solved through ensuring a recovering patient is in lateral position including those at risk such as obese patients.
As well, circulation monitoring in post-anaesthetic recovery room is critical if proper recovery is to be achieved. This can be achieved through application of knowledge about the anatomy as well as physiology of the cardiovascular system in managing cardiopulmonary circulation in the in post-anaesthetic recovery room. In particular, management of blood pressure is increasingly significant and a patient with a systolic blood pressure of equal to or less that 90mmHG or which does not match the baseline pre-anaesthetic blood pressure should be evaluated by an anaesthesiologist (UK National Core Competencies for Post-anaesthesia Care 2013, 2013). What is more, circulation monitoring involves heart rate monitoring in which patients in post-anaesthetic recovery room and exhibiting a cardiac rhythm that does not match their baseline pre-anaesthetic rhythm should be evaluated. This procedure should involve an anaesthesiologist. The monitor of heart rate is critical among patients in post-anaesthetic recovery room patients simply because such patients are known for their unstable heart rates due to other complication resulting out of the operation. For instance, increased heart rate among these patients may result because of poor ventilation as well as pain and it becomes increasingly important to monitor them. In addition, circulation monitoring in Cushing’s syndrome patients that are in in post-anaesthetic recovery room may involve oxygen saturation in which the aim is to establish the level of oxygen in blood. This is crucial to ensuring the overall well- being of these patients because poor circulation may be a sign of constricted ventilation.
As well, patient consciousness monitoring among Cushing’s syndrome patients in post-anaesthetic recovery room is crucial because the aim is to prepare them for transfer to the ward or discharge (Price and Tadbiri, 2008, p 56). In fact, the patient should be awake as well as aware of her or his surrounding and identity. It must be noted that central nervous system issues arising during surgery may lead to problems with consciousness in which there may be delayed awakening, issues with awareness, as well as central neurological damage. Past studies have speculated that delayed awakening among Cushing’s syndrome patients in post-anaesthetic recovery room more often than not is an outcome of persistent effects of anaesthetics (Rhona et al, n.d). In fact, persistent effects of anaesthetics may mean that a patient’s body or more particularly central nervous system is increasingly affected by anaesthetics. Nonetheless, less common causes of delayed awakening among Cushing’s syndrome patients in post-anaesthetic recovery room include decreased cerebral perfusion, hypoxia, sepsis, hypothermia, as well as hypoglycaemia.
Question 3
A post anaesthetic recovery scale is necessary for proper patient discharge as well as to ensure continued recovery and to avoid further complications. More so, the patient needs a proper recovery plan in which an environment matching or at least near hospital level is maintained. Some of the discharge requirements may include requiring a patient to score an afore-established score regarding a number of categories including respiratory. In fact, examination scores are documented on post-anaesthetic recovery room upon admission on hourly basis. In case the patient’s score fails to match the minimum discharge criteria an anaesthesiologist is consulted to evaluate the reasonableness of patient discharge. The supporting registered nurse will also be involved in which he or she will document the consultation to facilitate written and or verbal consent from a physician prior discharge.
It must be noted that patients recommended by a physician for transfer to the intensive care unit do not need a minimum score of a discharge for that matter. In addition, oxygen therapy to improve ventilation must have ended for a period exceeding half an hour prior discharge of Cushing’s syndrome patients in post-anaesthetic recovery room. Indeed, oxygen saturation must be maintained within the limits established through the anaesthesiologist involved in post-anaesthetic recovery room.
The preceding dose of respiratory tranquilizing drug must have been administered for a duration exceeding 15 minutes prior to discharge. For patients receiving constant opioid infusion they will meet the minimum point score as far as the consciousness score is concerned as well as meet the respiratory discharge standards. In addition, patients receiving reversal agents for neurovascular sedative as well as opioids ought to be monitored for half-hour since their last dose. Thi...