Diagnostic Case Study: Patient with Adrenal Crisis Brief Patient History A 64-year-old African-Ameri. Question
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Diagnostic Case Study: Patient with Adrenal Crisis
Brief Patient History
A 64-year-old African-American man with a history of bilateral deep vein thrombosis presented to our emergency department (ER) initially with headache and fatigue for 4 weeks, shortness of breath and generalized weakness.
Clinical Assessment
The physical examination showed that the patient was hypotensive with a blood pressure of 72/48 mm Hg. The physical examination showed a frail African-American man with pale conjunctivae. No other significant abnormality was noticed on examination.
Diagnostic Information
The laboratory studies showed hyponatraemia, hyperkalaemia, hypercalcaemia and acute kidney injury. Pertinent positive endocrinology studies included low aldosterone, low testosterone and high-adrencorticotropic hormone (ACTH). Pertinent negative endocrinology studies included normal prolactin, thyroid stimulating hormone, luteinizing hormone and insulin like growth factor-1.
Medical Diagnosis
Primary Adrenal Insufficiency.
Questions
1. What is the clinical definition of Primary Adrenal Insufficiency.
2. What information is present that validates the Diagnosis of Primary Adrenal Insufficiency? What distinguishes this from secondary adrenal insufficiency?
a. What additional clinical data would you like to see?
3. What are the significant risk factors for this diagnosis? Which of these findings were present in this patient (history and clinical data)?
4. What signs and symptoms do you expect of this physical presentation? Which ones are present in your patient?
a. Neurological
b. Respiratory
c. Cardiovascular
d. Skin
e. Gastro-intestinal
f. Genito-urinary
5. What major outcomes do you expect to achieve for this patient?
6. What problems or risks must be managed to achieve these outcomes?
7. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
a. What types of orders would you expect to see?
i. Monitoring
ii. Classification of meds (ie, anti-infectives, anti-emetics, etc)
iii. IV / oxygen
iv. Additional diagnostic studies
v. Treatments
8. What would be your “worst case” complication for this patient?
a. What are the warning signs and symptoms that your patient might be reaching this level? (include clinical and diagnostic findings).
9. What possible learning needs would you anticipate for this patient?
10. What cultural and age-related factors might have a bearing on the patient’s plan of care?
SCIENCE
HEALTH SCIENCE
NURSING
UNRS 411P
Diagnostic Case Study: Patient with Adrenal Crisis Brief Patient History A 64-year-old African-Ameri
