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Author Question: A patient who has chronic adrenal insufficiency is admitted to the hospital for an open ... (Read 38 times)

urbanoutfitters

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on: Jul 23, 2018
A patient who has chronic adrenal insufficiency is admitted to the hospital for an open cholecystectomy.
 
  The nurse obtaining the admission history learns that the patient takes hydrocortisone 25 mg PO daily in the morning. The patient's surgery is scheduled for the next morning. The nurse will expect an order to:
  a. administer the usual morning dose of hydrocortisone 25 mg PO.
  b. administer hydrocortisone 75 mg PO in the morning.
  c. administer hydrocortisone 75 mg IV before surgery.
  d. withhold the morning dose of hydrocortisone and give it after surgery.

Question 2

A patient with Cushing's syndrome has undergone surgery and radiation treatment. The nurse will expect to teach the patient about which medication?
 
  a. Cosyntropin
  b. Dexamethasone
  c. Fludrocortisone acetate (Florinef)
  d. Ketoconazole (Nizoral)


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Viet Thy

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Reply #1 on: Jul 23, 2018
Answer to Question 1

ANS: C
Patients who take steroids need extra steroid before situations that cause stress, such as surgery. Failure to administer the increased dose can prove fatal. For surgeries that cause moderate stress, such as a cholecystectomy, patients should be given 50 to 75 mg of hydrocortisone intravenously the day of the procedure, followed by a taper over 1 to 2 days to the usual replacement dose. Giving the usual dose or giving an increased oral dose is not indicated.

Answer to Question 2

ANS: D
The role of drugs in the treatment of Cushing's syndrome is limited; drugs are used only as adjuncts to surgery and radiation therapy. The most effective agent is ketoconazole, which suppresses steroid synthesis. Cosyntropin is used to diagnose adrenal insufficiency. Dexamethasone is a glucocorticoid used for replacement therapy and to diagnose Cushing's syndrome. Fludrocortisone is used for chronic mineralocorticoid replacement.


urbanoutfitters

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Reply #2 on: Jul 23, 2018
Both answers were spot on, thank you once again


Viet Thy

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Reply #3 on: Jul 23, 2018
Great! Please up vote :D


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